title: Characteristics of inflammatory bowel disease with onset during the first year of life.
abstract: 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.
authors.affiliation: 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
authors.forename: Frank M
authors.initials: FM
authors.lastname: Ruemmele
authors.forename: Maurice G
authors.initials: MG
authors.lastname: El Khoury
authors.forename: Cécile
authors.initials: C
authors.lastname: Talbotec
authors.forename: Chantal
authors.initials: C
authors.lastname: Maurage
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Mougenot
authors.forename: Jacques
authors.initials: J
authors.lastname: Schmitz
authors.forename: Olivier
authors.initials: O
authors.lastname: Goulet
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents