bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Rehydration Therapy for Low Birth Weight Neonates Suffering from Diarrhea in the Intensive Care Unit
Authors: Helmy Nabil , Abdalla Safia , Essaily Medhat El , Nassert Shafika , Hirschhorn Norbert
Published: January 2024

A total of 62 low birth weight (LBW) neonates (29 boys and 33 girls) suffering from diarrhea in our neonatal intensive care unit were included in this period of intense observation. The mean age was 13.89 ± 13.22 days and average body weight was 1,500.49 ± 281.45 g. Severity of dehydration was assessed by the Fortin‐Parent score. When the score was <8 (mild to moderate hypovolemia), oral rehydration therapy (ORT) was administered by feeding bottle or nasogastric tube hourly. Severely hypovolemic neonates needed intravenous rehydration; 52 neonates received ORT only using the World Health Organisation (WHO) formula; 58 neonates received either cow's milk‐based or soy‐based formula within 12 h after ORT began, and the rest within 24 h. Diarrhea lasted <1 day in 92% of cases. The regimen corrected hyponatremia and hypernatremia. Only two neonates developed mild asymptomatic hypernatremia. No child became edematous. Using the WHO solution, ORT was safely given to LBW neonates, sparing painful and potentially hazardous invasive techniques, and resulted in excellent outcomes.
Acute Appendicitis in Childhood in the Negev Region
Authors: Freud E. , Pilpel D. , Mares A. J.
Published: January 2024

In an attempt to explore the possible variation over time of acute appendicitis (AA) 406 medical files comprising all children aged 0–14 years operated on during an 11‐year period (1973–1983) at the Soroka Medical Center were reviewed. Only patients that were histopathologically confirmed were included in the study. Soroka Medical Center is the only general hosptal providing services to the entire population of the region. Hence, a reasonable coverage of all AA patients is expected. As a result, comparison of incidence rates among different subgroups is plausible. The annual rate of AA was 3.75 operations/10.000 children. The rates were somewhat higher for boys (5.20 versus 2.31, p. < 0.05). They were also higher for Jewish versus Bedouin children (4.44 versus 1.14, p. < 0.05). The highest rate of AA was among children in the 10‐to 14‐year‐old age group (7.79). A gradual increase in the rates of AA during the study period was noticed, over and above the increase in the region's populat in. However, the ratio of change over time was higher for the Bedouins. Although this cannot be proven, the caques of AA have been hypothesized to be multifactorial. Diet is considered to have an important role in the etiology of AA. Some seasonal trends could be observed. paralleling changes in humidity. viral and bacterial infeetions, suggesting the involvement of these factors in the etiology of AA.
The BUN/Creatinine Ratio in Localizing Gastrointestinal Bleeding in Pediatric Patients
Authors: Felber Sharon , Rosenthal Philip , Henton Donaby
Published: January 2024

Summary: Localizing the bleeding site in pediatric patients with gastrointestinal hemorrhage may require invasive and costly diagnostic procedures. A simple index to discriminate upper and lower bleeding sources would be invaluable. We evaluated the reliability of the calculated blood urea nitrogen/creatinine (BUN/Cr) ratio in segregating upper from lower gastrointestinal bleeding sites in 40 children. For upper gastrointestinal hemorrhage, the calculated BUN/Cr ratios (mg/mg) ranged from 10 to 140, with a mean value of 34. For lower gastrointestinal bleeders, the BUN/Cr rations ranged from 3.3 to 30, with a mean value of 16. All BUN/Cr ratios > 30 corresponded to patients with documented upper gastrointestinal bleeding sources. Calculation of the BUN/Cr ratio in the initial evaluation of gastrointestinal bleeding may prove useful in guiding the sequence of diagnostic procedures and examinations.
The Effect of Antenatal Betamethasone on Cord Blood Concentrations of Retinol‐Binding Protein, Transthyretin, Transferrin, Retinol, and Vitamin E
Authors: Georgieff Michael K. , Chockalingam Uma M. , Sasanow Sharon R. , Gunter Elaine W. , Murphy Edric , Ophoven Janice J.
Published: January 2024

Summary: We assessed the effect of short‐term (> 1 week) and prolonged (> 1 week) exposure to antenatal betamethasone on umbilical cord serum concentrations of retional‐binding protein (serum t1/2 ‐ 12 h), transthyretin (t1/2 ‐ 2 days), transferrin (t1/2 ‐ 8 days), retinol (vitamin A), and vitamin E in appropriate‐for‐gestational‐age preterm newborn infants of < 36 weeks' gestation. A group of 30 infants whose mothers received a single course of betamethasone < 1 week prior to delivery had significantly elevated mean retional‐binding protein and transthyretin but not transferrin concentrations when compared with a group of 30 gestational age‐and birth weight‐matched infants with no exposure to antenatal betamethasone. A group of eitht infants whose mothers received multiple (more than two) weekly course of betamethasone prior to delivery had significantly elevated mean serum concentrations of all three proteins when compared with eight gestational age‐and weight‐matched control infants with no betamethasone exposure. Serum retinol and vitamin E concentrations were measured in a group of 21 infants exposed to short‐term prenatal betamethasone and were significantly greater than in a group of 21 control infants without steroid exposure. We conclude that antenatal steroids increase the umbilical cord serum concentrations of retional‐binding protein, transthyretin, transferrin, retinol, and vitamin E. The effect on the various serum proteins is dependent on the duration of exposure to steroids.
Nutrient Balance Studies in the Preterm Infant
Authors: Cooke Richard J. , Perrin Fran , Moore Jamae , Paule Chuck , Ruckman Karen
Published: January 2024

Summary: Crossover and parallel studies were compared as methods of experimental design during nutritional balance studies in the preterm infant. Twelve formula‐fed infants (birth weight, 1,362 × 125 g, mean SD: gestational age, 32.3 × 1.7 weeks) were studied over 2 continuous weeks, “period” being the only obvious difference between the weeks. During each week, growth was determined, and 84‐h nutrient balance was performed. Growth was adequate during both weeks. Increased absorption and retention (mg/kg/day and percent) of calcium and copper were noted during the 2nd week. Increased retention (mg/kg/day and percent) of phosphorus and magnesium was noted also, indicating increased nutrient assimilation due to a period effect. However, the variance due to the period effect (crossover) was less than that associated with “patient characteristics” (parallel study). In addition, sample size requirements were less, indicating that crossover studies are more efficient than parallel studies as a method of experimental design.
Longitudinal Study of the Body Composition of Weight Gain in Exclusively Breast‐Fed and Intake‐Measured Whey‐Based Formula‐Fed Infants to Age 3 Months
Authors: Shepherd R. W. , Oxborough D. B. , Holt T. L. , Thomas B. J. , Thong Y. H.
Published: January 2024

Summary: Body composition and the composition of weight gain in 82 healthy infants during the first 3 months of life were measured in relation to the type of feeding and nutrient intakes by serial measurements of total body potassium (TBK), anthropometry, and formula intake. Infants were exclusively fed either breast milk (n = 34, B fed) or whey‐based formula (n = 48, F fed). Formula intakes were substantially lower than WHO‐FAO recommendations (although serial weights paralleled standards), and were significantly greater in male infants, who had greater gains in weight and lean tissue than females. In both sexes, tissues low in K (fat and extracellular water) were added faster to the body weight than lean tissue. Overall, compared with B fed infants, F fed infants gained less weight between birth and 10 days and more weight between 10 and 90 days, although mean actual weights at 90 days were similar: formula feeding caused greater fat deposition in males and greater daily gains in lean mass in females. Differences in both quantity and quality of ingested nutrients account for these differences although the biological importance of these findings is speculative. These studies further elucidate the nature of growth in relation to modern feeding practices and the question of optimal versus maximal nutrient intake and growth in early life.
Ascites Complicating Ventriculoperitoneal Shunts
Authors: Goodman Gary M. , Gourley Glenn R.
Published: January 2024

Ventriculoperitoneal shunts are currently a standard therapy for obstructive hydrocephalus. These shunts are associated with a variety of abdominal complications, one of which is the development of ascites. We report an 11‐year‐old girl with a ventriculoperioneal shunt in whom a low‐grade peritoneal infection presented with ascites. This case demonstrates the importance of diagnostic paracenteses, appropriate antibiotic therapy and the potential need to establish an alternative rout for cerebrospinal fluid diversion in patients with ventriculoperitoneal shunts and ascites.
Detection of Anti‐Endoplasmic Reticulum Antibody‐Positive Autoimmune Hepatitis in Children, Using an ELISA Technique
Authors: Paradis Khazal , Dib Amale , Homberg Jean‐Claude , Bernard Olivier , Alagille Daniel , Alvarez Fernando
Published: January 2024

Anti‐endoplasmic reticulum antibody positive autoimmune hepatitis in children is characterized by the recognition of a single 50,000 MW protein of the endoplasmic reticulum in liver microsomal fractions by their sera. We have developed an enzyme‐linked immunosorbent assay technique with rat liver microsomal preparations as the antigen to be used for detection of this disease, liters obtained may be useful in following the course of the disease and as an aid in determining when therapy can be discontinued. The technique is rapid, sensitive, reproducible, and simple to perform and is easier to manipulate than immunofluorescence or radioimmunoassay techniques.
Hepatocellular Carcinoma in Alagille's Syndrome
Authors: Rabinovitz Mordechai , Imperial Joanne C. , Schade Robert R. , Van Thiel David H.
Published: January 2024

Alagille's syndrome is a common form of familial intraphepatic cholestasis. In addition to the hepatobiliary system, many other organ systems are affected. Most of the affected patients survive through adulthood. Hepatic involvement is the cause of death in about one‐third of patients. Hepatocellular carcinoma complicating the course of this disease is very rare and has been reported previously in only three cases. We report a family in which three of four siblings with this syndrome developed hepatocellular carcinoma and died as a result of it. None of these children had a liver disease, other than Alagille's syndrome, that could account for the development of such a tumor. This experience suggests that Alagille's syndrome, or at least chronic cholestasis, may be a predisposing factor for the development of hepatocellular carcinoma. Annual determination of α‐fetoprotein and abdominal computed tomography (CT) scan may detect the development of a hepatocellular carcinoma in such cases while they are still resectable.
Children With Gastroesophageal Reflux With or Without Partial Thoracic Stomach (Hiatal Hernia) Have Normal Gastric Emptying
Authors: Jackson P. T. , Glasgow J. F. T. , Thomas P. S. , Carré I. J.
Published: January 2024

Gastric emptying was measured using a modification of the double‐sampling dye dilution technique in 16 children with gastroesophageal reflux and partial thoracic stomach (hiatal hernia), 13 with reflux per se, and 12 controls with nonspecific vomiting. No differences could be demonstrated between the rate of emptying in these groups. Our study failed to provide a rational explanation for the copious projectile vomiting that is a frequent manifestation of these disorders.
The Use of H2‐Receptor Antagonist in the Treatment of Peptic Ulcer Disease in Children
Authors: Tam P. K. H. , Saing H.
Published: January 2024

We report our 20 years' experience on the management of 78 children with primary chronic peptic ulcer, giving special emphasis to the recent 32 patients (29 duodenal ulcer, 3 gastric ulcer) who received H2‐antagonist therapy guided by endoscopic surveillance. The most striking observation was the marked decrease in the incidence of “failed medical treatment necessitating surgery” from 34.8% (16/46) in the pre‐H2‐antagonist era to 3.1% (1/32) in the H2‐antagonist era. H2 antagonist was uniformly well tolerated and without side‐effects. In 29 patients with duodenal ulcer, a 6‐week therapeutic course resulted in complete ulcer healing in 22 (75.9%). Further therapeutic courses resulted in complete ulcer healing in four additional patients (13.8%). There was only partial ulcer healing in two patients (6.9%) and nonhealing in one patient (3.49%). There were 11 episodes of recurrence in nine patients (symptomatic 5, asymptomatic 6). Recurrence was more frequent when nocturnal‐dose maintanence was not given (8/11 recurrences). All recurrences responded satisfactorily to further H2‐antagonist therapy. Patients with gastric ulcer responded even more favorably, all three healing completely with a single therapeutic course and not requiring maintenance therapy. We conclude that H2‐antagonist is safe and highly effective for healing peptic ulcer in children. For duodenal ulcer, maintenance therapy ensures a satisfactory remission rate.
Comparison of the D‐Xylose and Polyethylene Glycol Absorption Tests as Indicators of Mucosal Damage in Infants with Chronic Diarrhea
Authors: Lifschitz Carlos H. , Shulman Robert J. , Langston Claire , Gopalakrishna G. S.
Published: January 2024

The determination of serum levels of D‐xylose and the urinary excretion of an orally administered mixture of low‐molecular‐weight polyethylene glycol were compared to assess their sensitivity to predict smallbowel mucosal damage. Eighteen infants with severe diarrhea and villus atrophy were observed. Results of the D‐xylose and polyethylene glycol tests were compared with the villus‐to‐crypt ratios that were determined from biopsy specimens. The D‐xylose test predicted accurately 12 (67%) of the 18 small‐bowel biopsy results, while the polyethylene glycol test predicted 14 (78%). However, the McNemar test indicated that the two tests did not differ significantly in their ability to predict an abnormal small‐bowel biopsy. We conclude that neither the D‐xylose nor the polyethylene glycol test is a reliable indicator of small intestinal mucosal damage in infants with chronic diarrhea.
Nutrient Balance Studies in Premature Infants Fed Premature Formula or Fortified Preterm Human Milk
Authors: Ehrenkranz Richard A. , Gettner Patricia A. , Nelli Catherine M.
Published: January 2024

This report compares fat. nitrogen, calcium, phosphorus, zinc, and copper absorption and retention data from 13 nutritional balance studies performed in 12 appropriate‐for‐gestational‐age premature infants with birth weights ≤ 1.600 g fed a proprietary premature formula or their own mother's preterm human milk (PTHM) fortified with a powdered protein‐mineral supplement. At the time of each balance study, each infant had a stable condition, was tolerating feedings, and was gaining weight steadily. Stool and urine were collected separately; doses of carmine red given 72 h apart were used to define dietary intake and the stool and urine collections. The balance studies were performed at an average age of 36 postnatal days. Both diets were found to support weight gain and nutrient retention at similar rates. Balance studies (n = 7) with premature formula demonstrated a weight gain of 16.8 ± 5.2 g/kg/day, with a net fat absorption of 6.36 ± 0.97 g/kg/day, net nitrogen retention of 427.9 ± 47.1 mg/kg/day, net calcium retention of 95.0 ± 14.1 mg/kg/day, net phosphorus retention of 56.7 ± 5.9 mg/kg/day, net zinc retention of 208 ± 903 μg/kg/day, and net copper retention of 26.4 ± 30.8 μg/kg/day (mean ± SD). Comparison balance studies (n = 6) with fortified PTHM demonstrated a weight gain of 17.2 ± 7.1 g/kg/day, net fat absorption of 5.60 ± 1.55 g/kg/day, net nitrogen retention of 366.0 ± 84.0 mg/kg/day, net calcium retention of 82.2 ± 10.8 mg/kg/day, net phosphorus retention of 58.6 ± 5.9 mg/kg/day, net zinc retention of 685 ± 363 μg/kg/day, and net copper retention of 67.3 ± 37.2 μg/kg/day. These rates of weight gain and of fat, nitrogen, zinc, and copper retention approximate those of the third trimester of intrauterine life; only calcium and phosphorus retention approached the lower range of estimated in utero accretion.
α1‐Antitrypsin Deficiency and the PiMS Phenotype
Authors: Gourley Mark F. , Gourley Glenn R. , Gilbert Enid F. , Odell Gerard B.
Published: January 2024

We describe a premature infant with cholestatic liver disease and protease inhibitor MS phenotype. This infant demonstrated an abnormally low serum α1‐antitrypsin concentration. Liver histologic studies revealed diastase‐resistant, periodic acid‐Schiff‐positive globules inside hepatocytes. Immunoperoxidase staining for α1‐antitrypsin was positive. Electron microscopy showed amorphous material in the dilated lumina of the endoplasmic reticulum. These findings are characteristic of α1‐antitrypsin deficiency. We suggest that this usually nonpathologic phenotype resulted in cholestatic liver disease because of the cumulative effect of several cholestatic conditions.
Minimal Vitamin D and High Calcium and Phosphorus Needs of Preterm Infants Receiving Parenteral Nutrition
Authors: Koo Winston W. K. , Tsang Reginald C. , Succop Paul , Krug‐Wispe Susan K. , Babcock Diane , Oestreich Alan E.
Published: January 2024

Preterm infants (birth weight, 1,089 ± 91 g; gestational age, 28.9 ± 0.7 weeks; mean ± SEM) with mixed medical and surgical indications for parenteral nutrition (PN) were observed to determine the adequacy of infusates with fixed, low‐dose vitamin D (25 IU/dl) and two combinations of calcium and phosphorus. The duration of low‐dose vitamin D PN ranged from 5 to 52 days, with a median of 27 days. Twelve infants were randomly assigned to low (standard) Ca and P doses (5 mM each; 20 mg/dl of Ca and 15.5 mg/dl of P) and 13 high Ca and P doses (15 mM each; 60 mg/dl of Ca and 46.5 mg/dl of P). The maximum daily vitamin D intake was similar for both groups (31 ± 1.3 versus 33 ± 1.2 IU/kg). Vitamin D status in either group, as indicated by serum 25‐hydroxyvitamin D (25‐OHD) concentrations, was normal. There was no significant difference in observed changes of serial measurements of serum calcium, magnesium, phosphorus, alkaline phosphatase, creatinine (Cr), 25‐OHD, and vitamin D‐binding protein concentrations or urinary Ca:Cr and Mg:Cr ratios. In the low‐dose Ca and P group, the serum P level was consistently <4 mg/dl in five infants, serum 1,25‐dihydroxyvitamin D concentrations were higher, and tubular reabsorption of phosphorus was consistently <95% and significantly higher than in the high‐dose Ca and P groups. Severe bone demineralization apparent on X‐ray occurred in two infants, with a fractured distal left ulna in one of the two infants. Abdominal ultrasonograms showed gallbladder “sludge” in six infants (four in the low‐dose and two in the high dose Ca, P group) that resolved with enteral feeding. We conclude that for preterm infants receiving PN, the vitamin D requirement is minimal. A high Ca‐ and P‐level (15 mM each) infusate may be more appropriate than low Ca and P levels (5 mM each) to maintain Ca and P homeostasis.
Bacterial Infection
Authors: Wolf Anna , Pohlandt Frank
Published: January 2024

To test the hypothesis that bacterial infections are the main cause of acute cholestasis in short‐term intravenously fed newborns, two groups were studied. Group I consisted of 152 newborn infants who were fed intravenously for at least 7 days and in whom severe bacterial infections developed. Group II was formed of 92 newborn infants who were matched to the group I cases with respect to the year of birth, birth weight and gestational age, Apgar scores, and duration of parenteral nutrition but who did not have infections. Bacterial infections were diagnosed on the basis of impaired microcirculation with prolonged capillary filling time, a shift to the left in the white cell differential, and a positive blood culture. Cholestasis was diagnosed when the total serum bilirubin level was >4 mg/dl and the conjugated fraction made up more than 40% of the total. The results were that all 40 cases of cholestasis were found in the first group of infected infants. All of the other factors were distributed equally between both groups and could not be attributed as a major factor in the etiology of idiopathic neonatal cholestasis. The conclusion was that bacterial infections are the main cause of acute cholestasis in intravenously fed newborn infants.
Selective Precipitation of 14 kDa Stone/Thread Proteins by Concentration of Pancreaticobiliary Secretions
Authors: Forstner Gordon G. , Vesely Shirly M. , Durie Peter R.
Published: January 2024

Concentrated proteins in pancreatic juice could precipitate and plug pancreatic ducts, initiating pancreatic disease. In cystic fibrosis (CF), pancreatic fluid secretion is impaired due to defective anion transport and proteins are hyperconcentrated. To determine whether proteins in pancreatic secretions precipitate selectively or nonspecifically, duodenal secretions were obtained from subjects with and without cystic fibrosis, during pancreatic stimulation with cholecystokinin (CCK) and secretin, dialyzed against phosphate‐buffered saline (PBS), and concentrated in stages by ultrafiltration. Precipitates obtained by centrifugation at 15,600 g for 10 min at 4°C were analyzed by sodium dodecyl sulfate‐polyacrylamide gel electrophoresis. The only protein band regularly enriched in precipitates from 10 CF and 9 non‐CF samples had an Mr of approximately 14,000. Monoclonal antibodies, raised independently in two laboratories against either pancreatic stone protein (PSP) or pancreatic thread protein (PTP), reacted with the Mr 14,000 protein(s). Differential extraction of PTP and PSP by 0.1N HC1 and 10% sodium citrate produced Mr 14,000 products that reacted equally with each monoclonal antibody (MAB). Two‐dimensional gel electrophoresis demonstrated two Mr 14,000 spots in each extract with pI's of 5.8 and 6.0. Each spot reacted equivalently with the MABs for PSP and PTP. PSP/PTP type proteins are sparingly soluble in pancreatic secretions and could contribute to protein plugging in pancreatic disease.
Aneurysmal Dilatation of the Portal Vein
Authors: Lee Hung‐Chang , Yang Yhu‐Chering , Shih Shin‐Lin , Chiang Hsein‐Jar
Published: January 2024

In the following study, a case involving an aneurysmal dilatation of the portal vein is reported. The 5‐year‐old boy had a 2 month history of intermittent abdominal pain. A segmental dilatation of the portal vein was noted in the sonographic examination. The portal vein aneurysm diagnosis was later confirmed by superior mesenteric angiography and computed tomography. In our review of the literature, less than 30 cases of portal venous aneurysm have been reported. To our knowledge, this is the youngest case with such an anomaly.
Tannin‐Rich Carob Pod for the Treatment of Acute‐Onset Diarrhea
Authors: Loeb H. , Vandenplas Y. , Würsch P. , Guesry P.
Published: January 2024

Infants aged 3–21 months with acute diarrhea of bacterial and viral origin were treated as inpatients with oral rehydration fluid and randomly received for up to 6 days either a tannin‐rich carob pod powder (40% tannins or 21.2% polyphenols and 26.4% dietary fiber), 1.5 g/kg/day (n = 21) to a maximum of 15 g, or an equivalent placebo (n = 20). The duration of the diarrhea from admission was 2.0 ± 0.27 days in the test group and 3.75 ± 0.30 days in the placebo group (p < 0.001). Normalized defecation, body temperature, and weight and cessation of vomiting were reached more quickly by the patients who received the test substance. The test substance was well accepted and tolerated.
Intestinal Permeability Assessed with Polyethylene Glycols in Children with Diarrhea Due to Rotavirus and Common Bacterial Pathogens in a Developing Community
Authors: Johansen K. , Stintzing G. , Magnusson K. E. , Sundqvist T. , Jalil F. , Murtaza A. , Khan S. R. , Lindblad B. S. , Möllby R. , Orusild E. , Svensson L.
Published: January 2024

Intestinal permeability was assessed with different‐sized polyethylene glycols (PEG 400 and PEG 1,000) in small children with acute diarrhea. All children with acute diarrhea absorbed and excreted less PEG of all molecular sizes into the urine when compared with healthy control children (p < 0.001). Children with acute rotavius infection excreted significantly less PEG of all sizes than children with Shigella, Salmonella, and enteropathogenic Escherichia coli (EPEC) infection (p < 0.001–0.01), suggesting a more severe mucosal lesion caused by rotavirus. In patients with severe malnutrition there was also a significant decrease in absorption of PEGs observed. In addition, malnourished patients with rotavirus diarrhea showed a pronounced decrease of PEGs in comparison with well‐nourished patients. The ratio between the recovery of a large PEG molecule, 1,074 Da, and a small molecule, 370 Da, was utilized to assess the absorption of large molecules in relation to that of smaller ones. On applying this ratio, it was noted that the intestine in children with Shigella and EPEC infection was relatively more permeable to larger molecules than in healthy controls, while in rotavirus and Salmonella infection it was less permeable to larger molecules. In this study significant differences in the permeability characteristics were observed, suggesting etiology‐specific effects on the mucosal barrier.
Hypocalcemia Complicating Deferoxamine Therapy in an Infant with Parenteral Nutrition‐Associated Aluminum Overload
Authors: Klein Gordon L. , Snodgrass Wayne R. , Griffin M. Pamela , Miller Nancy L. , Alfrey Allen C.
Published: January 2024

Aluminum (Al) contaminates total parenteral nutrition (TPN) solutions given to infants, and high levels of Al have been demonstrated in their bone, serum, and urine. However, it is uncertain whether Al at current levels of contamination of TPN solutions is harmful to bone. We report an 8‐month‐old infant who developed osteopenic bone disease while receiving TPN, which did not respond to large amounts of calcium, phosphate, and vitamin D2. Serum and urine Al levels were greatly elevated and fell after a short course of deferoxamine. However, shortly after treatment began, serum calcium levels fell in the absence of hypercalciuria. We postulate that chelation of Al from this patient's bone permitted increased bone calcium uptake. This would suggest that Al at current levels of contamination of TPN solutions may impair bone calcium uptake and thus contribute to the pathogenesis or exacerbation of TPN‐related osteopenia.
Late Gastrointestinal Bleeding and Protein Loss after Distal Small‐Bowel Resection in Infancy
Authors: Couper R. T. L. , Durie P. R. , Stafford S. E. , Filler R. M. , Marcon M. A. , Forstner G. G.
Published: January 2024

Four children who underwent extensive small‐bowel resection in infancy developed recurrent iron deficiency anemia due to gastrointestinal bleeding between 4 and 12 years later. The initial resections were required for multiple ileal atresia (n = 2) and gastroschisis (n = 2). Three patients have had melena and one had persistently guaiac‐positive stools. Three patients had protein‐losing enteropathy, and in one there was persistent hypoalbuminemia. Colonoscopy identified circumferential ulcerative lesions at the surgical anastomosis (n = 2) and at laparotomy another patient had well‐defined linear ulcers close to the surgical anatomosis. Histology demonstrated focal ulceration with chronic inflammation, but did not show granulomata, crypt abcesses, or malignancy. Multiple imaging procedures and gastroduodenoscopy failed to identify an alternative bleeding source. Medical therapy including iron, antacids, sucralfate, H2 antagonists, and cholestyramine was ineffective. Two patients have undergone anastomotic resection. One experienced symptomatic recurrence 4 months after surgery. Repeat colonoscopy found ulceration at the new anatomosis with similar histology. The other patient remains asymptomatic 7 months postsurgery. Recurrent gastrointestinal hemorrhage due to anastomotic ulceration, of unknown etiology, appears to be a late complication of small‐bowel resection in infancy.
Epidemiology of Neonatal Jaundice in the Jerusalem Population
Authors: Gale Rena , Seidman Daniel S. , Dollberg Shaul , Stevenson David K.
Published: January 2024

Of 10,122 singleton babies born from January 1, 1984 to March 31, 1988, we compared 1,154 term infants with high serum bilirubin levels (>12.9 mg/dl) to 1,154 infants with low serum bilirubin levels (<12.9 mg/dl) randomly selected from the remaining 8,968 subjects. We found that a high bilirubin level was significantly associated with male sex; maternal diabetes (chronic and gestational); pregnancy‐induced hypertension; previous sibling with neonatal jaundice; delivery by cesarean section, vacuum, or forceps; epidural anesthesia; mother with blood type O; first delivery; cephalohematoma; short gestation; lower birth weight; and lower birth order (p < 0.01); and older maternal age, low percentile for birth weight, and the percentage of weight loss during hospitalization (p < 0.05). Variables with significantly different frequencies in control and study groups were used in a multivariate analysis, thus further refining the data by the use of logistic regression. Teenage mothers (<19 years old) had the lowest risk, whereas older mothers (>35 years old) had the highest risk of all age groups for having an infant with neonatal jaundice. First delivery and previous sibling with neonatal jaundice were also risk factors. Male sex, short gestation, and delivery by vacuum extraction were other notable risk factors. Our results suggest that, even among industrialized Western societies, risk factors may interact differently to produce higher neonatal serum bilirubin levels. The importance of a risk factor may also be dependent upon its relative prevalence in a parturient population.
Cow's‐Milk‐Induced Erosive Gastritis in an Infant
Authors: El Mouzan Mohamed I. , Al Quorain Abdulaziz A. , Anim Jehoram T.
Published: January 2024

A 3 1/2‐month‐old male infant presented with hematemesis due to erosive gastritis following whole‐cow's‐milk feeding. The presence of eosinophilic gastritis, the disappearance of symptoms after withdrawal of whole‐cow's‐milk feeding, and the association with facial eczema suggest that gastritis was induced by cow's milk. Cow's‐milk intolerance should be considered in the etiologic differential diagnosis of hematemesis and gastritis in infancy.
Nontransmural Myocardial Infarction as a Complication of Untreated Cystic Fibrosis
Authors: Aronson D. C. , Heymans H. S. A. , la Riviere A. V. , Naeff M. S. J.
Published: January 2024

In a 2‐year‐old boy with untreated cystic fibrosis, an acute deterioration of his chronic respiratory insufficiency developed due to bilateral pneumonia. This condition caused acute right‐sided heart failure and non‐transmural myocardial infarction of the inferior wall. In concordance with this diagnosis, a marked increase of CPK‐MB levels combined with transient severe ischemia on the ECG and the absence of myocardial injury at echocardiography was seen. At 3 years follow‐up, he was in good clinical condition.
Anti‐gliadin Antibody Panel and Xylose Absorption Test in Screening for Celiac Disease
Authors: Rich Edward J. , Christie Dennis L.
Published: January 2024

We prospectively evaluated the use of a widely used commercially available anti‐gliadin antibody (AGA) panel, and compared it with the xylose absorption test in screening pediatric patients with possible celiac disease for small intestinal biopsy. Sixty children were investigated with a I‐h xylose absorption test, IgG and IgA AGA panels, and small bowel biopsy; 15 patients were diagnosed with celiac disease. The xylose was sensitive (93%) but not specific (47%) for celiac disease. The IgG AGA test had high sensitivity (100%) but low specificity (58%), while the IgA AGA test had low sensitivity (53%) but high specificity (93%) in screening for celiac disease. We conclude that the AGA panel currently available in the United States is comparable to, but not significantly different than, the xylose absorption test when used as the only laboratory test in screening for celiac disease. A two‐step screening process would have best improved our ability to predict celiac disease. We recommend screening with the AGA panel, and obtaining a xylose test if only the IgG is abnormal. Biopsies should be performed in cases with high IgA AGA, or with abnormal IgG AGA and xylose values. This approach is clinically preferable, does not add cost, and spares children from unnecessary small bowel biopsies.
Cow's Milk‐Based Formula, Human Milk, and Soya Feeds in Acute Infantile Diarrhea
Authors: Haffejee Ismail E.
Published: January 2024

Acute infantile diarrhea is often managed by introducing lactose‐free diets empirically from the time of diagnosis, in addition to conventional rehydration therapy. In order to assess the efficacy of this, a therapeutic trial was undertaken in which hospitalized gastroenteritis patients previously on milk‐formula feeds were randomly fed, from the time of admission, either their original feed or a lactose‐free soya preparation; patients previously on human milk with or without a supplement continued to receive this during their diarrheal illness. The results show that in nonrotaviral gastroenteritis, there is no difference in the duration of the illness irrespective of the type of feed given. In rotaviral gastroenteritis, continued breast‐feeding significantly reduces the duration of acute diarrhea, while lactose‐free soya feeds do not lead to a significant reduction in the duration of the illness when compared to cow's milk‐formula feeds. Hence, it is concluded that (a) breast‐feeding should be continued during an episode of infantile diarrhea, and that (b) empirical use of soya preparations from the time of hospital admission is not justified; however, the latter should be considered in infants whose purging rate goes up or diarrheal disease severity worsens 3 to 4 days after the onset of diarrhea or hospital stay and who are passing significant amounts of reducing sugars in their stool.
Development of Exocrine Pancreas Function in Chronically Cannulated Pigs During 1–13 Weeks of Postnatal Life
Authors: Pierzynowski S. G. , Weström B. R. , Svendsen J. , Karlsson B. W.
Published: January 2024

The development of exocrine pancreas function was studied in Swedish Landrace pigs surgically fitted with a chronic pancreatic duct catheter and a duodenal re‐entrant cannula. The juice secretion and output of total protein and trypsin activity were followed before (basal secretion) and after feeding (postprandial secretion) during the first 1–13 weeks of life. The results showed that throughout the suckling period, up to 4–5 weeks of age, the basal pancreas function remained low and the secretory response to feeding, i.e., nursing sow milk, was also low. After weaning, the pancreatic juice secretion as well as the output of protein and trypsin activity markedly increased with respect to both basal and postprandial levels. Furthermore, the enzyme composition of the pancreatic juice changed qualitatively during this period. During the first 2 weeks of life, the intravenous administration of cholecystokinin (CCK) and secretin did not stimulate exocrine function, but a significant effect was achieved from 3–4 weeks of age. These results showed that there was both an increase in exocrine pancreas function and a qualitative change in the hydrolytic enzyme pattern during porcine postnatal ontogeny, apparently correlated with the changes in diet around weaning. An increase in the response of the pancreas to hormonal stimulation was also observed during the suckling period.
Cyclosporin‐Responsive Enteropathy and Protracted Diarrhea
Authors: Coulhard Mark , Searle Jeffrey , Patrick Mark , Ravenscroft Peter , Cleghorn Geoffrey , Shepherd Ross
Published: January 2024

We describe a child born to unrelated parents who developed severe protracted secretory type diarrhea associated with subtotal villus atrophy and intestinal inflammation at the age of 19 months. No infectious, metabolic, or anatomical basis for this condition was identified and the child required total parenteral nutrition for a period of 18 months despite trials of special enteral formulas, steroids, and anti‐inflammatory agents. This refractory “enteropathy” responded dramatically to the introduction of cyclosporin, with cessation of the secretory diarrhea, recovery from the enteropathy, and cessation of parenteral nutrition. The symptoms relapsed when cyclosporin was briefly discontinued and improved following reintroduction of this drug. This experience suggests a role for immune factors in the pathogenesis of the enteropathy in this case and that a trial of cyclosporin is worthy of consideration in similar cases.
Serological Markers and Celiac Disease
Authors: Calabuig M. , Torregosa R. , Polo P. , Tuset L. , Tomás C. , Alvarez V. , Garcia‐Vila A. , Brines J. , Vilar P. , Farré C. , Varea V.
Published: January 2024

We analyze the diagnostic efficacy of two celiac disease serological markers: anti‐gliadin (IgA and IgG class) and anti‐endomysium IgA‐class (EmA‐IgA) antibodies applied to 336 serum samples from celiac patients on both gluten‐challenge and gluten‐free diets, and a control group. The anti‐gliadin and anti‐endomysium antibodies levels were significantly higher among the gluten‐consuming celiac patients than in the other groups. The greatest efficacy in diagnosing celiac disease was achieved in the Ema‐IgA class test. The IgA‐class anti‐gliadin antibodies proved to be more specific, with a higher positive test predictive value than the IgG‐class anti‐gliadin antibodies, whereas the latter proved to be more sensitive, with a higher negative test predictive value than those of the IgA‐class anti‐gliadin antibodies. Our results also demonstrate that the simultaneous assessment of anti‐gliadin IgA‐ and IgG‐class antibodies constitutes a valid test in selecting patients suspected of having celiac disease. In turn the EmA‐IgA antibodies constitute a confirmative test for indication of an intestinal biopsy.
Dermatoglyphic (Fingerprint) Patterns in Celiac Disease
Authors: Weizman Zvi , Vardi Orna , Binsztok Mauricio
Published: January 2024

Fingerprints were obtained from 46 patients with celiac disease and compared with those of 46 control subjects matched for sex and ethnic origin. Whorls were more frequent and ulnar loops were less frequent, significantly, in celiac patients than in controls. A digital pattern of four or more whorls was present in 69% of celiac patients, but in only 28% of controls (p < 0.001). As a diagnostic test, the fingerprint's sensitivity, specificity, and positive and negative predictive values were 66, 73, 67, and 71%, respectively. Similarly, a pattern of four or less ulnar loops was evident in 44% of celiac patients as opposed to only 19% of controls (p < 0.005). Sensitivity, specificity, and positive and negative predictive values were 46%, 81%, 62%, and 63%, respectively. We conclude that particular dermatoglyphic patterns are significantly more common in patients with celiac disease than in controls. We therefore suggest that this marker be used as a diagnostic clue, indicating the need for further investigation.
Comparison of Total Serum Lipids Measured by Two Methods
Authors: Heubi James E. , Sokol Ronald J. , McGraw Catherine A.
Published: January 2024

to accurately assess vitamin E status, the ratio of serum vitamin E to total serum lipids is required. We compared two methods of measuring total serum lipids: (a) the calculated sum of measured cholesterol, triglycerides, and phospholipids, and (b) the colorimetric method. Over the entire range of total lipid concentrations (151–1,728 mg/dl), there was an excellent correlation between methods (r = 0.930; p < 0.001). No significant differences between measurements by these methods were found over the entire range and between 0 and 1,000 mg/dl; however, between 1,000 and 1,728 mg/dl, the measured total lipid concentration was higher (p = 0.023) than the added total lipid measurements. Despite this discrepancy, the methods appear comparable for clinical use in assessing vitamin E/total lipid status; the measured total lipids would be the preferred method because of the low cost and ease of performance of the test.
Nonocclusive Mesenteric Ischemia Associated with Propranolol Overdose
Authors: Pettei Michael J. , Levy Joseph , Abramson Sarah
Published: January 2024

We describe a case of massive propranolol overdose in a healthy 19‐year‐old woman associated with isolated mesenteric ischemia following shock. We postulate that endogenous catecholamine release from shock combined with massive β‐adrenergic blockade led to severe splanchnic vasoconstriction from unopposed α‐adrenergic activity. This case supports current thinking regarding the effect of vasoactive mediators on the gastrointestinal tract in humans and might be relevant to the mechanism of action of propranolol in the prophylaxis of variceal bleeding.
Nodular Gastritis and Helicobacter pylori
Authors: Bujanover Yoram , Konikoff Fred , Baratz Mimi
Published: January 2024

Numerous reports have established the association of Helicobacter pylori and peptic ulcer disease in adults. Recently, this association has also been demonstrated in children. We investigated 14 children and adolescents with recurrent abdominal pain. In six patients, endoscopy revealed gastritis and Helicobacter pylori was identified. Giemsa stain was more sensitive than culture or urease testing in identifying the bacteria. In four of the six, a nodular appearance of the antral mucosa was observed. The histological examination suggests lymphoid hyperplasia as the cause of the nodularity. All of the patients became symptomless after combined treatment with amoxicillin and bismuth subsalicylate. We conclude that nodular gastritis is a peculiar type of gastritis in children. It is frequently found in association with Helico‐bacter pylori infection.
Intestinal Giardiasis Associated with Ophthalmologic Changes
Authors: Mantovani M. Pettoello , Giardino I. , Magli A. , di Martino L. , Guandalini S.
Published: January 2024

In an ophthalmologic study of 90 children with symptomatic giardiasis, ocular alterations were found in 10. Eight of these subjects presented an extensive “salt and pepper” degeneration of the pigmented epithelium involving 360° of the midperiphery of both eyes. In one of the eight children, the pigmented epithelium showed atrophic areas, and in another there was a small hard exudate in the left eye. Of 2 remaining of the 10 children with ocular alterations, 1 presented with slight decoloration of the temporal half of the optic disc, and the other was affected by chorioretinitis. After single‐dose antiprotozoic therapy (tinidazole 50 mg/kg), parasitologic tests were negative in all subjects and remained so throughout a 1‐year follow‐up. However, the characteristic epithelial lesion remained unalterated in all eight children for the entire follow‐up period, as well as the optic disc decoloration in the only observed case. The child affected by chorioretinitis recovered after 3 weeks of combined treatment with bethametasone plus deflazacort. In two control groups, 1 of 200 healthy children and 1 of 200 children with gastrointestinal symptoms but without giardiasis, no case of “salt and pepper” degeneration of the pigmented epithelium or other significant ocular alterations was found.
Measurement of Gastrointestinal pH and Regional Transit Times in Normal Children
Authors: Fallingborg Jan , Christensen Lisbet A. , Ingeman‐Nielsen Margrethe , Jacobsen Bent A. , Abildgaard Kirsten , Rasmussen Henrik H. , Nørby Rasmussen Sten
Published: January 2024

Gastrointestinal pH and regional intestinal transit times of a capsule were measured in twelve healthy children aged 8–14 years using a radiotransmitting pH‐sensitive capsule. The location of the capsule was determined by fluoroscopy. pH in the stomach was 1.5, but rose to 6.4 in the duodenum (mean values). pH gradually rose in the small intestine and reached an alkaline peak value of 7.4 in the distal part. pH dropped to 5.9 in the cecum but rose to 6.5 in the rectum. Median gastric residence time of the capsule was 1.1 h. Small intestinal transit time was 7.5 h, and colonic transit time was 17.2 h. pH profile and intestinal transit times found in the present study are almost identical to values found in studies on healthy adults. It is therefore concluded that the release pattern of pH‐dependent sustained‐release tablets in children is likely to be equal to that of adults.
Enhanced Sodium Absorption by Citrate
Authors: Patra F. C. , Hamidur Rahman A. S. M. , Wahed M. A. , Al‐Mahmud K. A.
Published: January 2024

The effect of citrate on sodium, potassium chloride, and water absorption in the presence of glucose from the whole rat small intestine was studied by an in vivo marker perfusion technique. The perfusion solutions contained glucose and were similar in their electrolyte composition to the currently recommended oral rehydration solution for the treatment and prevention of diarrheal dehydration. Significantly more sodium and water absorption occurred from the citrate‐containing solution than from the one without citrate. It is concluded that citrate enhances net sodium absorption from a glucose electrolyte solution in the rat small intestine independent of glucose‐stimulated absorption.
Cisapride for Intractable Constipation in Children
Authors: Murray Robert D. , K. Li B. Ulysses , McClung H. Juhling , Heitlinger Leo , Rehm Donna
Published: January 2024

Twelve patients with chronic constipation refractory to the vigorous use of emollients, enemas, and/or laxatives were chosen for study of the investigational prokinetic agent, Cisapride. The patients included 8 boys and 4 girls with diagnoses of functional constipation. Ages ranged from 2 to 13 years; duration of symptoms before Cisapride use ranged from 1.5 to 9.75 years; duration of previous treatment ranged from 0.75 to 6 years. The mean number of doses of anticonstipation agents employed per week was 14. Of the 12 patients, 10 had persistent encopresis, while 11 required hospitalization for disimpaction an average of 1.6 times in the year prior to Cisapride use. Three had chronic urinary tract complaints. Anal manometry suggested a sensory deficit in 8 of 10 patients tested. Ganglion cells were identified by rectal biopsy in all 12 patients. Cisapride treatment (0.14–0.3 mg/kg/dose) spanned 26–72 weeks (61 ± 12). Stool frequency per week was not significantly changed, but five of seven patients who had reported hard stools had softer stools on the drug (p < 0.05). Encopresis ceased in 8 of 10 cases, while the number of episodes decreased substantially in the other 2 cases (p < 0.05). All alternate forms of anticonstipation therapy were withdrawn in 8 of 12 cases (p < 0.0001). Urinary problems improved in two of the three patients reporting symptoms. One patient showed no improvement in any parameter while on the agent, despite 26 weeks of administration. Side effects were infrequent, generally occurred early, and were limited to cramping, nausea, mild vomiting, anorexia, and headaches. One patient ceased use of the drug for persistent headaches. This open trial suggests the need for a controlled study of the drug Cisapride for the indication of unremitting constipation and encopresis in childhood.