Inflammatory bowel disease (IBD) is recognized in young children.
However, only rare data on onset and evolution are available in children younger than 1 year.
Dr Frank Ruemmele and colleagues analyzed characteristics and clinical course of children with very early onset IBD.
The research team were particularly interested in the relationship between bacterial infections and the use of antibiotics before the onset of IBD.
The IBD database of Necker-Enfants-Malades-Hospital was screened for IBD patients with disease onset during the first year of life and a follow-up of 3 years.
The researchers identified 10 patients during the period 1996 to 2002.
|5 patients had neonatal bacterial infection|
|Journal of Pediatric Gastroenterology & Nutrition|
All patients presented with rectal bleeding and had colonic involvement.
The team noted that 4 patients had definitive diagnosis of Crohn's disease.
Ulcerative or indeterminate colitis was seen in 2 and 4 children, respectively.
The team found that 5 of the patients had a positive history of neonatal or early-onset bacterial infection with use of antibiotics before onset of IBD.
The researchers observed that 4 patients were still breastfed, and 3 just weaned when GI symptoms started.
The team noted that 7 patients had a severe onset of disease requiring bowel rest, parenteral nutrition and steroid medication.
These patients also required azathioprine or cyclosporine medication.
Surgery was necessary in 3 of 10 patients.
The researchers observed disease relapses frequently, occurring in 8 of 10 children.
Dr Ruemmele's team concludes, “Very early onset IBD may reflect a subgroup of patients characterized by a particular sensitivity to modifications of the intestinal flora.”
“Neonatal IBD was most often severe in presentation and evolution.”