The natural history and clinical predictors of egg allergy in the first 2 years of life.
The Journal of Allergy and Clinical Immunology – 27 December 2013(10.1016/j.jaci.2013.11.032)
Rachel L. Peters, Shyamali C. Dharmage, Lyle C. Gurrin, Jennifer J. Koplin, Anne-Louise Ponsonby, Adrian J. Lowe, Mimi L.K. Tang, Dean Tey, Marnie Robinson, David Hill, Helen Czech, Leone Thiele, Nicholas J. Osborne, Katrina J. Allen, for the HealthNuts study. The full article is available here.
Most young children with egg allergy become tolerant to egg over time. This report from the Melbourne HealthNuts study showed that nearly half of children with oral challenge-confirmed raw egg allergy had resolved by age 2. The interesting finding is that tolerance of egg in baked products was a good predictor of future tolerance. Egg allergy resolved by age 2 in 13% of those previously intolerant to baked egg compared to a resolution rate of 56% in those who had previously tolerated baked egg. Those with early tolerance to baked eggs were about 5 times more likely to completely outgrow their egg alley by 2 years compared with those who reacted to baked eggs. Those infants who were having baked egg products in their diet frequently (without a problem) were the most likely to have their egg allergy resolve.
There is a paucity of data examining the natural history of and risk factors for egg allergy persistence, the most common IgE-mediated food allergy in infants.
We aimed to assess the natural history of egg allergy and identify clinical predictors for persistent egg allergy in a population-based cohort.
The HealthNuts study is a prospective, population-based cohort study of 5276 infants who underwent skin prick tests to 4 allergens, including egg. Infants with a detectable wheal were offered hospital-based oral food challenges (OFCs) to egg, irrespective of skin prick test wheal sizes. Infants with challenge-confirmed raw egg allergy were offered baked egg OFCs at age 1 year and follow-up at age 2 years, with repeat OFCs to raw egg.
One hundred forty infants with challenge-confirmed egg allergy at age 1 year participated in the follow-up. Egg allergy resolved in 66 (47%) infants (95% CI, 37% to 56%) by 2 years of age; however, resolution was lower in children with baked egg allergy at age 1 year compared with baked egg tolerance (13% and 56%, respectively; adjusted odds ratio, 5.27; 95% CI, 1.36-20.50; P = .02). In the subgroup of infants who were tolerant to baked egg at age 1 year, frequent ingestion of baked egg (5 times per month) compared with infrequent ingestion (0-4 times per month) increased the likelihood of tolerance (adjusted odds ratio, 3.52; 95% CI, 1.38-8.98; P = .009). Mutation in the filaggrin gene was not associated with the resolution of either egg allergy or egg sensitization at age 2 years.
Phenotyping of egg allergy (baked egg tolerant vs allergic) should be considered in the management of this allergy because it has prognostic implications and eases dietary restrictions. Randomized controlled trials for egg oral immunotherapy should consider stratifying at baseline by the baked egg subphenotype to account for the differential rate of tolerance development.
Children can develop prolonged course of diarrhoea following a gastroenteritis episode.
Young children with acute diarrhoea, typically due to infectious gastroenteritis, may temporarily stop producing lactase, the intestinal enzyme that digests lactose. This means they may not digest lactose, the main sugar in milk, and this may worsen or prolong the diarrhoea illness. However, there is uncertainty whether avoiding lactose-containing milk or milk products helps young children recover from acute diarrhoea more quickly.
To assess if avoiding or reducing intake of lactose-containing milk or milk products shortens the duration and severity of illness in young children with acute diarrhoea. We also sought other indicators of morbidity and overall mortality.
We searched the Cochrane Infectious Diseases Group Specialized Register (14 May 2013), Cochrane Central Register of Controlled Trials (CENTRAL) published in The Cochrane Library (Issue 4, 2013), MEDLINE (1996 to 14 May 2013), EMBASE (1974 to 14 May 2013), and LILACS (1982 to 14 May 2013), and the reference lists of potentially relevant trials, key conference proceedings, and wrote to individuals and organizations in the field.
Randomized or quasi-randomized controlled trials that assessed the effects of avoiding or reducing exposure to lactose in young children under five years with acute diarrhoea.
DATA COLLECTION AND ANALYSIS:
We extracted data using the standard methods of the Cochrane Infectious Diseases Group, and two review authors independently evaluated trial quality and data extraction. Continuous outcomes were compared using mean difference (MD), and dichotomous outcomes using the risk ratio (RR). We presented all results with 95% confidence intervals (CI) and assessed the quality of evidence using the GRADE approach.
We included 33 trials enrolling 2973 children with acute diarrhoea. Twenty-nine trials were exclusively conducted on inpatients, all from high- or middle-income countries. Fifteen trials included children aged below 12 months, and 22 excluded children who were being breast-fed.Compared to lactose-containing milk, milk products, or foodstuffs, lactose-free products may reduce the duration of diarrhoea by an average of about 18 hours (MD -17.77, 95% CI -25.32 to -10.21, 16 trials, 1467 participants, low quality evidence). Lactose-free products probably also reduce treatment failure (defined variously as continued or worsening diarrhoea or vomiting, the need for additional rehydration therapy, or continuing weight loss) by around a half (RR 0.52, 95% CI 0.39 to 0.68, 18 trials, 1470 participants, moderate quality evidence).Diluted lactose-containing milk has not been shown to reduce the duration of diarrhoea compared to undiluted milk or milk products (five trials, 417 participants, low quality evidence), but may reduce the risk of treatment failure (RR 0.65, 95% CI 0.45 to 0.94, nine trials, 687 participants, low quality evidence).
In young children with acute diarrhoea who are not predominantly breast-fed, change to a lactose-free diet may result in earlier resolution of acute diarrhoea and reduce treatment failure. Diluting lactose-containing formulas may also have some benefits but further trials are required to have confidence in this finding. There are no trials from low-income countries, where mortality for diarrhoea is high, and malnutrition is more common.
MacGillivray S, Fahey T, McGuire W. Lactose avoidance for young children with acute diarrhoea. Cochrane Database Syst Rev. 2013 Oct 31;10:CD005433. doi: 10.1002/14651858.CD005433.pub2. (Review) PMID: 24173771
Low Fat Milk
What is the right age I can give my child a low fat milk instead of whole milk?
The American Academy of Pediatrics (AAP) recommends breast milk for the first year of life. If breast milk is unavailable, the infant should be fed an iron-fortified formula. Babies are transitioned to whole milk at one year of age. The AAP recommends that children stay on whole milk until two years unless there is a reason to switch the baby to low fat milk sooner. Your doctor may make this recommendation for clinical reasons or because there is a family history of obesity, heart disease, or a cholesterol problem.
The reason the AAP recommends whole milk until two years of age has to do with a baby's growth and development. Infants triple their birth weight by one year and quadruple their birth weight by two years.
During this period, the baby's brain and nervous system are making amazing gains in size and complexity. Because the brain and nervous system are largely composed of fat tissue, it is reasoned that the baby should have a higher fat diet during this period of time.
Whole milk contains approximately 4% milk fat. It may help to gradually switch your child from whole milk to a lower fat milk. Therefore, many doctors recommend that children get reduced fat (2%) milk for a few weeks before switching them to low fat (1%) or no fat (skim) milk.
C Section Infants
Narrower range of helpful bacteria in guts of C-section infants.
Implications for development of immune system and allergies, say researchers
Decreased gut microbiota diversity delayed Bacteroidetes colonisation and reduced Th1 responses in infants delivered by Caesarean section Online First doi 10.1136/gutjnl-2012-303249
The range of helpful bacteria in the guts of infants delivered by caesarean section, during their first two years of life, is narrower than that of infants delivered vaginally, indicates a small study published online in the journal Gut.
This has implications for the development of the immune system, say the researchers, particularly as the C-section infants had lower levels of the major group of gut bacteria associated with good gut health, Bacteroidetes phylum, as well as chemicals that help curb allergic responses.
The researchers assessed the patterns of bacterial colonisation of the guts of 24 infants, nine of whom had been born by caesarean section one week, and then again at one, three, six, 12 and 24 months after birth.
They also took blood samples at six, 12 and 24 months to test for levels of immune system chemicals known as Th1 and 2 associated chemokines. Excess Th2 chemokines have been implicated in the development of allergies, which Th1 responses can counteract, say the authors.
The results showed that babies delivered by caesarean section, and who therefore did not pass down the mother’s birth canal, either lacked or acquired late one of the major groups of gut bacteria, the Bacteroidetes, compared with the babies born vaginally.
In some C-section infants acquisition of Bacteroidetes did not occur until a year after birth. The total range of bacteria among those born by C-section was also lower than that of their vaginally delivered peers.
The differences in bacterial colonisation between the two groups of infants were not down to their mums having been given antibiotics during C-section or after the procedure to prevent infection: the levels and range of bacteria sampled from both sets of mums were similar, the analysis showed.
Bacteria are important for priming the immune system to respond appropriately to triggers, and not overreact as is the case in allergies, diabetes, and inflammatory bowel disease, say the authors.
This includes the development of immune system T cells and the correct balance between their chemical messengers, Th1 and Th2.
The C-section infants had lower circulating levels of Th1 chemical messengers in their blood, indicating an imbalance between Th1 and Th2. “Failure of Th2 silencing during maturation of the immune system may underlie development of Th2-mediated allergic disease,” write the authors.
They point out that previous research has indicated that Bacteroides fragilis, one of the many Bacteroidetes, strongly influences the immune system, which ultimately enhances T cell activity and the Th1-Th2 balance.
“Thus, the lower abundance of Bacteroides among the C-section infants may be a contributing factor to the observed differences in the Th1-associated chemokines,” they write
Rotovirus v Norovirus
which is the most common cause of gastroenteritis?
Norovirus and Medically Attended Gastroenteritis in U.S. Children: New England Journal of Medicine 2013;368:1121-30.
From the Epidemiology Branch (D.C.P., A.T.C., M.W., A.J.H., B.L., U.D.P.) and the Gastroenteritis and Respiratory Viruses Laboratory Branch ( J.V., S.H.S.), Division of Viral Diseases, National Center for Immunizations and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta; et al
A real landmark in the immunization war against rotavirus: rotavirus is no longer the most common cause of gastroenteritis in the US. Norovirus now holds that ignominious title. Of course much remains to be done to combat rotavirus, especially in the developing world. Work is now underway on a norovirus vaccine but it has multiple variants which may make this challenging.
Cases of rotavirus-associated acute gastroenteritis have declined since the introduction of rotavirus vaccines, but the burden of norovirus-associated acute gastroenteritis in children remains to be assessed.
We conducted active surveillance for laboratory-confirmed cases of norovirus among children younger than 5 years of age with acute gastroenteritis in hospitals, emergency departments, and outpatient clinical settings. The children resided in one of three U.S. counties during the years 2009 and 2010. Fecal specimens were tested for norovirus and rotavirus. We calculated population-based rates of norovirus- associated acute gastroenteritis and reviewed billing records to determine medical costs; these data were extrapolated to the U.S. population of children younger than 5 years of age.
Norovirus was detected in 21% of young children (278 of 1295) seeking medical attention for acute gastroenteritis in 2009 and 2010, with norovirus detected in 22% (165 of 742) in 2009 and 20% (113 of 553) in 2010 (P = 0.43). The virus was also detected in 4% of healthy controls (19 of 493) in 2009. Rotavirus was identified in 12% of children with acute gastroenteritis (152 of 1295) in 2009 and 2010. The respective rates of hospitalization, emergency department visits, and outpatient visits for the norovirus were 8.6, 146.7, and 367.7 per 10,000 children younger than 5 years of age in 2009 and 5.8, 134.3, and 260.1 per 10,000 in 2010, with an estimated cost per episode of $3,918, $435, and $151, respectively, in 2009. Nationally, we estimate that the average numbers of annual hospitalizations, emergency department visits, and outpatient visits due to norovirus infection in 2009 and 2010 among U.S. children in this age group exceeded 14,000, 281,000, and 627,000, respectively, with more than $273 million in treatment costs each year.
Since the introduction of rotavirus vaccines, norovirus has become the leading cause of medically attended acute gastroenteritis in U.S. children and is associated with nearly 1 million health care visits annually. (Funded by the Centers for Disease Control and Prevention).
The article is available at: The New England Journal of Medicine
Is Infantile Colic an Early Form of Migraine?
In a case-control study, migraine was significantly associated with a history of infantile colic.
The etiology of infantile colic is uncertain. An association between colic and migraine has been proposed but not well studied. Investigators examined this association in a multicenter European case-control study of 208 consecutive children (age range, 6–18 years) diagnosed with migraine headache (66 with aura), 120 children with tension headache, and 471 controls from the same hospitals.
Infantile colic was ascertained on the basis of parent responses to a criteria-based structured interview and physician-recorded diagnosis in the child's mandatory health booklet. The prevalence of colic was 72% in children with migraine (70% with aura and 74% without aura), 33% in those with tension headaches, and 27% in controls. Odds ratios for infantile colic with migraine were 6.61 on the basis of parental reports and 6.68 on the basis of health booklet documentation. Tension headache was not associated with infantile colic. Among children with migraine, a pulsating quality of headache pain was significantly more common in those with colic than in those without.
This well-designed study adds to the growing body of research suggesting infant colic may be an early-life manifestation of genes that later in childhood are expressed as migraine headache. One possible explanation for the association is that infants with migrainous genetics may be sensitive to the new stimuli they encounter in early infancy and may express this sensitivity through excessive crying. Prospective longitudinal cohort studies are needed to further elucidate the relation between infant colic and pediatric migraine, as well as the relation between infant colic and other childhood periodic syndromes such as abdominal migraine. As the basic pathophysiology is unraveled, the promise of new interventions for both disorders beckons. Treatment of colic with current migraine medications is not recommended at this time.
Tdap Vaccination of Women During Every Pregnancy Recommended
Tdap Vaccination of Women During Every Pregnancy Recommended - Expanded strategy to protect neonates against pertussis. The incidence of pertussis has risen dramatically in recent years in the U.S., reflecting in part the relatively weak immunogenicity of the acellular pertussis vaccine introduced in 1996 compared with the whole-cell pertussis vaccines used before 1996. To compensate for this reduced immunogenicity, the Advisory Committee on Immunization Practices (ACIP) broadened the guidelines for tetanus toxoid, diphtheria toxoid,and acellular pertussis (Tdap) vaccination with a new recommendation to provide a booster for all adults and adolescents (JW Pediatr Adolesc Med Jul 25 2005).
However, because uptake has been poor, the booster has not lowered pertussis incidence or prevented serious disease in neonates. In 2011, the ACIP recommended Tdap vaccination of pregnant women after 20 weeks' gestation (JW Pediatr Adolesc Med Nov 30 2011). This recommendation, which is supported by the American College of Obstetricians and Gynecologists (Obstet Gynecol 2012; 119:690), does not extend to women who have been previously vaccinated.
Now, the ACIP has recommended that women receive a Tdap booster during the third trimester of every pregnancy. Because the antibody titer declines rapidly following vaccination, immunizing earlier during pregnancy is unlikely to provide adequate protection to the infant. The mechanism behind this strategy is twofold: By protecting the mother, vaccination will decrease her chances of contracting pertussis postpartum and exposing her newborn; and transplacental maternal antibodies will provide direct protection to the neonate during the early months.
Although the assumptions behind this recommendation are reasonable, further research is needed to address whether this strategy benefits newborns, and whether it is safe to administer the Tdap vaccine routinely during pregnancy (and repeatedly for women with several pregnancies). Furthermore, to my knowledge, no data are available on the acceptability of this approach to women or to obstetric care providers. Lastly, although the recommendation includes vaccination of adolescents and adults who expect to have close contact with the neonate, fathers should be specifically targeted.
Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three
Correspondence to Philippa Ellwood, Department of Paediatrics: Child and Youth Health, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Victoria Street West, Auckland 1142, New Zealand.
Background Certain foods may increase or decrease the risk of developing asthma, rhinoconjunctivitis and eczema. We explored the impact of the intake of types of food on these diseases in Phase Three of the International Study of Asthma and Allergies in Childhood.
Written questionnaires on the symptom prevalence of asthma, rhinoconjunctivitis and eczema and types and frequency of food intake over the past 12 months were completed by 13–14-year-old adolescents and by the parents/guardians of 6–7-year-old children. Prevalence ORs were estimated using logistic regression, adjusting for confounders, and using a random (mixed) effects model.
For adolescents and children, a potential protective effect on severe asthma was associated with consumption of fruit ≥3 times per week (OR 0.89, 95% CI 0.82 to 0.97; OR 0.86, 95% CI 0.76 to 0.97, respectively). An increased risk of severe asthma in adolescents and children was associated with the consumption of fast food ≥3 times per week (OR 1.39, 95% CI 1.30 to 1.49; OR 1.27, 95% CI 1.13 to 1.42, respectively), as well as an increased risk of severe rhinoconjunctivitis and severe eczema. Similar patterns for both ages were observed for regional analyses, and were consistent with gender and affluence categories and with current symptoms of all three conditions.
If the association between fast foods and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is causal, then the findings have major public health significance owing to the rising consumption of fast foods globally.
Children Treated With Common Anti-Fever Medications At Increased Risk For Kidney Injury.
Sick children, especially those with some dehydration from flu or other illnesses, risk significant kidney injury if given drugs such as ibuprofen and naproxen, Indiana University School of Medicine researchers said. In an article published online by the Journal of Pediatrics, Jason Misurac, M.D., and colleagues from IU and Butler University reported that nearly 3 percent of cases of pediatric acute kidney injury over a decade could be traced directly to having taken the common nonsteroidal anti-inflammatory drugs, or NSAIDs.
Although relatively few in terms of percentage of total kidney damage cases, the children with problems associated with NSAIDs included four young patients who needed dialysis, and at least seven who may have suffered permanent kidney damage, the researchers said.
"These cases, including some in which patients' kidney function will need to be monitored for years, as well as the cost of treatment, are quite significant, especially when you consider that alternatives are available and acute kidney injury from NSAIDs is avoidable." Dr. Misurac, a fellow in pediatric nephrology, said. Although such drugs have been linked to kidney damage in small, anecdotal reports, the study reported Thursday is believed to be the first large-scale study of the incidence and impact of acute kidney injury caused by NSAIDs.
The research team evaluated medical records at Riley Hospital for Children at IU Health in Indianapolis from January 1999 through June 2010 and found 1,015 cases in which patients had been treated for acute kidney injury from any cause.
After excluding cases in which the acute kidney injuries could possibly be explained by other factors, such as diseases affecting kidney function, the researchers found 27 cases, or 2.7 percent, in which the only factors were the administration of NSAIDs.
In nearly all cases, the NSAIDs were administered before the children were admitted to the hospital. Because many of the 1,015 cases involved multiple potential causes of acute kidney injury, the researchers said the 27 cases are likely an underestimate of the number of cases in which NSAIDs contributed to the kidney damage.
Among the researchers' findings: • Most of the children had been treated with recommended dosages. • All of the children under the age of 5 needed to undergo dialysis temporarily, were more likely than the older children to be placed in an intensive care unit and needed longer hospital stays. • The average cost for hospital and kidney specialist fees in the 27 cases was nearly $13,500, and the costs were much higher for younger children. At least $375,000 was spent on the NSAID-associated kidney injury cases at Riley Hospital over the study period, the researchers said, but billing data for other specialists were not available in the database, suggesting that the actual costs were likely much higher. NSAIDs affect kidney function by restricting blood flow to the blood-filtering components of the kidneys, which suggests the risks from the drugs are greater among children who are dehydrated due to the effects of their illness, such as vomiting or diarrhea, Dr. Misurac said.
Fever is normal during an infection and not in itself dangerous, he noted, so "one alternative to NSAIDs would be acetaminophen, but another alternative would be no medication at all, at least for a while, to let the body fight the infection."
Asthma Predictive Index.
Most wheezing during the first 3 years of life is related to viral respiratory infections. Respiratory viruses and symptoms of early asthma may be hard to tell apart, making diagnosis and treatment tricky. But doctors and parents now have a tool to help them predict with reasonable accuracy if the child will develop asthma or simply outgrow it. The asthma predictive index (API) is a guide to determining which small children will likely have asthma in later years. Children younger than 3 years who have had 4 or more significant wheezing episodes in the past year are much more likely to have persistent (ie, lifelong) asthma after 5 years if they have either of the following:
One major decisive factor
- Parent with asthma
- Physician diagnosis of eczema (atopic dermatitis)
- Sensitivity to allergens in the air (as determined by physician through positive skin tests or blood tests to allergens such as trees, grasses, weeds, molds, or dust mites)
- Two minor decisive factors
- Food allergies
- Greater than 4% blood eosinophils (a type of white blood cell often seen in allergic disease)
- Wheezing apart from colds
The API was developed after following almost 1,000 children through 13 years of age. It turned out that a wheezy child with a positive API at around 2 to 3 years of age meant there was about an 80% chance that child would have a definite diagnosis of asthma when entering first grade. Using the API, doctors and parents can watch more closely for symptoms of asthma as the child grows and if needed, start the right medications earlier. Earlier and better treatment can help keep children active and healthy, and their asthma in good control.
Cerebrospinal fluid findings in children with fever-associated status epilepticus: Results of the consequences of prolonged febrile seizures (FEBSTAT) study.
Cerebrospinal fluid findings were normal in children with febrile status epilepticus and no central nervous system infection. To investigate if fever-associated status epilepticus (FSE) alone causes cerebrospinal fluid (CSF) pleocytosis, researchers characterized CSF findings in children enrolled in the Febrile Status Epilepticus Study, a prospective, multicenter study of children presenting to one of five emergency departments (EDs) with FSE but no identified central nervous system infection or other pathologic condition. FSE was defined as a single seizure or a series of seizures without interim recovery lasting at least 30 minutes associated with fever >38.4°C. Of 200 children (age range, 1 month through 5 years; median age, 16 months), 154 (77%) underwent lumbar puncture (LP) at the discretion of the ED attending physician.
Children who underwent LP were significantly younger than those who did not (median age, 15 vs. 23 months), less likely to have had prior febrile seizures, and more likely to have longer duration of FSE and presence of focality. Of 136 children with nontraumatic LPs (<1000 CSF red blood cells), 126 (93%) had CSF with 3 white blood cells/mm3. Mean CSF protein and glucose levels were within normal limits (22 mg/dL and 90 mg/dL, respectively).
The authors correctly conclude that CSF pleocytosis in children with fever-associated status epilepticus cannot be attributed to an ictal phenomenon. Children with FSE and CSF pleocytosis should receive prompt intravenous antibiotics for potential bacterial etiologies as well as antivirals for suspected herpes simplex virus.
— - Katherine Bakes, MD
Published in Journal Watch Emergency Medicine December 14, 2012
Incomplete Recovery of the Gut Microbiome After Antibiotic Therapy in Infants.
Antibiotic use in infants causes changes in the gut microbiome that persist for at least 8 weeks.
Systemic antibiotic therapy can alter the gut microbiome, especially during the first two years of life when the complex symbiosis between intestinal flora and an infant's initially sterile gut develops. The use of high-throughput polymerase-chain-reaction 16S ribosomal RNA sequencing now makes it possible to investigate quantitative changes in the various species of the gut microbiome.
Using this sequencing technique, researchers in Ireland analyzed the stools of 18 infants: 9 who had been treated within 48 hours after birth with parenteral ampicillin and gentamicin and 9 age-matched, untreated controls. Treated infants' stool samples were collected 4 and 8 weeks after cessation of antibiotic treatment.
Compared with controls, antibiotic-treated infants had stool samples that, at 4 weeks, showed significantly higher proportions of Enterobacteriaceae (55% vs. 37%) and Peptostreptococcaceae (23% vs. 2%), but significantly lower proportions of Actinobacteria, Bifidobacterium, and Lactobacillus. By 8 weeks, only the Enterobacteriaceae levels remained significantly higher in the treated infants, and the Actinobacteria, Bifidobacterium, and Lactobacillus levels recovered to levels similar to those in controls. Despite this recovery, the number of different Bifidobacterium species remained lower in the antibiotic-treated infants. Furthermore, it appeared that the longer the antibiotic treatment lasted, the less complete the microbiome's recovery was.
Antibiotic use induces major changes in the gut microbiome of infants, but we don't yet know what those changes mean. It's not clear what functions the various bacterial species have within the gut or what the long-term course is after antibiotic exposure. Future research might clarify how antibiotic-induced changes in the gut may influence childhood risks for allergy, autoimmune diseases, and even obesity (JW Infect Dis Sep 5 2012) — and, possibly, how such adverse outcomes could be avoided.
— Thomas Glück, MD
Published in Journal Watch Infectious Diseases December 5, 2012
Fouhy F et al. High-throughput sequencing reveals the incomplete, short-term recovery of infant gut microbiota following parenteral antibiotic treatment with ampicillin and gentamicin. Antimicrob Agents Chemother 2012 Nov; 56:5811.