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This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Evidence-based recommendations and randomized controlled trials in the region are included. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by utilizing a modified Delphi process and applying the Likert scale in an electronic voting process. Bacillus clausii was recommended as an adjunct treatment with oral rehydration solution for acute viral diarrhea. B. clausii may also be considered for prevention of antibiotic-associated diarrhea, Clostridium difficile-induced diarrhea, and as adjunct treatment of Helicobacter pylori. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations currently apply to most Asia-Pacific countries. Ideally, these need to be validated with local randomized-controlled trials.

The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (<5 years). Exacerbating this problem, some children are described by their parent as a picky eater with behaviors such as eating limited food and unwillingness to try new foods. Timely intervention can help prevent nutritional decline and promote growth recovery; oral nutritional supplements (ONS) and dietary counseling (DC) are commonly used. The present study aimed to determine the effects of ONS along with DC on growth in comparison with the effects of DC only. Enrolled children (N = 321) were >24 to ≤48 months old, at malnutrition risk (weight-for-height percentile 3rd to 15th), and described as a picky eater by their parent. Enrollees were randomized to one of the three groups (N = 107 per group): ONS1 + DC; ONS2 + DC; and DC only. From day 1 to day 90, study findings showed significant increases in weight-for-height percentile for ONS1 + DC and for ONS2 + DC interventions, as compared to DC only (p = 0.0086 for both). There was no significant difference between the two ONS groups. Anthropometric measurements (weight and body mass index) also increased significantly over time for the two ONS groups (versus DC only, p < 0.05), while ONS1 + DC significantly improved mid-upper-arm circumference (p < 0.05 versus DC only), as well. ONS groups showed a trend toward greater height gain when compared to DC only group, but the differences were not significant within the study interval. For young Indian children with nutritional risk and picky eating behaviors, our findings showed that a 90-day nutritional intervention with either ONS1 or ONS2, along with DC, promoted catch-up growth more effectively than did DC alone.

Objectives This was a multicenter prospective randomized double-blind study with two parallel experimental groups (EXP GRPS) & an open-labeled control grp (CON). Objective was to investigate the effect of two oral nutritional supplements (ONS) along with dietary counseling (DC) vs DC alone on growth among picky eating children from India, aged > 24 m to ≤ 48 m over 90 days. Methods Study recruited 321 children [n = 107/grp] in ages mentioned above from urban/semi-urban India with a weight-for-height between 3rd–15th centile (WHO 2006) and picky eating behaviors. Subjects in the 2 EXP GRPS received a daily supplement of one of the two similar ONS [Pediasure (PDS) & Pediasure Advance (PDS Adv)} along with DC for 90 days, whereas subjects in CON received only DC. Children in both EXP GRPS consumed min of 1 & max to 2 servings of ONS/day & there were 5 study visits (Day 1, 7, 30, 60, 90). Primary variable was the change in WHO weight-for-height centile from Day 1 to 90. Secondary variables included change in weight-for-age, height-for-age, BMI-for-age, MUAC-for-age, average intake of energy, macros & micronutrients (using 24 hr. dietary recall) and change in appetite & palatability score. Results Post 90 days, both EXP GRPS had significantly higher change in growth parameters like weight-for-height centile (P = 0.0086), BMI-for-age centile (P = 0.0214 & P = 0.0203 for PDS & PDS Adv respectively) & weight-for-age centile (P = 0.0054) as compared to CON. PDS group reported a significant improvement in MUAC-for-age centile (P = 0.0241) vs CON post 90-days. Significant improvement in appetite score was reported by EXP GRPS (P = 0.0067 & P = 0.0245 for PDS & PDS Adv) vs CON. Significant improvement in avg. intake of energy, protein, fat, calcium, iron, vit C & thiamine was observed for EXP GRPS vs CON for all visit days except day1. Nutrient & energy intakes at baseline were lower than RDA's but ONS helped to fill the nutritional gaps at end of 90 days. There were no significant differences observed in the height-for-age and palatability score. Conclusions ONS's formulated with macro & micronutrients along with DC are more efficacious in catch up growth vs DC alone post 90 days supplementation. Funding Sources Abbott Nutrition has funded this study.

Umbilical cord blood stem cell transplantation has been used to cure many malignant disorders, hematological conditions, immune deficiency disorders and inherited metabolic disorders, even when it's partially HLA mismatched. Collection procedure is safe for mother and baby in an otherwise uncomplicated delivery. Public cord blood banking should be promoted over private banking. Private cord blood banking is highly recommended when an existing family member (sibling or biological parent) is suffering from diseases approved to be cured by allogenic stem cell transplantation. Otherwise, private cord blood banking is not a 'biological insurance', and should be discouraged. At present, autologous cord stem cells cannot be used for treating diseases of genetic origin, metabolic disorders and hematological cancers. Advertisements for private banking are often misleading. Legislative measures are required to regularize the marketing strategies of cord blood banking.

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Justification The IAP last published the guidelines “Comprehensive Management of Diarrhea” in 2006 and a review in 2016. The WHO in 2002 and the Government of India in 2004 recommended low osmolarity rehydration solution (LORS) as the universal rehydration solution for all ages and all forms of dehydration. However, the use of LORS in India continues to be unacceptably low at 51%, although awareness about ORS has increased from a mere 14% in 2005 to 69% in 2015. Availability of different compositions of ORS and brands in market added to the confusion. Process The Indian Academy of Pediatrics constituted a panel of experts from the fields of pediatrics, pediatric gastroenterology and nutrition to update on management of dehydration in children with particular reference to LORS and issue a current practice guideline. The committee met twice at CIAP HQ to review all published literature on the aspect. Brief presentations were made, followed by discussions. The draft paper was circulated by email. All relevant inputs and suggestions were incorporated to arrive at a consensus on this practice guideline. Objectives To summarize latest literature on ORT and empower pediatricians, particularly those practicing in rural areas, on management of dehydration by augmenting LORS use. Recommendations It was stressed that advantages of LORS far out-weigh its limitations. Increased use of LORS can only be achieved by promoting better awareness among public and health-care providers across all systems of medicine. LORS can also be useful in managing dehydration in non-diarrheal illness. More research is required to modify ORS further to make it safe and effective in neonates, severe acute malnutrition, renal failure, cardiac and other co-morbidities. There is an urgent need to discourage production and marketing all forms of ORS not in conformity with WHO approved LORS, under a slogan “One India, one ORS”.