Highlights from the ESPGHAN 2026

Rome V criteria and its presentation at ESPGHAN

Among the topics presented, the one that generated the most anticipation was the presentation of the pediatric Rome V criteria, and this was evidenced by the large number of people who filled the auditorium, leaving many outside, and with an online broadcast. The Rome V criteria differ from the Rome IV criteria in that they divide the pathologies of the upper and lower digestive tracts, in addition to removing the age division. Dr. Samuel Nurko introduced these criteria, and together with Drs. Rachel Rosen, Miguel Saps, but were, with Rome V, added to the pediatric section. Additionally, supragastric belching and aerophagia were included, as well as pediatric feeding disorders, which contributes to the classification of these pathologies that are common in daily pediatric consultations. In pain disorders, Dr. Di Lorenzo emphasized the inclusion of centrally mediated abdominal pain, a disorder included in the adult section, but which had not yet taken a significant role in the pediatric section. This entity, unlike other abdominal pain disorders, is continuous, debilitating, and from the outset requires multidisciplinary treatment to help this group of patients. Undoubtedly, a disorder that will require further research to understand its pathophysiology and treatment. Finally, biliary pain, which, although not common in pediatrics, should be considered when we have patients with pain in the right upper quadrant and no stones or pathology that explains the origin of the pain¹,².

Without any doubt, the Rome V criteria were an important part of this congress; however, other presentations and papers were highly compelling, especially regarding gut microbiota.

Probiotics for hyperbilirubinemia in newborns

A randomized clinical trial evaluated the effect of supplementation with Bifidobacterium breve M-16V and Bifidobacterium animalis subsp. lactis Bb-12 as an adjunct treatment to phototherapy in 79 newborns with neonatal jaundice. The objective was to determine if the modulation of the gut microbiota could improve the clinical response and counteract the dysbiosis induced by phototherapy.

Neonates who received probiotics had a higher frequency of bowel movements and a faster reduction in transcutaneous bilirubin levels compared to those treated solely with phototherapy. Additionally, a trend toward shorter hospital stays and better motor and language development scores between 18 and 24 months was observed, although these differences did not reach statistical significance.

The analysis of the microbiota showed an increase in bacterial diversity, a higher abundance of Bifidobacterium breve, and an increase in the Bifidobacterium/Escherichia coli ratio. Likewise, the metabolomic analysis revealed a profile compatible with increased DNA synthesis, cell growth, and regulation of the inflammatory response, suggesting a possible role of the microbiota in bilirubin metabolism and neurodevelopment.

Overall, these findings support the potential of Bifidobacterium M-16V and Bb-12 strains as a complement to phototherapy to promote the restoration of gut microbiota and optimize bilirubin clearance. However, multicenter studies with larger sample sizes are required to confirm these benefits and define their incorporation into clinical practice³.

Microbiota as a tool for predicting late-onset sepsis in newborns

A multicenter case-control study evaluated whether the intestinal microbiota profile can early identify very premature newborns at risk of developing late-onset sepsis (LOS). Faecal samples from 58 infants with LOS confirmed by blood culture and 58 matched controls, obtained up to 10 days before the clinical onset of the infection, were analyzed using 16S rRNA gene sequencing.

The changes in the microbiota were closely related to the microorganisms causing sepsis. Cases of LOS caused by Escherichia coli and other non-staphylococcal pathogens showed a progressive increase in Escherichia/Shigella before the onset of symptoms. A predictive model based on machine learning (Random Forest) showed excellent performance in identifying LOS due to E. coli in the development cohort, although its performance decreased in the external validation cohorts.

The authors conclude that the intestinal microbiota profile could become a promising tool for early detection, especially of E. coli sepsis, which would open the possibility of implementing preventive strategies and targeted interventions in high-risk premature newborns. However, additional studies are required to improve and validate these predictive models before their clinical application⁴.