bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanisms of Feeding Efficiency in Preterm Infants
Authors: Daniëls H. , Casaer P. , Devlieger H. , Eggermont E.
Published: January 2024

Nutritive sucking was studied in 18 preterm infants. Differences in feeding efficiency could not be explained by differences in sucking rate. Quick efficient drinking, however, was characterized by long sucking bursts and by a large amount of milk intake during each sucking movement. Slow inefficient drinking was characterized by short sucking bursts and by a small amount of milk intake during each sucking movement.
Lipid Composition of Prepartum Human Mammary Secretion and Postpartum Milk
Authors: Bitman Joel , Freed Lois M. , Neville Margaret C. , Wood D. L. , Hamosh Paul , Hamosh Margit
Published: January 2024

Changes in lipid composition of mammary secretions of five women were studied at two prepartum periods and compared with composition of colostrum, transitional, and mature human milk. Fat content was ∼1 g/dl during early (‐42.0 days before parturition) and late (‐9.5 days) prepartum periods and increased to 3–4 g/dl in colostrum (3.0 days post partum), transitional (7.2 days), and mature milk (56.2 days). Most of the lipid present was triglyceride either pre‐ (93%) or post‐ (97%) partum. All fat globule core lipids, with the exception of 1,3‐diglycerides, increased from prepartum concentrations to levels usually found in milk. Prepartum secretions contained higher amounts of the membrane components, phospholipid (3.2 g/dl), cholesterol (2.3 g/dl), and cholesteryl ester (1.1 g/dl), which declined postpartum to 0.65, 0.37, and 0.09 g/dl, respectively. Thus, the content of core lipids exhibited an opposite pattern to the content of membrane lipids pre‐ and postpartum. With regard to synthesis of fatty acids, prepartum secretory mechanisms appeared to be very similar to those occurring postpartum since fatty acid composition of prepartum secretions closely resembled that of postpartum milk.
Inactivation of Bile‐Salt‐Stimulated Human Milk Esterase
Authors: O'Connor Charmian J. , Longbottom John R. , Walde Peter
Published: January 2024

The activity of bile‐salt‐stimulated esterase was monitored in human milk during storage at room temperature, in a refrigerator (4°C), in a freezer (‐ 19°C), and in milk that had been freeze dried and rehydrated after storage of the lypophilized milk at 4°C and ‐ 19°C. In all cases, there was some loss of activity, independent of measurement in the presence or absence of sodium taurocholate, and the loss was highest in milk stored at room temperature, approximating a 50% loss in 1–2 days. Activation and inactivation of solutions of the purified enzyme have been identified by measuring its esterase activity against a variety of 4‐nitrophenylalkanoate esters at pH 7.3 within the temperature range 5–46.5°C. The optimum temperature was 42°C. The presence of bile salt partially serves to maintain the conformation of the bile‐salt‐binding site as the esterolytic binding site becomes inactivated at 50°C. Bile salts thus exert a positive template effect on the enzyme.
Developmental Differences in the Effect of Natural Feeding on Early Enteric Mucosal Growth of Guinea Pigs
Authors: Thompson John F. , Singh Malathy , Wang Yvonne , Zucker Christine , Heird William C.
Published: January 2024

In contrast to observations in other species, neither enteric mucosal weight, protein content, nor DNA content of either the suckled or artificially fed guinea pig changes over the first 24 h following term birth. In guinea pigs delivered 5 days prematurely, however, statistically significant increases in proximal enteric mucosal mass (38%), protein content (51%), and DNA content (35%) occur in suckled animals over the first 24 h of life but not in artificially fed animals. These observations illustrate that the enteric mucosal hyperplasia secondary to natural feeding, quantitatively and temporally, is species‐specific and suggest that this effect is manifested only during a finite period of intestinal development. They raise doubts, therefore, concerning the importance of early enteric mucosal hyperplasia in adaptation of all species to extrauterine life.
Budd‐Chiari Syndrome in a Premature Infant Receiving Total Parenteral Nutrition
Authors: McClead Richard E. , Birken Gary , Wheller John J. , Hansen Nancy B. , Bickers Rex G. , Menke James A.
Published: January 2024

A premature infant who developed Budd‐Chiari syndrome as a complication of total parenteral nutrition through an inferior vena cava catheter is presented. A novel approach to the treatment of this otherwise lethal condition is described. This very unusual complication in pediatric patients may be seen with increased frequency as more premature infants are treated with central vein total parenteral nutrition.
Statistical Analysis of Symptoms and Signs in Pediatric Patients with Peptic Ulcer
Authors: Tomomasa T. , Hsu J. Y. , Shigeta M. , Itoh K. , Ohyama H. , Terashima N. , Kambe Y. , Aoki S. , Kuroume T.
Published: January 2024

It is not well known which symptoms or signs related to peptic ulcer are crucial for its diagnosis in children. In order to clarify this problem, we evaluated the sensitivity, specificity, and positive and negative predictability of 13 ulcer‐related symptoms and signs. The data of 160 patients, who were suspected of having peptic ulcer and had undergone endoscopic examinations, were studied. It was significant that five symptoms, i.e., presence of pain in the epigastrium, relationship between the time of pain and that of eating, family history, vomiting, and bleeding, were frequently found in ulcer patients. There was, however, no symptom or sign that predicted by itself precisely the existence of a peptic ulcer. Thus, we computed a discriminant function by combining the data by multivariate analysis. With this score, we could predict the existence of ulcer more precisely. Finally, it was concluded (a) that epigastric pain, food‐related pain, vomiting, bleeding, and family history were crucial factors for the diagnosis of peptic ulcer in childhood and (b) that an overall consideration of symptoms and signs was needed for the evaluation of these factors.
Effect of Metoclopramide on Prolonged Intraesophageal pH Testing in Infants with Gastroesophageal Reflux
Authors: Hyams Jeffrey S. , Leichtner Alan M. , Zamett Lorna O. , Walters J. Ken
Published: January 2024

The effect of metoclopramide (MCP) on prolonged intraesophageal pH testing was evaluated in 42 infants with gastroesophageal reflux (GER). Following a baseline period of intraesophageal pH monitoring, MCP was administered by injection at 0.1 mg/kg/dose (10 patients), 0.2 mg/kg/dose (11 patients), or 0.3 mg/kg/dose (21 patients). The percentage of time of intraesophageal pH less than 4, reflux frequency, and acid clearance time were calculated for each subject before and after MCP for both 5% dextrose and formula feedings. These parameters were further separated into 2‐hour or shorter and more than 2‐hour postprandial periods. No significant differences with either type of feeding were noted at either 0.1 or 0.2 mg/kg/dose. Significant decreases in the percentage of time the intraesophageal pH was less than 4 (30.0 ± 2.9 versus 15.6 ± 3.1, p = 0.001), the reflux frequency (episodes/hour; 6.5 ± 0.9 versus 4.0 ± 0.6, p = 0.004), and the acid clearance time (minutes/episode; 3.8 ± 0.7 versus 2.2 ± 0.3, p = 0.047) were noted in the 2‐hour or shorter period following 5% dextrose feedings but not following the formula feedings in the subjects receiving 0.3 mg/kg/dose. Three of the 42 study patients developed increased irritability, and one developed dystonia following MCP. These data suggest that if a clinical trial of MCP in infants with GER is performed, a larger dose of the medication than previously appreciated might be required.
Duodenal Microflora in Infants with Acute Diarrheal Disease
Authors: Househam K. C. , Mann M. D. , Mitchell J. , Bowie M. D.
Published: January 2024

The duodenal microflora was determined qualitatively and quantitatively in a group of infants early in the course of diarrheal disease. Abnormal bacterial overgrowth in the duodenal aspirate was demonstrated in 70%. Coliforms and bacteroides species were present in significant numbers in 53%. No differences were found in the duodenal microflora distinguishing infants whose diarrhea persisted after 7 days in the hospital from those whose diarrhea resolved earlier.
Effects of Neonatal Undernutrition and Subsequent Nutritional Rehabilitation or Administration of Thyroxine and Hydrocortisone on the Inositol Phosphatase Activities in Rat Intestine
Authors: Rao R. K. , Ramakrishnan C. V.
Published: January 2024

Undernutrition during the suckling period imposed by maternal protein deficiency during lactation resulted in elevated inositol triphosphatase activity (units per gram of wet tissue) in the ileum and lower phytase activity in the duodenum and jejunum. Activities of inositol triphosphatase in the duodenum and jejunum and phytase in ileum were unaffected. Postweaning nutritional rehabilitation resulted in elevated specific activities of both enzymes in all segments; however, activities of whole segments were similar to the corresponding control values. Elevation of inositol triphosphatase (ileum) and decline of phytase (duodenum and jejunum) activities due to undernutrition were reversed by the administration of hydrocortisone or thyroxine during undernutrition. These results suggest that maturation of activities of inositol triphosphatase in ileum (by hydrocortisone) and phytase in all segments (by both hydrocortisone and thyroxine) is under hormonal regulation, and the effects of neonatal undernutrition may be partly due to hormonal imbalances.
Hepatic Failure Following Ingestion of Multiple Doses of Acetaminophen in a Young Child
Authors: Smith David W. , Isakson Gordon , Frankel Lorry R. , Kerner John A.
Published: January 2024

A 7‐month‐old male developed hepatic failure following the mistaken administration of multiple excessive doses of acetaminophen. Hepatic toxicity following multiple dose ingestion has been reported infrequently.

Risk factors for hepatic toxicity following multiple dose ingestion are discussed.
A Single Case of Hypophosphatemic Rickets with Hypercalciuria
Authors: Nishiyama Soroku , Inoue Fumitaka , Matsuda Ichiro
Published: January 2024

A single case of hypophosphatemic rickets with hypercalciuria and an elevated level of serum 1,25 dihydroxyvitamin D is reported. The characteristic features (genu valgum, rickets, short stature, increased renal phosphate excretion, decreased serum phosphorus level, elevated serum alkaline phosphatase level, and normal serum calcium level) were comparable to those in hypophosphatemic vitamin D resistant rickets. Massive doses of lα‐hydroxyvitamin D were not effective for the rickets and the biochemical defect in this patient. Long‐term phosphate supplementation on its own resulted in the reversal of all clinical and biochemical abnormalities except for the decreased ratio between the maximum tubular reabsorption rate for phosphorus and the glomerular filtration rate. In this patient, the concentration of serum 1.25 dihydroxyvitamin D seemed to be controlled by the concentration of serum phosphorus rather than by the serum parathyroid hormone level. It is noted that this is the first case of a single hypophosphatemic rickets with hypercalciuria.
Nutritional Regulation of Immunity and Infection
Authors: Chandra Ranjit Kumar
Published: January 2024

Malnutrition is the most common cause of acquired immune dysfunction worldwide. Nutritional deficiencies, excesses, and imbalances influence specific components of the immune system. The severity of immunological impairment depends upon the extent and nature of undernutrition, the presence of infection, and the age of onset of nutritional deprivation. Profound immunological changes occur in children with marasmus and kwashiorkor as well as in deficiencies of vitamins A, E, B6, folate, zinc, iron, copper, and selenium. On the other hand, obesity and excessive intake of several vitamins, minerals, cholesterol, and polyunsaturated fatty acids also impair immunocompetence. These epidemiological observations and immunological phenomena are of practical significance in clinical practice.
Enteric Protein Loss Measured by Fecal α1Antitrypsin Clearance in the Assessment of Crohn's Disease Activity
Authors: Griffiths Anne M. , Drobnies Adrienne , Soldin Steven J. , Hamilton J. Richard
Published: January 2024

We compared conventional measures of disease activity with 24‐h fecal α1antitrypsin clearance in 59 children and adolescents with Crohn's disease and 30 with ulcerative colitis. Among the Crohn's patients clearance was increased significantly in those with abnormal erythrocyte sedimentation rates (ESR) (>15 mm/h, p < 0.005) and diminished serum albumin (<35 g/L, p < 0.005), but not in those with an abnormal Crohn's disease activity index (CDA1 < 150). Correlation between α1‐antitrypsin clearance and ESR was poor (r = 0.17) as with CDAI (r = 0.09). We conclude that severity of enteric protein loss is not closely related to the degree of abnormality of commonly used measures of disease activity in young patients with Crohn's disease. In contrast, in patients with ulcerative colitis, α1antitrypsin clearance correlated more consistently with clinical assessment of inflammatory activity (p < 0.001).
Vitamin K Deficiency in Breast‐Fed Infants at One Month of Age
Authors: Motohara Kunihiko , Endo Fumio , Matsuda Ichiro
Published: January 2024

PIVKA‐II (protein induced by vitamin K absence or antagonist‐II) was measured, as an indicator of vitamin K deficiency, in breast‐fed infants of ∼1 month of age. The infants consisted of three different groups: untreated (group 1); those given 5 mg vitamin K once at birth (group 2); and those given 5 mg twice, at birth and at 14 days after birth (group 3). At 1 month of age, the rate of PIVKA‐II‐positive infants and their PIVKA‐II levels were significantly reduced in group 3 as compared with the levels of the other two groups, whereas these parameters were similar between groups 1 and 2. This observation suggested that vitamin K administration once at birth may be unsafe by 1 month of age. An additional administration of vitamin K seemed to be necessary for complete prevention of vitamin K deficiency, causing severe bleeding in breast‐fed infants of ∼1 month of age.
Tocopherols in Human Milk
Authors: Lammi‐Keefe Carol J.
Published: January 2024

A procedure for the determination of tocopherols in human milk using normal phase high‐performance liquid chromatography (HPLC) is described. The method involves extraction of the total lipid from milk and direct injection of the dissolved lipid into the HPLC without further fractionation. Operating conditions are as follows: instrument, Varian Model 5000 Liquid Chromatograph; column, Alltech‐NH2 (25 cm × 4.6 mm); solvents, n‐hexane:2‐propranol (98:2); flow rate, 2.0 ml/min; detector, 290 nm; and absorbance range, 0.01. Chromatographic separation of the tocopherol isomers, α, (β, γ, and δ, was achieved. The tocopherol isomers of milk were separated, allowing quantitation of α‐ and ‐γ‐tocopherol, the predominant milk isomers. Good recovery, reproducibility, and precision for the method were demonstrated.
Congenital Stenosis of the Esophagus Due to Tracheobronchial Remnants
Authors: Shoshany G. , Bar‐Maor J. A.
Published: January 2024

Lower esophageal strictures in infants in more than 90% of cases are related to reflux esophagitis, while the remainder are congenital or induced by injuries such as penetrating trauma or corrosion by caustic agents. Among congenital disorders cartilaginous remnants in the esophagus are very rare, but it is a possibility that should always be considered, especially if signs of esophagitis are not seen on esophagoscopy. The first aim, when evaluating the vomiting or regurgitating infant, is to establish whether this is due to an organic disorder. When stricture of the esophagus becomes evident following prolonged vomiting, clinicians tend to attribute this to reflux with peptic injury, and in most of the cases that will be correct (1). Carefully performed investigation will bring forth those rare etiologic factors that can be easily overlooked (2). The investigation has to include radiographic studies, esophagoscopy, pH monitoring, and in selected cases, manometry. Recognition of the correct etiologic factor that caused the stricture will pave the way for adequate management. We report on two patients with congenital stenosis of the lower esophagus due to cartilaginous rings, one of which was diagnosed preoperatively.
Reversible Valproate Fulminant Hepatic Failure
Authors: Colletti Richard B. , Trainer Thomas D. , Krawisz Bruce R.
Published: January 2024

Valproate fulminant hepatotoxicity, usually fatal, is believed to be idiosyncratic and metabolic without an immunologic basis. There are no previous reports of a hypersensitivity reaction among numerous cases of fatal valproate fulminant hepatitis. Little is known about the electron microscopical features of valproate hepatitis. We report a case of reversible fulminant hepatitis attributable to valproate with clinical and histological characteristics of a hypersensitivity reaction. Electron microscopical findings included microvesicular steatosis with normal‐appearing mitochondria.
Differential Distribution of Digestive Enzymes in Isolated Epithelial Cells from Developing Human Fetal Small Intestine and Colon
Authors: Ménard Daniel , Pothier Pierre
Published: January 2024

Summary: The human fetal colon has morphological and biochemical characteristics similar to that of the small intestine during development. A comparative study of these two organs was undertaken by selectively isolating their respective epithelium at different ages of gestation. Histological and biochemical analysis revealed a complete and selective removal of the epithelium from the underlying tissue regardless of their stage of development. Intestinal and colonic epithelial cells showed substantial differences with respect to protein content and distribution. All brush border membrane enzymes studied were present in the colon, although in much lower quantities than in the corresponding intestine. Between 90 and 99% of total disaccharidases. glucoamylase and γ‐glutamyl transpeptidase activities were recovered in the isolated cells. Epithelial content and distribution of alkaline phosphatase (ALP) activity differed markedly, however, between these two tissues. More than 45% of intestinal ALP activity was of nonepithelial origin at 15 weeks, and this percentage increased in a craniocaudal fashion to reach >93% in the 18‐week‐old colon. Inhibition studies using phenylalanine and levamisole showed that these intestinal and colonic isoenzymes are similar in nature although they differ in their respective distribution. The use oi pure fractions of epithelial cells provides an ideal system in which to compare specifically the functional development of intestinal and colonic epithelium.
Pyloric Stenosis and Eosinophilic Gastroenteritis in Infants
Authors: Snyder John D. , Rosenblum Norman , Wershil Barry , Goldman Harvey , Winter Harland S.
Published: January 2024

Eosinophilic gastroenteritis is known to cause gastric outlet obstruction in adults, but has been reported only rarely in infants presenting with pyloric stenosis, a common form of gastric outlet obstruction in children. We describe two infants who presented with classic clinical and radiographic evidence of pyloric stenosis and who were found to have histologic evidence of eosinophilic
Effect of Intralipid on the Phagocytic and Microbicidal Capacity of Human Monocytes in Culture
Authors: Padeh S. , Shor R. , Passwell J. H.
Published: January 2024

We studied the effect of Intralipid (ID in monocyte cultures based on the ability of the cultures to phagocytose and kill Candida albicans and produce the oxidative burst. The IL was taken up by monocytes in cultures, and these cells phagocytosed more Candida organisms than did the control cells [85 ± 2.2% in the IL treated (1%) compared to 68 ± 2.3% after 1 h in the control). The percentage of killing of Candida albicans, which had been taken up by the IL‐treated monocytes measured after 2 h in culture (48.3 ± 6.0%), was no different when compared to control (47.0 ± 5.8%). Following ingestion of IL. there was an increase in basal H2O2 production, however, the presence of the IL in the cells had no effect on the expected increase in H2O2 production following stimulation with either phorbol myris‐tate acetate (PMA) or zymosan particles. Compared to untreated cells, a significant increase in the number of monocytes with positive nitroblue tetrazolium staining was observed in monocytes that had ingested IL (when they were stimulated with either PMA or Candida microorganisms). Similar results were obtained in monocyte‐derived macrophages (i.e., monocytes in monolayer cultures for 10 days). These findings suggest that the essential monocyte functions of phagocytosis, microbicidal activity, and ability to elicit an oxidative burst are not directly altered by the conventional use of IL in clinical practice. Intralipid
Bile Salt‐Stimulated Lipase of Human Milk
Authors: Freed Lois M. , York Carla M. , Hamosh Paul , Mehta Nitin R. , Hamosh Margit
Published: January 2024

Human milk contains a lipase (bile salt‐stimulated lipase) that is considered to have an important role in infant fat digestion. In this study we compared the characteristics of bile salt‐stimulated lipase activity in milk samples from mothers delivering prematurely (26–30 and 31–37 weeks of gestation) and in milk from mothers delivering at term (38–42 weeks of gestation). Preterm milks were collected at day 1–5 and during week 6 of lactation. Term milks were collected during week 6 of lactation. The characteristics of the enzyme (kinetics. enzyme concentration, pH optimum, and pH stability, effects of bile salt structure and concentration, eserine inhibition) were identical regardless of length of pregnancy or duration of lactation. Bile salt‐stimulated lipase had a neutral to alkaline pH optimum (pH 7.3–8.6), was stable for 1 h at a wide pH range (pH 3.1–8.6), was active only in the presence of primary bile salts, and was inhibited by eserine. The data indicate that, following parturition at as early as 26 weeks of gestation, the mammary gland synthesizes bile salt‐stimulated lipase with identical characteristics as does the mammary gland after a full‐term pregnancy.
Vitamin E in Human Milk from Mothers of Preterm and Term Infants
Authors: Haug Martin , Laubach Christel , Burke Mechthild , Harzer Gerd
Published: January 2024

The content of vitamin E (α‐and β + γ‐to‐copherol) was analyzed in 63 human milk samples obtained from 13 mothers of preterm infants (“preterm” milk) and in 59 milk samples obtained from nine mothers of full‐term infants (“term” milk). The changing pattern of the α‐and (β + γ‐tocopherol content during the course of lactation was identical for both groups. Total vitamin E, α‐as well as (β + γ‐tocopherol, decreased during the first 2 weeks of lactation and remained constant thereafter. The ratio of α‐to β + γ‐tocopherol decreased from about 10:1 to 4:1. At days 3 and 36 of lactation, vitamin E contents (median values and ranges) expressed as milligrams α‐tocopherol equivalent per 100 ml were 1.45 (0.64–6.4) and 0.29 (O.I7–0.48). respectively, for preterm and 1.14 (0.63–4.21) and 0.28 (0.19–0.86). respectively, for term human milk. The vitamin E. α‐tocopherol and (β + γ‐tocopherol content of preterm human milk did not differ significantly (p ≤ 0.05) from that of term human milk at each sampling day. Based on these findings we conclude that the increased requirement of prematures for vitamin E is not reflected in the vitamin E content of milk from mothers delivering preterm infants.
The Incidence of Childhood Celiac Disease in Sweden
Authors: Stenhammar L. , Ansved P. , Jansson G. , Jansson U.
Published: January 2024

Within a defined population in southeast Sweden, celiac disease was diagnosed in 167 children born between 1970 and 1982. The diagnosis was based on the criteria of the European Society for Paediatric Gastroenterology and Nutrition. Another six children had an initial flat small intestinal mucosa but do not yet fulfill the criteria for the diagnosis of celiac disease. The incidence of celiac disease was 1.27/1,000 live births for the years 1970–1976 and 1.43/1,000 for 1977–1982. In contrast to our findings, a decline in the disorder during the late 1970s was reported from other countries. We discuss the observation that the incidences of celiac disease in children are moving discrepantly in different populations.
Serum Transthyretin Levels and Protein Intake as Predictors of Weight Gain Velocity in Premature Infants
Authors: Georgieff Michael K. , Sasanow Sharon R. , Pereira Gilberto R.
Published: January 2024

Nutritional intakes, transthyretin (prealbumin) levels, and anthropometric measurements were measured weekly in 26 preterm infants from week 2 of life throughout hospitalization. A sustained significant increase in protein intake occurred in 14 infants over a 2‐week period. When mean protein intake increased, mean transthyretin levels increased during the same week (p < 0.001), followed 1 week later by significant increases in mean weight, occipitofrontal head circumference (OFC), and mid‐arm circumference (MAC). In the other 12 infants, a sustained significant decrease in protein intake occurred over 2 weeks. When mean protein intake decreased (p < 0.01), transthyretin levels decreased during the same week (p < 0.05), followed I week later by significant decreases in mean weight and MAC growth. Over all hospitalization weeks (n = 95), rates of weight gain were more significantly associated with previous trends in transthyretin levels (p = 0.007) than with protein intake alone (p = 0.08). In particular, declines in rates of weight gain were predicted significantly more frequently by the prior week's transthyretin trend (70%) than by the trend in protein intake (47%). In growing premature infants, changes in transthyretin levels occur 1 week before changes in anthropometric measurements. Changes in transthyretin levels are more predictive than changes in protein intake alone for monitoring growth velocity in preterm infants.
Failure of Blind Small Bowel Biopsy in the Diagnosis of Intestinal Lymphangiectasia
Authors: Hart Michael H. , Vanderhoof Jon A. , Antonson Dean L.
Published: January 2024

A case of primary intestinal lymphangiectasia is presented in which multiple blind peroral jejunal biopsies were unable to document any abnormality, despite strongly suggestive clinical history and radiographic findings. Endoscopically directed biopsy was necessary to document the characteristic pathologic lesion. This report documents the importance of endoscopy in the diagnosis of intestinal lymphangiectasia when clinical history is suggestive of intestinal lymphangiectasia but standard small bowel biopsy fails to show any abnormality.
Long‐Term Effects of Early Kwashiorkor Compared with Marasmus. II. Intellectual Performance
Authors: Galler Janina R. , Ramsey Frank C. , Forde Victor , Salt Patricia , Archer Esther
Published: January 2024

Intellectual performance including IQ (Wechsler Intelligence Scale for Children‐Revised) and conservation was measured at ages 11–18 years in a follow‐up study of Barbadian girls and hoys who had histories of kwashiorkor (n ‐ 53) or marasmus (n ‐ 55) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n ‐ 58). On both IQ and conservation tests, children with previous kwashiorkor or marasmus had similar scores, which were significantly lower than scores of healthy comparison children. These findings were examined in relationship to current environmental conditions, which were similar in children with histories of kwashiorkor or marasmus and somewhat less advantaged than those of the comparison children. The effect of early malnutrition and related conditions at the time of the episode still emerged as significant even when the current environmental factors were controlled for.
Plasma and Urine Zinc in Infants and Children with Extrahepatic Biliary Atresia
Authors: Hambidge K. M. , Krebs N. E. , Lilly J. R. , Zerbe G. O.
Published: January 2024

The objective of this study was to undertake a pilot assessment of zinc status in infants and children with extrahepatic biliary atresia. Plasma zinc concentrations and urine zinc excretion rates were measured longitudinally in 45 infants and young children with this disorder. The mean (‐ SD) plasma zinc (298 observations) was 56.8 ‐ 17.9 μg dl (controls 85.6 ‐ 10.8). Plasma zinc was not correlated with age and did not appear to he related to repeated surgical procedures or to episodes of cholangitis. Plasma zinc was only weakly correlated with serum albumin (r ‐ 0.27, p ‐ 0.001). The 24‐h urine zinc excretion rates were correlated with age but not so strongly as for normal children. Hyperzincuria was evident from the linear regression equation of 24‐h urine zinc on age. On a body weight basis, urine zinc excretion rates were 6 times normal for the first 2 years and remained high across the entire age range, to replace these losses, net zinc absorption would need to increase by 40%. The relationship of these data to the zinc nutritional status of these patients and to their underlying hepatic disease remains to be clarified by more definitive studies.
Hepatobiliary Scintigraphy with Technetium‐99m Disofenin in the Evaluation of Neonatal Cholestasis
Authors: Cox Kenneth L. , Stadalnik Robert C. , McGahan John P. , Sanders Kathleen , Cannon Robert A. , Ruebner Boris H.
Published: January 2024

To assess the reliability of technetium‐99m disofenin scanning in evaluating neonatal cholestasis. 33 neonates (3 months of age) with direct hyperbilirubinemia were evaluated prospectively by cholescintigraphy. Results of this test were compared to those of standard serum tests of liver function, ultrasonography, and liver biopsy. The diagnosis of biliary atresia was suggested by a serum γ‐glutamyl transpeptidase (γ‐GTP) 300 units, absence of the gallbladder on ultrasonography, and a lack of delectable radioisotope in the gastrointestinal and or extrahepatic biliary tract on cholescintigraphy. Each of these tests lacked sensitivity and or specificity when compared to liver biopsy. Of the nine neonates with biliary atresia, three had gallbladders identified In ultrasonography and two had γ‐GTP 300 units Of the 24 neonates without biliary atresia, eight had cholescintigraphy without detectable radioisotope excretion, four had ultrasonography that failed to visualize the gallbladder, and nine had γ‐GTP 300 units. Cholescintigraphy excluded the diagnosis of biliary atresia when gut and or extrahepatic biliary excretion of isotope was seen. However, cholescintigraphy required more time. 6–8 days, and was less specific than ultrasonography and liver biopsy. We recommend that cholescintigraphy should not be routinely used in evaluating neonatal cholestasis, especially if it delays surgical intervention.
Serum Pepsinogen I in Childhood Duodenal Ulcer
Authors: Tam P. K. H.
Published: January 2024

To delineate possible genetic factors invoked in the pathogenesis of childhood duodenal ulcer (DU), serum pepsinogen I concentrations were measured in 14 patients and their parents. Sixty‐five normal subjects were simultaneously studied to determine normal values in relation to age. Hyperpepsinogenemia occurred in six of 14 patients and 13 of 28 parents. Hyperpepsinogenemic patients invariably had hyperpepsinogenemic parents, four of six having both parents affected. Hyperpepsinogenemic parents (10 of 13) usually but not invariably gave birth to hyperpepsinogenemic patients. Most hyperpepsinogenemic parents (11 of 13) were asymptomatic. Our findings suggest a genetic basis (hyperpepsinogenemia) for the predisposition to childhood DU in nearly half the patient population, the inheritance being likely to be autosomal dominant with incomplete penetrance. In addition, the existence of normopepsinogenemic families suggests that childhood DU is a heterogeneous entity and not a single disease. A high familial incidence of DU is also present in the normopepsinogenemic subgroup (four of eight) but whether genetic factors or socioenvironmental factors are responsible here will require elucidation from studies with other markers.
Neonatal Gallbladder Enlargement and α‐Antitrypsin Deficiency
Authors: Gremse David A. , Peevy Keith J. , Simon Neal , Wiseman Hollis J.
Published: January 2024

Patients with clinical signs of α1‐antitrypsin deficiency in the neonatal period usually present with prolonged obstructive jaundice. We report a patient with α1antitrypsin deficiency who presented with gallbladder enlargement in the neonatal period. This gallbladder enlargement may be due to cystic duct hypoplasia or atresia. which has been reported in association with α1‐antitrypsin deficiency. The diagnosis of α1‐Antitrypsin deficiency should be considered in neonates with gallbladder enlargement and prolonged obstructive jaundice.
Marked Basal Gastric Acid Hypersecretion and Peptic Ulcer Disease
Authors: Hyman Paul E. , Hassall Eric
Published: January 2024

Three children with peptic ulcer disease had recurrent symptoms unresponsive to cimetidine or ranitidine therapy alone. Acid secretory studies showed a marked basal acid hypersecretion, which was atropinesensitive in two of three patients and was best suppressed by ranitidine in combination with an anticholinergic drug. Marked reduction in acid output following intravenous atropine suggested that the hypersecretion was under vagal, muscarinic control. However, in one patient, large doses of the selective m1‐muscarinic antagonist pirenzepine were ineffective in suppressing basal acid hypersecretion. Given the efficacy and safety of drug therapy used in these children over a 3‐year period, we conclude that medical management is an effective alternative to surgery for pediatric patients with refractory or recurrent peptic ulcer disease.
Comparison of Two Special Infant Formulas Designed for the Treatment of Protracted Diarrhea
Authors: Galeano Narmer F. , Lepage Guy , Leroy Claudie , Belli Dominique , Levy Emile , Roy Claude C.
Published: January 2024

The nutritional management of intractable diarrhea and short bowel syndrome remains a challenging problem. The advantage of continuous nasogastric infusion is undisputed, but what to feed remains in question, and no studies, to these authors' knowledge, have yet compared two widely used specially designed protein hydrolysate formulas. A randomized crossover trial of two periods of 7 days was carried out with Alfare and Pregestimil administered by a constant infusion pump in six malnourished infants aged 1–13 months. Two had intractable diarrhea, and four the short bowel syndrome. Identical quantities of calories were administered during the two periods. There was good tolerance for both formulas and satisfactory weight gain. Despite compositional differences related to osmolality, the source of the hydrolysates and their profile, and the qualitative pattern of the carbohydrates, no difference was observed with regard to stool weight, Na+ and K+ losses, and the enteral absorption of fat, carbohydrate‐derived energy, and total energy. The percent absorption of nitrogen was somewhat higher (p < 0.01) with Pregestimil (83.8 ± 2.7) than with Alfare (77.3 ± 3.4), but nitrogen retention was unaffected. Energy absorption was the same on both formulas, but maldigested or malabsorbed carbohydrates accounted for 63% of total energy loss during Alfare feeding and 72% during the week of Pregestimil. These data call for studies with protein hydrolysate formulas reformulated with a lower concentration of carbohydrates and a higher one of fat.
Motilin Levels in Term Neonates Who Have Passed Meconium Prior to Birth
Authors: Mahmoud Eugene L. , Benirschke Kurt , Vaucher Yvonne E. , Poitras Pierre
Published: January 2024

Motilin levels were measured by radioimmunoassay from umbilical cord blood obtained at birth from 38 term neonates (median gestational age 40 weeks, range 39–42 weeks). Birth weights of these neonates ranged from 2,840 to 4,593 G (median 3,600 G). Forty‐two percent (16/38) of these neonates passed antenatal meconium.

The median motilin level was 177 fmol/ml in those neonates who passed antenatal meconium and 111.5 fmol/ml in those neonates who did not pass meconium prior to birth (p < 0.01). Although fetal distress has been found to be associated with elevated motilin levels at birth, such an association was not found in this study. These data support an association between elevated motilin levels at birth and antenatal meconium passage.
Giant Inflammatory Polyposis Causing Partial Obstruction and Pain in “Healed” Ulcerative Colitis in an Adolescent
Authors: Adelson Joel W. , deChadarévian J. ‐P. , Azouz E. Michel , Guttman Frank M.
Published: January 2024

A 16‐year‐old boy with chronic ulcerative colitis developed unexplained increasingly intractable abdominal pain and rectal bleeding over several months during a period when acute colitic attacks were quiescent. No abdominal mass was palpable. The cause of symptoms was subtotal colonic obstruction due to the development of massive or giant inflammatory (pseudo) polyposis, which had caused nearly complete obliteration of the lumen of the transverse colon. The radiological and histopathological findings are presented; this case confirms the conclusion drawn in a recent retrospective surgical pathology report that giant inflammatory polyposis may produce distinct symptoms, especially pain, independent of the existence of relatively quiescent underlying inflammatory bowel disease. This unusual complication of inflammatory bowel disease deserves greater clinical awareness.
An Electron Microscopic Investigation of Time‐Related Changes in the Intestine of Neonatal Mice Infected with Murine Rotavirus
Authors: Osborne M. P. , Haddon S. J. , Spencer A. J. , Collins J. , Starkey W. G. , Wallis T. S. , Clarke G. J. , Worton K. J. , Candy D. C. A. , Stephen J.
Published: January 2024

Seven‐day‐old mice were infected orally with murine rotavirus (EDIM) and regions of the gut examined at 24 h intervals up to 7 days by electron microscopy. Structural changes were correlated with data on viral antigen production, thymidine kinase activity, and clinical signs of diarrhea. No pathological changes were detected in the colon. Infection and structural damage were confined to the small intestine, with middle regions showing the most pronounced changes. Constriction of villus bases, edema of the lamina propria, and vacuolation of enterocytes occurred at 24 h postinfection (PI), i.e., before evidence of major virus replication. Transient villus atrophy occurred at 48 h PI. Recovery of villus length was evident by 72 h PI accompanied by evidence of marked enterocyte replication at villus bases. Many enterocytes were damaged with little evidence for the presence of virus particles. By 96 h PI, villi had almost recovered from infection although some enterocytes were still damaged; no virus particles were detected in these cells. A second phase of villus damage and edema of the lamina propria occurred at 120 h PI; the pathology resembled that at 24–48 h PI. By 144 to 168 h PI, recovery of the mucosa from infection was virtually complete. We suggest that many of the pathological features following rotavirus infection result from rotavirus‐induced ischemia of villi and that diarrhea results from malabsorption of fluid by damaged villi and hypersecretion of ions released from increased numbers of dividing cells at villus‐crypt borders.
Intestinal Enzyme Profiles in Normal and Rotavirus‐Infected Mice
Authors: Collins J. , Starkey W. G. , Wallis T. S. , Clarke G. J. , Worton K. J. , Spencer A. J. , Haddon S. J. , Osborne M. P. , Candy D. C. A. , Stephen J.
Published: January 2024

To investigate further the pathophysiology of rotavirus‐induced diarrhea, changes in specific activities of eight relevant intestinal enzymes [alkaline phosphatase, thymidine kinase, lactase, maltase, sucrase, Na+,K+‐adenosine triphosphatase (ATPase), adenylate and guanylate cyclases] were measured following infection of suckling mice with murine rotavirus (epizootic diarrhea of infant mouse strain) and compared with age‐matched control mice. The concentration of lactose within the lumen of the gastrointestinal tract during infection was also measured. During the course of infection, activities of alkaline phosphatase and lactase decreased, whilst the activity of thymidine kinase increased. Precocious maturation profiles of sucrase and maltase enzymes were observed. No significant changes were detected in the activities of Na+,K+‐ATPase or the adenylate and guanylate cyclases. These results are discussed in relation to existing and novel hypotheses on the pathogenesis of rotavirus‐induced diarrhea.
Vitamin D Metabolism in Biliary Atresia
Authors: Kimura Saburo , Seino Yoshiki , Harada Tokuzo , Nose Osamu , Yamaoka Kanji , Shimizu Kazuo , Tanaka Hiroyuki , Yabuuchi Hyakuji , Fukui Yuichi , Kamata Shinkichi , Okada Akira
Published: January 2024

In children with biliary atrcsia, defective intestinal absorption of vitamin D and impaired hepatic uptake and 25‐hydroxylation of vitamin D lead to a deficiency of vitamin D and rickets. We recently observed severe rickets in a 3‐year‐old boy with corrected biliary atrcsia resulting in jaundice, despite oral treatment with 1α‐hydroxyvitamin D, (1α‐OHD,) or 1,25‐dihydroxyvitamin D, [1,25‐(OH)2D3]. He had low 25‐hydroxyvitamin D (25‐OHD) and high 1.25‐(OH)2D serum levels. Intramuscular vitamin D2 administration produced radiological and biochemical evidence of recovery. Oral 1.25‐(OH)2D3 (O.1 μg/kg) and 25‐OHD3 (10 μg/kg) tolerance tests were done to assess the ability to absorb vitamin D and the effectiveness of using these drugs orally. Eleven children with corrected biliary atresia, aged 9 months to 7 years, were studied. In oral 1.25‐(OH)2D3 tolerance tests, the increments above the baseline serum levels of 1.25‐(OH)2D were 140.7 ± 27.4 pg/ml in non‐jaundiced patients (n = 5). In jaundiced patients (n ‐ 3). 1,25‐(OH)2D3 absorption in two patients with high basal 1.25–(OH)2D values was lower than that of nonjaundiced patients: however, the absorption in the third patient with a low basal value was similar to that of nonjaundiced patients. In oral 25‐OHD3 tolerance tests, the mean increase of serum 25‐OHD was 48.9 ± 30.6 ng/ml in non‐jaundiced patients (n = 5) and 23.7 ± 9.5 ng/ml in jaundiced patients (n ‐ 4), the peak serum 25‐OHD levels being reached 6–12 h after 25‐OHD3 loading. The increase of serum 25‐OHD in jaundiced patients tended to be less than that in nonjaundiced patients at 4 hours after 25‐OHD3 administration (15.1 ± 12.6 vs 48.9 ± 30.6 ng/ml), but the difference was not significant. In addition, oral treatment with 25‐OHD, (4 μg/kg/day) for 3 months resulted in marked increases in the serum 25‐OHD level and hone density in the jaundiced patients (n = 3).
Randomized Study of Premedication for Esophagogastroduodenoscopy in Children and Adolescents
Authors: Figueroa‐Colon Reinaldo , Grunow John E.
Published: January 2024

In order to compare three premeditation regimens, 58 children and adolescents were randomized to three groups: Group I, meperidine intramuscular; Group II, atropine intramuscular and diazepam intravenous; and Group III, meperidine, promethazine, and chlorpromazine intramuscular. Almost all patients required supplemental intravenous diazepam or meperidine to obtain adequate sedation. An endoscopist without knowledge of the medication group scored each patient for adequacy of sedation. Sedation was more effective in Group III than in Groups I and II (p < 0.005); however. Group III patients were less arousable at completion of the procedure (p < 0.0005) and had a greater duration of sedation (220 min compared with 56 and 88 min for Groups I and II, respectively, p < 0.001). Complications were minor and not associated with any specific treatment. The evidence from this study supports the following conclusions: (a) adequate sedation for esophagogastroduodenoscopy in pediatric patients requires sedation with more than one of the drugs used in this study; and (b) the regimen meperidine, promethazine, and chlorpromazine, with diazepam supplement, was superior in providing sedation, but patients required a longer period of recovery than did patients sedated with one of the other regimens.
Loss of the Glycocalyx of Enterocytes in Small Intestine
Authors: Poley J. Rainer
Published: January 2024

Observations are reported on biopsied small bowel mucosa by scanning and transmission electron microscopy in 10 infants and children with chronic diarrhea and intolerance to dietary protein(s). The most striking and consistent finding was widespread loss of glycocalyx from the surface of enterocytes, exposing the tips of the microvilli. Concomitantly, disaccharidase activities were markedly depressed in nine of the 10 patients, and such enzyme activities showed a tendency to return toward normal after removal of the offending dietary antigen(s) in concert with efforts to rebuild the glycocalyx. By light microscopy, no discernible structural damage was seen in eight of the 10 patients; two showed blunting of villi, but there was also loss ofglycocalyx. The pathogenesis of the loss of the glycocalyx is unknown. Its finding is rather unique, because it has not been observed in any other condition characterized by chronic diarrhea in children. It is possible that the loss of the glycocalyx is a sequel to cell damage by a hitherto not defined interaction between host and dietary protein. Immunologic processes may be involved.
Plasma Immunoreactive‐Trypsin(ogen) Levels During Development
Authors: Levine Jeremiah J. , Udall John N. , Bloch Kurt J. , Hanson Donald G. , James Brent C. , Walker W. Allan
Published: January 2024

We previously showed that the uptake of intact trypsin from the intestine of suckling animals was greater than that of weaned animals. To extend these studies, we measured plasma cationic immunoreactivetrypsin(ogen) in human subjects aged 3 days to 43 years. In agreement with the observation of other investigators, we found that the concentration of cationic immunoreactive‐trypsin(ogen) was significantly increased in 3‐day‐old infants compared with other age groups. None of the cationic immunoreactive‐trypsin in adult samples was bound to α1‐antitrypsin, whereas 28% of cationic immunoreactive‐trypsin in infant samples was bound to α1‐antitrypsin.
Cholesterol Ester Storage Disease
Authors: D'Agostino Daniel , Bay Luisa , Gallo Guillermo , Chamoles Nestor
Published: January 2024

Cholesterol ester storage disease (CESD) is infrequent in children. Four new cases in two nonrelated families are presented. Acid lipase deficiency in the leukocytes of the patients and reduced activity (50%) in those of parents were demonstrated. Clinical manifestations varied from neonatal cholestasis to asymptomatic hepatomegaly. Hepatic histology showed lipid vacuoles and cholesterol ester storage in hepatocytes and Kupffer cells. Increased levels of cholesterol and hepatomegaly were the first findings. There is as yet no specific treatment for CESD: however, the early detection of cases would make possible the timely control of complications.