Comparison of mechanical ventilatory constraints between continuous and intermittent exercises in healthy prepubescent children.

International audienceBBackground: The aim of this study was to evaluate the occurrence and severity of mechanical ventilatory constraints in healthy prepubescent children during continuous and intermittent exercise. Methods: Twelve prepubescent children (7 - 11 years old) performed 7 exercises on a treadmill: one graded test for the determination of maximal aerobic speed (MAS), three continuous exercises (CE) at 60, 70 and 80% of MAS and three intermittent exercises (IE), alternating 15s of exercise with 15s of passive recovery, at 90, 100 and 110% of MAS. During each CE and IE, tidal flow/volume loops were plotted within a maximal flow/volume loop (MFVL) measured at rest before each exercise. Expiratory flow limitation (expFL expressed in %Vt) was defined as the part of exercise tidal volume (Vt) meeting the boundary of MFVL. Breathing strategy was estimated by measuring inspiratory capacity relative to forced vital capacity and tidal volume relative to inspiratory capacity. Other breathing pattern parameters (ventilation VE, Vt, respiratory frequency f) were continuously recorded during exercise. Results: An "intensity" effect was found for during CE (p<0.001) but not during IE (p=0.08). The increase in was predominantly assumed by an increase in f for both exercise modalities. During each exercise, several children heterogeneously experienced expFL ranging between 10 - 90%Vt. For all exercises, Vt was predominantly regulated by an increase in Vt/IC with no change in IC/FVC from rest to exercise. Finally, no significant "modality" effect was found for mechanical ventilatory constraint parameters (expFL, VT/IC and IV/FVC). Discussion: We could conclude that neither of the modalities studied induced more mechanical ventilatory constraints than the other, but that exercise intensities specific to each modality might be greater sources of exacerbation for mechanical ventilatory constraints

Breastfeeding shows a protective trend toward adolescents with higher abdominal adiposity

Objective: The question of whether breastfeeding has a protective effect against the development of overweight or obesity later in life remains controversial, especially during adolescence. The objective was to assess the relationship between breastfeeding and adolescents' body composition. Methods: The HELENA study is a cross-sectional study involving 3,528 adolescents from 10 European cities. The outcome measures were body weight and height, subscapular skinfolds as well as waist circumferences. Breastfeeding, smoking status, and parental socioeconomic status were assessed by self-administered questionnaires. Dietary intake was recorded using two 24 hour recall surveys. Two adjustment approaches were used: i) covariance analysis adjusted for confounding factors (propensity score adjustment) observed between breastfeeding and body composition parameters (BMI Z-score; sum of skinfolds, waist-to-height ratio). An adjusted quantile regression analysis showed a non-significant trend for a protective effect of breastfeeding toward the highest percentiles of adiposity in boys but not in girls. This is of particular interest with respect to the superiority of the waist-to-height ratio over waist circumference and BMI for detecting cardiometabolic risk factors. Conclusion: This first European study, including a large set of factors influencing adolescents body composition, showed a non significant trend toward a protective effect of breastfeeding on highest percentiles of adolescent's abdominal adiposity

ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula.

BackgroundEsophageal atresia (EA) is one of the most common congenital digestive anomalies. With improvements in surgical techniques and intensive care treatments, the focus of care of these patients has shifted from mortality to morbidity and quality-of-life issues. These children face gastrointestinal (GI) problems not only in early childhood but also through adolescence and adulthood. There is, however, currently a lack of a systematic approach to the care of these patients. The GI working group of International Network on Esophageal Atresia comprises members from ESPGHAN/NASPGHAN and was charged with the task of developing uniform evidence-based guidelines for the management of GI complications in children with EA.MethodsThirty-six clinical questions addressing the diagnosis, treatment, and prognosis of the common GI complications in patients with EA were formulated. Questions on the diagnosis, and treatment of gastroesophageal reflux, management of "cyanotic spells," etiology, investigation and management of dysphagia, feeding difficulties, anastomotic strictures, congenital esophageal stenosis in EA patients were addressed. The importance of excluding eosinophilic esophagitis and associated GI anomalies in symptomatic patients with EA is discussed as is the quality of life of these patients and the importance of a systematic transition of care to adulthood. A systematic literature search was performed from inception to March 2014 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation

Food intake of European adolescents in the light of different food-based dietary guidelines : results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study

Objective: Since inadequate food consumption patterns during adolescence are not only linked with the occurrence of obesity in youth but also with the subsequent risk of developing diseases in adulthood, the establishment and maintenance of a healthy diet early in life is of great public health importance. Therefore, the aim of the present study was to describe and evaluate the food consumption of a well-characterized sample of European adolescents against food-based dietary guidelines for the first time. Design: The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, whose main objective was to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12.5-17.5 years. Setting: Ten cities in Europe. Subjects: The initial sample consisted of more than 3000 European adolescents. Among these, 1593 adolescents (54% female) had sufficient and plausible dietary data on energy and food intakes from two 24 h recalls using the HELENA-DIAT software. Results: Food intake of adolescents in Europe is not optimal compared with the two food-based dietary guidelines, Optimized Mixed Diet and Food Guide Pyramid, examined in this study. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk (and milk products), but consume much more meat (and meat products), fats and sweets than recommended. However, median total energy intake may be estimated to be nearly in line with the recommendations. Conclusion: The results urge the need to improve the dietary habits of adolescents in order to maintain health in later life

The natural history of primary sclerosing cholangitis in 781 children. A multicenter, international collaboration

There are limited data on the natural history of primary sclerosing cholangitis (PSC) in children. We aimed to describe the disease characteristics and long-term outcomes of pediatric PSC. We retrospectively collected all pediatric PSC cases from 36 participating institutions and conducted a survival analysis from the date of PSC diagnosis to dates of diagnosis of portal hypertensive or biliary complications, cholangiocarcinoma, liver transplantation, or death. We analyzed patients grouped by disease phenotype and laboratory studies at diagnosis to identify objective predictors of long-term outcome. We identified 781 patients, median age 12 years, with 4,277 person-years of follow-up; 33% with autoimmune hepatitis, 76% with inflammatory bowel disease, and 13% with small duct PSC. Portal hypertensive and biliary complications developed in 38% and 25%, respectively, after 10 years of disease. Once these complications developed, median survival with native liver was 2.8 and 3.5 years, respectively. Cholangiocarcinoma occurred in 1%. Overall event-free survival was 70% at 5 years and 53% at 10 years. Patient groups with the most elevated total bilirubin, gamma-glutamyltransferase, and aspartate aminotransferase-to-platelet ratio index at diagnosis had the worst outcomes. In multivariate analysis PSC-inflammatory bowel disease and small duct phenotypes were associated with favorable prognosis (hazard ratios 0.6, 95% confidence interval 0.5-0.9, and 0.7, 95% confidence interval 0.5-0.96, respectively). Age, gender, and autoimmune hepatitis overlap did not impact long-term outcome. CONCLUSION: PSC has a chronic, progressive course in children, and nearly half of patients develop an adverse liver outcome after 10 years of disease; elevations in bilirubin, gamma-glutamyltransferase, and aspartate aminotransferase-to-platelet ratio index at diagnosis can identify patients at highest risk; small duct PSC and PSC-inflammatory bowel disease are more favorable disease phenotypes

An international survey on anastomotic stricture management after esophageal atresia repair:considerations and advisory statements

BACKGROUND: Endoscopic dilatation is the first-line treatment of stricture formation after esophageal atresia (EA) repair. However, there is no consensus on how to perform these dilatation procedures which may lead to a large variation between centers, countries and doctor’s experience. This is the first cross-sectional study to provide an overview on differences in endoscopic dilatation treatment of pediatric anastomotic strictures worldwide. METHODS: An online questionnaire was sent to members of five pediatric medical networks, experienced in treating anastomotic strictures in children with EA. The main outcome was the difference in endoscopic dilatation procedures in various centers worldwide, including technical details, dilatation approach (routine or only in symptomatic patients), and adjuvant treatment options. Descriptive statistics were performed with SPSS. RESULTS: Responses from 115 centers from 32 countries worldwide were analyzed. The preferred approach was balloon dilatation (68%) with a guidewire (66%), performed by a pediatric gastroenterologist (n = 103) or pediatric surgeon (n = 48) in symptomatic patients (68%). In most centers, hydrostatic pressure was used for balloon dilatation. The insufflation duration was standardized in 59 centers with a median duration of 60 (range 5–300) seconds. The preferred first-line adjunctive treatments in case of recurrent strictures were intralesional steroids and topical mitomycin C, in respectively 47% and 31% of the centers. CONCLUSIONS: We found a large variation in stricture management in children with EA, which confirms the current lack of consensus. International networks for rare diseases are required for harmonizing and comparing the procedures, for which we give several suggestions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-020-07844-6) contains supplementary material, which is available to authorized users