A recent study (S Salvatore et al. J Pediatr 2019; 212: 44-51) examines the role of neonatal antibiotics and prematurity on the development of functional gastrointestinal disorders in the first year of life.
What is most striking, though, in this study is how many of these infants have a GI disorder.
Background: Prospective cohort multicenter study with 934 infants who completed study; n=302 premature, n=320 antibiotic recipients
718 (77%) had at least one functional GI disorder (FGID) based on Rome III criteria, including 47% with colic, 40% with regurgitation, 32% with dyschezia, 27% with constipation, and 4% with functional diarrhea
Preterm infants had FGID rate of 86% compared with 73% of full term infants (P=.0001)
Use of antibiotics was associated with FGIDs as well, with aRR of 1.16 (P=.001)
The prevalence of FGIDs was highest in the first three months of life and then improved markedly by 6 months of age; by 12 months of age, each of the FGIDs was well below 10%.
Limitation: This study relied on parental reports which could overestimate infant’s symptoms.
My take: More than 75% of infants had at least one FGID.
A new endoscopic technique’s efficacy has recently been reported (Gastroenterol 2015; 148: 324-33). Since this technique is not likely to be broadly applicable to the pediatric population for some time, I will not delve into all of the details.
In essence, a carefully selected group (n=129 from a screened group of 696) of adult patients with persistent regurgitation underwent transoral fundoplication; this eliminated troublesome regurgitation in 67% compared to 45% who were randomized to sham/PPI. Severe complications were rare.
Bottomline: This endoscopic procedure along with the Stretta procedure and the LINX device (using magnets) offer alternatives to surgical fundoplication in carefully-selected patients with refractory gastroesophageal reflux symptoms.
New drugs approved by FDA:
Ceftolozane (Zerbaxa) -combines a cephalosporin with a beta-lactamase inhibitor (tazobactam). Indications: complicated intra-abdominal infections (in combination with metronidazole), and complicated urinary tract infections. From FDA: FDA approves new antibacterial drug Zerbaxa