bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast Milk Volume and Composition During Late Lactation (7–20 Months>
Authors: Dewey Kathryn G. , Finley Dorothy A. , Lönnerdal Bo
Published: February 2024

Breast milk composition of 119 samples collected by 46 women during months 7–20 of lactation was compared with composition of 101 samples collected at 4–6 months. Breast milk intake of 10 infants was determined by test‐weighing for 1 or more months during months 7–16 of lactation. Longitudinal decreases in milk concentrations of zinc, copper, and potassium, previously documented for the first 6 months, continued into the second 6 months, while protein, iron, and sodium concentrations showed no further decline. Lactose, fat, calcium, and magnesium concentrations were similar to those in earlier stages of lactation. Weaning was associated with significant changes in milk composition: When milk volume fell below 300 ml/day, there was an increase in protein and sodium and a decrease in lactose, calcium, and zinc. Breast milk intake of infants not supplemented with cow's milk or formula averaged 875 ml/day (93% of total energy intake) at 7 months and 550 ml/day (50% of total energy intake) at 11–16 months. Total energy intake increased from 610 to 735 kcal/day, but energy intake per kilogram remained constant at a relatively low 70–79 kcal/kg/day. Our results suggest the need for further studies of nutrient intake and requirements of breast‐fed infants during late lactation.
Sugar Absorption in Healthy Preterm and Full‐Term Infants
Authors: Roggero P. , Mosca F. , Motta G. , Mangiaterra V. , Perazzani M. , Offredi M. L. , Marini A. , Careddu P.
Published: February 2024

We have studied carbohydrate absorption in 40 healthy term infants and 10 preterm neonates (31‐35 weeks gestation) by respiratory H2, fecal pH, and chromatographic analysis of stools. Sequential studies of H2 excretion (24‐h collection) in response to breast feeding were carried out in premature infants during the first 8 weeks of life. Five expired H2 during the first 2 weeks, and two continued to do so in the 3rd to 4th weeks. Breath H2 excretion fell below 10 ppm by 8 weeks and was not related to feeding or sleep. In term neonates, the frequency of incomplete carbohydrate absorption (4‐h test) at the end of the first week was 36% for 14 breast‐fed, 42% for 12 formula‐fed, and 64% for 14 mixed‐fed neonates (not significant differences). There were no significant differences between the absorbing and malabsorbing subjects in fecal pH. Chromatographic analysis showed only small quantities of sugars. In summary, incomplete carbohydrate absorption occurred in a high percentage of the newborns studied; the 24‐h test evaluated better than the 4‐h test; and negative breath H2 excretion indicated development of the capacity of the small intestine to hydrolyze carbohydrates. In the majority of the preterm malabsorbing babies, completely functional lactase occurs within the first month of life. The growth modulators in human milk may increase the rate of maturing of the small intestine.
Gastrointestinal Enhanced Insulin Release in Response to Glucose in Newborn Infants
Authors: Oliven Anita , King Katherine C. , Kalhan Satish C.
Published: February 2024

The purpose of this investigation was to determine whether or not gastrointestinal (GI) enhanced insulin response occurs in newborn infants soon after birth. Glucose infusion by intravenous or orogastric routes was given to infants during the first 4 days of life, aiming at achieving similar plasma glucose concentrations. Their plasma insulin responses were then compared. Thirty term, new‐born infants (10 appropriate for gestational age, 8 small for gestational age, 6 large for gestational age, and 6 infants of diabetic mothers) were studied. With intravenous glucose infusions of 8 mg/kg/min or orogastric infusion of 16 mg/kg/min, the plasma glucose concentrations achieved were similar and approximated 110 mg/dl. Plasma insulin responses were greater in infants receiving glucose via the GI route. The finding was in contrast to our previous data, in which no GI enhancement of insulin response was demonstrated. The present data suggest that in the term newborn infant, GI enhanced insulin release occurs only when a threshold of plasma glucose concentration has been exceeded. It appears that the enteroinsular axis is functional in newborns soon after birth.
Pooled Pasteurized Breast Milk and Untreated Own Mother's Milk in the Feeding of Very Low Birth Weight Babies
Authors: Stein H. , Cohen D. , Herman A. A. B. , Rissik J. , Ellis U. , Bolton K. , Pettifor J. , MacDougall L.
Published: February 2024

It has been shown that milk derived from mothers with term infants is not optimal for premature babies. There is also concern about the effect of heat sterilizing breast milk. At Baragwanath Hospital, the majority of mothers remain with and care for their premature babies. Over many years, pooled pasteurized breast milk has been fed to these babies before direct breast feeding is instituted. A study was done to compare feeding pooled pasteurized breast milk and untreated own mother's milk to very low birth weight babies. There was a significantly more rapid weight gain both in terms of regaining birth weight and, from this point, to reaching a weight of 1,800 g when using untreated own mother's milk. This occurred in spite of the fact that there was little difference, especially in terms of energy content, between the two types of breast milk. This was due to the fact that the pooled pasteurized milk was also largely obtained from mothers of premature babies. It is suggested from our data that slower weight gain in the group receiving the pooled pasteurized milk could be due to the pasteurization, which probably destroys heat‐labile milk lipase.
Insulin Involvement in Intestinal Macromolecular Transmission and Closure in Neonatal Pigs
Authors: Svendsen Lorraine S. , Weström Björn R. , Svendsen Jørgen , Ohlsson Bertil G. , Ekman Rolf , Karlsson Börje W.
Published: February 2024

The involvement of insulin in the intestinal transmission of macromolecules to blood and the cessation of this transport (intestinal closure) was studied in neonatal pigs by measuring the serum levels of the markers bovine serum albumin and fluorescein isothiocyanate labelled dextran 70,000 (FITC‐D) at 4 h after gavage feeding. In naturally suckled pigs, intestinal closure at 18 h was shown to be associated with an increase in serum immunoreactive insulin (IRI) levels. Similarly, intestinal closure obtained at ?? lactose/kg, was accompanied by an increase in serum IRI levels. Neither high serum IRI levels nor closure were observed in fasted pigs or in pigs gavage fed a total of 12 g lactose/kg. The effect of exogenous insulin on intestinal macromolecular transmission was studied by injecting 5 IU insulin/kg subcutaneously at 3 and 6 h, respectively, in newborn pigs gavage fed 10 ml sow colostrum/kg at 3 h intervals. This resulted in a reduction in the transmission of the markers when tested at 12 h, in comparison to littermates receiving the same amount of colostrum and littermates suckling the sow. It appears as if insulin, reflected as high serum levels over an extended period of time, is involved in the regulation of macromolecular trans?? ?? ulated that insulin may be involved in these processes by initiating the synthesis of membrane structural proteins in the enterocytes.
Anorectal Function and Continence Mechanisms in Childhood Encopresis
Authors: Wald Arnold , Chandra R. , Chiponis Darleen , Gabel Stewart
Published: February 2024

Summary: We compared anorectal sensory and motor functions, expulsion dynamics, and continence mechanisms in 50 children with encopresis and 21 healthy control children. When expulsion dynamics were studied, 43% of boys with encopresis inappropriately contracted the muscles near the anal canal compared with 10% of girls with encopresis (p > 0.05) and 10% of control children of both sexes (p < 0.05). In contrast to previous studies we demonstrated no abnormalities of thresholds of conscious rectal sensation or internal anal sphincter relaxation. In addition, children with encopresis had no demonstrable abnormalities of rectosphincteric continence mechanisms or strength of external anal sphincter contraction. We conclude that a significant number of boys with encopresis have abnormal anorectal expulsion dynamics, which may contribute to chronic fecal retention and incontinence. Abnormalities of anorectal sensory and motor function and of rectosphincteric continence mechanisms do not seem to be important in the pathogenesis of childhood encopresis.
Prospective Study of Colitis in Infancy and Early Childhood
Authors: Chong S. K. F. , Blackshaw A. J. , Morson B. C. , Williams C. B. , Walker‐Smith J. A.
Published: February 2024

Summary: Ten of a total of 106 children with chronic inflammatory bowel disease seen between 1973 and 1983 were aged 3 years or less (9%). These are the subject of this study. Colonoscopy and biopsy revealed ulcerative colitis in two, Crohn's disease in two, cow's milk‐induced colitis in two, and colitis of indeterminate type in four. The children were followed up and reassessed 2 years post‐treatment. The four children with ulcerative colitis and Crohn's disease were asymptomatic 6 months after treatment with sulfasalazine and/or prednisolone. The two breast‐fed infants with allergic colitis who were treated with cow's milk‐free diet in baby and mother showed clinical, endoscopic, and histological resolution. One of the remaining four children with indeterminate colitis is well and off all treatment, and two are well with minimal symptoms and taking sulfasalazine. One child continued to have frequent relapses and subsequently had subtotal colectomy performed with clinical improvement. Histopathology showed features suggestive of intestinal Behcet's disease. The present study shows that colonoscopy and mucosal biopsy allow a firm diagnosis to be established in 60% of cases of this selected group of very young children. In our experience colitis in infancy and early childhood appears to be a heterogeneous group of conditions. An initial assessment of indeterminate colitis should be followed with multiple mucosal biopsies to attempt further categorization.
Cholelithiasis in an Infant with Polycythemia
Authors: Tay Jean S. , Werlin Steven L.
Published: February 2024

An 11‐week‐old infant with polycythemia presented with cholestasis secondary to cholelithiasis. It is likely that hemolysis secondary to polycythemia predisposed our patient to cholelithiasis. We suggest that polycythemia may be a new cause of cholelithiasis in infancy.
The Pancreatic Duct Cell
Authors: Githens Sherwood
Published: February 2024

The pancreatic duct cell, although a minor cell type of the pancreas, plays an important role in fluid/ electrolyte and mucin secretion, and has been implicated in the development of pancreatic cancer, alcoholic pancreatitis, and cystic fibrosis. In the normal pancreas, the duct cell has the same low proliferative rate as acinar and endocrine cells. Under certain pathological circumstances, duct cells, as well as acinar and islet cells, may be stimulated to proliferate more rapidly. Pancreatic duct cells exhibit certain features not shared by acinar and/or endocrine cells, including a variety of antigens, mucins, enzymes, and morphological features. Adult duct cells resemble fetal pancreatic duct‐like cells morphologically, but they have differentiated to at least a limited extent

from their precursor cell type. Although there is no evidence that duct cells differentiate into acinar cells after pancreatic morphogenesis is complete, some islet cells develop from duct epithelium in the early postnatal period. Some pathological conditions may lead to the postnatal formation of islet cells from duct cells and may cause acinar cells to become duct‐like in morphology or to die and be replaced by duct cells. A better understanding of duct cells is now possible because of the development of techniques for their isolation and culture free from other cell types. Several such techniques are reviewed.
Fecal Secretory Immunoglobulin A in Breast Milk Versus Formula Feeding in Early Infancy
Authors: Koutras A. K. , Vigorita V. J.
Published: February 2024

We studied the effects of breast milk feeding versus formula feeding during the first 8 weeks of life on the development of local gastrointestinal humoral immune response by measuring fecal secretory immunoglobulin A (SIgA). Forty‐four infants were studied and classified into two groups: breast milk (n = 21) and standard Enfamil without iron (n = 23). The fecal specimens were analyzed at birth and 2, 4, and 8 weeks of age. Radial immune diffusion (RID) technique was used to assay the fecal SIgA during these four ages. Marked SIgA changes were detected in the breast milk‐fed group. At birth, no fecal SIgA was detected in either group. At 2, 4, and 8 weeks, significant differences were found between the two groups (p4 ≤ 0.001 and p8 ≤ 0.001).

This phenomenon of enhanced fecal SIgA in breast‐fed infants versus standard formula‐fed infants is not caused solely by the presence of IgA in breast milk; it represents a stimulatory effect of breast milk on the gastrointestinal humoral immunologic development. The possible active stimulatory role of breast milk on the development of immunologic competence and host defense is discussed. These data suggest an additional advantage of breast milk feeding during early life by the protective role of the earlier and enhanced production of SIgA in the gastrointestinal tract.
Histopathologic Features of the Liver in Pediatric Acquired Immune Deficiency Syndrome
Authors: Jonas Maureen M. , Roldan Eneida O. , Lyons Hernando J. , Fojaco Rita M. , Reddy Rajender K.
Published: February 2024

Autopsy and liver biopsy specimens from 30 pediatric patients with acquired immune deficiency syndrome (AIDS) or AIDS‐related complex (ARC) were retrospectively reviewed. Of 28 cases with histologic abnormalities, the following findings were noted singly or in combination: giant‐cell transformation, cytomegalovirus inclusions, Kaposi's sarcoma, diffuse lymphoplasmocytic infiltrate, granulomatous hepatitis, mild portal inflammation, necrosis around central veins, steatosis, and cholestasis. For the most part, abnormalities in the liver were not predictive of those in other organs, but the two children with the diffuse parenchymal lymphoplasmocytic infiltrate also had lymphoid interstitial pneumonitis (LIP). Liver histopathology in pediatric patients with AIDS shares some features with that in adults, but appreciable differences are noted. In particular, these differences include the higher frequency of giant‐cell transformation and the lower frequency of granulomas in children and the observation of diffuse lymphoplasmocytic infiltrate associated with LIP.
The Cyclic Vomiting Syndrome Described
Authors: Fleisher David R.
Published: February 2024

Cyclic vomiting syndrome (CVS) consists of discrete episodes of nausea and vomiting lasting hours or days, separated by symptom‐free intervals of similar or varying lengths. The disorder is not caused by underlying organic disease. The episodes tend to be similar in time of onset, duration, and symptomatology specific for each patient and are self‐limited. The majority of patients can identify experiences or conditions that may precipitate episodes, the commonest being heightened emotional states and infections. The onset of CVS most often occurs during preschool or early school years, although it may begin at any age, from infancy to mature adulthood. CVS episodes can recur for months or decades, and their subsidence cannot be predicted.
Apolipoprotein B Arg3500Gln Mutation Prevalence in Children With Hypercholesterolemia: A French Multicenter Study
Authors: Viola Sheila , Benlian Pascale , Morali Alain , Dobbelaere Dries , Lacaille Florence , Rieu Daniel , Ginies Jean Louis , Maurage Chantal , Meyer Martine , Lachaux Alain , Larchet Michel , Lenearts Catherine , Goulet Olivier , Sarles Jacques , Mouterde Olivier , Girardet Jean Philippe ,   French‐Speaking Group for Pediatric Hepatogastroenterology Nutrition
Published: February 2024

Background

Familial defective apolipoprotein B‐100, a dominantly inherited form of hypercholesterolemia caused by a single Arg3500Gln mutation, is silent in childhood but may confer a high risk of cardiovascular disease in adulthood. The objective was to determine the prevalence of familial defective apolipoprotein B‐100 in hypercholesterolemic French children and to provide a basis for targeting screening efforts in this population.

Methods

One hundred ninety children attending 13 pediatric clinics distributed throughout France were included based on the presence of type IIa hypercholesterolemia with a plasma low‐density lipoprotein–cholesterol level of more than 130 mg/dL. The Arg3500Gln mutation was detected in dried blood spots using a polymerase chain reaction assay combined with enzymatic restriction.

Results

Three hyperlipidemia phenotypes were found: monogenic dominant pure hypercholesterolemia (n = 117), polygenic hypercholesterolemia (n = 43), and combined hyperlipidemia (n = 11). Three unrelated children were heterozygous for the Arg3500Gln mutation; all three had monogenic dominant pure hypercholesterolemia (3/94 families; 3.2%), yielding a prevalence of 1.83% (3/164) in hypercholesterolemic children, which is similar to prevalences reported in European adults.

Conclusions

The familial defective apolipoprotein B‐100 mutation was common (1/31) in children with a phenotype of familial hypercholesterolemia, supporting screening in this population with the goal of preventing premature cardiovascular events.
Prevalence and Clinical Picture of Celiac Disease in Italian Down Syndrome Patients: A Multicenter Study
Authors: Bonamico Margherita , Mariani Paolo , Danesi Helene Maria , Crisogianni Massimo , Failla Pinella , Gemme Gerolamo , Quartino Alberto Rasore , Giannotti Aldo , Castro Massimo , Balli Fiorella , Lecora Margherita , Andria Generoso , Guariso Graziella , Gabrielli Orazio , Catassi Carlo , Lazzari Rosanna , Balocco Nicoletta Ansaldi , De Virgiliis Stefano , Culasso Franco , Romano Corrado ,   SIGEP,   Medical Genetic Group
Published: February 2024

Background

A multicenter research study of Down syndrome patients was carried out to estimate the prevalence of celiac disease in patients with Down syndrome and to show clinical characteristics and laboratory data of Down syndrome patients.

Methods

The authors studied 1,202 Down syndrome patients. Fifty‐five celiac disease patients (group 1) were compared with 55 immunoglobulin A antigliadin–positive antiendomysium antibodies–negative patients (group 2) and with 57 immunoglobulin A antigliadin–negative antiendomysium antibodies–negative patients (group 3).

Results

Celiac disease was diagnosed in 55 of 1,202 Down syndrome patients (4.6%). In group 1, weight and height percentiles were shifted to the left, whereas these parameters were normally distributed in groups 2 and 3. In celiac patients, diarrhea, vomiting, failure to thrive, anorexia, constipation, and abdominal distension were higher than in the other two groups. Low levels of hemoglobinemia, serum iron, and calcium were observed more frequently in group 1. The diagnosis of celiac disease was made after a mean period of 3.8 years from the initiation of symptoms. Sixty‐nine percent of patients showed a classic presentation, 11% had atypical symptoms, and 20% had silent celiac disease. Autoimmune disorders were more frequent (30.9%) in group 1 than in the other two groups examined (15%;P < 0.05).

Conclusions

This study reconfirms a high prevalence of celiac disease in Down syndrome. However, the diagnostic delay, the detection of atypical symptoms or silent form in one third of the cases, and the increased incidence of autoimmune disorders suggest the need for the screening of celiac disease in all Down syndrome patients.
Effects of Long‐term Consumption of a Fermented Infant Formula (with Bifidobacterium breve c50 and Streptococcus thermophilus 065) on Acute Diarrhea in Healthy Infants
Authors: Thibault H. , Aubert‐Jacquin C. , Goulet O.
Published: February 2024

Objective:

To determine whether long‐term consumption of a fermented infant formula could influence the incidence of acute diarrhea and its severity in healthy infants.

Method:

Nine hundred seventy‐one infants, ranging in age from 4 to 6 months, were included in a randomized, double‐blind, placebo‐controlled trial during a period of 5 months. They consumed daily either a fermented infant formula (FF) (fermentation with Bifidobacterium breve C50 and Streptococcus thermophilus 065) or a standard infant formula (SF) of the same nutritional composition.

Evaluation Criteria:

Number and duration of acute diarrhea episodes were evaluated. Severity of the episodes was determined by the number of hospital admissions, incidence of dehydration, number of medical consultations, number of oral rehydration solution prescriptions, and number of formula switches.

Results:

Growth of the infants and acceptability of the formulas were identical in the two groups. Incidence, duration of diarrhea episodes, and number of hospital admissions did not differ significantly between groups. Episodes were less severe in the FF (fermented formula) group. There were fewer cases of dehydration 2.5%versus 6.1% (P = 0.01), fewer medical consultations (46%v 56.6%, P = 0.003), fewer ORS prescriptions 41.9%v 51.9% (P = 0.003) and fewer switches to other formulas (59.5%v 74.9%, P = 0.0001) in FF infants compared to SF.

Conclusion:

A fermented formula may reduce the severity of acute diarrhea among healthy young infants. This outcome may be linked to the bifidogenic effects of fermentation products and their interactions with the intestinal immune system.
Intestinal Inflammation Measured by Fecal Neopterin in Gambian Children With Enteropathy: Association With Growth Failure, Giardia lamblia, and Intestinal Permeability
Authors: Campbell David I. , McPhail Graham , Lunn Peter G. , Elia Marinos , Jeffries Donald J.
Published: February 2024

Objectives:

Investigate whether fecal neopterin concentration (a potential marker of gut inflammation) in Gambian children with enteropathy was associated with growth failure. Secondary outcome measures tested the associations between Giardia lamblia infestation, fecal neopterin and lactulose mannitol absorption ratio(L:M), a measure of intestinal permeability.

Methods:

Seventy‐two children had height and weight measured every 6 to 8 weeks until 15 months of age in a rural Gambian village. L:M ratio, a measure of small intestinal permeability and fecal neopterin were measured at these times. Stool was examined by immunoflorescence and light microscope for Giardia cysts.

Results:

Long‐term height and weight gains were negatively associated with mean subject fecal neopterin concentration (r = −0.29 and −0.36, respectively; P < 0.001). There was no correlation between fecal neopterin and intestinal permeability or history of diarrhea. Of 72 children studied, 19 had Giardia cysts in stool and 38 had negative stool examinations. Infected children had a mean of 0.7 days of diarrhea/week (95% confidence interval [CI], 0.31–1.03) versus 0.8 days/week (95% CI, 0.71–0.85) in uninfected children. No difference in growth was detected between those with positive or negative fecal smears. Mean L:M ratio was the same in both groups (0.31; 95% CI, 0.26–0.34).

Conclusions:

Consistent with the theory that intestinal inflammation in tropical infants may impair growth, fecal neopterin concentrations were inversely associated with growth. Factors other than Giardia are causing enteropathy and growth failure in Gambian infants.
Diagnostic Role of Upper Gastrointestinal Endoscopy in Pediatric Inflammatory Bowel Disease
Authors: Castellaneta S. P. , Afzal N. A. , Greenberg M. , Deere H. , Davies S. , Murch S. H. , Walker‐Smith J. A. , Thomson M.
Published: February 2024

Background:

Discrimination between ulcerative colitis (UC) and Crohn disease (CD) may be difficult on ileo‐colonoscopy alone because of a lack of definitive lesions. Retrospective studies show upper gastrointestinal endoscopy may be helpful in confirming diagnosis in such cases.

Aims:

To prospectively determine importance of upper gastrointestinal endoscopy in diagnosis of inflammatory bowel disease (IBD) and assess factors predictive of upper gastrointestinal involvement in IBD.

Methods:

All pediatric patients were enrolled prospectively and consecutively over a 2‐year period and investigated with an ileo‐colonoscopy and barium meal follow‐through. Children with procto‐sigmoiditis, later confirmed histologically to be typical of UC, were excluded from the study. The remainder underwent upper gastrointestinal endoscopy. The protocol and methodology were determined a priori.

Results:

65 children suspected of IBD underwent colonoscopy. Of the total, 11 had recto‐sigmoiditis with typical macroscopic appearances of UC; once this was confirmed on histology these patients were excluded from the study. Of the 54 children (males, 31; median age, 11.1 years) remaining, 23 were initially diagnosed with CD on ileo‐colonoscopy and 18 (33%) were diagnosed with UC. The diagnosis remained ambiguous in 13 (six colonic, four ileo‐colonic, three normal colon) on clinical, radiologic and histologic grounds. Upper GI endoscopy helped to confirm CD in a further 11 (20.4%). Two patients were diagnosed with indeterminate colitis.

Upper gastrointestinal inflammation was seen in 29 of 54 (22 CD; 7 UC). Epigastric and abdominal pain, nausea and vomiting, weight loss and pan‐ileocolitis were predictive of upper gastrointestinal involvement (P < 0.05). However, 9 children with upper gastrointestinal involvement were asymptomatic at presentation (31%). Overall upper gastrointestinal tract inflammation was most common in the stomach (67%), followed by the esophagus (54%) and duodenum (22%).

Conclusions:

Upper gastrointestinal tract endoscopy should be part of the first‐line investigation in all new cases suspected of IBD. Absence of specific upper gastrointestinal symptoms do not preclude presence of upper gastrointestinal inflammation.
Preparation and Handling of Powdered Infant Formula: A Commentary by the ESPGHAN Committee on Nutrition
Authors: Agostoni Carlo , Axelsson Irene , Goulet Olivier , Koletzko Berthold , Michaelsen Kim F. , Puntis John W. L. , Rigo Jacques , Shamir Raanan , Szajewska Hania , Turck Dominique , Vandenplas Yvan , Weaver Lawrence T.
Published: February 2024

Powdered infant formulae are not sterile and may contain pathogenic bacteria. In addition, milk products are excellent media for bacterial proliferation. Multiplication of Enterobacter sakazakii in prepared formula feeds can cause devastating sepsis, particularly in the first 2 months of life. In approximately 50 published case reports of severe infection, there are high rates of meningitis, brain abscesses and necrotizing enterocolitis, with an overall mortality from 33% to 80%. Breast feeding provides effective protection against infection, one of the many reasons why it deserves continued promotion and support. To minimize the risk of infection in infants not fully breastfed, recommendations are made for preparation and handling of powdered formulae for children younger than 2 months of age. In the home setting, powdered infant formulae should be freshly prepared for each feed. Any milk remaining should be discarded rather than used in the following feed. Infant feeds should never be kept warm in bottle heaters or thermoses. In hospitals and other institutions written guidelines for preparation and handling of infant formulae should be established and their implementation monitored. If formula needs to be prepared in advance, it should be prepared on a daily basis and kept at 4°C or below. Manufacturers of infant formulae should make every effort to minimize bacterial contamination of powdered products.
Nutrition of Very Low Birth Weight Infants Fed Human Milk with or without Supplemental Trace Elements: A Randomized Controlled Trial
Authors: Loui Andrea , Raab Andrea , Wagner Mathias , Weigel Heidrun , Grüters‐Kieslich Annette , Brätter Peter , Obladen Michael
Published: February 2024

Background:

Very low birth weight infants (<1500 g) have high nutritional needs. Deficiencies of minerals, trace elements (especially zinc) may develop as a result of rapid growth, low body stores and low content of these substances in human milk We hypothesized that fortification of human milk might prevent deficiencies.

Methods:

Prospective, randomized trial to evaluate mineral, trace element, thyroid status and growth of infants fed human milk fortified with different amounts of calcium, phosphorus and protein, with (BMF) or without (FM 85) trace elements. Sixty‐two infants, 1000 to 1499 g birth weight, were randomized. Minerals and trace elements in serum, red blood cells and human milk and alkaline phosphatase activity, TSH, T4 and FT4 in serum were measured once until the fifth day and at 3 and 6 weeks of life. Clinical course and anthropometric measurements were recorded.

Results:

Intake of zinc, copper, manganese, calcium, phosphorus and magnesium was higher in the BMF group (P < 0.001). Serum zinc concentrations <0.49 mg/L occurred in 12% of the FM 85 group and 7% of the BMF group at 6 weeks (not significant). Median alkaline phosphatase activity was 436/379 IU/L in the FM 85/BMF group at 6 weeks (P < 0.01). The FM 85 group showed a higher weight gain (P < 0.05), possibly because of higher caloric (P < 0.01) and protein intake (P < 0.05) at 3 weeks.

Conclusions:

Zinc deficiency was rare. Elevated intake of calcium, phosphorus and zinc was associated with lower serum alkaline phosphatase activity but did not influence serum zinc concentration.
Distribution of Sialic Acids in the Milk of Spanish Mothers of Full Term Infants During Lactation
Authors: Martín‐Sosa Samuel , Martín María‐Jesús , García‐Pardo Luis A. , Hueso Pablo
Published: February 2024

Objectives:

The protective effect of human milk against infection is well known. Several non‐immunologic components, including complex carbohydrates, have been described. The present study was undertaken to determine the sialic acid distribution in different milk fractions (complex carbohydrates).

Methods:

Milk samples from 12 Spanish women at three different lactational stages (colostrum, transitional milk and mature milk) were analyzed. Total and glycoprotein‐bound, oligosaccharide‐bound, casein‐bound, and lipid‐bound sialic acids were determined.

Results:

Sialic acids from human milk are mainly bound to oligosaccharides and only a small amount is present bound to glycoproteins or in the free form. All the fractions analyzed showed a similar trend: sialic acids decrease rapidly along lactation. Casein‐bound sialic acid does not follow this trend. We detected the presence of an O‐acetylated species of N‐acetylneuraminic acid.

Conclusions:

In human milk from Spanish women we observed slightly different values than those previously reported. This could be a result of population differences but nutritional or methodological aspects can not be discarded.
Comparison of Invasive and Non‐Invasive Tests Diagnosis and Monitoring of Helicobacter Pylori Infection in Children
Authors: Hino B. , Eliakim R. , Levine A. , Sprecher H. , Berkowitz D. , Hartman C. , Eshach‐Adiv O. , Shamir Raanan
Published: February 2024

Background:

There are few reports which the tests used for diagnosing Helicobacter pylori infection and monitoring its eradication in children.

Study Aims:

Prospective evaluation of invasive (gastric histology, rapid urease test [RUT]) and non‐invasive (stool antigen [FemtoLab H. pylori], urea breath test [UBT]) tests in the diagnosis of H. pylori infection and post‐treatment eradication in children and adolescents.

Methods:

Ninety‐two patients (50 male, 42 female) referred for upper gastrointestinal endoscopy were prospectively enrolled. UBT was performed and stool specimens collected for monoclonal enzyme immunoassay for H. pylori antigen (FemtoLab) 1 to 4 days before endoscopy. H. pylori in gastric biopsies was evaluated by RUT and staining with hematoxylin‐eosin and giemsa. Eradication therapy was given to children with abdominal pain and H. pylori gastritis. FemtoLab H. pylori and UBT were repeated 6 weeks after the end of triple therapy.

Results:

Histology identified H. pylori in 49 of 92 (53%) subjects. Concordance between histology and RUT was found in 78 of 92 children. FemtoLab H. pylori was positive in 41 of 78 (52.6%) children with sensitivity, specificity, positive and negative predictive values of 97.5%, 94.7%, 95.1% and 97.3%, respectively. For UBT, these values were 100%, 96.9%, 97.5% and 100%, respectively. Twenty‐six of 36 patients who received triple therapy returned for eradication evaluation. Tests for H. pylori antigen in stool were positive in 10 of 26 and for UBT in 11 of 26.

Conclusion:

Stool antigen (FemtoLab) and UBT were equally effective in diagnosing and confirming eradication of H. pylori infection in children.
Association of Serum Interleukin‐8 Levels with the Degree of Fibrosis in Infants with Chronic Liver Disease
Authors: Nobili Valerio , Marcellini Matilde , Giovannelli Luigi , Girolami Elia , Muratori Flaminia , Giannone Germana , Devito Rita , De Benedetti Fabrizio
Published: February 2024

Objective:

Biliary atresia is a neonatal obstructive cholangiopathy characterized by a destructive, obliterative process affecting both the intrahepatic and extrahepatic ducts of the biliary tree that uniquely presents in the first months of life. The consequence of progressive inflammatory and sclerotic reaction is the development of obstructive jaundice. To determine the proinflammatory cytokine profile in children with biliary atresia, we measured circulating levels of interleukin (IL)‐1β, IL‐6, tumor necrosis factor‐α and IL‐8.

Methods:

Twelve children, five males and seven females, with biliary atresia were studied. In addition, four patients with progressive familial intrahepatic cholestasis and three with Alagille syndrome were also included. Five patients with neonatal hepatitis were studied as controls of a liver disease without portal fibrosis. Serum concentration of total and conjugated bilirubin, γ‐glutamyl transferase and glutamic‐pyruvic transaminase were measured by routine methods in all patients at time of sampling for the study. The degree of fibrosis in liver biopsies was scored using the histologic activity index.

Results:

In our study IL‐8 was detectable in 11 of 12 patients with biliary atresia with a median level of 262 pg/ml and a highly statistically significant difference (P < 0.0001) from controls. In patients with progressive familial intrahepatic cholestasis or with Alagille syndrome serum IL‐8 levels were similarly elevated. In patients with neonatal hepatitis, IL‐8 levels were marginally increased. Serum IL‐8 levels were significantly correlated (Rs = 0.725, P < 0.0001) with the histologic activity index.

Conclusions:

Although further studies are needed to determine the role of IL‐8 in portal inflammation, our results suggest that increased production of IL‐8 may be a mechanism leading to the progressive portal inflammation and fibrosis in patients with chronic liver disease.
Intestinal Barrier Function and Weight Gain in Malnourished Children Taking Glutamine Supplemented Enteral Formula
Authors: Lima Aldo A. M. , Brito Lúcia F. B. , Ribeiro Hildênia B. , Martins Ma Ceci V. , Lustosa Amália P. , Rocha Edna M. , Lima Noélia L. , Monte Cristina M. G. , Guerrant Richard L.
Published: February 2024

Objective:

We examined the effect of standard formula and glutamine or glycine supplemented enteral formula on intestinal permeability and weight gain in children with malnutrition.

Methods:

80 children aged 2 to 60 months with a weight‐for‐age z‐score less than −2 were studied. From December 1996 to April 1999, 27 study patients received nonsupplemented formula. From June 2001 to June 2002 an additional 53 patients were randomly assigned to receive formula supplemented with glutamine or glycine (isosmolar concentrations) for 10 days. Lactulose/mannitol excretion ratio was used as a measure of intestinal permeability and was performed before and after 10 days of nutritional rehabilitation. Weight was measured before and after treatment.

Results:

Patients were similar on admission with regard to age, sex, nutritional status and lactulose/mannitol ratio. The lactulose/mannitol ratio significantly improved (decreased) in children receiving formula supplemented with glutamine for 10 days but not in those receiving glycine or nonsupplemented formula. Weight gain occurred during therapy in all groups and was not statistically different among groups.

Conclusion:

Formula supplemented with glutamine improves intestinal barrier function compared with nonsupplemented formula but does not augment weight gain.
Body Composition of Children Aged 1 to 12 years with Biliary Atresia or Alagille Syndrome
Authors: Arvay Jessica L. , Zemel Babette S. , Gallagher Paul R. , Rovner Alisha J. , Mulberg Andrew E. , Stallings Virgina A. , Haber Barbara A.
Published: February 2024

Background:

Growth and body composition have not been well described in older children with biliary atresia or Alagille syndrome living with their native liver. To optimize nutritional management of these conditions it is essential to understand the normal growth characteristics.

Objectives:

The purpose of this study was to evaluate and compare the growth and body composition of children, particularly school‐age children, with biliary atresia and Alagille syndrome.

Methods:

A single observer measured height, weight, arm anthropometry and skin fold thickness in subjects aged 1 to 12 years with biliary atresia or Alagille syndrome who had not undergone liver transplantation.

Results:

Forty‐six subjects (10 biliary atresia/36 Alagille syndrome) were assessed. Biliary atresia subjects were below average in height for age with normal weight and elevated body mass index. Mean fat stores were mildly depressed. The z‐scores for body mass index and weight for age were inversely correlated with age. Alagille subjects were stunted and had low body weight and reduced fat and muscle stores. Body mass index z‐score was inversely correlated with age despite improved cholestasis.

Conclusions:

Children with Alagille syndrome had significant growth deficits as measured by weight, height and upper arm anthropometry at all ages studied. In contrast, subjects with biliary atresia had normal weights and heights. However, body mass index and weight for age z‐scores were lower in the older biliary atresia subjects. Few studies of anthropometry in biliary atresia or Alagille syndrome have included the school‐aged child. This study addresses this gap in knowledge and provides baseline data for nutritional interventions in these patients.
Helicobacter pylori and Specific Immunoglobulin E Antibodies to Food Allergens in Children
Authors: Kolho Kaija‐Leena , Haapaniemi Aaro , Haahtela Tari , Rautelin Hilpi
Published: February 2024

Objectives:

It has been suggested that chronic Helicobacter pylori infection may increase gastric permeability, predisposing infected children for the development of food allergies. We assessed the presence of food‐specific immunoglobulin (Ig)E antibodies in H. pylori positive children and controls.

Methods:

We measured specific IgE values to six major food allergens (Pharmacia CAP‐system) in a group of school‐aged Caucasian (n = 36) and non‐Caucasian (n = 38) children with a known H. pylori status. All children had undergone upper gastrointestinal endoscopy because of abdominal complaints.

Results:

Among H. pylori positive children (mean age, 8.8 years; range, 5‐15 years, 25 female, 26 male), 33% (17 of 51) had an elevated food‐specific IgE level to at least one of the food allergens tested. Unexpectedly, the majority of those with elevated serum food‐specific IgE levels (12 of 17) were to cow's milk. Among H. pylori negative children (mean age, 9.3 years; range, 5‐15 years, 13 female, 10 male), 26% (6 of 23) of the children had an elevated serum IgE level to at least one of the food allergens tested, and 9% (2 of 23) were positive to cow's milk. The difference in the number of children with an elevated serum IgE level for cow's milk in H. pylori positive and negative children was not significant. The severity of gastritis did not correlate with the presence of food‐specific IgEs.

Conclusions:

H. pylori infection had no effect on the manifestation of specific IgE to major food allergens in school‐aged children. An IgE response to cow's milk was common among these school‐aged children.
Patent Ductus Arteriosus, Indomethacin and Necrotizing Enterocolitis in Very Low Birth Weight Infants: A Population‐Based Study
Authors: Dollberg Shaul , Lusky Ayala , Reichman Brian ,   Israel Neonatal Network
Published: February 2024

Background:

Patent ductus arteriosus is a risk factor for the development of necrotizing enterocolitis. The use of indomethacin to treat patent ductus arteriosus in preterm infants may either decrease the incidence of necrotizing enterocolitis by stabilizing or closing the ductus arteriosus or increase its incidence by a direct constricting effect on mesenteric blood vessels. The authors sought to evaluate the interrelationship between patent ductus arteriosus, treatment with indomethacin and the risk of necrotizing enterocolitis in very low birth weight infants.

Method:

The Israel National database includes prospectively collected data on 99% of all very low birth weight infants in Israel. The study population comprised 6146 infants of 24‐34 weeks' gestation born between 1995 and 2000. The effect of patent ductus arteriosus on necrotizing enterocolitis was assessed using multiple regression analysis.

Results:

Necrotizing enterocolitis occurred in 5.5% (n = 343) of all infants, in 9.4% of infants with patent ductus arteriosus and in 8.9% of infants who received indomethacin. The occurrence of necrotizing enterocolitis was independently associated with the presence of patent ductus arteriosus among infants not treated with indomethacin (odds ratio, 1.85) and those who received indomethacin therapy (odds ratio, 1.53). Indomethacin therapy in absence of patent ductus arteriosus was not associated with an increased risk of necrotizing enterocolitis (odds ratio, 0.72).

Conclusions:

Patent ductus arteriosus is an independent risk factor for the development of necrotizing enterocolitis in very low birth weight infants. Therapy with indomethacin did not have a significant effect on the risk for necrotizing enterocolitis.
Skin Prick Test Reactivity to Supplemental Enzymes in Cystic Fibrosis and Pancreatic Insufficiency
Authors: Griese Matthias , Dokupil Kathi , Latzin Philipp
Published: February 2024

Background:

Patients with cystic fibrosis and pancreatic insufficiency take supplemental pancreatic enzymes of porcine or plant origin on a daily basis.

Objective:

The frequency of immediate skin prick hypersensitivity reactions to such enzymes and the correlations to gastrointestinal symptoms and nutritional status were assessed in a single center prospective descriptive study.

Methods:

Skin prick tests using five different freshly prepared porcine pancreatic enzyme preparations, one enzyme preparation of fungal origin, porcine meat and cat epithelia were performed in patients with cystic fibrosis and pancreatic insufficiency and in healthy control subjects.

Results:

Positive skin tests in the 48 patients with cystic fibrosis were no more frequent than in 21 control subjects. No correlations with the frequency of gastrointestinal symptoms, nutritional status and lung function were found.

Conclusion:

Although immediate hypersensitivity reactions to pancreatic enzyme preparations in subjects with cystic fibrosis are not common, individuals with possible allergic reactions to supplemental enzymes should be identified by skin prick tests and in unclear cases by double‐blind placebo‐controlled provocation tests.
Effect of Maternal Consumption of Lactobacillus GG on Transfer and Establishment of Fecal Bifidobacterial Microbiota in Neonates
Authors: Gueimonde Miguel , Sakata Shinji , Kalliomäki Marko , Isolauri Erika , Benno Yoshimi , Salminen Seppo
Published: February 2024

Background:

Establishment of the gut microbiota at birth provides a substantial source of microbial stimuli for the maturation of the immune system. Deviations in this process precede the development of specific diseases providing the rationale for the use of probiotics to counteract them.

Objective:

This study was designed to characterize both the mother‐infant bifidobacteria transfer at birth and the development of bifidobacteria microbiota during the first weeks of life in infants whose mothers received Lactobacillus rhamnosus GG or placebo.

Methods:

Species‐specific PCR was used to assess the fecal bifidobacterial composition of mothers before and after delivery and in infants at 5 days and 3 weeks of age.

Results:

Bifidobacterium longum was the species most commonly found in the mothers. Bifidobacterium catenulatum was the most prevalent group in infants at 5 days of age and B. longum the predominant species at 3 weeks. At 5 days of age, infants whose mothers received L. rhamnosus GG showed a significantly higher occurrence of B. breve and lower of B. adolescentis than those from the placebo group. In addition, L. rhamnosus GG consumption increased the bifidobacterial diversity in infants and reduced the Bifidobacterium microbiota similarity between mother and infant.

Conclusions:

These results indicate that specific changes in the transfer and initial establishment of bifidobacteria in neonates take place as consequence of the consumption of L. rhamnosus GG by the mothers.
Has R&D investment become riskier for CEOs after the Sarbanes Oxley Act?
Authors: Lee SeungWon
Published: February 2024

This study explores the link between R&D investment variability and CEO turnover across the eras surrounding the Sarbanes‐Oxley Act (SOX). It posits that, after SOX, R&D expenditure hikes not matched by sales growth may trigger more frequent CEO turnover, driven by a perceived increase in risk. Data from 1996 to 2010 reveal that, before SOX, R&D increases positively correlate with CEO job stability. In contrast, after SOX, a rise in R&D spending is linked to a higher rate of CEO turnover, particularly involuntary dismissals. The study further identifies that post‐SOX, the negative impact of R&D spikes on CEO turnover is significantly mitigated when such investment aligns with sales growth. The findings suggest a significant influence of R&D investments on CEO turnover, underscoring the need for boards to deliberate the consequences of R&D spending and CEO turnover to better align shareholders and CEO interests.