{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:02:12Z","timestamp":1779778932928,"version":"3.53.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Background<\/jats:title>\n Exclusive enteral nutrition (EEN) is the first-line therapy for children with active luminal Crohn's disease (CD). However, its implementation in routine care is still limited. Given the impact of the disease on age-appropriate development and quality of life in children and adolescents, as well as the rising incidence rates, the use of this effective and low-risk therapy should be intensified. Previous studies have demonstrated that patient registries can provide support in following guideline-based care. This study represents a secondary analysis of the CLARA cluster-randomized trial and aims to describe real-world patterns of enteral nutrition (EN) use and implementation gaps for children with luminal CD.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This secondary analysis was based on data from a cluster-randomized, controlled trial (DRKS00015505). In the intervention group (IG), treatment providers documented the care of children and adolescents with inflammatory bowel disease (IBD) in the CEDATA-GPGE patient registry and received automated feedback on entered data and potential deviations from guideline recommendations (care deficits). In the control group (CG), treatments were documented as usual in patients' charts only. For this secondary analysis, initial treatment strategies for children with luminal CD during the first 90 days after diagnosis were compared between centers with registry-based documentation (IG) and those without (CG). The primary outcome was the documented use and pattern of EN, including the duration of EEN and combination therapies.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 319 children recruited (IG: 21 centers,\n n<\/jats:italic>\n \u2009=\u2009160 patients; CG: 26 centers,\n n<\/jats:italic>\n \u2009=\u2009159 patients), 170 patients were diagnosed with CD (IG:\n n<\/jats:italic>\n \u2009=\u200988; CG:\n n<\/jats:italic>\n \u2009=\u200982). A total of 110 patients were included in the analysis (IG:\n n<\/jats:italic>\n \u2009=\u200958; CG:\n n<\/jats:italic>\n \u2009=\u200952). A non-significant trend towards higher overall use of EN was observed in the IG (72.4% vs. 61.5%;\n p<\/jats:italic>\n \u2009=\u20090.225). EEN for the recommended duration was uncommon in both groups (IG: 9.5%; CG: 18.8%). Patients who did not receive nutrition therapy as initial treatment (IG:\n n<\/jats:italic>\n \u2009=\u200916; CG:\n n<\/jats:italic>\n \u2009=\u200920) were predominantly treated with a combination of immunosuppressants, aminosalicylates (5-ASA), biologicals, and\/or steroids (IG:\n n<\/jats:italic>\n \u2009=\u200913; CG:\n n<\/jats:italic>\n \u2009=\u20096). Overall, the use of steroids within the first 90 days after diagnosis was more frequent in the CG compared to the IG (CG:\n n<\/jats:italic>\n \u2009=\u200922; IG:\n n<\/jats:italic>\n \u2009=\u200916,\n p<\/jats:italic>\n \u2009&lt;\u2009Chi\n 2<\/jats:sup>\n 0.028).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Registry documentation was associated with a non-significant increase in overall EN use but did not improve adherence to guideline-recommended EEN. The findings highlight a substantial gap between guideline recommendations and real-world implementation of EEN, underscoring the need to address structural, professional, and patient-related barriers.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2026.1787736","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T06:02:50Z","timestamp":1779775370000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of exclusive enteral nutrition in pediatric Crohn's disease: a secondary analysis of the CLARA registry study"],"prefix":"10.3389","volume":"14","author":[{"given":"L.","family":"Tischler","sequence":"first","affiliation":[{"name":"Institute for Community Medicine, University Medicine Greifswald","place":["Greifswald, Germany"]},{"name":"German Center for Child and Adolescent Health (DZKJ), Partner Site Rostock\/Greifswald, University Medicine Greifswald","place":["Greifswald, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Boerkoel","sequence":"additional","affiliation":[{"name":"Institute for Community Medicine, University Medicine Greifswald","place":["Greifswald, Germany"]},{"name":"German Center for Child and Adolescent Health (DZKJ), Partner Site Rostock\/Greifswald, University Medicine Greifswald","place":["Greifswald, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. M.","family":"Cantez","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics and Neonatology, University Children's Hospital, University Giessen","place":["Giessen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Krause","sequence":"additional","affiliation":[{"name":"Institute for Community Medicine, University Medicine Greifswald","place":["Greifswald, Germany"]},{"name":"German Center for Child and Adolescent Health (DZKJ), Partner Site Rostock\/Greifswald, University Medicine Greifswald","place":["Greifswald, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"de Laffolie","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics and Neonatology, University Children's Hospital, University Giessen","place":["Giessen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"van den Berg","sequence":"additional","affiliation":[{"name":"Institute for Community Medicine, University Medicine Greifswald","place":["Greifswald, Germany"]},{"name":"German Center for Child and Adolescent Health (DZKJ), Partner Site Rostock\/Greifswald, University Medicine Greifswald","place":["Greifswald, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S34","DOI":"10.1093\/jcag\/gwy050","article-title":"The impact of inflammatory bowel disease in Canada 2018: indirect costs of IBD care","volume":"2","author":"Kuenzig","year":"2019","journal-title":"J Can Assoc Gastroenterol"},{"key":"B2","first-page":"277","article-title":"CED Bei kindern und jugendlichen","volume-title":"Pflege bei Chronisch-entz\u00fcndlichen Darmerkrankungen","author":"Koletzko","year":""},{"key":"B3","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3238\/arztebl.2015.0121","article-title":"Inflammatory bowel disease in pediatric patients: characteristics of newly diagnosed patients from the CEDATA-GPGE registry","volume":"112","author":"Buderus","year":"2015","journal-title":"Dtsch Arztebl Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1016\/j.crohns.2014.04.005","article-title":"Consensus guidelines of ECCO\/ESPGHAN on the medical management of pediatric Crohn's disease","volume":"8","author":"Ruemmele","year":"2014","journal-title":"J Crohns Colitis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1093\/ecco-jcc\/jjaa161","article-title":"The medical management of pediatric Crohn's disease: an ECCO-ESPGHAN guideline update","volume":"15","author":"van Rheenen","year":"2021","journal-title":"J Crohns Colitis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/MPG.0b013e3181c92c53","article-title":"Guidelines for the management of inflammatory bowel disease in children in the United Kingdom","volume":"50","author":"Sandhu","year":"2010","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.clnu.2016.12.027","article-title":"ESPEN Guideline: clinical nutrition in inflammatory bowel disease","volume":"36","author":"Forbes","year":"2017","journal-title":"Clin Nutr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"CD000542","DOI":"10.1002\/14651858.CD000542.pub3","article-title":"Enteral nutritional therapy for induction of remission in Crohn\u2019s disease","volume":"4","author":"Narula","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e72","DOI":"10.1055\/s-0034-1370084","article-title":"S3-Leitlinie der deutschen gesellschaft f\u00fcr Ern\u00e4hrungsmedizin (DGEM): Klinische ern\u00e4hrung in der gastroenterologie (Teil 4) \u2013 chronisch-entz\u00fcndliche darmerkrankungen","volume":"39","author":"Bischoff","year":"2014","journal-title":"Aktuel Ernahrungsmed"},{"key":"B10","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1007\/s00112-020-00852-9","article-title":"Epidemiologische forschung und behandlungsdatenanalyse zu chronisch-entz\u00fcndlichen darmerkrankungen","volume":"168","author":"de Laffolie","year":"2020","journal-title":"Monatsschr Kinderheilkd"},{"key":"B11","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1097\/MPG.0000000000001896","article-title":"Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the porto IBD group of ESPGHAN","volume":"66","author":"Miele","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1159\/000350369","article-title":"Influence of exclusive enteral nutrition therapy on bone density in pediatric Crohn's disease","volume":"63","author":"Werkstetter","year":"2013","journal-title":"Ann Nutr Metab"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1093\/ecco-jcc\/jjx060","article-title":"Exclusive enteral nutrition in pediatric Crohn's disease results in long-term avoidance of corticosteroids","volume":"11","author":"Connors","year":"2017","journal-title":"J Crohns Colitis"},{"key":"B14","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1111\/j.1365-2036.2007.03578.x","article-title":"Systematic review: nutritional therapy in pediatric Crohn\u2019s disease","volume":"27","author":"Day","year":"2008","journal-title":"Aliment Pharmacol Ther"},{"key":"B15","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1097\/00005176-200304000-00008","article-title":"Consensus and controversy in the management of pediatric Crohn disease: an international survey","volume":"36","author":"Levine","year":"2003","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.clnu.2018.01.020","article-title":"Exclusive enteral nutrition in Crohn's disease: evidence and practicalities","volume":"38","author":"Ashton","year":"2019","journal-title":"Clin Nutr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1097\/MPG.0b013e3181e2c724","article-title":"Physician attitudes and practices of enteral nutrition as primary treatment of pediatric Crohn disease in North America","volume":"52","author":"Stewart","year":"2011","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"251","DOI":"10.3238\/arztebl.m2022.0413","article-title":"First-line treatment for children and adolescents with Crohn's disease","volume":"120","author":"Leiz","year":"2023","journal-title":"Dtsch Arztebl Int"},{"key":"B19","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1016\/S2352-4642(24)00078-6","article-title":"Rare and severe adverse events in children with inflammatory bowel disease: PIBD-SETQuality registry","volume":"8","author":"Klomberg","year":"2024","journal-title":"Lancet Child Adolesc Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1002\/ibd.23008","article-title":"Disease phenotype at diagnosis in pediatric Crohn's disease: EUROKIDS registry","volume":"19","author":"de Bie","year":"2013","journal-title":"Inflamm Bowel Dis"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1038\/ajg.2017.97","article-title":"Trends in epidemiology of pediatric IBD in Canada","volume":"112","author":"Benchimol","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"627","DOI":"10.3238\/arztebl.m2024.0168","article-title":"The care of children with IBD: cluster randomized trial","volume":"121","author":"Tischler","year":"2024","journal-title":"Dtsch Arztebl Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"CD000259","DOI":"10.1002\/14651858.CD000259.pub4","article-title":"Audit and feedback: effects on professional practice","volume":"3","author":"Ivers","year":"2025","journal-title":"Cochrane Database Syst Rev"},{"key":"B24","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s13012-019-0883-5","article-title":"Clinical performance feedback intervention theory (CP-FIT)","volume":"14","author":"Brown","year":"2019","journal-title":"Implement Sci"},{"key":"B25","doi-asserted-by":"publisher","first-page":"644003","DOI":"10.3389\/fmed.2021.644003","article-title":"Running behind \u201cPOPO\u201d: predictors of poor outcome in pediatric Crohn's disease","volume":"8","author":"De Laffolie","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1007\/s10654-019-00500-x","article-title":"Guidelines for good epidemiological practice","volume":"34","author":"Hoffmann","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e5661","DOI":"10.1136\/bmj.e5661","article-title":"CONSORT 2010 Extension to cluster randomized trials","volume":"345","author":"Campbell","year":"2012","journal-title":"Br Med J"},{"key":"B28","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1186\/s12913-023-09639-6","article-title":"How can patient registries facilitate guideline-based healthcare?","volume":"23","author":"Leiz","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"880","DOI":"10.3390\/nu12030880","article-title":"Dietary therapy of Crohn\u2019s disease","volume":"12","author":"Levine","year":"2020","journal-title":"Nutrients"},{"key":"B30","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s40348-022-00141-9","article-title":"Implementation of exclusive enteral nutrition in pediatric Crohn\u2019s disease","volume":"9","author":"Peters","year":"2022","journal-title":"Mol Cell Pediatr"},{"key":"B31","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s40348-022-00139-x","article-title":"International survey of enteral nutrition protocols","volume":"13","author":"Whitten","year":"2012","journal-title":"J Dig Dis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1002\/jgh3.12121","article-title":"Exclusive enteral nutrition in children with IBD: physician perspectives","volume":"34","author":"Ho","year":"2019","journal-title":"J Gastroenterol Hepatol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"345","DOI":"10.5217\/ir.2017.15.3.345","article-title":"Japanese Physicians\u2019 Attitudes towards enteral nutrition","volume":"15","author":"Ishige","year":"2017","journal-title":"Intest Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1888","DOI":"10.1093\/ibd\/izad255","article-title":"The crohn\u2019s disease exclusion diet: a comprehensive review of evidence, implementation strategies, practical guidance, and future directions","volume":"30","author":"Sigall Boneh","year":"2024","journal-title":"Inflamm Bowel Dis"},{"key":"B35","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1055\/a-2699-7377","article-title":"Crohn's disease exclusion diet (CDED) and partial enteral nutrition (PEN) for remission induction in children and adolescents with Crohn's disease-updated statement from the CEDATA and nutrition\/dietetics\/nutritional medicine working groups of the SOCIETY FOR PAEDIATRIC GAstroenterology and Nutrition (GPGE)","volume":"64","author":"Alexanidou","year":"2026","journal-title":"Z Gastroenterol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"331","DOI":"10.3238\/arztebl.2017.0331","article-title":"Inflammatory bowel disease in childhood","volume":"114","author":"D\u00e4britz","year":"2017","journal-title":"Dtsch Arztebl Int"},{"key":"B37","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1111\/j.1365-2036.2007.03431.x","article-title":"Meta-analysis: enteral nutrition in children","volume":"26","author":"Dziechciarz","year":"2007","journal-title":"Aliment Pharmacol Ther"},{"key":"B38","doi-asserted-by":"publisher","first-page":"3069","DOI":"10.1007\/s10620-015-3722-9","article-title":"Two-year outcomes after EEN vs corticosteroids","volume":"60","author":"Grover","year":"2015","journal-title":"Dig Dis Sci"},{"key":"B39","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1007\/s12519-018-0204-0","article-title":"Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn\u2019s disease: a meta-analysis","volume":"15","author":"Yu","year":"2019","journal-title":"World J Pediatr"},{"key":"B40","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1016\/j.cgh.2006.03.010","article-title":"Polymeric diet vs corticosteroids","volume":"4","author":"Borrelli","year":"2006","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1093\/ecco-jcc\/jjy207","article-title":"Mucosal healing with enteral nutrition vs steroids","volume":"13","author":"Pigneur","year":"2019","journal-title":"J Crohns Colitis"},{"key":"B42","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005176-200007000-00005","article-title":"Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children","volume":"31","author":"Heuschkel","year":"2000","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B43","doi-asserted-by":"publisher","first-page":"CD000542","DOI":"10.1002\/14651858.CD000542.pub2","article-title":"Enteral nutritional therapy for induction of remission in Crohn's disease","author":"Zachos","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"key":"B44","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1111\/apt.14253","article-title":"Enteral nutrition therapy meta-analysis","volume":"46","author":"Swaminath","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"B45","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1002\/ibd.21415","article-title":"Outcomes of corticosteroid therapy in pediatric Crohn\u2019s disease","volume":"17","author":"Krupoves","year":"2011","journal-title":"Inflamm Bowel Dis"},{"key":"B46","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1097\/MPG.0b013e3182662233","article-title":"Management of pediatric ulcerative colitis","volume":"55","author":"Turner","year":"2012","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B47","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1055\/a-1199-6751","article-title":"Crohn's disease exclusion diet statement","volume":"58","author":"de Laffolie","year":"2020","journal-title":"Z Gastroenterol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1001\/jama.297.8.831","article-title":"Communication deficits in healthcare","volume":"297","author":"Kripalani","year":"2007","journal-title":"JAMA"},{"key":"B49","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1111\/j.1365-2753.2009.01235.x","article-title":"Continuity of care and outcomes","volume":"16","author":"Van Walraven","year":"2010","journal-title":"J Eval Clin Pract"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1787736\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T06:02:51Z","timestamp":1779775371000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1787736\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":49,"alternative-id":["10.3389\/fped.2026.1787736"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1787736","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"article-number":"1787736"}}