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Helicobacter pylori (Hp) plays an important role in the development of a variety of digestive diseases in children, but in addition to Hp, there are many other gastric microbiota also critical for children′s health.At present, the characteristics of children′s gastric microbiota may be still relatively unclear.This artical summarizes the composition, succession process and function of children′s gastric microbiota, and reviews the relationship between gastric microbiota and Helicobacter pylori infection in children.
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The immune mechanism of non-IgE-mediated food allergy is quite complex.Due to the lack of specific laboratory indicators and limited diagnosis and treatment methods, non-IgE-mediated food allergy is usually misdiagnosed.Therefore, it is urgent to clarify the pathogenesis of the disease and search for specific biomarkers and novel therapeutic targets.This review aims to summarize current research results on the immune mechanism of non-IgE-mediated food allergy from two aspects, including the specific immunity and innate immunity, and to explore the potential diagnostic markers.The results may provide novel ideas for effective therapeutic strategies of non-IgE-mediated food allergy.
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The diagnosis of food allergy in children is one hotspot attracting people′s attention in recent years.The incidence of it shows an increasing trend which exposes problems in the understanding of children′s food allergy in China, especially in the misdiagnosis and missed diagnosis.To further standardize the diagnosis and treatment of food allergy in children, based on the current domestic, foreign guidelines and relevant research evidence, the guideline recommends 16 clinical hot-button issues in the 4 aspects of diagnosis, treatment, prognosis, and prevention.Finally, a diagnosis flowchart has been formulated.The guideline aims to improve the standard diagnosis and treatment of food allergies in children in China.
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Objective:To analyze skin manifestations of pediatric inflammatory bowel disease (IBD) .Methods:Children with IBD were collected from pediatric wards in Peking University Third Hospital from January 2010 to January 2022, and their skin manifestations were retrospectively analyzed.Results:A total of 50 children with IBD were included, including 27 with Crohn′s disease and 23 with ulcerative colitis. Twenty-five (50%) patients had skin manifestations, including specific skin manifestations in 11 (22%) and relevant skin manifestations in 11 (22%) . Specific skin manifestations included cutaneous perianal Crohn′s disease in 2 cases, and anal fistula and/or perianal abscess in 9 cases; relevant skin manifestations included erythema nodosum in 5 cases, aphthous stomatitis in 3 cases, psoriasis in 1 case, polyarteritis nodosa in 1 case, and Henoch-Sch?nlein purpura in 1 case. Compared with the ulcerative colitis group, the Crohn′s disease group was more prone to suffer from specific skin manifestations and relevant skin manifestations, and there were significant differences in the prevalence of specific and relevant skin manifestations between the two groups (both P < 0.05) . Of the 27 children with Crohn′s disease, 19 (70%) had one or more skin manifestations, 2 of whom successively presented with 4 different skin manifestations. One child with Crohn′s disease and 1 with ulcerative colitis had 3 different skin manifestations in different periods. The fecal calprotectin level was elevated in all children with skin manifestations, and in 12 (48%) children without skin manifestations. The skin lesions of 5 children were improved or subsided after dose adjustment (1 case) or switch (4 cases) of biological agents. Conclusions:Half of the children with IBD have skin manifestations, and children with Crohn′s disease are more prone to have specific and relevant skin manifestations. Different skin manifestations could be observed in the same child in different periods. Multidisciplinary teamwork is conducive to the overall control of this disease.
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Helicobacter pylori infection in children can cause a variety of gastrointestinal and extra-digestive diseases, even the gastric cancer.Most Helicobacter pylori infections are acquired in childhood and can cause various manifestations such as nausea, vomiting, anorexia, idiopathic thrombocytopenic purpura, refractory iron deficiency anemia, and growth retardation.In recent years, many advances have been made in the study of children′s Helicobacter pylori infection.This review focuses on the risk factors of Helicobacter pylori infection in children, containing the perspectives of Helicobacter pylori strains, hosts and environment, and looks forward to further research directions.
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Objective:To analyze the risk factors of functional constipation in children aged 2-7 years.Methods:A case-control study was performed on 2-7-year-old children with functional constipation who were treated in the Department of Pediatrics, Peking University Third Hospital from May 20, 2019 to September 20, 2019 and healthy control children with same age.The general situation, defecation situation and factors that might affect the occu-rrence of constipation were collected through the questionnaire, the influence factors included antibiotic use before half year old, breastfeeding, dietary preferences, exercise, allergy-related medical history, parental medical history, family income and primary caregivers, which were analyzed by using a binary Logistic regression model. Results:A total of 203 subjects were included, including 81 children in the constipation group and 122 children in healthy control group.Thick stools, dry stools, painful bowel movements and reduced bowel movement frequency were the most common symptoms of functional constipation.The main causes children at this age were food supplements and going to kindergarten.The univariate analysis indicated that the history of anti-biotics before half year old, picky eating habits, exercise volume and allergy-related diseases, constipation-related family history, father′s allergic disease background, and whether the main caregivers were parents were significantly different between two groups (all P<0.05). The binary Logistic regre-ssion analysis revealed that father′s history of allergic diseases ( OR=2.302, 95% CI: 1.109-4.780), the use of anti-biotics within 6 months after birth ( OR=2.300, 95% CI: 1.053-5.022), parents′ history of constipation ( OR=2.151, 95% CI: 1.106-4.128), and dietary preference of staple food ( OR=3.526, 95% CI: 1.402- 8.867) were the risk factors for functional constipation in 2-7-year-old children. Conclusions:Parents′ history of constipation, father′s history allergic diseases and a dietary preference for staple food may be the risk factors for functional constipation.
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Objective:To investigate the clinical features and risk factors of feeding intolerance in premature infants.Methods:This is a retrospective study involving premature infants who were hospitalized in Peking University Third Hospital from January to December 2017. Those in the feeding intolerance group (FI group) were further divided into subgroups of gestational age (GA) < 31 weeks group and GA ≥ 31 weeks group, as well as birth weight (BW)<1 250 g group and BW≥1 250 g group. Medical records of all subjects were reviewed to retrieve relevant clinical information. Independent-samples t-test, Chi-square test, and logistic regression tests were used for statistical analysis. Results:There were 612 eligible subjects with 182 (29.7%) in the FI group and 430 (70.3%) in the feeding tolerance (FT) group. (1) In the FI group, there were 103 (56.6%) males and 79 (43.4%) females with an average GA of (30.6±2.3) weeks and BW of (1 298±417) g, and 134 (73.6%) were very low birth weight premature infants. Among the patients with FI, there were 93 in the GA<31 weeks group and 89 in the GA≥31 weeks group, and 93 in the BW<1 250 g group and 89 in the BW≥1 250 g group. The FI infants accounted for 63.2% of very low birth weight premature infants in the same period. (2) The age at diagnosis was (2.7±0.9) d and (13.2±6.9) d at recovery. And the duration of FI was (10.5±6.7) d. The main symptoms were gastric retention (100.0%, 182/182), abdominal distention (54.4%, 98/182) and vomiting (17.0%, 31/182). (3) FI in preterm infants with GA <31 weeks or BW <1 250 g occurred and disappeared later [GA subgroups: (2.4±0.8) vs (2.9±0.9) d, t=3.977 and (10.4±5.2) vs (16.0±7.3) d, t=5.935; BW subgroups: (2.5±0.9) vs (2.8±0.9) d, t=2.540 and (10.0±4.5) vs (16.3±7.4) d, t=6.951; all P<0.05] and had a longer duration than those with GA≥31 weeks or BW≥1 250 g [GA subgroups: (8.0±5.0) vs (13.0±7.3) d, t=5.450; BW subgroups: (7.5±4.3) vs (13.5±7.3) d, t=6.690; both P<0.05]. Premature infants with smaller GA took longer time to regain their birth weight [(9.4±4.1) vs (12.0±5.1) d, t=3.672, P<0.05] and those with lower BW were less likely to have symptom of vomiting [23.6% (21/89) vs 10.8% (10/93), χ2=5.308, P<0.05]. (4) Multivariate logistic regression analysis showed that BW was a protective factor for FI in premature infants ( OR=0.998, 95% CI: 0.997-0.998, P<0.001) and the independent risk factors for FI were neonatal respiratory distress syndrome ( OR=2.129, 95% CI: 1.163-3.897, P=0.014), multifetation ( OR=1.812, 95% CI: 1.116-2.941, P=0.016), caffeine citrate exposure within 48 h after birth ( OR=2.663, 95% CI: 1.619-4.381, P<0.001), continuous positive airway pressure (CPAP) treatment within 48 h after birth ( OR=5.211, 95% CI: 2.861-9.489, P<0.001) and intrauterine infection ( OR=1.988, 95% CI: 1.060-3.728, P=0.032). Conclusions:The incidence of feeding intolerance in premature infants is high. Premature infants with GA <31 weeks or BW <1 250 g may develop FI and recover at an older age, and suffer longer. Low BW, neonatal respiratory distress syndrome, multifetation, caffeine citrate exposure, or CPAP treatment within 48 h after birth and intrauterine infection are risk factors for FI in premature infants.
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Objective@#To investigate the impact of early antibiotics treatment on intestinal microbiota in preterm infants.@*Methods@#The cohort study was performed from January 2015 to June 2015 in Neonatal Intensive Care Unit of Peking University Third Hospital. A total of 33 preterm infants were enrolled, among whom 25 were antibiotics-exposure group, and 8 were non-exposure group. Serial stool samples were collected on the first day, 14th and 30th days of life and analyzed by high-throughput sequencing. In exposure group, intestinal microbiota was also analyzed at 8 months to 1 year of age. Categorical variables were analyzed with χ2 test, and continuous variables were analyzed with t test or non-parametric test.@*Results@#Proteobacteria was the most prominent flora after birth in all cases (exposure group 69.6%, non-exposure group 83.7%) . In exposure group, at the phylum level, Proteobacteria was the dominant bacteria within the first 30 days, followed by Firmicutes after 30 days of life. At the genus level, Escherichia was the most abundant genera within 30 days after birth, while Veillonella became dominant after 8 months to 1 year of life. In non-exposure group, at the phylum level, Proteobacteria was the dominant phylum within the first 30 days. At the genus level, Actinobacteria (37.5%) was the dominant genus after birth, followed by Escherichia within the first month. Intestinal bacterial abundance and diversity were lower in exposure group, which was most significant on 30th day of life (shannon index 2.6 vs.3.4, ACE index 563.9 vs.591.6) . The influence of single antibiotics was less significant than combined treatment (shannon index 2.7 vs.2.5, ACE index 727.3 vs.492.9) . At the genus level, compared to non-exposure group, there were significant decrease of Escherichia (9.3% vs. 54.3%, Z=-2.830, P=0.005), Klebsiella (0.03% vs.12.4%,Z=-2.240, P=0.025), and Clostridium (0.2% vs. 4.8%, Z=-2.979, P=0.003) in exposure group on 14 days of life. Bifidobacterium (0.1% vs.2.0%, Z=-2.349, P=0.019) in cases treated with combined antibiotics was lower than that treated with antibiotic monotherapy on 30 days of life.@*Conclusions@#Early application of combined antibiotics impacts on the intestinal microbiome of preterm infants significantly. The infants who have received antibiotic after birth have lower quantity and diversity of Clostridium, Lactobacillus, Bacteroides and Bifidobacterium.
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Objective To study the risk factors,clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection in NICU.Method Preterm infants diagnosed to have infection of aerogenes in our NICU during July 2014 to October 2014 were selected as the infection group in our study.Uninfected preterm infants whose gestational age and birth weight were similar to the infants in infection group were selected as the control group.The ratio of number of infants in infection group and control group was 1 ∶ 2.The basic situation,clinical application of antibiotics before infection,defecation times,invasive manipulations,and parenteral nutrition time of the two groups were retrospectively collected.The clinical manifestations,drug sensitivity and outcomes of preterm infants with aerogenes infection were analyzed.Result There were 8 infants in infection group (male:female =3∶5).The birth weight ranged from 780 to 2 760 g;and gestational age from 28 to 33 w.There were 16 infants in the control group (male:female =1 ∶ 1).The birth weight ranged from 1 070 to 1 780 g,and gestational age,from 29 to 33 w.The incidence of prenatal infection in infection group was higher than that in the control group (3/8 vs.4/16,P ＜ 0.05).Comparing the two study groups,there were statistical differences between them in the following aspects (all P ＜ 0.05):non-invasive respiratory support time [11 (6,36) d vs.4 (0,6) d] and invasive mechanical ventilation time [(1 (0,6) d vs.0 (0,0) d].All the 8 infants in infection group had pneumonia,3 of them with sepsis (1 case was extremely low birth weight infant,and 2 cases were very low birth weight infants),and one of them died from septic shock.Drug sensitivity analysis showed that aerogenes were resistant to all the third generation cephalosporins,and were sensitive to Meropenem and Piperacillin/Tazobactam.The resistance rates of Imipenem were 1/6 in the first month,2/6 in the second month,9/11 in the third month,and 2/4 in the fourth month,respectively.Conclusion Avoidance of prenatal infection and shortening of the application of ventilator may reduce the incidence of aerogenes infection.Most of infants with aerogenes infection have favourable prognosis.The resistance rate of third generation cephalosporins is very high.Aerogenes could develop resistance quickly to the antibiotics which is sensitive initially.
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Objective To find out the clinical characteristics related to neonate food allergy.Methods Ten subjects were diagnosed as neonate food allergy at the Third Hospital of Peking University from January 201 3 to January 201 5.The following clinical data:the gestational age,genter,age of onset,feeding,clinical manifestations,white blood cell count,eosinophilic granulocyte count,C -reactive protein(CRP),routine stool test and occult blood test,blood spe-cific IgE of cow′s milk and clinical outcomes were investigated.Results There were 4 term infants,and 6 preterm in-fants,including 2 very -preterm subjects.The gender ratio between male and female cases was 73.The age of onset from 1 day after birth to 43 days after birth,clinical investigation of neonate food allergy in 1 0 cases,and the average time was 20.3 d,the median age was 1 8.5 d,and the SD was 1 3.38 d.Their rectified gestational ages were from 30 to 37 weeks in 6 cases at onset.Four infants received breast feeding,3 infants received formula milk feeding,and the other 3 infants received mixed feeding.At onset,the symptoms were almost involved in the digestive system.The white blood cell counts of lab test were almost normal in 1 0 subjects.And eosinophilic granulocytes were elevated in 8 subjects.CRP elevated in 1 case,and those of the other 9 subjects were normal.The cow′s milk specific IgE antibody was elevated in 1 subject,and that of the other 9 subjects was normal.Two subjects were performed opened food challenge test and the finding were positive.Conclusions Both the term infants and the preterm infants can have food allergy,but the age of onset ranged widely.Breast feeding infants can also be attacked.The symptoms of the digestive tract were the main clinical manifestations of such neonates.The open -food challenge test is beneficial to diagnose but difficult to practice in the neonates.Dietetic treatment is the only method can therapy the disease.And mostly the clinical outcomes are desirable.
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<p><b>OBJECTIVE</b>To explore the clinical features and molecular mutation of early-onset familial adenomatous polyposis(FAP) in childhood.</p><p><b>METHOD</b>The clinical features, endoscopic findings, pathology and therapeutic effect of sulindac during 11 years follow-up in a child with FAP were retrospectively reviewed . Adenomatous polyposis coli (APC) gene mutation analysis was performed by PCR and first generation sequencing.</p><p><b>RESULT</b>This 6-year-old girl was admitted for intermittent bloody stool during the last one and a half years. Colonoscopy showed hundreds of polyps in the rectum and colon. Pathological examination revealed tubular adenomas with high grade dysplasia. During the follow-up period of 11 years, the child presented intermittent mucous bloody stool. Endoscopy showed the number of polyps in colon and rectum increased to thousands, and found multiple polyps in gastric fundus and body.She was treated with sulindac at the age of 13. Then the number of polyps and the grade of pathology showed a slight improvement and no carcinoma was seen on biopsy. She has not accepted surgery until now. Gene sequencing of this child revealed 5 bp deletion at codon 1,309 of exon 15 (c.3927_3931delAAAGA) of tumor suppressor gene, whereas none of her parents had the same mutation. And no polyps were found on her parents colonoscopy.</p><p><b>CONCLUSION</b>This child with FAP had an early onset of this disease, and clinical conditions were exacerbated with age. Sulindac was partially effective in controlling size and number of polyps. The site of mutation in this case was consistent with classic FAP, and without family history, the mutation may be a sporadic one.</p>
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Child , Female , Humans , Adenomatous Polyposis Coli , Biopsy , Colonoscopy , Gastrointestinal Hemorrhage , Genes, APC , Mutation , Polymerase Chain Reaction , Rectum , Retrospective StudiesABSTRACT
Food allergy refers to the body's abnormal immune response to food,which induces disorder and/or injuries of human body,and thus triggers a series of manifestations.Ninety percent of food allergy is due to the following allergen:milk,eggs,peanuts,nuts,seafood,soy,wheat,etc.The symptoms of digestive system are closely associated with the nature of allergen (including protein's family nature,three dimensional structure,biological activity and stability) and the body's own status (genetic factors,integrity of intestinal mucosal barrier and oral immune tolerance).The symptoms of digestive systems are not typical,and differ by various factors like body conditions,ages,regions and allergens,so the diagnosis is difficult.Food allergy is categorized by its mechanism:IgE,non IgE,and mix.The symptoms of digestive systems include vomiting,diarrhea,reflux,constipation and abdominal pain,etc,and relative diseases include food protein-induced enteropathy,food protein-induced enterocolitis syndrome,food protein-induced enterocolitis syndrome,food protein-induced proctocolitis,celiac disease,eosinophilic gastroenteritis,eosinophilic esophagitis and infantile colic,etc.Delayed diagnosis will result in failure to thrive,anemia and hypoproteinenia.Therefore,early diagnosis and treatment can effectively prevent malnutrition and improve the children's animation.
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<p><b>OBJECTIVE</b>To evaluate the clinical application of 24-hour esophageal multichannel intraluminal impedance-pH monitoring technique in preterm infants.</p><p><b>METHOD</b>This study enrolled 28 preterm (male 20, female 8) infants with symptoms suggestive of gastroesophageal reflux (GER) (frequent regurgitations, apnea, or transcutaneous oxygen saturation decreased). They had postmenstrual age from 26 to 32 weeks, median (28.9 ± 1.9)weeks, had birth weight from 850 to 1 700 g, median (1 250.4 ± 272.8)g, range 850-1700 g, and were studied at corrected gestational age from 28 to 40 weeks, median (34.5 ± 2.3)weeks. Combined measurement of esophageal pH and impedance was performed. The 24-hour pH-impedance recording was uploaded onto a portable storage card and for computer-assisted manual analysis, using a specialized software program. When values were distributed normally, they were presented as mean and standard deviation, compared using t test. When values were not distributed normally, they were presented as median, minimum and maximum. Median values were compared using the Mann-Whitney U non-parametric test. SPSS 17.0 software was used.</p><p><b>RESULT</b>In 28 preterm infants, 71.4% (20/28) had pathological acid refluxes with pH monitor, while 100% with combined measurement of esophageal pH and impedance. Gestational age, birth weight, corrected gestational age had no association with acid GER. Frequent regurgitations, apnea, or transcutaneous oxygen saturation decreased but there was no statistically significant difference between acid GER group and non-acid GER group. Eight cases had no pathological acid refluxes, but showed an increase of weakly acid refluxes than pathological acid refluxes group (P < 0.01) . The median number of reflux events in 24 hours for 28 cases was 64.5 (0-377) , 23.4% were acidic, while 76.4% were weakly acidic; 59.1% were liquid bolus refluxes, while 40.9% were mixed bolus refluxes. The positive ratio of symptoms related index and symptoms association probability were significantly increased combined measurement of esophageal pH and impedance versus pH monitor were used.</p><p><b>CONCLUSION</b>The 24-hour esophageal impedance-pH monitoring technique was safe and had good tolerance. We confirmed that it detected more weakly acidic refluxes, liquid bolus refluxes, and mixed bolus refluxes. And it provided more evidence for explaining the relationship between GER and clinical manifestation.</p>
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Female , Humans , Infant, Newborn , Male , Electric Impedance , Esophageal pH Monitoring , Esophagus , Gastric Acidity Determination , Gastroesophageal Reflux , Diagnosis , Infant, Premature , Infant, Premature, Diseases , Diagnosis , Monitoring, Physiologic , Methods , Sensitivity and SpecificityABSTRACT
Objective To investigate the epidemiological and clinical characteristics, risk factors, outcome and prevention strategy of very low birth weight infant (VLBWI) with nosocomial infection in neonatal intensive care unit (NICU). Methods The VLBWIs whose birth weight were less than 1500 g and hospital stays were more than 48 hours in NICU of Peking University Third Hospital from January 1, 1998 to December 31, 2008 were selected in this study. They were divided into nosocomial infection group and non-infection group. The clinical features and outcomes of nosocomial infection were summarized and the risk factors of which were analyzed with Logistic regression. Results There were 158 VLBWIs who fit for the criteria of our study during the eleven years, the mean birth weight was (1263.8± 155.5) g and the mean gestational age was (30.4±2.1) weeks. There were 70 times and 56 cases suffered from nosocomial infections. The incidence of nosocomial infection was 35.4% and hospital stay-related incidence was 14.4‰. Among 70 times of infections, there were 40(57.1%) pneumonia, 22(31.4%) septicemia, 4(5.8%) thrush, 1(1.4%)conjunctivitis, 1 ( 1.4%) upper respiratory tract infection and 2 (2.9%) unknown site infections.Forty-one strains of bacteria were isolated from 121 specimens, among which gram-negative bacillus accounted for 56.1% and gram-positive cocci for 46.3%. The duration of hospital stay of VLBWIs with nosocomial infection was significantly longer than that without [(43.7±15.5) d vs (26.3±14.4) d] (t = -7.058, P＜0.01). The fatality rate of VLBWIs with and without nosocomial infection was 3.6% (2/56) and 3.9% (4/102), and there was no significant difference (x2 = 0.012,P＞0.05). Logistic regression showed that mechanical ventilation (OR = 3.388, 95% CI: 1.656-6.932, P=0.001) and parenteral nutrition (OR= 7.054, 95%CI: 2.005-24.813, P=0.002) were risk factors of nosocomial infection. Conclusions The incidence of nosocomial infection in VLBWIs in NICU is high. Mechanical ventilation and parenteral nutrition should be avoided and the duration of invasive operation and treatment should be shortened as much as possible to minimize the chances of nosocomial infection in VLBWIs.
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0.05). Conclusion LCP enrichment formula is suitable to premature infants. Its lipid composition is more close to that of breast milk and benefit to the brain and retina development of premature infants.
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Objective To study the serum and gastric juice levels of epidermal growth factor (EGF) in response to early minimal enteral nutrition (MEN) in premature infants with severe illness and evaluate the clinical significance of early MEN. Methods Premature infants with critical score