A Case of Reactivated Acute Hepatitis in a 12-month-old Infant With Multiviral Infection, Including SARS-CoV-2 and Adenovirus.

Adenovirus hepatitis is of global concern due to its increasing incidence and poorly understood pathogenesis. Historically, adenovirus has contributed to the development of severe hepatitis in immunocompromised patients. The clinical course and management of such infections in previously healthy children remains elusive. We present a case of severe acute hepatitis in a previously healthy 12-month-old infant with a history of SARS-CoV-2 infection followed by multiviral infection including adenovirus. Additional evaluation revealed acute hepatitis without evidence of acute liver failure except for mild coagulopathy. She demonstrated clinical improvement with supportive therapy but later experienced reactivated hepatitis in the setting of a third new viral infection thereby warranting a second hospitalization. A liver biopsy was obtained due to concern for an underlying immunologic or metabolic etiology of her prolonged hepatitis. Our case provides insight into the medical management and clinical course of a previously healthy child with a history of SARS-CoV-2 and adenovirus infections leading to reactivated acute hepatitis.

Proton Pump Inhibitors in Children: the Good, the Bad, and the Ugly.

PURPOSE OF REVIEW: The evidence supporting or contesting the prescription of proton pump inhibitors (PPIs) for children and updates on side effects are reviewed. RECENT FINDINGS: PPIs remain an important therapeutic option for esophagitis and gastritis. However, recent studies demonstrate no benefit when prescribing PPIs for chronic cough, infantile reflux, asthma, or functional gastrointestinal disorders. Recent studies suggest adverse effects on microbiome diversity and immune function, resulting in increased rates of gastrointestinal infections, bone fractures, and atopic disorders. PPIs influence a variety of cell types within the in the innate and adaptive immune systems. PPI prescriptions in children may be indicated for select conditions; however, multiple side effects and immune effects have been described. While most of these side effects are rare and mild, some studies suggest enduring adverse effects. Future studies to elucidate the mechanism behind some of these immune and infectious complications will be beneficial.

Incontinence in Phelan-McDermid Syndrome.

OBJECTIVE: The aim of the study was to evaluate gastrointestinal symptoms and continence in the context of Phelan-McDermid Syndrome (PMS). METHODS: A prospective evaluation of children with PMS (n = 17) at the National Institutes of Health. RESULTS: Parent-reported history of symptoms were common: constipation (65%), reflux (59%), choking/gagging (41%), and more than half received gastrointestinal specialty care. No aspiration was noted in 11/11 participants who completed modified barium swallows. Four participants met criteria for functional constipation, 2 of whom had abnormal colonic transit studies. Stool incontinence was highly prevalent (13/17) with nonretentive features present in 12/17. Participants who were continent had significantly smaller genetic deletions (P = 0.01) and higher nonverbal mental age (P = 0.03) compared with incontinent participants. CONCLUSIONS: Incontinence is common in PMS and associated with intellectual functioning and gene deletion size. Management strategies may differ based on the presence of nonretentive fecal incontinence, functional constipation, and degree of intellectual disability for children with PMS.

Early Infant Risk Factors for Pediatric Eosinophilic Esophagitis.

OBJECTIVES: Eosinophilic esophagitis (EoE) is an inflammatory, atopic disease of the esophagus without a clear etiology. Our objective was to identify exposures and conditions in early infancy associated with the development of EoE. METHODS: A case-control study was performed using the Military Health System Database. Subjects diagnosed with EoE from October 2008 to September 2015 were matched 1:2 on age and sex. Early infant risk factors from the first 6 months of life were investigated. RESULTS: A total of 1410 cases with EoE were matched to 2820 controls. The median (interquartile range) age at diagnosis of EoE was 4.2 years (2.1-7.2) and 68.7% were boys. Proton pump inhibitors (adjusted odds ratio [aOR], 2.73; 95% confidence interval [CI] 1.93-3.88), histamine-2 receptor antagonists (aOR, 1.64; 95% CI 1.27-2.13), and antibiotics (aOR, 1.31; 95% CI 1.10-1.56) were associated with EoE. Prematurity (aOR, 1.46; 95% CI 1.12-1.89) and early manifestations of atopic disease such as milk protein allergy (aOR, 2.37; 95% CI 1.26-4.44) and eczema (aOR, 1.97; 95% CI 1.64-2.36) were related to increased odds for EoE. Erythema toxicum in infancy was strongly associated with a diagnosis of EoE (aOR 3.52; 95% CI 1.03-12.04). Infants with feeding difficulty (aOR, 1.45; 95% CI 1.18-1.77) and gastroesophageal reflux disease (aOR, 1.79; 96% CI 1.43-2.26) were also at increased risk for EoE. CONCLUSIONS: Acid-blocking medications and antibiotics during infancy were associated with later diagnosis of EoE. Erythema toxicum neonatorum, an eosinophilic immune phenomenon, was strongly associated with EoE. Identifying early infant risk factors for EoE may help to risk stratify the need for endoscopy.