Spanish National Registry of Paediatric Coeliac Disease: Changes in the Clinical Presentation in the 21st Century.

OBJECTIVES: Over the last several decades, there has been a tendency towards a predominance of less symptomatic forms of coeliac disease (CD) and an increase in the patient age at diagnosis. This study aimed to assess the clinical presentation and diagnostic process of paediatric CD in Spain. METHODS: A nationwide prospective, observational, multicentre registry of new paediatric CD cases was conducted from January 2011 to June 2017. The data regarding demographic variables, type of birth, breast-feeding history, family history of CD, symptoms, height and weight, associated conditions, serological markers, human leukocyte antigen (HLA) phenotype, and histopathological findings were collected. RESULTS: In total, 4838 cases (61% girls) from 73 centres were registered. The median age at diagnosis was 4 years. Gastrointestinal symptoms were detected in 71.4% of the patients, and diarrhoea was the most frequent symptom (45.9%). The most common clinical presentation was the classical form (65.1%) whereas 9.8% ofthe patients were asymptomatic. There was a trend towards an increase in the age at diagnosis, proportion of asymptomatic CD cases, and usage of anti-deamidated gliadin peptide antibodies and HLA typing for CD diagnosis. There was, however, a decreasing trend in the proportion of patients undergoing biopsies. Some of these significant trend changes may reflect the effects of the 2012 ESPGHAN diagnosis guidelines. CONCLUSIONS: Paediatric CD in Spain is evolving in the same direction as in the rest of Europe, although classical CD remains the most common presentation form, and the age at diagnosis remains relatively low.

Spanish Pediatric Inflammatory Bowel Disease Diagnostic Delay Registry: SPIDER Study From Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica.

Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory bowel disease, leading to potential complications. We examined the intervals and factors for DD in the pediatric population of Spain. Methods: We conducted a multicentric prospective study, including 149 pediatric inflammatory bowel disease patients, obtaining clinical, anthropometric, and biochemical data. Time to diagnosis (TD) was divided into several intervals to identify those where the DD was longer and find the variables that prolonged those intervals. Missed opportunities for diagnosis (MODs) were also identified. Results: Overall TD was 4.4 months (interquartile range [IQR] 2.6-10.4), being significantly higher in Crohn's disease (CD) than in ulcerative colitis (UC) (6.3 [IQR 3.3-12.3] vs. 3 [IQR 1.6-5.6] months, p = 0.0001). Time from the visit to the first physician until referral to a pediatric gastroenterologist was the main contributor to TD (2.4 months [IQR 1.03-7.17] in CD vs. 0.83 months [IQR 0.30-2.50] in UC, p = 0.0001). One hundred and ten patients (78.3%) visited more than one physician (29.9% to 4 or more), and 16.3% visited the same physician more than six times before being assessed by the pediatric gastroenterologist. The number of MODs was significantly higher in CD than that in UC patients: 4 MODs (IQR 2-7) vs. 2 MODs ([IQR 1-5], p = 0.003). Referral by pediatricians from hospital care allowed earlier IBD diagnosis (odds ratio 3.2 [95% confidence interval 1.1-8.9], p = 0.025). Conclusions: TD and DD were significantly higher in CD than those in UC. IBD patients (especially those with CD) undergo a large number of medical visits until the final diagnosis.

[Which variables influence compliance with physical activity recommendations in young children?] / ¿Qué variables influyen en el cumplimiento de las recomendaciones de actividad física en preescolares?

INTRODUCTION: There are established European guidelines for physical activity in childhood. The main goal of our study was to determine the factors that may influence compliance with European recommendations for physical activity in young children. METHODS: We included 136 children (aged 2-8 years) classified by weight status, calculated based on the body mass index z-score using the growth standards of the World Health Organization. We measured physical activity over 5 consecutive days with accelerometers and recorded the food intake. RESULTS: A greater level of physical activity was associated with a lower weight status category (B=-1.55; 95% CI: -2.02 to -1.08; P<.001), lower age (B=-1.33; 95% CI: -1.72 to -0.93; P<.001) and greater energy expenditure (B=0.02; 95% CI: 0.02 to 0.03; P<.001). The overall physical activity in the sample was light (mean=589 cpm/day). Children with overweight and obesity spent less time engaged in moderate to vigorous physical activity (P=.005) and more time engaged in sedentary activities (P=.005) compared to children with normal weight. All groups spent between 90 and 130minutes a day in sedentary activities, with a mean time spent that amounted to 15.5% of their time (excluding time spent sleeping). The adherence to European recommendations varied in association with sex (P=.010) and weight status (P=.038). CONCLUSION: Young children spent more than 100minutes a day engaged in sedentary activities. Most of the sample met the European recommendations for daily moderate to vigorous physical activity. However, the degree of adherence depended on sex and weight status.

Zinc concentration in preterm newborns at term age, a prospective observational study.

OBJECTIVES: To determine zinc concentrations and associated factors in a population of preterm newborns at term age. DESIGN: This analytical, descriptive, observational and prospective study was conducted in the neonatal unit of a tertiary hospital. Preterm newborn between gestational weeks 24 and 34 were included in the study. The patients were recruited close to the date of birth. Their clinical histories were collected, and the serum zinc concentrations (SZCs) at gestational weeks 37-41 were measured. This study aimed to measure SZC in a population of preterm newborns at term age, and analyse the anthropometric, clinical and nutritional parameters associated with a decrease in SZC. RESULTS: Overall, 83 preterm subjects were evaluated, including 44 (53%) female infants and 39 (47%) male infants. The median period of gestation was 31 (IQ25-IQ75: 29-33) weeks, and the mean weight at birth was 1.523±0.535 kg. The median SZC at term was 4.4 (IQ25-IQ75: 2.6-6.9) µmol/L. There were some variables associated with zinc concentrations like bronchopulmonary dysplasia (BPD), weight at birth, z-score of length at discharge, being small for gestational age and treatment with recombinant human erythropoietin, although the unique variable that was independent of the other variables in the multivariate analysis (p 0.01) was BPD. Preterm newborn with BPD had lower SZC at term age than those without (2.7 vs 4.9 µmol/L, p 0.005). CONCLUSIONS: Zinc concentrations in this preterm population were low. BPD was significantly and negatively correlated with zinc concentrations. CLINICAL TRIAL REGISTRATION: NCT03532555.

Effects of Watching Cartoons During an Echocardiography on Infants and Preschool Children. A Prospective Randomized Study.

Echocardiography is currently the main diagnostic technique in pediatric cardiology, but sometimes it is difficult to use in very young children, as a complete and accurate study depends on the patient's and family's cooperation. Children's behavior is one of the main problems for this procedure, and interventions like sedative medication have been used to facilitate its performance. The aim of this study was to analyze the effects of TV entertainment in infants and preschool children during echocardiography. We designed an experimental study in children with a heart murmur. An examination room was prepared with a TV on the ceiling, giving the children an unobstructed view during the echocardiography procedure. Fifty-eight patients were randomized into two groups: TV intervention vs. usual care (consisting of other distraction measures). The primary outcome was echocardiography time, but we also assessed blood pressure, quality of technique, child behavior, and parents' stress level. The TV group showed a statistically significant reduction in duration of the echocardiography and systolic and diastolic blood pressure, as well as better quality of technique and child behavior. Consequently, we recommend the use of a TV as a simple and useful distraction method for improving echocardiography in young children.

Physical activity values in two- to seven-year-old children measured by accelerometer over five consecutive 24-hour days.

INTRODUCTION: interpretation of accelerometer-derived physical activity in preschool children is confounded by differences in cut-off points. AIM: the purpose of this study was to analyze physical activity in 2-to-7-year-old children to establish reference values for daily activity. METHODS: observational study in children aged 2-7 years, without chronic diseases and whose parents provided informed consent. The main variable was physical activity, measured continuously over 120 hours (three workdays and two weekend days) by accelerometer. Secondary variables were weight status (body mass index [BMI] Z-score) and gender. The relationship between the main variable and secondary variables was determined through the t-test, ANOVA and the Pearson correlation coefficient. A multivariate model was used to obtain the standard deviation (SD) of all possible combinations of values, constructing percentiles of normality (x ± SD and x ± 2·SD). RESULTS: one hundred and thirty-six children (35% of municipality children) were included in the study (54.4% of them were girls). Their weight status distribution was: 25 underweight (18.4%), 54 normal weight (39.7%), 12 risk of overweight (8.8%), 22 overweight (16.2%) and 23 obese (16.8%). The median age was 5.7 years and the mean physical activity was 592 counts/minute. The boys undertook more physical activity (p = 0.031) and the underweight and normal-weight children undertook more physical activity than the overweight and obese children (p = 0.012). There were no significant differences according to age. The multivariate analysis showed significant differences (p < 0.001) according to gender and weight status. In boys, physical activity decreased as weight status increased. In contrast, the girls in the extreme BMI groups obtained higher levels of physical activity. CONCLUSION: overweight and obese preschool children had lower levels of physical activity than normal weight children. Physical activity levels were higher in boys.

Enfermedad de Hashimoto en una cohorte de 29 niños y adolescentes: Epidemiología, evolución y comorbilidad a corto y largo plazo / Hashimoto's disease in a cohort of 29 children and adolescents: Epidemiology, clinical course, and comorbidities in the short and long term

La tiroiditis de Hashimoto es la causa más común de bocio e hipotiroidismo en niños y adolescentes. Las manifestaciones clínicas y la evolución son variables. El objetivo de este trabajo es revisar las particularidades clínicas y evolutivas de la enfermedad de Hashimoto en población pediátrica. Se analizaron datos clínicos, analíticos, ecográficos, epidemiológicos y evolutivos de los pacientes con tiroiditis autoinmune del Hospital Universitario San Juan de Alicante desde enero de 2010 hasta enero de 2016. En el estudio, se incluyeron un total de 29 pacientes. Se observó una mayor prevalencia en niñas con una relación 2:1. El principal motivo de consulta fue la detección casual de una hormona estimulante de la tiroides elevada o de positividad de anticuerpos antitiroideos en una analítica por otro motivo. En la analítica inicial, el 53,3% de los pacientes presentaba hipotiroidismo subclínico y tan solo el 10% de ellos, hipotiroidismo franco. Dos de los pacientes desarrollaron cáncer de tiroides.

Hashimoto's thyroiditis is the most common cause of goiter and hypothyroidism among children and adolescents. Its clinical manifestations and course vary. The objective of this study was to review the clinical and evolutionary characteristics of Hashimoto's disease in the pediatric population. Clinical, analytical, ultrasound, epidemiological, and evolutionary data of patients with autoimmune thyroiditis seen at Hospital Universitario San Juan de Alicante between January 2010 and January 2016 were analyzed. A total of 29 patients were included in the study. A higher prevalence of girls was observed, at a 2:1 ratio. The main reason for consultation was the accidental detection of high thyroid stimulating hormone levels or positive anti-thyroid antibodies in a lab test done for other reason. In the initial analysis, 53.3% of patients had subclinical hypothyroidism and only 10% of them had frank hypothyroidism. Two patients developed thyroid cancer.

Hashimoto's disease in a cohort of 29 children and adolescents. Epidemiology, clinical course, and comorbidities in the short and long term. / Enfermedad de Hashimoto en una cohorte de 29 niños y adolescentes. Epidemiología, evolución y comorbilidad a corto y largo plazo.

Hashimoto's thyroiditis is the most common cause of goiter and hypothyroidism among children and adolescents. Its clinical manifestations and course vary. The objective of this study was to review the clinical and evolutionary characteristics of Hashimoto's disease in the pediatric population. Clinical, analytical, ultrasound, epidemiological, and evolutionary data of patients with autoimmune thyroiditis seen at Hospital Universitario San Juan de Alicante between January 2010 and January 2016 were analyzed. A total of 29 patients were included in the study. A higher prevalence of girls was observed, at a 2:1 ratio. The main reason for consultation was the accidental detection of high thyroid stimulating hormone levels or positive anti-thyroid antibodies in a lab test done for other reason. In the initial analysis, 53.3% of patients had subclinical hypothyroidism and only 10% of them had frank hypothyroidism. Two patients developed thyroid cancer.

La tiroiditis de Hashimoto es la causa más común de bocio e hipotiroidismo en niños y adolescentes. Las manifestaciones clínicas y la evolución son variables. El objetivo de este trabajo es revisar las particularidades clínicas y evolutivas de la enfermedad de Hashimoto en población pediátrica. Se analizaron datos clínicos, analíticos, ecográficos, epidemiológicos y evolutivos de los pacientes con tiroiditis autoinmune del Hospital Universitario San Juan de Alicante desde enero de 2010 hasta enero de 2016. En el estudio, se incluyeron un total de 29 pacientes. Se observó una mayor prevalencia en niñas con una relación 2:1. El principal motivo de consulta fue la detección casual de una hormona estimulante de la tiroides elevada o de positividad de anticuerpos antitiroideos en una analítica por otro motivo. En la analítica inicial, el 53,3% de los pacientes presentaba hipotiroidismo subclínico y tan solo el 10% de ellos, hipotiroidismo franco. Dos de los pacientes desarrollaron cáncer de tiroides.

Estimation of body fat among 2-to-7-year-old Spanish children by different skinfolds equations and waist-to-height ratio.

INTRODUCTION: It seems relevant to analyze the body composition in the early childhood. However, there is not an agreement in the protocol to assess body composition in this age range/group. OBJECTIVE: To determine the most useful equation to estimate the body fat percentage that preschool children contain and the utility of the waist-to-height ratio to determine abdominal obesity. METHODS: We measured (weight, height, waist circumference and skinfolds) in 285 children aged 2 to 7 years old. BMI Z-Score, waist-to-height ratio and body fat percentage were estimated by Brook and Lukaski, Siri, Goran, Slaughter, Deurenberg, Huang, Dezenberg and Hoffman equations. RESULTS: It was found 26% combined overweight and obesity, with similar distribution in both sexes. The body fat obtained with the Hoffman equation (15.6-31.9%) showed the highest correlation with children BMI Z-Score. Waist-to-height ratio also presented a good relationship with children weight status. There were not significant differences between gender and body fat percentage or waist-to-height ratio. CONCLUSIONS: Hoffman equation and waist-to-height ratio could be adequate to estimate body fat percentage and abdominal obesity respectively in Spanish preschool children from medium-low socioeconomic status.

Multivariate Analysis of Thyrotropin in Preterm Newborns Based on Adequacy of Weight for Gestational Age.

BACKGROUND: Different and conflicting data have been published concerning thyrotropin (TSH) levels among small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. The hypothesis of this study was that SGA preterm infants have higher TSH levels than those who are not underweight do. METHODS: This cross-sectional study analyzed the TSH levels of all preterm newborns with a negative congenital hypothyroidism screening result (TSH <7.5 µIU/mL). Secondary variables were sex, birth weight (SGA, AGA), days of life at blood extraction, maternal origin, gestational age, and being a twin or not. Two multiple linear regression models were constructed comparing TSH levels in SGA and AGA or the z-score for birth weight and the remaining variables. RESULTS: A sample including 5819 preterm infants was obtained: 53.8% male, 23.3% twins, and 3.3% SGA. TSH concentrations were 2.16 ± 2.0 µIU/mL for the SGA infants and 1.80 ± 1.5 µIU/mL for the AGA infants (p = 0.012), with a negative correlation (p < 0.001) between TSH levels and the z-score for the weight of the newborn. The multivariate analysis comparing TSH levels between SGA and AGA gave the following: SGA (B = 0.46, p < 0.001), Latin American mother (B = -0.16, p = 0.029), days of life at blood extraction (B = -0.26, p < 0.001), and gestational age ≤28 weeks (B = -0.56, p < 0.001). Using the z-score for the weight, the associations were: maternal origin North Africa (B = 0.19, p = 0.042), days of life at blood extraction (B = -0.27, p < 0.001), gestational age ≤28 weeks (B = -0.55, p < 0.001), and z-score for weight (B = -0.12, p < 0.001). CONCLUSIONS: Our multivariate analysis suggests that TSH concentrations are higher in SGA infants than they are in AGA infants, and this should be taken into account when establishing a reference interval appropriate for this population. The clinical relevance remains unknown, but lines of research are opened that may allow a better understanding of the long-term morbidities in these newborns.

Highest Plasma Phenylalanine Levels in (Very) Premature Infants on Intravenous Feeding; A Need for Concern.

OBJECTIVE: To analyse the association in newborns between blood levels of phenylalanine and feeding method and gestational age. STUDY DESIGN: This observational, cross-sectional study included a sample of 11,829 infants between 2008 and 2013 in a Spanish region. Data were recorded on phenylalanine values, feeding method [breast, formula, mixed (breast plus formula), or partial or fully intravenous feeding], gestational age in weeks (<32, 32-37, ≥37), gender and days since birth at the moment of blood collection. Outcomes were [phenylalanine] and [phenylalanine] ≥95th percentile. Associations were analysed using multivariate models [linear (means difference) and logistic regression (adjusted odds ratios)]. RESULTS: Higher phenylalanine values were associated with lower gestational age (p<0.001) and with intravenous feeding (p<0.001). CONCLUSION: The degree of prematurity and intravenous feeding influenced the plasma concentration of phenylalanine in the newborn. Caution should be taken in [phenylalanine] for newborns with intravenous feeding, monitoring them carefully. Very preterm infants given the recommended amount of amino acids should also be strictly monitored. These findings should be taken into consideration and call for adapting the amounts to the needs of the infant.

Motilidad esofágica en niños con reflujo gastroesofágico: gammagrafía de tránsito con bolo líquido y semisólido / Esophageal motility in patients with gastroesophageal reflux liquid and semisolid transit scintigraphy

Para valorar la presencia de trastornos de la motilidad esofágica en niños con reflujo gastroesofágico (RGE), y determinar su reversibilidad con tratamiento médico, hemos empleado la gammagrafía de tránsito esofágico (GTE) con bolos líquido y semisólido, calculando el tiempo de tránsito esofágico (TTE). Se estudiaron 41 pacientes (32 líquido y 26 semisólido). Resultados: El TTE con líquido no fue diferente del grupo control (14.9 +/- 19.6 vs 8.7 +/- 2.2 sec). Sin embargo, el TTE con bolo semisólido fue significativamente mayor en pacientes que en controles (37.2 +/- 36.2 vs 9.9 +/- 3.3 sec; p < 0.001). Tras 6 meses de tratamiento el TTE líquido no cambió, mientras que con semisólido disminuyó significativamente (p<0.005). Conclusión: Estos datos apoyan que los leves trastornos motores detectados en niños con RGE son secundarios y parcialmente reversibles con tratamiento adecuado, y sólo pueden ser detectados por técnicas sensibles como la GTE con bolo semisólido.

To detect oesophageal motility disorders in children with gastroesophageal reflux (GER), and to determine their reversibility with medical treatment, we employed the esophageal transit scintigraphy (ETS) with liquid and semisolid boluses, calculating the global “transit time” (TT). 41 patients underwent an ETS (32 liquid and 26 semisolid). Results: The esophageal TT in liquid studies was not different from that obtained in the control group (14.9 +/- 19.6 vs 8.7 +/- 2.2 sec). Semisolid TT was significantly higher in patients than in controls (37.2 +/- 36.2 vs 9.9 +/- 3.3 sec; p < 0.001). After 6 months of treatment semisolid TT significantly decreased (p < 0.005), whereas no changes were observed with the liquid technique. Conclusion: These data support that the mild esophageal motor disturbances seen in children with GER are secondary and partially reversible with treatment, and can only be detected by sensitive techniques such as ETS with semisolid bolus.