Introduction: Recently, significant interest from families and healthcare providers has arisen to use blenderized tube feedings (BTF). Although many institutions are providing this nutritional option, literature documenting outcomes and safety is lacking. Methods: A retrospective chart review was performed on pediatric patients receiving BTF at Rutgers-Robert Wood Johnson University Hospital between January 2013 and April 2017. Demographic data and dietary information before and after BTF were collected. Reasons for diet initiation, symptoms, and anthropometrics were recorded. Adverse events and outcomes were assessed through physician documentation and relevant medication changes. Results: Thirty-five patients (24 boys) received BTF. Age at initiation of BTF ranged from 1 to 19 years (mean 8.3 +/− 5.8 [SD] years). Length of follow-up ranged from 1 to 45 months (mean 15 +/− 12.2 months). The most common reason for starting BTF was gastroesophageal reflux disease (GERD) (N = 32). Almost all patients were on medications for GERD, constipation, or gastrointestinal dysmotility before starting BTF (N = 33). Majority of patients had improvement in relevant symptoms (N = 20); 13 of 33 patients on gastrointestinal medications were able to wean or stop medication(s). BMI z scores did not differ before and after BTF initiation (P = 0.558). No serious life-threatening adverse events were found. Conclusions: Our data suggest that BTF is a safe dietary intervention that may improve gastrointestinal symptoms in pediatric patients. Further prospective studies are needed to compare safety and efficacy of BTF and commercial formulas in pediatric patients.

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Summary Background Little data are available regarding the effectiveness and associated microbiome changes of faecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI) in children, especially in those with inflammatory bowel disease (IBD) with presumed underlying dysbiosis. Aim To investigate C. difficile eradication and microbiome changes with FMT in children with and without IBD. Methods Children with a history of recurrent CDI (≥3 recurrences) underwent FMT via colonoscopy. Stool samples were collected pre‐FMT and post‐FMT at 2–10 weeks, 10–20 weeks and 6 months. The v4 hypervariable region of the 16S rRNA gene was sequenced. C. difficile toxin B gene polymerase chain reaction was performed. Results Eight children underwent FMT for CDI; five had IBD. All had resolution of CDI symptoms. All tested had eradication of C. difficile at 10–20 weeks and 6 months post‐FMT. Pre‐FMT patient samples had significantly decreased bacterial richness compared with donors (P = 0.01), in those with IBD (P = 0.02) and without IBD (P = 0.01). Post‐FMT, bacterial diversity in patients increased. Six months post‐FMT, there was no significant difference between bacterial diversity of donors and patients without IBD; however, bacterial diversity in those with IBD returned to pre‐FMT baseline. Microbiome composition at 6 months in IBD‐negative patients more closely approximated donor composition compared to IBD‐positive patients. Conclusions FMT gives sustained C. difficile eradication in children with and without IBD. FMT‐restored diversity is sustained in children without IBD. In those with IBD, bacterial diversity returns to pre‐FMT baseline by 6 months, suggesting IBD host‐related mechanisms modify faecal microbiome diversity.

Background Fecal microbiota transplantation (FMT) treats Clostridioides difficile infection (CDI). Little is known regarding the changes in antimicrobial resistance (AMR) genes and potential pathogen burden that occur in pediatric recipients of FMT. The aim of this study was to investigate changes in AMR genes, potential pathogens, species, and functional pathways with FMT in children. Methods Nine children with recurrent CDI underwent FMT. Stool was collected from donor and recipient pre-FMT and longitudinally post-FMT for up to 24 weeks. Shotgun metagenomic sequencing was performed. Reads were analyzed using PathoScope 2.0. Results All children had resolution of CDI. AMR genes decreased post-FMT (P < .001), with a sustained decrease in multidrug resistance genes (P < .001). Tetracycline resistance genes increased post-FMT (P < .001). Very low levels of potential pathogens were identified in donors and recipients, with an overall decrease post-FMT (P < .001). Prevotella sp. 109 expanded in all recipients post-FMT, and no recipients had any clinical infection. Alpha diversity was lower in recipients vs donors pre-FMT (P < .001), with an increase post-FMT (P ≤ .002) that was sustained. Beta diversity differed significantly in pre- vs post-FMT recipient samples (P < .001). Bacterial species Faecalibacterium prausnitzii and Bacteroides ovatus showed higher abundance in donors than recipients (P = .008 and P = .040, respectively), with expansion post-FMT. Biosynthetic pathways predominated in the donor and increased in the recipient post-FMT. Conclusions FMT for CDI in children decreases AMR genes and potential pathogens and changes microbiota composition and function. However, acquisition of certain AMR genes post-FMT combined with low levels of potential pathogens found in donors suggests that further study is warranted regarding screening donors using metagenomics sequencing before FMT.

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