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Splanchnic oxygenation patterns at first feed in stable preterm infants: Correlation with feeding intolerance development
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Abstracts / Digestive and Liver Disease 47S (2015) e237–e276
P018 SPLANCHNIC OXYGENATION PATTERNS AT FIRST FEED IN STABLE PRETERM INFANTS: CORRELATION WITH FEEDING INTOLERANCE DEVELOPMENT S. Martini 1,∗ , B. Battistini 1 , A. Aceti 1 , P. Rucci 2 , G. Faldella 1 , L. Corvaglia 1 1 U.O. Terapia Intensiva Neonatale, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Bologna, Italy 2 Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
Introduction and aim: Due to their gastro-intestinal immaturity, preterm infants are more prone to develop feeding intolerance (FI), which frequently hampers the establishment of an adequate enteral nutrition. Previous Doppler studies showed an impaired mesenteric blood flow velocity after the first feed in preterm infants developing FI. We aimed to evaluate splanchnic oxygenation patterns in response to the first enteral feed and possible correlations with subsequent FI development. Methods: Stable preterm infants (gestational age ≤34 weeks) underwent a 3-hour Near-Infrared Spectroscopy monitoring at first enteral feed administration. The enrolled infants were retrospectively allocated into 2 groups in relation to the development of FI during their hospital stay (food intolerance [FI] vs. food tolerance [FT]). Mann–Whitney U test was used to compare splanchnic oxygenation patterns between the two groups. Statistical significance was set at p < 0.05. Results: Seventy-eight preterm infants were enrolled; 30 out of 78 developed FI during their hospital stay. Splanchnic oxygenation patterns in response to the first feed differed significantly between two groups, with lower values of splanchnic tissue oxygenation in the FI group during the first 35 after the first feed and from 1 h 30 on (p < 0.05). Conclusions: Splanchnic oxygenation in response to the first enteral feed is significantly lower in preterm infants developing FI. This finding could reflect an early impairment of mesenteric regional circulation with subsequent tissue hypoxia, which might possibly predispose to the development of FI. http://dx.doi.org/10.1016/j.dld.2015.07.066 P019 ORAL ABSORPTION OF IRON BIS-GLYCINATE CHELATE IN CHILDREN WITH CELIAC DISEASE AND IRON DEFICIENCY G.A. Mazza 1,∗ , E. Battaglia 2 , L. Pedrelli 2 , R. Miniero 1 , L. Giancotti 3 1
Scuola di Specializzazione in Pediatria, Università Magna Graecia di Catanzaro, Italy 2 Lab Analisi Chimica-Clinica-RIA Osp, Pugliese-Ciaccio. Catanzaro, Italy 3 Cattedra di Pediatria Università “Magna Graecia” di Catanzaro – Centro regionale conferma diagnostica e follow-up della malattia celiaca, Italy Objective: Iron deficiency (ID) and iron deficiency anemia (IDA) are very common conditions in children with celiac disease (CD), mainly due to iron malabsorption. We demonstrated good absorption and bioavailability of iron bis-glycinate chelate (IBC) in 11 children at diagnosis of CD (with ID or IDA) using the oral iron absorption test (OIAT) and observing an increase in serum iron after
3 h at least twice the baseline values. Here we report preliminary data, after a 3-months course of IBC therapy. Methods: We considered 3 patients (aged 18, 16 and 14 respectively) with CD at diagnosis, positive to the OIAT, who started the free gluten diet (GFD) and received oral iron therapy (14 mg/d). We reassessed iron nutritional status and serological markers of CD after 3 months. Results: Treatment was well tolerated. Serum iron, transferrin, ferritin and red blood cell indices significantly improved in all patients along with a partial reduction of the serological markers of disease. Conclusions: These results confirm good reliability of the OIAT in the planning of oral iron therapy. Furthermore our data demonstrate the good efficacy of the IBC in children with newly diagnosed CD, who still bring the characteristic lesions of the duodenal mucosa, therefore poor in DMT1 expression. This would suggest that IBC has a different way of absorption not mediated by the DMT1. For this reason IBC might represent a leader compound in the treatment of ID and IDA in patients with CD even at time of diagnosis. We declare no conflict of interest. http://dx.doi.org/10.1016/j.dld.2015.07.067 P020 BMI ASSESSMENT IN CHILDREN WITH CELIAC DISEASE BEFORE AND AFTER GLUTEN FREE DIET G.A. Mazza 1,∗ , V. Talarico 1 , M. Barreca 1 , S. Lavano 1 , R. Miniero 1 , L. Giancotti 2 1
Scuola di Specializzazione in Pediatria. Università Magna Graecia di Catanzaro, Italy 2 Cattedra di Pediatria Università “Magna Graecia” di Catanzaro, Centro regionale conferma diagnostica e follow-up della malattia celiaca, Italy Introduction: The clinical presentation of celiac disease (CD) has changed in the last decade and patients are often overweight at diagnosis. Furthermore there is concern that patients might gain further weight while on gluten free diet (GFD). The aim of this study is to evaluate the distribution of the Body Mass Index (BMI) values at the time of diagnosis in a cohort of celiac children living in Calabria, and to estimate the impact of the GFD on their BMI. Materials and methods: We conducted a retrospective analysis on the medical records of children with CD, aged 6 months-20 years, observed at our unit. Each patient was evaluated at the time of diagnosis of CD (T0) and after 24 months from the beginning of the diet (T1). A total of 125 patients, 35 males and 90 females, were grouped into 4 categories, as defined by the Centers for Disease Control and Prevention, according to their BMI percentile at T0: underweight, normal-weight, overweight, obese. Results: At T0 9.6% of patients were overweight, 6.4% obese and 69.6% normal-weight, the remaining 14.4% underweight. At T1 10.4% of patients were underweight, 66.4% normal weight, 12% overweight and 11.2% obese. Conclusions: A normal or high BMI is a common condition at diagnosis of CD in children, even if less than in the control population. Albeit the GFD has a beneficial effect on the BMI of underweight patients but it could be responsible for an undesirable BMI increase in patients who are normal-weight at diagnosis of CD. http://dx.doi.org/10.1016/j.dld.2015.07.068
Abstracts / Digestive and Liver Disease 47S (2015) e237–e276
P018 SPLANCHNIC OXYGENATION PATTERNS AT FIRST FEED IN STABLE PRETERM INFANTS: CORRELATION WITH FEEDING INTOLERANCE DEVELOPMENT S. Martini 1,∗ , B. Battistini 1 , A. Aceti 1 , P. Rucci 2 , G. Faldella 1 , L. Corvaglia 1 1 U.O. Terapia Intensiva Neonatale, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Bologna, Italy 2 Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
Introduction and aim: Due to their gastro-intestinal immaturity, preterm infants are more prone to develop feeding intolerance (FI), which frequently hampers the establishment of an adequate enteral nutrition. Previous Doppler studies showed an impaired mesenteric blood flow velocity after the first feed in preterm infants developing FI. We aimed to evaluate splanchnic oxygenation patterns in response to the first enteral feed and possible correlations with subsequent FI development. Methods: Stable preterm infants (gestational age ≤34 weeks) underwent a 3-hour Near-Infrared Spectroscopy monitoring at first enteral feed administration. The enrolled infants were retrospectively allocated into 2 groups in relation to the development of FI during their hospital stay (food intolerance [FI] vs. food tolerance [FT]). Mann–Whitney U test was used to compare splanchnic oxygenation patterns between the two groups. Statistical significance was set at p < 0.05. Results: Seventy-eight preterm infants were enrolled; 30 out of 78 developed FI during their hospital stay. Splanchnic oxygenation patterns in response to the first feed differed significantly between two groups, with lower values of splanchnic tissue oxygenation in the FI group during the first 35 after the first feed and from 1 h 30 on (p < 0.05). Conclusions: Splanchnic oxygenation in response to the first enteral feed is significantly lower in preterm infants developing FI. This finding could reflect an early impairment of mesenteric regional circulation with subsequent tissue hypoxia, which might possibly predispose to the development of FI. http://dx.doi.org/10.1016/j.dld.2015.07.066 P019 ORAL ABSORPTION OF IRON BIS-GLYCINATE CHELATE IN CHILDREN WITH CELIAC DISEASE AND IRON DEFICIENCY G.A. Mazza 1,∗ , E. Battaglia 2 , L. Pedrelli 2 , R. Miniero 1 , L. Giancotti 3 1
Scuola di Specializzazione in Pediatria, Università Magna Graecia di Catanzaro, Italy 2 Lab Analisi Chimica-Clinica-RIA Osp, Pugliese-Ciaccio. Catanzaro, Italy 3 Cattedra di Pediatria Università “Magna Graecia” di Catanzaro – Centro regionale conferma diagnostica e follow-up della malattia celiaca, Italy Objective: Iron deficiency (ID) and iron deficiency anemia (IDA) are very common conditions in children with celiac disease (CD), mainly due to iron malabsorption. We demonstrated good absorption and bioavailability of iron bis-glycinate chelate (IBC) in 11 children at diagnosis of CD (with ID or IDA) using the oral iron absorption test (OIAT) and observing an increase in serum iron after
3 h at least twice the baseline values. Here we report preliminary data, after a 3-months course of IBC therapy. Methods: We considered 3 patients (aged 18, 16 and 14 respectively) with CD at diagnosis, positive to the OIAT, who started the free gluten diet (GFD) and received oral iron therapy (14 mg/d). We reassessed iron nutritional status and serological markers of CD after 3 months. Results: Treatment was well tolerated. Serum iron, transferrin, ferritin and red blood cell indices significantly improved in all patients along with a partial reduction of the serological markers of disease. Conclusions: These results confirm good reliability of the OIAT in the planning of oral iron therapy. Furthermore our data demonstrate the good efficacy of the IBC in children with newly diagnosed CD, who still bring the characteristic lesions of the duodenal mucosa, therefore poor in DMT1 expression. This would suggest that IBC has a different way of absorption not mediated by the DMT1. For this reason IBC might represent a leader compound in the treatment of ID and IDA in patients with CD even at time of diagnosis. We declare no conflict of interest. http://dx.doi.org/10.1016/j.dld.2015.07.067 P020 BMI ASSESSMENT IN CHILDREN WITH CELIAC DISEASE BEFORE AND AFTER GLUTEN FREE DIET G.A. Mazza 1,∗ , V. Talarico 1 , M. Barreca 1 , S. Lavano 1 , R. Miniero 1 , L. Giancotti 2 1
Scuola di Specializzazione in Pediatria. Università Magna Graecia di Catanzaro, Italy 2 Cattedra di Pediatria Università “Magna Graecia” di Catanzaro, Centro regionale conferma diagnostica e follow-up della malattia celiaca, Italy Introduction: The clinical presentation of celiac disease (CD) has changed in the last decade and patients are often overweight at diagnosis. Furthermore there is concern that patients might gain further weight while on gluten free diet (GFD). The aim of this study is to evaluate the distribution of the Body Mass Index (BMI) values at the time of diagnosis in a cohort of celiac children living in Calabria, and to estimate the impact of the GFD on their BMI. Materials and methods: We conducted a retrospective analysis on the medical records of children with CD, aged 6 months-20 years, observed at our unit. Each patient was evaluated at the time of diagnosis of CD (T0) and after 24 months from the beginning of the diet (T1). A total of 125 patients, 35 males and 90 females, were grouped into 4 categories, as defined by the Centers for Disease Control and Prevention, according to their BMI percentile at T0: underweight, normal-weight, overweight, obese. Results: At T0 9.6% of patients were overweight, 6.4% obese and 69.6% normal-weight, the remaining 14.4% underweight. At T1 10.4% of patients were underweight, 66.4% normal weight, 12% overweight and 11.2% obese. Conclusions: A normal or high BMI is a common condition at diagnosis of CD in children, even if less than in the control population. Albeit the GFD has a beneficial effect on the BMI of underweight patients but it could be responsible for an undesirable BMI increase in patients who are normal-weight at diagnosis of CD. http://dx.doi.org/10.1016/j.dld.2015.07.068