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Introduction

Breastfeeding, recognized for its essential nutrition and health benefits, potentially influences central nervous system development. This study delves into the nuanced relationship between breastfeeding duration and neurodevelopment in five-year-old children.

Aims & Methods

A cohort of 72 children living in Varna, Bulgaria was followed up from birth to age five, all of them being term-born infants with normal birth weight and devoid of perinatal infections or abnormalities. Comprehensive data on demographics and dietary practices were collected. Neurodevelopmental assessments at five years included motor and speech development, articulation, nonverbal intelligence, and behavior, evaluated using the validated NDT5 tool. Children were stratified into 2 groups based on breastfeeding duration (up to age six months vs. over six months). Statistical analysis was performed using Jamovi 2.0.0.0.

Results

Children in both groups exhibited similar demographic characteristics and BMI distributions. Notably, significant differences emerged between the groups in girls' motor development (U=54, p=0.018) and overall development (U=52, p=0.045). Similarly, boys showed disparities in nonverbal intelligence (U=66.5, p=0.008), as evidenced by both intention-to-treat (ITT) and per-protocol (PP) analyses.

Conclusion

Breastfeeding duration appears to exert a discernible influence on neurodevelopment in five-year-old children. Notably, distinct effects were observed in girls' motor development and boys' nonverbal intelligence. Further longitudinal investigations are warranted to optimize neurodevelopmental outcomes based on breastfeeding duration.

EXPLORING THE IMPACT OF BREASTFEEDING DURATION ON NEURODEVELOPMENT IN FIVE-YEAR-OLD CHILDREN

Maria Dzhogova 1, Evelina Atanasova 1, Desislva Zhelyazkova 1, Martin Petrov 1, Simonetta Popova 1, Ralitsa Yordanova 2, Ivan Ivanov 2, Rouzha Pancheva 1

1 Medical University of Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria

2 Medical University of Plovdiv, Plovdiv, Bulgaria

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

NUTRITION (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Mistakes In Articles

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Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.

Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

Christos Tzivinikos, Ilse Broekaert, Jorge Amil Dias, Matjaz Homan

Topics

Paediatrics Small Intestine & Nutrition Stomach & H. Pylori

Citation

Broekaert I.J, Dias J.A, Homan M and Tzivinikos C. Mistakes in gastrostomy insertion in children and adolescents and how to avoid them. UEG Education 2024; 24: 34-38.

Published

2024

UEG Standards and Guidelines

Position Paper

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Abstract

Objectives

Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimize its utility and safety.

Methods

A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations before placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long-term care, and ethical considerations were addressed.

A systematic literature search was performed from 1982 to November 2018 using PubMed, the MEDLINE, and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.

During a consensus meeting, all recommendations were discussed and finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors.

Results

A total of 33 recommendations were voted on using the nominal voting technique.

Conclusions

JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team providing active follow-up and care.

The Use of Jejunal Tube Feeding in Children

Ilse Broekaert

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Paediatrics Small Intestine & Nutrition

Citation

Journal of Pediatric Gastroenterology and Nutrition, 69: 239-258

Published

2019

UEG Standards and Guidelines

Position Paper

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Abstract

Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities.

Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction.

The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources.

In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.

Feeding the Late and Moderately Preterm Infant

A. Lapillonne

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Paediatrics Small Intestine & Nutrition

Citation

Journal of Pediatric Gastroenterology and Nutrition, 69: 259-270

Published

2019

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Introduction

Nutrition is one of the important risk factors for the occurrence of functional gastrointestinal disorders in children. These disorders, including functional dyspepsia (FD) and irritable bowel syndrome (IBS), are increasingly prevalent in the pediatric population. Understanding dietary patterns in affected children is crucial for developing preventive and therapeutic strategies.

Aims & Methods

The aim is to study eating behavior disorders in children with functional gastrointestinal disorders and to analyze the diet of children with combined functional gastrointestinal pathology.
Materials and methods: 110 children aged 6 to 18 with functional gastrointestinal disorders were examined. Patients were divided into two groups: 44 with a combination of symptoms of functional dyspepsia and irritable bowel syndrome and 66 with functional dyspepsia. The control group consisted of 30 practically healthy children. The diagnosis of functional dyspepsia and irritable bowel syndrome was established on the basis of clinical symptoms according to the Rome IV criteria (2016). In order to detect a violation of the nutritional regime, children were interviewed according to a questionnaire developed by us. They also studied the food preferences of schoolchildren using the Youth Adolescent Food Frequency Questionnaire, adapted to the model of children's nutrition in Ukraine.

Results

The frequency of eating disorders (absence of breakfast or full lunch at school, reduced number of meals) in children with functional disorders is higher than in healthy children. In children with overlap syndrome, these disorders were detected statistically significantly more often than in children with isolated functional dyspepsia. In children with functional disorders, the frequency of consumption of vegetables, cereals and cereal products is lower than in healthy children, and the consumption of meat, sausages and confectionery, fast food, chips, nuts, seeds, energy and sweet carbonated drinks, and fruit juices is higher. In children with a combination of functional dyspepsia and irritable bowel syndrome, the frequency of consumption of vegetables, cereals, and grain products is lower, and the consumption of confectionery, fast food, energy and sweet carbonated drinks is higher than in children with functional dyspepsia.
We conducted an analysis of nutrition in children with a combined pathology of functional dyspepsia (FD) and irritable bowel syndrome (IBS) (see table below).

Indicator Eating less than 3 times a day	Combined FD and IBS, n = 44, N 14	% ± m 31.8 ± 7.3*	Functional Dyspepsia n = 66, N 8	% ± m 12.2 ± 4.4	Control Group n = 30, N 3	% ± m 10 ± 5.5
Skip breakfast	17	38.6 ± 7.3*	5	7.6 ± 3.9	4	13.3 ± 6.2***
Eat sandwiches for breakfast	14	31.8 ± 6.7	27	40.9 ± 7.4**	4	13.3 ± 6.2
Eat hot meals for breakfast	13	29.7 ± 6.6*	34	51.6 ± 7.5	22	73.3 ± 8.1***
Do not eat lunch at school	2	4.54 ± 1.51	5	7.57 ± 3.98	0	-
Eat lunch in school cafeteria	19	43.2 ± 7.5	42	63.2 ± 7.3	20	66.7 ± 8.6
Buy food in school snack bar	21	47.7 ± 7.53*	15	22.7 ± 6.3**	2	6.7 ± 4.5*
Bring food from home	2	4.5 ± 1.5	4	6.1 ± 3.7**	8	26.6 ± 8.1*
Have an afternoon snack	23	52.3 ± 7.6*	55	83.0 ± 5.6	27	90.0 ± 5.5*
Eat dinner	43	92.7 ± 3.9	61	92.4 ± 3.9	30	100

Legend:
* – statistically significant difference (p < 0.05) between groups I and II;
** – statistically significant difference (p < 0.05) between group II and the control group;
*** – statistically significant difference (p < 0.05) between group I and the control group.

Conclusion

Violation of the regime and quality of nutrition is a risk factor for the formation of functional gastrointestinal disorders in children, which must be taken into account in treatment.

References

Chouliaras G, Kondyli C, Bouzios I, Spyropoulos N, Chrousos GP, Roma-Giannikou E. Dietary Habits and Abdominal Pain-related Functional Gastrointestinal Disorders: A School-based, Cross-sectional Analysis in Greek Children and Adolescents. J Neurogastroenterol Motil 2019; 25:113-122. https://doi.org/10.5056/jnm17113
Alatas, F. S., Salsabila, K., Amalia, N., & Hanafi, G. (2022). Functional gastrointestinal disorders and nutritional status in junior high school students. Paediatrica Indonesiana, 62(4), 243-8. https://doi.org/10.14238/pi62.4.2022.243-8
Katsagoni CN, Karagianni V-M, Papadopoulou A. Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies. Nutrients. 2023; 15(12):2708. https://doi.org/10.3390/nu15122708

THE DEVELOPMENT OF FUNCTIONAL GASTROINTESTINAL DISORDERS IN SCHOOL-AGE CHILDREN: THE INFLUENCE OF MALNUTRITION AND EATING DISORDERS

Olga Bielousova 1

1 Vilnius University, Vilnius, Lithuania

Conference

UEG Week Berlin 2025

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

NUTRITION (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Objectives

To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800 g.

Methods

The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee of Nutrition (CoN) led a process that included CoN members and invited experts. Invited experts with specific expertise were chosen to represent as broad a geographical spread as possible. A list of topics was developed, and individual leads were assigned to topics along with other members, who reviewed the current literature. A single face-to-face meeting was held in February 2020. Provisional conclusions and recommendations were developed between 2020 and 2021, and these were voted on electronically by all members of the working group between 2021 and 2022. Where >90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached.

Results

In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier.