Very Early Onset Inflammatory Bowel Disease: Diagnostic and Therapeutic Challenges for Pediatric Gastroenterologists.

Very early onset inflammatory bowel disease (VEO-IBD) is called when age of onset of IBD occurs below 6 years. Though it is rare, it has been increasing over last decade with decreasing age of onset. VEO-IBD is different compared with pediatric and adult-onset IBD in many aspects, including the disease type, location of the lesion, disease behavior and genetic susceptibility. These children with VEO-IBD are usually present with more severe disease than older children and adults. VEO-IBD is associated with monogenic defect. The thought of a monogenic cause of VEO-IBD was first confirmed by the detection of mutations of interleukin 10 (IL-10) receptor genes that cause impaired IL-10 signaling. Monogenic IBD possesses significant concern because it usually presents with refractory to conventional IBD treatment or fistulous Crohn's disease, so early treatment with biologics or an alternative approach such as hematopoietic stem cell transplantation (HSCT) might be looked-for. Before establishing IBD, we must think of more common diseases of this age group. Infection and Cow's milk protein allergy (CMPA) are two common conditions and it can cause severe colitis. Confirmation of chronic intestinal inflammation by endoscopies is of greatest significance for the diagnosis of IBD. There should be no age limit for performing endoscopies. Severe disease should be treated with biologic agents and surgery. Identification of genes associated with IBD leads to better understanding of its pathogenesis, which could help to provide more targeted interventions. We discuss the topic here to create awareness among Pediatricians so that the patients can be benefited.

Comparison of Growth of School Children in Mymensingh City Area, Bangladesh Using the 2000 CDC Standards and 2007 WHO Standards.

Growth assessment is an essential component of child health surveillance. The most influential tool in the growth assessment is the growth chart. Growth parameters of children are usually interpreted in relation to international standards like the NCHS/1977, CDC/2000 and WHO/2007 growth charts. This comparative study was carried out in the Department of Paediatrics, Mymensingh Medical College, Mymensingh, Bangladesh from November 2014 to October 2015 to compare the growth parameters of children using 2000 CDC standards and 2007 WHO standards. A total of five hundred healthy school children, aged 6 to 10 years were randomly selected proportionately from each class of five government primary schools from Mymensingh city area. Children with physical deformities and acutely ill and those with chronic debilitating diseases were excluded from the study. The mean and median weight, height and BMI were calculated for each age and sex. The median weight, height and BMI were then standardized by converting them to Z-scores (SD) for comparing against known reference values of 2000 CDC and 2007 WHO charts. Among 500 children, 252(50.4%) were boys and 248(49.6%) were girls. The mean age was found 8.0±1.42 years in boys and 8.04±1.42 years in girls. The mean weight was found 24.4±6.36kg in boys and 24.08±6.35kg in girls. The mean height was 125.90±10.16cm in boys and 125.38±10.74cm in girls. The mean weight, height and BMI of boys and girls were found to be lower in all age groups with compared to 2000 CDC standard and 2007 WHO standard but were closer to the WHO standards compared to the CDC standards. According to CDC and WHO in the study it was observed that underweight was found 16.3% and 14.7%, stunting 7.1% and 6.7%, overweight 6.7% and 8.7%, and obese 2.8% and 4.0% respectively in male subjects. On the other hand, in female subjects it was observed that according to CDC chart and WHO chart underweight was found 19.4% and 13.3%, stunting 6.0% and 4.8%, overweight 7.3% and 8.1% and obese 2.0% and 2.0% respectively. The findings in this study imply that growth pattern of Bangladeshi school children is closer with WHO standards and wider from CDC standards.