It is currently unclear whether seasonality affects the onset of inflammatory bowel diseases (IBDs: Crohn disease and ulcerative colitis) in children. Here, we examined the records of pediatric patients with IBD diagnosed between 2009 and 2015 in a discovery cohort of 169 cases and a validation cohort of 122 subjects, where the month of symptoms onset could be determined. No seasonal patterns could be identified in respect to conception, birth, and disease onset. An annual rhythm of symptomatic onset, however, correlating with academic semesters was identified. IBD symptoms in the discovery cohort presented significantly more (P = 0.0218) during 5 months including the initiation (August, September, January) and the termination of academic semesters (December, May) compared to any other 5 months of the year. This observation was validated in the independent cohort (P < 0.0001). Our findings imply that academic stress may contribute to disease onset in pediatric IBD, which may improve timely diagnosis.

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Umbilical venous catheterization (UVC) for central intravenous access is associated with increased morbidity and mortality. Two neonates were transferred to our institution with cystic liver lesions after UVC placement. Case 1: A 39-week female presented with hypoglycemia and respiratory distress, received total parental nutrition and intravenous lipids (TPN/ILs) after umbilical artery catheterization/UVC placement. The conjugated bilirubin increased from 0.3 to 3.7 mg/dL, 48 hours after starting TPN/IL. Abdominal ultrasound (Fig. 1) demonstrated hepatomegaly, a cystic lesion in the right hepatic lobe, and a complex abdominal collection. Case 2: A 34-week female presented with respiratory distress and had UVC placement. The condition deteriorated with elevated aspartate aminotransferase/alanine aminotransferase (995/205) U/L and conjugated bilirubin of 0.5 mg/dL. Computed tomography scan demonstrated a multiseptated structure in the right hepatic lobe consistent with fat (Fig. 2). Both hepatic lesions were treated conservatively, but a percutaneous abdominal drain was required in Case 1.TPN/IL hypertonicity with elevated pH causes chemical irritation, leading to extravasation with compression of nearby structures (1). TPN/IL led to a cystic hepatic lesion (likely containing fat), with cholestatic hepatitis. Injury post-UVC has been reported, but fat accumulation is rare. Hepatic TPN/IL accumulation is a rare complication that may lead to significant liver injury (2-4).