Human Milk is the Feeding Strategy to Prevent Necrotizing Enterocolitis
Abstract
The use of human milk in the neonatal intensive care unit clearly has short and long-term beneficial effects, but its role in the prevention of necrotizing enterocolitis (NEC) cannot be understated. Immaturity of the intestinal tract, barrier function, and mucosal defense contributes to NEC. Human milk feeding enhances maturity of the intestinal tract, barrier functions, and mucosal defenses by providing components such as immunoglobulin A, lactoferrin, lysozyme, oligosaccharides, epidermal growth factor, acetylhydrolase, erythropoietin, arginine and glutamine, and polyunsaturated fatty acids, an...
Source: Current Pediatrics Reports - September 24, 2014 Category: Pediatrics Source Type: research
Impact of Feeding and Medical Practices on the Development of Necrotizing Enterocolitis
Abstract
A single, unifying mechanism explaining the cause of necrotizing enterocolitis has remained elusive. It is unlikely that one precipitating cause will be found. However, it is increasingly evident that common risk factors do exist such as intestinal immaturity, dysbiosis, and feeding (including type of feeding). Modifying these risk factors to facilitate optimal postnatal intestinal development may lessen the vulnerability to intestinal injury in the preterm infant. Understanding the feeding and medical practices employed in the neonatal intensive care unit and their potential effects on postnatal...
Source: Current Pediatrics Reports - September 20, 2014 Category: Pediatrics Source Type: research
The Impact of Neonatal Illness on Nutritional Requirements: One Size Does Not Fit All
Abstract
Sick neonates are at high risk for growth failure and poorer neurodevelopment than their healthy counterparts. The etiology of postnatal growth failure in sick infants is likely multi-factorial and includes undernutrition due to the difficulty of feeding them during their illness and instability. Illness also itself induces fundamental changes in cellular metabolism that appear to significantly alter nutritional demand and nutrient handling. Inflammation and physiologic stress play a large role in inducing the catabolic state characteristic of the critically ill newborn infant. Inflammatory and s...
Source: Current Pediatrics Reports - September 11, 2014 Category: Pediatrics Source Type: research
Pediatric Fecal Microbiota Transplantation
Abstract
Given the emerging role of the intestinal microbiota as a key regulator of host physiology in health and disease, therapies that modulate enteric bacterial communities offer promise for a variety of clinical disorders. Fecal microbiota transplantation (FMT) represents a fundamental approach to manipulate the gut microbiota, accomplished by administering stool from a healthy donor into the gastrointestinal tract of a diseased recipient. However, despite the plausible feasibility of FMT, there is a paucity of clinical trials evaluating its efficacy, particularly in the pediatric population. To th...
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
The Complexity of the Resurgence of Childhood Vaccine-Preventable Diseases in the United States
Abstract
Vaccines have saved the lives of innumerable children from infectious diseases. In the United States, state mandates for school immunization requirements and federal funding have enabled high immunization coverage and have resulted in historic low levels of many infectious diseases. However, in recent years, there have been widespread outbreaks of a number of vaccine-preventable infectious diseases, including measles, mumps, and pertussis. Reasons for these resurgences vary and are complex. They include decreases in vaccination rates, waning immunity, changes in the vaccine, and changes in the ...
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
Management of Congenital Toxoplasmosis
Abstract
Prompt diagnosis and rapid initiation of medical treatment are critical for the best outcomes in infants with congenital toxoplasmosis. This is important for pregnant women, fetuses, and infants, including those with active retinitis and choroidal neovascular membranes. For hydrocephalus, prompt placement of a ventriculoperitoneal shunt is key for improved outcomes. Pyrimethamine and Sulfadiazine with Leucovorin are first-line medicines. For later recurrences of active retinitis, Azithromycin or Clindamycin are sometimes substituted for Sulfadiazine as second-line treatments, given with Pyramet...
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
Human Metapneumovirus and Its Role in Childhood Respiratory Infections
Abstract
The human metapneumovirus has acquired the attention of the scientific community because it has been shown to be one of the most important viral pathogens in respiratory tract infections. Since its discovery in 2001, it has rapidly been shown that the virus infects all age groups, but the major burden is observed in pediatric patients. In this review, we focus on the clinical features of the human metapneumovirus, its epidemiology, antiviral therapy of HMPV infections and future treatment options. (Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
Gut and Breast Milk Microbiota and Their Role in the Development of the Immune Function
Abstract
The gastrointestinal immune system consists of both innate and adaptive immunity. The microbiota plays an important role in gastrointestinal immune function. In newborns, the maternal gut microbiota may either come across into the amniotic fluid or secrete factors that enter the amniotic fluid and affect the development of oral tolerance in utero. Adequate colonization must occur in the immediate postpartum period for the appropriate mucosal immune response since it is apparent that later attempts at colonization do not have the same impact. Human milk, being also a direct source of microbes, r...
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
Current Diagnosis and Treatment of Pediatric Latent Tuberculosis Infection
Abstract
The goal of diagnosing and treating latent tuberculosis infection (LTBI) in children is to prevent future cases of tuberculosis (TB) disease. In low-prevalence countries, LTBI screening, testing, and treatment are risk based. Testing is limited by lack of a reference standard; both available methods—the tuberculin skin test (TST) and interferon gamma release assays (IGRAs)—have significant limitations. The antigens used in IGRAs are not found in BCG-Mycobacterium bovis or most non-tuberculous mycobacteria, making these tests more specific for Mycobacterium tuberculosis infection than the TS...
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
NASH and the Cross-Talk Between the Gut and Liver
Abstract
Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic diseases of the liver, even in pediatrics. NAFLD ranges from simple fat accumulation (steatosis) to inflammation and fibrosis [nonalcoholic steatohepatitis (NASH)]. The progression of disease is a critical aspect, since the evolution of fatty liver to fibrotic stages may be the prelude to cirrhosis and hepatocellular carcinoma. Accumulating evidence has shown that the connection between the gut and the liver is crucial among the factors involved in liver disease progression. In patients with NAFLD, small bowel bac...
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
The Potential for use of Probiotics in Pediatric Irritable Bowel Syndrome and Inflammatory Bowel Disease
Abstract
Controlled trials of probiotics in irritable bowel syndrome are promising, but most are limited by suboptimal design and small sample size. A recent report from the Rome foundation group included 32 randomized clinical trials of probiotics. Seventy-five percent of these studies (including the 4 pediatric ones) did show an improvement in symptoms, but the therapeutic gain over placebo was generally modest. The patients most benefitting from probiotics appear to be those with predominant diarrhea and those who have developed irritable bowel syndrome after an episode of gastroenteritis. A review f...
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
Gluten Sensitivity in Pediatrics: A Clinical Conundrum
Abstract
Non-celiac gluten sensitivity (NCGS) is a condition in which symptoms are triggered by gluten ingestion, in which both allergic and autoimmune mechanisms have been ruled out.
The “classical” presentation of NCGS is a combination of gastrointestinal symptoms (including abdominal pain, bloating, and bowel habit abnormalities) and extra-intestinal manifestations. So far, NCGS has been described extensively in adults, and few data are available for the pediatric population. Due to lack of a serological or histological marker, the diagnosis of NCGS remains clinical and it is based on the ...
Source: Current Pediatrics Reports - September 1, 2014 Category: Pediatrics Source Type: research
Striking While the Iron is Hot: Understanding the Biological and Neurodevelopmental Effects of Iron Deficiency to Optimize Intervention in Early Childhood
Abstract
Prenatal and early postnatal iron deficiency (ID) is associated with long-term neurobiological alterations and disruptions in cognitive, social, and behavioral development. Early life ID is particularly detrimental as this is a period of rapid neurodevelopment. Even after iron supplementation, cognitive and social disruptions often persist in formerly iron-deficient individuals. Observational studies of the acute and long-term effects of early life ID yield different results based on the timing of ID. Further, intervention studies demonstrate some improvement for certain domains but still show re...
Source: Current Pediatrics Reports - August 23, 2014 Category: Pediatrics Source Type: research
Optimizing Growth and Neurocognitive Development While Minimalizing Metabolic Risk in Preterm Infants
This article will review the available literature on the impact of nutrition, illness and growth during several different epochs (i.e. first weeks of life, later inpatient weeks and post-discharge) on both neurodevelopmental and metabolic outcomes in preterm infants. (Source: Current Pediatrics Reports)
Source: Current Pediatrics Reports - August 17, 2014 Category: Pediatrics Source Type: research
Understanding the Coexistence of Food Insecurity and Obesity
Abstract
Coexistence of food insecurity and obesity is expected given that both are consequences of economic and social disadvantage. Food insecurity and obesity are positively associated in adult women but not men. There is some evidence of association in adolescents, but mixed results for children. Distinct from adults, children experience cognitive, emotional, and physical awareness of food insecurity and take responsibility for it by participating in adult strategies, initiating their own strategies, and taking action to obtain additional food or money for food. Food insecurity is detrimental for chil...
Source: Current Pediatrics Reports - July 29, 2014 Category: Pediatrics Source Type: research
