Healthy Pediatric Population Research Articles

Focus on Cardiologic Findings in 30 Children With PANS/PANDAS: An Italian Single-Center Observational Study

Objective: Cardiac involvement in PANS has not been clarified relying on the scientific literature available until today. It is known that streptococcal infections play a role in the etiology of a great number of diseases including Sydenham chorea and rheumatic fever, among others. Based on the suspected pathogenesis of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) reported in the medical literature, we decided to investigate the cardiologic involvement in children with a recent PANS/PANDAS diagnosis.Methods: The study population satisfies PANS (1) and PANDAS (2) criteria of diagnoses. Cardiologic assessment was performed through clinical examination, electrocardiography, and echocardiography.Results: In the selected pediatric population, a significant number of children presented mitral valve involvement, systolic murmurs and electrocardiographic abnormalities. High ASLOT levels did not seem to be associated to a cardiac involvement.Conclusions: Often PANS is difficult to diagnose because it is little known by physicians and most of the cardiologic findings described in this study are common among the healthy pediatric population. Also, ASLOT levels seems not to be predictive of cardiac involvement. Furthermore, the existence of PANDAS as a clinical entity is associated with a group of anti-neuronal autoantibodies found in Sydenham chorea is still controversial. We recommend a complete cardiologic evaluation in those children who meet the PANS/PANDAS diagnostic criteria.

Linear Growth in Children and Adolescents with Type 1 Diabetes Mellitus.

Ensuring normal linear growth is one of the major therapeutic aims in the management of type one diabetes mellitus (T1DM) in children and adolescents. Many studies in the literature have shown that pediatric patients with T1DM frequently present some abnormalities in their growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis compared to their healthy peers. Data on the growth of T1DM children and adolescents are still discordant: Some studies have reported that T1DM populations, especially those whose diabetes began in early childhood, are taller than healthy pediatric populations at diagnosis, while other studies have not found any difference. Moreover, many reports have highlighted a growth impairment in T1DM patients of prepubertal and pubertal age, and this impairment seems to be influenced by suboptimal glycemic control and disease duration. However, the most recent data showed that children treated with modern intensive insulin therapies reach a normal final adult height. This narrative review aims to provide current knowledge regarding linear growth in children and adolescents with T1DM. Currently, the choice of the most appropriate therapeutic regimen to achieve a good insulin level and the best metabolic control for each patient, together with the regular measurement of growth parameters, remains the most important available tool for a pediatric diabetologist. Nevertheless, since new technologies are the therapy of choice in young children, especially those of pre-school age, it would be of great interest to evaluate their effects on the growth pattern of children with T1DM.

Chronic Kidney Disease in Children Aged 6–15 Years and Associated Risk Factors in Apizaco, Tlaxcala, Mexico, a Pilot Study

Introduction: Tlaxcala, a small state in central Mexico, has the highest prevalence of chronic kidney disease (CKD) deaths in population aged 5–14 in Mexico, most of them with unknown etiology. Objective: To determine the prevalence of CKD in apparently healthy pediatric population in Apizaco, Tlaxcala. Methods: A cross-sectional pilot study was carried out in children deemed as healthy; subjects with previous diagnosis of CKD were excluded. Informed consent was obtained in all cases. A physical examination was performed, a questionnaire was applied. Blood and urine samples were obtained for serum creatinine, urinalysis, and microalbumin/creatinine ratio. A second and third evaluation was performed after 6 and 18 months in those found with urinary anomalies/CKD to confirm the diagnosis. Results: One hundred and nine subjects completed physical examination, which are the biological samples. Median age was 12 years. CKD stage 2 was confirmed in 5 subjects in the sixth month confirmation visit (4.6%). One patient accepted renal biopsy and Alport Syndrome was found. In a robust multivariate analysis, the risk factors related to reduction in the glomerular filtration rate were males –5.15 mL/min/1.73 m² (p = 0.002), older participants as by –1.58 mL/min/1.73 m² per year (p < 0.0001), and among participants living close to a river –3.76 mL/min/1.73 m² (p = 0.033). Discussion/Conclusion: The prevalence of CKD in the population studied in Apizaco Tlaxcala was confirmed in 4.6 cases per 100 inhabitants between 6 and 15 years. Males, older age, and living close to a river were the risk predictive factors. More studies are needed to determine the causes of the high CKD prevalence in this population.

Normative Data Set of SWAY Balance Mobile Assessment in Pediatric Athletes.

To examine and describe normative values for an objective, mobile measure of postural stability commonly used in concussion assessments, SWAY Balance (SWAY Medical, Tulsa, Oklahoma). Retrospective analysis of baseline balance assessments in a healthy pediatric population. Baseline assessments completed by certified athletic trainers at an outpatient concussion center or sports medicine offices in Philadelphia, PA and surrounding suburban Pennsylvania and New Jersey or during an athletic trainer's baseline assessment of collegiate athletes at a National Collegiate Athletic Association (NCAA) Division-II University in Fort Lauderdale, FL. Test results of a sample of 466 athletes aged 5 to 18 years were included. The SWAY Balance test was administered using a mobile device on all participants as part of a standard preseason, baseline evaluation, following the standard evaluation protocol. Baseline SWAY Balance mobile assessment balance and reaction time scores, age and sex effects, were examined. Normative scores are described, with results stratified into 4 age groups (5-9, 10-12, 13-17, and 18 years old). Balance scores, overall and within each individual stance score, improved with the age of the participants. Sex effects on balance were only seen in single-leg stances, with females outperforming males. Reaction time was found to be faster in males and improved with age, peaking at 13 to 17 years old and slowing in 18-year-olds. Normative, age-specific SWAY Balance test results provided are of clinical use as references in the concussion assessments of pediatric athletes.

Age-Dependent Changes of Kidney Injury Biomarkers in Pediatrics.

Currently used creatinine-based parameters for monitoring kidney function are not reliable for early detection of kidney injury (KI), particularly tubular damage. Several KI biomarkers allow for early detection of glomerular and tubular damage and may help to prevent drug-related chronic kidney diseases in pediatrics. This literature review describes the state of current research and investigates reference values for these KI biomarkers in neonates, infants, and children to better understand age-related changes. A total of 12 of 237 screened studies fulfilled predefined criteria, including 219 preterm neonates, 70 neonates, 596 infants, and 1726 children. KI biomarkers were analyzed in urine (6 studies), in serum/plasma (5 studies) and in serum and urine (1 study). Four studies (n=555) measured urinary kidney injury molecule-1, whereas urinary neutrophil gelatinase-associated lipocalin was assessed in 5 studies (n=888), and 2 studies (n=203) investigated serum cystatin C. This review of KI biomarkers in different pediatric age groups indicates that (1) the majority of KI biomarkers are measured in urine; (2) the 3 most commonly analyzed KI biomarkers are urinary neutrophil gelatinase-associated lipocalin, urinary kidney injury molecule-1, and serum cystatin C; (3) values of KI biomarkers appear to decrease from prematurity to infancy; and (4) there is an unmet need to further enhance knowledge on age-dependent changes of KI biomarkers in pediatrics. Studies are needed to better characterize reference values for these key KI biomarkers in healthy pediatric populations and to evaluate the value of these markers in the early detection of drug-related KI in neonates, infants, and children.

Stepwise approach of development of dermo-cosmetic products in healthy and atopic dermatitis paediatric population: safety evaluation, clinical development and postmarket surveillance.

Background/objectivesPaediatric skin, considered sensitive, and infant skin, more susceptible to percutaneous toxicity, require specially formulated cosmetic products. As recently shown, early use of emollients in infants “at risk” of developing atopic dermatitis has shown controversial results in reducing the incidence of atopic dermatitis. Development of dermo‐cosmetic products for this specific population should especially ensure tolerance and safety. In absence of good clinical practice guideline, we propose here a stepwise approach for the development of paediatric cosmetic skincare products.MethodsOur stepwise methodology for cosmetics aimed at paediatrics, starts with in vitro assessment of product's ingredients safety, followed by preclinical and clinical evaluations of the final product, including sequentially: (1) Repeated Open Application Test (ROAT), (2) Human Repeated Insult Patch Test (HRIPT), (3) In‐use dermatological and ophthalmological tolerance studies (sequentially in 3a: healthy adults, 3b: healthy paediatric subjects and finally 3c: paediatric patients). We also describe the integrated cosmetovigilance–toxicological surveillance during the clinical development phase and postmarketing.ResultsAs illustrated with one dermo‐cosmetic product intended to be used as a preventative/maintenance treatment for atopic dermatitis in paediatric population, we show that using this stepwise methodology to test a product reduces potential risks of irritation and contact dermatitis in this sensitive population.ConclusionStandardized ethical stepwise development approach is needed to ensure the commercialization of safe and well‐tolerated dermo‐cosmetics for paediatrics. The approach described here could potentially serve as guidance for evaluation of new paediatric cosmetic products.

Health-related quality of life in children after laparoscopic gastrostomy placement

IntroductionA gastrostomy placement (GP) is an established treatment to provide enteral feeding in pediatric patients with feeding difficulties aiming to improve nutritional status and health-related quality of life (HRQoL). The aim of this study was to evaluate HRQoL in children with severe feeding difficulties who have undergone GP.Materials and methodsA cross-sectional study was performed including 128 patients who had undergone laparoscopic GP (2004–2011). HRQoL was evaluated using the validated Pediatric Quality of Life 4.0 Inventory. Multiple regression analysis was performed to identify predictors of HRQoL.ResultsAfter a mean follow-up of 4.0 years (interquartile range 2.9–6.2) after GP, mean HRQoL was 53.0 out of 100 (standard deviation 21.1). HRQoL was significantly lower in children with neurologic impairment, with a mean difference of −21.4 points between neurologically impaired and neurologically normal children (p < 0.001). HRQoL was also lower in children with cardiac disease (−19.0 points; p = 0.01) and in children with a history of previous gastrointestinal surgery (−15.2 points; p = 0.03). Feeding through a gastrojejunostomy tube (−33.0 points; p = 0.01) and higher age at the time of operation (−1.2 points per year; p = 0.03) were also associated with lower HRQoL. GP-related complications requiring reintervention were associated with lower HRQoL, although this association was not statistically significant (p = 0.06).ConclusionsChildren with severe feeding difficulty, who have undergone GP, have significantly lower HRQoL compared to a healthy pediatric population. Neurologic impairment, cardiac disease, a history of gastrointestinal surgery, older age, and the need for jejunal feeding through the gastrostomy were predictive of even lower HRQoL.

S8A-12 SESSION 8A: METOPIC SYNOSTOSIS OPHTHALMOLOGIC ABNORMALITIES IN CHILDREN WITH TRIGONOCEPHALY

Introduction: Little has been described in the literature regarding ophthalmic abnormalities in non-syndromic midline craniosynostosis. The few studies on non-syndromic trigonocephaly and ocular abnormalities have shown that non-syndromic trigonocephaly is associated with a greater risk of abnormal visual functioning in young children, up to the age of 8 years. However, visual functioning in children after that age, when optic development is complete, hasn’t been studied yet. The purpose of this study is therefore to assess the prevalence of visual abnormalities in children with non-syndromic trigonocephaly between the age of 8 to 18 years. Methods: A retrospective, cross-sectional study of patients between the age of 8 and 18 years, with non-syndromic trigonocephaly was conducted. Ophthalmologic records were assessed for the following parameters: refractive errors, astigmatism, strabismus, and a history of amblyopia. Refractive error was determined using autorefraction or skiascopy after use of cycloplegia. Myopia was classified as spherical equivalent (SE) < -0.50 dioptre (D), emmetropia as SE between -0.50 D and +0.50 D, mild hyperopia as SE between +0.50 D and +2.00 D, moderate hyperopia as SE between +2.00 D and +6.00 D, and high hyperopia as SE > +6.00 D. Astigmatism was defined as > 1.00 D. Strabismus was subdivided in manifest and latent strabismus. Presence of strabismus and amblyopia was determined using the cover test, binocular sensory testing, and visual acuity. Results: We included 83 patients with non-syndromic trigonocephaly, with a mean age of 10.5 years (SD 2.0). Thirty-three of these 83 patients had abnormal visual functioning (39.7%). Of all 83 patients, 23 had hyperopia (27.7%), 7 had myopia (8.4%), 19 had astigmatism (22.9%), 7 had amblyopia (8.3%), and 12 had strabismus (14.3%). Manifest strabismus was present in 7 patients (8.3%), while latent strabismus was present in 5 patients (6.0%). Conclusion: Prevalence of hyperopia, astigmatism, amblyopia, and strabismus was higher in patients with non-syndromic trigonocephaly, compared to the prevalence found in the healthy paediatric population. Therefore, long-term surveillance of visual functioning of paediatric patients with non-syndromic trigonocephaly by an ophthalmologist is recommended.

Normal values of native T1 and T2 relaxation times on 3T cardiac MR in a healthy pediatric population aged 9-18 years.

Native myocardial T1 and T2 relaxation times are diagnostic tools used in clinical practice for adult and pediatric populations. Use of a mapping technique requires accurate knowledge of normal ranges in healthy patients, which is lacking in pediatric populations. To establish normal values for native T1 and T2 mapping in healthy pediatric subjects of different ages and sex. Prospective. Thirty-eight healthy children (9-18 years; mean age 14.0 ± 2.7). Cardiac MR with a 3T scanner. T1 and T2 mapping using MyoMaps software. T1 and T2 relaxation times were calculated from a 0.7-1.0 cm2 region of interest placed at the mid-ventricular short-axis slice in the interventricular septum by two observers. Inter- and intraobserver variability was assessed. The Student's t-test or the Mann-Whitney test for unpaired samples was applied to compare one continuous variable between two category groups. One-way analysis of variance (ANOVA) or a Kruskal-Wallis test was applied to compare one continuous variable between three category groups. Correlation between two continuous variables was assessed with a Pearson or Spearman test. The mean native T1 relaxation time was 1223 ± 29 msec and T2 relaxation time was 43 ± 4.5 msec. There was no correlation between T1 /T2 values and age or body surface area (for T1 P = 0.94 and 0.90 and for T2 P = 0.19 and 0.64, respectively). There was weak correlation between T1 values and body mass index (BMI) (r = 0.448, P = 0.005). T2 values were significantly higher in females compared with males (44.6 ± 4.2 vs. 40.4 ± 3.8 msec, P = 0.002). We found a significant rise of T2 relaxation time in the pubertal period (age 13-15 years) comparing to prepubertal (age 9-12 years). Inter- and intraobserver agreement of T1 (r = 0.93; r = 0.99) and T2 (r = 0.96; r = 0.95) were high. We report normal values of native T1 and T2 relaxation times obtained with Myomaps software for 3T cardiac MR in a healthy pediatric population. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:912-918.

Are Omentin Rs2274907 and Vaspin Rs2236242 Gene Polymorphisms Related to Body Composition, Lipid Profile and Other Adipokines in Prepubertal Healthy Children?

ABSTRACTPurpose/Aim: So far no research concerning the omentin-1 (ITLN1) rs2274907 and vaspin (SERPINA12) rs2236242 polymorphisms has been carried out in a healthy pediatric population. We analyzed associations of these polymorphisms with anthropometric parameters, lipid profile, as well as adiponectin, leptin and soluble leptin receptor (sOB-R) levels in prepubertal healthy children, to search for their possible role in the risk of obesity and obesity-related disorders.Materials and Methods: Frequencies of these polymorphisms were analyzed by the restriction fragment length polymorphism in 89 normal-weight children. The body composition was measured by dual-energy X-ray absorptiometry. Serum levels of adipokines were measured using ELISA methods.Results: We observed differences in values of HDL-cholesterol (p = 0.002) and triglycerides (p = 0.039) in children carrying different genotypes of the ITLN1 rs2274907 polymorphism. In children carrying different genotypes of the SERPINA12 rs2236242 polymorphism differences in BMI (p =0.025) and BMI Z-score (p = 0.01) values were found. Significant relations between anthropometric parameters and levels of HDL-cholesterol and triglycerides were associated with minor alleles of the studied polymorphisms. In addition, leptin/sOB-R ratio was related to HDL-cholesterol (p = 0.004) and triglycerides (p = 0.03) levels in children carrying minor allele of the SERPINA12 rs2236242 SNP.Conclusions: We suggest that both ITLN1 rs2274907 and SERPINA12 rs2236242 polymorphisms influence body composition and lipid profile in prepubertal healthy children. Relations between anthropometric parameters, lipid and adipokine levels may be associated with minor alleles of the studied polymorphisms. The possible role of these polymorphisms in the modulation of the risk of obesity and obesity-related disorders in the later life might be considered.

Effect of Daily Intake of Lactobacillus casei on Microbial Diversity and Dynamics in a Healthy Pediatric Population

Emerging evidence exists that an altered gut microbiota is a key factor in the pathophysiology of a variety of diseases. Consequently, microbiota-targeted interventions, including administration of probiotics, have increasingly been evaluated. Mechanisms on how probiotics contribute to homeostasis or reverse (effects of) dysbiosis remain yet to be elucidated. In the current study, we assessed the effects of daily Lactobacillus casei strain Shirota (LcS) ingestion in healthy children aged from 12–18 years on gut microbiota compositional diversity and stability. Results were compared to healthy children without LcS exposure. For a period of 6 weeks, fecal samples were collected weekly by both groups. In total, 18 children were included (6 probiotics; 12 non-probiotics). At 1-week intervals, no differences in diversity and stability were observed in children exposed to LcS versus controls. LcS ingestion by healthy children does not result in a more diverse and stable gut microbiota composition. Large double-blind placebo-controlled randomized clinical trials in children should be performed to gain more insight on potential beneficial health consequences.

Inferior vena cava, abdominal aorta, and IVC-to-aorta ratio in healthy Caucasian children: Ultrasound Z-scores according to BSA and age

The pediatric ultrasound measurement of the inferior vena cava (IVC) and aorta (AO) with the study of the collapsibility index (CI) and of IVC-to-AO ratio (IVC/AO) can provide clinicians in the acute care setting with information on abnormal volume status but one of the major limitations is a lack of reference normal values by body surface area (BSA) and age. The aim of this study was to provide reference ranges for the sonographic measurement of IVC, AO, and IVC/AO ratio in healthy Caucasian Italian children. MethodsWe enrolled prospectively 516 healthy Caucasian Italian children aged between 1 month and 16 years. Echocardiographic IVC and AO diameters were collected and presented separately for children aged ≤1 year and for children aged over 1 year. For children >1 year we categorized subjects into 3 years classes. CI and IVC/AO for the systolic aortic diameter were then calculated. For children over 1 year, age reference ranges were age-related or BSA-related; for children of ≤1 year, reference ranges were determined with their 90% confidence intervals regardless of age and of BSA. ResultsTables and charts with reference ranges for all the echocardiographic measurements are presented for children aged >1 year according to age and BSA. The equations to obtain percentile and Z-score for each echocardiographic measurement are provided. The reference ranges for children aged ≤1 year are shown considering the small 90% confidence intervals for upper and lower limits.CI was 30% (SD 17%) in children >1 year and 36% (SD 16%) in children <1 year. IVC/AOs showed age-dependent values from 0.83 (SD 0.20) age <1 year to 1.22 (SD 0.31) in older subjects. ConclusionsWe report reliable reference ranges for echocardiographic measurement of IVC, AO, CI, and IVC/AO for a Caucasian Italian healthy pediatric population.

Usefulness of Cerebral Palsy Curves in Mexican Patients: A Cross-Sectional Study.

Cerebral palsy describes a group of movement and posture disorders that cause activity limitation, and are attributable to nonprogressive disorders that occur in the fetal or infant brain. The growth of these children should not be compared with those of the healthy population. We studied 452 children, 186 female and 266 male. We compared the results in 2 growth charts, Centers for Disease Control and Prevention (CDC) and cerebral palsy, and the results were statistically significant ( P = .00001). With the CDC charts, 40.71% of the patients were below the 5th percentile and only 5.5% of them when we used the charts for cerebral palsy patients. The Mexican cerebral palsy patients were similar to US cerebral palsy patients when we compared height ( P = .4075) and body mass index (BMI) ( P = .4075). Only the weight was found to be different ( P = .00001). All the correlation indexes were negative: Eating and Drinking Ability Classification System (EDACS)-BMI (rho = -0.4798) ( P = .00001), Communication Function Classification System (CFCS)-BMI (rho = -0.4353) ( P = .00001), and Gross Motor Function Classification System (GMFCS)-BMI (rho = -0.3584) ( P = .00001). The growth charts of the healthy pediatric population tend to overestimate the underweight. We propose to use cerebral palsy charts as a reference in our patients. It is possible to determine a functional profile (communication, gross motor function and safety, and feed efficiency) for the cerebral palsy population based on their BMI.

Principal component and correlation analysis of biochemical and endocrine markers in a healthy pediatric population (CALIPER)

BackgroundReference intervals (i.e. normative ranges) established from a healthy reference population are essential to accurately interpret disease biomarkers. Biomarker concentration may partially depend on associations with other biomarkers due to various physiological and pathophysiological processes. In this study, a robust correlation analysis was performed to identify physiological biomarker associations in the healthy pediatric CALIPER cohort. MethodsPopulation reference values for 35 biochemical and 20 fertility/endocrine markers were analyzed for correlations in all subjects, male adolescents, female adolescents, and young children. Associations between biomarkers were assessed by Spearman's rank correlation and a multivariate analysis technique, principal component analysis (PCA). ResultsOf 197, 90, 59, and 32 significant correlations between biochemical markers in all subjects, male adolescents, female adolescents, and children, respectively, 23, 19, 16, and 9 were moderately strong (r > 0.5 or r < −0.5). Of 98, 24, 33, and 16 significant correlations between fertility/endocrine markers in all subjects, male adolescents, female adolescents, and children, respectively, 17, 8, 11, and 5 were moderately strong. Results were agreeable between Spearman's rank method and PCA. In some cases, biomarker correlations differed between sexes. ConclusionsUsing PCA, this study provides for the first time an extensive analysis of circulating biomarker associations in a healthy pediatric cohort. These data can inform future studies of potential confounding factors or particular variables that should be considered in test result interpretation for specific diseases.

Anatomic variations of the paranasal sinuses in the general pediatric population.

The prevalence of sinuses' anatomic variations in the healthy pediatric population has not been studied. The study describes the prevalence of known anatomic variations with regard to gender and age in this population. A single academic institute observational cohort study. A total of 200 head CT scans were reviewed, subdivided into five equal age subgroups (0-4.99; 5-7.99; 8-10.99; 11-13.99; 14-17 years), with an equal male to female ratio. Different subgroups were randomly assigned to two senior residents (100 CTs each). A senior rhinologist and radiologist were randomly selected to review 100 CTs each. Consensus was reached after a joint review. Each CT was evaluated for the presence of sinuses and the following variations: deviated septum, frontoethmoidal, infraorbital, posterior-ethmoid cells (Kuhn, Haller, and Onodi cells, respectively) and concha bullosa. Definitions were made according to the European Position on Rhinosinusitis 2012. Gender did not affect sinus development or anatomical variations. The frontal and sphenoid sinuses were significantly less developed in the 0-4.99 years group. The point prevalence of concha bullosa and deviated septum significantly increased with age. The point prevalence of Haller cells demonstrated borderline significance among age groups, with children 0-4.99 demonstrating the lowest point prevalence. A significant association was found between the existence of Haller cells to Kuhn and Onodi cells. Anatomical variations should be expected in the pediatric population. Familiarity with their point prevalence and associations may assist pediatric endoscopic sinus surgery planning.

Estimation of Z-Scores of Cardiac Structures in Healthy Indian Pediatric Population

Estimation of Z-Scores of Cardiac Structures in Healthy Indian Pediatric Population

Survival of L. casei DG\xae (Lactobacillus paracasei CNCMI1572) in the gastrointestinal tract of a healthy paediatric population

PurposeAbility to survive the digestive process is a major factor in determining the effectiveness of a probiotic. In this study, the ability of the probiotic L. casei DG® (Lactobacillus paracasei CNCMI1572) to survive gastrointestinal transit in healthy children was investigated for the first time.MethodsTwenty children aged 3–12 years received L. casei DG® as drinkable solution of 1 × 109 colony forming units (CFU), once daily for 7 consecutive days. Recovery in faecal samples was evaluated at baseline and at different time-points during and after administration. Defecation frequency, faeces consistency, digestive function and product safety were also assessed.ResultsNineteen (95%) of the 20 enrolled children presented viable L. casei DG® cells in their faeces at least once during the study, with a maximum count (mean 4.3 log10 CFU/g ± 2.3) reached between day 4 and 6 from the beginning of consumption. Notably, for 11 (57.9%) of the 19 children with viable cells, L. casei DG® survived in faecal samples up to 3 days after treatment end. Defecation frequency, faeces consistency and digestive function did not change considerably during or after study treatment. Safety of the study product was very good.ConclusionsThis study showed for the first time that L. casei DG® survives the gastrointestinal transit when ingested by children with a paediatric probiotic drinkable solution containing 1 × 109 CFU, and persists in the gut up to 3 days after the end of product intake, demonstrating resistance to gastric juices, hydrolytic enzymes and bile acids.

Assessment of brain-derived neurotrophic factor and osteopontin in a healthy pediatric population

Abstract non disponibile

P 153 - Variability of gait parameters in children: The importance of normative data establishment

The aim of this study was to initiate the development of a database with the normative gait fundamental biomechanical parameters of a healthy pediatric population for the Laboratório de Biomecânica e Morfologia Funcional. Twenty-seven children cleared for neurological and musculoskeletal impairments, aged between seven and nine years old joined this study. From those twenty-seven, eleven completed a test-retest study with a median interval of seven days. Anthropometric, time-distance and peak values for the lower limb kinematic parameters were computed. The Interclass Correlation Coefficient (ICC) and the Standard Error of Measurement (SEM) were calculated for the kinematic parameters. Eight variables revealed SEM values between 2° and 5°, while all others were below 2°. Higher SEM was found for the variables Cadence (3.64 steps/min), Mean Value of Pelvic Tilt (2.48°), Maximum Hip Angle (2.56°), Minimum Hip angle (4.94°), Knee Angle at Initial Contact (2.40°), and Ankle ROM (2.79°). The MDC was below 6º in most of the variables.

Pediatric reference intervals for calculated LDL cholesterol, non-HDL cholesterol, and remnant cholesterol in the healthy CALIPER cohort

ObjectivesIncreased prevalence of pediatric obesity and associated co-morbidities has heightened the concern for cardiovascular disease (CVD) risk later in life. Although the fasting lipid profile is traditionally used to assess CVD risk, the non-fasting lipid profile may simplify lipid testing and better predict CVD risk. Unfortunately, non-fasting lipid reference values are limited, particularly for children. The Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) has recruited thousands of healthy pediatric subjects to develop a pediatric reference interval database. Here, CALIPER reports pediatric reference intervals for non-fasting calculated low-density lipoprotein cholesterol (LDLc), non-high-density lipoprotein cholesterol (non-HDLc) and remnant cholesterol. MethodsNon-fasting serum samples from the CALIPER cohort of community children and adolescents were previously analyzed for HDLc, total cholesterol, and triglycerides. These values were used to calculate LDLc, non-HDLc, and remnant cholesterol and subsequently establish reference intervals with corresponding 90% confidence intervals according to CLSI EP28-A3c guidelines. Reference intervals were also calculated using alternative statistical methods highlighted in recent literature. ResultsAll three lipid parameters required an age partition at 1 year due to wider reference intervals in the first year of life. LDLc and non-HDLc required sex partitioning for subjects 1–<10 years. Non-HDLc upper reference limit was higher than the 2011 National Heart, Lung, and Blood Institute (NHLBII) pediatric recommended cut-offs, suggesting elevated atherogenic lipoproteins in a proportion of apparently healthy pediatric subjects. The LDLc upper reference limit (10–<19 year partition) was the same as the NHLBI cut-off, potentially due to lower calculated LDLc values in the non-fasting state. ConclusionsWith the increased use of non-fasting lipid profiles, age- and sex-specific reference intervals and appropriate clinical decision limits are necessary for pediatric lipid monitoring. Our data supports the notion that appropriate decision limits, rather than reference intervals, should be used to interpret lipid levels in children as there is a high prevalence of hyperlipidemia in the apparently healthy pediatric population.