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Anemia is one of the most frequent extra-intestinal manifestations of inflammatory bowel disease. Insidious onset, variability of symptoms and lack of standardized screening practices may increase the risk of underestimating its burden in children with IBD. Despite its relevance and peculiarity in everyday clinical practice, this topic is only dealt with in a few documents specifically for the pediatric field. The aim of the current guidelines is therefore to provide pediatric gastroenterologists with a practical update to support the clinical and therapeutic management of children with IBD and anemia. A panel of 19 pediatric gastroenterologists and 1 pediatric hematologist with experience in the field of pediatric IBD was agreed by IBD Working group of the Italian Society of Gastroenterology, Hepatology and Nutrition (SIGENP) to produce the present article outlining practical clinical approaches to the pediatric patient with IBD and anemia. The levels of evidence and recommendations have been defined for each part of the statement according to the GRADE system. [ABSTRACT FROM AUTHOR]

Constipation is a common problem in children, accounting for about 3% of all primary care visits and up to 25% of referrals to paediatric gastroenterologists. Although polyethylene glycol often proves effective, most children require prolonged treatment and about 50% of them have at least one relapse within the first 5 years after initial recovery. When conventional treatment fails, children are considered to have refractory constipation. Children with refractory constipation deserve specialist management and guidance. Over the last decades, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed. The present review analyses the possible diagnostic investigations for children with refractory constipation, focusing on their actual indications and their utility in clinical practice. Moreover, we have also analytically reviewed medical and surgical therapeutic options, which should be considered in selected patients in order to achieve the best clinical outcome. [ABSTRACT FROM AUTHOR]

Functional Gastrointestinal Disorders (FGIDs) are common in pediatric age. To estimate the prevalence of FGIDs in Italian children and evaluate the impact of diet. Healthy children aged 4–18 years were recruited in a multicenter cross-sectional study. We evaluated their eating habits and the presence of FGIDs, using Rome IV criteria, 3-day food diaries and Mediterranean Diet Quality Index (KIDMED) questionnaires. Seven hundred forty subjects were enrolled:369 children aged 4–9 years (Group A), and 371 adolescents 10–18 years old (Group B). The overall prevalence of FGIDs was 26.4% in Group A and 26.2% in Group B, with a significant higher prevalence in females in both groups. The most frequent disorders were functional constipation, functional dyspepsia, and abdominal migraine. No significant difference in FGIDs prevalence was found between Northern and Southern Italy, despite significant variation in diet. In Group A there was a significant difference in KIDMED between North and South (5.3 ± 1 vs 6 ± 1.2, respectively; p = 0.001). A significant association between FGIDs and KIDMED was found in Group A (OR=0.83, p = 0.034), but not in Group B (OR=0.89, p = 0.166). FGIDs are common in Italian children, with a higher prevalence in females. Despite significant differences in dietary habits between North and South, FGIDs prevalence does not vary significantly. [ABSTRACT FROM AUTHOR]

Aims: Childhood and adolescent obesity has been defined as a planetary epidemic by WHO "globesity". The obesogenic environment, defined as a life environment promoting a high-energy intake and a sedentary lifestyle, significantly contributes to the genesis and the diffusion of the globesity. In the last decades, several authors and working groups tried to develop methodological instruments in order to guarantee a reliable analysis of an obesogenic environment. Their efforts have led to the production of a relatively large number of questionnaires with different characteristics. The general aim of these questionnaires is to identify the factors that significantly contribute to the creation of an obesogenic environment around children and adolescents. As a result of this work, a number of studies were carried out using such questionnaires. Aim of this review is to evaluate ad hoc questionnaires useful to identify and analyze obesogenic environment.Data Synthesis: The search was carried out in February-March 2017 using the PubMed-Medline and Scopus databases (time interval: the last 10 years). After the selection and verification phases, a total of 14 studies were selected and therefore included in the present review.Conclusions: The questionnaires constructed and validated to analyze multiple constitutive elements of an obesogenic environment at the same time are complex and must be administered by qualified and trained staff. On the other hand, when two or more questionnaires are used to analyze different factors, the questionnaires used are generally shorter, self-administered, and generally easier to understand and interpret. [ABSTRACT FROM AUTHOR]

Background Iodine is an essential micronutrient for intellectual development in children. Information on iodine intakes based on 24-h urinary iodine excretion (UIE) is scant, because iodine status is only assessed by the measurement of urinary iodine concentration (UIC) in spot urine samples. Objectives The aim of our study was to evaluate the iodine intake of school-age children and adolescents, using UIE measurement in 24-h urine collections. Methods The study population included 1270 healthy subjects (677 boys, 593 girls) aged 6–18 y (mean age ± SD: 10.3 ± 2.9) from 10 Italian regions. Daily iodine intake was estimated as UIE/0.92, based on the notion that |$\sim$| 92% of the dietary iodine intake is absorbed. The adequacy of intakes was assessed according to the Dietary Reference Values for iodine of the European Food Safety Authority (EFSA). Body mass index (BMI) and UIC were also measured for each subject. Results Based on the scientific opinion of EFSA, 600 of 1270 subjects (47.2%) had a lower than adequate iodine intake, with a higher prevalence among girls (54.6%) compared with boys (40.2%) (P  < 0.001). Although UIE and 24-h urinary volumes increased with age (P  < 0.001), a progressive decrease in the percentage of subjects with iodine excretion <100 µg/24 h (P  < 0.001) was observed, without any significant difference in the percentage of subjects with UIC <100 µg/L. No significant association was detected between BMI z -score and UIE (P  = 0.603) or UIC (P  = 0.869). Conclusions A sizable proportion of our population, especially girls, appeared to be at risk of iodine inadequacy. The simple measurement of UIC could lead to underestimation of the occurrence of iodine deficiency in younger children, because of the age-related smaller urine volumes producing spuriously higher iodine concentrations. [ABSTRACT FROM AUTHOR]

Objectives To prospectively investigate the occurrence of postinfectious functional gastrointestinal disorders (FGIDs), diagnosed according to the Rome III criteria, in children with acute diarrhea of different infectious etiology. Study design This was a prospective cohort multicenter study. Children 4-17 years of age presenting with acute diarrhea who tested positive for an enteric infection were recruited within 1 month from the episode and matched with control subjects of similar age and sex. Symptoms were evaluated with a validated questionnaire for FGIDs at the time of enrollment in the study and after 3 and 6 months. Results A total of 64 patients (36 boys; median age 5.3 years; age range 4.1-14.1 years) were recruited, 32 subjects in each arm. Infections included rotavirus (56.8%), salmonella (30%), adenovirus (6.6%), norovirus (3.3%), and Giardia lamblia (3.3%). FGIDs were significantly more common in exposed patients compared with controls within 1 month from acute diarrhea (40.6% vs 12.5% [P = .02, relative risk (RR) = 1.9]), 3 months (53% vs 15.6% [P = .003, RR = 2.2]), and 6 months (46.8% vs 15.6% [P = .01, RR = 1.9]) later. No correlation was found between different etiologies, age, or sex, and any type of FGIDs. Among exposed children, abdominal pain--related FGIDs were significantly more frequent compared with controls after 6 months from infection (P = .04, RR = 1.7). Conclusion This prospective cohort multicenter study supports postinfectious FGIDs as a true entity in children. There seems to be a significant increase in abdominal pain--related FGIDs after acute diarrhea in children within 1 month and 3 and 6 months later. [ABSTRACT FROM AUTHOR]

In 1967, 42 specimens of the green gastropod snail Turbo marmoratus (Linnaeus 1758) from Vanuatu were introduced in one single Tahiti reef, in French Polynesia. The population has been since protected to maximize its chance of spreading, to eventually provide an additional resource for local fishermen. After 45 years of natural dispersal and controlled transfers throughout Society, Tuamotu and Gambier Archipelago, we investigated the population status on 23 different islands and atolls. T. marmoratus failed to colonize Tuamotu and Gambier archipelagos, and Society western atolls. Conversely, it successfully established on the forereefs of all other Society islands and atolls. Densities were the highest on the windward side of Raiatea-Tahaa Islands, with up to 180 individuals per hectare. The observed densities and preliminary extrapolated stock for these two islands justify the rotational opening of the fishery, although additional local investigations on the biology of the species would be useful. The influence of this alien species on the ecology of local reefs remains unknown. [ABSTRACT FROM AUTHOR]

BACKGROUND: Small bowel transplantation has now become a recognized treatment of irreversible, permanent, and subtotal intestinal failure. OBJECTIVE: The aim of this study was to assess intestinal absorption at the time of weaning from parenteral nutrition in a series of children after intestinal transplantation. DESIGN: Twenty-four children (age range: 14-115 mo) received intestinal transplantation, together with the liver in 6 children and the colon in 16 children. Parenteral nutrition was slowly tapered while increasing enteral tube feeding. The absorption rate was measured from a 3-d stool balance analysis performed a few days after the child had weaned from parenteral nutrition to exclusive enteral tube feeding. Results were analyzed according to the resting energy expenditure (REE; Schofield formula). Results: All children were weaned from parenteral nutrition between 31 and 85 d posttransplantation. Median intakes were as follows: energy, 107 kcal · kg-1 · d-1 (range: 79-168 kcal · kg-1 · d-1); lipids, 39 kcal · kg-1 · d-1 (range: 20-70 kcal · kg-1 · d-1); and nitrogen, 17 kcal · kg-1 · d-1 (range: 11-27 kcal · kg-1 · d-1). Median daily stool output was 998 mL/d (range: 220-2025 mL/d). Median absorption rates were 88% (range: 75-96%) for energy, 82% (range: 55-98%) for lipids, and 77% (range: 61-88%) for nitrogen. The ratios for ingested energy to REE and absorbed energy to REE were 2.2 (range: 1.6-3.6) and 1.8 (range: 1.3-3.3), respectively. Conclusion: These data indicate a suboptimal intestinal graft absorption capacity with fat malabsorption, which necessitates energy intakes of at least twice the REE. [ABSTRACT FROM AUTHOR]

Abstract: Garganica goat milk was characterized for protein composition and the impact of milk protein mixture, casein and β-lactoglobulin fraction on cytokine production by cultured peripheral blood mononuclear cells from infants with cow''s milk protein allergy. Bulk milk samples were collected in a dairy goat farm located in the Gargano area (Southern Italy), cow milk was used as control. Ten patients with cow''s milk protein allergy (6 males; mean age 8.4±6.4months) and ten non-allergic control subjects (6 males; mean age 7.4±3.1months) were consecutively included in the study. Although the amount of total casein was comparable in cow and goat milk (56.08% vs. 55.33%, respectively) the distribution of principal casein fractions was different according to species. α-CN on total casein was more than 50% both in raw and pasteurized cow milk whereas it was always lower than 40% in goat milk and an opposite trend was observed for β-CN. Production of tumor necrosis factor-α after exposure to goat milk casein and β-lactoglobulin was lower than after exposure to the same fractions from cow milk. Goat milk induced higher levels of regulatory interleukin-10 by peripheral blood mononuclear cells than cow milk. Results on tumor necrosis factor-α evidenced that it is important to test the immune reactivity against each protein fraction before considering goat milk as a safe substitute for feeding infant with cow''s milk protein allergy. [Copyright &y& Elsevier]

Abstract: Excess dietary sodium chloride (salt) intake is etiologically related to hypertension and cardiovascular disease (CVD). Moderate reduction of salt intake reduces blood pressure (BP) and is expected to contribute to reduce the risk of CVD. Previous community-based trials to reduce BP by means of salt reduction were very successful. The initial positive results of national strategies of dietary salt intake reduction in several European countries, driven by the initiative of the World Health Organisation (WHO) and non-governmental organisations such as the World Action of Salt and Health (WASH), have paved the way for action in other European Union (EU) member states. In Italy, several initiatives aiming at reduction of salt intake at the population level have been recently undertaken. These initiatives include i) the evaluation of current dietary habits promoted by the Working Group for Dietary Salt Reduction in Italy (GIRCSI); ii) the chemical analysis of the bread salt content, a major source of sodium intake in Italy, and the agreement between the bakers’ associations and the Ministry of Health for a gradual reduction of the bread salt content; iii) the implementation of educational campaigns to increase population awareness, iv) the involvement of the food catering system. In the immediate future, food reformulation must be extended to other food categories in collaboration with industry, foods’ salt targets ought to be defined, the food labelling system must be improved and population salt awareness must be further increased through educational campaigns. The GIRCSI Working Group is committed to pursue these objectives. [Copyright &y& Elsevier]

Abstract: Objective: Little is known about the incidence and risk factors of hospital-acquired malnutrition in children with mild illness (grade 1 clinical conditions) and its timing of occurrence. The aim of this study was to recognize any early stage of denutrition and possible risk factors leading to nutritional deterioration in children hospitalized due to mild clinical conditions. Methods: Four hundred ninety-six children (age 1–192 mo) with mild clinical conditions were studied. Weight and height were measured. Weight was assessed daily and body mass index (BMI) Z-score was calculated for all patients. Results: Children with a BMI Z-score <−2 SD on admission showed a mean BMI decrease at the end of their hospital stay, which was significantly higher than in children who showed a better nutritional condition at admission. Risk factors for hospital-acquired malnutrition were an age <24 mo, a duration of hospital stay >5 d, fever, and night-time abdominal pain. Conclusion: Hospital stay has an impact on the nutritional status of children affected by mild clinical conditions. Children already malnourished on admission were found to be at risk for further nutritional deterioration during their hospital stay; and in all groups of children identified by their BMI Z-score at admission, nutritional status declined progressively. [Copyright &y& Elsevier]

Abstract: AD is characterized by a widespread cognitive impairment and deficit in functional competency to perform activities of daily living (ADL). The longitudinal reliability of cognitive and functional performance indices and the strength of relationship between patients cognitive impairment and their functional competence are still open issues. The aim of this study has been to evaluate, in a selected sample of patients with AD treated with AChEl, the slopes of cognitive impairment and disability. Among 249 AD patients, according to DSM-IV criteria, with presence/absence of associated vascular lesions (AD+VD), eligible for AChEl treatment, we selected subjects with mild to moderate cognitive impairment, without high comorbidity and severe psychiatric disease, with caregiver who resided with, or had frequent contact with the patient. Patients that changed treatment shifting from one AChEl to another, that didn’t tolerate inhibitors (drop-out), and that presented behavioral and psychological symtoms of dementia (BPSD) requiring neuroleptic treatment during the study period were excluded from the final analysis. A sample of 99 subjects (30 males, 69 females; mean age of 79.4±5.0 years), completing a 15 months follow-up was considered. Cognitive performance remained stable after 15 months of treatment, but disability increased. No difference was found due to the AChEl compound used. The same hold true for the subgroups with presence/absence of a vascular components, whereas subgroup with mild cognitive performance showed a cognitive decline, parallel to the functional one. Our data underline the efficacy of AChEl in the treatment of AD with presence/absence of vascular component. Nevertheless, the judgement on the level of efficacy of AChEl could be biased by the level of reliability of the indices considered. [Copyright &y& Elsevier]

Abstract: Children with cerebral palsy (CP) often demonstrate abnormal feeding behaviours, leading to reduced food consumption and malnutrition. Moreover, most of them present with gastrointestinal disorders, such as gastroesophageal reflux disease (GERD) and/or chronic constipation (CC), and poor motor function rehabilitation. The aim of our study was to assess the possible relationship between malnutrition and gastrointestinal problems and to evaluate the role of nutrition on their gross motor abilities in a population of children with CP and mental retardation. Patients: Twenty-one consecutive children (10 boys; mean age: 5.8±4.7 years; range: 1–14 years) with CP and severe mental retardation. Methods: Nutritional assessment included the measurement of body mass index (BMI=W/H2), fat body mass (FBM) and fat free mass (FFM). Children with symptoms suggesting GERD underwent prolonged 24h intraesophageal pH monitoring and/or upper GI endoscopy with biopsies before and after a 6 months of pharmaceutical (omeprazole) and nutritional (20% increment of daily caloric intake) treatments. The motor function was evaluated by “The Gross Motor Function Measure” (GMFM) before and after the 6 months on nutritional rehabilitation. Results: BMI for age was ⩽5° percentile in 11 children (52%) and FBM was ⩽80% of ideal value for height in 15 (71%). GERD was present in 14 children (67%), 9 of them were affected by both GERD and CC. Among children with FBM⩽80%, GERD was present in 11 (73%) and CC in 9 (60%). Considering the group of patients with BMI⩽5° percentile, 9 out of 11 children had GERD (82%) and 7 had CC (64%). Fourteen malnourished children (FBM⩽80%) completed the 6 months nutritional trial. Their starting and final means±SD BMI were 13.56±1.31 and 14.15±1.85 (p =0.08), respectively. GMFM values were significantly (p <0.05) improved in 9/14pts (Group A), while it remained unchanged in 5/14pts (Group B). Nine children with GERD and malnutrition completed the 6 months of pharmaceutical and nutritional treatments. Their initial mean±SD weight was 10.1±2.9kg, whereas the final mean±SD weight was 12.7±4kg (p <0.05). A marked improvement of GERD was noted in four of nine (44.4%) children. Despite successful nutritional rehabilitation with a BMI achievement of ⩾25° percentile, five of nine (55.5%) patients had persistent GERD when they were taken off the medication. Conclusions: Malnutrition and gastrointestinal disorders are very common in children with cerebral palsy. Improved nutritional status, particularly fat free mass gain, appears to have an impact on motor function in children with CP. [Copyright &y& Elsevier]

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic, threatening global public health. In the current paper, we describe our successful treatment of one COVID-19 pneumonia patient case with high mortality risk factors. Our experience underlines the importance of the use of a multidisciplinary therapeutic approach in order to achieve a favorable clinical outcome. Further, enhancing the capability of the COVID-19 diagnosis with the use of the chest imaging modalities is discussed. [ABSTRACT FROM AUTHOR]

The authors convey their response to a feedback about their report on the recruitment of Italian schoolchildren and adolescents for the evaluation of dietary iodine intake using 24-hour urine collections. Topics mentioned include true habitual dietary iodine intake of a population through the urine samples, age-specific Adequate Intakes of iodine set by the European Food Safety Authority, and the use of gold-standard assessment of 24-hour urinary iodine excretion.

Pediatric care in Italy has been based during the last 40 years on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. The pediatric health care system in Italy is part of the national health system. It is made up of 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care. This overview will also include a brief report on neonatal care, pediatric preventive health care, health service accreditation programs, and postgraduate training in pediatrics. The quality of the Italian child health care system is now considered to be in serious danger because of the restriction of investments in public health caused both by the 2008 global and national economic crisis and by a reduction of the pediatric workforce as a result of progressively insufficient replacement of specialists in pediatrics. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence of irritable bowel syndrome (IBS) subtypes in childhood at diagnosis and their changes over 1 year. Study design: This is an observational, prospective, multicenter study. Consecutive pediatric patients with IBS, according to Rome III criteria, were enrolled over a 1-year period. Parents recorded weekly stool frequency and consistency and gastrointestinal and extraintestinal symptoms in a diary. Stool consistency was scored according to the Bristol Stool Form Scale. Children were evaluated after 2, 3, 6, and 12 months. Results: We enrolled 100 children with IBS (median age 9.9 years, range 4.2-16.7 years, 52 girls and 48 boys). At time of enrollment, constipation-IBS was the prevalent subtype (45%), with a prevalence of girls at 62% (P < .005); diarrhea-IBS was reported in 26% of children, with a prevalence of boys at 69% (P < .005); and alternating-IBS was described in 29% of children, without a difference between sexes. During the follow-up, 10% of patients changed their IBS subtypes at 2 months, 9% at 3 months, 7% at 6 months, and 6.3% at 12 months. Twenty-four percent of patients changed IBS subtype between the time of enrollment and 12 months. Conclusions: Constipation-IBS is the prevalent subtype in children, with a higher frequency in girls. In boys, diarrhea-IBS is the most common subtype. It is important to acquire knowledge about IBS subtypes to design clinical trials that may eventually shed new light on suptype-specific approaches to this condition. [Copyright &y& Elsevier]

Objectives: To compare the effectiveness of a mixture of acacia fiber, psyllium fiber, and fructose (AFPFF) with polyethylene glycol 3350 combined with electrolytes (PEG+E) in the treatment of children with chronic functional constipation (CFC); and to evaluate the safety and effectiveness of AFPFF in the treatment of children with CFC. Study design: This was a randomized, open label, prospective, controlled, parallel-group study involving 100 children (M/F: 38/62; mean age ± SD: 6.5 ± 2.7 years) who were diagnosed with CFC according to the Rome III Criteria. Children were randomly divided into 2 groups: 50 children received AFPFF (16.8 g daily) and 50 children received PEG+E (0.5 g/kg daily) for 8 weeks. Primary outcome measures were frequency of bowel movements, stool consistency, fecal incontinence, and improvement of other associated gastrointestinal symptoms. Safety was assessed with evaluation of clinical adverse effects and growth measurements. Results: Compliance rates were 72% for AFPFF and 96% for PEG+E. A significant improvement of constipation was seen in both groups. After 8 weeks, 77.8% of children treated with AFPFF and 83% of children treated with PEG+E had improved (P = .788). Neither PEG+E nor AFPFF caused any clinically significant side effects during the entire course of the study period. Conclusions: In this randomized study, we did not find any significant difference between the efficacy of AFPFF and PEG+E in the treatment of children with CFC. Both medications were proved to be safe for CFC treatment, but PEG+E was better accepted by children. [ABSTRACT FROM AUTHOR]