DOI QR코드

DOI QR Code

Birth Weight and the Development of Functional Gastrointestinal Disorders in Infants

  • Baldassarre, Maria Elisabetta (Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari) ;
  • Di Mauro, Antonio (Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari) ;
  • Salvatore, Silvia (Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria) ;
  • Tafuri, Silvio (Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari) ;
  • Bianchi, Francesco Paolo (Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari) ;
  • Dattoli, Enzo (Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria) ;
  • Morando, Lucia (Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria) ;
  • Pensabene, Licia (Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro) ;
  • Meneghin, Fabio (Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan) ;
  • Dilillo, Dario (Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan) ;
  • Mancini, Valentina (Pediatric Unit, Saronno Hospital) ;
  • Talarico, Valentina (Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro) ;
  • Tandoi, Francesco (Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria) ;
  • Zuccotti, Gianvincenzo (Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan) ;
  • Agosti, Massimo (Unit of Pediatrics and Neonatology, "F. Del Ponte" Hospital, Dipartimento di Medicina e Chirurgia University of Insubria) ;
  • Laforgia, Nicola (Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari)
  • Received : 2020.02.15
  • Accepted : 2020.04.21
  • Published : 2020.07.15

Abstract

Purpose: To assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life. Methods: This is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10-90th percentile), small (SGA, weight <10th percentile), and large (LGA, weight >90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life. Results: Among 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic. Conclusion: We observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.

Keywords

References

  1. Baldassarre ME, Di Mauro A, Cintoli AN, Mincarone G, Tafuri S, Laforgia N. Non-communicable chronic diseases: the role of neonatal characteristics. Iran J Pediatr 2017;27:e9322.
  2. Salvatore S, Baldassarre ME, Di Mauro A, Laforgia N, Tafuri S, Bianchi FP, et al. Neonatal antibiotics and prematurity are associated with an increased risk of functional gastrointestinal disorders in the first year of life. J Pediatr 2019;212:44-51. https://doi.org/10.1016/j.jpeds.2019.04.061
  3. Sondergaard C, Skajaa E, Henriksen TB. Fetal growth and infantile colic. Arch Dis Child Fetal Neonatal Ed 2000;83:F44-7. https://doi.org/10.1136/fn.83.1.F44
  4. Vandenplas Y, Hauser B, Salvatore S. Functional gastrointestinal disorders in infancy: impact on the health of the infant and family. Pediatr Gastroenterol Hepatol Nutr 2019;22:207-16. https://doi.org/10.5223/pghn.2019.22.3.207
  5. Mahon J, Lifschitz C, Ludwig T, Thapar N, Glanville J, Miqdady M, et al. The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England. BMJ Open 2017;7:e015594. https://doi.org/10.1136/bmjopen-2016-015594
  6. Indrio F, Di Mauro A, Riezzo G, Cavallo L, Francavilla R. Infantile colic, regurgitation, and constipation: an early traumatic insult in the development of functional gastrointestinal disorders in children? Eur J Pediatr 2015;174:841-2. https://doi.org/10.1007/s00431-014-2467-3
  7. Savino F, Castagno E, Bretto R, Brondello C, Palumeri E, Oggero R. A prospective 10-year study on children who had severe infantile colic. Acta Paediatr Suppl 2005;94:129-32. https://doi.org/10.1111/j.1651-2227.2005.tb02169.x
  8. Indrio F, Di Mauro A, Riezzo G, Panza R, Cavallo L, Francavilla R Prevention of functional gastrointestinal disorders in neonates: clinical and socioeconomic impact. Benef Microbes 2015;6:195-8. https://doi.org/10.3920/BM2014.0078
  9. Baldassarre ME, Di Mauro A, Mastromarino P, Fanelli M, Martinelli D, Urbano F, et al. Administration of a multi-strain probiotic product to women in the perinatal period differentially affects the breast milk cytokine profile and may have beneficial effects on neonatal gastrointestinal functional symptoms. A randomized clinical trial. Nutrients 2016;8:677. https://doi.org/10.3390/nu8110677
  10. Baldassarre ME, Palladino V, Amoruso A, Pindinelli S, Mastromarino P, Fanelli M, et al. Rationale of probiotic supplementation during pregnancy and neonatal period. Nutrients 2018;10:1693. https://doi.org/10.3390/nu10111693
  11. Baldassarre ME, Di Mauro A, Capozza M, Rizzo V, Schettini F, Panza R, et al. Dysbiosis and prematurity: is there a role for probiotics? Nutrients 2019;11:1273. https://doi.org/10.3390/nu11061273
  12. Bertino E, Spada E, Occhi L, Coscia A, Giuliani F, Gagliardi L, et al. Neonatal anthropometric charts: the Italian neonatal study compared with other European studies. J Pediatr Gastroenterol Nutr 2010;51:353-61. https://doi.org/10.1097/mpg.0b013e3181da213e
  13. Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 2006;130:1519-26. https://doi.org/10.1053/j.gastro.2005.11.065
  14. Patel RM. Short- and long-term outcomes for extremely preterm infants. Am J Perinatol 2016;33:318-28. https://doi.org/10.1055/s-0035-1571202
  15. Marild K, Stephansson O, Montgomery S, Murray JA, Ludvigsson JF. Pregnancy outcome and risk of celiac disease in offspring: a nationwide case-control study. Gastroenterology 2012;142:39-45.e3. https://doi.org/10.1053/j.gastro.2011.09.047
  16. Salvatore S, Finazzi S, Radaelli G, Lotzniker M, Zuccotti GV; Premacel Study Group. Prevalence of undiagnosed celiac disease in the parents of preterm and/or small for gestational age infants. Am J Gastroenterol 2007;102:168-73. https://doi.org/10.1111/j.1572-0241.2006.00958.x
  17. Steiner N, Wainstock T, Sheiner E, Segal I, Landau D, Walfisch A. Small for gestational age as an independent risk factor for long-term pediatric gastrointestinal morbidity of the offspring. J Matern Fetal Neonatal Med 2019;32:1407-11. https://doi.org/10.1080/14767058.2017.1406473
  18. Mezoff EA, Aly H. The winding road to understanding the neonatal origins of inflammatory gastrointestinal disorders. J Pediatr Gastroenterol Nutr 2013;57:543-9. https://doi.org/10.1097/mpg.0b013e3182a321f1
  19. Iacono G, Merolla R, D'Amico D, Bonci E, Cavataio F, Di Prima L, et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis 2005;37:432-8. https://doi.org/10.1016/j.dld.2005.01.009
  20. Milidou I, Sondergaard C, Jensen MS, Olsen J, Henriksen TB. Gestational age, small for gestational age, and infantile colic. Paediatr Perinat Epidemiol 2014;28:138-45. https://doi.org/10.1111/ppe.12095
  21. Das UG, Sysyn GD. Abnormal fetal growth: intrauterine growth retardation, small for gestational age, large for gestational age. Pediatr Clin North Am 2004;51:639-54. https://doi.org/10.1016/j.pcl.2004.01.004
  22. Barker DJ. Adult consequences of fetal growth restriction. Clin Obstet Gynecol 2006;49:270-83. https://doi.org/10.1097/00003081-200606000-00009
  23. Ciccone MM, Scicchitano P, Salerno C, Gesualdo M, Fornarelli F, Zito A, et al. Aorta structural alterations in term neonates: the role of birth and maternal characteristics. BioMed Res Int 2013;2013:459168.
  24. Rhoads JM, Collins J, Fatheree NY, Hashmi SS, Taylor CM, Luo M, et al. Infant colic represents gut inflammation and dysbiosis. J Pediatr 2018;203:55-61.e3. https://doi.org/10.1016/j.jpeds.2018.07.042
  25. Shamir R, St James-Roberts I, Di Lorenzo C, Burns AJ, Thapar N, Indrio F, et al. Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms. J Pediatr Gastroenterol Nutr 2013;57 Suppl 1:S1-45.
  26. Melville JM, Moss TJ. The immune consequences of preterm birth. Front Neurosci 2013;7:79. https://doi.org/10.3389/fnins.2013.00079
  27. Chatrath R, Saili A, Jain M, Dutta AK. Immune status of full-term small-for-gestational age neonates in India. J Trop Pediatr 1997;43:345-8. https://doi.org/10.1093/tropej/43.6.345
  28. Steinborn A, Engst M, Haensch GM, Mahnke K, Schmitt E, Meuer S, et al. Small for gestational age (SGA) neonates show reduced suppressive activity of their regulatory T cells. Clin Immunol 2010;134:188-97. https://doi.org/10.1016/j.clim.2009.09.003
  29. Rathore DK, Nair D, Raza S, Saini S, Singh R, Kumar A, et al. Underweight full-term Indian neonates show differences in umbilical cord blood leukocyte phenotype: a cross-sectional study. PLoS One 2015;10:e0123589. https://doi.org/10.1371/journal.pone.0123589
  30. Prentice S. They are what you eat: can nutritional factors during gestation and early infancy modulate the neonatal immune response? Front Immunol 2017;8:1641. https://doi.org/10.3389/fimmu.2017.01641
  31. Di Mauro A, Neu J, Riezzo G, Raimondi F, Martinelli D, Francavilla R, et al. Gastrointestinal function development and microbiota. Ital J Pediatr 2013;39:15. https://doi.org/10.1186/1824-7288-39-15
  32. Indrio F, Di Mauro A, Riezzo G, Di Mauro F, Francavilla R. Microbiota in healthy term infant. Early Hum Dev 2013;89:S15-7. https://doi.org/10.1016/S0378-3782(13)70083-5
  33. Indrio F, Riezzo G, Raimondi F, Di Mauro A, Francavilla R. Gut motility alterations in neonates and young infants: relation to colic? J Pediatr Gastroenterol Nutr 2013;57:S9-11. https://doi.org/10.1097/01.mpg.0000441926.82812.46
  34. Saps M, Pensabene L, Di Martino L, Staiano A, Wechsler J, Zheng X, et al. Post-infectious functional gastrointestinal disorders in children. J Pediatr 2008;152:812-6.e1. https://doi.org/10.1016/j.jpeds.2007.11.042
  35. Baldassarre ME, Di Mauro A, Tafuri S, Rizzo V, Gallone MS, Mastromarino P, et al. Effectiveness and safety of a probiotic-mixture for the treatment of infantile colic: a double-blind, randomized, placebocontrolled clinical trial with fecal real-time PCR and NMR-based metabolomics analysis. Nutrients 2018;10:195. https://doi.org/10.3390/nu10020195
  36. Indrio F, Riezzo G, Raimondi F, Di Mauro A, Francavilla R. Microbiota involvement in the gut-brain axis. J Pediatr Gastroenterol Nutr 2013;57:S11-5. https://doi.org/10.1097/01.mpg.0000441927.20931.d6
  37. Grunau R. Early pain in preterm infants. A model of long-term effects. Clin Perinatol 2002;29:373-94, vii-viii. https://doi.org/10.1016/S0095-5108(02)00012-X
  38. Shenassa ED, Brown MJ. Maternal smoking and infantile gastrointestinal dysregulation: the case of colic. Pediatrics 2004;114:e497-505. https://doi.org/10.1542/peds.2004-1036
  39. Salvatore S, Abkari A, Cai W, Catto-Smith A, Cruchet S, Gottrand F, et al. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatr 2018;107:1512-20. https://doi.org/10.1111/apa.14378
  40. Pensabene L, Salvatore S, D'Auria E, Parisi F, Concolino D, Borrelli O, et al. Cow's milk protein allergy in infancy: a risk factor for functional gastrointestinal disorders in children? Nutrients 2018;10:1716. https://doi.org/10.3390/nu10111716
  41. Levy RL. Exploring the intergenerational transmission of illness behavior: from observations to experimental intervention. Ann Behav Med 2011;41:174-82. https://doi.org/10.1007/s12160-010-9254-9
  42. Laforgia N, Di Mauro A, Favia Guarnieri G, Varvara D, De Cosmo L, Panza R, et al. The role of oxidative stress in the pathomechanism of congenital malformations. Oxid Med Cell Longev 2018;2018:7404082. https://doi.org/10.1155/2018/7404082
  43. Langer O. Fetal macrosomia: etiologic factors. Clin Obstet Gynecol 2000;43:283-97. https://doi.org/10.1097/00003081-200006000-00006

Cited by

  1. Cow’s Milk Allergy or Gastroesophageal Reflux Disease-Can We Solve the Dilemma in Infants? vol.13, pp.2, 2020, https://doi.org/10.3390/nu13020297
  2. Antibiotic use but not gastrointestinal infection frequently precedes first diagnosis of functional gastrointestinal disorders vol.9, pp.9, 2020, https://doi.org/10.1002/ueg2.12164