bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Cobalamin Deficiency in Guatemalan School Children: Diet, Helicobacter pylori, or Bacterial Overgrowth?
Authors: Rogers Lisa M. , Boy Erick , Miller Joshua W. , Green Ralph , Rodriguez Monica , Chew Francisco , Allen Lindsay H.
Published: January 2024

Objectives

The authors investigated whether low vitamin B12 intake, impaired gastric function, Helicobacter pylori infection, and bacterial overgrowth were risk factors for the high prevalence of cobalamin deficiency observed in Guatemalan children.

Methods

The plasma cobalamin concentration of 556 school children was measured and classified as low, marginal, or adequate. In 60 children from each of these three groups, concentrations of serum methylmalonic acid (MMA), plasma homocysteine, and plasma holotranscobalamin II were measured, and usual dietary B12 intake was estimated. Serum gastrin and pepsinogen I concentrations were measured, and H. pylori and bacterial overgrowth were diagnosed using 13C‐urea and 13C‐xylose breath tests, respectively.

Results

H. pylori infection was present in 83% (144 of 174) of children, and bacterial overgrowth was found in 25% (28 of 113). Children with H. pylori infection had higher serum gastrin and pepsinogen I. There were no significant differences among the plasma cobalamin groups in the prevalence of H. pylori infection, bacterial overgrowth, serum gastrin, or pepsinogen I concentrations. However, there was a significant positive correlation between serum MMA and gastrin concentrations. The average daily consumption of dietary B12 was 5.5 ± 5.2 μg/day, but intakes for 23% of children were <1.8 μg/day. B12 intake from fortified snacks added an additional 0.3 ± 0.2 μg/day. B12 intake was not significantly different among the plasma cobalamin groups, but it was significantly correlated with plasma cobalamin.

Conclusions

The specific cause of cobalamin deficiency in this population remains unclear, but these results suggest that low dietary B12 intake is a risk factor and alterations in gastric secretions may also play a role.
Effect of Nucleotides on Diarrhea and Immune Responses in Healthy Term Infants in Taiwan
Authors: Yau Kuo‐Inn Tsou , Huang Chung‐Bin , Chen Walter , Chen Shu‐Jen , Chou Yi‐Hong , Huang Fu‐Yuan , Kua Ka Em , Chen Nancy , McCue Maggie , Alarcon Pedro A. , Tressler Randy L. , Comer Gail M. , Baggs Geraldine , Merritt Russell J. , Masor Marc L.
Published: January 2024

Objectives

The aim of this study was to compare the effects of an infant formula fortified with nucleotides (NF) with those of a control formula (CF) on the incidence of diarrhea, respiratory tract infections (RTIs), and immune responses in healthy term infants.

Methods

This 12‐month, double‐blind study was conducted on 1‐ to 7‐day‐old infants randomized to receive NF or CF exclusively until 12 weeks of age, and fed the assigned formula with solid food until 12 months. NF was supplemented with 72 mg/L of nucleotides, based on the total potentially available nucleotide content of human milk. Subjects were evaluated within 1 week of birth, at 4 weeks, and every 4 weeks thereafter until 48 weeks of age. The primary outcome variable was the incidence of diarrhea. Secondary variables included RTIs, serum immunoglobulin concentrations, and response to hepatitis B vaccine.

Results

Compared with subjects fed CF (n = 170), those fed NF (n = 166) had a trend toward reduced risk of diarrhea from 8 to 48 weeks of age and a significantly lower risk of 25.4% (P = 0.05) between 8 and 28 weeks. NF subjects had significantly higher serum immunoglobulin A concentrations (P < 0.05) throughout the 48‐week study. The NF group had an increased risk of upper RTIs, the same incidence of lower RTIs, and the same antibody response to hepatitis B vaccination as the CF group, based on one‐sided tests. Growth was normal in both groups, and no adverse events were considered to be formula‐related.

Conclusions

Healthy term infants from 8 to 28 weeks of life are less likely to experience diarrhea and have higher serum immunoglobulin A concentrations with NF compared with formula without added nucleotides.
Breath Test Using A Single 50‐mg Dose of 13C‐Urea to Detect Helicobacter pylori Infection in Children
Authors: Canete Alfonso , Abunají Yamil , Alvarez‐Calatayud Guillermo , DeVicente Mercedes , González‐Holguera José A. , Leralta María , Pajares José M. , Gisbert Javier P.
Published: January 2024

Background

The 13C‐urea breath test is an accurate, noninvasive method for the diagnosis of Helicobacter pylori in adults. A dose of 75 to 100 mg of urea is generally used, especially in adults, but the optimal dose in children is still unknown. Our aim was to determine whether urea breath test performed with a single 50‐mg dose of 13C‐urea was sufficient and accurate for diagnosing H. pylori infection in children.

Methods

Consecutive children 4 to 14 years of age undergoing upper intestinal endoscopy to evaluate symptoms of recurrent abdominal pain were prospectively included. Exclusion criteria included use of antibiotics or proton pump inhibitors during the last month, gastric surgery, and previous H. pylori eradication therapy. Reference criteria for diagnosis of infection were based on histology, culture, and serology. Urea breath test (TAU‐KIT; Isomed, S.L., Madrid, Spain) was performed as follows: citric acid (Citral pylori) dissolved in 100 mL of water was initially given. Ten minutes later, a baseline exhaled breath sample was collected, and thereafter 50 mg of 13C‐urea dissolved in 50 mL of water was given. A second breath sample was obtained 30 minutes later. Breath samples were analyzed by isotope ratio mass spectrometry. The endoscopist, the pathologist, the microbiologist, and the person responsible for reading the serology and the urea breath test were all unaware of H. pylori status by the other diagnostic methods.

Results

One hundred children were included (40% males; mean age, 9.2 ± 2 years; mean weight, 33.9 ± 12 kg). Based on the reference criteria, 45% were infected, 37% were not infected, and 18% were indeterminate. Sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 91% (95% confidence interval [CI], 79%–96%), 97% (95% CI, 86%–99%), 98% (95% CI, 87%–91%), and 90% (95% CI, 76%–96%). Positive and negative likelihood ratios were of 33 and 0.09. Any cutoff point between 2 and 14 δ units had the same high diagnostic accuracy. The area under the receiver operating characteristic curve was 0.94. No adverse effects were reported.

Conclusion

Urea breath test using 50 mg of urea is sufficient and accurate for the diagnosis of H. pylori infection in children. Use of a small test dose significantly lowers the cost of the test.
A Comparison of Budesonide and Prednisone for the Treatment of Active Pediatric Crohn Disease
Authors: Levine Arie , Weizman Zvi , Broide Efrat , Shamir Raanan , Shaoul Ron , Pacht Avi , Dinari Gabriel , On Avi , Weiss Batya , Bujanover Yoram ,   Members of the Israeli Pediatric Gastroenterology Association Budesonide Study Group
Published: January 2024

Objectives

Budesonide has been found effective in patients with mild and moderate Crohn disease and has been found to cause fewer side effects than prednisone. The use of oral budesonide has not been prospectively evaluated in children with Crohn disease. Therefore, the authors initiated a trial to compare remission and tolerance to budesonide and prednisone in children with mild or moderately active Crohn disease.

Methods

A prospective randomized open controlled 12‐week trial was carried out comparing pH modified release budesonide, 9 mg, versus prednisone, 40 mg, in children with active mild to moderate pediatric Crohn disease.

Results

Thirty‐three patients (20 boys and 13 girls; mean age, 14.3 years) enrolled and completed the study. The groups treated with budesonide and prednisone did not differ by age, onset of disease, location of disease, or disease activity. The remission rate at 12 weeks was 47% in the budesonide treatment group and 50% in the prednisone treatment group. Side effects occurred in 32% and 71% of patients treated with budesonide and prednisone, respectively (P < 0.05). Severity of cosmetic side effects was significantly lower in patients treated with budesonide (P < 0.01).

Conclusions

Remission rates for Crohn disease with budesonide and prednisone treatment in this study were similar. Pediatric patients treated with budesonide had significantly fewer side effects than patients treated with prednisone. Budesonide should be considered an alternative to prednisone in pediatric patients with mild to moderate disease activity.
Efficacy and Safety of Oral Pantoprazole 20 mg Given Once Daily for Reflux Esophagitis in Children
Authors: Madrazo‐de la Garza Armando , Dibildox Miguel , Vargas Antonio , Delgado Juan , Gonzalez Jorge , Yañez Patricia
Published: January 2024

Objectives

To investigate the efficacy and safety of oral pantoprazole, 20 mg (0.5 to 1.0 mg/kg/day) once daily for 28 days, in pediatric patients with reflux esophagitis.

Methods

Patients in this study (n = 15; 6 to 13 years old, 9 boys) had reflux esophagitis grade Ic or II (Vandenplas classification). The efficacy of pantoprazole to reduce esophageal acid exposure time (pH < 4), reduce the number and duration of reflux episodes, and to increase the percentage of time with gastric pH > 3 was assessed by continuous 24‐hour pH monitoring. The intensity of 5 common symptoms of esophagitis was scored before and after treatment on a 4‐point scale. Esophagitis was assessed at baseline and after treatment by visual inspection and by the histology of biopsies from the distal third of the esophagus.

Results

Before treatment, the median percentage of time with intra‐esophageal pH <4 was 9.3%. After 28 days of therapy with pantoprazole, this value decreased to 2.7% (P = 0.0006). The median percentage of time with intragastric pH > 3 increased from 21% at baseline to 39% on day 28 of therapy (P = 0.005). After 28 days of treatment, all patients experienced at least partial relief from reflux symptoms. Endoscopically confirmed healing of esophagitis was seen in 47% of children (Savary‐Miller classification). Histologic evidence of healing was not observed. Median serum gastrin levels were slightly elevated over baseline levels (from 74 pg/ml to 93 pg/ml). In one patient there was a transient elevation of serum GOT and GPT during treatment.

Conclusions

Oral pantoprazole 20 mg daily provided gastric acid control in 15 pediatric patients with reflux esophagitis with partial clinical improvement of symptoms after 28 days of treatment. Pantoprazole was safe and well tolerated.
Complementary Food Supplements to Achieve Micronutrient Adequacy for Infants and Young Children
Authors: Nestel P. , Briend A. , de Benoist B. , Decker E. , Ferguson E. , Fontaine O. , Micardi A. , Nalubola R.
Published: January 2024

Many children in developing countries survive on a nutritionally inadequate diet. Dietary inadequacies during the complementary feeding period can be prevented by using complementary food supplements (CFSs) such as water dispersible or crushable micronutrient tablets, micronutrient sprinkles added to food just before feeding, or fortified spreads added to food just before feeding or fed as a snacks. A meeting was convened to discuss technical and operational issues related to the development of these new approaches and to identify knowledge gaps. The technical issues covered: what micronutrients to include, tolerable upper intake limits, bioavailability, micronutrient and macronutrient stability, package systems and amounts, encapsulation technologies, methods to limit or eliminate allergens, bacterial and chemical contamination, interactions between CFSs and complementary foods, and flavoring agents. Operational issues included: identifying the market positioning of CFSs, cost positioning of CFSs, regulatory requirements, CFS production and technology transfer, quality assurance, and public‐private sector partnership and coordination. Intervention trials are needed to determine the efficacy of CFSs in preventing micronutrient deficiencies. Other important knowledge gaps relate to technical and operational issues. Sprinkles and tablets are produced using well‐known technologies, but further research is needed to modify them for use as CFSs. Spread development is not as advanced as sprinkle and tablet development, and further research is needed to improve the technology. Although none of the products is ready for widespread use, enough information is available to set research priorities and accelerate product development and implementation.
Randomized Double‐Blind Study of the Nutritional Efficacy and Bifidogenicity of a New Infant Formula Containing Partially Hydrolyzed Protein, a High β‐Palmitic Acid Level, and Nondigestible Oligosaccharides
Authors: Schmelzle Hansjörg , Wirth Stefan , Skopnik Heino , Radke Michael , Knol Jan , Böckler Heinz‐Michael , Brönstrup Anja , Wells John , Fusch Christoph
Published: January 2024

Objectives

The aim of this study was to evaluate the nutritional efficacy and bifidogenic characteristics of a new infant formula containing partially hydrolyzed whey protein, modified vegetable oil with a high β‐palmitic acid content, prebiotic oligosaccharides, and starch.

Methods

In a double‐blind study, healthy formula‐fed term infants aged younger than 2 weeks were randomized to receive either the new infant formula (NF) or a standard formula (SF) until the age of 12 weeks. Anthropometric measurements were taken at enrollment, 6 weeks, and 12 weeks. In a subsample of infants, blood samples were taken at 6 weeks and stool samples were taken at enrollment and 6 weeks. Blood samples were analyzed for biochemical measures of protein status and amino acids, and stools were analyzed for total bacteria and bifidobacteria. Mothers completed a feeding diary and questionnaire at 6 and 10 weeks.

Results

One hundred fifty‐four infants were enrolled in the study; 102 completed the trial. The growth of infants in both formula groups was in line with published growth curves. During the first 6 weeks, NF girls gained more weight and head circumference than the SF girls. These velocity differences were not maintained throughout the 12‐week study period. The NF stools had a higher proportion of bifidobacteria at 6 weeks compared with the SF stools, and they were softer. There were no clinically significant differences in the blood biochemical and amino acid values between groups. Both formulas were well tolerated by the infants.

Conclusions

When compared with a standard infant formula, the new formula supported satisfactory growth, led to higher counts of bifidobacteria in the feces, produced blood bio‐chemical values typical of formula‐fed infants, and was well tolerated.
Helicobacter pylori Antigens in Stool Specimens of Gastritis Children Before and After Treatment
Authors: Gościniak Grażyna , Przondo‐Mordarska Anna , Iwańczak Barbara , Blitek Aleksander
Published: January 2024

Background

Various testing methods are successfully applied to the diagnosis of Helicobacter pylori infection, but noninvasive techniques are still needed for therapeutic monitoring, especially in children. In the search for new noninvasive techniques for the diagnosis of H. pylori infection, the authors evaluated an enzyme immunoassay for the detection of H. pylori antigen in stool (HpSA).

Methods

The authors studied 62 H. pylori–positive children with chronic gastritis and 45 control subjects. H. pylori infection was diagnosed using cultures and histology of gastric biopsy specimens and a stool antigen test before treatment (clarithromycin, amoxicillin, omeprazole for 7 days) and 4 weeks to 6 weeks after treatment.

Results

Before therapy, antigen in stool was detected in 55 of 62 H. pylori–positive patients, which indicates that the sensitivity of the HpSA test was 88.7%. Of the 45 control subjects (with negative culture and histology results), 43 had negative results for H. pylori in the stool test (specificity, 95.5%). After completion of therapy, eradication was obtained (and confirmed by culture and histology) in 53 of the 62 H. pylori–positive children (85.5%). Four weeks to 6 weeks after eradication therapy, the sensitivity, specificity, positive predictive value, and negative predictive value of the stool antigen (HpSA) test were 88.9%, 96.2%, 80%, and 98%, respectively.

Conclusions

The accuracy of the HpSA test for the detection of H. pylori in human stool 4 weeks to 6 weeks after treatment is comparable with the accuracy of the culture results. The stool antigen (HpSA) test was found to be a useful method for posttreatment eradication testing of H. pylori infection in children.
A Prospective Study of the Efficacy and Tolerance of a Chimeric Antibody to Tumor Necrosis Factors (Remicade) in Severe Pediatric Crohn Disease
Authors: Cezard Jean‐Pierre , Nouaili Nizar , Talbotec Cécile , Hugot Jean‐Pierre , Gobert Jean‐Gérard , Schmitz Jacques , Mougenot Jean‐François , Alberti Corinne , Goulet Olivier
Published: January 2024

Objectives

To evaluate the efficacy and toxicity of infliximab in children with severe Crohn disease (CD), the authors prospectively monitored 21 children aged 15 ± 2 years with severe CD who they treated with infliximab (5 mg/kg) on days 0, 15, and 45. One patient received only one injection. Eighteen patients were corticosteroid dependent, and 6 were receiving parenteral nutrition. Three patients were corticoid resistant (1 mg/kg/d >15 days). Sixteen had perianal disease.

Results

The Harvey‐Bradshaw index (HB) decreased from 8 ± 3 on day 0 to 1 ± 2 on day 45 (P = 0.001). The inflammation factors decreased (P = 0.001), and albumin increased (P = 0.002). Nineteen children were in complete remission (HB < 4) on day 45, and 2 had improved (HB = −6 points). Tumor necrosis factor‐α (TNFα) in the stools (n = 16) decreased (P = 0.04). All perianal fistulas (n = 12) were closed by day 90. Fourteen of 21 patients had stopped taking steroids at 3 months, and all had stopped parenteral nutrition. Growth velocity was significantly greater after infliximab administration (Z score, +0.5) than before (−0.45;P = 0.004). Nineteen of 21 patients had relapsed (90%) at 1 year despite continued immunosuppressors. Seven had surgery because of an uncontrolled relapse (5), stenosis (1), or fistula (1). Six patients developed antinuclear antibodies (1/40–1/640e), and two had anti‐DNA antibodies. Epstein‐Barr virus (EBV) polymerase chain reaction (PCR) values increased (>100‐fold) in eight patients. One child developed an anaphylactic reaction to the medication, and one had a catheter‐related sepsis.

Conclusion

Infliximab produces spectacular results for children with severe CD and is well tolerated. However, its effect is transitory for many (90%), with frequent relapses despite continued immunosuppressors. Long‐term management with infliximab should be tested despite its worrying side effects.
The Complexity of Feeding Problems in 700 Infants and Young Children Presenting to a Tertiary Care Institution
Authors: Rommel Nathalie , De Meyer Anne‐Marie , Feenstra Louw , Veereman‐Wauters Gigi
Published: January 2024

Background:

Feeding problems are common in infants and young children. A multidisciplinary team approach contributes to better patient care. However, few quantitative data on multidisciplinary feeding assessment of children have been published.

Objectives:

The first aim of this study was to characterize the etiology of feeding difficulties in 700 children referred for assessment of severe feeding difficulty. The authors differentiated medical, oral, and behavioral categories. The second aim was to assess the prevalence of prematurity and dysmaturity in the patients and their relationship to the type of feeding problem.

Methods:

Clinical data from 700 children aged less than 10 years who were examined for severe feeding problems were analyzed.

Results:

Close to 50% of the children had a combined medical and oral condition underlying their feeding difficulties. More than half of the children were examined for gastrointestinal conditions, particularly gastroesophageal reflux disease. Behavioral problems were more frequently seen in children aged more than 2 years. The results indicate that oral sensory‐based feeding problems are related to past medical intervention. Children with feeding disorders had a significantly lower birthweight for gestational age. Preterm babies were overrepresented in this population.

Conclusions:

A multidisciplinary team approach is essential for assessment and management because combined medical and oral problems are the most frequent cause of pediatric feeding problems. A significant relationship was found between the type of feeding problem and age. Infants born preterm and/or with a birthweight below the tenth percentile for gestational age are at greater risk for developing feeding disorders. JPGN 37:75‐84, 2003.
Functional Outcomes of Pediatric Liver Transplantation
Authors: Alonso E. M. , Neighbors K. , Mattson C. , Sweet E. , Ruch‐Ross H. , Berry C. , Sinacore J.
Published: January 2024

The functional status and health‐related quality of life (HRQOL) of children who survive liver transplantation (LT) have not been well documented. The purpose of this study was to determine the functional status and HRQOL in this population using a validated measure for children, the Child Health Questionnaire‐Parent Form 50 (CHQ‐PF50).

Methods

The CHQ‐PF50 instrument was completed by the parents of 55 children who agreed to participate in a mailing survey. Subscale scores for the sample were compared with those of a published normal population (n = 391).

Results

Study sample characteristics were: 87% Caucasian, 54.5% female, mean age at survey was 9.6 years (range, 5–17 years). Responding caregivers were 95% biologic parents and 93% female. Compared with the normal population, LT recipients had lower subscale scores for general health perceptions (P < 0.0005), emotional impact on parents (<0.0005) and disruption of family activities (0.0005). The mean physical summary score of the LT recipients was lower than that of the normal population 48.1 ± 12.1 (P = 0.005), but the mean psychosocial summary score was similar 48.8 ± 11.9 (P = 0.156). Within the LT population, the original diagnosis (biliary atresia vs. other), type of LT (living donor vs. cadaveric), age at LT, z score for height, and hospital days did not significantly influence any of the subscale scores.

Conclusions

Children who have survived LT have functional outcomes in the physical domain that are lower than those of normal children. Self‐esteem and mental health in this group appeared normal. The parents in this sample experienced more emotional stress and disruption of family activities than did parents in a normal population.
Plasma Markers of Platelet Activation in Cystic Fibrosis Liver and Lung Disease
Authors: Schwarz Kathleen B. , Rosensweig Jeffrey , Sharma Savitri , Jones Lawrence , Durant Michael , Potter Carol , Narkewicz Michael R.
Published: January 2024

Background

Transforming growth factor beta 1 (TGFβ1) is a major fibrogenic cytokine, the expression of which is increased in the livers of children with cystic fibrosis liver disease (CFLD) and in the bronchoalveolar lavage fluid of patients with cystic fibrosis pulmonary disease (CFPD). The purpose of our study was to investigate the usefulness of plasma TGFβ1 as a noninvasive marker of CFLD and CFPD, or both and to investigate the contribution of platelet‐derived TGFβ1 to plasma TGFβ1 by correlating the latter with platelet factor 4 (PF4).

Methods

Three groups of patients with cystic fibrosis were studied: 1) those with CFLD, 2) those with CF and no liver disease (CFNLD), and 3) those with CFPD. Controls were healthy adolescents and adults. Plasma TGFβ1 was assayed using the R and D Quantikine quantitative sandwich enzyme immunoassay technique and PF4 (American Bioproducts ELISA kit).

Results

Plasma TGFβ1 was markedly increased in CFPD (15 ± 3 ng/mL) versus healthy adults (1 ± 0 ng/mL; P < 0.004. The PF4 values followed a similar pattern: 105 ± 8 ng/mL in CFPD versus 12 ± 4 ng/mL (P < 0.0001). Plasma TGFβ1 values in CFLD did not differ from CFNLD patients of comparable age nor from values for healthy adolescents. Plasma TGFβ1 values were strongly correlated with values for PF4:r = 0.543, P < 0.0001.

Conclusions

Plasma TGFβ1 is not a useful marker of CFLD. The increased plasma TGFβ1 and PF4 in CFPD patients are of interest both as possible noninvasive markers of pulmonary fibrosis and because the increased values suggest that platelet activation may play a pathogenetic role in CFPD.
Results of a New Technique in the Treatment of Severe Esophageal Stenosis in Children: Poliflex Stents
Authors: Broto Jesús , Asensio Marino , Vernet Jose Maria Gil
Published: January 2024

Objectives

The authors present their experience in treating cases of severe esophageal stenosis resistant to conventional dilatation through the placement of silicone stents, describe a precise placement technique, and establish a standard protocol for the use of these devices.

Methods

The authors detail the placement procedure and follow‐up in a series of 10 patients (5 male, 5 female) between 1 and 23 years, in whom the technique was used. Nine patients had severe esophageal scarring caused by alkaline agents, and another had severe stenosis resulting from esophageal atresia; all were included in the dilatation program from the age of 6 months to 19 years. The method employs a self‐expanding biocompatible stent that is placed using a special applicator over the stenotic area after performing a dilatation. This is maintained long enough to guarantee esophageal scarring without stenosis, permitting oral feeding of the patient. In general, the children experienced nausea and some vomiting during periods lasting from 12 to 48 hours; these episodes were more common when the lesion was higher and longer. Treatment with midazolam and ondansetron relieved the symptoms. All patients received omeprazole while the stent was in place.

Results

Five patients received one stent, four others required two, and another needed three because of restenosis. In the five patients who required stent replacement, a low dose of steroids (0.3 mg/kg/24 h) was administered 2 weeks before and also during the placement time. Currently, five patients are completely cured, with follow‐up ranging from 4 to 19 months. Three patients now require stent replacement, and two others are under observation after having the stent removed. Long‐term tolerance to the stent has been excellent in all cases. The time the stent was in place varied from 20 to 133 days.

Conclusions

The siliconated polypropylene stents (Poliflex/Rüsch) appear to be a promising new tool in the conservative treatment of esophageal stenosis. The stents permit normal feeding during application, substantially reduce treatment time, and avoid repeated anesthesia sessions for dilatations.
Copper Deficiency And Excess In Infancy: Developing A Research Agenda
Authors: Araya Magdalena , Koletzko Berthold , Uauy Ricardo
Published: January 2024

Copper deficiency and excess have been recognized as potential health problems for infants and children worldwide. Clinical manifestations of copper deficiency and excess are well characterized but the precise sequence by which high copper intake interacts with genetic control systems, leading to liver damage in infants, is unknown. The possibility that genetic mutations or epigenetic factors related to the functional development of copper homeostasis, could make otherwise normal infants on normal copper intake more susceptible to copper toxicity has been an issue of concern. In January 2001 a group of pediatricians and researchers interested in this area met at Tegernsee, Bavaria, Germany, to reviewing the state of knowledge on the topic. They addressed six main issues: 1) The relevance of copper deficit and excess as health problems. 2) The appropriate biomarkers to identify and characterize copper status 3) The genetic variability in copper metabolism 4) The mechanisms of whole body copper homeostasis in early life and their changes with age 5) The development of experimental and animal models to address research questions on copper homeostasis in infants. 6) The safe upper and lower limits of copper intake/exposure from water and food. We present here the highlights of the discussions and the main conclusions of the meeting.
Bone Mineral Density of the Lumbar Spine in Children and Adolescents With Celiac Disease on a Gluten‐Free Diet in São Paulo, Brazil
Authors: Sdepanian Vera Lucia , de Miranda Carvalho Cecília Noronha , de Morais Mauro Batista , Colugnati Fernando Antonio Basile , Fagundes‐Neto Ulysses
Published: January 2024

Background

To compare bone mineral density (BMD) in children and adolescents with celiac disease (CD) and control subjects and to evaluate diet adequacy and calcium metabolism in patients with CD.

Methods

Thirty patients with asymptomatic CD (17 children, 13 adolescents), on a gluten‐free diet, and 23 healthy subjects were studied. BMD of the lumbar spine (dual energy x‐ray absorptiometry) was performed on all patients and control subjects. In patients, food diaries for nine nonconsecutive days were obtained and analyzed. In patients, laboratory tests pertaining to calcium balance were obtained.

Results

The mean weight and height of the adolescents with CD were lower than those of control subjects (weight: 45.8 ± 10.5 kg v 55.3 ± 10.5 kg, P = 0.037; height: 153.0 ± 11.0 cm v 167 ± 12.0 cm, P = 0.007). The mean BMD in adolescents with CD was significantly lower than that of the control subjects (0.917 ± 0.116 g/cm2v 1.060 ± 0.158 g/cm2, P = 0.015), whereas no significant difference was found between children with CD and control subjects (P = 0.595). A multiple‐regression model shows that increases in BMD relative to height were lower in adolescents with CD than in control subjects. The proportion of adolescents who had started a gluten‐free diet after 2 years of age was higher than that of children with CD (P < 0.001). High percentages of magnesium, calcium, and phosphorous deficiencies were present in CD patients' diets. The serum levels of ionized and total calcium and parathormone were normal.

Conclusions

The BMD of adolescents with CD was lower than that of the control subjects, whereas no difference was found between the BMD of children with CD and that of control subjects.
Are Proton Pump Inhibitors Indicated for the Treatment of Gastroesophageal Reflux in Infants and Children?
Authors: Rudolph Colin D.
Published: January 2024

Randomized controlled trials in the pediatric population that support the efficacy of proton pump inhibitors for the treatment of gastroesophageal reflux (GER) are lacking. Studies are needed to establish the safety of long‐term acid suppression in infants and children, as well as to confirm a causal relationship between GER and extraesophageal symptoms and signs.
Octreotide Therapy for Control of Acute Gastrointestinal Bleeding in Children
Authors: Eroglu Y. , Emerick K. M. , Whitingon P. F. , Alonso E. M.
Published: January 2024

Objectives

To evaluate the outcomes of octreotide use in children with gastrointestinal bleeding with or without portal hypertension.

Methods

The medical charts of children who received continuous octreotide infusion for the indication of gastrointestinal bleeding from January 1995 to December 2000 were retrospectively reviewed.

Results

Twenty‐one children with portal hypertension received octreotide infusions (1–2 μg/kg/h) during 35 gastrointestinal bleeding episodes. The duration of infusion ranged from 19 hours to 7 days. Bleeding ceased in 71% of children. Post‐treatment rebleeding occurred in 52%, and the mortality was 19%. Response to octreotide, rebleeding, and mortality did not differ significantly between patients with or without intrinsic liver disease.

Twelve children with gastrointestinal bleeding unrelated to portal hypertension received octreotide during 14 episodes. The duration of octreotide ranged from 3 hours to 36 days. Fifty percent of children had resolution of bleeding during the infusion. Post‐treatment rebleeding occurred in 29%, and the mortality was 50%. No major adverse events were observed in either group.

Conclusions

A high rate of bleeding control was achieved with octreotide during acute gastrointestinal bleeding in children with portal hypertension. However, controlled studies are needed for more definitive description of its clinical effects. The role of octreotide is less clear in gastrointestinal bleeding unrelated to portal hypertension.
Gastrointestinal and Other Clinical Manifestations in 17 Children With Congenital Disorders of Glycosylation Type Ia, Ib, and Ic
Authors: Damen Gerard , de Klerk Hans , Huijmans Jan , den Hollander Jan , Sinaasappel Maarten
Published: January 2024

Objectives

The typical signs and symptoms of congenital disorders of glycosylation (CDG) include dysmorphy, failure to thrive, and neurologic abnormalities. However, more and more children diagnosed at a young age are not dysmorphic and do not have neurologic involvement. The authors studied the gastrointestinal and other clinical manifestations of CDG type Ia, Ib, and Ic.

Methods

As of January 2003, 17 children were identified with CDG at the authors' institution. The medical records of the patients were reviewed.

Results

Five children had CDG Ia, three children CDG Ib, and nine children CDG Ic. Age at diagnosis ranged from 2 months to 15 years. Failure to thrive was present in 80% of patients with CDG Ia, in 66% of those with CDG Ib, and in 11% of those with CDG Ic. Five children had protein‐losing enteropathy (two CDG Ia, two CDG Ib, and one CDG Ic). Hepatomegaly was present in 40% of patients with CDG Ia, in 66% of those with CDG Ib, and in 11% of those with CDG Ic. In CDG Ic, hepatomegaly was transient. In CDG Ia, histologic analysis of the liver showed swollen hepatocytes, steatosis, and fibrosis. In CDG Ib, hamartomatous collections of bile ducts were seen. In one patient with CDG Ib, the clinical picture was restricted to congenital hepatic fibrosis for more than a decade.

Conclusions

The study confirms the heterogeneity of the clinical picture in children with CDG type Ia, Ib, and Ic. Children with protein‐losing enteropathy should be tested for CDG. Protein‐losing enteropathy can be caused, not only by CDG Ia and Ib, but also by type Ic. Children with congenital hepatic fibrosis should be tested for CDG, even in the absence of other symptoms. In CDG Ib, histologic analysis of the liver showed hamartomatous collections of bile ducts (Meyenburg complex).
Constipation and Intestinal Neuronal Dysplasia Type B: A Clinical Follow‐up Study
Authors: Schimpl Guenther , Uray Elisabeth , Ratschek Martin , Höllwarth Michael E.
Published: January 2024

Objective

Intestinal neuronal dysplasia type B (IND B) is one of the gastrointestinal motility disorders with a defined malformation of the parasympathetic submucous and myenteric ganglia. The clinical presentation of IND B is variable, ranging from intestinal obstruction in the neonatal period to acute or chronic constipation in childhood.

Methods

Between 1993 and 1996, 105 patients (49 females and 56 males) were treated for constipation, and in all of them an IND type B was confirmed histopathologically. Twenty‐two neonates, 42 infants to 6 months of age (38% of them were premature, and 5% had additional malformations), and 41 patients to the age of 4 years were included in this study.

All 105 patients had been treated conservatively. Treatment consisted of diet in all patients, cisapride in 70% of them, laxatives in 52%, and repeated anal dilatations in 12% of the patients. The mean duration of their treatment lasted from 3 months to 10 months (mean, 6 months).

Results

The clinical follow‐up 5 to 9 years later in 89 of the 108 (85%) patients showed daily defecation in 80% of them and every second day in 14% of them. Only 5 (6%) patients experience recurrent constipation, which responds well to diet and laxatives.

Conclusions

In young patients, constipation related to IND B can be treated successfully by conservative treatment regimens, including diet, laxatives, and prokinetic drugs.
Effect of Baclofen on Emesis and 24‐Hour Esophageal pH in Neurologically Impaired Children With Gastroesophageal Reflux Disease
Authors: Kawai Masanobu , Kawahara Hisayoshi , Hirayama Satoru , Yoshimura Norikazu , Ida Shinobu
Published: January 2024

Objectives

Gastroesophageal reflux disease (GERD) is difficult to control with medical therapy in neurologically impaired children. The gamma‐aminobutyric acid type B receptor agonist baclofen was recently reported to reduce reflux in adult patients with GERD by reducing the incidence of transient lower esophageal sphincter relaxations. The current study was undertaken to investigate the effects of baclofen on GERD in neurologically impaired children.

Methods

Eight neurologically impaired children with GERD between 2 months and 16 years were studied. Baclofen (0.7 mg/kg/day) was administered orally or via nasogastric tube in three divided doses 30 minutes before meals for 7 days. The frequency of emesis on and off baclofen were recorded as a measure of clinical impact. Twenty‐four–hour esophageal pH monitoring was conducted before and on the seventh day of the administration of baclofen.

Results

The frequency of emesis was significantly decreased (P = 0.03). The total number of acid refluxes was significantly decreased both during the entire 24‐hour period (P = 0.01) and during the postprandial period (P = 0.049). The number of acid refluxes longer than 5 minutes was significantly decreased during the 24‐hour period (P = 0.02). The percentage total time of esophageal pH <4.0 and esophageal acid clearance time were not significantly different during the 24‐hour period or during the postprandial period. No adverse effects were observed, except for a slight reduction in muscle tone in one subject.

Conclusions

In this 1‐week trial, repetitive administration of baclofen reduced the frequency of emesis and the total number of acid refluxes in neurologically impaired children with GERD.
The Risk of Celiac Disease in 107 Families With at Least Two Affected Siblings
Authors: Gudjónsdóttir Audur H. , Nilsson Staffan , Ek Johan , Kristiansson Bengt , Ascher Henry
Published: January 2024

Objectives

Screening for celiac disease (CD) in the apparently healthy members of 107 nuclear families with two affected siblings (sib pair) and estimating the risk of CD in siblings and parents.

Methods

One hundred seven families from Sweden and southern Norway with at least two affected children were investigated. Frozen sera from 187 of the 192 healthy parents and from 94 of 95 siblings without diagnosed CD were examined for total immunoglobulin A (IgA) and anti‐endomysial antibodies (EMA). Individuals with positive antibody titers underwent small intestinal biopsy.

Results

Positive test for EMA was found in 6 of 94 (6.3%) siblings without previously diagnosed CD and in 8 of 189 (4.2%) parents. CD was confirmed by small intestinal biopsy in all siblings and seven parents. The estimated risk for CD in multiply affected families was 26.3% for siblings and 12.9% for parents. An unexpected male preponderance was found among the new CD cases (10 males, 3 females).

Conclusion

The risk of CD in the members of nuclear families with two affected children is approximately three times higher than that when only one child is affected. The high male preponderance of new cases is unexpected and could not be explained fully by more silent disease in males as compared with females. Considering the high level of knowledge about CD in these families, the number of undiagnosed cases is surprisingly high. The authors suggest that serologic screening should be offered to all first‐degree relatives of patients with CD.
Composition of Milk Obtained From Unmassaged Versus Massaged Breasts of Lactating Mothers
Authors: Foda Mervat I. , Kawashima Takaaki , Nakamura Sadako , Kobayashi Michiko , Oku Tsuneyuki
Published: January 2024

Background:

The Oketani method is a program of breast massage and clinical counseling developed by the midwife Satomi Oketani. The purpose of this study is to examine the effects of the method on the quality of breast milk by determining the chemical composition of the milk before and after massage.

Methods:

Milk samples were obtained immediately before and after massage from healthy, exclusively breast‐feeding Japanese mothers at two different periods of lactation one <3 months the other >3 months after parturition. Lipids, whey protein, casein, lactose, ash, and total solids in milk were measured in milk samples. The gross energy content of milk was estimated.

Results:

Breast massage significantly increased lipids in the late lactating period but not in the early lactating period. In the early lactating period casein was increased by breast massage but was not significantly affected in the late lactating period. Breast massage caused a significant increase in total solids from the first day to 11 months post partum. The gross energy in the late lactating period was significantly increased by breast massage but not in the early lactating period. Lactose was not significantly changed by breast massage.

Conclusions:

Breast massage improves the quality of human milk by significantly increasing total solids, lipids, and casein concentration and gross energy. The milk of mothers treated by Oketani breast massage may improve the growth and development of infants.
Colonic Expression of MUC2, MUC5AC, and TFF1 in Inflammatory Bowel Disease in Children
Authors: Shaoul Ron , Okada Yoshio , Cutz Ernest , Marcon Margaret A.
Published: January 2024

Background:

The quantity and quality of mucins are affected in inflammatory bowel disease (IBD) both because of a reduction in the number of goblet cells and a decrease in the number of sugar residues per oligosaccharide side chain. Alteration in the types of mucins and aberrant location may contribute to the underlying pathology by affecting the mucus barrier function or may instead be a response to inflammation. The authors used the periodic acid‐Schiff/Alcian blue stain to distinguish neutral and acidic mucins, and used specific antibodies to the mature goblet cell mucin MUC2, MUC2 core antigen, foveolar cell mucin MUC5AC, and gastric trefoil factor (TFF1), to characterize their presence and distribution in colonic tissue sections from patients with IBD.

Results:

Both core and mature MUC2 were expressed in all colonic goblet cells from patients with ulcerative colitis (UC) and Crohn disease and from healthy controls. MUC5AC and TFF1, which are not normally expressed by colonic tissue, also were expressed in scattered goblet cells, coexpressing with MUC2. In areas of goblet cell depletion, MUC2 was present in cytoplasmic granules of flattened, cuboidal, nongoblet‐cell–like surface cells. The staining was more intense and homogenous with the MUC2 core antibody, suggesting expression of relatively immature mucin. Some of these cells also coexpressed MUC5AC but to a lesser extent. These findings are not unique to IBD but were also found in other types of intestinal inflammation.

Conclusion:

The study confirms earlier observations that MUC2 is the major colonic mucin in IBD. It appears in two forms: mature MUC2 in goblet cells and immature MUC2 especially in secretory granules of cells that are not phenotypically goblet cells. MUC5AC and TFF1 expression in goblet cells is common in IBD and other inflammatory conditions of the colon. These changes may represent a nonspecific repair function of the colon cells to compensate for damage to barrier function.
Nontyphoid Salmonellosis in Taiwan Children: Clinical Manifestations, Outcome and Antibiotic Resistance
Authors: Huang I‐Fei , Wagener Marilyn M. , Hsieh Kai‐Sheng , Liu Yung‐Ching , Wu Tzee‐Chung , Lee Wei‐Yang , Chiou Christine C.
Published: January 2024

Objectives:

The purposes of this study were to investigate the epidemiologic, clinical, and microbiologic features of patients with nontyphoid salmonellosis and to elucidate the impact of resistance on the outcome of nontyphoid salmonellosis in Taiwan. The authors also sought to develop a severity score to derive an objective guideline for antibiotic use in nontyphoid salmonellosis in the era of increasing antibiotic resistance.

Methods:

The authors prospectively monitored 311 children with nontyphoid salmonellosis in Kaohsiung, Taiwan. The demographic, clinical, and microbiologic features, underlying diseases, treatment regimen, complications, and outcome were analyzed. In vitro susceptibility testing of the isolates was performed.

Results:

The median age of affected patients was 15 months. Salmonella enteritidis B caused 68.5% of episodes, followed by S. enteritidis C1 (11.9%), D (7.7%), C2 (7.1%), E (2.6%), S. choleraesuis (1.6%), and S. paratyphi (0.6%). Sixty percent of isolates were resistant to ampicillin. Patients with bacteremia could not be differentiated from patients without bacteremia on clinical grounds. Patients receiving antibiotics that were inactive in vitro (discordant therapy) had more days of fever and longer hospital stay compared with patients receiving antibiotics that were active in vitro (concordant therapy). Patients receiving no antibiotic treatment had the fewest days of fever and shortest hospital stays, especially among patients with mild illness (severity score, 0–1).

Conclusion:

Blood culture should be obtained in patients with nontyphoid salmonellosis to detect bacteremia. In treating antibiotic‐resistant nontyphoid salmonellosis, antibiotics are still not mandatory for patients who present with primarily gastrointestinal symptoms and limited signs of systemic inflammation reflected by a low severity score (low C‐reactive protein, fewer band cells in peripheral blood, and fewer days of fever before admission). Susceptibility data should be promptly obtained because use of discordant antibiotics appears to prolong illness.
Is an Abbreviated Pediatric Crohn's Disease Activity Index Better Than the Original?
Authors: Shepanski Melissa A. , Markowitz Jonathan E. , Mamula Petar , Hurd Linda B. , Baldassano Robert N.
Published: January 2024

Objective:

The Pediatric Crohn's Disease Activity Index (PCDAI) is a validated measure of disease activity comprised of historical, laboratory and physical examination parameters. It has been suggested that an abbreviated PCDAI may be of similar utility without requiring laboratory evaluations or calculated height velocity. The aim of this study was to compare an abbreviated PCDAI and the original PCDAI and also compare the abbreviated PCDAI and a quality‐of‐life measurement.

Methods:

The authors prospectively analyzed quality of life and disease activity, using the IMPACT‐35 Questionnaire, the PCDAI and an abbreviated PCDAI consisting of three historical items (abdominal pain, stools and patient functioning) and three physical examination items (weight, abdomen and perirectal disease).

Results:

Forty subjects aged 5–24 years (22 males) were included in analysis. Correlations were performed between the original PCDAI, an abbreviated PCDAI and the IMPACT‐35. There was a significant, strong correlation between the PCDAI and the abbreviated PCDAI (n = 40, r = 0.849, p <0.001), a significant, moderate correlation between PCDAI and IMPACT‐35 (n = 29, r = −0.547, p = 0.002) and a significant, moderate correlation between the abbreviated PCDAI and IMPACT‐35 (n = 29, r = −0.579, p <0.001).

Conclusions:

An abbreviated PCDAI predicted disease activity as well as the full PCDAI. The IMPACT‐35 correlated well with disease activity based on both PCDAI and an abbreviated PCDAI. An abbreviated PCDAI may offer advantages over the original PCDAI and should be prospectively validated in future studies.