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Association between stool consistency and clinical variables among infants with cystic fibrosis: Findings from the BONUS study
Institution:1. Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Children''s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA;2. Lead Biostatistician, Research Administration, Children''s Medical Center Dallas, Dallas, TX, USA;3. Associate Professor, Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children''s Research Institute, Seattle, WA, USA and Division of Pulmonary Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA;4. WNY Pediatric Gastroenterology and Volunteer Faculty, University of Buffalo School of Medicine, Buffalo, NY, USA;5. Associate Professor, Division of Gastroenterology, Hepatology and Nutrition, Texas Children''s Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA;6. Vice Chair and Endowed Professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA;7. Emeritus Clinical Professor of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA;8. Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern and Children''s Health, Dallas, TX, USA;1. Leeds Institute of Medical Research at St James''s, University of Leeds, Leeds, United Kingdom;2. Leeds Adult Cystic Fibrosis Unit, St James''s University Hospital, Leeds, United Kingdom;1. Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Australia;2. Faculty of Medicine, The University of Queensland, Brisbane, Australia;3. Translational Research Institute, Brisbane, Australia;1. Pneumologisches Studienzentrum München-West, München, Germany;2. Division of Cystic Fibrosis, CF Center Westbrandenburg, Campus Potsdam, Potsdam, Germany;3. Cardiff University, School of Biosciences, Cardiff, Wales, UK;4. SMERUD, Karenslyst alle 6, 0278 Oslo, Norway;5. AlgiPharma AS, Industriveien 33, 1337 Sandvika, Norway;1. Division of Paediatric Medicine, Department Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario M5G 1X8, Canada;2. Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada;3. Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada;4. Translational Medicine Program, Hospital for Sick Children, University of Toronto, Toronto, Canada;5. Division of Respirology, Department of Medicine St Michael''s Hospital, University of Toronto, Toronto, Canada;1. Pediatric Pulmonary Medicine, UPMC, Children''s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA;2. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;3. Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, IN, USA;4. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA;1. Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States;2. Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States;3. State Hygienic Laboratory at the University of Iowa, Coralville, IA, United States
Abstract:Background: Concerns related to stool consistency are common in the first year of life among children with cystic fibrosis (CF). However, normal stool patterns for infants with CF have not been described.Methods: Secondary analysis was completed from the previously described BONUS cohort which followed 231 infants with CF through the first 12 months of life. Pain, stool category, stool frequency, feeding type, PERT dose, acid suppression medication, antibiotics usage, stool softener usage and fecal calprotectin were described at 3, 6, and 12 months. Repeated measure ANOVA was used to test the difference in mean stool number. Generalized linear mixed models were used to investigate the relationship between stool characteristics and various factors.Results: The frequency of constipation was stable throughout the first year of life (10–13%) while watery stool significantly decreased from 21.3% at 3 months to 5.8% at 12 months (p=<0.001). The number of stools at months 6 (mean=2.40) and 12 (mean=2.50) are significantly lower than in month 3 (mean=2.83), p<0.025. Exclusive breast feeding was associated with an increased risk for constipation (OR=2.64  1.60–4.37], p = 0.002) while exclusive formula feeding and acid suppression was associated with decreased risk for constipation (OR=0.40  0.26–0.61], p=<0.0001 and OR=0.59  0.39–0.89], p = 0.01 respectively). Pain was not significantly associated with stool consistency.Conclusion: Stool frequency and consistency evolves in infant with CF in a fashion similar to that reported in non-CF infants over the first year. Constipation was not associated with pain and was less common among infants receiving acid suppression or exclusively formula feeding.
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