Podcast listeners, we’re here today from ESPGHAN with the berry-picked best and freshest of what your society had to offer at its 58th Annual Meeting in Lille from 24 through 27 June. Mind you, “the best” reflects the opinion of our discussant, Dr Elena Cernat – she’s done the culling and the selecting.
We should go into Dr Cernat’s background a bit. She comes from southeastern Romania and began her medical training at the opposite end of the country, in Cluj-Napoca (or Kolozsvár, or Klausenburg – Romania has always been multicultural), leaving for Valencia through the Erasmus programme and taking her degree there. She now works in Yorkshire – that is, in Leeds – and she has served as ESPGHAN’s abstract reviewer, for podcast purposes, for several years. Here are her choices.
As always, though, what matters is: what you think. Listen along and, we hope, enjoy!
Nutrition 1
PROSPECTIVE COURSE OF MORE THAN ONE HUNDRED EUROPEAN CHILDREN WITH SHORT BOWEL SYNDROME TREATED WITH TEDUGLUTIDE FOR 2 YEARS
Lorenzo Norsa et al.
Objectives and Study: Teduglutide is a therapeutic option for patients with intestinal failure from short bowel syndrome (SBS); however, long-term real-world data in paediatrics remain limited.
Methods: In 104 paediatric patients receiving teduglutide, clinical response and parenteral nutrition (PN) weaning were assessed at 12 and 24 months. Demographic, anatomical, nutritional, and laboratory variables were compared between patients weaned and not weaned off PN at 24 months.
Results: Among the 68 patients who responded at 12 months (defined as a PN reduction of ≥20%), 57 (84%) maintained their response at 24 months, while only 11 (16%) lost response. Conversely, 9 of 36 (25%) initial non-responders achieved a response at 24 months (p<0.001). Regarding PN weaning, 19 out of 21 patients (90.5%) who were weaned at 12 months remained PN-independent at 24 months; one died from a teduglutide-unrelated cause, and one restarted PN after 18 months because of poor weight gain. Twelve children (8/12 responders at 12 months) achieved PN weaning between 12 and 24 months. Overall, 31 (30%) patients were weaned off PN at 24 months (Figure 1). Weaned patients had significantly longer residual small bowel length (p=0.043), greater preservation of the ileocecal valve (p=0.005), and, at baseline, higher citrulline levels (p<0.001), lower PN dependency indices (p=0.002), and higher oral-enteral caloric intake (p=0.001).
Conclusions: This real-world paediatric study demonstrates that PN independence in children with SBS treated with teduglutide is durable and can be achieved progressively over time, including beyond the first year of treatment. Anatomical and functional intestinal markers appear critical in determining PN independence. These findings support the long-term effectiveness of teduglutide as an individualized treatment strategy in paediatric intestinal failure.
Nutrition 2
PERSONALIZED NUTRITIONAL STRATEGIES TO PREVENT POSTNATAL GROWTH FALTERING IN PRETERM INFANTS
Objectives and Study: Extremely preterm and very low birthweight (VLBW) infants are highly vulnerable to postnatal growth faltering (GF) due to immature gastrointestinal function, increased nutritional needs, and clinical comorbidities. Current ESPGHAN nutritional recommendations may underestimate protein requirements for the highest-risk infants. This study evaluated whether an individualized, nutrition-focused follow-up strategy could reduce growth faltering and improve linear growth in infants <28 weeks’ gestational age (GA) and/or <1000 g at birth.
Methods: A cohort of 229 preterm infants was analyzed across three groups: an intervention group receiving individualized weekly nutritional assessments and targeted adjustments, with protein increased up to 5.5 g/kg/day; a retrospective control group matched for GA, birthweight, and sex; and an external group from Weill Cornell Medicine (WCM). Growth (weight, length, head circumference) and z-scores were measured at birth, 14 days, 36 weeks postmenstrual age (PMA), and discharge. Growth faltering was defined as a >1-point decline in z-score for weight or length from birth. Logistic and linear regression models were adjusted for major morbidities.
Results: Baseline characteristics were comparable across groups. The intervention significantly reduced GF compared with controls: 17.8% lower at 36 weeks PMA (p=0.021) and 25.3% lower at discharge (p=0.001), with outcomes similar to the WCM reference group (Figure 1). Exponential weight gain improved in the intervention group at 36 weeks PMA (16.1 [13.9; 17.15] vs. 15 [13.6; 16.3] g/kg/day, p=0.04). Length growth was also higher in the intervention and WCM groups, while head circumference growth showed no differences. Protein intakes in the intervention group frequently exceeded current ESPGHAN upper limits (≈4.5–5 g/kg/day), paired with adequate energy provision, and were associated with improved growth.
Conclusions: Individualized nutritional follow-up effectively reduces growth faltering and enhances linear and weight growth in extremely preterm infants. Many infants appear to require protein intakes above current recommendations to achieve optimal growth, without adverse effects.
Dr. Cernat has chosen the following song: Non, je ne regrette rien - Edith Piaf
