Pubertal staging is rarely needed in a general paediatric clinic and I wonder if there is a way to avoid the difficult issues in examining older children and young people.
I think the issues around chaperones are complex, as a male doctor, male patients often do not want a female nurse as a chaperone and on the whole peri-pubertal girls do not want to be examined at all by a male doctor.
My strategy, when needed, is therefore to ask older children and young people to let me know what they think their pubertal stage is - testicular size can be self-assessed using a standard orchidometer, all other changes can be described with reference to standard drawings from a growth chart.
I realise this is not evidence based practice but wonder if there is the possibility of a trial to compare paediatrician-assessed as opposed to self-assessed staging in non-specialist clinics?
Dear authors, the article made for some interesting reading especially as the current DKA ICP recommended by BSPED has now been in force for almost 2 years. It provides some perspective on whether the difference in liberalized vs conservative management is clinically significant or otherwise. Our question relates to whether the authors found any data in the studies regarding change in osmolarity / rate of rise of sodium which are early predictors for risk of cerebral oedema.
By excluding all deaths, it is possible that a significant number of high-cost high-need patients were missed? Some deaths will follow a prolonged admission and care may have been escalated, for example to PICU, prior to death.
Dear editor, we read with interest the randomised controlled trial by Borgström et al.1 showing the lack of effectiveness of daytime urotherapy as first-line treatment of nocturnal enuresis. While the study has the remarkable point of strength of a prospective trial with a control, we take exception with some of the authors’ statements, and believe that some limits should be acknowledged.
Reduction of enuresis frequency was evaluated after 7 and 8 weeks since the beginning of the study while previous studies showed effectiveness for longer treatments, lasting four months, with a 60% success rate2. While the authors acknowledge this difference they simply state that a longer duration would disqualify the therapy as a first-line choice anyway, increasing the risks of drop out. We believe that this is, as the author state in the discussion, simply their view, which is not based on any evidence. The length of a treatment should not necessarily rule out it as a first line option, especially when weighted against the costs of other options, specifically unpleasantness of the alarm and possible adverse effects of desmopressin. As a matter of fact, it could be speculated that 8 weeks are a too short period in a physiological perspective to develop different voiding patterns after years of an enuretic bladder function.
Moreover, patients’ follow-up consisted only in contact by phone after 2 and 6 weeks, without clinical examination, and this could have contributed t...
Dear editor, we read with interest the randomised controlled trial by Borgström et al.1 showing the lack of effectiveness of daytime urotherapy as first-line treatment of nocturnal enuresis. While the study has the remarkable point of strength of a prospective trial with a control, we take exception with some of the authors’ statements, and believe that some limits should be acknowledged.
Reduction of enuresis frequency was evaluated after 7 and 8 weeks since the beginning of the study while previous studies showed effectiveness for longer treatments, lasting four months, with a 60% success rate2. While the authors acknowledge this difference they simply state that a longer duration would disqualify the therapy as a first-line choice anyway, increasing the risks of drop out. We believe that this is, as the author state in the discussion, simply their view, which is not based on any evidence. The length of a treatment should not necessarily rule out it as a first line option, especially when weighted against the costs of other options, specifically unpleasantness of the alarm and possible adverse effects of desmopressin. As a matter of fact, it could be speculated that 8 weeks are a too short period in a physiological perspective to develop different voiding patterns after years of an enuretic bladder function.
Moreover, patients’ follow-up consisted only in contact by phone after 2 and 6 weeks, without clinical examination, and this could have contributed to poor effectiveness of urotherapy too.
Lastly and above all, the authors considered daytime incontinence and voiding dysfunction among the exclusion criteria of the study, but it is well known that many enuretic children present daytime symptoms too in up to 90% of cases2 or bladder dysfunction even with enuresis as the only detectable symptom.3 These disorders, once identified, must be treated because they can lead to urological dysfunctions in adulthood4 and behavioural therapy still represents a cornerstone of treatment. We believe that this is a further reason why urotherapy should not be disqualified as a first-line treatment only without the evidence of long term treatment data.
In conclusion, we suggest that daytime urotherapy studies need to be carried out for longer periods to confirm or rule out its effectiveness. Until then urotherapy should not be considered an alternative choice to alarm therapy and pharmacological treatment but a complementary one, in order to obtain a global approach to nocturnal enuresis in children.
Bibliography
1. Borgström M, Bergsten A, Tunebjer M, et al. Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial. Archives of Disease in Childhood Published Online First: 24 January 2022. doi: 10.1136/archdischild-2021-323488
2. Pennesi M, Pitter M, Bordugo A, Minisini S, Peratoner L. Behavioral therapy for primary nocturnal enuresis. J Urol. 2004; 171(January):408-410. doi:10.1097/01.ju.0000097497.75022.e8
3. Yeung CK, Chiu HN, Sit FKY. Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol. 1999; 162:1049-1055.
4. Bower WF, Sit FKY, Yeung CK. Nocturnal Enuresis in Adolescents and Adults is Associated With Childhood Elimination Symptoms. J Urol. 2006; 176(October):1771-1775. doi:10.1016/j.juro.2006.04.087
re Diagnosing urinary tract infection in children: time to ditch the pad?
Harkensee C, Clennett J, Wilkinson S, et al
Arch Dis Child 2021; 106: 935-936
We read with interest the article by Harkensee et al, (1) suggesting that the urinary collection pad (UCP) no longer had a role in obtaining samples for diagnosis of urinary tract infections (UTI). Whilst it is well established that there is an unacceptably high rate of contamination with UCPs making them unsuitable for microbiological culture, and that the preferred (non-invasive) method for obtaining a sample for culture is by 'clean catch' +/- stimulation or Quick-Wee method, we would suggest that the UCP has a role in screening for UTI, by dipstick analysis of the aspirated pad sample for leucocyte esterase (LE) and nitrites (2). It would be useful, in a paediatric 'acute referral clinic' or Emergency Department, in infants or children, with non-specific abdominal pain, or fever without a focus, where a combination of a negative test for both LE and nitrites can be reasonably used to exclude UTI, and equally a positive LE and nitrite result would indicate a high likelihood of a UTI and the need to obtain a 'clean catch' or catheter specimen for microbiological analysis (3). The advantages of the UCP are that it allows 'point of care' dipstick analysis with inf...
re Diagnosing urinary tract infection in children: time to ditch the pad?
Harkensee C, Clennett J, Wilkinson S, et al
Arch Dis Child 2021; 106: 935-936
We read with interest the article by Harkensee et al, (1) suggesting that the urinary collection pad (UCP) no longer had a role in obtaining samples for diagnosis of urinary tract infections (UTI). Whilst it is well established that there is an unacceptably high rate of contamination with UCPs making them unsuitable for microbiological culture, and that the preferred (non-invasive) method for obtaining a sample for culture is by 'clean catch' +/- stimulation or Quick-Wee method, we would suggest that the UCP has a role in screening for UTI, by dipstick analysis of the aspirated pad sample for leucocyte esterase (LE) and nitrites (2). It would be useful, in a paediatric 'acute referral clinic' or Emergency Department, in infants or children, with non-specific abdominal pain, or fever without a focus, where a combination of a negative test for both LE and nitrites can be reasonably used to exclude UTI, and equally a positive LE and nitrite result would indicate a high likelihood of a UTI and the need to obtain a 'clean catch' or catheter specimen for microbiological analysis (3). The advantages of the UCP are that it allows 'point of care' dipstick analysis with information to guide clinical decision-making immediately, is passive with minimal parental effort and disruption to the child, there is less likelihood of missing a sample (compared with 'clean catch') and is the preferred collection method of parents.
Perhaps, it's not time to ditch the pad: pads have a place!
Mervyn S Jaswon
James Diviney
Dept of Paediatrics, Whittington Hospital, London1.Diagnosing urinary tract infection in children: time to ditch the pad?
1.Diagnosing urinary tract infection in children: time to ditch the pad?
Clennett J, Wilkinson S, et al Arch Dis Child 2021; 106: 935-936
2. Urine collection methods and dipstick testing in non-toilet-trained children.
Diviney J, Jaswon M S, Pediatric Nephrology 2021; 36; 1697-1708
3. Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of UTI in children: a systematic review and economic model.
Whiting P, Westwood M, et al HEalth Technol Assess 10:iii-iv, xi-xiii" "
Child mortality in Europe dropped considerably in the first year of the pandemic, but since mid-2021 it is increasing considerably, as the data from the euromomo registry suggest. https://www.euromomo.eu/graphs-and-maps/ I first thought that Corona "saves children´s life" (for an intolerable expense), but now the contrary is true. While by the end of 2020 almost 400 Children (0-14) less died in the participating countries, excess mortality in Europa was about 500 Children at the end of 2021. So it was to early to draw conclusions.
We read with great interest recent study by Vergnano et al.1 investigating the epidemiology, age at infection, clinical characteristics, and outcome of listeria infection in the young infant. We congratulate the authors on providing a novel and interesting study that is relevant to the UK population and agree that the empirical use of amoxicillin in the paediatric infant should be reconsidered given the conclusions of their data.
However, when considering how we might be able to incorporate your novel findings into our centres practice, we required further clarification on table 2. The table describes increased oxygen requirement/respiratory support in 2/27 infants and yet, within results, report a prevalence of increased oxygen requirement/respiratory support of 89%. Furthermore, hypotension requiring inotropes is reported to occur in 4/27 infants but has a reported prevalence of 115%. These reported data appear to be miscalculated.
Clinical identification of invasive listeriosis through the understanding of symptoms within the infant is a key finding of this study given its poor description within the current literature2. We conducted a focused literature search and found scarce information on infant symptom prevalence; one notable exception includes the MONALISA study by Charlier et al.3 which recorded detailed clinical features (appendix p 21). Early diagnosis of invasive listeriosis has been demonstrated to have key prognostic value...
We read with great interest recent study by Vergnano et al.1 investigating the epidemiology, age at infection, clinical characteristics, and outcome of listeria infection in the young infant. We congratulate the authors on providing a novel and interesting study that is relevant to the UK population and agree that the empirical use of amoxicillin in the paediatric infant should be reconsidered given the conclusions of their data.
However, when considering how we might be able to incorporate your novel findings into our centres practice, we required further clarification on table 2. The table describes increased oxygen requirement/respiratory support in 2/27 infants and yet, within results, report a prevalence of increased oxygen requirement/respiratory support of 89%. Furthermore, hypotension requiring inotropes is reported to occur in 4/27 infants but has a reported prevalence of 115%. These reported data appear to be miscalculated.
Clinical identification of invasive listeriosis through the understanding of symptoms within the infant is a key finding of this study given its poor description within the current literature2. We conducted a focused literature search and found scarce information on infant symptom prevalence; one notable exception includes the MONALISA study by Charlier et al.3 which recorded detailed clinical features (appendix p 21). Early diagnosis of invasive listeriosis has been demonstrated to have key prognostic value in the literature4. Consequently, we submit that clearly described clinical presentations, and an understanding of their respective prevalence, could reduce the high mortality associated with invasive listeriosis3 and improve patient outcomes in the future.
Given the relative lack of understanding and the debate within the literature relating to the symptomatic presentation and clinical picture of listeria infection in the infant, especially in a UK population, your article has the potential to clarify clinical signs of useful predictive value. We would be very grateful for clarification on this matter to incorporate into our own practice.
References
1. Vergnano S, Godbole G, Simbo A, et al. Listeria infection in young infants: results from a national surveillance study in the UK and Ireland. Archives of Disease in Childhood 2021;106(12):1207-10. doi: 10.1136/archdischild-2021-321602
2. de Noordhout CM, Devleesschauwer B, Angulo FJ, et al. The global burden of listeriosis: a systematic review and meta-analysis. The Lancet Infectious Diseases 2014;14(11):1073-82. doi: https://doi.org/10.1016/S1473-3099(14)70870-9
3. Charlier C, Perrodeau É, Leclercq A, et al. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. The Lancet Infectious Diseases 2017;17(5):510-19. doi: https://doi.org/10.1016/S1473-3099(16)30521-7
4. Hof H. An update on the medical management of listeriosis. Expert Opinion on Pharmacotherapy 2004;5(8):1727-35. doi: 10.1517/14656566.5.8.1727
The Centers for Disease Control and Prevention (CDC) now recommends a Covid -19 vaccine for children ages 5 and older. Johns Hopkins Medicine encourages all families to have eligible children vaccinated with the Covid - 19 vaccine. Currently, Pfizer's vaccine is the only approved Covid-19 vaccine for children and its side effects are still the same in children. Children might notice pain at the injection site (upper arm), and could feel more tired than usual. Headache, achy muscles or joints, and even fever and chills are also possible and these side effects are usually temporary and generally clear up with 48 hours.
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Under the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown b...
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Under the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown by Pfizer to concentrate in the ovaries and testes5 in rats. These more theoretical risks may be of less concern to adults, particularly those a relatively high risk from covid. But for children, with their whole lives ahead of them, we absolutely must remember the maxim, ‘First do no harm’.
Most importantly, the authors state that, ‘Subjecting children to potential risk of vaccine adverse effects to drive indirect effects with little or no direct benefit might be ethically questionable’. I would contest that is unethical to ask children to take a vaccine to boost herd immunity or to offset political decisions such as school closures, at a stage when the drug trials have still to be completed. Policy makers would do well to re-read the Universal Declaration on Bioethics and Human Rights6 and to follow the authors’ guidance to ‘weigh up the risks and benefits with caution and to proceed with care’.
1. Zimmermann P, Pittet LF, Finn A, et al. Should children be vaccinated against COVID-19? Archives of Disease in Childhood Published Online First: 03 November 2021. https://doi.org/10.1136/archdischild-2021-323040
2. UK Health Security Agency. COVID-19 vaccine surveillance report Week 44 https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
3. Ishay Y, Kenig A, Tsemach-Toren T, et al. Autoimmune phenomena following SARS-CoV-2 vaccination. Int Immunopharmacol. 2021;99:107970. https://doi.org/10.1016/j.intimp.2021.107970
4. Jiang, H, Mei, Y-F. SARS–CoV–2 Spike Impairs DNA Damage Repair and Inhibits V(D)J Recombination In Vitro. Viruses 2021, 13, 2056. https://doi.org/10.3390/v13102056
5. Pfizer biodistribution data. https://www.naturalnews.com/files/Pfizer-bio-distribution-confidential-d...
6. Universal Declaration on Bioethics and Human Rights (2005). http://portal.unesco.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECT...
I read with great interest the article by Haisma et al. that reports on fecal calprotectin instability.(1) The authors are to be commended on their study. However, some points deserve comment.
The authors tested the stability of calprotectin after the stool was homogenized. The clinical relevance of this is unclear since what is important is the stability of calprotectin in stool after collection and before analysis. The studies that have evaluated fecal calprotectin stability in this situation are in alignment; calprotectin is stable in unprocessed stool at room temperature for at least 3 days with some studies suggesting up to a week (for review see D’Amico et al.).(2)
No support is provided for the statement by Haisma et al. that calprotectin instability in stool samples sent by mail may lead to errors in treat-to-target strategies. Indeed, the literature says otherwise.
1. Haisma SM, van Rheenen PF, Wagenmakers L, Muller Kobold A. Calprotectin instability may lead to undertreatment in children with IBD. Arch Dis Child. 2020;105:996-8 doi: 10.1136/archdischild-2018-316584 [published Online First: 2019/01/19].
2. D'Amico F, Rubin DT, Kotze PG, et al. International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases. United European Gastroenterol J. 2021;9:451-60 doi: 10.1002/ueg2.12069 [published Online First: 2021/05/08].
Pubertal staging is rarely needed in a general paediatric clinic and I wonder if there is a way to avoid the difficult issues in examining older children and young people.
I think the issues around chaperones are complex, as a male doctor, male patients often do not want a female nurse as a chaperone and on the whole peri-pubertal girls do not want to be examined at all by a male doctor.
My strategy, when needed, is therefore to ask older children and young people to let me know what they think their pubertal stage is - testicular size can be self-assessed using a standard orchidometer, all other changes can be described with reference to standard drawings from a growth chart.
I realise this is not evidence based practice but wonder if there is the possibility of a trial to compare paediatrician-assessed as opposed to self-assessed staging in non-specialist clinics?
Dear authors, the article made for some interesting reading especially as the current DKA ICP recommended by BSPED has now been in force for almost 2 years. It provides some perspective on whether the difference in liberalized vs conservative management is clinically significant or otherwise. Our question relates to whether the authors found any data in the studies regarding change in osmolarity / rate of rise of sodium which are early predictors for risk of cerebral oedema.
By excluding all deaths, it is possible that a significant number of high-cost high-need patients were missed? Some deaths will follow a prolonged admission and care may have been escalated, for example to PICU, prior to death.
Dear editor, we read with interest the randomised controlled trial by Borgström et al.1 showing the lack of effectiveness of daytime urotherapy as first-line treatment of nocturnal enuresis. While the study has the remarkable point of strength of a prospective trial with a control, we take exception with some of the authors’ statements, and believe that some limits should be acknowledged.
Reduction of enuresis frequency was evaluated after 7 and 8 weeks since the beginning of the study while previous studies showed effectiveness for longer treatments, lasting four months, with a 60% success rate2. While the authors acknowledge this difference they simply state that a longer duration would disqualify the therapy as a first-line choice anyway, increasing the risks of drop out. We believe that this is, as the author state in the discussion, simply their view, which is not based on any evidence. The length of a treatment should not necessarily rule out it as a first line option, especially when weighted against the costs of other options, specifically unpleasantness of the alarm and possible adverse effects of desmopressin. As a matter of fact, it could be speculated that 8 weeks are a too short period in a physiological perspective to develop different voiding patterns after years of an enuretic bladder function.
Moreover, patients’ follow-up consisted only in contact by phone after 2 and 6 weeks, without clinical examination, and this could have contributed t...
Show More26th January 2022
To the Editor
Archives of Disease in Childhood
re Diagnosing urinary tract infection in children: time to ditch the pad?
Harkensee C, Clennett J, Wilkinson S, et al
Arch Dis Child 2021; 106: 935-936
We read with interest the article by Harkensee et al, (1) suggesting that the urinary collection pad (UCP) no longer had a role in obtaining samples for diagnosis of urinary tract infections (UTI). Whilst it is well established that there is an unacceptably high rate of contamination with UCPs making them unsuitable for microbiological culture, and that the preferred (non-invasive) method for obtaining a sample for culture is by 'clean catch' +/- stimulation or Quick-Wee method, we would suggest that the UCP has a role in screening for UTI, by dipstick analysis of the aspirated pad sample for leucocyte esterase (LE) and nitrites (2). It would be useful, in a paediatric 'acute referral clinic' or Emergency Department, in infants or children, with non-specific abdominal pain, or fever without a focus, where a combination of a negative test for both LE and nitrites can be reasonably used to exclude UTI, and equally a positive LE and nitrite result would indicate a high likelihood of a UTI and the need to obtain a 'clean catch' or catheter specimen for microbiological analysis (3). The advantages of the UCP are that it allows 'point of care' dipstick analysis with inf...
Show MoreChild mortality in Europe dropped considerably in the first year of the pandemic, but since mid-2021 it is increasing considerably, as the data from the euromomo registry suggest. https://www.euromomo.eu/graphs-and-maps/ I first thought that Corona "saves children´s life" (for an intolerable expense), but now the contrary is true. While by the end of 2020 almost 400 Children (0-14) less died in the participating countries, excess mortality in Europa was about 500 Children at the end of 2021. So it was to early to draw conclusions.
Dear Editor,
We read with great interest recent study by Vergnano et al.1 investigating the epidemiology, age at infection, clinical characteristics, and outcome of listeria infection in the young infant. We congratulate the authors on providing a novel and interesting study that is relevant to the UK population and agree that the empirical use of amoxicillin in the paediatric infant should be reconsidered given the conclusions of their data.
However, when considering how we might be able to incorporate your novel findings into our centres practice, we required further clarification on table 2. The table describes increased oxygen requirement/respiratory support in 2/27 infants and yet, within results, report a prevalence of increased oxygen requirement/respiratory support of 89%. Furthermore, hypotension requiring inotropes is reported to occur in 4/27 infants but has a reported prevalence of 115%. These reported data appear to be miscalculated.
Clinical identification of invasive listeriosis through the understanding of symptoms within the infant is a key finding of this study given its poor description within the current literature2. We conducted a focused literature search and found scarce information on infant symptom prevalence; one notable exception includes the MONALISA study by Charlier et al.3 which recorded detailed clinical features (appendix p 21). Early diagnosis of invasive listeriosis has been demonstrated to have key prognostic value...
Show MoreThe Centers for Disease Control and Prevention (CDC) now recommends a Covid -19 vaccine for children ages 5 and older. Johns Hopkins Medicine encourages all families to have eligible children vaccinated with the Covid - 19 vaccine. Currently, Pfizer's vaccine is the only approved Covid-19 vaccine for children and its side effects are still the same in children. Children might notice pain at the injection site (upper arm), and could feel more tired than usual. Headache, achy muscles or joints, and even fever and chills are also possible and these side effects are usually temporary and generally clear up with 48 hours.
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Show MoreUnder the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown b...
I read with great interest the article by Haisma et al. that reports on fecal calprotectin instability.(1) The authors are to be commended on their study. However, some points deserve comment.
The authors tested the stability of calprotectin after the stool was homogenized. The clinical relevance of this is unclear since what is important is the stability of calprotectin in stool after collection and before analysis. The studies that have evaluated fecal calprotectin stability in this situation are in alignment; calprotectin is stable in unprocessed stool at room temperature for at least 3 days with some studies suggesting up to a week (for review see D’Amico et al.).(2)
No support is provided for the statement by Haisma et al. that calprotectin instability in stool samples sent by mail may lead to errors in treat-to-target strategies. Indeed, the literature says otherwise.
1. Haisma SM, van Rheenen PF, Wagenmakers L, Muller Kobold A. Calprotectin instability may lead to undertreatment in children with IBD. Arch Dis Child. 2020;105:996-8 doi: 10.1136/archdischild-2018-316584 [published Online First: 2019/01/19].
2. D'Amico F, Rubin DT, Kotze PG, et al. International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases. United European Gastroenterol J. 2021;9:451-60 doi: 10.1002/ueg2.12069 [published Online First: 2021/05/08].
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