Sathe, Meghana; Rong Huang; Sonya Heltshe; Alexander Eng; Elhanan Borenstein; Samuel I. Miller; Lucas Hoffman; Daniel Gelfond; Daniel H. Leung; Druck Borowitz; Bonnie Ramsey and A. Jay Freeman

To identify factors that increase risk of gastrointestinal-related (GI-related) hospitalization of infants with cystic fibrosis (CF) during the first year of life. Methods: The Baby Observational and Nutrition Study was a longitudinal, observational cohort of 231 infants diagnosed with CF by newborn screening. We performed a post-hoc assessment of the frequency and indications for GI-related admissions during the first year of life. Results: Sixty-five participants had at least one admission in the first 12 months of life. High pancreatic enzyme replacement therapy (PERT) dosing (>2000 LU/kg/meal) (hazard ratio, HR = 14.75, p = 0.0005) and use of acid suppressive medications (HR = 4.94, p = 0.01) during the study period were positively associated with subsequent GI-related admissions. High levels of fecal calprotectin (fCP) (>200 μg/g) and higher relative abundance of fecal Klebsiella pneumoniae were also positively associated with subsequent GI-related admissions (HR = 2.64, p = 0.033 and HR = 4.49, p = 0.002, respectively). During the first 12 months of life, participants with any admission had lower weight-for-length z-scores (WLZ) (p = 0.01). The impact of admission on WLZ was particularly evident in participants with a GI-related admission (p < 0.0001). Conclusions: Factors associated with higher risk for GI-related admission during the first 12 months include high PERT dosing, exposure to acid suppressive medications, higher fCP levels, and/or relative abundance of fecal Klebsiella pneumoniae early in life. Infants with CF requiring GI-related hospitalization had lower WLZ at 12 months of age than those not admitted as well as those admitted for non GI-related indications.