COVID-19 and Gastrointestinal and Hepatobiliary Diseases.

Since its initial onset in 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread quickly across the globe, resulting in the potentially life-threatening respiratory coronavirus disease 2019 (COVID-19). Although less commonly reported, COVID-19 has also been associated with gastrointestinal and hepatic manifestations, which may occur more frequently in children. This has also led to concern about the susceptibility of children to the SARS-CoV-2 virus who have underlying chronic digestive disease and may be treated with immune suppression. As such, recommendations and expert consensus regarding the management of chronic gastrointestinal and hepatobiliary disease have been of great interest during the pandemic and international database reporting has informed our understanding. The impact of COVID-19 on the gastrointestinal tract and its influence on the management of pediatric digestive disease is reviewed in this article. [Pediatr Ann. 2021;50(8):e315-e319.].

Metagenomic Alterations in Gut Microbiota Precede and Predict Onset of Colitis in the IL10 Gene-Deficient Murine Model.

BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) are chronic inflammatory disorders where predictive biomarkers for the disease development and clinical course are sorely needed for development of prevention and early intervention strategies that can be implemented to improve clinical outcomes. Since gut microbiome alterations can reflect and/or contribute to impending host health changes, we examined whether gut microbiota metagenomic profiles would provide more robust measures for predicting disease outcomes in colitis-prone hosts. METHODS: Using the interleukin (IL) 10 gene-deficient (IL10 KO) murine model where early life dysbiosis from antibiotic (cefoperozone [CPZ]) treated dams vertically transferred to pups increases risk for colitis later in life, we investigated temporal metagenomic profiles in the gut microbiota of post-weaning offspring and determined their relationship to eventual clinical outcomes. RESULTS: Compared to controls, offspring acquiring maternal CPZ-induced dysbiosis exhibited a restructuring of intestinal microbial membership in both bacteriome and mycobiome that was associated with alterations in specific functional subsystems. Furthermore, among IL10 KO offspring from CPZ-treated dams, several functional subsystems, particularly nitrogen metabolism, diverged between mice that developed spontaneous colitis (CPZ-colitis) versus those that did not (CPZ-no-colitis) at a time point prior to eventual clinical outcome. CONCLUSIONS: Our findings provide support that functional metagenomic profiling of gut microbes has potential and promise meriting further study for development of tools to assess risk and manage human IBD.

The Role of Disaccharidase Deficiencies in Functional Abdominal Pain Disorders-A Narrative Review.

Disaccharidase deficiencies are reportedly underdiagnosed in pediatric populations. Though typically thought to cause diarrheal disease, they can also be a cause of abdominal pain and dyspepsia, and patients diagnosed with these functional disorders may actually have associated enzyme deficiencies. While the effects of lactose deficiency have been widely studied, sucrase, maltase, and isomaltase are less frequently considered when approaching a patient with an apparent functional abdominal pain disorder. This review seeks to provide an up-to-date narrative on the current scientific literature on the possible role of sucrase, maltase, and isomaltase deficiency in pediatric functional gastrointestinal disorders.

Prevalence and Resolution of Lupus Anticoagulant in Children.

BACKGROUND: Lupus anticoagulant (LA) is an autoantibody that inhibits phospholipid-dependent reactions. Studies on the incidence and prevalence of LA in the pediatric population are lacking. The objective of our study was to determine the incidence and potential risk of complications of LA in children presenting with abnormal partial thromboplastin time (PTT). Our secondary objective was to identify signs, symptoms, and medical history associated with the presence of LA as documented in the literature. We focused on the correlation between signs of LA in the form of laboratory values consistent with bleeding abnormalities and the presence of clinical symptoms of bleeding. METHODS: We conducted a record-based retrospective analysis of 112 children and adolescents referred to the Department of Hematology/Oncology at Children's Hospital of New Orleans for abnormal coagulation profiles and/or history of mucocutaneous bleeding. Participants were followed up until PTT values normalized. RESULTS: In our study population with suspected bleeding disorder, the preliminary incidence of LA was 21%. We found that resolution of LA correlated with correction of PTT in 90% of patients. CONCLUSION: To minimize extensive and expensive blood workup, we recommend that screening for LA be included in the evaluation of children with prolonged PTT, even if they have a negative history of bleeding problems.

Late ELISA Testing in Infants Born to HIV-Positive Mothers.

We present the case of a young boy who was born to a human immunodeficiency virus (HIV)-positive mother and originally found to be uninfected. Evidence-based guidelines were followed regarding the mother's prenatal and infant's postnatal care, including the avoidance of breast milk. HIV DNA polymerase chain reaction qualitative tests were obtained at birth, 6 weeks and 4 months, and were all negative. He also received 6 weeks of prophylactic zidovudine. Despite these measures, his health began to decline at 17 months of age and antibody and serology tests performed at this time confirmed HIV infection. Guidelines no longer recommend routine antibody testing at 18 months of age to confirm the absence of infection in exposed infants with a record of negative virology in the first year of life. Based on this case and others we propose that this test be added back to the national guidelines for the early detection and prompt treatment of HIV infection in infants born to HIV-positive mothers.