Search

(1) Background: Milk fat globule membrane (MFGM), composing fat droplets responsible for lipid transport in breast milk, has been shown to possess immunological and antimicrobial effects. Standard formulas (SF) are devoid of MFGMs during the production process. The study’s aim was to evaluate the safety and benefits of MFGMs supplementation in children. (2) Methods: We searched four databases for randomized controlled trials evaluating the supplementation of MFGMs in children. Growth parameters were chosen as the primary outcome. (3) Results: Twenty-four publications of seventeen studies were included. Meta-analyses assessing the primary outcomes at the age of 4 months included four studies (814 children) comparing the MFGM-supplemented formulas and SF, and two trials (549 children) comparing the MFGM-supplemented formulas and breastfeeding. The primary outcomes were non-inferior in all the experimental MFGM formulas compared to SF, or even represented more similar results to breastfed infants. The promising effects, including a lower incidence of acute otitis media and improved cognitive development, cannot be firmly confirmed due to the small amount of existing evidence. No significant adverse effects were reported in any of the assessed products. (4) Conclusions: The available data signaled beneficial effects and a good safety profile, requiring future research with well-designed trials.

This cross-sectional online survey performed in Poland aimed to improve understanding of how COVID-19 pandemic restrictions affected complementary feeding practices among parents of infants aged 4 to 12 months. Self-selected parents were recruited through the internet. The anonymous questionnaire was opened during two intervals during COVID-19 restrictions. The primary outcome was an assessment of sources of information and infant feeding practices in the context of COVID-19 restrictions. Data from 6934 responders (92.2% mothers) were analyzed. Most responders received information from multiple sources, with other parents, family members, or friends being the most frequently reported (48.6%), followed by webinars and experts’ recommendations (40.8%). COVID-19 restrictions largely did not impact the method of feeding, changes in feeding patterns, or complementary feeding introduction, although the latter was more likely to be impacted in families with average versus the best financial situations. Multivariate logistic regression analysis also most consistently showed that parents with a tertiary education and living in a city above 500 k were at higher odds of using webinars/experts’ recommendations, internet/apps, and professional expert guides and lower odds of claiming no need to deepen knowledge. This study clarifies major issues associated with complementary feeding practices during the implementation of COVID-19 restrictions in Poland.

The aim of this study was to evaluate the diagnostic accuracy of the Clinical Dehydration Scale (CDS), the World Health Organization (WHO) scale, and the Gorelick scale for dehydration assessment in children. A prospective, observational study was carried out between October 2014 and December 2016. Eligible participants were children aged 1 month to 5 years with acute diarrhea. After hospital admission, each patient's weight was recorded and the degree of dehydration based on three scales was assessed. The reference standard was the percentage weight change between the discharge and admission weights. The main outcomes were the sensitivity, specificity, positive likelihood ratio (LR), and negative LR. Of 128 children enrolled in the study, complete data were available from 118 patients for analysis. Most of children presented with no or mild dehydration. Only the CDS showed limited value in confirming a diagnosis of dehydration ≥6% (positive LR 3.9, 95% CI 1.1 to 9.1), with no value in ruling it out (negative LR 0.6, 95% CI 0.2 to 0.99).In our cohort, the CDS was of limited diagnostic value in ruling in severe dehydration in children with acute gastroenteritis. The WHO and Gorelick scales were not helpful in the assessment of dehydration. What is Known : • Treatment of acute gastroenteritis (AGE) is based on assessing and correcting the degree of dehydration. • Several scales combining various signs and symptoms have been developed, including the Clinical Dehydration Scale (CDS), and the World Health Organization (WHO) scale, and the Gorelick scale. None of these scales is internationally accepted for best accuracy in diagnosing dehydration in children. What is New: • The CDS was of limited diagnostic value in ruling in severe dehydration in children with AGE. • The WHO and Gorelick scales were not helpful in the assessment of dehydration.

Neurodevelopment has been linked, among other factors, to maternal and early infant diets. The objective of this review, which is part of the NUTRIMENTHE research project ‘The effect of diet on the mental performance of children’ (www.nutrimenthe.com), was to update current evidence on the effects of nutritional interventions such as iron, folic acid or n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation during pregnancy and/or in early life on the mental performance and psychomotor development of children. In May 2014, we searched MEDLINE and The Cochrane Database of Systematic Reviews for relevant studies published since 2009. The limited updated evidence suggests that iron supplementation of infants may positively influence the psychomotor development of children, although it does not seem to alter their mental development or behaviour. The use of multivitamin-containing folic acid supplements during pregnancy did not benefit the mental performance of the offspring. Evidence from randomised controlled trials (RCT) did not show a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on childhood cognitive and visual development. Caution is needed when interpreting current evidence, as many of the included trials had methodological limitations such as small sample sizes, high attrition rates, and no intention-to-treat analyses. Taken together, the evidence is still inconclusive. Large, high-quality RCT to assess the effects of supplementation with iron, LCPUFA or folic acid are still needed to further clarify the effects of these, and other nutrients, on neurodevelopment. Recent recommendations from scientific societies are briefly presented.

Aim This study assessed the inter-rater variability of stool assessment, comparing the judgement of parents and a physician using the Amsterdam Infant Stool Scale (AISS) and the evaluation by another physician using photographs. Methods The stools of children aged two to18 months, who were not toilet trained, were independently assessed in vivo using the AISS by the parents and the first physician. Another physician, unaware of the results of the in vivo evaluation, assessed two stool photographs taken by the first physician with a smartphone. Results Having analysed 100 stools, we found excellent inter-rater agreement between the parents and the first physician for consistency (kappa 0.87; 95% confidence interval [95% CI] 0.78-0.95) and colour (kappa 0.81; 95% CI: 0.71-0.91) and good inter-rater agreement for the amount (kappa 0.79; 95% CI 0.7-0.88). We found moderate inter-rater agreement between the parents’ in vivo assessment and the second physician's photographic assessment for stool consistency (kappa 0.5; 95% CI 0.36-0.64) and amount (kappa 0.44; 95% CI 0.29-0.59) and a fair inter-rater agreement for colour (kappa 0.33; 95% CI 0.21-0.45). Conclusion When parents and a physician used the AISS under in vivo conditions there was better inter-rater agreement than photographic evaluation by a second physician. This article is protected by copyright. All rights reserved.

To assess the effectiveness of Lactobacillus casei rhamnosus Lcr35 (Lcr35) in the management of functional constipation in children.A randomized, double-blind, placebo-controlled trial was conducted in 94 children aged5 years with functional constipation according to the Rome III criteria. Children were assigned to receive Lcr35 (8 × 10Eighty-one (86%) children completed the study. There was no significant difference in treatment success between the placebo and the Lcr35 group (28/40 vs 24/41, respectively; relative risk, 0.6, 95% CI 0.24-1.5, P = .4). There was a significant increase in the frequency of defecation from baseline to week 4 in both the placebo group (median [IQR] 2.0 [1.0, 2.0] to 6.0 [4.0, 9.0], P .001) and in the Lcr35 group (2.0 [1.0, 2.0] to 4.0 [3.0, 5.0], P .001), but the defecation frequency in the placebo group was significantly greater than that in the Lcr35 group at weeks 1, 2, 3, and 4.Lcr35 as a sole treatment was not more effective than placebo in the management of functional constipation in children5 years. This study adds to current recommendations that do not support the use of probiotics in the treatment of childhood constipation.ClinicalTrials.gov: NCT01985867.

Zaburzenia ze spektrum autyzmu (Autism Spectrum Disorders- ASD) są spowodowane zaburzeniami wczesnych faz rozwoju ośrodkowego układu nerwowego i zwykle są rozpoznawane w pierwszych latach życia. Pomimo wspólnych cech takich jak upośledzenie rozwoju społeczno-komunikacyjnego oraz stereotypowe zachowania posiadają zróżnicowany przebieg i obraz kliniczny. Do najważniejszych czynników etiologicznych należą geny i czynniki środowiskowe działające w okresie prenatalnym, perinatalnym i noworodkowym. Wskazuje się na rolę rzadko występujących wariantów genetycznych o dużej sile oddziaływania np. zmienności liczby powtórzeń w genach odpowiedzialnych za architekturę synaps i połączeń międzysynaptycznych. Postuluje się również udział występujących często wariantów o niewielkiej sile oddziaływania, w tym m.in. polimorfizmów w genach kodujących białka układu peptydów prospołecznych – oksytocyny i wazopresyny. Spośród środowiskowych czynników ryzyka wymienia się szkodliwe oddziaływania w czasie ciąży i porodu, choć do tej pory nie potwierdzono ich swoistego znaczenia, a niekiedy wskazuje się, że również niektóre z nich mogą wynikać pierwotnie z przyczyn genetycznych. W niektórych przypadkach, zwłaszcza z zaburzeniami towarzyszącymi– niepełnosprawnością intelektualną, padaczką i dysmorfiami- wskazuje się na celowość szczegółowej diagnostyki molekularnej, która obecnie może przyczynić się do wykrycia genetycznego podłoża zaburzenia w około 20% przypadków.

To systematically evaluate the effects of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation of pregnant and/or lactating women on the neurodevelopment and visual function of their children.Systematic review. Randomized controlled trials (RCTs) comparing n-3 LCPUFA maternal supplementation were identified through electronic databases (MEDLINE, EMBASE, the Cochrane Library) and the references of reviewed articles.Overall, 13 publications, some with important methodological limitations, were included. With regard to supplementation during pregnancy, among 3 RCTs that evaluated this intervention, 1 RCT (n = 72) showed significantly better eye and hand coordination assessed with the Griffiths Mental Development Scales at 30 months of age. Another RCT (n = 29) demonstrated an effect of n-3 LCPUFA supplementation on the cloth step of intentional solutions of the 2-step problem-solving test. No other effects were demonstrated. There was no consistent effect of n-3 LCPUFA supplementation during pregnancy on the children's visual acuity. With regard to supplementation during lactation, among 3 RCTs that assessed this intervention, 1 RCT (n =133) showed significant improvement on the Bayley Psychomotor Development Index in 30-month-old children; however, there was no influence of such supplementation on the results of different tests performed in the same group of children or in others. There was no consistent effect of n-3 LCPUFA supplementation during lactation on the children's visual function. Supplementation during pregnancy and lactation (3 RCTs) did not affect child neurodevelopment assessed up to 7 years of age.Evidence from RCTs does not demonstrate a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on child neurodevelopment and visual acuity. These results should be interpreted with caution due to methodological limitations of the included studies.

To summarize the literature concerning gastrointestinal infections in the pediatric population, primarily in developed countries. Searches of MEDLINE and the Cochrane Library databases were performed in August 2009 to locate studies published in the last 18 months.Several independent guidelines based on systematic reviews of the best available evidence related to rotavirus vaccination and to the management of acute gastroenteritis were recently published. Despite subtle differences, there is agreement between the scientific societies that rotavirus vaccination should be offered to all children worldwide. Likewise, there is consensus in the guidelines that rehydration therapy is the mainstay of treatment for acute gastroenteritis and should be applied promptly. For oral rehydration, a reduced osmolality oral rehydration solution should be used. Regular feeding should not be interrupted and should be carried on following initial rehydration. The use of some antiemetics and antidiarrheal drugs has been studied; however, they are generally not necessary. The use of probiotics with documented efficacy may be considered. Antibiotics should not be routinely administered to children with gastroenteritis.This review discusses the most recent relevant guidelines related to gastrointestinal infections in children, which may facilitate provision of more standardized advice and treatment to patients by healthcare providers.

The aim of the study was to evaluate the effectiveness and safety of 2 different polyethylene glycol (PEG) doses for the maintenance treatment of functional constipation in children.Children with functional constipation according to the Rome III criteria were randomly assigned to receive PEG 4000 at a dose of either 0.7 g/kg (high-dose group; n = 45) or 0.3 g/kg (low-dose group; n = 47) for 6 weeks. Adjustment of the therapy was recommended in the event of3 bowel movements (BM) per week or ≥3 BM per day. The primary outcome measure was treatment success, defined as ≥3 BM per week with no fecal soiling during the last week of the intervention.A total of 90 of 92 randomized children, with a mean age of 3.7 ± 2.1 years, completed the study. In the analysis based on allocated treatment, treatment success was similar in both groups (relative risk 0.9, 95% confidence interval 0.78-1.03). Compared with the high-dose PEG group, the low-dose PEG group had an increased need for therapy adjustment of borderline significance (relative risk 2.0, 95% confidence interval 1.0-4.2), an increased risk of painful defecation, a lower number of stools per week, and lower parental satisfaction. Adverse events were similar in both groups.To achieve treatment success, both tested doses of PEG were equally safe and effective in the treatment of children with functional constipation.

Many protocols of bowel preparation are available for use in children; however, none of them is commonly accepted. The aim of the study was to evaluate the efficacy and acceptability of high-volume polyethylene glycol (PEG) versus low-volume PEG combined with bisacodyl (BPEG) versus sennosides for colonoscopy preparation in children.Participants ages 10 to 18 years were randomly assigned to receive either PEG 60 or PEG 30 mL kg⁻¹ day⁻¹ plus oral bisacodyl 10 to 15 mg/day or sennosides 2 mg kg⁻¹ day⁻¹ for 2 days. A blinded assessment of bowel cleansing was made by the endoscopist according to the Aronchick and Ottawa scales. Patient acceptability was evaluated with the visual-analog scale. Analysis was done on an available case analysis basis.Of 240 patients enrolled in the study 234 patients were available for analysis of the efficacy of colon cleansing. There were no significant differences found among the 3 groups for the proportions of participants with excellent/good (PEG: 35/79, BPEG: 26/79, sennosides 25/76) and poor/inadequate (PEG: 20/79, BPEG: 28/79, sennosides 28/76) bowel preparation evaluated with the Aronchick scale and for the mean Ottawa total score (PEG: 5.47 ± 3.63, BPEG: 6.22 ± 3.3, sennosides: 6.18 ± 3.53). Acceptability of bowel cleansing protocol was similar in all of the groups (P = 0.8).All 3 cleansing methods showed similar efficacy and tolerability; however, none of them was satisfactory.

Treatment measures for constipation in children are often not satisfactory. The aim was to assess the efficacy of glucomannan (GNN) as a sole treatment for functional constipation.Children aged 3-16 years with functional constipation according to Rome III criteria were randomly assigned to receive GNN (2.52 g/d) or placebo for 4 weeks.Of the 80 children, 72 (90%) completed the study. The primary outcome, treatment success (≥3 stools per week with no soiling), was similar in the GNN (n = 36) and placebo (n = 36) groups (relative risk 0.95, 95% CI 0.6 to 1.4). In the GNN group, the stool consistency score was higher at week 1 (P 0.0001), lower at week 3 (P = 0.008), and similar at weeks 2 and 4. Stool frequency was higher only at week 3 (P = 0.007). Abdominal pain episodes were more frequent in the GNN group at week 1 (P = 0.04) and week 4 (P 0.0001) but were similar between groups at weeks 2 and 3. No difference was observed in the frequency of any other secondary outcome or adverse event.In our setting, GNN, as dosed in this study, was not more effective than placebo in achieving therapeutic success in constipated children. The trial was registered at ClinicalTrials.gov (http://clinicaltrials.gov), number NCT01151878.

Objective Search for evidence supporting target age, level of intervention and target values for low-density lipoprotein (LDL) cholesterol levels in children with familial hypercholesterolemia. Design Systematic review and meta-analysis. PubMed, Medline, CINAHL and Cochrane Reviews databases from 1966 to 2007 were searched for articles reporting statin therapy in children and adolescents aged 8–18 years. Retrieved articles were screened for double-blind randomised controlled trials (RCTs). Results Seven trials involving 884 patients met inclusion criteria. Meta-analysis findings showed significantly reduced total cholesterol, LDL cholesterol and apolipoprotein B, whereas high-density lipoprotein cholesterol and apolipoprotein A1 were significantly increased by statin therapy. Evidence on target level in children was limited to one study attainment of LDL cholesterol treatment target in 60% of the subjects in the treatment group and none in the placebo group reached their target LDL cholesterol. Evidence on the effect of statins on surrogate markers of atherosclerosis was limited to two studies (one RCT on the effect upon the carotid intima-media thickness (n=211; mean difference (MD) −0.01; 95% CI −0.03 to −0.00), and one showing that the mean absolute change in flow-mediated dilation after 28 weeks of statin treatment was significantly higher in the simvastatin group compared to placebo group (MD 2.7%; 95% CI 0.42 to 4.98). Conclusions There is no firm evidence regarding when to start statin treatment or what target LDL cholesterol level should be attained. Recent recommendations that favour statins as the first-line drug treatment for hypercholesterolemia are evidence based. Studying high-risk groups (obese or diabetic patients) and incorporating composite end points may help define treatment guidelines.

CONTEXT. Currently, thickened feeds are increasingly being used to treat infants with gastroesophageal reflux, driven in large part by the baby food industry. Previous meta-analyses have shown that although thickened formulas do not seem to reduce measurable reflux, they may reduce vomiting. However, because data are limited, there is still uncertainty regarding the use of thickening agents. OBJECTIVE. Our goal was to systematically evaluate and update data from randomized, controlled trials on the efficacy and safety of thickened feeds for the treatment of gastroesophageal reflux in healthy infants. METHODS. The Cochrane Library, Medline, Embase, and CINAHL databases and proceedings of the European and North American pediatric gastroenterology conferences (from 2000) were searched in May 2008; additional references were obtained from reviewed articles. Only randomized, controlled trials that evaluated thickened feeds used in infants for at least several days for the treatment of gastroesophageal reflux were considered for inclusion. Three reviewers independently performed data extraction by using standard data-extraction forms. Discrepancies between reviewers were resolved by discussion between all authors. Only the consensus data were entered. RESULTS. Fourteen randomized, controlled trials with a parallel or crossover design, some with methodologic limitations, were included. Use of thickened formulas compared with standard formula significantly increased the percentage of infants with no regurgitation, slightly reduced the number of episodes of regurgitation and vomiting per day (assessed jointly or separately), and increased weight gain per day; it had no effect on the reflux index, number of acid gastroesophageal reflux episodes per hour, or number of reflux episodes lasting >5 minutes but significantly reduced the duration of the longest reflux episode of pH < 4. No definitive data showed that one particular thickening agent is more effective than another. No serious adverse effects were noted. CONCLUSIONS. This meta-analysis shows that thickened food is only moderately effective in treating gastroesophageal reflux in healthy infants.

The aim of this study was to determine the frequency of non-diagnosed coeliac disease in patients with recurrent aphthous stomatitis, admitted to the Department of Oral Medicine, Dental Institute, Warsaw Medical School in the years 1999-2000. The examination comprised 20 subjects (10 females and 10 males), mean age: 40 years. In one patient anti-endomysial antibody, the markers of coeliac disease (IgAEmA-80j) were detected.

To assess the efficacy of glucomannan (GNN) as the sole treatment for abdominal pain-related functional gastrointestinal disorders (FGIDs).We conducted a double-blind, placebo-controlled, randomized trial. Patients were recruited among children referred to the Department of Paediatrics, Medical University of Warsaw. Included in the study were children aged 7-17 years with abdominal pain-related FGIDs classified according to the Rome III diagnostic criteria. The children were randomly assigned to receive GNN, a polysaccharide of 1,4-D-glucose and D-mannose, a soluble fiber from the Japanese Konjac plant, at a dosage of 2.52 g/d (1 sachet of 1.26 g 2 times a day), or a comparable placebo (maltodextrin) at the same dosage. The content of each sachet was dissolved in approximately 125 mL of fluid and was consumed twice daily for 4 wk.Of the 89 eligible children, 84 (94%) completed the study. "No pain" and "treatment success" (defined as no pain or a decrease ≥ 2/6 points on the FACES Pain Scale Revised) were similar in the GNN (n = 41) and placebo (n = 43) groups [no pain (12/41 vs 6/43, respectively; RR = 2.1, 95%CI: 0.87-5.07) as well as treatment success (23/41 vs 20/43; RR = 1.2, 95%CI: 0.79-1.83)]. No significant differences between the groups were observed in the secondary outcomes, such as abdominal cramps, abdominal bloating/gassiness, episodes of nausea or vomiting, or a changed in stool consistency. GNN demonstrated no significant influence on the number of children requiring rescue therapy, school absenteeism, or daily activities.In our setting, GNN, as dosed in this study, was no more effective than the placebo in achieving therapeutic success in the management of FGIDs in children.