Florence Campeotto

Introduction Among foreign body ingestions in children, button battery ingestion is becoming increasingly common. When the battery is impacted in the oesophagus, the risk of complications is significant. The aim of this study was to share our experience in managing children with oesophageal button battery impaction and assess the occurrence of short-term and long-term complications. Methods This was a retrospective study conducted at a tertiary French paediatric centre. Children with oesophageal button battery impaction managed between 1 January 2017 and 31 December 2022 were included. Clinical data, endoscopic findings and treatments were recorded at battery removal and during follow-up at 1 week and at 1, 3 and 12 months. Complications were noted at each follow-up. Patients were compared based on the presence or absence of complications to identify associated risk factors. Results Among 79 children included in the study, 31 experienced one or more complications by 12 months postingestion: oesophageal stenosis (n=14), mediastinitis (n=18), tracheoesophageal fistula (n=3), oesophageal perforation (n=5) and vocal cord paralysis (n=3). Most complications were diagnosed within the first week, except for oesophageal stenosis, which had an average delay of 38.2 days. Risk factors for complications included younger age, longer time to battery removal and oesophageal mucosal necrosis observed during follow-up endoscopy 1 week postremoval. Conclusion The rate of complications following oesophageal button battery impaction remains high. However, protocolised management involving rapid battery extraction, early endoscopic review and intraoperative nasogastric tube placement may reduce the risk of severe complications and oesophageal stenosis.

This study aimed to describe the effectiveness of biofeedback (BFB) rehabilitation in children with retentive encopresis (RE). A retrospective, single-institution study was conducted in children with BFB sessions for RE between 2017 and 2020. Manometry data and associated envy scores were analysed. BFB was a success (recovery from RE or ≥50% reduction in faecal soiling) in 37/44 (84%) children at the last session and in 32/44 (73%) 6 months later. The median age of children was higher in the success group at 6 months (p=0.013). BFB could then be clinically effective in children with RE.

Formulas adapted to infant feeding, although most of the time made from cow’s milk proteins, can be made from hydrolyzed rice protein but they must be classified as “formulas for specific medical needs”, according to European regulations. The nutritional quality of rice proteins is thus suitable to be used in infant formulas giving that it is supplemented by certain amino acids which can be lacking. Besides, hydrolysis is required to facilitate their water solubility and digestibility. Owing to a low allergenicity of rice and to the absence of the cross-allergy between milk proteins and rice proteins, these formulas are adapted to the diet of children with cow’s milk protein allergy (CMPA), which explains their growing use in some countries. However, CMPA, an expanding disorder, has consequences for growth, bone mineralization, and often has an association with allergy to other foods, including cow’s milk extensive hydrolysate, so that a surveillance of the adaption of hydrolyzed rice protein formulas (HRPF) to CMPA, the absence of unexpected side effects, and the appropriate response to its various health hazards seems mandatory. This paper analyses the health problem deriving from CMPA, the industrial development of hydrolyzed rice protein formulas, and the limited number of clinical studies, which confirms, at the moment, a good allergic tolerance and safety. The goal is to better advise heath care professionals on their use of HRPFs during CMPA.

Background: The aim of this study was to estimate the frequency of functional gastrointestinal disorders (FGIDs) in infants aged up to 12 months according to the new ROME IV criteria defining these disorders, and to describe the management of FGIDs in France. Methods: This French non-interventional, cross-sectional, and multicenter study was conducted among private-outpatient physicians who each included four consecutive patients aged up to 12 months. The frequency of FGIDs was described using the ROME IV criteria versus clinicians’ diagnosis. The characteristics of infants with and without FGID were compared, and the management of the FGIDs was described. Results: In the 1722 infants analyzed, the following frequencies were observed according to the ROME IV criteria versus the physicians’ diagnosis: regurgitation 41% versus 45%; colic 18% versus 30%; constipation 9% versus 19%; diarrhea 3% versus 8%. Of note, FGID infants were less frequently exclusively breastfeeding at the maternity hospital (p < 0.001), were introduced to cow’s milk earlier after leaving the maternity hospital (p < 0.001), and more frequently had symptoms suggestive of cow’s milk protein allergy (p < 0.001). Physicians frequently recommended an adapted infant formula (in 77% to 82% of cases depending on the FGID diagnosed) and prescribed a specific treatment in 51% to 66% of infants (probiotics: 35% to 64%). Conclusions: This real-world study confirms the high frequency of FGIDs in infants in France, and provides new information regarding the characteristics of FGID infants.

Aim: Very preterm birth is associated with a high risk of enteropathies. Diagnosis is challenging, especially in mild forms, leading to unnecessary periods of cessation of enteral feeding. This study aimed at establishing a prognosis score of enteropathy combining clinical parameters and faecal calprotectin concentration.Methods: This prospective multicentric study included preterm neonates born at a gestational age of 33 weeks or less. Stools were collected weekly until hospital discharge, and daily in case of digestive events for calprotectin measurement (ELISA and immunochromatography) and microbiota analyses (16S rRNA gene sequencing).Results: Among the 121 neonates included, 21 experienced at least one episode of enteropathy, mainly mild forms. By ELISA testing, median faecal calprotectin was 88 (8‐798) µg/g faeces. No statistically significant association was found between the outset of enteropathy and maternal and neonatal characteristics, and calprotectin levels. The agreement between ELISA and immunochromatography assay was moderate (intra‐class correlation coefficient 0.58, 95%CI [0.47‐0.66]). Comparison of species diversity and relative bacterial abundance profiles between infants with or without enteropathy revealed no specific alterations associated with enteropathy.Conclusion: The study failed to propose a prognostic score of enteropathy, probably due the large inter‐ and intra‐individual variability of faecal calprotectin in very preterm neonates.