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Gastrointestinal Factors Associated With Hospitalization in Infants With Cystic Fibrosis: Results From the Baby
Meghana Sathe1, Rong Huang2, Sonya Heltshe3,4
1Division Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern and Children's Health.
Insights
High pancreatic enzyme replacement therapy (PERT) dosing and acid suppressive medications increase GI-related hospitalizations in infants with cystic fibrosis (CF). Fecal markers like calprotectin and Klebsiella pneumoniae also indicate higher risk.
Area of Science:
- Pediatric Gastroenterology
- Cystic Fibrosis Research
- Infant Health
Background:
- Infants with cystic fibrosis (CF) are at increased risk for gastrointestinal (GI) complications.
- Understanding early-life hospitalization risk factors is crucial for timely intervention in CF infants.
Purpose of the Study:
- To identify factors associated with increased risk of GI-related hospitalization in infants with CF during their first year of life.
- To analyze the impact of GI admissions on infant growth metrics.
Main Methods:
- Longitudinal, observational cohort study of 231 infants diagnosed with CF via newborn screening.
- Post-hoc analysis of GI-related admission frequency and indications within the first 12 months.
- Statistical assessment of risk factors including pancreatic enzyme replacement therapy (PERT) dosing, acid suppressive medications, fecal calprotectin (fCP), and fecal microbial composition (Klebsiella pneumoniae).
Main Results:
- Sixty-five participants (28%) experienced at least one GI-related admission.
- High PERT dosing (>2000 lipase units/kg/meal) and acid suppressive medication use were significantly associated with increased GI admissions (HR=14.75, P=0.0005 and HR=4.94, P=0.01, respectively).
- Elevated fCP levels (>200 μg/g) and higher abundance of fecal K. pneumoniae also correlated with higher GI admission risk (HR=2.64, P=0.033 and HR=4.49, P=0.002, respectively).
- Infants with any admission, particularly GI-related, exhibited lower weight-for-length z scores (WLZ) at 12 months.
Conclusions:
- High PERT dosing, acid suppressive medications, elevated fCP, and K. pneumoniae presence are key early-life risk factors for GI hospitalization in CF infants.
- GI-related hospitalizations are linked to poorer growth outcomes (lower WLZ) in infants with CF.
Objectives:
To identify factors that increase the risk of gastrointestinal-related (GI-related) hospitalization of infants with cystic fibrosis (CF) during the first year of life.
Methods:
The Baby Observational and Nutrition Study was a longitudinal, observational cohort of 231 infants diagnosed with CF by newborn screening. We performed a post-hoc assessment of the frequency and indications for GI-related admissions during the first year of life.
Results:
Sixty-five participants had at least one admission in the first 12 months of life. High pancreatic enzyme replacement therapy (PERT) dosing (>2000 lipase units/kg per meal; hazard ratio [HR] = 14.75, P = 0.0005) and use of acid suppressive medications (HR = 4.94, P = 0.01) during the study period were positively associated with subsequent GI-related admissions. High levels of fecal calprotectin (fCP) (>200 μg/g) and higher relative abundance of fecal Klebsiella pneumoniae were also positively associated with subsequent GI-related admissions (HR = 2.64, P = 0.033 and HR = 4.49, P = 0.002, respectively). During the first 12 months of life, participants with any admission had lower weight-for-length z scores (WLZ) (P = 0.01). The impact of admission on WLZ was particularly evident in participants with a GI-related admission (P < 0.0001).
Conclusions:
Factors associated with a higher risk for GI-related admission during the first 12 months include high PERT dosing, exposure to acid suppressive medications, higher fCP levels, and/or relative abundance of fecal K pneumoniae early in life. Infants with CF requiring GI-related hospitalization had lower WLZ at 12 months of age than those not admitted as well as those admitted for non-GI-related indications.
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