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Background and Objectives: To assess the prevalence, etiology, diagnosis of primary and secondary lactose intolerance (LI), including age of onset, among children 1-5 years of age. Suspected/perceived lactose intolerance can lead to dietary restrictions which may increase risk of future health issues. Methods and Study Design: MEDLINE, CAB Abstract, and Embase were searched for articles published from January 1995-June 2015 related to lactose intolerance in young children. Authors independently screened titles/abstracts, full text articles, for eligibility against a priori inclusion/exclusion criteria. Two reviewers extracted data and assessed quality of the included studies. Results: The search identified 579 articles; 20 studies, the majority of which were crosssectional, were included in the qualitative synthesis. Few studies reported prevalence of primary LI in children aged 1-5 years; those that did reported a range between 0-17.9%. Prevalence of secondary LI was 0-19%. Hydrogen breath test was the most common method used to diagnose LI. None of the included studies reported age of onset of primary LI. Conclusions: There is limited recent evidence on the prevalence of LI in this age group. The low number of studies and wide range of methodologies used to diagnose LI means that comparison and interpretation, particularly of geographical trends, is compromised. Current understanding appears to rely on data generated in the 1960/70s, with varied qualities of evidence. New, high quality studies are necessary to understand the true prevalence of LI. This review is registered with the International Prospective Register for Systematic Reviews (PROSPERO).

BackgroundThe management of a hemodynamically significant patent ductus arteriosus (hsPDA) associated with cardiomegaly and at least more than 1.5 mm in preterm infants is still a controversial topic. Previously, prophylaxis with ibuprofen was practiced in some units Nowadays, a conservative strategy with the use of diuretics and fluid restriction is considered a treatment option, alongside medical treatment with cyclo-oxygenase inhibitors (eg. Ibuprofen,indomethacin), paracetamol and surgery. The impact of the these practices have not been well studied.ObjectivesWe aim to determine the impact of hsPDA on the short term growth and cognitive outcomes of very low birth weight (VLBW) infants managed at a tertiary unit in Singapore from 2014 to 2018.MethodsA retrospective study on growth and cognitive outcomes was conducted on patients recruited from the outpatient follow-up clinic. Baseline neonatal demographics, treatment of hsPDA and short term neonatal morbidities were collected. Information on postnatal growth, health outcomes and cognitive testing scores were collected as well. Categorical data were compared with Chi squared test between those with medical or surgery treatment and those with conservative treatment.Continuous data with normal distribution was reported with means and Student t test was used for analysis. Those with skewed distribution was reported with medians and Mann-Whitney test was performed.Results89 children were recruited at a median age of 34.5 (IQR 18–52) months, with equal gender distribution. Interestingly, infants (n=61) who had hsPDA requiring treatment were more mature (29.9 vs 27.5 weeks) and heavier 1305 g vs 985 g (P < 0.01) at birth compared to VLBWs with conservative treatment (n=21). Despite their maturity and also larger weight, those who required treatment were more likely to have been mechanically ventilated 66.7% vs 33.3% (p < 0.01). As such, those who required PDA treatment had increased incidence of chronic lung disease (CLD) at 36 weeks (83.8% vs 60.8%%,p=0.04), increased length of stay (79.5 vs 59.0 days, P <0.01) and requirement of inhaled medications on follow-up. Growth failure of VLBWs with conservative treatment was evident until 6 months corrected age. Median cognitive scores were not statistically different, 97(IQR 85–105) vs 92 (IQR 81–101) when measured at ages 2–5 years. No differences were seen in the hearing loss or cerebral palsy rates. No association between PDA treatment and CLD were identified with a low cognitive score of less than 85.ConclusionsIn our small cohort, the presence of a hemodynamically significant PDA requiring treatment was associated with a higher incidence of CLD needing long term medication but no impairment of cognition and growth at follow-up.