C Becheanu

Clinical characteristics of rotavirus diarrhea in hospitalized Romanian infants.

Clinical characteristics of rotavirus enteritis were evaluated by comparison with acute diarrhea of other etiologies. We reviewed the medical records of children (aged 0–12 months) admitted with acute diarrhea in our hospital between January and December 2011. Of the 839 patients, 49.3% had rotavirus diarrhea. The incidence of severe disease was significantly higher for rotavirus diarrhea (65.2%, P < 0.01) than for other types of diarrheal disease.

Antibiotic treatment of Clostridium difficile infection in children – a challenge in pediatric practice

Results Between January 1 2005 and July 31 2014, 52 patients were diagnosed with CDI. A large number of cases (61%) were diagnosed in the age group 1 to 4 years. The sex ratio was M/F = 0.9/1. 36% of patients had communityacquired CDI. In mild/moderate forms metronidazole was administered as a first-line treatment in 32 (61%) cases and proved efficient in 25/32 (78.1%) cases; vancomycin was used and was efficient in 18 cases. In severe forms (7.7%), the association of intravenous metronidazole and oral vancomycin was the option of choice and this approach cured all these cases. We report 11 patients with recurrent CDI (21%); in these cases oral vancomycin was efficient for the treatment of the recurrence. In 3 cases with a second recurrence rifaximin was the chosen therapy. Six out of 11 children with recurrent CDI had comorbidities (Hirschsprung disease, ulcerative colitis).

P30 Why is cow’s milk protein allergy diagnosis so difficult in infants with gastrointestinal symptoms?

Background and aims Current research reveals an increasing prevalence of cow’s milk protein allergy (CMPA). We aimed to evaluate infants with gastrointestinal symptoms and the consequent diagnosis of CMPA in a Romanian paediatric population. Methods Authors report partial results (July 2014-November 2016) of an on-going prospective study conducted in the Gastroenterology Department of ‘Grigore Alexandrescu’ Emergency Children’s Hospital, Bucharest. Children aged≤12 month with gastrointestinal symptoms suggestive for CMPA were included (persistent diarrhoea, bloody stools, loose mucous stools, recurrent vomiting, food refusal, constipation, abdominal pain). All underwent clinical evaluation, blood work-up, exclusion diet and for those without immediate reaction a oral food challenge (OFC) was done. Results Our study included 139 infants with symptoms suggesting CMPA. We excluded 87 patients: 7 infants didn’t respond to exclusion diet, 11 of them had negative OFC and the rest of 69 didn’t have an OFC (parents refused, had growth impairment or were lost from follow-up). 52 children were consequently diagnosed with CMPA following ESPGHAN guidelines. Median age at onset of symptoms was 3 months. 92% of infants came from urban areas. Sex ratio M/F=0.9. One third of the patients had a first-degree sibling with allergy. Only 37.5% were exclusively breastfeed until 4 month. Growth impairment was noted in 42.3% of cases. The most frequent presenting symptoms were loose mucous stool (46%), recurrent vomiting (28.8%), regurgitation (28.8%), food refusal (25%), bloody stools (23%). Cutaneous manifestations (urticaria, atopic eczema) were associated in 88.4% of patients. Specific IgEs were positive in 44.2% of patients. 15.3% of infants associated another food allergy (mostly eggs allergy). Conclusions CMPA remains a challenge for the paediatrician. Gastrointestinal symptoms are non-specific. However, associated cutaneous manifestations may be an usefull clinical indicator of CMPA. The gold standard in diagnosing CMPA remains OFC, which in daily practice is underused.

P246 Diagnosing caeliac disease in a romanian paediatric gastroenterology department over three decades

Background and aim Over the last decades, the diagnosis of cæliac disease (CD) changed significantly both in terms of clinical picture and laboratory diagnosis. The authors present the perspective of a Pædiatric Gastroenterology Department over a 32 years period. Method We performed a retrospective study including patients diagnosed with CD from Jan.1985 until Dec.2016 in „Gr. Alexandrescu’ Children’s Hospital. Three groups were formed, according to the diagnostic procedures used over time: first-intestinal biopsy, second-serology and biopsy, third-serology and biopsy or high values of anti-transglutaminase antibodies, a second positive serologic marker and HLA typing. Clinical characteristics at presentation were analysed. Results 231 children were included. First group contained 20 patients (mean age at diagnosis 5.9 years) diagnosed with classic forms of CD from 1985 until 1995 (1.8/year). Gastrointestinal (GI) symptoms were described in all, particularly chronic diarrhoea (90%). Four presented with cæliac crisis (20%). Second group included 152 patients diagnosed from 1996 until 2006 (once serologic screening was available the number of patients/year increased to 13.8). Mean age at diagnosis was 4.4 years. 86.8% presented with GI symptoms, but only 51.9% had chronic diarrhoea. Cæliac crisis was rarely seen (0.6%). Instead of classic forms with malabsorbtion, atypical presentations with non-GI symptoms were reported in 13.1%. Third group consisted of 59 patients diagnosed from 2007 until 2016 (at a mean age of 4). The number of patients presenting to a Gastroenterology Department decreased considerably (5.9/year). Half of the patients that reached our department presented with mild GI symptoms other than chronic diarrhoea: constipation, abdominal pain (50.9%). Conclusion Three decades ago the Pædiatric Gastroenterologist was diagnosing classic forms of CD with chronic diarrhoea in small numbers of children. Once cæliac serology was available, the diagnosis shifted to a large number of patients with a broad clinical spectrum. Now CD diagnosis is again set progressively less frequent in the Gastroenterology Department as mild GI symptoms suggesting rather functional than organic disease are often the form of presentation. As long as the CD awareness is high, the diagnosis might be successfully established in the primary care setting, in many cases without biopsy, according to the ESPGHAN guidelines.

O-047a Parents’ Complementary Feeding Related Information Sources – An Observational Study

Introduction and aims The impact of early nutrition habits is of extreme importance for future development and nutritional status. Many aspect of infants’ nutrition are based upon traditions and popular beliefs of the societies. This study was aimed to identify nutrition-related information sources for parents towards complementary feeding practices and to determine the variables that influence decision making regarding this nutritional period. Methods A longitudinal study was carried out in “Grigore Alexandrescu” Emergency Children’s Hospital from Bucharest, the capital of Romania, evaluating toddlers at their check-up visit at 1 year old. Data collection included interview questionnaires with parents upon 3 outcomes: complementary feeding, socio-demographic aspects and nutrition related information source. Results A total of 382 parents completed the questionnaire, with a response rate equivalent to 85.29%. There is a percentage of 44.7% of mothers that declaired they followed the paediatrician advise upon complementary feeding. This is mainly the case for urban population (56.0% vs. 21.6%), highly educated mothers (69.2% vs. 11.1%) and high economic level (69.8% vs. 12.9%). Friends and family are the most important sources for nutrition information mainly for mother in rural regions, low incomes and basic educational level (p < 0.05, CI 95%). Multivariate analyses showed that friends and family used as nutrition information sources are among risk factors for inappropriate complementary feeding practices (p < 0.001, CI 95%). Conclusion Paediatricians and primary health care providers should offer solid and valuable alternatives to parents using non-medical sources of information when weaning their infants in order to avoid future mistakes.

PO-0524 Neonatal Systemic Candidiasis: A 12-year Study

Background Invasive Candida species have become a common cause of late-onset sepsis in neonatal intensive care units. Significant risk factors include low birth weight, exposure to broad spectrum antibiotics, parenteral nutrition, lipid emulsion, central venous catheter and abdominal surgery. Material and method We performed a retrospective study over a period of 12 years (Jan 2002 to Jan 2014) in our hospital NICU. The aims of this study were to investigate the incidence of the systemic candidiasis, mortality rate, the implicated Candida strains, specific risk factors and antifungal treatment. Results All of our cases were outpatients. The average incidence of systemic candidiasis was 5.8% (111 cases) with a specific average mortality of 28%. In 96 cases (86.5%) not albicans Candida species were identified. 83 patients (74.7%) underwent abdominal surgery interventions; from these 42 had malformations of digestive tract and 16 presented abdominal wall defects. 12 operated patients remained with temporary ileostomies, 5 had colostomies and 4 cases associated short bowel syndrome. Also 23 (20.7%) were premature with birth weight under 1500 g; 25 cases presented also a bacterial sepsis. The antifungal therapy consisted of Fluconazol iv during the period 2002–2006; starting 2007 we used mainly Caspofungin iv. Also, starting 2011 all the patients with risk factors received oral prophylaxis with Nistatin. Conclusions Neonatal sepsis with Candida species still has a high rate of mortality and morbidity mainly linked of specific risk factors and other severe illnesses. Thereof more randomised trials regarding both oral and iv prophylaxis are needed.

PO-0145 Celiac Disease – The Experience Of A Single Centre In 29 Years

Aims The study aimed to evaluate the epidemiological and clinical profile of the patients diagnosed with celiac disease in ‘Grigore Alexandrescu’ Children’s Hospital over a 29 years period. Methods We performed a retrospective study including 224 patients diagnosed with celiac disease, from January 1985 until December 2013. Three groups resulted. The first group included patients diagnosed from 1985 until 1995, before celiac serology was available, the second group patients diagnosed from 1996 until 2006 using qualitative antitissue-transglutaminase antibodies and the third group patients diagnosed from 2007 until 2013 using quantitative antitissue-transglutaminase antibodies and HLA DQ2/DQ8 typing. From the medical records we extracted age and clinical characteristics of patients at presentation. Results The groups included 1.8, 13.8 and 7.7 patients/year. The mean age at diagnosis was 5.9 ± 4.7, 4.4 ± 3.6 and 4.4 ± 3.5 years respectively. Gastrointestinal symptoms were described in 100%, 86.8% and 59.2%, particularly chronic diarrhoea in 90%, 51.9% and 48.1%. Twenty percent of patients in the first group presented with celiac crisis, only 0.6% in the second group and none in the third. Non-gastrointestinal symptoms were not observed in the first group and were reported in the second and third groups in 13.1% and 61.1%. Conclusion Since 2007 a decreasing tendency in the number of patients diagnosed/year was observed. Gastrointestinal symptoms were initially the sole clinical finding, particularly chronic diarrhoea, but in time patients presented with non-gastrointestinal symptoms or oligosymptomatic/asymptomatic celiac disease with an increasing frequency.

706 Intestinal Epithelial Dysplasia - A Case Report of a Milder Phenotype

The intractable diarrhea of infancy remains a difficult challenge for the pediatrician. We report a rare case of a five-month-old female infant admitted in “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest for diarrheic stools and severe malnutrition with birth onset. She was exclusively breastfed with poor gain weight (360g in 5 months). During the 5 months of life the child was repeatedly admitted to other hospitals because of diarrhea and failure to thrive without a precise diagnosis. We mention that she had a sister who died at 3 months old because of severe diarrhea with birth onset. At admission the infant had severe malnutrition with watery diarrhea and facial dysmorphism. After extensive investigations we excluded infections and allergic causes, cystic fibrosis, immune and autoimmune enterophaty, motility disorders. We performed inferior and superior endoscopies with biopsies that excluded microvillus inclusion disease. Examination of the biopsy specimens (optic and electronic microscopy) revealed the diagnosis of intestinal epithelial dysplasia (IED). The patient received parenteral and enteral nutrition with elemental formulas. Previous reports have suggested that IED may be a congenital inherited autosomal recessive disease. We report a case of congenital enteropathy that represents a diagnostic and therapeutically challenge.

701 Burden of Rotavirus Gastroenteritis Among Hospitalized Infants in Romania

Background and Aims The rotavirus infection is a major cause of acute diarrhea in young children. The study aimed to evaluate the impact on healthcare and the economic burden associated with rotavirus gastroenteritis in infants, looking at incidence, disease severity and hospitalization costs. Methods We conducted an observational, retrospective study which included children younger than one year, hospitalized with rotavirus gastroenteritis in the Department of Pediatrics in “Grigore Alexandrescu” Emergency Children’s Hospital from January until June 2011. From the medical records we extracted: month of admission, age and sex, history of the disease, clinical characteristics, data on hospital course and costs of hospital stay. Vesikari severity score was calculated for each patient (score ≥11 = severe infection). Results We selected 429 infants hospitalized with acute diarrhea from a total of 11383 patients admitted in our department. The study included 247 infants with rotavirus gastroenteritis (2.17% of all children hospitalized). The percentage of rotavirus diarrhea was 57.6%. The highest incidence of rotavirus infection was recorded in January (78%). Mean age was 7 months and 62.3% of infants had severe diarrhea. Mean severity score was 11.3. Nosocomial infection represented 25.5% of cases. The mean duration of hospitalization was 6.4 days; the average cost for hospitalization was 581.3 euros/patient. Conclusions The rotavirus infection represented the etiology of acute diarrhea in more than half the cases. We report a high percentage of severe gastroenteritis and a significant percentage of nosocomial rotavirus diarrhea. The considerable medical costs should justify prevention through vaccination.

724 Hla Dq2/Dq8 Typing in Children Diagnosed with Celiac Disease

Background and Aims Genes encoding HLA DQ2/DQ8 are associated with celiac disease (CD) and testing for their presence has high negative predictive value for the diagnosis. The aim of this study was to assess the role of HLA typing in symptomatic individuals in whom the diagnosis of CD is uncertain. Methods We proceded a retrospectiv study leaded on a group of children investigated for CD in “Grigore Alexandrescu” Emergency Children’s Hospital from 2007 to 2012 that underwent HLA typing. Inclusion criteria were all patient with mild enteropathy (Marsh 1, 2, 3a), moderate elevated values of tisular tranglutaminase (tTG) antibodies (between cut off point and 5 times nomal value) and poor response to gluten free diet. The medical records of all patients investigated for CD were reviewed. Results 164 patients were performed HLA typing; 26 patients satisfied the inclusion criteria; 20 (76.9%) of these had HLA DQ2/DQ8 present and 6 (23.07%) had a negative test for HLA DQ2/DQ8. The mean age of our investigated group was 23.46 months and the mean age for HLA DQ2/DQ8 negative group was 21.08 months. Sex distribution indicated 9 boys and 17 girls. Gastrointestinal symptoms dominated: 17 children had diarrhea, 9 had failure to thrive and 13 patients had both chronic diarrhea and poor weight gain. Conclusion Patients with clinical suspicion of CD that have moderate levels of tTG antibodies, mild biopsy changes and poor response to gluten free diet need to have HLA typing specially at younger ages (under 3 years old).