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Crohn's Disease Forum » Parents of Kids with IBD » Paediatric IBD - Articles and Research


 
06-30-2014, 02:54 PM   #121
7vNH
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This post has a quote about how a child's early exposure to antibiotics is strongly correlated to IBD: http://www.crohnsforum.com/showpost....&postcount=435

For kids currently affected, that's not going to help, except that maybe FMT might become a more logical way to proceed.
06-30-2014, 04:31 PM   #122
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This has been discussed here before most kids here do not "fit" that model or the one about breastmilk or junk food as the cause .
Good theories on paper .


Fwiw my non Ibd kid had way more antibiotics
Ibd kiddo has super immune system on all levels and hardly ever needed an antibiotics but showed signs of crohn's since birth .
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06-30-2014, 05:35 PM   #123
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This has been discussed here before most kids here do not "fit" that model or the one about breastmilk or junk food as the cause .
Good theories on paper .
That quote was not supposed to bring in any ideas about breast milk or junk food. The idea is that the child's early microbiome was artificially altered by antibiotics and that was undeniably related to IBD later in this large population. Not saying anything about causation, only correlation.

Fwiw my non Ibd kid had way more antibiotics
Ibd kiddo has super immune system on all levels and hardly ever needed an antibiotics but showed signs of crohn's since birth .
That's an unexpected n=2! Not to get too personal, but interesting facts in your case would include whether the mother had a narrowed microbiome at the time of delivery (pre-delivey antibiotics?) and if the mother was able to colonize the baby (vaginal vs C section) with a robust microbiome.
07-10-2014, 06:56 AM   #124
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I have mulled over many theories and whilst I had one child diagnosed I entertained some of them as a possibility. Then my other child was diagnosed and the disease mirrored exactly that of the sibling in location, type and severity and genetics loomed large on the horizon for me and it has stayed there. That is not to say that there aren’t other influences but where I once gave them equal standing I now give them scant regard.

Of the three main theories that circulate around childhood my two do not fit any of them:

1. Antibiotics. My daughter was diagnosed at 14 and my son at 17, neither had been prescribed antibiotics from the time they were born until diagnosed. I too had not had antibiotics for many, many years prior to my pregnancies.

2. Birth. Both were normal vaginal deliveries.

3. Breastfed. Both were breastfed. My daughter for 12 months and my son for 18 months.

Dusty.
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Last edited by DustyKat; 07-10-2014 at 04:47 PM.
07-10-2014, 03:39 PM   #125
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I agonized for quite awhile after dx about all the little things I could've/should've maybe done differently to prevent IBD in my son. sigh!

I heard a fantastic talk a couple years back about causes. It was along the lines that genetics prime the system (make one susceptible) and inflammation starts with an environmental trigger (whether bacterial/viral infections, antibiotics use, diet, air pollution, etc). I think one's genes determine which organ is affected by the runaway immune system too, whether gut/joints/brain/skin, etc
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07-23-2014, 08:36 PM   #126
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First published study that I am aware of that followed kids on remicade for 5 years. Found linear growth catch up to normal by year 3 in Tanner stage 1/2 patients who started remicade within 18 months of diagnosis. Found sustained response improved by simultaneous use of immunomodulator for >= 30 months. Study authors from Toronto, Canada


Infliximab Maintains Durable Response and Facilitates Catch-up Growth in Luminal Pediatric Crohn's Disease.

http://www.ncbi.nlm.nih.gov/pubmed/24865777

CONCLUSIONS:

These data demonstrate sustained effectiveness of infliximab in children and adolescents with luminal CD. Durability of response is increased by concomitant immunomodulation. Clinical response is associated with enhanced linear growth, particularly when therapy is initiated early.
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08-19-2014, 04:41 PM   #127
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not exactly pediatric IBD article, but still thought provoking - impact on immune system in space. Might have study implications on disease onset.

http://www.nasa.gov/content/study-re.../#.U_JyuPldWSo
08-21-2014, 07:43 AM   #128
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http://www.hindawi.com/journals/grp/2013/482108/

New study on EEN use ( or under use )
08-23-2014, 09:51 PM   #129
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23 and me has partnered up with Pfizer to start looking for more IBD solutions. Looking for US participants in their study and they wave the fee for genetic info.
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08-24-2014, 06:56 AM   #130
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EEN new slides
08-24-2014, 07:09 AM   #131
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http://www.naspghan.org//files/docum...EB_4-25-14.pdf
08-24-2014, 07:13 AM   #132
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Pediatric ibd
08-24-2014, 07:19 AM   #133
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08-24-2014, 07:21 AM   #134
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23 and me Ibd discussion
Including pros and cons concerning how the info will be used plus protected health info .
08-24-2014, 07:36 AM   #135
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09-11-2014, 07:15 PM   #136
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Hi everyone, as I'm a newbie I'm unable to link, so please search the title in order to read the entire article. Love to all you parents and caregivers of babies with dis-ease. ♥

PS. I also posted this in the Parents of Kids with IBD thread.

Crohn’s Disease Linked To Imbalance In Gut Microbiota
By Susan Scutti | Mar 12, 2014 12:57 PM EDT

A Study of Newly Diagnosed Children

To conduct the current research, a team of scientists analyzed data from the RISK Stratification Study, which was designed to investigate the factors involved in newly diagnosed pediatric cases of Crohn's disease or other inflammatory bowel diseases. At 28 institutions across the U.S. and Canada, intestinal tissue samples were taken from 447 children with a clear diagnosis of Crohn's and 221 control participants with non-inflammatory gastrointestinal conditions. The researchers also analyzed samples from an additional group of about 800 participants in previous studies, for a total of more than 1,500 individuals.

The researchers identified a proportional increase in inflammatory bacteria and a decrease in non-inflammatory, beneficial bacteria in Crohn's patients when compared with participants without the disease. (Specifically, they found an increase of Enterobacteriaceae, Pasteurellaceae, Veillonellaceae, and Fusobacteriaceae, and a decrease of Erysipelotrichales, Bacteroidales, and Clostridiales).

This imbalance was even greater in patients whose symptoms were more severe. Plus, a comparison of patients who had taken antibiotics with those who had not indicated antibiotic use amplifies microbial imbalance.
09-19-2014, 04:49 PM   #137
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Small study but sounds promising for those with children that have refractory IBD:

The use of sirolimus (rapamycin) in the management of refractory inflammatory bowel disease in children.

Abstract only…

Background
Management of refractory inflammatory bowel disease (IBD) in children is challenging and once response to conventional medical therapy deviates from the expected, options are often limited. Sirolimus is commonly used in post-transplantation management and is used sparsely as rescue therapy in refractory Crohn's disease. In the present study, we report the efficacy of sirolimus as an adjuvant immunosuppressive therapy in a retrospective case review of a selected group of IBD children who were refractory to the conventional treatments.

Methods
Medical records of children with refractory IBD unresponsive to conventional therapy and started on sirolimus between 2006 and 2012 were retrospectively reviewed. Clinical response, through Pediatric Ulcerative Colitis Activity Index (PUCAI) and Pediatric Crohn's Disease Activity Index (PCDAI), as well as intestinal inflammation, through specific histological scores, was evaluated.

Results
The records of 14 patients were analyzed. Eleven of them had ulcerative colitis (UC) and 3 Crohn's disease (CD); mean age at diagnosis was 9.1 years (standard deviation 3.8). Of UC patients, 5 (45%) achieved clinical remission and 2 (18%) showed clinical response. All CD patients went into clinical remission. Mucosal healing was achieved by 5 children (45%) with UC and 2 (67%) with CD patients. One child with ulcerative colitis was weaned off adalimumab, while 2 children with CD were weaned off prednisolone and methotrexate successfully.

Conclusion
Our data provide evidence that sirolimus seems to be effective as rescue therapy in a subgroup of children with severe IBD refractory to conventional therapies by inducing both clinical remission and mucosal healing.

http://www.ecco-jccjournal.org/artic...266-9/abstract
10-13-2014, 03:22 AM   #138
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Restarting infliximab for IBD after a drug holiday:

Not a paediatric study but an interesting article…

Restarting infliximab therapy after a drug holiday is safe and effective for patients with inflammatory bowel disease (IBD), according to a new study1 in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.

"Our findings suggest that starting infliximab after a history of prior therapy can be very beneficial to patients," said lead study author Filip Baert, MD, PhD, from the department of gastroenterology, University Hospitals Leuven in Belgium. "Most striking, response to infliximab can be regained in a subset of patients who previously had lost response to the treatment and failed several other treatments thereafter."

Researchers conducted a retrospective single-center study to evaluate the efficacy of restarting infliximab in inflammatory bowel disease patients, both those suffering from Crohn's disease and ulcerative colitis. The average duration of infliximab holiday was 15 months.

Patients who were in remission at the time infliximab was discontinued were the best candidates, with a 78 percent response rate at one year. In patients with a previous loss of response or an infusion reaction, the strategy was effective in 45 percent of patients at one year; while less than the other group, this may be enough in cases where the patient has failed other treatment options.

This study shows that starting pharmacologic monitoring (i.e., checking levels of medicine in the blood and antibodies to infliximab) early after restarting infliximab can guide physicians to predict the long-term efficacy and safety of restarting this treatment. In clinical practice, these tests are not always readily available; however, measuring drug levels and antibodies early after restarting infliximab is very valuable and allows early optimization.

How safe is the strategy? Of the 128 patients re-treated, 7 had severe infusion reactions, generally during the second or third induction dose. Unfortunately, premedication did not protect against all infusion reactions, but simultaneous immunomodulators did. Therefore, immunomodulator therapy should be strongly considered in these patients.

Patients may initially stop infliximab therapy due to loss of response, and, despite the current recommendations, patients sometimes will discontinue therapy for various reasons, including durable remission, pregnancy, safety or financial concerns.

"Clinicians understandably have been reluctant to rechallenge patients with infliximab given the fear of immediate or delayed hypersensitivity reactions with dose interruptions. This study provides the important message that restarting infliximab after a drug holiday is feasible," added Dr. Baert.

Infliximab was the first anti-tumor necrosis factor (TNF) biologic for Crohn's disease and still is used frequently for its efficacy in both Crohn's and ulcerative colitis. Studies have shown that loss of response to infliximab is about 13 percent per patient-year of treatment.

http://www.medicalnewstoday.com/releases/282165.php
10-24-2014, 12:13 PM   #139
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fight against c-diff article:
http://news.sciencemag.org/biology/2...ronic-diarrhea
10-27-2014, 04:53 AM   #140
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The Diagnostic Approach to Monogenic Very Early Onset Inflammatory Bowel Disease

http://www.gastrojournal.org/#/artic...ext?mobileUi=1
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11-01-2014, 04:13 PM   #141
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Consensus guidelines of ECCO/ESPHGAN on the mefical management of pediatric Crohn's disease:

http://www.csge.org/index.php?m=cont...8102039271.pdf
01-07-2015, 03:40 PM   #142
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Incidence, Outcomes, and Health Services Burden of Very Early Onset Inflammatory Bowel Disease

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01-15-2015, 05:44 AM   #143
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Abstract Only:

Health-Related Quality of Life in Youth with Crohn's Disease: The Role of Disease Activity and Parenting Stress.

OBJECTIVES:
Health-related quality of life (HRQOL) is an important, but understudied construct in pediatric IBD. Family-level predictors of HRQOL have been understudied as are the mechanisms through which disease activity impacts HRQOL. The current study examines the relationship between a family-level factor (parenting stress) and HRQOL in youth with Crohn's disease. Parenting stress is examined as a mechanism through with disease activity impacts HRQOL.

METHODS:
99 adolescents with Crohn's disease and their parents were recruited across three sites. Adolescents completed the IMPACT-III (IBD-specific HRQOL). Parents completed the Pediatric Inventory for Parents, a measure of medically-related parenting stress that assesses: 1) stress due to the occurrence of medical stressors and 2) stress due to the perceived difficulty of stressors. Disease activity was obtained from medical records.

RESULTS:
Parenting stress due to the occurrence of medical stressors partially mediated the disease severity-HRQOL relationship, reducing the relationship between these variables from 49.67% to 31.58% (B = -.56, p < .0001). Boot strapping analysis confirmed that the indirect effect of disease severity on HQROL via parenting stress significantly differed from zero. Parenting stress due to the perceived difficulty of medical stressors partially mediated the disease severity-HRQOL relationship, reducing the relationship from 49.67% to 30.29% (B = -.55, p < .0001). The indirect effect was confirmed via bootstrapping procedures.

CONCLUSIONS:
As disease severity increased, parenting stress also increased, and adolescent HRQOL decreased. Parenting stress should be considered and assessed for along with medical factors as part of a comprehensive approach to improving HRQOL in adolescents with Crohn's disease.

http://www.ncbi.nlm.nih.gov/pubmed/25564807
01-22-2015, 06:33 PM   #144
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http://www.practicalgastro.com/pdf/A...DayArticle.pdf

Interesting EEN article. Especially support for continuing supplemental after the exclusive period is over.
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01-24-2015, 07:12 PM   #145
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The course of anaemia in children and adolescents with Crohn’s disease included in a prospective registry

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Aim
The aim of this study is to determine the prevalence and evolution of anaemia in prospectively followed children and adolescents diagnosed with Crohn’s disease (CD).

Methods
The BELCRO registry (inclusion May 2008–April 2010), describing current clinical treatment practice of children diagnosed with CD, provided data on age, height, body mass index (BMI), paediatric Crohn’s disease activity index (PCDAI), therapy and haemoglobin (Hb) at diagnosis 12 and 24 months follow-up. Anaemia was defined as Hb < −2 sd, while severe anaemia was defined as Hb < −4 sd. Patients were classified as child ≤13 and adolescent >13 years of age.

Result
Ninety-six were included, 13 dropped out due to insufficient Hb data (37 females/46 males; median age 13.3 years, range 2.2–17.8 years). At diagnosis, the median Hb sd was −2.66 (−8.4; 1.07) and was correlated with the PCDAI (p = 0.013). At diagnosis, 51/83 (61 %) were anaemic and all had active disease. Hb z-score significantly improved (p < 0.0001) but 26/68 (38 %) remained anaemic at 12 months and 29/76 (38 %) at 24 months of follow-up. The correlation to the PCDAI disappeared. At 24 months, children were more likely to be anaemic. There was no difference in iron dose nor duration of iron supplements between children and adolescents. Iron treatment was more readily given to patients presenting with anaemia. Hb did not differ between patients with (n = 28) or without iron supplements. Half of the patients with persisting anaemia were given iron supplements, of which, only three were given intravenously.

Conclusion
Anaemia remains an important extra-intestinal manifestation of CD in children. Physicians, lacking optimal treatment strategies, undertreat their patients.

http://link.springer.com/article/10....384-014-2042-4
Copied to Parent’s Forum.

Last edited by DustyKat; 01-24-2015 at 07:14 PM. Reason: Title added
02-06-2015, 10:21 PM   #146
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SICUS, MRE, CE effective for imaging small bowel in pediatric IBD

Small-intestine contrast ultrasonography, magnetic resonance enterography and capsule endoscopy were all found to be effective options for imaging the small bowel to diagnose pediatric inflammatory bowel disease, according to recent study data.

Aiming to evaluate the performance of these three methods in assessing pediatric Crohn’s disease and detecting active lesions in specific segments of the small bowel, researchers performed a prospective, masked comparison study involving 25 children with known or suspected CD. All patients underwent ileocolonoscopy, magnetic resonance enterography (MRE; 1.5-Tesla whole-body MRI, Siemens Medical Solutions), small-intestine contrast ultrasonography (SICUS; Aplio XG, Toshiba Medical Systems) and capsule endoscopy (CE; PillCam, Given Imaging) during a 1-week period from April 2012 to April 2013. They compared the results of each method with a consensus reference standard for the upper small bowel and with ileocolonoscopy for the terminal ileum.

In the jejunum, SICUS and CE both had 92% (95% CI, 61-100) sensitivity, which was higher than MRE (75%; 95% CI, 43-94) but not significantly, whereas the specificity of MRE (94%; 95% CI, 73-100) was significantly higher compared with CE (61%; 95% CI, 36-83). In the proximal and mid-ileum, MRE and CE both had 100% sensitivity (95% CI, 56-100 with MRE; 95% CI, 48-100 with CE) vs. 80% (95% CI, 43-99) with SICUS, but CE had 74% specificity (95% CI, 49-90) compared with 92% (95% CI, 73-99) for both SICUS and MRE. At the terminal ileum, SICUS and MRE both had 94% sensitivity (95% CI, 64-100 with SICUS; 95% CI, 71-100 with MRE) vs. 81% (95% CI, 54-96) with CE, whereas CE had 90% (95% CI, 55-100) specificity vs. 80% (95% CI, 51-96) with MRE and 79% (95% CI, 49-95) with SICUS.

“Our study supports the use of radiation-free and well-tolerated imaging modalities as a means of first-line investigation in children with suspected or already diagnosed CD,” the researchers concluded. “The combination of SICUS and [C-reactive protein], given its high sensitivity, specificity, low-cost, and non-invasiveness, could be suggested as a first-line diagnostic approach in suspected [small-bowel] CD. MRE and CE can be subsequently used in patients with inconclusive workups, based on the local expertise and availability.” – by Adam Leitenberger

http://www.healio.com/gastroenterolo...-pediatric-ibd
02-15-2015, 03:31 AM   #147
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Occult Blood and Perianal Exam: Value Added in Pediatric Inflammatory Bowel Disease Screening.

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Objective:
Pediatric inflammatory bowel disease (IBD) often presents insidiously and standard blood tests are normal in 20% of patients. We hypothesize that fecal occult blood testing (FOBT) and the perianal examination in addition to blood tests provide important information during the screening process for IBD. The goal of this study was to measure the diagnostic value of adding FOBT and perianal examination to standard screening labs in evaluating children and adolescents for IBD.

Methods:
The medical records of consecutive patients undergoing ileocolonoscopy for IBD were reviewed. Laboratory test results, FOBT, and perianal examination prior to the decision to perform the ileocolonoscopy were recorded. Standard limits of laboratory tests were used. Multivariate logistic regression was performed on a discovery cohort and applied to an independent validation cohort.

Results:
The discovery cohort included 335 patients (85 IBD and 250 non-IBD). 61.2% had FOBT and perianal examination performed prior to the decision to perform the ileocolonoscopy. 119 patients had complete blood testing, FOBT, and perianal exam available for full analysis. The sensitivity of the lab testing was 80.5% for IBD and the sensitivity of FOBT with perianal examination was 65.9%. However, the combined sensitivity of lab testing and FOBT with perianal examination was 97.6%. The most predictive model included CRP, platelets and FOBT with perianal examination and was superior to the lab value-only model (P < 0.001) which was validated in a separate cohort.

Conclusions:
Perianal examination and FOBT improves sensitivity in screening children for IBD.

http://journals.lww.com/jpgn/Abstrac...ampaign=buffer
02-22-2015, 02:47 AM   #148
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Urinary Tract Infection in Infancy Is a Risk Factor for Chronic Abdominal Pain in Childhood.

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Objective:
Adverse early life events are key factors for development of functional gastrointestinal disorders (FGIDs). Urinary tract infection (UTI) is associated with chronic pelvic pain in adults, a finding that has been recapitulated in murine models, but the relation between UTI and chronic pelvic and abdominal pain has not been studied in children. We hypothesized that UTI in infancy increases the risk of FGIDs and chronic abdominal pain (CAP) in childhood.

Methods:
The present study included children, ages 4 to 18 years, with a single UTI in the first year of life and their siblings with no history of UTI. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms–Rome III Version (QPGS-III) by telephone. Children meeting QPGS-III criteria for FGIDs but with pain less than once weekly were considered to have CAP.

Results:
A total of 57 patients with UTI and 58 sibling controls were identified. Mean age at UTI was 4.8 months, and mean time since UTI was 9.3 years. At the time of survey, mean age of patients was 9.7 years (5–16 years, 40% boys) and that of controls was 9.6 years (range 4–17 years, 57% boys). FGIDs were diagnosed in 6 of 57 (11%) patients, and 1 of 58 (2%) controls (P = 0.06). CAP was identified in 10 of 57 (18%) patients and 2 of 58 (3%) controls (P = 0.02). Predominant sex (female), infecting organism (E coli), and treatment (third-generation cephalosporin) were similar in patients with UTI with and without CAP.

Conclusions:
We show for the first time that UTI is associated with CAP in childhood. We speculate that pelvic organ sensory convergence explains our findings.

Source:
http://journals.lww.com/jpgn/pages/a...ampaign=buffer
04-06-2015, 05:13 AM   #149
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VEO IBD symposium 2014:

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04-13-2015, 11:09 AM   #150
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Chronic Granulomatous Disease and Crohn's Disease Histopathological Distinctive Features: A Pediatric Study

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