A. Laneve

Lactobacillus GG improves recovery in infants with blood in the stools and presumptive allergic colitis compared with extensively hydrolyzed formula alone.

OBJECTIVES To determine the benefits of Lactobacillus rhamnosus GG (LGG) in an extensively hydrolyzed casein formula (EHCF) in improving hematochezia and fecal calprotectin over EHCF alone. STUDY DESIGN Fecal calprotectin was compared in 30 infants with hematochezia and 4 weeks after milk elimination with that of a healthy group. We also compared fecal calprotectin and hematochezia on 26 formula-fed infants randomly assigned to EHCF with LGG (Nutramigen LGG) (EHCF + LGG) or without (Nutramigen) (EHCF - LGG) and on 4 breastfed infants whose mothers eliminated dairy. RESULTS Fecal calprotectin in those with hematochezia was significantly higher than in comparisons (mean +/- SD 325.89 +/- 152.31 vs 131.97 +/- 37.98 microg/g stool, t = 6.79, P < .0001). At 4 weeks, fecal calprotectin decreased to 50% of baseline but was still significantly higher than in comparisons (157.5 +/- 149.13 vs 93.72 +/- 36.65 microg/g, P = .03). Fecal calprotectin mean decrease was significantly larger among EHCF + LGG compared with EHCF - LGG (-214.5 +/- 107.93 vs -112.7 +/- 105.27 microg/g, t = 2.43, P = .02). At 4 weeks, none of the EHCF + LGG had blood in stools, and 5/14 on EHCF - LGG did (P = .002). CONCLUSION Fecal calprotectin is elevated in infants with hematochezia and possible allergic colitis. EHCF + LGG resulted in significant improvement of hematochezia and fecal calprotectin compared with the EHCF alone.

Observational study on candidaemia at a university hospital in southern Italy from 1998 to 2004

In an observational study on candidaemia in hospitalised patients, conducted in a southern Italy hospital during 1998–2004, 155 cases were noted. Candida albicans (CA) was isolated in 71 (45.8%) cases involving mainly patients recovered in ICU, General Surgery and Neonatology. Candida non‐albicans (CnA) species were isolated by 84 (54.2%) candidaemic patients, and in particular, Candida parapsilosis was the most frequent species isolated in Pediatric Oncology. 91.6% of the patients had a central venous catheter and only 46.4% were receiving antifungal prophylaxis. Among these patients, 87.5% (63) developed CnA infections; in particular, 41 patients had a C. parapsilosis bloodstream infection. During our study, we observed a variable drift from 1998 to 2003; we registered an evident increment of CnA candidaemia (76.9%) and a decrease of CA cases (23%) only in 2004. The mortality was 26.7%, and we observed that CA was associated with the highest rate of mortality (53.6%). Although Candida infections are correlated primarily with risk factors, their resolution depends on timely diagnosis and early therapy.

Fecal calprotectin (FC) in newborns: is it a predictive marker of gastrointestinal and/or allergic disease?

Fecal calprotectin seems to provide a safe and non-invasive means of helping differentiate between patients with organic and non-organic intestinal disease. Aim of our study was to evaluate if FC levels at birth and at first month of age can be a predictive biomarker of organic or functional gastrointestinal disease (FGIDs) and/or allergic disease diagnosed in 2 years old children. Between December 2007 and January 2008 a telephonic interview has been proposed to the parents of 109 consecutive healthy children, in which FC was measured at birth two years before. For our study, a modified version of the original paediatric questionnaire on paediatric functional gastrointestinal disorders (QPGS) was used for the interview. Specific questions were added to detect allergic diseases. We did’nt find any statistically significant result between FC measured at birth and during first month of life in children with allergy or not. The interference of familiarity does not lead to a statistically significant change in the fecal calprotectin values during the first month of life.

A Case of Fetal Midgut Volvulus and Jejunal Atresia: Nutritional Support and Maintenance of Mucosal Function and Integrity

Fetal midgut volvulus is a quite rare disease. Here, we report a case of a preterm newborn with fetal peritonitis, jejunal atresia with volvulus of post-atresic small bowel since about 30 cm from ileo-cecal valve (ICV) followed by a not-used microileus and microcolon. The surgical intervention consisted in the resection of volvulated necrotic small bowel followed by primary anastomosis. After surgery, total parenteral nutrition (TPN) has been started since 16th of post-operative days when enteral feeding (EN) was administered with a lactose-free formula containing hydrolyzed protein and medium-chain triglycerides (Pregestimil). Re-establishing intestinal continuity was preferred rather than stoma that would have required TPN. In fact, re-operation could have led to a shorter residual small bowel (RSB), since the anastomosis was at 15 cm from ICV. Our study provides evidence that not only the type of procedure (enteral versus parenteral) of nutritional support, but also the type of milk may modify the outcome. Early EN should be encouraged in newborn abdominal surgical patients because it is associated with reduced complications.

Usefulness of tissue transglutaminase type 2 antibodies in early pregnancy

Celiac disease (CD), an autoimmune disease triggered by dietary gluten, is a multi-systemic disorder that primarily results in mucosal damage of the small intestine. Reproductive disorders and pregnancy complications have been associated with CD. Conflicting results have been published concerning CD and the risk of impaired fetal growth with reduced birthweight. The aim of our multicentric, perspective, case–control study was to determine the prevalence of undiagnosed CD in mothers of small for gestational age (SGA) newborns in two regions of Italy. The study included 480 mothers: group A consisted of 284 SGA newborns’ mothers and group B consisted of 196 appropriate for gestational age (AGA) newborns’ mothers. Tissue transglutaminase type 2 antibodies (TG2) IgA and IgG were measured in blood samples. We diagnosed two new cases of CD in asymptomatic mothers. It may be appropriate to include the TG2 to the panel of prenatal blood test.

PP54 PROBIOTIC VSL#3 MAY BE EFFECTIVE TO CHANGE THE PROFILE OF CYTOCHINES AND IMMUNOGLOBULINS IN BREAST MILK?

The first month of life represents a critical period for the maturation of the infant’s immune system and, thus, this is a window of opportunity to adopt measures to reduce the risk of diseases. Aim of Study: To examine the specific effects of maternal supplementation with the oral probiotic VSL#3 on breast milk health promoting agents (cytokines and immunoglobulins). Patients andMethods: The study population consisted of 18 healthy pregnant women recruited from the Policlinico Hospital-Department of Obstetrics, Gynecology and Neonatology, University of Bari (Italy). Exclusion criteria were the use of antibiotics or other probiotics during the study period, diabetes and other chronic illnesses. Half of the mothers received daily VSL#3 probiotic supplementation starting from 1 month before delivery until 1 month after delivery while the other 9 pregnant women were used as control. VSL#3 (VSL Pharmaceuticals, Inc, Towson, MD) consisted of sachets containing 900 billion live lyophilized bacteria of 4 strains of Lactobacillus (L. paracasei, L. plantarum, L. acidophilus, and L. delbrueckii subsp. bulgaricus), 3 strains of bifidobacteria (B. longum, B. breve, and B. infantis), and 1 strain of Streptococcus thermophilus. Milk and stool samples were collected 3 days (T0) and one month (T30) after delivery in order to assess cytokines values (Il-6, IL-1β, Il-10 and TGFβ-1) and immunoglobulin values (IgA, IgG, IgM) in breast milk of healthy mothers and immunoglobulins values (IgA, IgG, IgM) in stool samples of their newborns,.The concentrations of TGF-β1, IL-6, IL-10 and IL-1β were analyzed using commercial kits (R & D System Inc., Minneapolis, MN, USA; Research Diagnostics Inc., Flandern, NJ, USA). Statistical analysis: Analysis was done by SPSS. A non parametrical test for independent samples (U-Mann-Whitney) was performed for each variable examined. Results: TGF-β values (pg/ml) were higher at T0 in VSL#3 group (mean: 637±520 vs 381±143.31 (p<0.006). and increased significantly at T30 in the VSL#3 group (1754±1151.16) but not in control group (273±53.81) (p<0.001). IL10: in both groups, there was significant decrease between T0 and T30. No group difference was observed at T0 but at T30, IL10 levels were significantly higher in the VSL#3 group (85±9.81 vs 72±17.93) (p=0.01). IL-1β: significantly higher at T0 in VSL#3 group (284±448.63 vs 46±68.01) (p=0.02). Immunoglobulins. IgA and IgM levels were significantly higher (p<0.05) at T30 and IgG levels were significantly higher at both T0 and T30 in the milk samples of the VSL#3 group (p<0.05). Regarding the stool samples, IgM levels were significantly higher at T0 and T30 and IgA and IgG were significantly higher at T30 in the VSL#3 group (p<0.05) Conclusion: These data indicate that VSL#3 may be a powerful immunomodulator in terms of cytokines and immunoglobulin production, mostly at mucosal surface. Preliminary experiments also indicate that VSL#3 can represent a good supplement in the diet of pregnant women.