Baldassarre, Maria Elisabetta
(Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari)
,
Di Mauro, Antonio
(Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari)
,
Salvatore, Silvia
(Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria)
,
Tafuri, Silvio
(Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari)
,
Bianchi, Francesco Paolo
(Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari)
,
Dattoli, Enzo
(Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria)
,
Morando, Lucia
(Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria)
,
Pensabene, Licia
(Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro)
,
Meneghin, Fabio
(Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan)
,
Dilillo, Dario
(Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan)
,
Mancini, Valentina
(Pediatric Unit, Saronno Ho)
,
Talarico, Valentina
,
Tandoi, Francesco
,
Zuccotti, Gianvincenzo
,
Agosti, Massimo
,
Laforgia, Nicola
Purpose: To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. Methods: This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up...
Purpose: To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. Methods: This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10-90th percentile), small (SGA, weight 90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life. Results: Among 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic. Conclusion: We observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.
Purpose: To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. Methods: This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10-90th percentile), small (SGA, weight 90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life. Results: Among 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic. Conclusion: We observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
제안 방법
In this large neonatal cohort, the authors evaluated only infantile colic, defined by Wessel's criteria, at six months of life through parental interviews, and observed the strongest association with colic among infants with a birth weight <2,000 g (OR=1.7; 95% CI, 1.3–2.2) and born before gestational week 32 (OR=1.6; 95% CI, 1.1–2.4) [20].
Univariate logistic regression analysis was used to evaluate the association between FGIDs and birth weight classifications, delivery mode, feeding pattern, antibiotic use during the first week of life, and the duration of hospitalization after birth (>4 days/≤4 days).
대상 데이터
The study was conducted between 2014 and 2016 in five Italian pediatric and neonatal units (Varese, Milano, Parma, Bari, and Catanzaro). According to the study protocol, the exclusion criteria were: a) severe acute infection or neonatal complications; b) known genetic syndromes, or congenital and malformative disorders; c) surgery; d) major neurologic, immune, metabolic, cardiac, or renal diseases; e) absence of parental consent; and f ) language difficulties.
데이터처리
For non-normally distributed variables, a normalization model was set. A one-way ANOVA (parametric) with Bonferroni correction were used to compare normally distributed variables between groups. A Kruskall-Wallis test and Dunn test with Bonferroni correction was used to compare non-normally distributed continuous variables between groups, as appropriate.
Categorical variables were compared using a chi-squared or Fisher's exact test.
이론/모형
A Skewness and Kurtosis test were used to evaluate the normal distribution of continuous variables. For non-normally distributed variables, a normalization model was set.
Subsequently, for each outcome, a multivariate logistic regression model was used with the same variables applied in the univariate logistic regression analysis. The adjusted RR (aRR) values were calculated with the 95% CI.
성능/효과
As expected, comparisons between SGA, AGA, and LGA neonates showed significant differences in gestational age, mode of delivery, birth weight, rate of breastfeeding, antibiotic use, and the duration of hospital stay (p<0.05 for all; Table 1).
Nonetheless, we are aware of some limitations of our research. First, we based our results on parental reports with a possible overestimation of symptoms in the more vulnerable populations of ELBW and SGA related to likely increased caregiver stress. More importantly, we cannot exclude that a lack of information regarding the occurrence of viral infections [34], probiotic administration [35,36], and other potential confounders such as neonatal gastric suction or other invasive procedures [37], respiratory support or naso-gastric tube feeding, exposure to smoke [38], daycare attendance, feeding characteristics [39], cow's milk protein allergies [40], and a family history of FGIDs [41] may have influenced our risk estimates of FGIDs.
In conclusion, ELBW, SGA, and LGA newborns appear to be at an increased risk of developing FGIDSs, especially infantile colic during the first months of life.
In this secondary analysis of a large neonatal cohort study, ELBW, SGA, and LGA newborns showed a significant increased risk for the development of at least one FGID throughout the first year of life, compared to neonates with different birth weight.
참고문헌 (43)
1 Baldassarre ME Di Mauro A Cintoli AN Mincarone G Tafuri S Laforgia N Non-communicable chronic diseases: the role of neonatal characteristics Iran J Pediatr 2017 27 e9322
2 Salvatore S Baldassarre ME Di Mauro A Laforgia N Tafuri S Bianchi FP Neonatal antibiotics and prematurity are associated with an increased risk of functional gastrointestinal disorders in the first year of life J Pediatr 2019 212 44 51 31201028
3 Søndergaard C Skajaa E Henriksen TB Fetal growth and infantile colic Arch Dis Child Fetal Neonatal Ed 2000 83 F44 7 10873171
4 Vandenplas Y Hauser B Salvatore S Functional gastrointestinal disorders in infancy: impact on the health of the infant and family Pediatr Gastroenterol Hepatol Nutr 2019 22 207 216 31110953
5 Mahon J Lifschitz C Ludwig T Thapar N Glanville J Miqdady M The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England BMJ Open 2017 7 e015594
6 Indrio F Di Mauro A Riezzo G Cavallo L Francavilla R Infantile colic, regurgitation, and constipation: an early traumatic insult in the development of functional gastrointestinal disorders in children? Eur J Pediatr 2015 174 841 842 25504357
7 Savino F Castagno E Bretto R Brondello C Palumeri E Oggero R A prospective 10-year study on children who had severe infantile colic Acta Paediatr Suppl 2005 94 129 132 16214780
8 Indrio F Di Mauro A Riezzo G Panza R Cavallo L Francavilla R Prevention of functional gastrointestinal disorders in neonates: clinical and socioeconomic impact Benef Microbes 2015 6 195 198 25609653
9 Baldassarre ME Di Mauro A Mastromarino P Fanelli M Martinelli D Urbano F Administration of a multi-strain probiotic product to women in the perinatal period differentially affects the breast milk cytokine profile and may have beneficial effects on neonatal gastrointestinal functional symptoms. A randomized clinical trial Nutrients 2016 8 677
10 Baldassarre ME Palladino V Amoruso A Pindinelli S Mastromarino P Fanelli M Rationale of probiotic supplementation during pregnancy and neonatal period Nutrients 2018 10 1693
12 Bertino E Spada E Occhi L Coscia A Giuliani F Gagliardi L Neonatal anthropometric charts: the Italian neonatal study compared with other European studies J Pediatr Gastroenterol Nutr 2010 51 353 361 20601901
15 Marild K Stephansson O Montgomery S Murray JA Ludvigsson JF Pregnancy outcome and risk of celiac disease in offspring: a nationwide case-control study Gastroenterology 2012 142 39 45.e3 21995948
16 Salvatore S Finazzi S Radaelli G Lotzniker M Zuccotti GV Premacel Study Group Prevalence of undiagnosed celiac disease in the parents of preterm and/or small for gestational age infants Am J Gastroenterol 2007 102 168 173 17100963
17 Steiner N Wainstock T Sheiner E Segal I Landau D Walfisch A Small for gestational age as an independent risk factor for long-term pediatric gastrointestinal morbidity of the offspring J Matern Fetal Neonatal Med 2019 32 1407 1411 29157049
18 Mezoff EA Aly H The winding road to understanding the neonatal origins of inflammatory gastrointestinal disorders J Pediatr Gastroenterol Nutr 2013 57 543 549 23857343
19 Iacono G Merolla R D'Amico D Bonci E Cavataio F Di Prima L Gastrointestinal symptoms in infancy: a population-based prospective study Dig Liver Dis 2005 37 432 438 15893282
20 Milidou I Søndergaard C Jensen MS Olsen J Henriksen TB Gestational age, small for gestational age, and infantile colic Paediatr Perinat Epidemiol 2014 28 138 145 24261325
21 Das UG Sysyn GD Abnormal fetal growth: intrauterine growth retardation, small for gestational age, large for gestational age Pediatr Clin North Am 2004 51 639 654 15157589
23 Ciccone MM Scicchitano P Salerno C Gesualdo M Fornarelli F Zito A Aorta structural alterations in term neonates: the role of birth and maternal characteristics BioMed Res Int 2013 2013 459168 23984364
24 Rhoads JM Collins J Fatheree NY Hashmi SS Taylor CM Luo M Infant colic represents gut inflammation and dysbiosis J Pediatr 2018 203 55 61.e3 30177353
25 Shamir R St James-Roberts I Di Lorenzo C Burns AJ Thapar N Indrio F Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms J Pediatr Gastroenterol Nutr 2013 57 Suppl 1 S1 S45 24356023
26 Melville JM Moss TJ The immune consequences of preterm birth Front Neurosci 2013 7 79 23734091
28 Steinborn A Engst M Haensch GM Mahnke K Schmitt E Meuer S Small for gestational age (SGA) neonates show reduced suppressive activity of their regulatory T cells Clin Immunol 2010 134 188 197 19837002
29 Rathore DK Nair D Raza S Saini S Singh R Kumar A Underweight full-term Indian neonates show differences in umbilical cord blood leukocyte phenotype: a cross-sectional study PLoS One 2015 10 e0123589 25898362
30 Prentice S They are what you eat: can nutritional factors during gestation and early infancy modulate the neonatal immune response? Front Immunol 2017 8 1641 29234319
31 Di Mauro A Neu J Riezzo G Raimondi F Martinelli D Francavilla R Gastrointestinal function development and microbiota Ital J Pediatr 2013 39 15 23433508
33 Indrio F Riezzo G Raimondi F Di Mauro A Francavilla R Gut motility alterations in neonates and young infants: relation to colic? J Pediatr Gastroenterol Nutr 2013 57 S9 11
34 Saps M Pensabene L Di Martino L Staiano A Wechsler J Zheng X Post-infectious functional gastrointestinal disorders in children J Pediatr 2008 152 812 6.e1 18492522
35 Baldassarre ME Di Mauro A Tafuri S Rizzo V Gallone MS Mastromarino P Effectiveness and safety of a probiotic-mixture for the treatment of infantile colic: a double-blind, randomized, placebo-controlled clinical trial with fecal real-time PCR and NMR-based metabolomics analysis Nutrients 2018 10 195
36 Indrio F Riezzo G Raimondi F Di Mauro A Francavilla R Microbiota involvement in the gut-brain axis J Pediatr Gastroenterol Nutr 2013 57 S11 5
39 Salvatore S Abkari A Cai W Catto-Smith A Cruchet S Gottrand F Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants Acta Paediatr 2018 107 1512 1520
40 Pensabene L Salvatore S D'Auria E Parisi F Concolino D Borrelli O Cow's milk protein allergy in infancy: a risk factor for functional gastrointestinal disorders in children? Nutrients 2018 10 1716
41 Levy RL Exploring the intergenerational transmission of illness behavior: from observations to experimental intervention Ann Behav Med 2011 41 174 182 21170690
42 Laforgia N Di Mauro A Favia Guarnieri G Varvara D De Cosmo L Panza R The role of oxidative stress in the pathomechanism of congenital malformations Oxid Med Cell Longev 2018 2018 7404082 30693064
※ AI-Helper는 부적절한 답변을 할 수 있습니다.