Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia.

OBJECTIVES: Aerodigestive disorders encompass various pathological conditions affecting the lungs, upper airway, and gastrointestinal tract in children. While advanced care has primarily occurred in specialty centers, many children first present to general pediatric gastroenterologists with aerodigestive symptoms necessitating awareness of these conditions. At the 2021 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the aerodigestive Special Interest Group held a full-day symposium entitled, Pediatric Aerodigestive Medicine: Advancing Collaborative Care of Children with Aerodigestive Disorders. The symposium aimed to underline the significance of a multidisciplinary approach to achieve better outcomes for these complex patients. METHODS: The symposium brought together leading experts to highlight the growing aerodigestive field, promote new scientific and therapeutic strategies, share the structure and benefits of a multidisciplinary approach in diagnosing common and rare aerodigestive disorders, and foster multidisciplinary discussion of complex cases while highlighting the range of therapeutic and diagnostic options. In this article, we showcase the diagnostic and therapeutic approach to oropharyngeal dysphagia (OPD), one of the most common aerodigestive conditions, emphasizing the role of a collaborative model. CONCLUSIONS: The aerodigestive field has made significant progress and continues to grow due to a unique multidisciplinary, collaborative model of care for these conditions. Despite diagnostic and therapeutic challenges, the multidisciplinary approach has enabled and greatly improved efficient, high-quality, and evidence-based care for patients, including those with OPD.

Amniotic fluid minerals, trace elements, and prenatal supplement use in humans emerge as determinants of fetal growth.

Amniotic fluid (AF), which is swallowed by the developing fetus, contains minerals and trace elements, but their association with fetal growth has not been explored. Our objectives were to assess (1) whether concentrations of AF minerals and trace elements were associated with changes in 5 fetal ultrasound measurements (estimated weight, bi-parietal diameter, head circumference, abdominal circumference, femur length) between 16-20 and 32-36 wks gestation and (2) whether a prenatal supplement was associated with concentrations of AF minerals and trace elements or the 5 fetal ultrasound measurements. We measured, using inductively coupled plasma-mass spectrometry (ICP-MS), 15 minerals and trace elements (aluminum, arsenic, calcium, chromium, copper, iron, lead, magnesium, nickel, potassium, rubidium, selenium, silver strontium, zinc) in amniotic fluid collected from 176 pregnant women undergoing age-related amniocentesis for genetic testing (15.7 ±â€¯1.1 wks). AF mineral concentrations, prenatal supplement use, and determinants of ultrasound measurements during early and late pregnancy were used in models to assess their impact on change in fetal ultrasound measurements. Positive associations were identified for change in bi-parietal diameter with AF calcium, for change in head circumference with AF copper and nickel, and for change in femur length with AF selenium. Arsenic was negatively associated with estimated fetal weight, and this relationship was modified by prenatal supplement use. Additionally, AF chromium concentrations were lower in women taking prenatal supplements. In conclusion, AF minerals were associated with fetal ultrasound indices, supporting a biological role for calcium, copper, nickel and selenium in promoting in-utero fetal growth. Evidence of a mineral-vitamin interaction between arsenic and folic acid in prenatal supplements and mineral-mineral interaction between iron and chromium would suggest that attention be paid to mineral and trace element formulation of prenatal supplements.