bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Feeding Yogurt Versus Milk in Children with Persistent Diarrhea
Authors: Boudraa Ghazalia , Touhami Mahmoud , Pochart Philippe , Soltana Rachida , Mary Jean‐Yves , Desjeux Jehan‐François
Published: January 2024

Although the pathophysiology of persistent diarrhea in children remains unclear, it has been suggested that it may be related to the composition of the food ingested. Since lactase deficiency and cow's milk protein intolerance are often identified in children with persistent diarrhea, replacement of milk with yogurt should be beneficial. We, therefore, compared the clinical outcome of children (aged 3–36 months) with persistent diarrhea randomly assigned to receive either milk or yogurt for 5 days. Preliminary results on 45 of the 100 children indicated clinical failure, which was determined after a 5% loss of body weight per day or the persistence of diarrhea after 5 days, in only 14% of the children fed yogurt compared to 42% of those fed milk (p < 0.05). These preliminary results strongly suggest a clinical advantage of feeding yogurt rather than milk in children with persistent diarrhea.
Hepatomegaly as a Single Presenting Sign of Stage IV‐S Neuroblastoma
Authors: Bujanover Yoram , Hareel Avikam , Burstein Yoav
Published: January 2024

This article presents the case of an infant who on routine physical examination at the age of 5 months was found to have hepatomegaly. The initial investigation revealed borderline liver function tests, and ultrasonog‐raphy showed multiple space‐occupying lesions. Further workup using different imaging techniques, urinary vanillylmandelic acid, serum catecholamines, and liver biopsy led to the diagnosis of stage IV‐S neuroblastoma. No primary site outside of the liver could be demonstrated. The tumor regressed spontaneously.
Diagnostic Value of Serum γ‐Glutamyl Transpeptidase Activity in Liver Diseases in Children
Authors: Maggiore G. , Bernard O. , Hadchouel M. , Lemonnier A. , Alagille D.
Published: January 2024

The clinical usefulness of serum γ‐glutamyl transpeptidase (γGT) assay for the diagnosis of liver disease in children was assessed retrospectively in 398 children investigated from 1981 to 1986, in whom diagnosis was ascertained according to currently accepted criteria including liver histology in each case. Serum γGT activity was within normal limits in 10 controls, in 19 children with portal vein obstruction, and in 10 of 12 children with congenital hepatic fibrosis. Serum γGT was raised in all children with biliary atresia, sclerosing cholangitis, paucity of interlobular bile ducts, and α1‐antitrypsin deficiency with jaundice. Serum γGT was normal in spite of patent clinical signs of cholestasis in 3 patients with benign recurrent intrahepatic cholestasis, 1 infant with posthemolytic neonatal cholestasis, and in 22 of 28 patients with progressive idiopathic cholestasis akin to Byler disease. In the latter group, children with raised serum γGT displayed extensive portal fibrosis and bile duct proliferation on liver histology, while this was not a prominent feature in children with normal serum γGT. These results indicate (a) the value and limits of the assay for serum γGT activity in children with liver disease, (b) that raised serum γGT may be considered a fairly reliable index of bile duct damage, and (c) that serum γGT may prove a useful tool in separating two forms of progressive idiopathic cholestasis, with or without bile duct involvement.
Patient and Procedure Variables Associated with Complications Following Variceal Sclerotherapy in Children
Authors: Proujansky Roy , Orenstein Susan R. , Kocoshis Samuel A.
Published: January 2024

Variceal sclerotherapy has been performed in the pediatric population, but techniques and dosages of sclerosant recommended in the literature are largely empirical. Having accumulated much data through experience with sclerotherapy in children, we have identified patient and procedure variables associated with early and late complications. We reviewed our experience with 37 pediatric patients, ages 1–18, who underwent 150 sclerotherapy sessions. Sclerotherapy was associated with 12 early complications in 11 patients. Early complications were bleeding (five), respiratory problems (three), false channel formation (two), and gross hematuria (two). Four patients developed strictures. We identified the following variables associated with complications: for bleeding, platelet count <100,000/mm3; for respiratory complications and false channel formation, weight <12 kg; for false channel formation, dosage of sclerosant/kg/session > 1.75 ml/kg; for gross hematuria, total sclerosant/session >20 ml. A need for more than six sclerotherapy sessions for obliteration of varices was associated with a greater frequency of stricture formation. Sclerotherapy can be performed safely in children. Patients <12 kg or with platelet counts <100,000/mm3 should be monitored carefully for respiratory complications and postprocedure bleeding. Sclerosant dosages >1.75 ml/kg, or 20 ml total sclerosant, should be given with caution.
Cisapride Decreases Prolonged Episodes of Reflux in Infants
Authors: Vandenplas Yvan , de Roy Catherine , Sacre Liliane
Published: January 2024

Twenty‐nine infants (2–4 months old), with pathological gastroesophageal reflux assessed by 24‐h esophageal pH monitoring, were studied. Cisapride or placebo was randomly added to positional treatment, prone‐antiTrendelenburg position, which was applied to all infants. The pH monitoring was repeated after 13–16 days of treatment and revealed a significant improvement in both groups for most parameters. But the number of reflux episodes lasting longer than 5 min and the total number of reflux episodes had not decreased significantly in the placebo group. Only in the number of reflux episodes lasting longer than 5 min was improvement during treatment significantly greater in the cisapride group. This suggests cisapride both prevented reflux and improved esophageal clearance. These results suggest that in addition to other therapeutic measurements, such as positional treatment (which was previously demonstrated to be effective in this age group), cisapride might be of benefit in the treatment of gastroesophageal reflux disease.
Intestinal Motility in Symptomatic Children with Fundoplication
Authors: Di Lorenzo Carlo , Flores Alejandro , Hyman Paul E.
Published: January 2024

Fundoplication alters the anatomy of the lower esophageal sphincter but should have no direct effects on motility distal to the sphincter. Of 55 children referred for evaluation of symptoms consistent with upper gastrointestinal motor dysfunction, 28 had undergone fundoplication 6 months to 4 years earlier to treat severe gastroesophageal reflux that had failed medical management. All 28 children had symptoms that were unchanged or worsened after fundoplication. In all children, we studied fasting and fed antroduodenal motility, and compared results from groups with and without fundoplication. Abnormalities in antroduodenal motility were found in 25 of 28 of the fundoplication group and in 25 of 27 of unoperated children. We found a wide range of abnormalities, but there were no differences in the types or severity of abnormalities between groups. In summary, in children with severe functional gastrointestinal symptoms, antroduodenal manometry uncovered physiological abnormalities, and fundoplication failed to relieve symptoms. These data suggest that preoperative intestinal manometry could identify children unlikely to benefit from fundoplication.
Human Intestinal Disaccharidase Activities
Authors: Heitlinger Leo A. , Rossi Thomas M. , Lee Ping‐cheung , Lebenthal Emanuel
Published: January 2024

The relationship between intestinal morphology, disaccharidase activity, and disaccharide absorption is controversial. A retrospective study of 798 consecutive biopsies was performed to determine whether disaccharidase activities varied by subject age, biopsy technique, and degree of villus atrophy. Lactase activity was inversely correlated with age in the absence or presence of villus atrophy; sucrase, maltase, and palatinase activities did not correlate with age. Biopsies obtained by capsule or endoscopy had similar disaccharidase activities. In subjects 24 months of age or younger, the degree of mucosal injury was inversely correlated with lactase activity. In subjects older than 24 months, the degree of mucosal injury was inversely correlated with maltase and, to a lesser extent, lactase activities. The data suggest that disaccharidase activities in mucosal biopsies, whether obtained by endoscopy or capsule, are diminished in the presence of mucosal injury and correlate inversely with the degree of injury.
Activities of Lipase and Trypsin in Duodenal Juice of Infants Small for Gestational Age
Authors: Boehm G. , Bierbach U. , Senger H. , Jakobsson I. , Minoli I. , Moro G. , Räihä N. C. R.
Published: January 2024

In 18 low birth weight infants, small for gestational age, with different degrees of intrauterine growth retardation the activities of pancreatic lipase and trypsin and the concentrations of bile acids were measured in preprandially aspirated duodenal juice. The results were compared to those of 24 low birth weight infants, appropriate for gestational age, with comparable birth weights and postnatal ages. The activities of both measured pancreatic enzymes were negatively correlated with the degree of intrauterine growth retardation, expressed as the difference between the individual birth weight and the weight of the 10th percentile of the intrauterine growth curve (lipase: r = −0.697, p < 0.001; trypsin: r = −0.739, p < 0.001). The activity of trypsin in the small for gestational age infants was within the range of that found in the infants appropriate for gestational age. However, the lipase activity was decreased in infants who presented with growth retardation of >400 g/kg birth‐weight. The concentrations of bile acids were similar in both groups (4.60 ± 2.51 and 4.55 ± 2.26 mmol/L, respectively) and sufficient for activating the bile salt stimulated lipase in human milk. The data suggest that in intrauterine growth retarded infants the lipase activity in the duodenal juice can be a limiting factor for optimal fat digestion. This should be considered in the nutritional management of such infants.
A New Direct Pancreatic Function Test in Pediatrics
Authors: Madrazo‐de la Garza J. A. , Gotthold M. , Lu R. B. , Hill I. D. , Lebenthal E.
Published: January 2024

Traditional methods for collecting duodenal fluid are time consuming and technically difficult. A simple endoscopic method is proposed in this report as a means of collecting duodenal fluid to perform exocrine pancreatic function tests. Thirty‐five patients between 24 and 36 months of age were studied for pancreatic exocrine function. Twenty‐seven presented with chronic diarrhea and 8 with failure to thrive. In 20 patients (group 1), duodenal fluid was collected by means of a double‐lumen tube and sequential administration of pancreozymin (PZN) and secretin (SEC). The rest (group 2) had duodenal aspiration from the level of the papilla of Vater through a fiberoptic endoscope following administration of SEC only. The procedure took approximately 3 h in group 1 and 45 min in group 2. Secretin administration produced comparable levels of enzymes in both groups. Pancreozymin produced the highest enzyme levels, but this was only significantly higher than SEC‐induced levels in the case of lipase. Endoscopic collection of duodenal fluid following SEC administration is a safe, quick, and reliable method of collecting pancreatic secretion.
Abnormal Low Ratio of Cholic Acid to Chenodeoxycholic Acid in a Cholestatic Infant with Severe Hypoglycemia
Authors: Kimura Akihiko , Yuge Ken , Yukizane Shigenori , Kage Masayoshi , Nittono Hiroshi , Mahara Reijiro , Kurosawa Takao , Tohma Masahiko
Published: January 2024

We report a premature infant with severe hypoglycemia (serum glucose: 6 mg/dl) and cholestasis (serum total bile acids: 211.55 μmol/L) caused by hypoplasia of the interlobular bile ducts. This patient had developed intracranial hemorrhage and sepsis while undergoing treatment for hypoglycemia. As a result of endocrine evaluation, we made a diagnosis of idiopathic panhypopituitarism, congenital absence or hypoplasia of the pituitary gland. Moreover, we found abnormal bile acid profiles: The ratio of cholic acid to chenodeoxycholic acid was abnormally low in serum (0.04) and in biliary bile (0.33). However, 3α,7α,12α‐trihydroxy‐5β‐chole‐stan‐26‐oic acid and bile alcohols were not detected. We therefore suspected that the severe cholestasis and abnormal bile acid profiles in the serum and biliary bile in this patient were related to physiologic immaturity of the enterohepatic circulation of bile acids and immaturity of hepatic 12α‐hydroxylation.
Transient Gluten Hypersensitivity
Authors: Iacono G. , Nocerino A. , Guandalini S. , Carroccio A. , Cavataio F. , Balsamo V.
Published: January 2024

We report a case of transient gluten hypersensitivity, demonstrated by jejunal histology at diagnosis, normalization after gluten‐free diet, and acute clinical and histological relapse after a challenge with gluten powder at the age of 1 year, resembling that observed in cow's milk protein intolerance. Subsequent provocation tests did not show any alteration. Cases of supposed transient gluten hypersensitivity are rarely reported; our patient is characterized by the acute reaction to gluten challenge associated with a damaged histological picture and depressed levels of complement.
Alanine‐Based Oral Rehydration Solution
Authors: Sazawal S. , Bhatnagar S. , Bhan M. K. , Saxena S. K. , Arora N. K. , Aggarwal S. K. , Kashyap D. K.
Published: January 2024

This randomized, double‐blind trial determined whether adding 90 mmol/L of alanine with a reduction in glucose to 90 mmol/L (alanine ORS) improves the efficacy of the standard oral rehydration solution (WHO‐ORS). One hundred twenty‐nine males aged 3–48 months with weight for length ≥70% of NCHS, diarrheal duration ≤96 h, and clinical signs of mild to moderate dehydration were randomly allocated to either treatment group. During 0–6 h of treatment, ORS was offered at 120 ml/kg for rehydration without food or water. Beyond 6 h, ORS was offered as a volume‐to‐volume replacement for stool losses and a mixed diet of uniform composition was offered in amounts standardized for body weight. The most frequently isolated pathogens in alanine ORS and WHO‐ORS groups were rotavirus (42 and 48%, respectively) and enterotoxigenic Escherichia coli (15 and 12%, respectively). In the 0–6 h period when food was withheld, median urine output in ml/kg (8;5, p < 0.05) and percentage decrease in total serum solids (9:7%, p = 0.06) was significantly greater in alanine ORS than in WHO‐ORS; median ORS intake and stool output were marginally lower in the alanine group but the differences were statistically not significant. Between 0 h and recovery, although the median values for duration of diarrhea (56.5 and 65.0 h), ORS consumption (260 and 323 ml/kg), and stool output (188.4 and 216.3 g/kg) were lower in the alanine ORS group, these differences with the WHO‐ORS group were not statistically significant. Our findings are consistent with improved efficacy of WHO‐ORS following alanine fortification but the clinical benefits achieved in these mildly dehydrated cases fall short of what may be clinically meaningful and of relevance to public health
Serum Concentrations of Extracellular Matrix Components
Authors: Calçado Antonio , Trivedi Premila , Portmann Bernard , Mowat Alex P.
Published: January 2024

Laminin, hyaluronic acid (HA), procollagen III amino‐terminal propeptide (PIIINP), and procollagen I carboxy‐terminal propeptide (PICP) concentrations were measured by radioimmunassay or radiometric assay in sera from 21 patients with glycogen storage disease (GSD). Laminin was increased in 16 of 29 samples from the six children with GSD I, 25/43 from the seven with GSD III, and 3/19 from the eight with GSD IX; laminin correlated with serum aspartate aminotransferase and γ‐glutamyltransferase but not with serum triglycerides, cholesterol, lactate, or urate. HA was increased in 20% of samples from GSD I, 58% from GSD III, and in none from GSD IX; HA correlated with serum lactate and urate but not with liver function tests, serum cholesterol, or triglycerides. Serum PIIINP was increased in only eight samples and PICP in only one; children with poor linear growth had low PIIINP and PICP. Immunostaining studies of nine liver biopsies taken at diagnosis showed increased laminin and PIIINP staining in portal tracts, fibrous septa, and around sinusoids in periportal regions; children with a greater degree of immunostaining did not always show significantly higher values of serum laminin or PIIINP. We speculate that raised serum laminin may reflect fibrogenesis (but not necessarily established fibrosis) in response to tissue damage in GSD, raised HA may reflect disturbed sinusoidal endothelial cell function, and low PIIINP and PICP impaired somatic growth rather than intrahepatic pathology.
Measurement of Colonic Transit Time in Children
Authors: Casasnovas A. Bautista , Cives R. Varela , Jeremias A. Villanueva , Castro‐Gago M. , Cadranel S. , Sierra R. Tojo
Published: January 2024

Transit times through the whole colon and its segments were measured in 10 healthy children and 14 children suffering constipation secondary to myelomeningocele. The subjects ingested radio‐opaque markers on three successive days, and on the fourth a plain abdominal roentgenogram was taken using fast film. In the healthy children, total colonic transit time (mean ± SD) was 37.8 ± 6.2 h, with segmental times of 10.8 ± 3.5 h for the right colon, 12.2 ± 2.7 h for the left, and 14.7 ± 2.1 h for the rectosigmoid; upper normal limits of 17.8 h for the right colon, 17.6 h for the left, 19.1 h for the rectosigmoid, and 50.2 h for the total colonic transit time were established. In the constipated children, the total transit time was 59.9 ± 5.4 h, with segmental times of 15.9 ± 2.3 h for the right colon, 18.9 ± 2.3 h for the left, and 25.0 ± 2.6 h for the rectosigmoid. The technique described is simple, is easy to use in clinical practice, and involves a lower radiation dose than other methods. It may prove useful for measurement of colonic transit time in suitable patients.
Realimentation of Dehydrated Children with Acute Diarrhea
Authors: Römer Hans , Guerra Marisa , Piña José M. , Urrestarazu María I. , García Doris , Blanco María E.
Published: January 2024

A randomized, prospective study was performed on 73 male children between 3 and 14 months of age with mild to moderate dehydration caused by acute diarrhea, and who were rehydrated with WHO‐ORS, and then at 4 h after admission were fed either cow's milk or an experimental diet based on chicken, plantain, and coconut oil. There were no statistically significant differences in the admission characteristics. The group of children fed cow's milk had a higher total volume of diarrheic evacuations (p < 0.05). The average duration of diarrhea was 20 h shorter in the group of infants on the milk‐free formula. A significant correlation was observed between the volume of diarrhea and the WHO‐ORS consumed during the first 48 h, but not to the volume of diet intake.
Evaluation of Growth and Changes in Body Composition Following Neonatal Diagnosis of Cystic Fibrosis
Authors: Greer Ristan , Shepherd Ross , Cleghorn Geoffrey , Bowling Francis G. , Holt Terence
Published: January 2024

Early deficits in nutritional status that might require specific treatment and early response to nutritional therapy were studied longitudinally in 25 infants with cystic fibrosis (CF) diagnosed by neonatal screening, using anthropometric and research body composition methodology, and evaluation of pancreatic function. At the time of confirmed diagnosis (mean 5.4 weeks), body mass, length, total body fat (TBF), and total body potassium (TBK) were all significantly reduced. Following diagnosis and commencement of therapy there was a normalization of weight, length, and TBK by 6–12 months of age, indicating catch‐up growth. But in some individuals the response was incomplete, and as a group, mean total body fat remained significantly lower than normal at 1 year of age. Seven of 25 (28%) were pancreatic sufficient at diagnosis, and all but one had evidence of declining pancreatic function requiring the institution of pancreatic enzyme therapy during the next 1–9 months. The median age of commencement of enzyme therapy was 10 weeks (range 5 weeks to 11 months). These longitudinal assessments emphasize the dynamic changes occurring in absorptive function, body composition, and nutritional status following neonatal diagnosis of cystic fibrosis and may reflect previously described abnormalities of energy metabolism in this age group. Abnormal body composition is evident in most CF infants following diagnosis by neonatal screening but pancreatic damage may still be evolving. We suggest that early active nutritional therapy and surveillance for changes in pancreatic function are warranted in CF infants diagnosed by neonatal screening.
Growth and Metabolic Responses in Low‐Birth‐Weight Infants Fed Human Milk Fortified with Human Milk Protein or with a Bovine Milk Protein Preparation
Authors: Moro G. E. , Minoli I. , Fulconis F. , Clementi M. , Räihä N. C. R.
Published: January 2024

Unfortified human milk does not normally provide enough protein to secure maximal growth in low‐body‐weight (LBW) infants. Due to the practical difficulties in obtaining human milk protein (HMP), a bovine milk protein preparation (BMP) was designed by computer calculation to contain as close as possible the amino acid composition of the nutritionally available human milk proteins. Twenty‐one AGA, LBW infants (BW of 1,180 to 1,600 g, GA of 27 to 33 weeks) were randomly assigned to be fed HM enriched either with HMP (9 infants) or BMP (12 infants). When full volume intake (170 ml/kg/day) was reached, the protein intakes were 3.6 ± 0.5 and 3.3 ± 0.3 g/kg/day, respectively, in the two diet groups. During the study period of 24 days, the infants achieved intrauterine or better weight gains: 32.9 ± 3.3 g/day (17.7 ± 1.9 g/kg/day) in the HMP group and 34.7 ± 7.3 g/day (18.3 ± 3.5 g/kg/day) in the BMP group. Serum urea nitrogen, acid‐base status, and albumin values were normal and similar in both groups of infants. Plasma concentrations of total essential and total amino acids at the end of the study were 3,999 and 1,539 μmol/L and 3,899 and 1,422 μmol/L in the HMP and the BMP groups, respectively. The concentrations of all individual plasma amino acids were similar in both feeding groups. These results show that feeding human milk fortified with a modified bovine milk protein preparation produces satisfactory growth and a plasma amino acid profile similar to that found in LBW infants fed exclusively human milk protein at similar intakes.
Duodenal Intubation and Aspiration Test
Authors: Faweya A. G. , Akinyinka O. O. , Sodeinde O.
Published: January 2024

Summary: A prospective study involving 27 infants with cholestatic jaundice was carried out to evaluate the diagnostic utility of the 24‐h duodenal drainage test. Extrahepatic cholestasis was confirmed by either exploratory laparotomy or autopsy in 12 of 13 cases without bile drainage, with only one false‐positive result. The sensitivity of this test for extrahepatic cholestasis was 100% while the accuracy and specificity were 96.3 and 93.3%, respectively. The corresponding sensitivity, accuracy, and specificity for liver biopsy in patients with extrahepatic cholestasis were 83.3, 92.6, and 100%, respectively. It is concluded that the duodenal drainage test is a simple, rapid, and inexpensive procedure with high sensitivity and specificity in the diagnosis of infantile cholestasis.
Prolonged Postprandial Abdominal Pain Following Kawasaki Syndrome with Acute Gallbladder Hydrops
Authors: Bishop Warren P. , Kao Simon C. S.
Published: January 2024

Summary: Acute hydrops of the gallbladder is a well‐recognized complication of Kawasaki syndrome. We report a case of a child with this syndrome whose gallbladder hydrops slowly resolved after intravenous γ‐globulin therapy. However, he continued to experience postprandial right upper quadrant abdominal pain. Hepatobiliary scintigraphy revealed normal filling of the gallbladder but marked impairment of meal‐stimulated gallbladder emptying. Endoscopy with biopsy of the esophagus, stomach, and duodenum was normal, ruling out peptic complications of his aspirin therapy. This child's discomfort improved slowly over several months, finally ending approximately 6 months after the onset of his illness. A repeat gallbladder emptying study done ultrasonographically at that time revealed near‐normal meal‐stimulated gallbladder emptying. We conclude that poor emptying of the gallbladder may be associated with prolonged abdominal pain in Kawasaki syndrome. Meal‐stimulated gallbladder emptying can be assessed by a simple ultrasonographic technique and should be considered in any patient with Kawasaki syndrome and abdominal pain.
Heart Rates of Breast‐Fed and Formula‐Fed Infants
Authors: Butte Nancy F. , O'Brian Smith E. , Garza Cutberto
Published: January 2024

Heart rates of 46 breast‐fed and formula‐fed infants were monitored continuously for −18 h at 1 or 4 months of age. Heart rate differed significantly by age (1 month > 4 months; p < 0.001) and feeding mode (breastfed < formula‐fed; p < 0.001). Approximately 58% of the variability in heart rate could be attributed to feeding mode, sex, and age. Heart rate was correlated significantly with energy intake (r = 0.60; p < 0.001), but not sleeping metabolic rate or total daily energy expenditure. Energy intake accounted for none of the variability in heart rate beyond that explained by feeding mode, sex, and age.
Congenital Diabetes Mellitus and Fatal Secretory Diarrhea in Two Infants
Authors: Jonas Maureen M. , Bell Michael D. , Eidson Margaret S. , Koutouby Raghad , Hensley George T.
Published: January 2024

Two unrelated male infants presented with brittle insulin‐dependent diabetes mellitus in the first days of life. Subsequently they each developed severe secretory diarrhea, with stool volumes of more than 100 ml/ kg/day. Extensive biochemical and serological investigation failed to reveal the etiology of the diarrhea. The infants, cared for at different institutions, underwent therapeutic trials of various agents including loperamide, cholestyramine, prednisone, indomethacin, and somato‐statin analogue, without response. Both infants succumbed to septicemia and malnutrition related to diarrhea and poor control of glycemia. At autopsy, both were found to have absence of islets of Langerhans in the pancreas, and diffuse dysplastic changes in small and large intestinal mucosae. In particular, the entire alimentary tract in each case was lined by epithelia most typical of foregut mucosa: secretory‐type glands, absent crypts of Lieberkuhn, and absent villi. These cases are contrasted with previously‐reported infants with congenital diabetes mellitus, and the possible interrelation of these two highly unusual findings, congenital diabetes mellitus and diffuse intestinal dysplasia, is examined.
Button Gastrostomy Obstructing the Ileocecal Valve Removed by Colonoscopic Retrieval
Authors: Berman James H. , Radhakrishnan Jayant , Kraut Jerome R.
Published: January 2024

A 16‐year‐old male with profound developmental disability acutely developed retching, irritability, and abdominal distension. He had undergone a fundopli‐cation and placement of a feeding gastrostomy 6 months earlier. A button gastrostomy tube was subsequently placed, but was noted to be missing from the stoma when the patient was awakened by his mother one morning. Within 48 hours he developed signs of abdominal obstruction. Abdominal radiography confirmed the presence of the gastrostomy button at the ileocecal valve. After a trial of decompression and medical management failed, the button was successfully removed endoscopically, resulting in prompt resolution of the obstruction. Gastrostomy buttons are a newer alternative to conventional catheters, but can become dislodged and migrate, as illustrated by this case. Refinements in the outer wing design may be needed.
Colostral Antioxidants
Authors: Buescher E. Stephen , McIlheran Sarah M.
Published: January 2024

Human colostrum contains several antioxidants which prevent the detection of human polymorpho‐nuclear leukocyte (PMN) respiratory burst products. Using column chromatography to fractionate colostrum, two peaks of antioxidant activity were resolved away from colostral proteins and further characterized. One peak contained both cytochrome c‐reducing activity and H2O2‐depleting activity. This peak had the chromatographic, spectral, and antioxidant characteristics of ascorbate, and by high performance liquid chromatography (HPLC) methods, was shown to contain ascorbate as well as at least four other materials. The antioxidant activity in this peak was totally ascorbate oxidase sensitive and partially uricase sensitive. The other peak contained only H2O2‐depleting activity and had the chromatographic, spectral, and antioxidant characteristics of uric acid. By HPLC, uric acid was the only component in this peak and its antioxidant activity was completely uricase sensitive and ascorbate oxidase resistant. Colostral uric acid levels were measured in eight postpartum women and found to be approximately one‐third of simultaneously determined serum uric acid levels. Colostrum contains at least two separate antioxidants, one of which is ascorbate‐like and the other is uric acid. We speculate that these antioxidants may function in human colostrum as traps for neutrophil‐generated reactive oxygen metabolites.
Macroamylasemia in a 5‐Year‐Old Girl
Authors: D'Avanzo Michele , Cobbaert Christa , Tolone Carlo , Toraldo Roberto , Canino Gianfranco , Vetrano Francesco , Santinelli Raffaele , Iafusco Ferdinando
Published: January 2024

In macroamylasemia, a macromolecular complex consisting of amylase linked to immunoglobulins circulates in the plasma and usually causes benign hyperamylasemia with low or normal amylasuria. Macroamylasemia is extremely rare in pediatric patients as it has been described in only four patients. We report herein the case of a 5‐year‐old girl with abdominal pain and macroamylasemia. To recognize macroamylase, we used agar gel electrophoresis, PEG precipitation, and fast protein liquid chromatography (FPLC). In our case, FPLC was found to be the most reliable method for the identification of the macromolecular complex. Macroamylasemia is merely a biochemical abnormality that is not associated with any kind of pathology. Its identification is therefore essential in order to avoid a wrong diagnosis, i.e., pancreatitis, with consequent inappropriate therapies.
Use of Intravenous Lipid and Hyperbilirubinemia in the First Week
Authors: Adamkin D. H. , Radmacher P. G. , Klingbeil R. L.
Published: January 2024

Serum triglycerides, free fatty acids, unconjugated bilirubin, and albumin were evaluated in 40 neonates receiving 0.5–3.5 g/kg/day of a 50/50 soybean‐safflower lipid emulsion infused during 18 h. The purpose of the study was to evaluate lipid tolerance and unconjugated hyperbilirubinemia according to our total parenteral nutrition protocol, which initiates lipid on postnatal day 4. Mean serum triglycerides and free fatty acids were within the range of prelipid infusion values at all dosages, and no statistically significant differences were noted between very‐low‐birth‐weight neonates and those > 1,500 g birth weight. Mean free fatty acid:albumin molar ratio was < 1.0 at all dosages and no individual patient values exceeded a ratio of 3.0. Mean peak serum unconjugated bilirubin of 5.8 mg/dl on postnatal day 3 was stable or fell the next 10 days of lipid‐inclusive total parenteral nutrition. Initiating intravenous lipid on the 4th postnatal day at 0.5 g/kg/day and increasing at 0.5 g/kg/day increments at the end of the 1st postnatal week appears to be tolerated well. However, 5% of serum triglyceride levels exceeded 200 mg/dl. Therefore, in view of the unpredictability of a given patient's tolerance to lipid infusion, there should be monitoring for lipemia.
Influence of Infant Diets on the Ecology of the Intestinal Tract of Human Flora‐Associated Mice
Authors: Hentges David J. , Marsh Wallace W. , Petschow Byron W. , Thai Wendy R. , Carter Melody K.
Published: January 2024

The effect of diet on intestinal ecology was studied in germ‐free mice that were inoculated orogastrically with predominant intestinal flora components isolated from the feces of breast‐fed human infants. The flora components colonized the intestines of mice and persisted at fixed population levels. Groups of flora‐ associated mice were fed either human milk, bovine milk, whey‐dominant formula, or formula modifications exclusively for 2 weeks, and then examined for changes in small intestinal and cecal flora composition, cecal pH, and resistance to intestinal colonization with Salmonella typhimurium. Dietary variations influenced the composition of the flora to a moderate degree but the differences were generally not statistically significant. However, the addition of bovine lactoferrin to the whey‐dominant formula resulted in significantly greater counts of Bifidobacterium, Bacteroides, Enterococcus and total aerobes in the small intestine when compared with mice fed unsup‐plemented formula. Bifidobacterium was present in large numbers in both the ceca and small intestines of mice fed the lactoferrin‐supplemented formula. Despite similarities in intestinal flora patterns among mice fed the various diets, human milk consumption resulted in a lower pH of cecal contents and a greater resistance to colonization by Salmonella typhimurium after orogastric challenge than the consumption of the other diets.
Type of Acidosis and Clinical Outcome in Infantile Gastroenteritis
Authors: Weizman Zvi , Houri Sion , Gradus Dorit Ben‐Ezer
Published: January 2024

To explore different types of metabolic acidosis in acute gastroenteritis of infancy, and to correlate it with nutritional status and clinical outcome, we examined prospectively 27 consecutive infants admitted with moderate to severe dehydration and arterial blood pH 7.20. Serum anion gap, creatinine, divalent cations (Ca, Mg), and the anionic contribution of total protein, lactate, and phosphate as well as ketones and urine pH, were determined on admission and compared with age‐matched controls. Twenty infants (Group A) presented with normal anion gap (13.1 ± 2.7) associated with hyperchloremia (115.8 ± 4.2 mmol/L, p < 0.01) and diminished bicarbonate (9.7 ± 2.4 mmol/L, p < 0.01), compared with controls. The other seven infants (group B) demonstrated an increased anion gap (26.7 ± 3.2, p < 0.01), associated with significant elevations of lactate (3.4 ± 0.7 mmol/L, p < 0.001), total protein (93.4 ± 12.3 g/L, p < 0.01), as well as phosphate (2.3 ± 0.2 mmol/L, p < 0.01) and creatinine (164.9 ± 45.1 μmol/L, p < 0.001), compared with controls. No significant deviations of blood divalent cations or ketones were noted in both groups. Urine pH was ± 5.5 in all subjects. Analysis of nutritional status and clinical outcome in both groups revealed significant differences. Infants in group B, compared with group A, were significantly more severely malnourished (7 of 7 versus 4 of 20, p < 0.001), were more likely to have prolonged diarrhea ( > 14 days) (5 of 7 versus 3 of 20, p < 0.001), and required longer durations of both intravenous therapy (6.7 ± 2.3 versus 2.2 ± 0.7 days, p < 0.001) and hospitalization (19.4 ± 4.6 versus 5.4 ± 1.6 days, p < 0.001). We conclude that some infants with acute diarrhea may develop severe dehydration and anion‐gap acidosis associated with lactic acidemia and renal dysfunction. These high‐risk infants more often demonstrate severe malnutrition, persistent course of diarrhea, and prolonged hospital stay. Early identification of such infants, and aggressive therapy, will probably improve outcome.
Persistent Diarrhea and Malnutrition—The Impact of Treatment on Small Bowel Structure and Permeability
Authors: Sullivan Peter B. , Lunn Peter G. , Northrop‐Clewes Christine , Crowe Peter T. , Marsh Michael N. , Neale Graham
Published: January 2024

Previous studies using dual sugar permeability tests suggested that damage to the small intestinal mucosa plays an important part in the development of persistent diarrhea in The Gambia. The present study has extended these findings by examining the effect of nutritional rehabilitation on intestinal permeability and mucosal morphology. Intestinal permeability, measured by lactulose:man‐nitol (L:M) absorption, and mucosal structure, measured by a quantitative, computerised morphologic technique, were evaluated in 20 children before and after such treatment. L:M ratios were high on admission, (0.66 ± 0.36) and, despite some temporary improvement, did not significantly improve (0.49 ± 0.30) following rehabilitation for one month. The changes in L:M ratio were largely due to an increase in lactulose absorption, showing that the small intestinal mucosa becomes more “leaky” as a result of nutritional rehabilitation. Although no correlation was found between measures of intestinal permeability and mucosal morphology, nutritional restitution was associated with a significant increase in size of the mucosal crypt cell compartment, but not in villous epithelial volumes during the same period. It is necessary to establish, by further prospective studies, the interval required for full restitution of small intestinal structure and function during treatment for persistent diarrhea.
Transient Protein‐Losing Hypertrophic Gastropathy Associated with Mycoplasma pneumoniae Infection in Childhood
Authors: Amitai D. Ben , Zahavi I. , Dinari G. , Garty B. Z.
Published: January 2024

A 3‐year‐old boy with transient protein loss due to hypertrophic gastropathy is described. Serologic evidence of concomitant Mycoplasma pneumoniae infection was present. Although sometimes associated with infections, protein‐losing hypertrophic gastropathy has not been reported previously in association with Mycoplasma pneumoniae infection.
In Vivo Effect of Yogurt on Excretion of Enteropathogen Escherichia coli RDEC‐1 During Acute Diarrhea in the Just‐Weaned Rabbit
Authors: Gotteland Martin , Pochart Philippe , Dabbech Moufida , Bisetti Nathalie , Desjeux Jehan‐François
Published: January 2024

Yogurt has been shown to inhibit, by various mechanisms, pathogenic bacterial growth in vitro, including that of the rabbit Escherichia coli strain RDEC‐1. To determine whether this in vitro inhibition by yogurt has an in vivo counterpart, 60 newly weaned New Zealand rabbits were randomly assigned to receive a diet supplemented with either milk or yogurt. Four days later, rabbits were infected intragastrically with 108E. coli strain RDEC‐1. During the 30 days postinfection, animals were checked regularly for weight, stool characteristics, and fecal excretion of bacteria. Results show that the duration of diarrhea as well as bacterial excretion were the same in the milk and yogurt groups, indicating that in vivo, yogurt did not interfere with the growth of the pathogenic E. coli strain RDEC‐1. The pattern of the survival curves was significantly different in the two groups (p < 0.03), but the difference between their mortality at 30 days postinfection was not significant (80% in the milk group versus 67% in the yogurt group). These results indicate that the bactericidal activity of yogurt observed in vitro against the E. coli strain RDEC‐1 does not have an in vivo counterpart in the model of the just‐weaned rabbit infected by RDEC‐1.
Determination of Body Composition in Growing Rats by Total Body Electrical Conductivity
Authors: Morbach Connie A. , Brans Yves W.
Published: January 2024

Total body electrical conductivity (TOBEC), measured with an Em‐Scan SA‐1 analyzer, was evaluated as a means of estimating fat‐free mass and total body water content noninvasively in small laboratory animals. Ninety‐four rats whose weight ranged from 5.53 to 170.84 g at 0–50 days of age were studied. The animals were killed by intraperitoneal injection of a pentobarbital overdose. After weight, crown‐rump length (CRL) and TOBEC were measured, and the animals were minced with scissors and desiccated to constant weight in a convection oven. Fat was extracted by multiple bathings in petroleum ether followed by Soxhlet extraction. Fifty‐four rats were used to determine the relation between fat‐free mass (FFM), total body water (TBW), and TOBEC# (E) by regression analysis. The best correlations were observed between FFM and (E X CRL)1/2 (r = 0.995, p < 0.0001) and between TBW and (E X CRL)1/2 (r = 0.995, p < 0.0001). Forty rats were used to determine the predictive value of TOBEC estimates. With this instrument, TOBEC tended to underestimate FFM by an average of 3.9% and TBW by 5.3%. Accuracy was questionable for animals smaller than 13 g and TOBEC did not provide useful estimates of total body fat. Subject to these limitations, TOBEC instruments should prove to be useful for sequential in vivo estimations of body composition during growth and development of small animals.
Factors Affecting Long‐Chain Polyunsaturated Fatty Acid Composition of Plasma Choline Phosphoglycerides in Preterm Infants
Authors: Leaf Alison A. , Leighfield Martin J. , Costeloe Kate L. , Crawford Michael A.
Published: January 2024

Long‐chain polyunsaturated fatty acid (LCPUFA) composition of choline phosphoglycerides was measured in the plasma of 22 preterm infants at birth and at expected date of delivery (EDD). In a subgroup of 10 infants, data were also collected at regular intervals between birth and EDD. Levels at birth showed a positive correlation between arachidonic acid (AA) and birth weight, p<0.01, and between docosahexaenoic acid (DHA) and gestational age, p<0.01. Percentage compositions of both AA and DHA fell rapidly between preterm birth and expected date of delivery, at a time when they would remain high in utero. For AA, the mean value fell from 16.52 to 7.18%, and for DHA from 4.49 to 2.63%. Levels of DHA fell less in babies fed breast milk than in those fed formula milk, p<0.05, and levels of AA fell less in those requiring a large number of blood transfusions, p<0.05. The level of DHA fell more in those infants with intrauterine growth retardation, p<0.05. Although these nutrients share common metabolic pathways for their synthesis, they appear to be affected by different factors in both the fetus and the preterm infant. Low levels at this time may adversely affect brain and retinal development.
Effects of Indomethacin in Congenital Chloride Diarrhea
Authors: Mayatepek Ertan , Seyberth Hannsjörg W. , Nützenadel Walter
Published: January 2024

Clinical and biochemical effects of indomethacin were monitored in a patient with congenital chloride diarrhea (CCD) before and after 10 days of therapy. During indomethacin treatment, no clinical improvement could be achieved whereas hyperreninemia and hyperaldosteronism improved. Excretion rates of prostaglandin (PG) E2, PGF2α, as well as PGE‐M were found to be slightly raised and decreased during therapy with indomethacin. However, loss of electrolytes remained substantially unchanged. Prostaglandins, therefore, seem to play no important role in intestinal loss of electrolytes in CCD, and it is suggested that indomethacin is of no importance in the treatment of patients with CCD.
Ultrasonography and Gastric Emptying
Authors: LiVoti G. , Tulone V. , Bruno R. , Cataliotti F. , Iacono G. , Cavataio F. , Balsamo V.
Published: January 2024

We have applied ultrasonography to the evaluation of gastric emptying in children. Two different populations have been investigated: normal children and children with gastroesophageal reflux. All the patients were <6 months of age. The diagnosis of gastroesophageal reflux was defined by 24‐h pH measurement. The technique, used to measure gastric emplying, is the one described by Bolondi et al. In this research we used the simplified method. All children had been submitted to the examination after 4‐h fasting. The standard meal was the usual milk formula, 300 ml/m2 body surface area (BSA). A cross‐section area of the gastric antrum was determined before a meal and every 15 min for 2 h. The examination was concluded after two measurements were equal to the basal one. The normal gastric emptying curve was determined by a control group. Patients with gastro‐esophageal reflux showed three different kind of gastric emptying: (a) normal gastric emptying in 20% of cases, (b) abnormal gastric emptying in 15% of cases, and (c) intermediate cases in which the plateau curve is abnormal but the end time of gastric emptying is normal. We defined these three kinds of curves as type I or normal, type III or abnormal, and type II or intermediate. The estimate of frequency in patients with gastroesophageal reflux is similar to the reported data of the literature.
Field Trial of an Infant Formula Containing Anti‐rotavirus and Anti‐Escherichia coli Milk Antibodies from Hyperimmunized Cows
Authors: Brunser Oscar , Espinoza Julio , Figueroa Guillermo , Araya Magdalena , Spencer Eugenic , Hilpert Helmut , Link‐Amster Harriet , Brüssow Harald
Published: January 2024

Two groups of 124 and 108 children, respectively, living in urban Santiago, Chile in low socioeconomic conditions were prospectively followed for 6 months for their incidence of diarrhea. Each cohort was divided into two subgroups receiving either a commercial milk formula or the same formula containing 1% (wt/wt) bovine milk immunoglobulin concentrate from cows hyperimmunized with human rotaviruses and the major enteropathogenic Escherichia coli (EPEC) serogroups. Neither group differed with respect to incidence of diarrhea (98 episodes in 117 treated children versus 95 episodes in 115 control children), duration and clinical symptoms of diarrhea, and weight gain. Furthermore, neither group differed with respect to isolation of rotavirus (14 and 13 isolates in treatment and control groups, respectively) and isolation of enteropathogenic E. coli (14 and 15 isolates in treatment and control groups, respectively). The treatment but not the control formula contained neutralizing antibody against all human rotavirus serotypes. Titers were comparable to human breast milk samples. All isolated EPEC serogroups were included in the vaccine used for the immunization of the cows. The treatment, but not the control formula, protected mice against a lethal challenge with an EPEC strain. In conclusion, feeding an antibody‐supplemented formula had no positive effect on diarrheal diseases under the conditions of a fairly well‐controlled small‐scale field trial.
BUN/Cr Ratio as an Index of Gastrointestinal Bleeding Mass in Children
Authors: Urashima Mitsuyoshi , Toyoda Shigeru , Nakano Toshiyuki , Matsuda Shuichi , Kobayashi Naoaki , Kitajima Haruo , Tokushige Aijirou , Horita Hideki , Akatsuka Jun‐ichi , Maekawa Kihei
Published: January 2024

Determining the site and severity of blood loss is important in the management of children with gastrointestinal (GI) bleeding. Blood urea nitrogen (BUN) and serum creatinine (Cr) were measured on the day of hospitalization and the ratio of BUN/Cr was calculated in 11 children with 16 episodes of upper GI bleeding and 49 with lower GI bleeding. There was a significant difference between the two GI bleeding groups with regard to BUN/ Cr ratio (p ≥ 0.001). When the ratio was 30 or above, the specificity of upper GI bleeding was 98% with a sensitivity of 68.8%. A linear relationship was found between the BUN/Cr ratio and AHb (AHb = 0.08 χ BUN/Cr ± 0.8 g/dl) for bleeding originating from the upper GI tract. This study confirms that measurement of the BUN/Cr ratio is useful for localizing the source of bleeding to the upper GI tract and also demonstrates its usefulness as an estimation of the severity of blood loss from the upper GI tract.