Infant nutrition (donor human milk vs. maternal milk) and long-term neurodevelopmental and growth outcomes in very low birth weight infants.

BACKGROUND: Human milk, the ultimate source of nutrition for premature infants, enhances host defense mechanism, gastrointestinal maturation, lowers infection rate, improves neurodevelopmental outcomes, and reduces long-term cardiovascular and metabolic disease. Recently, there has been an increase in donor breast milk (DBM) use for premature infants; however, data are limited on the long-term effects of DBM on the infant's growth and neurodevelopmental outcomes. OBJECTIVE: To determine if there is an association between type of infant nutrition (maternal breast milk (MBM) or DBM) and neurodevelopmental and growth outcomes in very low birth weight (VLBW) infants. DESIGN/METHODS: Retrospective cohort study of VLBW (<1500 g) infants admitted to the Baylor Scott & White Memorial Hospital Neonatal Intensive Care Unit from January 2014 to December 2016. Infants with major congenital anomalies, born at an outside hospital, who were nil per os (NPO) for >15 days, or who died before NICU discharge were excluded. Infants were stratified into two groups (MBM or DBM) based on predominant nutrition (>50%) received in the first month of life. Primary outcomes of neurodevelopmental delay(s) between 2 and 4 years of age identified via ICD 9/10 codes. Growth data (weight, length, and head circumference) were obtained from well-check visits at 12-, 18-, 24-, 36-, and 48-months. Severity of illness was determined using the Clinical Risk Index in Babies-II (CRIB-II) score. Generalized linear models were used to assess the relationship between nutrition and neurodevelopmental delay and trends in growth over time. RESULTS: Two hundred and nine infants were included: 146 MBM; 63 DBM. Median gestational age was 28 weeks (range, 23-35) and median birthweight was 1050 g (range, 410-1470). There were no significant differences in birthweight, gestational age, CRIB-II score, or length of stay between the groups. Infants fed DBM had a significantly larger weight z-score (p=.005), length z-score (p=.01), and head circumference z-score (p=.04), on average from birth to 48 months compared to MBM infants, while controlling for NICU length of stay and number of follow-up months; however, this only equated to DBM infants being 0.5 in taller and 0.9 lbs heavier at 48 months. There were no statistically significant differences among type of infant nutrition and long-term neurodevelopmental outcomes, while controlling for CRIB-II score. CONCLUSIONS: Infants fed DBM have a slightly greater propensity for growth over time compared to infants fed MBM. Longer follow-up is needed to further determine the effect, infant nutrition has on neurodevelopmental outcomes.

Clinical Presentation and Outcomes of Children With Human Granulocytic Anaplasmosis.

BACKGROUND: Adults with the tick-borne disease human granulocytic anaplasmosis (HGA) have a spectrum of acute febrile illnesses that, if untreated, might be severe. Clinical presentation and outcomes of children with HGA have been poorly described. METHODS: A retrospective analysis was conducted to determine the frequency, presentation, and outcomes of pediatric patients with HGA between 1994 and 2015 in a region of Wisconsin in which HGA is highly endemic. Patients with related International Classification of Diseases Ninth and Tenth Revision (ICD-9 and ICD-10, respectively) codes or positive HGA laboratory test results were evaluated and classified as having had confirmed, probable, or suspected HGA on the basis of the Centers for Disease Control and Prevention (CDC) case definition. The Fisher's exact and Wilcoxon rank-sum tests were used in statistical comparisons. RESULTS: Of 187 children identified with possible HGA, 17 (9%) had confirmed, 75 (40%) had probable, and 91 (49%) had suspected infections. The number of cases rose sharply in 2010 and has remained between 16 and 36 cases per year since that time. A minority of children with confirmed or probable infections had elevated liver transaminase levels (33%), leukopenia (24%), thrombocytopenia (17%), or anemia (8%); 6 (7%) of these children required hospitalization. Children with evidence of concurrent HGA and Lyme disease (27% of confirmed or probable cases) had a higher risk of hospitalization (odds ratio, 6.55 [95% confidence interval, 1.11-38.78]). None of these children had life-threatening disease or died. CONCLUSIONS: Evidence suggests that the frequency of HGA in children is increasing. Although most children had mild disease, doxycycline remains the treatment of choice, because outcome data for children without treatment remains limited.

Bowel Perforation Associated With Infliximab Use in a Pediatrics Patient.

Crohn's disease (CD) is an idiopathic inflammatory disease of the gastrointestinal tract and typically causes inflammation with granuloma formation. Biologic agents like infliximab (IFX) that target tumor necrosis factor alpha (TNF-α), have emerged as important medications for treating refractory CD. With increasing use, there also are reports of rare but potentially fatal complications associated with exposure to TNF-α, such as bowel perforation. We present a case report of spontaneous bowel perforation in a child with Crohn's while on IFX therapy, and a review of the current literature. The purpose of this report is to alert physicians to this rare association, especially in pediatric patients with intestinal strictures.

Successful Treatment of Collagenous Gastritis in a Child With a Gluten-Free Diet.

Collagenous gastritis is a rarely encountered disease entity first described in 1989, and it is very rarely reported in children. We report the case of a 13-year-old boy with clinical, endoscopic, and histological findings of collagenous gastritis who reported rapid and sustained symptom resolution on a gluten-free diet.