Functional gastrointestinal disorders, quality of life, and behaviour in adolescents with history of infant colic.

AIM: To assess the prevalence of functional gastrointestinal disorders (FGIDs), health-related quality of life (HRQOL), and behavioural problems in a cohort of adolescents with a history of infant colic (IC), as defined by Wessel's criteria. METHODS: 388 adolescents, aged 15-18 years, who participated in a randomised controlled trial for infants with colic, were invited for our observational follow-up study. Prevalence of FGIDs was assessed with the Rome IV Questionnaire on Paediatric Gastrointestinal Disorders (RIV-QPGD), HRQOL through self-report of the Paediatric Quality of Life Inventory (PedsQL), and behavioural problems through parent-report of the child behaviour checklist (CBCL). Multivariable models were used to compare prevalence rates of FGIDs and HRQOL scores. RESULTS: 190 (49%) adolescents with a history of IC (cases) and 381 controls were included (median age 17.0 [IQR 16.0-17.0] and 16.0 [15.0-17.0] years, respectively). Cases had a significantly higher risk for postprandial distress syndrome compared to controls (aOR 2.49 (95%CI 1.18-5.25), p = 0.002). After multivariable regression, total, physical and school HRQOL scores were significantly lower in cases compared to controls (p = 0.003, 0.001, and 0.009). CONCLUSION: Adolescents with a history of IC demonstrate higher prevalence rates of postprandial distress syndrome compared to controls. However, conclusions should be made with caution due to attrition and information bias.

Infantile colic.

Infant colic is characterized by excessive and often inconsolable crying in an otherwise healthy and well-fed infant. Infant crying follows a developmental pattern, starting to increase around 2 weeks of age (corrected for gestational age at birth), peaking at 5 to 6 weeks, and trailing down by about 12 weeks. There is also a circadian component in that infants cry more in the evening than at other times. Infant colic can be thought of as an amplified version of the maturational, circadian-influenced behavior of infant crying. There is substantial evidence for an association between infant colic and migraine. Children with migraine are more likely to have been colicky as infants, and in a prospective, population-based study, young adults with migraine without aura were more than twice as likely to have been colicky as infants. Mothers with migraine are more likely to have infants with colic, particularly those mothers with higher headache frequency. Clinicians should be aware of these associations in order to be able to counsel appropriately pregnant women with migraine about the possibility of having an infant with colic (and its time-limited nature), and to help make an accurate diagnosis of migraine in children and adolescents presenting with recurrent headaches.

A cross-sectional study of colic and rate of return to racing in Thoroughbreds at Seoul Racecourse in Korea between 2010 and 2020.

BACKGROUND: The incidence of colic and the outcomes of colic surgery have not been surveyed in racetracks in Korea. OBJECTIVES: This study examined the incidence, mortality, and case fatality of colic and investigated the effects of age and sex after an exploratory celiotomy on the long-term survival rate (return to racing), subsequent racing performance, and career longevity. METHODS: The incidence, mortality, and case fatalities of colic were examined over an 11-year period. The records of 40 horses that had undergone a celiotomy, after participating in at least one race and 75 race-matched control horses were analyzed. The racing performance and career length of the horses that returned to racing post-surgery were compared with a control group. RESULTS: The annual incidence, fatality rate of colic, and annual mortality rate at Seoul Racecourse were 6.5, 2.8 per 100 horse-years, and 0.2 deaths cases per 100 horse-years, respectively. Of the 40 horses that underwent colic surgery, 26 (65%) returned to racing. The likelihood of returning to racing decreased with increasing age of the horses, and geldings had a lower probability of returning. While the performance in the five preoperative races between the two groups was not significantly different, a significant decrease in racing performance was observed after the surgery date (p < 0.01). Horses that underwent colic surgery did not show a significant decrease in career length. CONCLUSIONS: Surgical treatment for colic at the age of three and four years had a negative impact on the racing performance. On the other hand, there was no significant difference in career longevity between the two groups.

Persistent and new-onset symptoms after cholecystectomy in patients with uncomplicated symptomatic cholecystolithiasis: A post hoc analysis of 2 prospective clinical trials.

BACKGROUND: Laparoscopic cholecystectomy is the gold standard for treating biliary colic in patients with gallstones, but post-cholecystectomy abdominal pain is commonly reported. This study investigates which symptoms are likely to persist and which may develop after a cholecystectomy. METHODS: Patients from 2 previous prospective trials who underwent laparoscopic cholecystectomy for symptomatic cholecystolithiasis were included. Patients completed questionnaires on pain and gastrointestinal symptoms before surgery and at 6 months follow-up. The prevalence of persistent and new-onset abdominal symptoms was evaluated. RESULTS: A total of 820 patients received cholecystectomy and were included, 75.4% female (n = 616/820) mean age 49.4 years (standard deviation 13.7). At baseline, 74.1% (n = 608/820) of patients met all criteria for biliary colic. Cholecystectomy successfully resolved biliary colic in 94.8% (n = 327/345) of patients, but 36.5% (n = 299/820) of patients reported persistent abdominal pain after 6 months of follow-up. The prevalence of most abdominal symptoms reduced significantly. Symptoms such as flatulence (17.8%, n = 146/820) or restricted eating (14.5%, n = 119/820) persisted most often. New-onset symptoms were frequent bowel movements (9.6%, n = 79/820), bowel urgency (8.5%, n = 70/820), and new-onset diarrhea (8.4%, 69/820). CONCLUSION: Postcholecystectomy symptoms are mainly flatulence, frequent bowel movements, and restricted eating. Newly reported symptoms are mainly frequent bowel movements, bowel urgency, and diarrhea. The present findings give clinical guidance in informing, managing, and treating patients with symptoms after cholecystectomy.

Infant colic and abdominal pain; associations with infant multimorbidity and maternal perceived stress up to 3 months postpartum-A cross-sectional/cohort study in the PreventADALL study.

AIMS AND OBJECTIVES: The primary aim was to explore whether infants with pain symptoms (colic, abdominal pain and visit to healthcare provider with pain or other discomforts) had increased multimorbidity (common infections, eczema and food sensitivity) compared with infants without these conditions. Secondarily, we aimed to determine whether infant pain symptoms were associated with maternal perceived stress in pregnancy and 3 months postpartum. BACKGROUND: Infant colic and abdominal pain are common concerns in early infancy. Nevertheless, to our knowledge, little research exists on the relationship between infant pain and common infant infections, eczema and food sensitization as comorbidities, and the impact of infant pain on the development of maternal perceived stress from pregnancy to infancy is inconsistent. DESIGN: This study was cross-sectional and partly prospective. METHODS: The sample consisted of mother-infant pairs (N = 1852); information regarding infant pain and multimorbidity was collected from the 3-month questionnaire and postpartum visits in the PreventADALL prospective cohort study. Chi-square tests and regression analyses were conducted. The STROBE checklist was followed. RESULTS: Our results showed a statistically significant higher proportion of respiratory and other infections in infants with pain symptoms. The odds of infant pain were higher for infants with multimorbidity compared to those with no comorbidity. Mothers of infants with colic and of infants visiting healthcare with pain and other discomforts reported statistically significant higher perceived stress by 3 months compared with mothers of infants with no reported pain. CONCLUSION: Our results indicate an association between infant pain symptoms and the presence of infections. Mothers of infants with colic and visiting healthcare had higher perceived stress compared to the no pain group. IMPLICATIONS FOR PRACTICE: Our study indicates that infant pain is associated with infant multimorbidity and maternal perceived stress, which may be useful when planning diagnostic, treatment and coping strategies in infant and family care. PATIENT OR PUBLIC CONTRIBUTION: The PreventADALL is a collaborative study with governmental and patient organisation representation. Selected infants with parents were also contributing during calibrating courses on eczema assessment for the data collectors. TRIAL REGISTRATION: The study was approved by the Regional Committee in Norway (2014/518) and Sweden (2014/2242-31/4) and registered at clinicaltrial.gov (NCT02449850). Link for clinical trials: https://clinicaltrials.gov/ct2/show/NCT02449850.

Epidemiology of Colic: Current Knowledge and Future Directions.

Epidemiologic studies are essential for the generation of evidence-based, preventive health care strategies. This includes ways to minimize colic risk and assist informed decision making concerning diagnosis, treatment, and likely outcomes. It is important to consider that colic is not a simple "disease" but is a syndrome of abdominal pain that encompasses multiple different disease processes, and which is multifactorial in nature. This review focuses on prevention and diagnosis of colic, including specific forms of colic, communications with owners/carers concerning colic risk and management, and areas of future research.

Bowel habits in healthy infants and the prevalence of functional constipation, infant colic and infant dyschezia.

AIM: During infancy bowel habits change. Most infants with gastrointestinal problems have a functional gastrointestinal disorder (FGID), a major reason for visiting paediatricians. This study aims to provide data on stool frequency and consistency during the first year, prevalence rates for functional constipation (FC) and to establish associations with relevant demographic data. The occurrence of infant colic (IC) and infant dyschezia (ID) was also reported. METHODS: This prospective observational birth-cohort study enrolled 122 healthy full-term infants. Questionnaires were completed at 2 weeks and 2, 6 and 12 months. RESULTS: Stool frequency decreased with age and consistency changed, with fewer runny stools. At 2 weeks, 24.3% had at least one of the studied FGID. FC was found in 2.6%-14.3% (up to 12 months), IC was found in 4.9%-3.4% (up to 2 months) and ID in 22.1%-3.9% (up to 6 months). Infants with an FGID had a lower weight and more healthcare visits than infants without. Breastfeeding and a high percentage of runny stools at 2 weeks of age decreased the odds of developing FC. CONCLUSION: Data on bowel habits and the prevalence of FC, IC and ID are presented. FGID during infancy is common and affects children's well-being, while their families need support and advice.

A multicenter retrospective case-cohort study on the prevalence of incisional morbidities in late pregnant mares following exploratory celiotomy (2014-2019): 579 cases.

OBJECTIVE: To report the prevalence and risk factors for incisional morbidities in late pregnant and nonpregnant/early pregnant control mares following colic surgery. DESIGN: Multicenter, retrospective, cohort study from January 2014 to December 2019. SETTING: Two university teaching hospitals and 1 private referral center. ANIMALS: Five hundred and seventy-nine fillies and mares ≥2 years old that underwent celiotomy. Pregnant mares (n = 54) were >240 days in gestation from the last known breeding date and were compared to control females (n = 525) undergoing colic surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Morbidity rates were not different between mare groups with 56% of pregnant mares and 51% of control mares reporting at least 1 morbidity. Incisional swelling was the most common reported complication in both groups. Incisional swelling was associated with shorter hospital stays (odds ratio [OR], 0.18; P < 0.01), and drainage was associated with a longer hospital stay (OR, 1.27; P ≤ 0.01) and with use of an abdominal bandage (OR, 4.4; P < 0.01). Herniation was associated with hypercapnia under anesthesia (OR, 1.1; P = 0.048), previous abdominal surgery (OR, 8.3; P = 0.003), and with use of an abdominal bandage (OR, 56; P = 0.006). Body wall dehiscence was associated with longer hospital stay (OR, 1.2; P < 0.01). Nonsurvival was higher in pregnant mares (13%) compared to control mares (5%; P = 0.02). CONCLUSIONS: The prevalence of incisional morbidities did not differ between pregnant and control mares undergoing colic surgery. Several factors were associated with incisional morbidities, including the duration of surgery and anesthesia, anesthetic variables, abdominal bandage use, previous ventral abdominal incision, and longer duration of hospitalization.

Impact of the COVID-19 pandemic on mental health in parents of infants with colic and on healthcare use.

AIM: To examine the impact of the COVID-19 pandemic on the mental health of parents of infants with colic and on healthcare use. METHODS: Retrospective cohort study. Data of 64 parents of infants with colic prepandemic and 43 parents of infants with colic during the pandemic were analysed using validated questionnaires on parental stress, depression and anxiety. Additionally, we evaluated the number of outpatient clinic visits and admission rates pre- and during the pandemic by collecting data on the diagnosis treatment combination 'excessive crying' from electronic patient files in three secondary hospitals in the Netherlands. RESULTS: Mothers in the pandemic group reported significantly higher levels of depression than mothers in the prepandemic group (12.3 ± 7.0 and 8.8 ± 5.2; p = 0.04). Moreover, mothers showed a trend towards higher stress levels during the pandemic (29.6 ± 9.6 and 25.2 ± 8.1; p = 0.06). During the pandemic, admission numbers of infants with colic compared to prepandemic data increased with 34% (146 vs. 196). CONCLUSION: Mothers of infants with colic reported significantly more feelings of depression during the COVID-19 pandemic. Furthermore, the pandemic was associated with increased healthcare use amongst infants with colic. With the continuing pandemic, we recommend active perinatal support for this vulnerable population.

Prevalence of Functional Gastrointestinal Disorders in Brazilian Infants Seen in Private Pediatric Practices and Their Associated Factors.

OBJECTIVES: To assess the prevalence of the most frequent functional gastrointestinal disorders (FGIDs) in Brazilian infants seen in private pediatric clinics and their relationship with cesarean delivery, breastfeeding, and history of prematurity. METHODS: This cross-sectional study enrolled 5080 infants under 12 months old with routine visits in private pediatric clinics in Brazil. The mothers answered questions about the type of delivery, type of feeding (breast milk, infant formula, cow milk, mixed feeding), history of prematurity, and gastrointestinal symptoms. Rome IV criteria were used to diagnose FGIDs. RESULTS: The prevalence of infant regurgitation was 10.7% (487/4560); infant colic, 6.1% (131/2162); infant dyschezia, 4.0% (157/3895); functional constipation, 7.6% (341/4506); and functional diarrhea, 0.09% (2/2186). Prematurity was associated ( P < 0.05) with infant regurgitation (odds ratio [OR] = 1.41; 95% confidence interval [CI]: 1.05, 1.90), infant colic (OR = 1.97; 95% CI: 1.19, 3.24), infant dyschezia (OR = 1.64, 95% CI: 1.02, 2.64), and functional constipation (OR = 1.44; 95% CI: 1.02, 2.02). Prematurity was associated ( P < 0.001) with two or more FGIDs between 21 days and 150 days of age (OR = 3.06; 95% CI: 1.74, 5.37). CONCLUSION: FGIDs are common in infants seen in the private pediatric practice in Brazil. History of prematurity was associated with infant regurgitation, infant colic, functional dyschezia, and functional constipation.

Neonatal Antibiotics and Food Allergy Are Associated With FGIDs at 4-6 Years of Age.

OBJECTIVES: Antibiotics may contribute to the development of functional gastrointestinal disorders (FGIDs). This study aimed to determine whether antibiotics during the first week of life, infantile colic in the first year of life, gut-associated immune markers at 1 year of age, and allergies at 4-6 years of age in term-born children were associated with a higher prevalence of FGIDs at 4-6 years of age. METHODS: A prospective observational cohort of 436 term-born infants was followed up at the age of 4-6 years; 151 received broad-spectrum antibiotics (AB+), and 285 healthy controls (AB-). Validated Questionnaire On Pediatric Gastrointestinal Symptoms-Rome III and International Study of Asthma and Allergy in Childhood questionnaires were sent to parents of 418 available children. The independent t-test, chi-squared test or non-parametric test and logistic multivariate regression analyses were used. RESULTS: In total, 340 of 418 (81%) questionnaires were completed. Only the presence of functional abdominal pain was significantly higher in AB+ than AB- (4% vs 0.4%, respectively, P  = 0.045). Children with food allergy fulfilled significantly more often the criteria for irritable bowel syndrome (IBS) and abdominal migraine (26% vs 9%, P  = 0.002 and 7% vs 1%, P  = 0.043, respectively) compared to non-allergic children. No differences in FGIDs existed at the age of 4-6 years between children with and without a history of infantile colic. There were significant differences in gut-associated immune markers between children with and without FGIDs. CONCLUSION: Antibiotics during the first week of life resulted in a higher risk for functional abdominal pain at 4-6 years. Furthermore, food allergy was associated with IBS and abdominal migraine at 4-6years.

Infant colic, young children's temperament and sleep in a population based longitudinal cohort study.

BACKGROUND: Colic and sleep problems are common among infants, constitute challenges and distress for parents, and are often reasons for seeking help from health professionals. The literature debates whether infant colic and sleep problems are linked together or not. Further, limited evidence exists on how colic impacts on child temperament and sleep during early childhood. Thus, the purpose of this study was to increase our knowledge of the characteristics of infants with a history of colic compared to infants without, and to study how infant colic is associated with the development of child temperament and sleep over time. METHODS: The study is based on The Norwegian Mother, Father and Child Cohort Study (MoBa), a population-based cohort study conducted by the Norwegian Institute of Public Health. This sample contains 88,186 mothers and children. Data was retrieved from questionnaires distributed to mothers at recruitment (in pregnancy) and when the child was 6 months, 18 months, 3 years, and 5 years. Data was analysed using linear mixed models and GLM models for repeated measures. RESULTS: At 6 months, infants with reported colic are described as fussier, present more sleeping problems, are breastfed less, and the families visit the child health centre more often when compared to the non-colic group. Mothers of children with reported colic perceive their children's temperament significantly more challenging from the age of 6 months to 5 years. Further, children with reported colic were more likely to sleep less than recommended (22%) and to have more frequent night awakenings (14%) than usual for their age (6 months to 5 years). CONCLUSION: Infant colic often occurs together with other signs of regulatory problems which may amplify the load on the parents. Moderate differences in temperament and sleep-problems across time, between those with colic and those without, indicate that the diagnosis of colic is moderately associated with later behavioural difficulties. However, it is demanding for the parents, and important to be aware of and act upon symptoms of colic in the child health centres to reduce the parents' load and prevent adverse long-term outcomes.

Clinical and pathological examination of mycotoxicosis as an associated risk factor for colic in equine.

A retrospective cohort study was conducted on two Egyptian horse farms with most of horses were suffered from abdominal pain to describe the associations between the occurrence of mycotoxicosis and equine colic. The farms owner complain was an unexpected increase in number of colic cases and deaths among horses. The association between colic and risk factors (sex, type of food either dry or mixed with roughages and hematobiochemical parameters) was compared using independent sample T-test. The associations between possible prognostic indicators for colic caused by mycotoxicosis was estimated using logistic regression analysis model. The cumulative incidence, incidence rates for colic attacks, survival rate among diseased horses were additionally estimated. Our results showed that a total of 24 out of the 132 horses suffered from colic due to feeding of ration contaminated with high percent of mycotoxin including Aflatoxins, Ochratoxins and or fusarium mycotoxins. The total cumulative incidence of colic due to mycotoxicosis was 19.7%. The horses fed on dry rations had more chance of developing colic than horses fed on mixed rations (P < 0.05). The overall incidence rate of colic due to mycotoxicosis was estimated at 18 colic attack/1000 horse/month. The mortality rate of horses suffered from colic due to mycotoxicosis was estimated at 5.9% (5/85), while the case fatality rate was estimated at 25% (n = 5/20). Inconclusion, our results showed that mycotoxicosis are considered an important risks factor for colic cases development in equine practice.

Functional Dyspepsia and Irritable Bowel Syndrome are Highly Prevalent in Patients With Gallstones and Are Negatively Associated With Outcomes After Cholecystectomy: A Prospective, Multicenter, Observational Study (PERFECT - Trial).

OBJECTIVE: To determine the prevalence of FD and IBS in patients eligible for cholecystectomy and to investigate the association between presence of FD/ IBS and resolution of biliary colic and a pain-free state. SUMMARY BACKGROUND DATA: More than 30% of patients with symptomatic cholecystolithiasis reports persisting pain postcholecystectomy. Coexistence of FD/IBS may contribute to this unsatisfactory outcome. METHODS: We conducted a multicenter, prospective, observational study (PERFECT-trial). Patients ≥18 years with abdominal pain and gallstones were included at 5 surgical outpatient clinics between 01/2018 and 04/2019. Follow-up was 6 months. Primary outcomes were prevalence of FD/IBS, and the difference between resolution of biliary colic and pain-free state in patients with and without FD/IBS. FD/IBS was defined by the Rome IV criteria, biliary colic by the Rome III criteria, and pain-free by an Izbicki Pain Score ≤10 and visual analogue scale ≤4. RESULTS: We included 401 patients with abdominal pain and gallstones (assumed eligible for cholecystectomy), mean age 52 years, 76% females. Of these, 34.9% fulfilled criteria for FD/IBS. 64.1% fulfilled criteria for biliary colic and 74.9% underwent cholecystectomy, with similar operation rates in patients with and without FD/IBS. Postcholecystectomy, 6.1% of patients fulfilled criteria for biliary colic, with no significant difference between those with and without FD/IBS at baseline (4.9% vs 8.6%, P = 0.22). Of all patients, 56.8% was pain-free after cholecystectomy, 40.7% of FD/IBS-group vs 64.4% of no FD/IBS-group, P < 0.001. CONCLUSIONS: One third of patients eligible for cholecystectomy fulfil criteria for FD/IBS. Biliary colic is reported by only a few patients postcholecys-tectomy, whereas nonbiliary abdominal pain persists in >40%, particularly in those with FD/IBS precholecystectomy. Clinicians should take these symptom-dependent outcomes into account in their shared decision-making process. TRIAL REGISTRATION: The Netherlands Trial Register NTR-7307. Registered on 18 June 2018.

Usefulness of endoscopic ultrasound in patients with minilithiasis and/or biliary sludge as a cause of symptoms of probable biliary origin after cholecystectomy.

INTRODUCTION: Endoscopic ultrasound (EUS) is a more sensitive technique than transabdominal ultrasound for the diagnosis of gallstones. This greater sensitivity, especially in the diagnosis of microlithiasis/biliary sludge, facilitates the indication of cholecystectomy in patients with symptoms of probable biliary origin but may result in over-indication of this surgery. OBJECTIVES: Evaluate the role of EUS in the diagnosis of minilithiasis/biliary sludge in patients with digestive symptoms of probable biliary origin by resolving the symptoms after cholecystectomy. Analyse factors related to the remission of symptoms following cholecystectomy. PATIENTS AND METHODS: Retrospective, longitudinal, single-centre study based on a prospective database of 1.121 patients undergoing EUS. Seventy-four patients were identified as meeting inclusion-exclusion criteria (diagnosed with minilithiasis/sludge by EUS after presenting digestive symptoms of probable biliary origin without a history of complicated cholelithiasis). A telephone questionnaire for symptoms was conducted with cholecystectomized patients. Factors related to a good response were analysed with logistic regression analysis. RESULTS: Of the 74 patients, 50 were cholecystectomized (67.5%), mean age 49 years (SEM 2.26) (41 women). Seventy percent of patients (35/50) presented remission of symptoms with median follow-up 353.5 days (95% CI, 270-632.2). The only variable associated with remission of symptoms was the presence of typical biliary colic with an OR of 7.8 (95% CI, 1.8-34; p=0.006). No complications associated with EUS were recorded. One patient (2%) suffered haemoperitoneum and 18% (9/50) suffered diarrhoea following cholecystectomy. CONCLUSIONS: EUS is a very useful technique for the indication of cholecystectomy in patients with minilithiasis/sludge and typical symptoms of biliary colic.

Prevalence and perinatal risk factors of parent-reported colic, abdominal pain and other pain or discomforts in infants until 3 months of age - A prospective cohort study in PreventADALL.

AIMS AND OBJECTIVES: To estimate the prevalence and perinatal risk factors associated with parent reported colic, abdominal pain and pain or other discomforts in infants until 3 months of age. BACKGROUND: Infant colic is a common concern for parents and clinicians. The prevalence varies in different studies and its symptoms overlap with other conditions like abdominal pain and discomfort. Diagnosis criteria are challenging, pathogenesis unclear and risk factors are conflicting. DESIGN: This was a prospective cohort study. METHODS: The 1852 mother-child pairs from the PreventADALL prospective birth-cohort answering the 3 months questionnaire were included. Information on perinatal risk factors was collected from the inclusion visit and questionnaires during pregnancy at 18 and 34 weeks, as well as birth charts. STROBE checklist was followed. RESULTS: The reported prevalence of colic was 3% (59/1852), abdominal pain 22% (415/1852) and pain or other discomfort 6% (119/1852), with a total of 26% (478/1852) infants. Mothers on sick leave in pregnancy and reporting any allergic diseases had a significantly higher odds of reporting infant colic, abdominal pain and pain or other discomforts. Mothers with higher perceived stress in pregnancy exhibited a trend towards higher odds for reporting infant pain. Mothers coming from Sweden were less likely to report infant abdominal pain compared to mothers from Norway. CONCLUSIONS: The prevalence of abdominal pain and pain or other discomforts was higher than the prevalence of colic. Perinatal risk factors connected to maternal health were associated with all three symptoms. RELEVANCE TO CLINICAL PRACTICE: Colic and abdominal pain are stressful, symptoms overlap and risk factors for both can be identified in pregnancy. Our study suggests that it is difficult for parents to distinguish among infant colic, abdominal pain and other pain or discomfort and some report two or all three symptoms. Identifying the perinatal risk factors associated with infant pain may help target and support parents.

Heavy metal contamination in Peru: implications on children's health.

Cerro de Pasco, Peru, has been excessively contaminated with heavy metals due to high mining activities in the region. We investigated the presence of chronic exposure to heavy metals in children living in Cerro de Pasco and its effect on health. Heavy metal concentrations were determined in hair samples collected from 78 children living in a region exposed to an open-pit mine (Paragsha region) and from other 16 children unexposed to mine activities (Carhuamayo region). Children exposed to the mine showed statistically significant higher concentration of aluminum, antimony, arsenic, cadmium, chromium, iron, lead, tin and thallium (p < 0.05) than control children. Hair samples collected from the same children in two occasions (2016 and 2018) showed that the exposure is chronic with higher levels of heavy metals observed in 2018. The concentration of heavy metals was higher in hair tip than in hair root samples. Heavy metals are associated with substantial higher risk of nosebleed (odds ratio, OR = 15.40), chronic colic (OR = 7.30), dermatologic alterations (OR = 6.16), mood alterations (OR = 7.07), presence of white lines on nails (OR = 12.10), reduced visual camp (OR = 3.97) and other symptoms (OR = 5.12). Chronic heavy metal exposure implies various negative consequences on children's health. Preventive measures are crucial to protect children's health.

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals.

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.

Lack of Association Between Barometric Pressure and Incidence of Colic in Equine Academic Ambulatory Practice.

Anecdotal accounts correlate equine colic onset to changing weather conditions; however, atmospheric effects on colic have not been studied extensively. We hypothesized that changes in barometric pressure would increase the likelihood of a colic diagnosis compared with other noncolic sick events. Multivariable logistic regression analysis was used to look for associations between colic diagnosis and barometric pressure. The University of Pennsylvania Field Service electronic medical records were searched by identifiable examination type via billing procedure codes collecting 3,108 emergent and nonemergent medical events along with corresponding weather data from the National Weather Service from January 1, 2005, through January 1, 2017. Barometric pressure values and changes were not found to be statistically associated with a diagnosis of colic (P = .1). Horses that did not survive were almost 12 times more likely to have a diagnosis of colic (odds ratio [OR]: 11.97; P < .0001). Horses with disease recurrence were 30% more likely to have a diagnosis of colic (OR: 1.29; P = .006). The likelihood of colic diagnosis increased with increasing latitude (OR: 2.43; P = .04). Horses were more likely to be diagnosed with colic in the fall (OR: 1.72; P < .0001), spring (OR: 1.29; P = .04), and summer (OR: 1.85; P < .0001), compared with winter. Stallions were 48% less likely to colic compared with mares (OR: 0.52; P = .016) and Quarter Horses were 32% less likely to colic compared with Thoroughbreds and Arabians (OR: 0.68; P = .047). This study provided evidence that changes in barometric pressure were not a contributing risk factor for colic, although seasons with changing weather and latitude may play a role.

The Impact of Parental Migraine on Children.

PURPOSE OF REVIEW: This review surveys our current understanding of the impact of parental migraine on children. Understanding the impact of migraine on others in a family unit is critical to describing the full burden of migraine and to developing psychosocial supportive interventions for patients and their families. RECENT FINDINGS: Having a parent with migraine is associated with several early developmental features including infant colic. Adolescent children of parents with migraine self-report their parent's migraine interferes with school and activities and events. Further, migraine is perceived to impact the relationship between the parent and child. Having a parent with migraine increases a child's risk of having migraine, and having more severe migraine disease. However, children with migraine whose parent also has migraine appear to receive more early and aggressive treatment. The impact of migraine extends beyond the parent with migraine and influences children across biological, psychological, and social domains.