Differences in growth patterns and catch up growth of small for gestational age preterm infants fed on fortified mother's own milk versus preterm formula.

Small for gestational age (SGA) is typically defined as birthweight < 10th percentile for age. Limited data are available regarding the growth of SGA preterm infants in relation to feeding type. We aimed to study SGA preterm infants fed fortified mother's own milk (MOM) or preterm formula (PF) on growth patterns and catch-up growth at discharge and two-years corrected age (CA). Our retrospective cohort study included data from medical records and follow-up questionnaires about SGA preterm infants born at <37 weeks fed on MOM (n=40) and PF (n=40). Weight, length/height and head circumference (HC) were collected at birth, discharge and at two years CA, and Δ z-scores were calculated.The MOM group had significantly larger negative change in weight and length z-scores between birth and discharge, and smaller positive change in HC z-score (-0.47 (±0.41) v. -0.25 (±0.36), P= 0.01; -0.63 (±0.75) v. -0.27 (±0.75), P= 0.03; 0.13 (±0.67) v. 0.41 (±0.55), P= 0.04, respectively). Almost half the MOM fed infants experienced poor length growth by discharge compared to 22% of PF fed infants (P=0.03). By two years CA, both groups had similar positive change in weight and HC z-scores, but MOM fed infants had a slower increase in height z-score (0.64 (±1.30) v. 1.33 (±1.33), P=0.02), and only 40% had achieved catch-up height compared with 68% of the PF group (P=0.02).Our study indicates that fortified MOM fed SGA preterm infants may need extra nutritional support in the first two years of life to achieve height growth potential.

Adherence to gluten-free diet and follow-up of pediatric celiac disease patients, during childhood and after transition to adult care.

Long-term data on pediatric celiac disease (CD) patients after transition to adult care is scarce. We aimed to evaluate patients' adherence to a gluten-free diet (GFD), the normalization of celiac serology and the frequency of follow-up before age 18, and to study changes in adherence and follow-up frequency after transition to adult care. Presenting symptoms, serology and biopsy results, patients' reported GFD adherence, frequency of follow-up visits, and complications before and after 18 years were collected for CD patients diagnosed between 1998 and 2017. Of 441 CD patients diagnosed and followed in childhood, a quarter (108/441) were over 18 y (years) at data collection. Median age at diagnosis 7.1 y (9 months-18 y), at data collection 23 y (18-38 y), disease duration 11.3 y (2-36 y). Below the age of 18 y, most patients 386/436 (88.5%) reported adherence to GFD, and most 372/425 (85.7%) normalized serology. Of the 441 patients, only 3 failed to attend any follow-up visit, and 338/441 (76.6%) attended yearly visits. Over the age 18 y, serology testing was done in 78/108 (72.2%), every 1-3 y in 46/78 (59%). Serology normalized in 61/78 (78.2%). Most adult patients 77/108 (71.5%) never attended a gastroenterology clinic. CD-related complications were rare. Younger age at diagnosis, regular follow-up visits in childhood, resolution of symptoms, and normalization of serology before age 18 were identified as predictors of negative serology after the age of 18 y.Conclusions: Children who have regular follow-up and normalize serology before age 18 years are likely to maintain a GFD and have negative serology as adults. What is Known: • The rate of adherence to gluten-free diet (GFD) is higher among children compared to adults. • Data on long-term follow-up after transition to adult care is scarce. What is New: • Patients diagnosed with CD at a younger age (<12 y), who have yearly follow-up visits, resolution of symptoms, and negative serology in childhood are very likely to maintain GFD and have negative serology as adults. • Even though most patients do not attend GI clinics after transition to adulthood, most adhere to GFD, and complications are rare.

Lack of association between Helicobacter pylori infection and childhood overweight/obesity.

BACKGROUND: The reduction in the prevalence of Helicobacter pylori (H. pylori) infection in developed countries coincides with the increasing incidence of obesity and might be a contributing factor to the obesity epidemic. We aimed to evaluate the association between H. pylori infection and childhood overweight/ obesity in Israeli children. MATERIAL AND METHODS: Patients diagnosed with H. pylori infection by endoscopy, histology, and a positive culture, between January 2013 and August 2018, were identified and compared with H. pylori-negative children, of the same age and gender, undergoing endoscopy for the same indications during the same time period. Data collected included the following: age, gender, height, weight, BMI, BMI percentile, and the indication for endoscopy. Patients with missing anthropometric data or having a disease affecting growth were excluded. RESULTS: We included 146 H. pylori-positive children and 146 age- and gender-matched H. pylori-negative patients. 63.7% (186/292) were female, mean age 13.1 ± 3.7. Overweight (BMI between the 85th-95th percentile) and obesity (BMI > 95th percentile) were present in 56/292 (19.2%). Among the H. pylori-positive children, 11.6% were overweight, 7.5% obese, among the H. pylori-negative children, 10.3% were overweight, 8.9% obese, demonstrating no differences between the groups. The main indication for endoscopy was abdominal/ epigastric pain in 79.8% (233/292). The percent of children with a BMI ≥ 85% did not differ by gender age or the indication for endoscopy. CONCLUSIONS: No association between H. pylori infection and childhood overweight/ obesity was demonstrated. This is in contrasts with previous pediatric studies demonstrating an inverse correlation.

Reassessing vitamin D supplementation in preterm infants: a prospective study and review of the literature.

Objectives Recommendations for vitamin D (VitD) intake and target serum levels of 25(OH)D in preterm infants are diverse. We hypothesized that preterm infants with low birth weight (BW) have low dietary intake of VitD and therefore should be supplemented with higher amounts of VitD. Methods Infants with BW < 2 kg were supplemented with 600 units of VitD a day during the first 2-6 weeks of life, whereas infants with BW>2 kg continued with the routine supplementation of 400 units of VitD daily. Serum levels of 25(OH)D, calcium, phosphorous, alkaline phosphatase (AP) and parathyroid hormone (PTH) were assessed 24 h after birth and before discharge. The total daily intake of vitD was calculated in each infant. Results Sixty-two infants were enrolled, 49 with BW < 2 kg. After birth, only 24% had sufficient levels of 25(OH)D, whereas before discharge 45 of 54 infants (83%) available for analysis reached sufficient levels of 25(OH)D. All 54 infants demonstrated significant elevation in serum levels of calcium, phosphorous, AP and significant reduction in PTH levels. The total daily intake of VitD was lower than recommended (800-1000 IU/d) in 16 of 45 infants with BW < 2 kg (36%) and in all nine infants with BW>2 kg. Nevertheless, only 2 of 25 infants with insufficient intake of VitD demonstrated insufficient levels of serum 25(OH)D. No case of vitamin D excess was recorded. Conclusions Increased supplementation of VitD (600 IU/d) for premature newborns with BW < 2 kg is effective in increasing both total daily intake of VitD and serum levels of 25(OH)D.

Early, rapidly progressive enteral nutrition promotes growth of very low birth weight (VLBW) infants.

AIM: This study describes the effects of a quality improvement program to promote improved postnatal nutrition on the growth of very low birth weight (VLBW) infants. METHODS: Daily data regarding nutrition and growth were collected from the medical record of VLBW infants born during 1995-2010. The infants were grouped by year of birth in order to compare infants from before, during and after the policy change. Evaluation of growth included age in days at a return to birth weight and the proportion of infants with weight below the 10th percentile at discharge. RESULTS: The caloric and protein intake improved significantly. The age at a return to birth weight fell (p < 0.01) from 14.6 ± 5 d to 11 ± 8 d after the change. The proportion of infants with a discharge weight below the 10th percentile for corrected age fell (p < 0.01) from 72.1% to 42.1%. Data on enteral feeding showed that increased rate of enteral feeds (EF) was associated with better growth (p < 0.001). CONCLUSION: Increasing awareness led to increase in caloric and protein intake in VLBW infants. Aggressive EF was associated with more rapid weight gain. However, the provision of protein and calories during the first 2 weeks of life still falls short of the latest European Society of Pediatric Gastroenterology, Hepatology and Nutrition recommendations.