JPGN Journal Club November 2023: Pediatric H. pylori Resistance, Antenatal MgSO4, and Preterm Feeding Debates

Dr Alex Knisely today in JPGN Journal Club is bantering happily with Dr Andreas Jenke, who for discussion has chosen two articles and a pair of Letters to the Editor, thrust and parry, attack and defence. He believes that correspondence of this sort often affords insight into what is at issue in the matter addressed – and he may well be right. Along with those, we have a contribution from Dr S Bonilla of Boston Children’s Hospital – Helicobacter pylori Antimicrobial Resistance Using Next-Generation Sequencing in Stool Samples in a Pediatric Population – and another from Dr B Özer Bekmez of Ankara City Hospital – Antenatal Neuroprotective Magnesium Sulfate in Very Preterm Infants and Its Association With Feeding Intolerance. Dr Özer Bekmez and her team compared the courses of pre-term infants who received magnesium sulfate (MgSO4) for neuroprotective purposes and pre-term infants who did not receive MgSO4. Findings included “a significant difference in intrauterine growth retardation (IUGR), preterm premature rupture of membranes, and the usage of antenatal steroids between the groups” – those receiving MgSO4 had worse IUGR, were more likely to have suffered from rupture of membranes, and were more likely to have been exposed to steroids ; they also went on to have more bronchopulmonary dysplasia and to require longer mechanical ventilation, with greater incidences of necrotising enterocolitis, feeding intolerance, and delay in enteral feeding. The authors posit these adverse outcomes as consequent on MgSO4 exposure. Were the dice loaded, though, given the more troubled antenatal course of those receiving MgSO4 ? Might MgSO4 administration have made no difference to outcome ? The study design with Dr Bonilla and team was less questionable, perhaps. Although few patients were studied, when stool yielded enough microbial DNA for evaluation, results of next-generation sequencing correlated well with those of antibiotic sensitivity testing in cultured gastric-biopsy material. Regrettable, though, that the authors made so little of potential benefits of speed – if DNA test results were in hand substantially before results of standard culture, selective antibiotic therapy might begin more quickly than possible at present, a boon to all. Now for the letter pair, with Ms A Aloysius and colleagues writing in regard to the recent ESPGHAN Preterm Enteral Nutrition Position Paper (2022)—Issues of Oral Feeding on CPAP and Dr N Embleton offering a response on behalf of the position-paper authorial team. The initial letter says, in effect, “We as speech and language therapists believe that this position paper does not adequately address transition to oral feeding ! ” – the response says, “Erm, we rather think that we did, and here are the parts of our text in which we did, but whatever – yes, this is an important aspect of care, and one best approached in a multidisciplinary manner.” Fewer fireworks than in the best correspondential wars, and one must read the position paper to see if the speech and language therapists’ discipline truly was shortchanged. As always, happy listening – and happy reading !