bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Tube System for Collection of Uncontaminated Jejunal Juice
Authors: Nielsen Ole Haagen , Hjelt Karsten , Krasilnikoff P. A. , Justesen Tage , Rasmussen Sten Nørby
Published: February 2024

A tube system for collection of uncontaminated jejunal juice in children is described. It consists of an outer tube, the distal end of which is closed with a membrane, and an inner aspiration tube. When the outer tube is positioned at the site of aspiration, the membrane is perforated by applying air pressure through the outer tube. The tube was tested in 72 Danish children. With only one intubation having to be repeated, aspiration was achieved in all the children (95% confidence limits, 92.60‐99.97%). The median intubation time was 10 min (range, 2‐35 min). Mean time for aspiration of 1 ml of jejunal juice varied from 1 to 30 min (median, 5 min). The site of aspiration in the jejunum—expressed as the position of the tip of the inner tube—was from 0 to 6 cm distal to the ligament of Treitz (median, 3 cm). There were no complications.
Breath Hydrogen Analysis
Authors: Ostrander Clinton R. , Cohen Ronald S. , Hopper Andrew O. , Shahin Susan M. , Kerner John A. , Johnson John D. , Stevenson David K.
Published: February 2024

Hydrogen gas (H2) is a product of the fermentation of dietary carbohydrate (CHO) by bacteria in the lumen of the gastrointestinal tract in man. Thus, H2 is actually an exogenously produced gas, which either is passed as flatus, or diffuses into the body and is exhaled. In the adult, a fairly constant fraction is expired, providing a reliable indicator of total colonic H2 production. Breath H2 analysis currently represents a useful clinical means of testing adults and older children for the malabsorption of CHO. Noninvasive and easy procedures for the collection of expired air have encouraged their increasingly widespread use in pediatrics. Evidence to date suggests that breath H2 analysis may provide the best available method for estimating semiquantitatively the degree of CHO malabsorption. The association of the results of breath H2 analysis with other clinical measures of CHO digestion and absorption is expected, but discrepancies can also be anticipated based on the nature of this particular trace gas method. The interpretation of the results of breath H2 analysis in neonates and young infants remains especially problematic because of confounding variables which are difficult to control and are measured infrequently.
Congenital Dysautonomia with Secretory Diarrhea
Authors: Hyman Paul E. , Ament Marvin E. , Heyman Melvin B.
Published: February 2024

A 1‐year‐old boy was evaluated because of failure‐to‐thrive and persistent diarrhea. His illness was characterized by autonomic dysfunction sharing some features of both familial dysautonomia and congenital sensory neuropathy with anhidrosis, but was consistent with neither diagnosis. The gastrointestinal tract was involved: esophageal motility was abnormal and moderate secretory diarrhea was present. This report documents an unusual case of congenital autonomic dysfunction with secretory diarrhea.
Pseudomembranous Colitis Presenting as Mild, Chronic Diarrhea in Childhood
Authors: Schwarz Ronald P. , Ulshen Martin H.
Published: February 2024

Two children presented with mild, chronic diarrheal illnesses. Investigation revealed typical pseudomembranous colitis in both cases, which responded to therapy. While variation in the severity of pseudomem‐branous colitis is recognized, the subtle, chronic presentation exemplified by these cases has not previously been well described.
Lipids in Human Milk
Authors: Lammi‐Keefe Carol J. , Jensen Robert G.
Published: February 2024

Recent work on lipid classes and the fatty acid composition of milk is reviewed. At least 98% of the lipids are triacylglycerols with about 1% phospholipids and 0.3–0.4% cholesterol. Desmosterol has been identified. The major phospholipids (% of total) are: sphingomyelin (32), phosphatidylcholine (25), and phosphatidyl‐ethanolamine (28). The 12:0 content of colostrum is lower than that of mature milk. The 18:2 content of mature milk can be altered by diet; otherwise, the fatty acid composition is remarkably constant. Long‐chain polyunsaturates appear to be needed for development of the infant's brain and nervous system. Data on the contents of these acids are given. The fat‐soluble vitamins have been analyzed by high‐performance liquid chromatography. The amounts of vitamins D and K in milk, unlike those of A and E, are lower than the quantities required to meet the U.S. Recommended Daily Allowances. Vitamin D sulfate does not appear to be a significant antirachitic component of human milk. Nutritional and analytical aspects are emphasized throughout and areas for future investigations indicated.
New Method for the Estimation of Lean Body Mass in Infants (EMME Instrument)
Authors: Klish W. J. , Forbes G. B. , Gordon A. , Cochran W. J.
Published: February 2024

An innovative, safe, and rapid method suitable for the determination of lean body mass in infants is described. The machine (EMME) operates on the principle that a biologic specimen in an electromagnetic field perturbs the field proportional to its conductivity which is dependent on the amount of electrolyte present. The physical characteristics of the EMME signal are described. Experiments done with phantom infants composed of electrolyte solution and corn oil showed a very linear relationship between fat‐free volume and the natural log of the EMME signal (r = 0.97). A similar relationship was noted for ground beef (r = 0.91) and live rabbits (r = 0.99). The EMME instrument appears to hold promise as a rapid noninvasive means of determining lean body mass in infants.
Effect of Phototherapy on the Physiologic Cholestasis of the Neonate
Authors: Levi Nathan , Trevisan Marina , Perini Roberto , Tamaro Giorgio , Torre Giuliano , Tiribelli Claudio
Published: February 2024

Phototherapy (PT) has been reported to increase bile acid excretion in the bile of adults with liver cirrhosis. We investigated the effect of PT on the levels of serum total bile acids (STBA), conjugated cholic acid (CCA), conjugated chenodeoxycholic acid (CCDCA), conjugated lithocholic acid (CLCA), and sulfolithocho‐lylgiycine (SLCG) in 13 neonates with unconjugated nonhemolytic hyperbilirubinemia before and after 12 h of PT. The treatment produced a statistically significant (p < 0.02) reduction in both STB A and CCA levels, whereas no effect on the other fractions was observed. The percentage of reduction was the same for STBA and CCA concentrations, indicating that the effect is related to a specific reduction in CCA levels. The magnitude of the expected decrease in the level of serum bilirubin is not correlated with that in bile acids in individual cases. The data are interpreted as suggesting that PT can affect the metabolism of bile acids by decreasing STBA and CCA levels in neonates through an increase in their biliary excretion associated with the reduced intestinal absorption of CCA occurring in newborns.
Fetal and Maternal Amino Acid Concentrations During Fasting in the Ewe
Authors: Lemons James A. , Reyman Debra , Schreiner Richard L.
Published: February 2024

The present investigation was undertaken to quantitate the whole‐blood amino acid concentrations of the mother and fetus over an extended period of fasting using a chronic sheep preparation. Fetal amino acid levels generally increased or remained relatively high during the fast (e.g., alanine, glycine, valine, leucine). In contrast to the situation in the fetus, most amino acids (alanine, glycine, glutamine, serine, and threonine) decreased in concentration in the ewe with fasting. Alanine levels changed most dramatically in the ewe, decreasing to less than 50% of the fed state values within 72 h of fasting. Therefore, while the supply of gluconeogenic amino acids becomes limited within the maternal circulation during fasting, levels of these amino acids remain high or increase in the fetal arterial blood.
Acarboxy Prothrombin in Cord Plasma from Normal Neonates
Authors: Atkinson Peter M. , Bradlow Basil A. , Moulineaux John D. , Walker Nigel P.
Published: February 2024

Acarboxy prothrombin was detected in the plasma of 48 of 128 umbilical cord plasma samples and in all of 65 patients receiving coumadin. None was found in 20 normal adults. Although the prevalence was the same in blacks, whites, and neonates of mixed origin, levels were significantly higher in blacks. There was a negative correlation between the level of acarboxy prothrombin and the prothrombin index. There was no correlation between maternal age, birth weight, gestational age, obstetrical complications, race, socioeconomic status, albumen, or u‐foetoprotein and the incidence of cord plasma acarboxy prothrombin.
Use of Golytely® in Children and Adolescents
Authors: Tolia Vasundhara , Fleming Sandra , Dubois Reuben S.
Published: February 2024

Proper cleansing of the bowel is essential to ensure an adequate colonoscopic examination. The experience of 24 children and adolescents with Golytely, a new colonic lavage solution, is presented. Oral Golytely was found to be less inconvenient for patients, safe, and more cost‐effective because it decreased hospitalization time.
Amylase in Human Milk from Mothers of Preterm and Term Infants
Authors: Hegardt P. , Lindberg T. , Börjesson J. , Skude G.
Published: February 2024

Amylase activity and isoenzyme pattern were determined in preterm human milk from 25 mothers during the first 55 days after delivery and from 25 mothers delivered at term. The diurnal variation in amylase activity and the variation during a feeding were studied in two mothers. There is a high amylase activity in preterm colostrum, which slowly decreases during the first 2 months. The individual variation in amylase activity is considerable. There is no difference in amylase activity in preterm and term human milk. The isoamylase of preterm milk is of the salivary type, just as in term milk. There is no great variation in amylase activity during a feeding or from one feeding to another.
Manometric Demonstration of Aberrant Right Subclavian Artery Associated with Dysphagia
Authors: Orenstein S. R.
Published: February 2024

An aberrant right subclavian artery was associated with unusual manometric findings in a 2‐year‐old girl with dysphagia. Awareness of this entity and its manometric characterization are useful for physicians evaluating patients with dysphagia.
Small Bowel Obstruction in Chronic Granulomatous Disease
Authors: Lindahl Julie A. , Williams Faren H. , Newman Stephen L.
Published: February 2024

Intestinal obstruction, enteritis, and colitis have been reported in patients with previously documented chronic granulomatous disease (CGD). We describe here an 11‐year‐old boy whose initial presentation was compatible with inflammatory bowel disease. A mild but persistent dermatitis was his only other manifestation of CGD.
Pulmonary Excretion Rate of Carbon Monoxide as an Index of Total Bilirubin Formation in Adult Male Wistar Rats with Common Bile Duct Ligation
Authors: Stevenson David K. , Salomon William L. , Moore Linda Y. , Trudgen Julie K. , Cowan Barrett E. , Vreman Hendrik J. , Kwong Linda K.
Published: February 2024

Total bilirubin formation (TBF) in the rat after a short period of common bile duct ligation was studied by measuring the pulmonary excretion rate of CO (VECO). At postoperative day 3, the VECO of experimental animals was higher when compared with the pre‐operative VECO (p < 0.005); whereas the VECO of control animals did not change. Also, on the 3rd postoperative day, the relative rate of early labeling of bilirubin following the administration of δ‐aminolevulinic acid‐5‐14C, a preferential hepatic heme synthesis precursor, was similar between the experimental and control animals; only the experimental animals had an abnormal peroxide hemolysis test. We conclude that common bile duct ligation in the rat is associated with elevations in the VECO, indicating significant increases in TBF, and the source of the increase is probably of erythropoietic origin. This finding may be relevant to the understanding of the pathophysiology of obstructive jaundice in human neonates.
Discordance of Milk Protein Production Between Right and Left Mammary Glands
Authors: Britton John R.
Published: February 2024

The cases of two lactating mothers whose milk from right and left mammary glands differed dramatically in protein concentration and composition are presented. The discordance in protein quality between the two breast milks underscores the need to sample both breasts in future studies of milk proteins and suggests that each breast may possess some degree of autonomy with respect to milk protein production.
Well‐Compensated Primary Bile Acid Malabsorption Presenting as Chronic Nonspecific Diarrhea
Authors: Jonas A. , Diver‐Haber A. , Avigad S.
Published: February 2024

Increased fecal bile acid loss and defective in vitro ileal bile acid uptake were demonstrated in an 8‐year‐old boy with diarrhea starting in the neonatal period. His continuously normal physical development and good nutritional status are in keeping with a well‐preserved cholic acid pool and normal duodenal bile acid concentration. Isolated bile acid malabsorption can remain well compensated and present as the chronic nonspecific diarrhea syndrome of childhood.
Severe Hemorrhage from Intestinal Hemangiomatosis in Klippel‐Trenaunay Syndrome
Authors: Schmitt Bernhard , Posselt Hans Georg , Waag Karl Ludwig , Müller Hartmut , Bender Steffen W.
Published: February 2024

A child with Klippel‐Trenaunay syndrome (KTS) and severe anemia caused by bleeding from diffuse intestinal hemangiomatosis is presented. Hemangiomas of the bowel should be considered in any child with unexplained anemia and coexisting cutaneous hemangiomas. The diagnostic workup of patients with KTS and symptomatic hemangiomatosis is outlined with respect to indications for surgical management.
Intussusception of the Vermiform Appendix
Authors: Casteels Minne , Eggermont E. , Kerremans R. , Ponnette E.
Published: February 2024

Intussusception of the vermiform appendix (IVA) in a 14‐year‐old girl is reported. The diagnosis was made preoperatively, which is rare: only five other cases have been reported. IVA can present with variable symptoms. This patient presented with episodes of recurrent severe paroxysmal pain and vomiting, each episode being separated by several uneventful weeks. The diagnosis of IVA could be made at the fourth attack of colic by the radiological visualization of a “spiral shell” filling defect at the bottom of the cecum that was reducible by intravenous injection of a spasmolytic. Laparotomy with appendectomy rescued the patient from these distressing episodes. Although IVA is an uncommon condition, one should be aware of its existence and include it in the differential diagnosis of acute abdominal syndromes. When confronted with a clinical picture of intussusception in older children or adolescents, one should especially remember this entity as a differential diagnosis with other causes of intussusception, especially tumors.
Characterization of Vitamin E Status in Cholestatic Children by Conventional Laboratory Standards and a New Functional Assay
Authors: Cynamon Harry A. , Isenberg J. Nevin
Published: February 2024

In the present study, the clinical application of a new functional test for vitamin E deficiency was evaluated. Erythrocytes from cholestatic children at risk for vitamin E deficiency and appropriate controls were incubated in vitro with hydrogen peroxide and the malondialdehyde generated and released into the supernatant quantitated. The results of these incubations were compared with fasting plasma vitamin E levels, the ratio of plasma vitamin E to plasma lipid levels, and, in some instances, hydrogen peroxide hemolysis tests. Malondialdehyde formation was less than 6% in controls and vitamin E‐sufficient cholestatic children. However, cholestatic vitamin E‐deficient children had a mean malondialdehyde formation of 41%. The results also suggest that for children less than 4 months of age, a ratio of plasma vitamin E to total plasma lipids less than 0.6 mg/g may be sufficient to provide protection from in vitro peroxidation. The authors suggest that this functional assay of vitamin E status be included in the evaluation of individuals with the potential for vitamin E deficiency.
Home Parenteral Nutrition in Chronic Intestinal Diseases
Authors: Amarnath R. P. , Fleming C. Richard , Perrault Jean
Published: February 2024

Nine children and adolescents with chronic intestinal diseases and growth failure were treated with home parenteral nutrition (HPN) for 7–63 months. All patients improved their growth velocities on HPN, with an average height gain of 9 cm. The mean growth velocity in six patients with Crohn's disease increased more than fivefold (from 0.67 ± 0.4 cm/year to 3.8 ± 1.09 cm/year), and they gained a mean of 11.4 ± 3.4 kg/year. The three patients without Crohn's disease [intestinal pseudo‐obstruction (two), severe short bowel (one)] increased growth velocity from an average of 2.9 ± 1.1 cm to 6.1 ± 1.34 cm/year and gained a mean of 10 ± 2.84 kg/year. Patients without Crohn's disease grew faster on HPN than age comparable patients with Crohn's disease. Also, the two patients with Crohn's disease who were younger and had their disease for a shorter period (<3 years) grew better than older patients with Crohn's disease who had their disease for a mean of 8 ± 1.3 years. All patients improved clinically, and three with Crohn's disease achieved complete remission. Five of the nine patients had psychosocial adjustment problems while on HPN. In conclusion, HPN is a relatively safe and effective means to stimulate growth in children and adolescents who cannot meet nutritional needs by the enteral route.
Gastrointestinal Processing of Gastrically Administered Prostaglandin F2α in Suckling and Weanling Rats
Authors: Bedrick Alan D. , Koldovský Otakar
Published: February 2024

In view of the presence of prostaglandins in milk, studies were performed to determine if maturational differences are present in the gastrointestinal processing of exogenous prostaglandin F2α. Suckling (10‐to 14‐day‐old) and weanling (30‐day‐old) rats were gastrically fed 3H‐labeled prostaglandin F2α and killed 2 h later. Characterization of radioactivity present in the stomach from animals of both age groups revealed low prostaglandin F2α metabolism. Analyses of proximal, middle, and distal intestinal segments revealed age‐related differences in prostaglandin metabolism. The amount of unmetabolized PGF2α in intestinal segments of suckling rats ranged from 11.4 to 13.5%. In weanling rats, there was a tendency toward increased amounts of intact PGF2α in proximal (16.3 ± 1.6%) and middle (17.6 ± 2.2%) regions; however, 25.9 ± 1.9% of the tissue radioactivity present in the distal small intestine of weanling rats was authentic PGF2α, significantly greater than that of the distal segment of suckling rats. The intestine of weanling rats contained greater amounts of less polar metabolites. These results indicate that orogastrically fed prostaglandin can pass through the gastrointestinal tract of developing rats and be delivered to the distal intestinal mucosa intact.
Effects in Premature Infants of Normalizing Breath H2 Concentrations with CO2
Authors: Kien C. Lawrence , Liechty Edward A. , Myerberg David Z. , Mullett Martha D.
Published: February 2024

Interval sampling of expired breath samples from the anterior nares is a feasible and noninvasive method for detecting elevated breath H2 and thus colonic carbohydrate fermentation, especially in nontherapeutic research studies of healthy premature infants. However, there may be a risk of falsely low breath H2 concentration and an unacceptable experimental error due to contamination with room air as well as with dead space air. We studied ten premature infants (28–32 week gestational age and 2–4 weeks postnatal age) who were receiving either a proprietary formula containing equal proportions of lactose and glucose polymer, or a similar formula in which lactose was the sole carbohydrate. In 70 breath samples (obtained 30–180 min after feeding) we assessed the coefficient of variation in breath hydrogen concentration among three aliquots obtained over a 3–5 min interval. Breath was collected from the anterior nares. The interaliquot coefficient of variation averaged 11% when expressed as parts per million per 5% CO2, compared to 19% when expressed as parts per million (Wilcoxon, p < 0.001). Mean breath hydrogen concentration at each time period using the former method (parts per million per 5% CO2) was about 100% higher than when using the latter method. Although ventilation rate can alter alveolar CO2, normalizing for CO2 concentration reduces a major source of experimental error.
Recovery of Exogenous Heme as Carbon Monoxide and Biliary Heme in Adult Rats After Tin Protoporphyrin Treatment
Authors: Hintz Susan R. , Kwong Linda K. , Vreman Hendrik J. , Stevenson David K.
Published: February 2024

We studied the effect of tin protoporphyrin (TP) on bilirubin production in adult Wistar rats by quantifying in vivo carbon monoxide (CO) excretion and the simultaneous excretion of biliary heme after common bile duct cannulation. A known amount of heme was injected intravenously as red blood cells (RBC) damaged with a sulfhydryl inhibitor, N‐ethylmaleimide. The recovery of heme as CO or biliary heme in the cannulated animals was calculated as the molar percent of heme recovered over heme injected. For cannulated controls (n = 4), the recovery was 89 ± 6% SD, and no heme appeared in bile. Cannulated rats treated with TP (n = 4) had 64 ± 11% recovered as CO and 30 ± 11% as heme in bile. Our findings suggest that TP is an effective in vivo inhibitor of exogenous heme catabolism and bilirubin production in adult rats. Furthermore, this inhibition results in increased excretion of heme into the bile proportional to the degree of inhibition.
Gastrointestinal Peptide Profile in Children with Celiac Disease
Authors: Hernanz Angel , Polanco Isabel , Codoceo Rosa , Lama Rosa , Vazquez Carlos
Published: February 2024

In order to investigate if a plasma profile of gastrointestinal peptides reflects changes in jejunal mucosa in celiac disease, we studied basal and postprandial plasma levels of gastrin, secretin, somatostatin, vasoactive intestinal polypeptide (VIP), and neurotensin in children with untreated and treated celiac disease and in a control group of children. Basal and 30‐min postprandial secretin concentrations were statistically significantly lower in untreated celiac children compared to both treated celiac (p < 0.01 and p < 0.05, respectively) and control children (p < 0.001). Plasma secretin levels 30 min after a breakfast meal were also statistically significantly lower (p < 0.001) in treated celiac children with respect to the control group. In both untreated and treated celiac groups, basal and postprandial plasma levels of somatostatin and VIP were statistically significantly decreased (p < 0.001) compared to control children. Moreover, there was a significant rise in postprandial levels of neurotensin after a breakfast meal in untreated celiac children. On the contrary, there was no rise of neurotensin in healthy children. These findings seem to indicate that determination of plasma profile of gastrointestinal peptides in children with celiac disease may be useful in monitoring the development of this disease and, thus, the number of jejunal biopsies could be decreased.
In Vitro Solubility of Calcium Glycerophosphate Versus Conventional Mineral Salts in Pediatric Parenteral Nutrition Solutions
Authors: Hanning R. M. , Mitchell M. K. , Atkinson S. A.
Published: February 2024

Low‐birth‐weight infants requiring total parenteral nutrition receive inadequate intakes of calcium (Ca) and phosphorus (P) due to poor solubility of available mineral salts. To optimize Ca/P delivery, we tested the effects on in vitro solubility of mineral salt:calcium glycerophosphate (CaGP) versus calcium gluconate and K2HPO4 (CG + P); Ca:P ratios of 1:1 (at 12.5 and 25 mmol/L of Ca and P) and 2:1 (25:12.5 mmol/L): amino acid (AA) formulation: Aminosyn (A), Aminosyn‐PF (A‐PF), TrophAmine (T) or Vaminolac (V); and AA concentration (25 versus 8.3 g/L). Parenteral nutrition solutions contained 10% dextrose and vitamins and minerals typical of a neonatal prescription. Solutions were sampled at preparation, after 24 h in the neonatal unit (25°C), and from before and after a 0.22‐μm filter in extension tubing through which solutions were pumped at 5 ml/h within an incubator at 37°C. Samples were analyzed for Ca and pH, and precipitation by spectrophotometry at 600 nm and light microscopy at × 100 magnification. The Ca concentration was unaffected by filtration. While spectrophotometry detected only gross precipitation, with light microscopy crystal formation was evident with 25 mmol/L of Ca and P as CG + P in A and T at 25 g of AA/L and in A, V, T, and A‐PF at 8.3 g of AA/L. Precipitation did not occur with CaGP or CG + P at 12.5 mmol/L of Ca and P. Under in vitro conditions mimicking the neonatal unit, CaGP versus CG + P resulted in greater mineral solubility even at low AA concentrations.
Chronic Pancreatitis and Pancreas Divisum in an Infant
Authors: Yaffe Michael R. , Gutenberger James E.
Published: February 2024

We describe an infant with pancreas divisum diagnosed by endoscopic retrograde cholangiopancre‐atography. This infant had chronic and unremitting pancreatitis that only became amenable to surgery following the use of somatostatin analog after the usual and customary treatment for pancreatitis was ineffective.
Hepatic Disease Associated with Intrauterine Parvovirus B19 Infection in a Newborn Premature Infant
Authors: Metzman Ross , Anand Aditi , DeGiulio Patricia A. , Knisely A. S.
Published: February 2024

A hydropic premature infant with intrauterine growth retardation died at 4 days of age and was found at necropsy to have advanced liver disease. Clinical and serologic findings in mother and infant were consistent with recent parvovirus B19 infection. Parvovirus can cause fetal liver disease in animals, and some instances of congenital hepatic dysfunction in man may be due to intrauterine parvovirus B19 infection.
Gastric Bezoar After Hepatic Transplantation
Authors: Schwarzenberg Sarah Jane , Freese Deborah K. , Payne William D. , Ascher Nancy L. , Sharp Harvey L.
Published: February 2024

A gastric bezoar complicated the postoperative course of three children following successful hepatic transplantation. Two patients had evidence of extremely erratic absorption of the cyclosporine (CSA) used for immunosuppression. Gastric bezoars usually occur in patients with gastric dysmotility and/or patients ingesting poorly digestible material. Although several factors may contribute to bezoar formation after hepatic transplantation, a major predisposing factor may be the administration of the large quantities of olive oil required for solubilization of CSA.
Neurologic Investigations of Childhood Abdominal Migraine: A Combined Electrophysiologic Approach to Diagnosis
Authors: Good Peter A.
Published: February 2024

Neurologic studies of childhood migraine, including imaging techniques and electrophysiology, have identified a number of abnormalities, but none of high specificity. Therefore, a diagnostic marker for childhood migraine and its equivalents remains elusive. In this study a combined electrophysiologic approach is assessed, using measurements of visually provoked β‐activity, highfrequency photic following responses, and visually stimulated event‐related potentials. Eighteen children younger than 10 years of age with abdominal migraine and/or cyclic vomiting syndrome were investigated with these techniques. They were compared with the responses from a number of control groups, including a group diagnosed as childhood migraine with or without aura. Individually, each investigation yielded high sensitivities but low specificities (<50%). However, when these techniques were used in combination the specificity for migraine rose to >90%. There was no significant difference between abdominal migraineurs and those with migraine with or without aura in any of the parameters studied. This combined approach is potentially useful in the diagnosis of abdominal migraine and supports the view that abdominal migraine can be classed as a true childhood migraine equivalent.
Randomized, Multicenter Trial of Two Different Formulas for Very Early Enteral Feeding Advancement in Extremely‐Low‐Birth‐Weight Infants
Authors: Mihatsch Walter Alexander , von Schoenaich Patrik , Fahnenstich Hubert , Dehne Norma , Ebbecke Hartmut , Plath Christian , von Stockhausen Hans‐Burkhardt , Gaus Wilhelm , Pohlandt Frank
Published: February 2024

Background

In extremely‐low‐birth‐weight (ELBW) infants, formula feeding is required if human milk is not available. The tolerance of a new `high' lactose (55 g/L), low protein, low phosphate, hydrolyzed protein formula (HLF) for early enteral feeding advancement of ELBW infants was compared with that of a low lactose (1 g/L) hydrolyzed protein formula (LLF).

Methods

In a randomized multicenter trial, 99 ELBW infants were fed according to a standardized protocol beginning at 48 hours of age with 12 ml/kg daily increments. Primary outcome was the cumulative milk feeding volume (CFV) from days 3 to 14. The authors hypothesized that feeding HLF as a supplement to human milk would increase the CFV at least by 20% in at least 60% of matched pairs compared with LLF. A secondary issue was to investigate whether human milk would increase the CFV compared with formula.

Results

The CFV was 720 mL/kg (range, 0–962 mL/kg) with HLF and 613 mL/kg (range, 3–1,283 mL/kg) with LLF feeding. There was no 20% difference. On day 14, the median feeding volume was 103 mL/kg. The CFV was 533 mL/kg (range, 0–962 mL/kg) in infants who received less than 10% of human milk and 832 mL/kg (range, 74–1,283 mL/kg) in infants who received more than 10%. Necrotizing enterocolitis (Bell stage ≥2) occurred only with LLF feeding (n = 5;P < 0.05).

Conclusions

The study failed to find the hypothesized 20% advantage of the new HLF. The observed advantage of human milk supports the hypothesis that it should be the first diet in ELBW infants; however, this hypothesis still must be confirmed in a controlled, randomized trial.
Chronic Subcutaneous Octreotide Decreases Gastrointestinal Blood Loss in Blue Rubber–Bleb Nevus Syndrome
Authors: Gonzalez Daniela , Elizondo Ben J. , Haslag Sara , Buchanan George , Burdick J. Steven , Guzzetta Philip C. , Hicks Barry A. , Andersen John M.
Published: February 2024

Background

A patient affected by blue rubber–bleb nevus syndrome had chronic gastrointestinal bleeding requiring weekly blood transfusions. Despite multiple surgical and endoscopic procedures to treat the venous malformations, the patient continued to bleed primarily from lesions in the small bowel. Therefore, this patient was treated with octreotide, a somatostatin analog known to decrease splanchnic blood flow and that is used for acute and chronic gastrointestinal bleeding.

Methods

Octreotide therapy, 5.7 μg/kg subcutaneously twice daily, was initiated, and the patient was followed up clinically. Complete blood counts, blood glucose concentration, pancreatic enzyme concentration, liver function tests, and growth hormone concentration were monitored during treatments.

Results

During the 4 weeks after initiation of octreotide therapy, hemoglobin concentration was maintained without the need for transfusions. Octreotide decreased the patient's monthly need for blood transfusion from 52 ± 7 mL · kg−1 · mo−1 of packed red blood cells to 23 ± 7 mL · kg−1 · mo−1. She had no detectable side effects or growth inhibition. Other medical interventions including ‐εaminocaproic acid, nadolol, and total parenteral nutrition with bowel rest were not as effective as octreotide alone.

Conclusion

Octreotide decreased the patient's need for blood transfusions. Possible mechanisms include altering blood flow to the gastrointestinal tract and direct effects on the venous malformations.
Intestinal Protein and LPH Synthesis in Parenterally Fed Piglets Receiving Partial Enteral Nutrition and Enteral Insulinlike Growth Factor 1
Authors: Park Yoo Kyoung , Dudley Mary A. , Burrin Douglas G. , Donovan Sharon M.
Published: February 2024

Background

Providing partial enteral nutrition (PEN) supplemented with insulinlike growth factor‐1 (IGF‐1) to parenterally fed piglets increases lactase–phlorizin hydrolase (LPH) activity, but not LPH mRNA. The current aim was to investigate potential mechanisms by which IGF‐1 up‐regulates LPH activity.

Methods

Newborn piglets (n = 15) received 100% parenteral nutrition (TPN), 80% parenteral nutrition + 20% parenteral nutrition (PEN), or PEN + IGF‐1 (1.0 mg · kg−1 · d−1) for 7 days. On day 7, [2H3]‐leucine was intravenously administered to measure mucosal protein and brush border LPH (BB LPH) synthesis.

Results

Weight gain, nutrient intake, and jejunal weight and length were similar among the treatment groups. Partial enteral nutrition alone increased mucosal weight, villus width and cross‐sectional area, LPH activity, mRNA expression, and high mannose LPH precursor (proLPHh) abundance compared with TPN (P <0.05). Insulinlike growth factor‐1 further increased mucosal weight, LPH activity, and LPH activity per unit BB LPH approximately twofold over PEN alone (P < 0.05) but did not affect LPH mRNA or the abundance of proLPHh (one of the LPH isoforms) or mature LPH. Isotopic enrichment of [2H3]‐leucine in plasma, mucosal protein, and LPH precursors, and the fractional and absolute synthesis rates of mucosal protein and LPH were similar among the treatment groups. Insulinlike growth factor‐1 treatment increased total mucosal protein synthesis (60%, P < 0.05) but not LPH synthesis compared with the other two groups.

Conclusions

Because IGF‐1 did not affect the fractional synthesis rate of either mucosal protein or LPH, the authors suggest that enteral IGF‐1 increases mucosal protein mass and LPH activity by suppressing mucosal proteolytic degradation.
Guideline for the Evaluation of Cholestatic Jaundice in Infants: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Authors: Moyer Virginia , Freese Deborah K. , Whitington Peter F. , Olson Alan D. , Brewer Fred , Colletti Richard B. , Heyman Melvin B.
Published: February 2024

For the primary care provider, cholestatic jaundice in infancy, defined as jaundice caused by an elevated conjugated bilirubin, is an uncommon but potentially serious problem that indicates hepatobiliary dysfunction. Early detection of cholestatic jaundice by the primary care physician and timely, accurate diagnosis by the pediatric gastroenterologist are important for successful treatment and a favorable prognosis. The Cholestasis Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has formulated a clinical practice guideline for the diagnostic evaluation of cholestatic jaundice in the infant. The Cholestasis Guideline Committee, consisting of a primary care pediatrician, a clinical epidemiologist (who also practices primary care pediatrics), and five pediatric gastroenterologists, based its recommendations on a comprehensive and systematic review of the medical literature integrated with expert opinion. Consensus was achieved through the Nominal Group Technique, a structured quantitative method.

The Committee examined the value of diagnostic tests commonly used for the evaluation of cholestatic jaundice and how those interventions can be applied to clinical situations in the infant. The guideline provides recommendations for management by the primary care provider, indications for consultation by a pediatric gastroenterologist, and recommendations for management by the pediatric gastroenterologist.

The Cholestasis Guideline Committee recommends that any infant noted to be jaundiced at 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin. However, breast‐fed infants who can be reliably monitored and who have an otherwise normal history (no dark urine or light stools) and physical examination may be asked to return at 3 weeks of age and, if jaundice persists, have measurement of total and direct serum bilirubin at that time.

This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition on the evaluation of cholestatic jaundice in infants. The American Academy of Pediatrics has also endorsed these recommendations. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all patients with this problem.
Treatment of Functional Abdominal Pain in Childhood With Cognitive Behavioral Strategies
Authors: Youssef Nader N. , Rosh Joel R. , Loughran Mary , Schuckalo Stephanie G. , Cotter Ann N. , Verga Barbara G. , Mones Richard L.
Published: February 2024

Objective:

The aim of this study was to assess the efficacy of a cognitive‐behavioral approach to the treatment of recurrent abdominal pain caused by childhood functional gastrointestinal disorders (FGIDs).

Methods:

From September 2001 to December 2002, 18 patients (12 male; mean age, 12.1 ± 4.9 years) with chronic abdominal pain (mean duration, 11.8 ± 13.3 months) caused by FGIDs were referred to our facility's mind‐body institute (MBI). Treatment included guided imagery and progressive relaxation techniques. The mean number of sessions per patient was 4.3 ± 3.4. Outcomes included change in abdominal pain and quality of life, evaluated by the Pediatric Quality of Life Scale (PedsQL®). Follow‐up was 10.6 ± 2.3 months after the last MBI session.

Results:

Abdominal pain improved in 89% of patients; weekly pain episodes decreased from 5.5 ± 0.9 to 2.0 ± 2.7 (P < 0.05); pain intensity (0 to 3 scale) decreased from 2.7 ± 0.6 to 0.6 ± 0.7 (P < 0.04); missed school days/month decreased from 4.6 ± 1.7 to 1.4 ± 3.2 (P < 0.05); social activities/week increased from 0.3 ± 0.6 to 1.3 ± 0.6 (P < 0.05); physician office contacts/year decreased from 24 ± 10.2 to 8.7 ± 13.1 (P = 0.07). PedsQL® scores (0 to 100 scale) improved from 55.3 ± 11.9 to 80.0 ± 10.7 (P < 0.03).

Conclusions:

Guided imagery and progressive relaxation can safely and effectively reduce chronic abdominal pain in children with FGIDs. This treatment also improved social functioning and school attendance.
Gastric Emptying of Solids in Children with H. pylori‐Positive and H. pylori‐Negative Non‐Ulcer Dyspepsia
Authors: Sýkora Josef , Malán Alexander , Záhlava Jan , Varvars̆ká Jana , Stozĭcký František , Siala Konrad , Schwarz Jan
Published: February 2024

Objective:

There is currently no data available in children on possible relationships among Helicobacter pylori, gastric motility and gastric inflammation. This is a prospective study of gastric emptying (GE) in symptomatic children with and without H. pylori who met symptom‐based criteria for non‐ulcer dyspepsia (NUD).

Methods:

47 consecutive dyspeptic patients (23 males; age range, 7 to 18 years) were enrolled. All patients had extensive negative diagnostic investigations. Scintigraphic solid‐phase gastric emptying was assessed.

Results:

21 H. pylori‐positive and 26 H. pylori‐negative patients were identified with non‐ulcer dyspepsia. The groups were not different in clinical symptoms except that pain related to feeding was more frequent in infected children (P < 0.03). Nodular antral gastritis was found more frequently in the H. pylori positive group (P < 0.0001). The gastritis score was more severe in H. pylori infected than H. pylori negative patients in both fundic and body mucosa (P < 0.001). Within the H. pylori‐positive NUD group, the mean half‐time GE of a solid meal was significantly accelerated compared to the non‐infected group (P < 0.05). There was no difference in the intragastric food distribution and curves of gastric emptying of both groups. A significant relationship was found between the degree of gastric body inflammation gastric emptying, but not antral inflammation. Gastric emptying rate did not differ by sex or age of the subjects in either group.

Conclusions:

In dyspeptic children with H. pylori, gastric emptying of a solid was significantly accelerated compared with symptomatic H. pylori uninfected patients. This suggests that H. pylori is able to induce gastric emptying acceleration. Our findings add more information on H. pylori infection and gastroduodenal disease.
Intestinal Imaging of Children with Acute Rotavirus Gastroenteritis
Authors: Bass Dorsey , Cordoba Eileen , Dekker Cornelia , Schuind Anne , Cassady Christopher
Published: February 2024

Objective:

To examine the morphology and motility of the distal small bowel of infants with rotavirus gastroenteritis using non‐invasive/non‐ionizing imaging technology.

Methods:

Prospective, non‐randomized observational study of five infants with symptomatic rotavirus infection. Infants were imaged by real‐time magnetic resonance imaging (MRI) and ultrasound within 5 days of onset of gastroenteritis symptoms. Imaging studies were repeated in the convalescent period 5 to 9 weeks later.

Results:

Three of five infants had a significant increase in the ileal wall thickness visualized by ultrasound during acute rotavirus infection compared with convalescence. The number and size of mesenteric lymph nodes visualized by ultrasound appeared similar in the acute and convalescent phases, as did peristaltic activity assessed by MRI.

Conclusion:

Abdominal ultrasound can detect changes in ileal wall thickness in infants with rotavirus infection. These changes may reflect ileal inflammation elicited by viral infection. Such studies may prove useful in evaluating morphologic response to attenuated rotavirus vaccines.
The Effect of Flavoring Oral Rehydration Solution on its Composition and Palatability
Authors: te Loo D. Maroeska , van der Graaf Fedde , Ten Walther Tjon A.
Published: February 2024

Objective:

As a number of mild to moderately dehydrated children refuse to drink oral rehydration solution (ORS) because of its strong salty taste, many parents and health workers flavor ORS with the childs favorite juice. The effects of flavoring ORS on electrolyte content and osmolality were assessed and the palatability of various solutions were compared with commercially flavored ORS.

Methods:

Osmolality, sodium, potassium, chloride and glucose content after flavoring with varying concentrations of apple juice, orange juice or orangeade was determined. Two of the solutions were offered to 30 children and adults to assess palatability.

Results:

All additions to ORS (apple juice, orange juice or orangeade) caused a decrease of sodium (−30 to −53 mmol/L) and chloride (−27 to −47 mmol/L) content, whereas osmolality increased to greater than 311 mOsm/kg. These homemade oral rehydration solutions did not fulfill ESPGAN criteria for ORS, and rehydration will therefore be less effective. The majority of subjects also preferred the commercially flavored ORS.

Conclusion:

Only very small amounts of apple juice or orange juice can be added to the ORS without significantly altering electrolyte composition and osmolality. Palatability, however, does not improve compared with commercially flavored ORS. We therefore recommend using commercially flavored ORS, the composition of which fulfills ESPGAN criteria.
Esophageal Motor Activity in Children with Gastro‐esophageal Reflux Disease and Esophagitis
Authors: Chitkara Denesh K. , Fortunato Christine , Nurko Samuel
Published: February 2024

Objective:

To evaluate esophageal body motor contractions occurring during esophageal reflux in pediatric patients with gastro‐esophageal reflux disease (GERD).

Methods:

Patients referred for the evaluation of GERD who were evaluated with combined 24‐hour pH probe and esophageal manometry test (MP24) were included. Patients were separated into the following groups: Group C ‐ normal pH probe and normal EGD; Group 1 ‐ abnormal pH probe and normal EGD; and Group 2 ‐ abnormal pH probe and EGD with histologic esophagitis. Esophageal motor function during reflux episodes was analyzed.

Results:

Twenty‐five patients were included. All had a normal stationary esophageal manometry. Patients in Groups 1 and 2 had significantly more gastroesophageal reflux by pH probe than Group C (P < 0.01). During the MP24, patients in Group 1 and 2 had significantly fewer contractions per minute pre‐, during, and post‐GER (P < 0.05). There were significant differences in the number of isolated and prolonged contractions (>7 sec) during prolonged GERD episodes >5 minutes (P < 0.05).

Conclusion:

Children with GERD have a decreased number and abnormal esophageal body contractions with esophageal reflux. This suggests that children with GERD with and without esophagitis have impaired esophageal body acid clearance.
Relative Expression and Localization of the Insulin‐Like Growth Factor System Components in the Fetal, Child and Adult Intestine
Authors: Freier Serem , Eran Maya , Reinus Constantin , Ariel Ilana , Faber Joseph , Wilschanski Michael , Braverman Danny
Published: February 2024

Background:

The insulin‐like growth factors (IGFs) are important in the development and maintenance of the gastrointestinal tract.

Objectives:

To compare the expression of IGFs and their receptors in the stomach and duodenum of the fetus, the child and the adult. To identify the cells mainly responsible for the production of the members of the IGF system.

Methods:

Tissue was obtained from fetus after abortion and from children and adults during diagnostic endoscopy and biopsy. The expression of the IGFs and their receptors was estimated by an RNAse protection assay and sections were stained with antisera to the components of IGF system.

Results:

The tissues from the stomach and the duodenum expressed the two IGFs and their receptors at all stages of life. The fetal IGF receptors I and II, were approximately ten times higher than in the child and IGF‐II was five times higher. Immunohistochemical staining showed the components of the IGF system to be localized to the gastric glands and to the basotlateral border of the gastric epithelial cells. In the duodenum, they were concentrated at the apical portion of the epithelial tissue. They could also be identified in ganglion cells and nerves.

Conclusions:

The IGFs and their receptors in the stomach and duodenum are expressed in all age groups and mostly are highest in the fetus. The IGF system proteins were located in the gastric glands and epithelium and in the apical portion of the villous epithelium of the duodenum.
Probiotics for the Management of Infantile Colic
Authors: Szajewska Hania , Dryl Radosław
Published: February 2024

Purpose of review:

Evidence suggests that the gut microbiota in subjects with infantile colic differs from the gut microbiota in an unaffected population. In colicky infants, dysbiosis may affect gut motor function and gas production resulting in abdominal pain/colic. If so, it is logical to assume that manipulation of the gut microbiota may play a therapeutic role and also could be a preventive measure in the evolution of these disorders. We aimed to evaluate evidence on the effectiveness of probiotics for treating and preventing infantile colic.

Recent findings:

The administration of Lactobacillusreuteri DSM 17938 is likely to reduce crying time in breastfed infants with infantile colic, but its role in formula‐fed infants is less clear. Data summarized in the current review suggest that L reuteri DSM 17938 may be effective in the reduction of crying/colic both in breastfed and formula‐fed infants. Other probiotics (single or in combinations) were studied in single trials only.

Given the lack of effective therapy for infantile colic and the good safety profile of L reuteri DSM 17938, this therapeutic option could be discussed with caregivers. Data on other probiotics, either positive or negative, are too limited to allow one to draw reliable conclusions.