Factors for Gastrointestinal-Related Hospitalizations Among Infants With Cystic Fibrosis

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Investigators assessed which factors contribute to risk for GI-related hospitalizations in infants with cystic fibrosis.

Among infants with cystic fibrosis (CF), risk for admission to the hospital for gastrointestinal (GI)-related symptoms was associated with exposure to acid suppressive medications, pancreatic enzyme replacement therapy (PERT) dosing, fecal calprotectin (fCP) levels, and relative abundance of fecal Klebsiella pneumoniae (K pneumoniae). These findings were published in the Journal of Pediatric Gastroenterology and Nutrition.

Data for this analysis were sourced from the Baby Observational and Nutrition Study (BONUS), a multicenter, longitudinal, prospective, observational cohort which recruited infants (N=231) born with CF in the United States between 2012 and 2015. Hospital admissions during the first 12 months of life were assessed on the basis of clinical characteristics.

A total of 65 infants were hospitalized once (n=49) or ³2 times (n=16). Hospitalizations occurred due to respiratory indications (n=40), GI-related issues (n=21), and other causes (n=9).

Specific GI-related indications included failure to thrive or poor weight gain (n=15), gastrostomy tube (n=4), reflux or emesis (n=2), electrolyte disturbances (n=2), constipation (n=1), diarrhea (n=1), and rectal prolapse (n=1). The median hospital stay was 5.0 (range, 1.0-44.0) days.

All-cause hospitalization was associated with decreased average z-scores for weight (P <.0001), length (P <.001), and weight-for-length (P =.01). All factors were significantly associated with GI-related hospitalizations (all P £.01) and only mean length z-scores were associated with respiratory-related hospitalizations (P =.03).

Compared with infants who were not hospitalized, those hospitalized for GI-related symptoms were exposed to acid suppressants (100% vs 62.9%; P <.001), had >1% relative abundance of fecal K pneumonia (55.6% vs 22.9%; P <.01), and >200 mg/g fCP (60% vs 35.5%; P =.03). In addition, patients who had high PERT dosing (>2000 LU/kg/meal) were at increased risk for a subsequent hospitalization due to GI symptoms (P =.031).

High PERT dosing was an independent predictor of GI-related hospitalization (hazard ratio [HR], 14.75; P =.0005) and acid suppressive medications were predictors for subsequent GI-related admission (HR, 4.94; P =.003).

This study was limited by its cross-sectional design, in which it remains unclear whether any of the significant factors were causative for GI-related hospitalizations.

The study authors concluded that infants with CF who were exposed to acid suppressive medications, were given high-dose PERT, had a high relative abundance of fecal K pneumonia, or high fCP levels were more likely to have a GI-related hospitalization during the first year of life.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Sathe M, Huang R, Heltshe S, et al. Gastrointestinal factors associated with hospitalization in infants with cystic fibrosis: results from the baby observational and nutrition study. J Pediatr Gastroenterol Nutr. 2021;73(3):395-402. doi:10.1097/MPG.0000000000003173