Search

Regular, long-term anthropometric follow-up is one of the fundamental methods of assessing the child’s health and well-being. However, there is still a lot of inconsistency in anthropometric practices and standards that may have a negative impact on clinical practice (e.g. delay in diagnosing children with growth or feeding disorders, genetic and metabolic syndromes). The paper discusses the principles of basic measurements: length/height, body weight, circumferences: head, chest and arm. Attention was also paid to the use of professional anthropometric equipment. Appropriately performed measurements allow the calculation of weight-height indices, which define nutrition disturbances (overweight, obesity and malnutrition), and also constitute the basis for conducting specialised diagnostics. In 2011, a group of experts recommended standards of body length/height, body weight, head circumference and body mass index developed by the World Health Organization for children up to 5 years of age. In 2013, nationwide reference values for weight, height and body mass index for children aged from 3 to 6 years were published and accepted as valid (OLA project). They complemented previously developed percentile charts for children aged 7–18 years (OLAF project). The paper proposes to adopt uniform standards of anthropometric measurements and to initiate a discussion in the paediatric community on the acceptance of common growth charts for the basic anthropometric measurements.

Purpose Proton-pump inhibitors (PPIs) are frequently used to treat gastroesophageal reflux disease (GERD) in children, but recent evidence suggests a potential association between PPI treatment and some types of infections. The aim of this study was to assess the effectiveness of Lactobacillus rhamnosus GG (LGG) for the prevention of gastrointestinal and respiratory tract infections in children with GERD treated with PPI (omeprazol). Methods Children younger than 5 years with GERD were assigned by a computer-generated list to receive LGG (109 colony-forming units) or placebo, twice daily, concomitantly with PPI treatment for 4-6 weeks; they were followed up for 12 weeks after therapy. The primary outcome measures were the percentage of children with a minimum of one episode of respiratory tract infection and the percentage of children with a minimum of one episode of gastrointestinal infection during the study. Results Of 61 randomized children, 59 patients (LGG n=30; placebo n=29, mean age 11.3 months) were analyzed. There was no significant difference found between the LGG and placebo groups, either for the proportion of children with at least one respiratory tract infection (22/30 vs. 25/29, respectively; relative risk [RR] 0.85, 95% confidence interval [CI] 0.66-1.10) or for the proportion of children with at least one gastrointestinal infection (9/30 vs. 9/29, respectively; RR 0.97, 95% CI 0.45-2.09). Conclusion LGG was not effective in the prevention of infectious complications in children with GERD receiving PPI. Caution is needed in interpreting these results, as the study was terminated early due to slow subject recruitment.

(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.

IntroductionIn the first year of life it is crucial to maintain a well-balanced diet. It ensures optimal growth and development of the child. Feeding difficulties experienced by a child might lead to impairment of the nutritional status. Despite the importance of the subject, we did not find much recent published information. The aim of the study was to assess the etiology and growth parameters in children with feeding difficulties.Material and methodsChildren with feeding difficulties admitted to the Department of Pediatrics (September 2013 – April 2019) were recruited. Feeding difficulties were diagnosed by a minimum of two specialists. Based on medical records and clinical evaluation they were categorized as: organic, nonorganic or mixed (both medical and behavioral). To assess nutritional status weight, length/height, and body mass index (BMI) were obtained and compared with WHO reference standards.ResultsFour hundred twenty-two children with mean age of 35 months (range: 3 to 156 months) were recruited. Fifty-three percent of feeding difficulties were nonorganic (behavioral), whereas the remaining 47% were caused by mixed factors. Organic factors were mostly related to gastroenterological disorders, food allergy or coexistence of more than one medical problem. Underweight (weight < –2 z-score) was observed in 18% of patients, stunted growth (length/height < –2 z-score) in 11%, wasting (BMI < –2 z-score) in 15%, and overweight (BMI > + 2 z-score) in 1%.ConclusionsOur study showed that organic feeding difficulties coexisted with a behavioral component. The observed nutritional impairments in children with feeding difficulties indicate that there is a need for quick detection of these difficulties in order to provide appropriate support and help as soon as possible.

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.

ObjectiveTo systematically assess the diagnostic accuracy of the Clinical Dehydration Scale (CDS), the WHO Scale and the Gorelick Scale in identifying dehydration in children with acute gastroenteritis (AGE).DesignThree databases, two registers of clinical trials and the reference lists from identified articles were searched for diagnostic accuracy studies in children with AGE. The index tests were the CDS, WHO Scale and Gorelick Scale, and reference standard was the percentage loss of body weight. The main analysed outcomes were the sensitivity, specificity, positive likelihood ratio (LR) and negative LR.ResultsTen studies were included. In high-income countries, the CDS provided a moderate-to-large increase in the post-test probability of predicting moderate to severe (≥6%) dehydration (positive LR 3.9–11.79), but it was of limited value for ruling it out (negative LR 0.55–0.71). In low-income countries, the CDS showed limited value both for ruling in and ruling out moderate-to-severe dehydration. In both settings, the CDS showed poor diagnostic accuracy for ruling in or out no dehydration (ConclusionLimited evidence suggests that the CDS can help in ruling in moderate-to-severe dehydration (≥6%) in high-income settings only. The WHO and Gorelick Scales are not helpful for assessing dehydration in children with AGE.

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.

Background The appropriate diagnosis and management of cow's milk allergy (CMA) is challenging. We aimed to systematically review the quality of the existing guidelines on CMA. Methods The Cochrane Library, MEDLINE, and EMBASE databases were searched from 2010 to November 2015. The methodological rigor, quality, and transparency of relevant guidelines were assessed with the use of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Results Of 15 included guidelines, 2, both developed by recognized scientific organizations, achieved the highest score (100%). Eight others were considered to be of high quality (i.e., overall quality scores >60%). The quality scores for each domain varied. Of all domains, clarity and presentation had the highest mean score, and applicability had the lowest mean score. The scores (mean ± SD) for individual domains were as follows: domain 1 (score and purpose) 62% ± 36%; domain 2 (stakeholder involvement) 56% ± 33%; domain 3 (rigor of development) 55% ± 38%; domain 4 (clarity of presentation) 71% ± 29%; domain 5 (applicability) 44% ± 33%; and domain 6 (editorial independence) 60% ± 36%. One guideline had the maximum possible score of 100% for all AGREE II domains Conclusion A number of guidelines on CMA are available; however, their quality varies. Overall, the guidelines developed by recognized professional/scientific organizations were of the highest quality. These guidelines should be recommended for use. Still, the methodological quality of CMA guidelines may be improved. This article is protected by copyright. All rights reserved.

Aim of the current study was to evaluate the inter-observer agreement between pathologists in the diagnosis of celiac disease (CD), in the qualified context of a multicenter study. Biopsies from the “PreventCD” study, a multinational- prospective- randomized study in children with at least one-first-degree relative with CD and positive for HLA-DQ2/HLA-DQ8. Ninety-eight biopsies were evaluated. Considering diagnostic samples with villous atrophy (VA), the agreement was satisfactory (κ = 0.84), but much less when assessing the severity of these lesions. The use of the recently proposed Corazza-Villanacci classification showed a moderately higher level of agreement (κ = 0.39) than using the Marsh-Oberhuber system (κ = 0.31). 57.1% of cases were considered correctly oriented. A number of >4 samples per patient was statistically associated to a better agreement; orientation did not impact on κ values. Agreement results in this study appear more satisfactory than in previous papers and this is justified by the involvement of centers with experience in CD diagnosis and by the well-controlled setting. Despite this, the reproducibility was far from optimal with a poor agreement in grading the severity of VA. Our results stress the need of a minimum of four samples to be assessed by the pathologist.

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.

AIM We explored the diagnostic accuracy of the clinical dehydration scale (CDS), the World Health Organization (WHO) scale and the Gorelick scale for assessing dehydration in children admitted to a Tanzanian referral hospital. METHODS This was a prospective, observational study, carried out from April 2015 to January 2017 on children aged one month to five years admitted to the hospital with acute diarrhoea lasting less than five days. Before rehydration therapy, each patient's weight was recorded and the degree of dehydration was assessed based on the three scales. The reference standard was the percentage weight change between admission and discharge. The main outcomes were the sensitivity, specificity and positive and negative likelihood ratios (LRs) of the scales. RESULTS Data from 124 eligible patients were available. The CDS showed limited value for ruling in cases with some dehydration (LR 1.9, 95% confidence interval 1.1-2.8), but was of no value in assessing no and moderate to severe dehydration. The WHO and Gorelick scales were of no value in evaluating any degree of dehydration. CONCLUSION The WHO and Gorelick dehydration scales were no use for assessing dehydration in small children, and the CDS was of limited use for predicting cases with some dehydration.

Introduction: Inadequate vitamin D level is associated with altered bone turnover and bone loss, which increases the fracture risk. Aim: To assess the seasonal prevalence of inadequate (insufficient or deficient) serum vitamin D levels in community-dwelling postmenopausal Polish women screened for osteoporosis. Material and methods : A cross-sectional observational study based on the regional urban non-institutionalized sample (n = 107) of postmenopausal Caucasian women in the age range of 51-83 years, not taking any medication and free from any condition likely to affect vitamin D status or calcium/bone metabolism. The outcome measures were the mean 25-OH vitamin D level across all the seasons and the percentage of vitamin D deficiency and insufficiency and defined as < 20 ng/dl (50 nmol/l) and 20-30 ng/dl (50-75 nmol/l), respectively. Results: No statistically significant difference has been found in the mean vitamin D level, regardless of the season (p = 0.4). The prevalence of vitamin D deficiency and insufficiency were in spring 54% and 32%, in summer 46% and 46%, in autumn 67% and 27%, and in winter 61% and 22%, respectively. Conclusions : Vitamin D inadequacy is common in a sample of Polish community-dwelling postmenopausal women regardless of the season.

Aim. To systematically update diagnostic accuracy of the Clinical Dehydration Scale (CDS) in clinical recognition of dehydration in children with acute gastroenteritis. Methods. Six databases were searched for diagnostic accuracy studies in which population were children aged 1 to 36 months with acute gastroenteritis; index test was the CDS; and reference test was post-illness weight gain. Results. Three studies involving 360 children were included. Limited evidence showed that in high-income countries the CDS provides strong diagnostic accuracy for ruling in moderate and severe (>6%) dehydration (positive likelihood ratio 5.2-6.6), but has limited value for ruling it out (negative likelihood ratio 0.4-0.55). In low-income countries, the CDS has limited value either for ruling moderate or severe dehydration in or out. In both settings, the CDS had limited value for ruling in or out dehydration

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.

Summary Background A lack of reliable treatments for abdominal pain-related functional gastrointestinal disorders prompts interest in new therapies. Aim To evaluate systematically the effect of Lactobacillus rhamnosus GG (LGG) for treating abdominal pain-related functional gastrointestinal disorders in children. Methods MEDLINE, EMBASE, CINAHL, the Cochrane Library, trial registries and proceedings of major meetings were searched for randomised controlled trials (RCTs) evaluating LGG supplementation in children with abdominal pain-related functional gastrointestinal disorders based on the Rome II or Rome III criteria. Risk of bias was assessed for generation of the allocation sequence, allocation concealment, blinding and follow-up. Results Compared with placebo, LGG supplementation was associated with a significantly higher rate of treatment responders (defined as no pain or a decrease in pain intensity) in the overall population with abdominal pain-related functional gastrointestinal disorders (three RCTs, n = 290; risk ratio, RR 1.31, 95% CI 1.08–1.59, number needed to treat, NNT 7, 95% CI 4–22) and in the irritable bowel syndrome (IBS) subgroup (three RCTs, n = 167; RR 1.70, 95% CI 1.27–2.27, NNT 4, 95% CI 3–8). However, no difference was found in the rate of treatment responders between children with functional abdominal pain or functional dyspepsia who received placebo or LGG. The intensity of pain was significantly reduced in the overall study population and in the IBS subgroup. The frequency of pain was significantly reduced in the IBS subgroup only. Conclusion The use of Lactobacillus rhamnosus GG moderately increases treatment success in children with abdominal pain-related functional gastrointestinal disorders, particularly among children with IBS.

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.

SUMMARY Background Controversy exists surrounding the optimal treatment for inducing remission in active Crohn’s disease. Aim To review and update evidence on the effectiveness of enteral nutrition (EN) in treating active Crohn’s disease in children. Methods

Background and Aim: Adalimumab is well-established therapy for adults with Crohn’s disease [CD]. The aim of the study was to systematically assess the published evidence on the efficacy and safety of adalimumab for Crohn’s disease in children. Methods: MEDLINE, EMBASE, the Cochrane Library, and abstracts from the main gastroenterological meetings in the past 5 years were systematically searched up to July 2015 for randomised controlled trials and observational studies on the efficacy and safety of adalimumab for Crohn’s treatment in children and adolescents. Results: A total of 14 studies [1 randomised controlled trial, 13 case series], altogether including 664 patients [age: 1.9 to 21 years] were available for analysis. The studies differed with respect to patients’ characteristics, including percentage of infliximab-naive patients, disease duration, site of the disease, adalimumab doses, treatment duration, and follow-up period. The pooled remission rates were: 30% [ n = 93/309] at 4 weeks, 54% [ n = 79/145] at 3 months, 45% [ n = 18/40] at 4 months, 42% [ n = 146/345] at 6 months, 57% [ n = 20/35] at 8 months, and 44% [ n = 169/383] at 12 months. Of the total patients, 6% [ n = 13/207] were classified as primary non-responders and 12% [ n = 69/599] had severe adverse events reported including 2 deaths and 1 medulloblastoma. Withdrawal rate due to adverse events reported in one study was 35% [ n = 64/182]. Conclusion: According to low-quality evidence based mainly on case series, approximately half of children with Crohn’s disease on adalimumab therapy achieve remission during the first year of the therapy with reasonable safety profile. There is still a need for high-quality evidence on effectiveness and safety of adalimumab for paediatric Crohn’s disease.

Introduction Rectal faecal impaction (RFI) from functional constipation is a common problem in children. Maintenance therapy should start after successful disimpaction. However, there is uncertainty with regard to the optimal disimpaction regimen. Aim We systematically evaluated the effect of polyethylene glycol (PEG) compared to enema for treating RFI. Material and methods The MEDLINE, EMBASE, and the Cochrane Library, with no language restrictions, were searched up to July 2014 for randomised controlled trials (RCTs) evaluating the effect of PEG compared with enema for disimpaction in children with functional constipation. The risk of bias was assessed using the Cochrane risk of bias tool. Results Two RCTs, involving 170 children aged 1 to 17 years, met the inclusion criteria. The studies were generally low in methodological quality. Compared with the enema group, the PEG 3350 group had significantly reduced chance for treatment success, but the difference was of a borderline statistical significance (RR = 0.83, 95% CI: 0.7-0.99). The use of PEG was also more likely to increase defecation frequency, but increased the risk of watery stools and increased faecal incontinence. Other outcomes, in general, were similar in both groups. Conclusions Current evidence does not allow us to conclude which intervention is more effective for treating RFI in children with functional constipation. These results should be interpreted with caution due to the limited number of trials and the low quality of reporting in these trials, high or unknown risk of bias, and sparse data. Further high-quality, adequately powered RCTs are needed to determine the optimal management.

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.

Summary Background Problems with the standard triple treatment recommended for Helicobacter pylori eradication therapy include unsatisfactory (less than 80%) eradication rates among children. Aim To assess the evidence for sequential therapy compared with triple therapy on H. pylori eradication rates in children. Methods The Cochrane Library, MEDLINE and EMBASE databases were searched in May 2012, with no language restrictions, as were abstracts from major gastroenterology conferences, for randomised controlled trials (RCTs) comparing sequential therapy with standard triple therapy for H. pylori eradication. Additional references were obtained from reviewed articles. Authors were contacted for extra information. Dichotomous data were pooled to obtain the relative risk (RR) of the eradication rate, with a 95% CI. Results Ten RCTs involving a total of 857 children aged 3–18 years met the inclusion criteria. Of the 409 patients in the sequential therapy group, 318 (78%, 95% CI 73–82) experienced eradication compared with 314 of the 444 patients (71%, 95% CI 66–75) in the standard triple therapy group (RR 1.14, 95% CI 1.06–1.23, number needed to treat 15; fixed-effects model). Sequential therapy was superior to 7-day standard triple therapy, but was not significantly better than 10-day or 14-day triple therapy. There were no significant differences between groups in the risk of adverse effects. Conclusions The pooled evidence suggests that 10-day sequential therapy compared with standard triple therapy may be considered as an option for increasing the eradication rates in children; however, it is still less than desired.

Background: A lack of safe and reliable treatments for abdominal pain-related functional gastrointestinal disorders (FGIDs) has prompted interest in new therapies. Aim: To systematically evaluate the effect of dietary fibers for treating abdominal pain-related FGIDs in children. Methods: In December 2011, MEDLINE, EMBASE and the Cochrane Library were searched for randomized controlled trials (RCTs) evaluating fiber supplementation in children with FGIDs. Results: Only 3 RCTs were identified, which enrolled a total of 167 children and adolescents (5–17 years old) with recurrent abdominal pain. Only 1 study used the Rome III criteria. Patients were supplemented with different dietary fiber types for 4–6 weeks. The use of dietary fibers did not influence the proportion of responders to treatment, and improvement did not occur in reported clinically relevant outcomes such as no pain or a significant decrease in pain intensity (risk ratio 1.17, 95% confidence interval 0.75–1.81). Conclusion: There is no evidence that supplementation with fiber as a dietary manipulation may be useful for treating children with FGIDs. However, one should not overlook the fact that the main limitation for recommendation of the routine fiber use in clinical practice derives from the weak quality and paucity of available studies.

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.

Although not currently recommended, dioctahedral smectite (smectite) is commonly used to treat acute infectious diarrheal in many countries. To evaluate systematically the effectiveness of smectite in treating acute infectious diarrhea in children. Using medical subject headings and free language terms, the following electronic databases were searched for studies relevant to acute infectious diarrhea and smectite: medline, embase, cinahl and the cochrane library; additional references were obtained from reviewed articles. Only randomized controlled trials were included. Nine randomized controlled trials (1238 participants) met the inclusion criteria. Combined data from six randomized controlled trials showed that smectite significantly reduced the duration of diarrhea compared with placebo. The pooled weighted mean difference was (22,7 h, 95% CI: 24,8 to 20,6) with a fixed model and remained significant in a random effect model (24,4 h, 95% CI: 29,8 to 19,1). The chance of cure on intervention day 3 was significantly increased in the smectite vs. the control group (RR 1,64, 95% CI: 1,36–1,98; number needed to treat 4,95% CI: 3–5). Adverse effects were similar in both groups. Smectite may be a useful adjunct to rehydration therapy in treating acute pediatric gastroenteritis. However, the results of this meta analysis should be interpreted with caution as most of the included studies had important limitations. Cost effectiveness analyses should be undertaken before routine pharmacological therapy with smectite is recommended.Key words: dioctahedral smectite, meta_analysis, acute infectious diarrhea, children.

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.

We agree that gastroesophageal reflux (GER) does not need treatment, as stated by Dr Vandenplas. Nevertheless, thickened feeds are increasingly being used to treat infants with GER, driven in large part by the baby-food industry. Consequently, the objective of our review was to provide some resolution to the uncertainty regarding the use of thickening agents, as an adjunct to infant formula, in the treatment of GER in generally healthy infants. We concluded that thickened food is only moderately effective in treating …

StreszczenieCel pracyPorównanie skuteczności środków miejscowo znieczulających skórę w redukcji bólu podczas planowanego pobierania krwi u dzieci.Pacjenci i metodyBadaniem objęto 78 pacjentów w wieku 7–14 lat, u których w celach diagnostycznych pobierano krew, a których losowo przydzielono do grupy otrzymującej 2% żel Lignocainum Hydrochloricum U (czas aplikacji preparatu 15 min), 5% krem EMLA (czas aplikacji 60 min) lub placebo (wazelinę białą) (czas aplikacji 30 min). Każda z badanych grup liczyła 26 osób Po pobraniu krwi dzieci dokonywały oceny bólu odczuwanego w trakcie nakłucia na podstawie Obrazowej Skali Oceny Bólu.WynikiStwierdzono znamiennie statystyczną różnicę nasilenia bólu pomiędzy grupą otrzymującą 2% lignokainę a grupą z zastosowaniem placebo (średnia różnica: –1,58 95% CI –2,44 do –0,72) oraz pomiędzy grupą EMLA a grupą placebo (średnia różnica:–1,73 95% CI –2,62 do –0,84), przy braku różnicy pomiędzy grupą EMLA a grupą otrzymującą lignokain® (średnia różnica: –0,15 95% CI –0,78 do 0,48). Istotny klinicznie ból zgłaszało znamiennie więcej dzieci w grupie otrzymującej placebo (12/26), zarówno w porównaniu z pacjentami znieczulanymi 2% lignokainą (1/26) (ryzyko względne [relative risk, RR] 0,08 95%CI 0,01 do 0,06), jak i dzieci otrzymujących krem EMLA (1/26) (RR 0,08 95%CI 0,01 do 0,06).Wnioski2% żel Lignocainum Hydrochloricum U i krem EMLA znamiennie redukują ból podczas pobierania krwi u dzieci w porównaniu z placebo. Skuteczność żelu 2% Lignocainum Hydrochloricum U jest porównywalna z kremem EMLA w zmniejszeniu bólu związanego z pobieraniem krwi.AbstractAimTo compare the effectiveness of local anesthetics: 2% gel Lignocainum Hydrochloricum U, Emla cream and placebo in the reduction of needle related pain in school age children.Pateints and methods78 patients in the age of 7–14y undergoing blood testing were randomly assigned to one of the three groups receiving either 2% gel lignocaiini hydrochloircum or placebo. After venipuncture assessed pain intensity with the use of Faces Pain Scale.ResultsThere has been statistically significant deifference found in the mean pain intensity between 2%lignocaine and placebo (mean difference: –1,58, 95% CI –2,44 to –0,72), EMLA and placebo (mean difference: –1.73, 95%CI: –2.62 to –0.84), with no difference between 2% lignocaini and EMLA (mean difference: –0,15, 95% CI –0,78 to 0,48). Clinically significant pain was reported in higher proportion of patients from placebo group (12/26), than lignocaini group (1/26) (relative risk, [RR]: 0,08, 95%CI 0,01 to 0,06) and EMLA group (1/26) (relative risk, [RR]: 0,08, 95%CI 0,01 to 0,06)Conclusion2% lignocaini hydrochlorici and EMLA showed similar anesthetic effect but significantly better than placebo.