RESUMEN
OBJECTIVE: To evaluate the presentation, therapeutic management, and long-term outcome of children with very early-onset (VEO) (≤ 5 years of age) inflammatory bowel disease (IBD). STUDY DESIGN: Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational registry at multiple centers in North America. RESULTS: One hundred twelve children were ≤ 5 years of age with no child enrolled at <1 year of age. Of those, 42.9% had Crohn's disease (CD), 46.4% ulcerative colitis (UC), and 10.7% had IBD-unclassified. Among the children with CD, children 1-5 years of age had more isolated colonic disease (39.6%) compared with 6- to 10-year-olds (25.3%, P = .04), and 11- to 16-year-olds (22.3%, P < .01). The change from a presenting colon-only phenotype to ileocolonic began at 6-10 years. Children 1-5 years of age with CD had milder disease activity (45.8%) at diagnosis compared with the oldest group (28%, P = .01). Five years postdiagnosis, there was no difference in disease activity among the 3 groups. However, compared with the oldest group, a greater proportion of 1- to 5-year-olds with CD were receiving corticosteroids (P < .01) and methotrexate (P < .01), and a greater proportion of 1- to 5-year-olds with UC were receiving mesalamine (P < .0001) and thiopurine immunomodulators (P < .0002). CONCLUSIONS: Children with VEO-CD are more likely to have mild disease at diagnosis and present with a colonic phenotype with change to an ileocolonic phenotype noted at 6-10 years of age. Five years after diagnosis, children with VEO-CD and VEO-UC are more likely to have been administered corticosteroids and immunomodulators despite similar disease activity in all age groups. This may suggest development of a more aggressive disease phenotype over time.
Asunto(s)
Enfermedades Inflamatorias del Intestino/diagnóstico , Adolescente , Edad de Inicio , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Enfermedades Inflamatorias del Intestino/terapia , Masculino , América del Norte , Fenotipo , Pronóstico , Estudios Prospectivos , Sistema de RegistrosRESUMEN
OBJECTIVE: To quantify optimal minimum durations of exclusive breastfeeding associated with maintenance of any breastfeeding at 15 time points during the first year of life. STUDY DESIGN: Mothers (n = 1189) from the prospective Infant Feeding Practices Study II cohort who initiated exclusive breastfeeding with healthy term infants were included. In a 80:20 split-sample validation study, receiver operating characteristic curves estimated optimal minimum durations of exclusive breastfeeding needed to predict maintenance of any breastfeeding at 15 time points during the first year (n = 951). Logistic regression estimated the predictive performance of the identified thresholds adjusted for maternal age, race, education, parity, support system, and return-to-work status. Results were validated in the remaining 20% (n = 238). RESULTS: Optimal minimum durations ranged from 4.0-17.1 weeks of exclusive breastfeeding associated with maintenance of any breastfeeding at 15 time points. All estimated threshold durations were statistically significant after adjustment. CONCLUSIONS: Using a methodological approach unique to breastfeeding duration research, the authors report optimal durations of exclusive breastfeeding associated with duration of any breastfeeding at time points throughout the first year. Perinatal clinicians, pediatricians, lactation professionals, policymakers, researchers, and families might apply these findings to achieve desirable collective breastfeeding duration outcomes.
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Lactancia Materna/métodos , Lactancia Materna/psicología , Lactancia Materna/estadística & datos numéricos , Conducta Alimentaria/fisiología , Madres , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Curva ROC , Factores Socioeconómicos , Factores de Tiempo , Adulto JovenRESUMEN
We tested the performance of potassium hydroxide (KOH) in the modified Apt test under different experimental conditions using sodium hydroxide as a positive control. Like sodium hydroxide, KOH differentiated fresh fetal and adult blood stains on a cloth but not dried blood. KOH may be used to perform the Apt test at the bedside.
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Pruebas Hematológicas/métodos , Hidróxidos , Compuestos de Potasio , Adolescente , Adulto , Humanos , Recién Nacido , Persona de Mediana Edad , Sistemas de Atención de Punto , Hidróxido de Sodio , Adulto JovenRESUMEN
OBJECTIVES: To test the hypothesis that circulating activated T cells may release cytokines that decrease bone turnover in children with Crohn disease. STUDY DESIGN: Newly diagnosed Crohn disease and healthy controls of similar age were compared for bone age, bone mineral content and density, markers of bone remodeling, and serum concentration and in vitro T-cell production of receptor activator of nuclear factor kappaB ligand (RANKL), interferon (INF)-gamma, and osteoprotegerin (OPG). RESULTS: Newly diagnosed children with Crohn disease (n=23) had similar bone mineral density (BMD) z-scores and body mass index as the controls (n=40). Biochemical markers of bone remodeling indicated a state of low bone turnover in the Crohn disease patients compared with controls. Serum OPG (pmol/L; mean+/-SD, median) was higher (4.24+/-1.74, 3.98 vs 3.38+/-0.83, 3.41; P<.05), and serum RANKL (pmol/L) was lower in the Crohn disease patients (0.50+/-0.86, 0.28 vs 1.02+/-1.63, 0.49; P<.01), consistent with decreased bone resorption. Activated T cells from Crohn disease patients produced a higher concentration of INF-gamma (ng/microg protein) than those from controls (20.03+/-26.39, 8.70 vs 9.76+/-14.10, 6.17; P<.05). CONCLUSIONS: The newly diagnosed children with Crohn disease exhibited reduced bone remodeling, possibly due to T-cell INF-gamma and OPG.
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Resorción Ósea/inmunología , Enfermedad de Crohn/inmunología , Citocinas/sangre , Activación de Linfocitos , Linfocitos T/metabolismo , Adolescente , Biomarcadores , Densidad Ósea/inmunología , Remodelación Ósea/inmunología , Resorción Ósea/etiología , Proteínas Portadoras/sangre , Estudios de Casos y Controles , Niño , Enfermedad de Crohn/complicaciones , Femenino , Glicoproteínas/sangre , Humanos , Interferón gamma/sangre , Modelos Logísticos , Masculino , Glicoproteínas de Membrana/sangre , Osteoprotegerina , Ligando RANK , Receptor Activador del Factor Nuclear kappa-B , Receptores Citoplasmáticos y Nucleares/sangre , Receptores del Factor de Necrosis Tumoral/sangreRESUMEN
OBJECTIVE: To determine whether the clinical features of neonatal seizures are of value in predicting outcome. STUDY DESIGN: Demographic features, clinical seizure types, etiologic factors, and laboratory findings of all 77 patients with seizures admitted to our neonatal intensive care unit over a consecutive 7-year period were extracted from the medical records. RESULTS: Twenty-three (30%) died; 59% of the survivors had abnormal neurologic examinations, 40% were mentally retarded, 43% had cerebral palsy, and 21% were epileptic at mean follow-up of 3.5 years. Compared with patients with other seizure types, those with subtle and generalized tonic seizures had a significantly higher prevalence of epilepsy (P =.04 and P =.01 respectively); mental retardation (P =.02; P =.007), and cerebral palsy (P =.03; P =.002). Subtle seizures were, in addition, more likely to be associated with abnormalities on the neurologic examination at follow-up (P =.03). Similar outcome comparisons for those with focal and multifocal clonic, focal tonic, and multifocal myoclonic seizures revealed no significant differences. However, patients with >or=2 seizure types were significantly more likely to have epilepsy (P =.02), mental retardation (P =.001), cerebral palsy (P =.001), and abnormal examinations (P =.05). CONCLUSIONS: Clinical semiology is predictive of outcome in neonates with seizures and suggests the presence of unique pathophysiologic processes for different seizure types.