Dysphagia Research Articles

Effects of sintilimab plus chemotherapy as first-line treatment on health-related quality of life in patients with advanced esophageal squamous cell carcinoma: results from the randomized phase 3 ORIENT-15 study

In ORIENT-15 study, sintilimab plus chemotherapy demonstrated significant improvement on overall survival (OS) versus placebo plus chemotherapy in first-line treatment of advanced esophageal squamous cell carcinoma (ESCC). Here, we report effect of sintilimab plus chemotherapy on health-related quality of life (HRQoL) in patients with advanced ESCC. From December 14, 2018 to August 28, 2022, HRQoL was evaluated in all randomized patients using European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 items (QLQ-C30), EORTC Quality of Life Questionnaire Oesophageal Cancer Module 18 items (QLQ-OES18), and visual analogue scale (VAS) of the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L). Mean scores of each scale were described by treatment group through week 60. Least-squares mean (LSM) score change from baseline through week 24 were analyzed using the mixed-model repeated-measures method. Time to the first onset of deterioration (TTD) and OS for each scale were estimated. Clinical Trials Registration: NCT03748134. As of August 28, 2022, 689 of 690 enrolled patients were assessed for HRQoL analysis (sintilimab group: 340, placebo group: 349). Median follow-up was 32.2 months. Differences in LSM favored sintilimab over placebo for QLQ-C30 social functioning (LSM difference: 3.06, 95% CI: 0.55 to 5.57; P=0.0170), pain (-2.24, 95% CI:-4.30 to-0.17; P=0.0337), fatigue (-2.24, 95% CI:-4.46 to-0.02; P=0.0479), constipation (-3.27, 95% CI-5.49 to-1.05; P=0.0039), QLQ-OES18 pain (-1.77, 95% CI-3.11 to-0.43; P=0.0097), trouble swallowing saliva (-2.09, 95% CI:-3.77 to-0.42; P=0.0146), and choked when swallowing (-3.23, 95% CI:-5.60 to-0.86; P=0.0076). TTD favored sintilimab over placebo for QLQ-OES18 dysphagia (Hazard ratio [HR]: 0.76, 95% CI: 0.61-0.94, P=0.0104), and trouble swallowing saliva (HR: 0.48, 95% CI: 0.35-0.67, P<0.0001). Improved OS were observed in patients with better performance in several functioning and symptom scales of QLQ-C30 and QLQ-QES18. The statistically significant differences of several HRQoL scales and improvements in delayed deterioration observed in our study further support the use of sintilimab plus chemotherapy as first-line treatment for advanced ESCC. This study was funded by Innovent Biologics and was co-funded by Eli Lilly.

A case of neurodevelopmental disorder with epilepsy, cataracts, feeding difficulties, and delayed brain myelination caused by a variant in NACC1 gene

A case of neurodevelopmental disorder with epilepsy, cataracts, feeding difficulties, and delayed brain myelination caused by a variant in NACC1 gene

Liquid Dynamics in the Upper Respiratory–Digestive System with Contracting Pharynx Motions and Varying Epiglottis Angles

Swallowing disorders, or dysphagia, can lead to bolus aspiration in the airway, causing serious adverse health effects. Current clinical interventions for dysphagia are mainly empirical and often based on symptoms rather than etiology, of which a thorough understanding is still lacking. However, it is challenging to study the swallowing process that involves sequential structural motions and is inaccessible to standard visualization instruments. This study proposed an in vitro method to visualize swallowing hydrodynamics and identify the fundamental mechanisms underlying overflow aspirations. An anatomically accurate pharynx–epiglottis model was developed from patient-specific CT images of 623 µm isotropic resolution. A compliant half-pharynx cast was prepared to incorporate dynamic structures and visualize the flow dynamics in the mid-sagittal plane. Three locations of frequent overflow aspiration were identified: the epiglottis base, cuneiform tubular recesses, and the interarytenoid notch. Water had a consistently higher aspiration risk than a 1% w/v methylcellulose (MC) solution. The contracting–relaxing pharynx and flapping epiglottis spread the liquid film, causing a delayed esophageal entry and increased vallecular residual, which was more pronounced with the MC solution. Dispensing the liquid too slowly resulted in water aspiration, whereas this was not observed with the MC solution. An incomplete epiglottis inversion, such as horizontal or down-tilt 45°, aggravated the aspiration risks of water. This study suggests that it is practical to use anatomically accurate respiratory–digestive models to study the swallowing process by incorporating varying physiological details.

Breast-feeding Practices among Primipara mothers at Selected Community, Chennai

Introduction: Breast milk is the best and most comprehensive source of nutrients for babies. Poor baby feeding practices are the cause of 60% of infant and early child mortality worldwide. The growth and development of children may be negatively impacted by inappropriate newborn feeding practices, particularly in underdeveloped and developing nations. Hence the present study was undertaken to determine the Breast-feeding Practices among Primipara Mothers at Selected Community, Chennai. Methods: A descriptive correlational design was used. The study was carried out in a community area in Chennai. Using the purposive sampling technique, 100 primipara mothers with infants between the ages of 1-12 months who fulfil the inclusion criteria were selected after obtaining formal agreement from the relevant authorities of the selected community area and ethical clearance from the institutional ethical committee. The data was gathered through interview method using pre-tested instruments such as background variable proforma, obstetrical variable proforma, and proforma to evaluate primipara mothers' breastfeeding practices. Results: The study findings revealed that 73% of the primipara mothers had moderately adequate practice. None of them in the category of needs improvement. There was a significant association between selected obstetrical variables such as mode of delivery and practice on breast feeding in primipara mothers (p&lt;0.05). Those who had normal vaginal delivery had good practice when compared to those who delivered through LSCS.

Heated humidified high-flow nasal cannula: a new conservative approach for neonatal nasal stenosis

PurposeThe aim of this study is to evaluate the efficacy of heated humidified high flow nasal cannula (HFNC) therapy as a conservative treatment option for newborns suffering from nasal stenosis, a condition that often leads to respiratory distress and feeding difficulties. Given the increasing utilization of HFNC in various upper and lower respiratory tract indications, characterized by its flow-based mechanism and minimal mucosal damage, we seek to investigate its potential benefits in this specific patient population.MethodsA retrospective chart review of newborns with congenital nasal stenosis treated with HFNC for respiratory distress or feeding difficulties in a pediatric tertiary center between 2014 and 2022. Data were collected for demographic characteristics, clinical presentation and ventilatory requirements, pre and post HFNC application.ResultsSix infants with nasal stenosis were included in the study cohort. Five were diagnosed with congenital pyriform aperture stenosis, three of whom had additional midnasal stenosis. One patient had nasal synechiae. Two patients had failed surgical treatment and all patients failed conservative treatment prior to HFNC treatment. Following HFNC use, improvement was noted in oxygen saturations, heart and respiratory rates, meal volumes and weight. None of the patients required any additional sinonasal surgical treatment. No complications were observed.ConclusionsIn this case series, we present the first documented use of HFNC treatment for nasal stenosis, showing favorable results. Further studies with a larger cohort, wider range of conditions and extended follow-up periods are needed to establish the risks and benefits of HFNC for neonatal nasal stenosis.

Neurodevelopmental outcomes and occupational participation of preterm children at school age: a scoping review

Preterm children may experience major challenges that affect their occupational participation and daily functioning, especially at school age. This scoping review aims to examining and synthesizing the available literature about adverse neurodevelopmental outcomes and occupational participation restrictions of preterm children born &lt; 37 weeks of gestation. The MEDLINE, Science Direct, CINAHL databases were searched from January 2013 to December 2023, for published cohort studies that assessed the neurodevelopmental outcomes and occupational participation of school-aged preterm children, compared to full-term born peers. Out of 6631 identified articles, 13 studies met the inclusion criteria and involved 958 preterm children, aged 6-10 years old. Studies included in the current scoping review reported adverse neurodevelopmental outcomes, such as cognitive impairment, executive function and sensory processing deficits, emotional and behavioral problems, language and visual perception difficulties, as well as occupational participation restrictions, like feeding difficulties, academic challenges and peer relationship problems. Findings suggest that neurodevelopmental deficits and occupational participation restrictions, especially in extremely preterm children, not only exist in early childhood but persist during school age. Future research should focus on exploring potential differences or patterns in neurodevelopmental outcomes and occupational participation between preterm groups with different gestational age ranges.

Clinical and molecular genetic analysis of a child with comorbid 16p11.2 microdeletion syndrome and Rett syndrome

To explore the genetic characteristics of a child with comorbid 16p11.2 microdeletion syndrome and Rett syndrome (RTT). A male infant who was admitted to Gansu Provincial Maternity and Child Health Care Hospital in May 2020 was selected as the study subject. Clinical data of the infant was collected. Genomic DNA was extracted from peripheral blood samples from the infant and his parents, and subjected to whole exome sequencing (WES). Candidate variant was verified by Sanger sequencing. The patient, a 4-day-old male infant, had presented with poor response, poor intake, feeding difficulties, and deceased at 8 months after birth. WES revealed that he has harbored a 0.643 Mb deletion in the 16p11.2 region, which encompassed key genes of the 16p11.2 microdeletion syndrome such as ALDOA, CORO1A, KIFF22, PRRT2 and TBX6. His father has carried the same deletion, but was phenotypically normal. The deletion was predicted to be pathogenic. The child was also found to harbor a maternally derived c.763C>T (p.R255X) hemizygous variant of the MECP2 gene, which was also predicted to be pathogenic (PVS1+PS4+PM2_Supporting). The 16p11.2 deletion and the MECP2: c.763C>T (p.R255X) variant probably underlay the pathogenesis in this infant.

Advancing the Understanding of Vesicle-Associated Membrane Protein 1-Related Congenital Myasthenic Syndrome: Phenotypic Insights, Favorable Response to 3,4-Diaminopyridine, and Clinical Characterization of Five New Cases

BackgroundCongenital myasthenic syndromes (CMS) are a group of inherited neuromuscular junction (NMJ) disorders arising from gene variants encoding diverse NMJ proteins. Recently, the VAMP1 gene, responsible for encoding the vesicle-associated membrane protein 1 (VAMP1), has been associated with CMS. MethodsThis study presents a characterization of five new individuals with VAMP1-related CMS, providing insights into the phenotype. ResultsThe individuals with VAMP1-related CMS exhibited early disease onset, presenting symptoms prenatally or during the neonatal period, alongside severe respiratory involvement and feeding difficulties. Generalized weakness at birth was a common feature, and none of the individuals achieved independent walking ability. Notably, all cases exhibited scoliosis. The clinical course remained stable, without typical exacerbations seen in other CMS types. The response to anticholinesterase inhibitors and salbutamol was only partial, but the addition of 3,4-diaminopyridine (3,4-DAP) led to significant and substantial improvements, suggesting therapeutic benefits of 3,4-DAP for managing VAMP1-related CMS symptoms. Noteworthy is the identification of the VAMP1 (NM_014231.5): c.340delA; p.Ile114SerfsTer72 as a founder variant in the Iberian Peninsula and Latin America. ConclusionsThis study contributes valuable insights into VAMP1-related CMS, emphasizing their early onset, arthrogryposis, facial and generalized weakness, respiratory involvement, and feeding difficulties. Furthermore, the potential efficacy of 3,4-DAP as a useful therapeutic option warrants further exploration. The findings have implications for clinical management and genetic counseling in affected individuals. Additional research is necessary to elucidate the long-term outcomes of VAMP1-related CMS.

Factors influencing gastrostomy tube feeding duration and nutrition outcomes in pediatric patients with Down syndrome: A descriptive cohort study.

Feeding difficulty is widely recognized in patients with Down syndrome, and many patients require gastrostomy tube (G-tube) placement for nutrition. No reliable factors have been identified to predict the expected duration of G-tube feeds in patients with Down syndrome. This descriptive cohort study aimed to determine the factors affecting the duration of G-tube feeds. We also investigated change in body mass index (BMI) from G-tube placement to discontinuation. Medical records of patients with Down syndrome seen by a pediatric gastroenterologist at a tertiary care center between September 1986 and December 2021 were reviewed. Data collection included demographics, anthropometrics, comorbidities, and feeding route. Comparison was performed between patients who discontinued G-tube feeds and those who did not. Two hundred twenty patients (45% female) were included. The median age at G-tube placement was 5 months (interquartile range [IQR]: 0.2-1.3 years). There were 113 (51%) patients who discontinued G-tube feeds, after a median duration of 31.6 months (IQR: 15.6-55.7 months). Tracheostomy was the only covariant associated with a longer duration of G-tube feeds (158 months vs 53 months; P = 0.002). Neither age at G-tube placement nor any comorbidities were associated with BMI status at discontinuation of G-tube. In our cohort of patients with Down syndrome, age at placement of G-tube did not impact the duration of G-tube feeds. Most patients who had a G-tube placed were likely to require enteral feeds for at least 1 year. Those who had a tracheostomy needed their G-tube for a longer time.

Novel 14q32.2 paternal deletion encompassing the whole DLK1 gene associated with Temple syndrome

BackgroundTemple syndrome (TS14) is a rare imprinting disorder caused by maternal UPD14, imprinting defects or paternal microdeletions which lead to an increase in the maternal expressed genes and a silencing the paternally expressed genes in the 14q32 imprinted domain. Classical TS14 phenotypic features include pre- and postnatal short stature, small hands and feet, muscular hypotonia, motor delay, feeding difficulties, weight gain, premature puberty along and precocious puberty.MethodsAn exon array comparative genomic hybridization was performed on a patient affected by psychomotor and language delay, muscular hypotonia, relative macrocephaly, and small hand and feet at two years old. At 6 years of age, the proband presented with precocious thelarche. Genes dosage and methylation within the 14q32 region were analyzed by MS-MLPA. Bisulfite PCR and pyrosequencing were employed to quantification methylation at the four known imprinted differentially methylated regions (DMR) within the 14q32 domain: DLK1 DMR, IG-DMR, MEG3 DMR and MEG8 DMR.ResultsThe patient had inherited a 69 Kb deletion, encompassing the entire DLK1 gene, on the paternal allele. Relative hypermethylation of the two maternally methylated intervals, DLK1 and MEG8 DMRs, was observed along with normal methylation level at IG-DMR and MEG3 DMR, resulting in a phenotype consistent with TS14. Additional family members with the deletion showed modest methylation changes at both the DLK1 and MEG8 DMRs consistent with parental transmission.ConclusionWe describe a girl with clinical presentation suggestive of Temple syndrome resulting from a small paternal 14q32 deletion that led to DLK1 whole-gene deletion, as well as hypermethylation of the maternally methylated DLK1-DMR.

‘Counselling is not just providing information’: perceptions of caregivers and stakeholders on the design of nutrition and health counselling interventions for families with young children in rural Kenya

BackgroundGlobally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs.ObjectiveFor the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling.DesignWe employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo.SettingHealth and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya.ParticipantsWe interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya.ResultsNutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers.ConclusionThere is a disconnect between the caregivers’ preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.

Epiglottis calcification: forgotten cause of dysphagia in elderly population

BackgroundDysphagia is a relatively common clinical issue in elderly population with numerous causes, which are divided into oropharyngeal and substernal categories. Most of the causes of dysphagia can be diagnosed easily with clinical and radiological examinations. However, we encountered a rare cause of dysphagia in an elderly patient, which can be missed easily during diagnostic workup, that entity is epiglottis calcification.Case presentationA 91-year-old male presented with complaints of recurrent aspirations and difficulty in swallowing. Physical examination revealed no abnormalities in the oral cavity, pharynx and nose. Flexible fiberoptic laryngoscopic examination was performed, which mildly swollen and posteriorly moved epiglottis with limited mobility during swallowing. Computed tomography scan of the larynx revealed significant asymmetric amorphous calcification of the free edge of the aryepiglottic, pharyngoepiglottic, and epiglottis folds.ConclusionsAlthough dysphagia is a common problem in elderly, it has serious complications such as recurrent aspirations, pneumonia and nutritional deficiency. One of the rare causes of dysphagia in elderly is epiglottic calcifications, which impairs its flexibility and the functionality, and may predispose to difficulty in swallowing and recurrent aspirations.

An adolescent case of ASXL3-related disorder with delayed onset of feeding difficulty

BackgroundASXL3-related disorder, first described in 2013, is a genetic disorder with an autosomal dominant inheritance that is caused by a heterozygous loss-of-function variant in ASXL3. The most characteristic feature is neurodevelopmental delay with consistently limited speech. Feeding difficulty is a main symptom observed in infancy. However, no adolescent case has been reported.Case presentationA 14-year-old girl with ASXL3-related syndrome was referred to our hospital with subacute onset of emotional lability. Limbic encephalitis was ruled out by examination; however, the patient gradually showed a lack of interest in eating, with decreased diet volume. Consequently, she experienced significant weight loss. She experienced no symptoms of bulimia, or food allergy; therefore, avoidant/restrictive food intake disorder (ARFID) was clinically suspected.ConclusionsWe reported the first case of ASXL3-related disorder with adolescent onset of feeding difficulty. ARFID was considered a cause of the feeding difficulty.

Speech services by speech volunteers for children with cleft lip and palate in professional lacking area: Pilot study

Background: Cleft lip and cleft palate are the most common birth defects. Children with cleft lip with or without cleft palate (CP±L) face a vary of challenges, depending on the type and severity of the cleft including speech difficulty, dental problems, feeding difficulty, ear infections and hearing loss. Articulation error is the most common residual defect in children with cleft palate with or without cleft lip. Objective: To compare the numbers of pre- and post- articulation errors after using the Model of Speech Therapy by Volunteers (STV) for children with CP±L. Materials and methods: 9 children, aged range 6; 4-14; 2 years old, were included in this study and completely participated in the study. Pre- and post-articulation tests by Myanmar Articulation, Resonation, Nasal Emission and Nasal Turbulence Test were assessed at Mahamuni Monastery, and Thiriyadana Guha Pone Htoon Shan Monastery, Tachileik, Myanmar. STV is composed of a 3-day speech camp (1st month), 3 times 1-day site visits for complicated cases (2nd, 6th, and 10th months) and 3 times of 1-day follow-up speech camps (4th, 8th, and 12th months), Phonological approaches, traditional strategies, and specific techniques for speech correction in children with CP±L were taught to speech volunteers (SVs) and caregivers. Homework was assigned to SVs and caregivers. SVs provided a session of 45-minute speech correction every week. Caregivers practiced 5 sessions of 30 minutes in speech exercises /weeks at home. Results: STV revealed significant reductions in the numbers of articulation errors including articulation screening test [median difference: MD=6 (95% confident interval: CI=5.2-9.2)], and Myanmar articulation standard test at both word and sentence levels; [MD=8 (95% CI=6.5-10.8) and MD=5 (95% CI=4.2-8.3), respectively]. Conclusion: STV significantly decreased a number of articulation errors in children with CP±L of Myanmar, a professional lacking area, and could be applied in any area that has a similar situation. The result was a primary study, the further research should enroll more participants for generalization.

Examining the Relationship between Quality of Life and Baseline Hemoglobin Level in Lung Cancer with Chemotherapy Treatment Using EORTC QLQ-LC13

Background: The effect of lung cancer and its various treatments on the overall well-being can be substantial. This study seeks to examine the correlation between quality of life and baseline hemoglobin (Hb) levels in lung cancer patients who are receiving chemotherapy. Method: This study involved 30 patients with non-small cell lung cancer (NSCLC) who underwent platinum-based chemotherapy. Baseline Hb level were collected from medical records. The patients' quality of life was assessed using interviews utilizing the EORTC QLQ-LC13 questionnaire. Result: Baseline Hb levels and pain relief after medication score was positively correlated (r=0.559, p=0.001). Baseline Hb levels and difficulty swallowing score was negatively correlated (r=-0.386, p=0.035). Determined cut-off point for the total score was 303.5. However, the correlation between Hb levels and overall quality of life was insignificant (r=-0.096, p=0.615). Conclusion: According to the quality of life indicators in the questionnaire, there is a notable association between lower baseline Hb levels and reduced effectiveness of pain relief medication, as well as an increase in difficulty swallowing. However, the underlying cause for this correlation is unclear. On the other hand, the correlation between baseline Hb levels and the overall scores of quality of life in the questionnaire was not found to be significant.

Generation of a human induced pluripotent stem cell line from a patient with GM3 synthase deficiency using self-replicating RNA vector

GM3 synthase deficiency (GM3SD) is caused by biallelic variants in the ST3GAL5 gene. Early clinical features of GM3SD include infantile onset of severe irritability and feeding difficulties, early intractable seizures, growth failure, hypotonia, sensorineural hearing impairment. We describe the generation and characterization the human induced pluripotent stem cell (hiPSC) line derived from fibroblasts of a 13-year-old girl with GM3 synthase deficiency resulted compound heterozygous for two new variants in the ST3GAL5 gene, c.1166A > G (p.His389Arg) and the c.1024G > A (p.Gly342Ser). The generated hiPSC line shows a normal karyotype, expresses pluripotency markers, and is able to differentiate into the three germ layers.

Growth trajectories and need for oral feeding support among infants with neonatal encephalopathy treated with therapeutic hypothermia.

Identify feeding supports required among infants with neonatal encephalopathy and determine growth trajectories to 3 years. Single-center retrospective cohort study of 120 infants undergoing therapeutic hypothermia. Logistic regression and stratified analyses identified whether clinical factors, EEG-determined encephalopathy severity, and MRI-based brain injury predict feeding supports (nasogastric tube, oral feeding compensations) and growth. 50.8% of infants required feeding supports in the hospital, decreasing to 14% at discharge. Moderate-to-severe encephalopathy and basal ganglia injury predicted feeding support needs. Yet, 35% of mildly encephalopathic infants required gavage tubes. Growth trajectories approximated expected growth of healthy infants. Infants with neonatal encephalopathy-even if mild-frequently experience feeding difficulties during initial hospitalization. With support, most achieve full oral feeds by discharge and adequate early childhood growth. Clinical factors may help identify infants requiring feeding support, but do not detect all at-risk infants, supporting routine screening of this high-risk population.

Feeding Issues in Infants Referred for Frenotomy.

The diagnosis of ankyloglossia has increased significantly around the world over the last decade. Frenotomy is indicated in infants with ankyloglossia to improve breastfeeding, although there is little scientific evidence of its efficacy. The purpose of this study is to evaluate whether infants being referred for frenotomy had feeding issues prior to the procedure. A retrospective chart review was undertaken for all infants under one year of age referred with ankyloglossia to a pediatric otolaryngology practice or a pediatric hospital between 2018 and 2020. Data included age at referral, gender, comorbidities, feeding issues, whether ankyloglossia was diagnosed, and whether frenotomy was done. Frequencies and non-parametric comparisons were calculated. Of the 646 consultations made for tongue tie, a diagnosis of ankyloglossia was made in 94.7% (N=612) of the patients based on clinical judgment. The most common feeding complaints were poor latch (57.1%, N=369) and painful latch (50.3%, N=325). Eighty one (12.5%) patients did not have a reported feeding difficulty. Most patients had an anterior tongue tie (85.8%, N=554), with some showing signs of restricted tongue movement (30.1%, N=184). Ankyloglossia was 4.03 times more likely to be diagnosed (p<.001) and frenotomy was 1.76 times more likely to be performed (p<.001) in the hospital setting compared to the clinic setting. Conclusion:Children under the age of one referred to otolaryngology for ankyloglossia were often diagnosed concordantly, although some lacked feeding issues that would indicate frenotomy. There are still knowledge gaps about infantile ankyloglossia in referring medical personnel.

Neonatal Hypoglycemia.

Neonatal hypoglycemia (NH) is broadly defined as a low plasma glucose concentration that elicits hypoglycemia-induced impaired brain function. To date, no universally accepted threshold (reference range) for plasma glucose levels in newborns has been published, as data consistently indicate that neurologic responses to hypoglycemia differ at various plasma glucose concentrations. Infants at risk for NH include infants of diabetic mothers, small or large for gestational age, and premature infants. Common manifestations include jitteriness, poor feeding, irritability, and encephalopathy. Neurodevelopmental morbidities associated with NH include cognitive and motor delays, cerebral palsy, vision and hearing impairment, and poor school performance. This article offers a timely discussion of the state of the science of NH and recommendations for neonatal providers focused on early identification and disease prevention.

A real-world cross-sectional study evaluating the role of an oral amino acid-based supplement in nutrient intake by preschoolers on a cow's milk elimination diet.

Food allergy has several negative nutritional consequences and may persist beyond the first year of lives. This study aimed to assess the role of a complete oral amino acid-based supplement in the diet of children on cow's milk protein elimination diet because of food allergy. This study included two groups of children aged 1-5 years paired by age and socioeconomic status: (1) study group, on cow's milk protein elimination diet plus an oral amino acid-based supplement, and (2) control group, on cow's milk protein elimination diet. Sociodemographic, clinical, anthropometric, and dietary data were obtained through online interviews. Two 24-h dietary recalls were collected on nonconsecutive days. Both groups comprised mostly boys. The study group presented lower values of body mass index. The frequency of feeding difficulties was similar between groups. The study group had a higher intake of energy, protein, carbohydrates, calcium, iron, zinc, phosphorus, magnesium, copper, selenium, vitamins D, E, B1, B2, B6, and B12, niacin, and folic acid compared to the control group. A higher proportion of children in the study group had adequate intake according to the recommendations made for energy, carbohydrates, iron, phosphorus, selenium, vitamins A, D, E, B1, B2, and B6, and folic acid. The use of a complete oral amino acid-based supplement has a positive effect on the diet quality of preschoolers on cow's milk elimination diet because of food allergy, promoting higher intake of energy, calcium, vitamin D, and other essential nutrients.