Characteristics of inflammatory bowel disease with onset during the first year of life.
BACKGROUND
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. In the present clinical study, we aimed to analyze characteristics and clinical course of children with very early onset IBD. We were particularly interested in the relationship between bacterial infections and the use of antibiotics before the onset of IBD.


METHODS
The IBD database of Necker-Enfants-Malades-Hospital was screened for patients with IBD with disease onset during the first year of life and a follow-up of at least 2.5 years. Ten patients were identified during the period 1996-2002.


RESULTS
All patients presented with rectal bleeding and had colonic involvement. Four patients had definitive diagnosis of Crohn disease; ulcerative or indeterminate colitis was seen in 2 and 4 children, respectively. Five of the patients had a positive history of neonatal or early-onset bacterial infection with use of antibiotics before onset of IBD, 4 patients were still breastfed and 3 just weaned when GI symptoms started. Seven patients had a severe onset of disease requiring bowel rest, parenteral nutrition and steroid medication, followed by azathioprine or cyclosporine medication. Surgery was necessary in 3 of 10 patients. Disease relapses were frequent and observed in 8 of 10 children.


CONCLUSIONS
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.
Ruemmele
Frank M
FM
Paediatric Gastroenterology Unit, Department of Paediatrics, Hôpital Necker-Enfants Malades, National Center for Rare Digestive Diseases INSERM EMI U793, University René Descartes, Paris, France. frank.ruemmele@nck.aphp.fr
El Khoury
Maurice G
MG
Talbotec
Cécile
C
Maurage
Chantal
C
Mougenot
Jean-François
JF
Schmitz
Jacques
J
Goulet
Olivier
O
D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents