rate among children ,5 years old of ∼36% in the state of Maharashtra. Malnutrition increases this rate almost fourfold. During the rehabilitation phase of severe acute malnutrition (SAM) management, a diet based on energy-dense local foods (EDLF) along with multivitamin and multimineral supplements given at regular intervals under supervision, with counseling and play therapy, results in rapid weight increases (.10 g/kg per day) in children with SAM in 14 days. This weight gain facilitates early discharge from inpatient care, reducing chances of secondary infections and subsequent mortality. This study aimed to determine catchup growth in children with SAM treated with EDLF, our “magic potion,” in a hospital- based nutrition rehabilitation center (NRC). METHODS: We conducted a prospective hospital-based in- terventional study at the NRC of a tertiary teaching gov- ernment hospital in Pune, India. Data are from July 2012 to August 2013. We enrolled children between the ages of 1 and 60 months who met World Health Organization criteria for SAM. The children were started on a specially prepared food consisting of puffed rice, sugar, milk powder, oil, groundnut powder, and water in predetermined propor- tions to provide 75, 100, and then 150 to 200 kcal per 100 mL. Supervised feedings with daily weight monitoring and structured play therapy were implemented. The data were analyzed to assess the effect of this diet on the daily weight gain in each child. RESULTS: Of the 120 children with SAM, 70% were girls, and the mean age was 14 months (range 1–60 months). Un- derlying systemic illness was seen in 73%; the most common were pneumonia and diarrhea with dehydration and shock. Risk factors for SAM were inappropriate feeding habits (60%; odds ratio [OR] 5 2.02; 95% confidence in- terval [CI], 0.68–5.94), incomplete vaccination (55%; OR 5 1.30; 95% CI, 0.45–3.72), and poverty (39%; OR 5 2.28; 95% CI, 0.78–6.69). Mean weight gain on the prescribed diet (EDLF) was good (.8 g/kg per day) in 52%. Weight gain was higher by almost 40% in the absence of underlying systemic illness in any week. No mortality was noted during the study period. All mothers and caretakers confidently prepared the diet themselves at the time of discharge. Follow-up at 6 months showed steady weight gain in all. CONCLUSIONS: The diet of EDLF was found to be suitable and cost-effective for nutrition rehabilitation of children with SAM, with good weight gain, as recommended by the World Health Organization. The cost of 100 g of this special feed is only 10 rupees (,25 cents) per 130 kcal, and it can be used for community management of SAM. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2014–3330G Arti Kinikar, Sandhya Khadse, Chhaya Valvi, Rajesh Kulkarni, Vrushali Bichkar B.J. Government Medical College, Pune, India Fecal Calprotectin During Treatment of Severe Infantile Colic With Lactobacillus reuteri DSM 17938: A Randomized, Double-Blind, Placebo-Controlled Trial BACKGROUND AND OBJECTIVES: Fecal calprotectin level has been reported to correlate with inflammation in inflammatory bowel disease in adults, and recently its relationship with infantile colic has also been described. Fecal calprotectin is elevated in infants with hematochezia and possible allergic colitis. The objectives were to evaluate fecal calprotectin at the time of enrollment and its variation after 3 weeks of therapy with a probiotic (Lactobacillus reuteri DSM 17938) in infants with severe infantile colic admitted to our hos- pital for either hematochezia, food allergy, or eczema. This study also aimed to compare fecal calprotectin values in infants with infantile colic and symptoms of food allergy with those in healthy infants. METHODS: Forty-three patients with severe infantile colic, diagnosed according to the Wessel definition, were pro- spectively enrolled; 25 received a probiotic and 18 received placebo. The study population was composed as follows: 23 (48%) boys, mean age at enrollment in the study 36.6 6 11.9 days, 36 (75%) exclusively breastfed. At enrollment, mothers were told to avoid cow’s milk in their diet. Clin- ical responders after study period were considered infants who had reduced crying time per day and whose calpro- tectin decreased by $50% compared with baseline. We measured fecal calprotectin levels in fresh stools of these patients before and after 3 weeks of therapy by using the Quantum Blue Calprotectin Rapid Test (Bühlmann Labo- ratories AG, Schönenbuch, Switzerland). During treatment clinical symptoms were assessed by parents, who used a di- ary to record time of infantile crying per day and stool characteristics. A group of 19 healthy controls were en- rolled only to provide calprotectin values for comparison. RESULTS: Forty-three infants (L. reuteri group, 25; placebo group, 18) completed the trial. A sustained clinical response after treatment with probiotic was observed in 17 (65.4%) treated patients; the average values of fecal calprotectin were 601 mg/g after therapy versus 920 mg/g before induction (P , .05). Posttreatment fecal calprotectin was signi ficantly lower in responders than in nonresponders (P 5 .012). The control group showed a mean calprotectin value of 100 mg/g, significantly different from that of the colicky group (P , .005). CONCLUSIONS: The administration of L. reuteri DSM 17938 significantly decreases crying time and fecal calprotectin level. Colicky infants have significantly higher calprotectin levels than healthy controls. Finally, fecal calprotectin assay after probiotic treatment with L. reuteri DSM 17938 can be PEDIATRICS Volume 135, Supplement 1, February 2015 S5 at Dip Scienze Pediatriche Biblioteca on August 20, 2015 pediatrics.aappublications.org Downloaded from