Meghana Sathe1, Rong Huang2, Sonya Heltshe3,4, Alexander Eng5, Elhanan Borenstein6,7,8, Samuel I Miller9, Lucas Hoffman10, Daniel Gelfond11, Daniel H Leung12, Drucy Borowitz13, Bonnie Ramsey4, A Jay Freeman14. 1. Division Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern and Children's Health. 2. Research Administration, Children's Medical Center Dallas, Dallas, TX. 3. Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute. 4. Division of Pulmonary Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 5. Division of Pulmonary Medicine, Department of Pediatrics, and Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA. 6. Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel. 7. Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 8. Santa Fe Institute, Santa Fe, NM. 9. Department of Microbiology, Department of Genome Sciences, and Department of Medicine, University of Washington. 10. Division of Pulmonary Medicine, Department of Pediatrics, and Department of Microbiology, University of Washington School of Medicine, Seattle, WA. 11. WNY Pediatric Gastroenterology and Volunteer Faculty, University of Buffalo School of Medicine, Buffalo, NY. 12. Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX. 13. Cystic Fibrosis Foundation, Bethesda, MD and Emeritus Clinical Professor of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY. 14. Division Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA.
Abstract
OBJECTIVES: To identify factors that increase the risk of gastrointestinal-related (GI-related) hospitalization of infants with cystic fibrosis (CF) during the first year of life. METHODS: The Baby Observational and Nutrition Study was a longitudinal, observational cohort of 231 infants diagnosed with CF by newborn screening. We performed a post-hoc assessment of the frequency and indications for GI-related admissions during the first year of life. RESULTS: Sixty-five participants had at least one admission in the first 12 months of life. High pancreatic enzyme replacement therapy (PERT) dosing (>2000 lipase units/kg per meal; hazard ratio [HR] = 14.75, P = 0.0005) and use of acid suppressive medications (HR = 4.94, P = 0.01) during the study period were positively associated with subsequent GI-related admissions. High levels of fecal calprotectin (fCP) (>200 μg/g) and higher relative abundance of fecal Klebsiella pneumoniae were also positively associated with subsequent GI-related admissions (HR = 2.64, P = 0.033 and HR = 4.49, P = 0.002, respectively). During the first 12 months of life, participants with any admission had lower weight-for-length z scores (WLZ) (P = 0.01). The impact of admission on WLZ was particularly evident in participants with a GI-related admission (P < 0.0001). CONCLUSIONS: Factors associated with a higher risk for GI-related admission during the first 12 months include high PERT dosing, exposure to acid suppressive medications, higher fCP levels, and/or relative abundance of fecal K pneumoniae early in life. Infants with CF requiring GI-related hospitalization had lower WLZ at 12 months of age than those not admitted as well as those admitted for non-GI-related indications.
OBJECTIVES: To identify factors that increase the risk of gastrointestinal-related (GI-related) hospitalization of infants with cystic fibrosis (CF) during the first year of life. METHODS: The Baby Observational and Nutrition Study was a longitudinal, observational cohort of 231 infants diagnosed with CF by newborn screening. We performed a post-hoc assessment of the frequency and indications for GI-related admissions during the first year of life. RESULTS: Sixty-five participants had at least one admission in the first 12 months of life. High pancreatic enzyme replacement therapy (PERT) dosing (>2000 lipase units/kg per meal; hazard ratio [HR] = 14.75, P = 0.0005) and use of acid suppressive medications (HR = 4.94, P = 0.01) during the study period were positively associated with subsequent GI-related admissions. High levels of fecal calprotectin (fCP) (>200 μg/g) and higher relative abundance of fecal Klebsiella pneumoniae were also positively associated with subsequent GI-related admissions (HR = 2.64, P = 0.033 and HR = 4.49, P = 0.002, respectively). During the first 12 months of life, participants with any admission had lower weight-for-length z scores (WLZ) (P = 0.01). The impact of admission on WLZ was particularly evident in participants with a GI-related admission (P < 0.0001). CONCLUSIONS: Factors associated with a higher risk for GI-related admission during the first 12 months include high PERT dosing, exposure to acid suppressive medications, higher fCP levels, and/or relative abundance of fecal K pneumoniae early in life. Infants with CF requiring GI-related hospitalization had lower WLZ at 12 months of age than those not admitted as well as those admitted for non-GI-related indications.
Authors: Moshe Ashkenazi; N Nathan; I Sarouk; B E Bar Aluma; A Dagan; Y Bezalel; S Keler; D Vilozni; O Efrati Journal: Lung Date: 2019-03-18 Impact factor: 2.584
Authors: Danielle Goetz; Benjamin T Kopp; Ann Salvator; Melissa Moore-Clingenpeel; Karen McCoy; Daniel H Leung; Margaret Kloster; Bonnie R Ramsey; Sonya H Heltshe; Drucy Borowitz Journal: Pediatr Pulmonol Date: 2019-01-22
Authors: Daniel H Leung; Sonya L Heltshe; Drucy Borowitz; Daniel Gelfond; Margaret Kloster; James E Heubi; Michael Stalvey; Bonnie W Ramsey Journal: JAMA Pediatr Date: 2017-06-01 Impact factor: 16.193