OBJECTIVES To describe diagnostic criteria used in children with coeliac disease (CD) and selective IgA deficiency; to determine if the publication of the 2012 ESPGHAN criteria prompted any changes; to evaluate the evolution of serological markers. METHODS Multicenter, retrospective, descriptive study of a cohort of children under 15 years with selective IgA deficiency diagnosed with CD (January 2006-December 2016). Demographic, clinical, genetic, histological and IgG-based antibodies were collected at diagnosis and follow-up. RESULTS 86 children were included, 60 diagnosed after the guide. Two groups were established G1 (n = 63) and G2 (n = 23) with or without diagnostic biopsy respectively. In G1 87.3% were symptomatic, 87.3% had HLA DQ2/DQ8 typing (all positive), all had IgG serology positive (71.5% ATG, 35% EMA, 19% DPG, 9.5% AGA) and all had villous atrophy (Marsh-Oberhuber 2-3). Follow-up data were available in 58 children, 34 after 2 years on a gluten-free diet. 52% remained ATG IgG positive despite good dietary adherence and symptom remission. Regarding G2 all were diagnosed post-2012, had typical symptoms, HLA DQ2/DQ8 positive and ATG IgG x 10 ULN. Additionally, EMA IgG was performed in 14 (60%), all positive. CONCLUSIONS In our cohort of children with selective IgA deficiency and diagnosed with CD, children without a diagnostic biopsy suggests that IgG serology was considered the equivalent as IgA isotype, even when this is not addressed in the aforementioned guidelines. Great heterogeneity was observed in the IgG serology used at diagnosis. After 2 year of a gluten-free diet, half of children remained with a positive serology.More than 10,000 preterm infants have participated in randomised controlled trials on probiotics worldwide, suggesting that probiotics in general could reduce rates of necrotising enterocolitis (NEC), sepsis, and mortality. However, answers to relevant clinical questions as to which strain to use, at what dosage, and how long to supplement, are not available. On the other hand, an increasing number of commercial products containing probiotics are available from sometimes suboptimal quality. Also, a large number of units around the world are routinely offering probiotic supplementation as the standard of care despite lacking solid evidence. Our recent network meta-analysis identified probiotic strains with greatest efficacy regarding relevant clinical outcomes for preterm neonates. Efficacy in reducing mortality and morbidity was found for only a minority of the studied strains or combinations. In the present position paper, we aim to provide advice which specific strains might potentially be used and which strains should not be used. Besides, we aim to address safety issues of probiotic supplementation to preterm infants, who have reduced immunological capacities and occasional indwelling catheters. For example, quality reassurance of the probiotic product is essential, probiotic strains should be devoid of transferable antibiotic resistance genes, and local microbiologists should be able to routinely detect probiotic sepsis. Provided all safety issues are met, there is currently a conditional recommendation (with low certainty of evidence) to provide either L. rhamnosus GG ATCC53103 or the combination of B. infantis Bb-02, B. lactis Bb-12, and Str. thermophilus TH-4 in order to reduce NEC rates.OBJECTIVE to compare the rates of nutrients consumption in children and adolescents with gastroesophageal reflux disease (GERD) compared to the control group without the disease. METHODS Based on symptom evaluation and esophageal pH-impedance recordings patients were allocated on to GERD and control groups. All patients underwent esophagogastroscopy. Levels of nutrients consumption were assessed with the use of food frequency questionnaire in the regard to the presence of the disease, esophagitis, and Z-score BMI. RESULTS Data of 219 children and adolescents were available for the final analysis. Risks to have GERD were higher in groups with obesity (RR 1.2 [95%CI 0.8-1.7]) and excessive weight (1.1 [0.9-1.4]). Energy values of the rations and amount of fat consumption were higher in the GERD group compared to the control when rations were compared according to Z-score BMI. In contrast to non-erosive form of GERD, patients with erosive esophagitis consumed more protein (percentage deviation from the recommended daily allowance Me[25%;75%]) 14.3[11.07;19.1]% vs 8.5 [6.71;14.1]%, total fat 36.8 [12.5;75.5]% vs 16.9 [10.1;17.9]%, and less polyunsaturated fats -54.3 [-73.4;-47.7]% vs -45.6 [-56.2;-33.1]%, P  less then  0.05. CONCLUSIONS The rations of children with GERD are characterized by higher calorie values and larger amounts of fat intake compared to the control group in the regard to Z-score BMI. Low dietary fiber consumption is additional factor associated with GERD in children with excessive weight and obesity. Compared to non-erosive GERD, higher intake of energy, protein, and total fat and lower of polyunsaturated fats revealed in GERD patients with erosive esophagitis.OBJECTIVES Studies have shown the advantages of carbon dioxide (CO2) over air insufflation in the adult population during colonoscopies. This study was designed to investigate the efficacy and safety of CO2 insufflation in deeply sedated children undergoing colonoscopy. METHODS This was a prospective, randomized, double-blind clinical trial. We recruited 100 consecutive pediatric patients who had colonoscopy under deep sedation for various indications. Patients were first randomized by history of abdominal pain and then randomly assigned to either CO2 or air insufflation. Post-procedural abdominal pain scores were registered on a 10-point visual analog rating scale and significant pain was defined as a score of 3 or higher. Abdominal circumferences and end tidal CO2 (ETCO2) levels were measured. Complications during and after the procedure were recorded. RESULTS We did not find statistically significant difference between CO2 and Air insufflation on univariate analysis due to low number of children experiencing significant pain after colonoscopy. After adjusting for baseline pain, we found that pain was significantly lower in patients after CO2 versus air insufflation on multivariable analysis (P = 0.03). The significant factors related to pain were duration of the procedure (P = 0.006), history of abdominal pain (P = 0.002) and previous abdominal surgery (P = 0.02). CO2 insufflation was associated with decreased abdominal circumference after colonoscopy (P = 0.002). Females were more likely to have pain regardless of intervention (P = .04). CONCLUSIONS Most children tolerate endoscopic procedures without significant pain. Our study was underpowered to show significant difference between Air and CO2 on univariate analysis. However, CO2 insufflation during colonoscopy may reduce post-procedural abdominal pain. Significant factors for increased pain on multivariate analysis included colonoscopy length over 30 min, history of abdominal pain and previous abdominal surgery.OBJECTIVES Glucagon Like Peptide 2 (GLP-2) is a 33 amino acid peptide hormone released from enteroendocrine L-cells following nutrient ingestion. It has been shown to exert trophic effects on the gut. We set out to measure GLP-2 concentrations in blood in children with diarrhoea and malnutrition. METHODS GLP-2 levels were measured in blood samples collected from five different groups of children (n = 324) at different time points (1) those with acute diarrhoea, during illness and 3 weeks after recovery; (2) persistent diarrhoea and severe acute malnutrition (SAM); (3) controls contemporaneous for diarrhoea; (4) stunted children from the community; (5) controls contemporaneous for the stunted children. Stool biomarkers and pathogen analysis was carried out on the children with stunting. RESULTS GLP-2 concentrations were higher during acute diarrhoea (median 3.1 ng/ml, interquartile range, IQR 2.1, 4.4) than on recovery (median 1.8, IQR 1.4, 3.1; P = 0.001), but were not elevated in children with persistent diarrhoea and SAM. In stunted children, there was a progressive decline in GLP-2 levels from 3.2 ng/ml (1.9, 4.9) to 1.0 (0.0, 2.0; P  less then  0.001) as the children became more stunted. Measures of seasonality (rainfall, temperature, food price index and Shiga toxin-producing Escherichia coli) were found to be significantly associated with GLP-2 concentrations in multivariable analysis. We also found a correlation between stool inflammatory biomarkers and GLP-2. CONCLUSIONS In diarrhoea, GLP-2 levels increased in acute but not persistent diarrhoea. Malnutrition was associated with reduced concentrations. GLP-2 displayed seasonal variation consistent with variations in nutrient availability.BACKGROUND Accumulating studies in recent years have revealed that platelet activation is an important factor inducing neutrophil extracellular traps (NETs) formation in vivo, while the mechanism of this process is not fully elaborated, restricting its clinical use. Our previous study found that a histone deacetylase inhibitor (HDACi) could attenuate serum H3 elevation in septic mice, which was related to NETs formation, and others found HDAC6 to be involved in platelet activation, indicating that HDACis may attenuate platelet activation and result in reduced NETs formation. METHODS Freshly isolated human platelets were activated by TRAP-6 with or without a HDACi, and secretion of α-granules was evaluated by testing PF4 in the supernatant using ELISA. NETs were induced by coincubating neutrophils with preactivated platelets, quantified by fluorescent intensity (FI) of Sytox green, monitored by live-cell imaging, and qualitatively analyzed by immunofluorescence. MAIN RESULTS An in vitro bioreactive system to induce and monitor NETs formation using platelets and neutrophils was established. The PF4 elevation stimulated by TRAP-6 in the supernatant of platelets was attenuated by the HDACi, and NETs formation that was induced by coincubating neutrophils with the preactivated platelets was decreased in the presence of the HDACi. CONCLUSION The HDACi attenuates NETs formation induced by activated platelets partially by modulating the secretion of platelets.BACKGROUND Toxin-producing, Gram-positive bacteria, can lead to severe and refractory septic shock with high attributable mortality. Adjunctive therapies such as intravenous immunoglobulins (IVIG) have been proposed for these patients. However, at presentation the presence of a toxin-producing organism is most often unknown. As IVIG is a potentially valuable but also limited resource, we investigated the use of IVIG in our critically ill patients requiring extracorporeal membrane oxygenation (ECMO). MATERIALS AND METHODS Retrospective cohort study (April 2016-March 2018) of adult patients with clinically suspected toxin-mediated shock requiring ECMO and who received IVIG in our regional severe respiratory failure (SRF)/ ECMO centre. RESULTS In 44% (15/34) of the patients, group A Streptococcus or Panton-Valentine Leukocidin producing S. aureus was isolated. IVIG use in these patients was safe. The mortality was 30%, lower than the predicted mortality of >90% based on the SOFA scores. CONCLUSION IVIG administration can be considered in a selected group of patients presenting with acute and very severe septic shock.