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Pediatric Gastroenterology and Nutrition
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Pediatric Gastroenterology and Nutrition

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Surgery".

Deadline for manuscript submissions: closed (1 February 2021) | Viewed by 17962

Special Issue Editor

Dr. Carmine Noviello

E-Mail Website
Guest Editor
Paediatric Surgery Unit, Departement of Woman, Child, General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, 81100 Caserta, CE, Italy
Interests: gastroesophageal reflux; hirschsprung’s disease; esophageal atresia; constipation; gastrostomy; necrotizing enterocolitis

Special Issue Information

Dear Colleagues,

The problems of the gastrointestinal system are among those most studied in the pediatric field. Constipation alone has a prevalence that, according to some studies, reaches 30% of the pediatric population and is the reason a third of patients are visited by a pediatric gastroenterologist. These children need a precise diagnosis, considering that at this age, constipation can be a sign of malformative disease, and they also need appropriate care and continuous checks.

Another important problem that affects the pediatric population is nutrition in neurologically impaired and syndromics patients who often require surgical treatment: gastrostomy, fundoplication, jejunostomy, etc.

The field of interest is very big and involves pediatric gastroenterologists, pediatric surgeons, nutritionists and all those who are interested in diseases of the digestive system in pediatric age. The goal would be to make a collection of works that tackle all intestinal problems, from the newborn to the adolescent.

There are many ideas, starting from the study of the important problem of constipation to the nutritional approach in neurologically impaired patients , passing through the classic pediatric malformative diseases up to the big problem of necrotizing enterocolitis.

We count on the help of experts in this area to solve the issues related to the abovementioned topics through excellent contributions.

Dr. Carmine Noviello
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastroesophageal reflux
  • constipation
  • gastroenterology
  • necrotizing enterocolitis
  • gastrostomy
  • children
  • pediatric surgery

Published Papers (7 papers)

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Editorial

Jump to: Research

2 pages, 147 KiB  
Editorial
New Surgical Frontiers for Nutrition in Children
by Carmine Noviello
Children 2021, 8(5), 400; https://doi.org/10.3390/children8050400 - 15 May 2021
Viewed by 1227
Abstract
Nutrition in pediatric age, if properly adapted to the various developmental phases, can be considered the first prevention tool for the most common pathologies of this age [...] Full article
(This article belongs to the Special Issue Pediatric Gastroenterology and Nutrition)

Research

Jump to: Editorial

16 pages, 289 KiB  
Article
Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices
by Miguel Baños-Peláez, Valeria Avila-Sosa, Luis Alberto Fernández-Carrocera, Gabriela González-Pérez, Sandra Carrera-Muiños, Maria Antonieta Rivera-Rueda, Guadalupe Cordero-González, Silvia Romero, Alejandra Coronado-Zarco, Estibalitz Laresgoiti-Servitje and Claudine Irles
Children 2021, 8(4), 253; https://doi.org/10.3390/children8040253 - 24 Mar 2021
Cited by 6 | Viewed by 2401
Abstract
(1) Background: The relationship between enteral nutrition and neonatal necrotizing enterocolitis (NEC) among premature neonates is still unclear. The present work was designed to assess the relationship between NEC and feeding strategies compared to control infants. (2) Methods: A retrospective case-control study of [...] Read more.
(1) Background: The relationship between enteral nutrition and neonatal necrotizing enterocolitis (NEC) among premature neonates is still unclear. The present work was designed to assess the relationship between NEC and feeding strategies compared to control infants. (2) Methods: A retrospective case-control study of premature infants (<35 weeks’ gestation) with or without NEC that examined feeding practices and clinical characteristics at birth and 3, 7, and 14-day hospitalization, with a longitudinal and cross-sectional analysis. (3) Results: A total of 100 newborns with NEC diagnosis and 92 neonates without the disease with similar demographic and clinical characteristics were included. The median day of NEC diagnosis was 15 days (Interquartile Range (IQR) 5–25 days). A significantly higher number of neonates that were fasting on days 7 and 14 developed NEC (p < 0.05). In the longitudinal analysis, generalized linear and mixed models were fit to evaluate NEC association with feeding strategies and showed that exclusive mother’s own milk (MM) and fortified human milk (FHM) across time were significantly less likely associated with NEC (p < 0.001) and that enteral fasting was positively related with NEC. In the cross-sectional analysis, a binary logistic regression model was fit and predicted 80.7% of NEC cases. MM was also found to correlate with a reduced risk for NEC (OR 0.148, 95% CI 0.044–0.05, p = 0.02), and in particular, on day 14, several factors were related to a decreased odd for NEC, including birth weight, antenatal steroids, and the use of FHM (p < 0.001). (4) Conclusions: MM and FHM were associated with less NEC compared to fasting on days 7 and 14. Feeding practices in Neonatal Intensive Care Units (NICUs) should promote exclusive MM across the two-week critical period as a potential guideline to improve NEC outcome. Full article
(This article belongs to the Special Issue Pediatric Gastroenterology and Nutrition)
9 pages, 579 KiB  
Article
Usefulness of Gastrojejunostomy Prior to Fundoplication in Severe Gastro-Esophageal Reflux Complicating Long-Gap Esophageal Atresia Repair: A Preliminary Study
by Francesca Destro, Luciano Maestri, Milena Meroni, Federico Rebosio, Giulia Del Re, Cecilia Mantegazza, Valeria Calcaterra and Gloria Pelizzo
Children 2021, 8(1), 55; https://doi.org/10.3390/children8010055 - 17 Jan 2021
Cited by 3 | Viewed by 1762
Abstract
Background: Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary [...] Read more.
Background: Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA. Methods: Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. Post-surgical follow-up, including growth evolution, complications, and parental quality of life (QoL), were considered. Results: The TGJ was placed at a mean age of 8.6 ± 5.6 months. The procedure was uneventful and well-tolerated in all seven cases. At 6.6 ± 2.0 months after TGJ placement, significant weight gain (weight z-score −2.68 ± 0.8 vs −0.9 ± 0.2, p < 0.001) was recorded, allowing the GERD surgery to proceed. A significant difference in hospital admissions between 3 months before and post-TGJ insertion was noted (4.8 ± 0.75 vs. 1.6 ± 0.52, p < 0.01). A significant amelioration of QoL after TGJ placement was also recorded; in particular, the biggest improvements were related to parents’ perceptions of the general health and emotional state of their babies (p < 0.001). Conclusions: The placement of TGJ as a temporary nutritional tool in selected cases of LGEA could improve nutritional conditions and parental QoL before fundoplication, allowing successful surgical treatment of GERD to be carried out. Full article
(This article belongs to the Special Issue Pediatric Gastroenterology and Nutrition)
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9 pages, 607 KiB  
Article
Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study
by Elisa Zambaiti, Calogero Virgone, Silvia Bisoffi, Roberta Stefanizzi, Francesco Fascetti Leon and Piergiorgio Gamba
Children 2021, 8(1), 22; https://doi.org/10.3390/children8010022 - 04 Jan 2021
Cited by 2 | Viewed by 1778
Abstract
Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is [...] Read more.
Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1–12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, p < 0.005) and days hospitalization/year (3 vs. 13, p = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, p = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center. Full article
(This article belongs to the Special Issue Pediatric Gastroenterology and Nutrition)
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10 pages, 235 KiB  
Article
Esophageal Atresia: Nutritional Status and Energy Metabolism to Maximize Growth Outcome
by Gloria Pelizzo, Francesca Destro, Giorgio Giuseppe Orlando Selvaggio, Luciano Maestri, Margherita Roveri, Alessandra Bosetti, Barbara Borsani, Erica Pendezza, Milena Meroni, Andrea Pansini, Enrico La Pergola, Giovanna Riccipetitoni, Annalisa De Silvestri, Hellas Cena and Valeria Calcaterra
Children 2020, 7(11), 228; https://doi.org/10.3390/children7110228 - 14 Nov 2020
Cited by 8 | Viewed by 3941
Abstract
Background: Long-term negative sequelae of esophageal atresia (EA) may induce poor growth and impaired nutritional status in childhood. We describe the nutritional profile and energy metabolism of children with repaired EA to identify malnutrition risk factors and optimize growth management. Methods: Twenty-one children [...] Read more.
Background: Long-term negative sequelae of esophageal atresia (EA) may induce poor growth and impaired nutritional status in childhood. We describe the nutritional profile and energy metabolism of children with repaired EA to identify malnutrition risk factors and optimize growth management. Methods: Twenty-one children (>4 years) were included, and anthropometric measurements, nutritional assessment, and energy metabolism were considered. The subjects were defined as undernourished if they met BMI < −2 standard deviation (SD). To grade undernutrition, we defined the prevalence of underweight, stunting, and wasting (cut-off level of <−2 SD). Medical records were reviewed for the type of EA and surgery and perinatal data. Results: Malnutrition was detected in 28.6% of children. Underweight was detected in 23.8% of patients (all with undernutrition p < 0.01). Wasting was noted in 28.6% of patients, of these 5 children were undernourished (p < 0.001) and stunting was noticed in only one patient with malnutrition (p = 0.5). Resting expenditure energy (REE) was lower in undernourished subjects compared to subjects with adequate nutritional status (p < 0.001). Malnutrition was associated to: type of EA (p = 0.003, particularly type A and C); intervention including deferred anastomosis due to long-gap repair (p = 0.04) with/or without jejunostomy (p = 0.02), gastric pull-up (p = 0.04), primary anastomosis (p = 0.04), pyloromyotomy in long-gap (p < 0.01); small for gestational age condition (p = 0.001). Conclusions: undernutrition risk factors, beyond the type of malformation, surgery, and perinatal factors, must be early considered to personalize nutritional programming. Energy metabolism is important to monitor the nutritional requirements. The management of nutritional issues is surely a contributory factor able to counteract the poor growth of children with EA. Full article
(This article belongs to the Special Issue Pediatric Gastroenterology and Nutrition)
10 pages, 218 KiB  
Article
High Resolution Manometry Guidance During Laparoscopic Fundoplication in Pediatric Surgically “Fragile” Patients: Preliminary Report
by Anna Maria Caruso, Mario Milazzo, Vincenzo Tulone, Carlo Acierno, Vincenza Girgenti, Salvatore Amoroso, Denisia Bommarito, Valeria Calcaterra and Gloria Pelizzo
Children 2020, 7(11), 215; https://doi.org/10.3390/children7110215 - 07 Nov 2020
Cited by 4 | Viewed by 1631
Abstract
Background: High resolution manometry (HRM), has been recently introduced in clinical practice to detect esophageal intraluminal pressure and esophageal motor function. We evaluated the feasibility and usefulness of intraoperative esophageal HRM during antireflux laparoscopic procedures in pediatric cases with neurological impairment (NI) or [...] Read more.
Background: High resolution manometry (HRM), has been recently introduced in clinical practice to detect esophageal intraluminal pressure and esophageal motor function. We evaluated the feasibility and usefulness of intraoperative esophageal HRM during antireflux laparoscopic procedures in pediatric cases with neurological impairment (NI) or esophageal atresia (EA). Methods: From January to November 2019, seven children (5 NI, 2 EA) with gastroesophageal reflux (GER) were enrolled. Data on intraoperative pressure changes of the esophagogastric junction (EGJ) and postoperative follow-up data were collected. Results: Average preoperative LES pressures were not significantly different from postoperative pressures. A sliding hernia was detected in all patients as evidenced by EGJ double peak pressures. Hernia correction after esophageal traction was complete in 71.4% of the patients, and residual hernia (<2 cm) was detected in 28.6%. Postoperative EGJ pressures were higher compared to preoperative sphincteric pressures (p < 0.001); in NI patients, higher postoperative values were noted compared to EA (p = 0.05). No sliding hernia and/or GER relapses were recorded. Two patients reported dysphagia postoperatively. Conclusions: Intraoperative HRM may optimize esophageal pressure changes during laparoscopic fundoplication. Further studies are needed to confirm the usefulness of a tailored surgical approach to reduce postoperative complications. Full article
(This article belongs to the Special Issue Pediatric Gastroenterology and Nutrition)
7 pages, 2057 KiB  
Article
Preliminary Study on the Echo-Assisted Intersphincteric Autologous Microfragmented Adipose Tissue Injection to Control Fecal Incontinence in Children Operated for Anorectal Malformations
by Giovanni Parente, Valentina Pinto, Neil Di Salvo, Simone D’Antonio, Michele Libri, Tommaso Gargano, Vincenzo Davide Catania, Giovanni Ruggeri and Mario Lima
Children 2020, 7(10), 181; https://doi.org/10.3390/children7100181 - 13 Oct 2020
Cited by 7 | Viewed by 4496
Abstract
Aim of the study: To assess the efficacy of a novel technique (echo-assisted intersphincteric autologous microfragmented adipose tissue injection, also called “anal-lipofilling”) in the management of non-responsive fecal incontinence in children born with anorectal malformations (ARMs). Methods: Following ethical committee approval (CHPED-MAR-18-02), anal-lipofilling [...] Read more.
Aim of the study: To assess the efficacy of a novel technique (echo-assisted intersphincteric autologous microfragmented adipose tissue injection, also called “anal-lipofilling”) in the management of non-responsive fecal incontinence in children born with anorectal malformations (ARMs). Methods: Following ethical committee approval (CHPED-MAR-18-02), anal-lipofilling was proposed to patients with fecal incontinence not responsive to medications or bowel management (bowel enema and/or transanal irrigation automatic systems), then a prospective study was conducted. Anal-lipofilling consisted of three phases: lipoaspiration from the abdominal wall, processing of the lipoaspirate with a Lipogems system and intersphincteric injection of the processed fat tissue via endosonographic assistance. A questionnaire based on Krickenbeck’s scale (KS) was administered to the patients to evaluate the clinical outcome. Main Results: Four male patients (three recto-urethral fistula, and one recto-perineal fistula) underwent the anal-lipofilling procedure at a mean age of 13.0 ± 4.2 yrs. There were no complications during or after the procedure. From an initial assessment of the patients there was an improvement in the bowel function at a median follow up of 6 months, with better scores at KS (100% Soiling grade three pre-treatment vs. 75% grade one post-treatment). Conclusions: Even if our Study is preliminary, echo-assisted anal-lipofilling could be considered as a feasible and safe alternative technique in the management of the fecal incontinence in non-responding ARMs patients. More studies are still necessary to support the validity of the implant of autologous adipose tissue in the anal sphincter as a therapy for fecal incontinence in children born with ARMs. Full article
(This article belongs to the Special Issue Pediatric Gastroenterology and Nutrition)
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