bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Zinc Intake and Growth During Infancy
Authors: Friel James K. , Gibson Rosalind S. , Kawash George F. , Watts John
Published: January 2024

Summary:

Energy, protein, zinc intake, and weight and length were monitored at 3, 6, and 12 months in 50 preterm infants (corrected for gestational age) (mean birthweight, 1,054 ± 234 g; mean gestation, 29 ± 2.5 weeks) and 60 full‐term infants (mean birthweight, 3,509 ± 269) g; mean gestation, 40 ± 1 weeks). Mean energy and protein intake (per kilogram body weight) was higher (p < 0.05) for the preterm infants at all times and met the recommended levels for preterm infants. No significant differences in zinc intake (per kilogram body weight) between the two groups existed, and at 3 months, mean zinc intake in the preterm group (per kilogram body weight) was below the recommended level for full‐term infants. At no time were the growth percentiles of the preterm group equal to those of the fullterm group. Multiple regression equations predicting length at 3 months and weight at 12 months for all the infants were significant, the significant variables being length at birth and zinc intake (milligrams per day) at 3 months, and weight at birth and dietary zinc intake (milligrams per day) at 12 months, respectively. Results indicate that zinc intake played a more important role in explaining the length at 3 months and weight at 12 months than did any other variables, including intakes of protein and energy, gestational age, socioeconomic index of the father, midparent height, sex, and age of introduction of solid foods. Results thus support the suggestion that infants, especially those born prematurely, are at risk for inadequate intake of dietary zinc.
Energy Intake, Norepinephrine Excretion, and Oxygen Consumption in Low Birthweight Infants
Authors: Weinstein Marie Ritthamel , Bell Edward F. , Oh William
Published: January 2024

Summary:

Eleven healthy, appropriately grown low birthweight infants, ages 3–15 days and 28–33 weeks gestation, were the subjects of this study. Energy intake, urinary norepinephrine excretion, and metabolic rate as reflected in VO2 were examined concurrently. Energy intakes were recorded. Simultaneous collection of a timed urine for norepinephrine excretion and measurement of VO2 using indirect calorimetry were performed. A servo control device was used to maintain an abdominal skin temperature of 36.5°C. The results demonstrated increases in energy intake, urinary norepinephrine, and VO2 with advancing postnatal age. Simple linear regression analysis revealed significant positive correlations between energy intake and VO2 (p < 0.003), norepinephrine excretion and VO2 (p < 0.003), postnatal age and VO2 (p < 0.01), and postnatal age and energy intake (p < 0.001). Multiple regression analysis revealed a strong positive correlation between urinary norepinephrine excretion and VO2, and energy intake and VO2. When postnatal age was added to the multiple linear regression analysis as a variable, energy intake was no longer strongly correlated with VO2. This implies postnatal age and energy intake are closely linked in this study, and further studies are needed to better define these relationships.
Safflower Oil Emulsion Administration During Parenteral Nutrition in the Preterm Infant. 2. Effect on Triglyceride and Free Fatty Acid Levels
Authors: Cooke Richard J. , Buis Marlene , Zee Paulus , Yeh Yu‐Yan
Published: January 2024

Summary:

During a study to evaluate the effect of a safflower oil emulsion on essential fatty acid status during parenteral nutrition, we also measured plasma triglycerides and plasma free fatty acids (FFA) in a group of preterm infants. Subjects received 0.34 g/kg (group 1) or 0.68 g/kg (group 2) of lipid daily for 5 days. Essential fatty acid status remained normal in both groups, but the changes in plasma triglycerides were greater (p < 0.025), and hypertriglyceridemia was somewhat more common (p = 0.06) in group 2 than in group 1. Plasma FFA did not differ in either treatment group. However, postinfusion FFA were greater (p < 0.05) and FFA uptake was less (p < 0.05) in infants at <32 than at 32–34 weeks gestation, but in no instance did postinfusion FFA exceed an FFA/albumin ratio of 6:1. In addition, triglycetide and FEST uptake did not improve during the study, but the changes in plasma triglycerides and FFA were greater (p < 0.05) at the end than at the beginning of the study.
Assessment of Abbreviated Techniques for Determination of Milk Volume Intake of the Human Milk‐Fed Infant
Authors: Matheny Rebecca J. , Picciano Mary Frances
Published: January 2024

Summary:

Two recently proposed abbreviated techniques for estimation of 24‐h milk intake of the breast‐fed infant were evaluated as to whether they could serve as appropriate substitutes for measured 24‐h intakes. One technique involves the doubling of 12‐h milk intakes, whereas the other uses the product of the mean of two consecutive midpoint feedings and the frequency of nursing for the defined 24‐h period. Data from three consecutive 24‐h intake measurements at 4, 8, and 12 weeks on 22 solely breast‐fed infants were used for the evaluation. Correlational and paired t test analyses were conducted to compare intakes from each abbreviated technique with measured intakes. All calculated intakes derived from doubling 12‐h periods commencing in the morning exceeded values obtained for full‐day measures. These overestimations resulted from higher milk consumption during the early hours of the day, with proportionate intakes ranging from 0.55 to 0.77. Doubled half‐day calculations initiated later in the day (2 p.m.‐2 a.m.) were similar to mean measured 24‐h intakes, with proportionate intakes ranging from 0.47 to 0.51. Correlations between all calculated intakes and measured intakes ranged from 0.51 (p = 0.111) to 0.93 (p = 0.001). Estimated mean intakes derived by the method utilizing nursing frequency and the mean for two nursings were similar to measured 24‐h mean intakes. Correlations between such 24‐h calculated and measured intakes ranged from 0.70 (p = 0.001) to 0.97 (p < 0.001). Results indicate that doubled half‐day measures involving the 2 p.m.‐2 a.m. time frame and estimated intakes calculated from nursing frequency and the mean for two nursings may be appropriate approaches for population studies. However, such abbreviated techniques cannot be supported as substitutes for measured 24‐h intakes for individual infants.
Lactase Insufficiency Revisited
Authors: Forget P. , Lombet J. , Grandfils C. , Dandrifosse G. , Geubelle F.
Published: January 2024

The definition of “insufficient” small bowel lactase activity varies greatly among authors. The present study is aimed at redefining lactase insufficiency by comparing intestinal lactase activity and results of the lactose breath hydrogen test. Primary “insufficient” lactase activity was considered to be present when a child with a normal small bowel histology showed lactose malabsorption as measured by the lactose breath hydrogen test. The lactase activity of 22 “normal” children ranged from 0.77 to 4.57 U/g wet weight, while five children showed primary lactase insufficiency as defined above. Small bowel lactase activity in the latter patients was <0.74 U/g wet weight. Sucrase and maltase activities were similar in both groups of patients. We conclude that children with a normal small bowel histology should be considered to have primary lactase insufficiency when small bowel lactase activity is below 0.75 U/g wet weight.
Congenital Selective Malabsorption of Glucose and Galactose
Authors: Evans Lynleigh , Grasset Etienne , Heyman Martine , Dumontier Anne Marie , Beau Jean‐Pierre , Desjeux Jehan‐Fran$cCois
Published: January 2024

We review here the case histories and results of in vivo and in vitro tests for eight children with congenital selective glucose and galactose malabsorption (GGM) whom our laboratory has followed up since 1971. Clinically, GGM was manifested by intractable, acidic, sugar‐containing diarrhea that started during the neonatal period. Diarrhea only abated when glucose and galactose were removed from the diet. The disease was notable for the absence of other symptoms, although mellituria was a common finding. Defective sugar transport was permanent, but sugar tolerance appeared to increase with age. In vitro, intracellular mucosal glucose concentration (C) was significantly below control level in GGM intestinal tissue for concentrations (M) of 10 and 0.1 mM glucose in the medium. C/M for galactose also decreased, while the C/M ratios for alanine and xylose were within the control range. Glucose influxes across the luminal membrane, net glucose transepithelial fluxes, and electrical parameters were all consistent with defective sodium and glucose cotransport at the brush border membrane of jejunal epithelial cells. However, the present results are also consistent with a small residual active transport system observed only at low glucose concentration in the medium. Further observations are needed to establish the role of glucose transport systems in absorption of other monosaccharides, the relationship between kidney and intestinal sodium‐glucose cotransport systems, and their genetic control.
Toxicity Mechanisms of Wheat and Other Cereals in Celiac Disease and Related Enteropathies
Authors: Auricchio Salvatore , De Ritis Giorgio , De Vincenzi Massimo , Silano Vittorio
Published: January 2024

This paper is a critical appraisal of current theories on the mechanisms of toxicity of wheat and other cereals in celiac disease and some related enteropathies. The “peptidase deficiency,” “primary immune defect,” and “gluten‐lectin” theories on celiac disease are examined and critically discussed on the basis of the relevant data available in 88 references. Special attention has been paid in this review to the nature of the cereal components triggering the appearance of toxic symptoms and signs in celiac disease as well as to underlying action mechanisms. The gluten‐lectin theory is the one best able to explain, in addition to celiac discase, some secondary intolerances that may occur in temporarily predisposed individuals as a consequence of several causes, including viral hepatitis and intestinal infections, as well as the occurrence of intestinal lesions in healthy subjects administered very high amounts of gluten.
Participation of Pancreatic Enzymes in the Degradation of Intestinal Sucrase‐Isomaltase
Authors: Riby Jacques E. , Kretchmer Norman
Published: January 2024

The pancreatic ducts of the rats were bypassed with a catheter placed within the common bile duct to prevent the entry of pancreatic enzymes into the duodenum without interrupting bile flow. For 8 days, the animals were fed a diet (peptones, sucrose, coconut oil, vitamins, and minerals) that could be digested without pancreatic enzymes. Control animals were sham operated and pair‐fed with the same diet. Relative rates of synthesis and degradation were estimated by pulse labeling and double labeling, respectively, for sucrase and for total protein, in intestinal mucosa and along the gradient of cells collected from the tip of the villus to the bottom of the crypt. The rate of degradation of sucrase was 1.7 times greater than that of total protein in controls, whereas in animals with the pancreatic bypass it was equal to that of total protein. This decrease in rate of degradation produced a proportional increase of activity of sucrase in experimental animals. The hydrolytic effect of pancreatic enzymes on sucrase was apparent along the entire length of the villus but not in the crypt. These data support the hypothesis that pancreatic proteases release sucrase‐isomaltase from the brush border membrane, resulting in the observed increase of the rate of degradation. Electrophoretic separation of immunoprecipitated sucrase‐isomaltase showed that the intact pro‐sucrase‐isomaltase observed in operated animals is split into two subunits (sucrase and isomaltase) by action of pancreatic proteases in control animals.
Clinical Associations of Norwalk‐Like Virus in the Stools of Children
Authors: Storr J. , Rice S. , Phillips A. D. , Price E. , Walker‐Smith J. A.
Published: January 2024

From among 1,360 stool specimens examined during the 19‐month period from March 1982 to September 1983, small round‐structured viruses, morphologically indistinguishable from the Norwalk agent, were detected by electron microscopy in 42 specimens from 28 children. Diarrhoea was mild, and vomiting, although frequently observed, was not an invariable feature. Mild pyrexia occurred in three patients. Many cases occurred some time after admission to the ward; this and other features suggested a hospital‐acquired infection. These cases in particular tended to have other viral infectious agents detected at the same time. Persistent diarrhoea occurred in only three cases; one with preexisting gastrointestinal pathology, and two with a combined Norwalk‐like agent, astrovirus, and rotavirus infection.
Comparison of Macronutrient Concentration of Preterm Human Milk Between Two Milk Expression Techniques and Two Techniques for Quantitation of Energy
Authors: Thomas M. Rita , Chan Gary M. , Book Linda S.
Published: January 2024

Generally, when newborns in intensive care units receive human milk, we do not know the quantity of nutrients in that milk because such analysis is time‐consuming and expensive. In our study, however, we sought (a) to compare fat, protein, lactose, and energy concentration of a three‐times‐a‐day sampling with a 24‐h expression and (b) to measure the difference between the calculated energy yield from protein, fat, and carbohydrate measurements and bomb calorimetry. At 14–18 days postpartum, 20 mothers of premature infants (30–34 weeks' gestation) expressed milk three times a day: 8 a.m., 12 p.m., and 8 p.m. At these three times, each mother expressed 3–5 ml of fore‐milk and 3–5 ml of hind‐milk for the sampling; the result was pooled for a 24‐h expression. Only fat concentration differed significantly between fore‐ and hind‐milk samples. Protein, fat, lactose, and energy concentration did not differ significantly between the two collection methods, 24‐h expression and sampling. Moreover, we found no significant difference between the calculated number for energy content and the bomb calorimetry method of energy determination. The average fore‐ and hind‐milk samples at 12 p.m. matched the 24‐h milk expression. For clinical use, a milk sample obtained around 12 p.m. can predict macronutrient concentration, therefore allowing us to calculate an infant's approximate nutrient consumption.
Bile Salt Roles in Bile‐Salt‐Stimulated Lipase Activity
Authors: O'Connor Charmian J. , Walde Peter , Wallace Robert G.
Published: January 2024

The hydrolysis of 4‐nitrophenylacetate and phenylsalicylate, catalyzed by human milk lipase in the presence of a range of concentrations of sodium cholate, has been measured at pH 7.3 and 37.5°C, and maximum activity was observed for both substrates at 1 mmole/ dm−3 bile salt. Lineweaver‐Burk plots for the enzyme‐catalyzed hydrolysis of N‐methylindoxyl myristate and 4‐nitrophenyloctanoate yielded values of Km equal to 34 and 20 μmoles/dm−3, respectively. However, an increase in the concentration of the latter substrate beyond 10 μmoles/dm−3 was not accompanied by a corresponding increase in the rate of hydrolysis. Comparison of these hydrolysis data with literature data for a variety of hydrophobic substrates suggests that there are two roles for the bile salt in the enzyme‐catalyzed reaction—the first involving binding onto several sites on the enzyme, and the second solubilization of oil‐phase substrates.
Effects of Calcium and Phosphorus Supplementation on Calcium Retention and Fat Absorption in Preterm Infants Fed Pooled Human Milk
Authors: Salle B. , Senterre J. , Putet G. , Rigo J.
Published: January 2024

Fat, phosphorus, and calcium balance studies were performed in normal very low birth weight infants (BW ≥ 1,500 g) fed either normal or calcium‐ and phosphorus‐supplemented pooled pasteurized human milk. Calcium and phosphorus supplements were 27 mg/dl and 24.5 mg/dl, respectively, throughout the study. Measured calcium and phosphorus intake in the supplemented group averaged 90 ± 6 mg/kg/day and 62 mg/kg/day, respectively, compared to 47 ± 7 mg/kg/day and 24 ± 6 mg/kg/day in the nonsupplemented group. The percent of fat, calcium, and phosphorus absorption was similar in the two groups: respectively, 71 ± 23%, 73 ± 13%, and 93 ± 2% in the supplemented group compared to 75 ± 11%, 71 ± 14%, and 92 ± 4% in the nonsupplemented group. Calcium and phosphorus retention reached 62 ± 12 mg/kg/day and 53 ± 4 mg/kg/day in the supplemented group against 21 ± 10 mg/kg/day and 21 ± 5 mg/kg/day in the nonsupplemented group. These data support the notion that calcium, in addition to phosphorus supplementation in pooled human breast milk, improves both calcium and phosphorus retention in preterm infants.
Comparison of the Cholesteryl Ester Composition of Human Milk from Preterm and Term Mothers
Authors: Bitman Joel , Wood D. L. , Mehta N. R. , Hamosh P. , Hamosh Margit
Published: January 2024

Milk was obtained on postpartum days 2–3 (colostrum) and days 7, 21, 42, and 84 from mothers of 18 very premature (VPT, 26–30 weeks gestational age), 28 premature (PT, 31–36 weeks), and 6 term (T, 37–40 weeks) infants. Lipids were extracted in chloroform‐methanol and analyzed by thin‐layer (TLC) and gas liquid chromatography (GLC). Fatty acid composition of cholesteryl esters was determined by GLC after isolation of cholesteryl esters by preparative TLC and preparation of methyl esters of the constituent fatty acids. As lactation progressed, amounts of total cholesterol and cholesteryl esters declined. Cholesteryl esters decreased from about 5 mg/dl in colostrum to 1 mg/dl in mature milk. The cholesteryl esters of colostrum from mothers of premature infants were different in fatty acid composition from those of term infants. Proportions of medium‐chain saturated fatty acids (12:0, 14:0, 16:0) of preterm colostrum (VPT and PT) were considerably lower than in term colostrum: 23% of total fatty acids versus 35%. Proportions of 18:3, 20:3, and 20:4 of VPT (5.6%) and PT (6.2%) colostrum were considerably higher than T colostrum (1.8%). The fatty acid composition of cholesteryl esters of VPT, PT, and T milk was relatively similar at all subsequent lactation periods. Fatty acids esterified with cholesterol in weight percents were as follows: 10:0, 0.7; 12:0, 2.6; 14:0, 2.3; 16:0, 11.4; 16:1, 5.0; 18:0, 8.8; 18:1, 32.9; 18:2, 30.6; 18:3, 1.7; 20:3, 0.9; and 20:4, 1.8. Unsaturated fatty acids contributed 73 wt % of fatty acids in cholesteryl esters, which is considerably higher than in milk triglycerides. The greatest difference occurred in 18:2 content, which was 30.6% in cholesteryl esters and only 13.0% of total fatty acids in milk. Results suggest that unsaturated fatty acids are associated preferentially with the cholesteryl ester fraction and that the fatty acid composition of cholesteryl esters differs from the composition of total milk lipid.
Effect of Cholecystokinin‐Octapeptide on Total Parenteral Nutrition‐Induced Changes in Hepatic Bile Secretion and Composition in the Rat
Authors: Innis Sheila M.
Published: January 2024

These studies investigated the ability of twice‐daily administration of cholecystokinin‐octapep‐tide (CCK‐8) to prevent changes in hepatic bile secretory function and bile composition resulting from total parenteral nutrition (TPN) in young, growing rats. Bile was collected from the common duct before and during i.v. infusion of sodium taurocholate following 7 days of TPN. TPN resulted in a reduction of hepatic bile flow, reduced bile molar cholesterol and phospholipid content, and reduction of the taurocholate secretory rate maximum (SRm) and bile salt‐independent bile flow (BSIF). Rats treated with CCK‐8 throughout their TPN retained high bile flows, BSIF, and SRm. CCK‐8 at the dose used did not correct abnormalities in the hepatic bile composition or the magnitude of bile flow generated in response to i.v. taurocholate infusion. These findings suggest that the ability of CCK‐8 to maintain high bile flows during TPN may have prophylactic relevance for prevention of TPN‐induced gallbladder disease. However, these studies also suggest that a component of current TPN systems induces damage to hepatic bile metabolism and excretion that is additional to that due to the reduced stimulation of bile flow that accompanies elimination of oral food intake.
Aneurysmal Bone Cyst of the Femur in a Child with Celiac Disease
Authors: Stenhammar L. , Karlsson G.
Published: January 2024

A case of aneurysmal bone cyst of the femur in a 2‐year‐old boy with celiac disease is described. The bone cyst presented with a pathological fracture while the boy was undergoing gluten challenge. The definite diagnosis of celiac disease according to the criteria for mulated by the European Society for Paediatric Gastroenterology and Nutrition was established. A hypothetical association between the two disorders is discussed.
Epidermal Growth Factor Does Not Act as a Primary Cue for Inducing Developmental Changes in Suckling Mouse Jejunum
Authors: Ménard Daniel , Arsenault Pierre , Gallo‐Payet Nicole
Published: January 2024

The direct influence of epidermal growth factor (EGF) on the differentiation and proliferation of small intestine was studied in organ culture. Eight‐day‐old mouse small intestine was cultured during 2 days in serum‐free Leibovitz L‐15 medium alone or supplemented with EGF (50, 100, and 500 ng/ml) either at room temperature or at 37°C. Brush border membrane hydrolytic activities, namely, sucrase, lactase, glucoamylase, trehalase, maltase, and alkaline phosphatase, were assayed in the intestinal tissue as well as in the culture medium. None of the brush border enzymic activities was affected by the addition of EGF to the culture medium. This lack of effect is not temperature dependent since it occurred both at room temperature and at 37°. The addition of hydrocortisone (10–6M) to the culture medium induced the appearance of sucrase activity and increased the activity of the other brush border enzymes. The simultaneous addition of EGF with hydrocortisone did not influence the response of the intestinal explants to hydrocortisone. The deoxyribonucleic acid (DNA) content was determined while DNA synthesis was evaluated by the incorporation of (3H)‐thymidine. The addition of EGF did not affect DNA content or (3H)‐thymidine incorporation into DNA either at room temperature or at 37°. The EGF binding to epithelial cells did not significantly vary throughout the culture period and a down‐regulation process occurred in presence of EGF. These observations strongly suggest that EGF does not act as a primary cue for inducing developmental changes in suckling mouse small intestine. It is proposed that EGF induces a systemic reaction in vivo that then influences the neonatal small intestine.
Immune‐Complex Glomerulonephritis in Crohn's Disease
Authors: Glassman Mark , Kaplan Matthew , Spivak William
Published: January 2024

A 13‐year‐old girl presented with a history of fever, arthritis, conjunctivitis, abdominal pain, and diarrhea. Colonoscopy and barium enema were consistent with Crohn's disease. A renal biopsy, performed because of persistent proteinuria and hematuria in the absence of obstruction to the urinary tract, revealed diffuse proliferative necrotizing glomerulonephritis; IgG, IgM, and C3 were deposited on the involved glomeruli. Circulating immune complexes were present in her serum. This immune‐complex glomerulonephritis represents a previously unreported extraintestinal manifestation of inflammatory bowel disease.
Adenocarcinoma of Colon in a Child
Authors: Gupta Suresh K. , Caballes Romeo L.
Published: January 2024

The diagnosis of adenocarcinoma of the colon in juvenile subjects usually poses a difficult problem due to its clinical presentation, which usually mimics disorders that are commonly found in children. This article presents the case of a 13‐year‐old boy who was admitted 2 weeks earlier to another hospital, where his condition was not recognized. He presented with abdominal signs and symptoms suggestive of diseases such as gastroenteritis, appendicitis, and intussusception which are common in this age group. The x‐ray film showed dilated loops of small bowel and the proximal portion of colon, suggesting intestinal obstruction. At surgery, a 4 × 4 cm tumor in the transverse colon was resected. Microscopically, the lesion showed moderately differentiated adenocarcinoma with foci of mucin production.
Trimebutine‐Induced Phase III‐Like Activity in Infants with Intestinal Motility Disorders
Authors: Boige N. , Cargill G. , Mashako L. , Cezard J. P. , Navarro J.
Published: January 2024

Duodenal manometric recordings were performed in five male children (mean age 11.7 ± 6.8 months) suffering from severe digestive pathology with clinical findings of dysmotility; they required total parenteral nutrition: one case of enteropathy following intestinal resection for congenital small bowel atresia, and four cases of intestinal pseudoobstruction. The basal 3‐h fasting recordings showed complete disorganization of interdigestive activity characterized by an absence of migrating motor complexes and a marked basal hypomotility with motor indices lower than in control subjects. Intravenous trimebutine (3 mg/kg) produced a phase III‐like activity 88 ± 121 s after administration in four cases. The activity lasted 236 ± 105 s and had a mean frequency of 11.75 ± 0.86 waves/min. It was propagated aborally in the two patients having two duodenal recording sites. Trimebutine‐induced phase III activity was followed by signs of peristalsis in two patients.
Arginine‐Induced Insulin and Growth Hormone Secretion in Children with Nutritional Rickets
Authors: Soliman Ashraf T. , Aref Mohamed K. , Rogol Alan D.
Published: January 2024

We evaluated arginine‐induced insulin and growth hormone (GH) secretion in ten children with vitamin D deficiency rickets and compared these values with those of eight age‐matched control children. All ra‐chitic children had biochemical (increased serum alkaline phosphatase activity and decreased calcium ± phosphate product) and clinical evidence for rickets. After an intravenous infusion of arginine‐HCl (10% solution, 0.5 g/kg), blood samples were obtained for the measurement of serum insulin and GH concentrations. The mean insulin level 30 min after the start of the infusion was 22.2 ± 17.1 μU/ml for the rachitic children. This value is significantly below that for the normal children, 63.4 ± 38.7 μU/ml (p = 0.004). Neither the fasting insulin level nor any others after the arginine infusion differed significantly from those for the control children. There were no significant differences in the fasting or the arginine‐stimulated GH levels between the rachitic and control children. The concentrations of insulin‐like growth factors did not differ between the two groups.
Small Intestinal Permeability in Pediatric Clinical Practice
Authors: Hamilton I. , Hill A. , Bose B. , Bouchier I. A. D. , Forsyth J. S.
Published: January 2024

Passive permeability of small intestine to lactulose and mannitol was studied in children suspected of having intestinal disease, using a hypertonic differential sugar absorption test. Children with coeliac disease and cows' milk intolerance were shown to have an elevated urinary lactulose/mannitol recovery ratio when compared with controls, children with normal jejunal biopsy, or children in whom alternative explanations for failure to thrive had been demonstrated. The abnormality in permeability ratio principally reflects a reduced urinary recovery of mannitol following oral administration. This study demonstrates that a hypertonic sugar absorption test is well tolerated even by young children, is practicable in routine clinical pediatric practice, and is capable of demonstrating abnormal intestinal function in children with small intestinal disease.
Iron Deficiency in Children with Celiac Disease
Authors: Bonamico Margherita , Vania Andrea , Monti Stefano , Ballati Guiduccio , Mariani Paolo , Pitzalis Giorgio , Benedetti Clorinda , Falconieri Paola , Signoretti Armando
Published: January 2024

To evaluate the incidence of either evident anemia or a subclinical status of iron deficiency in celiac disease (CD), we studied 80 celiac children aged 6 months to 18 years. They were subdivided into various groups according to morphology of gut mucosa and diet. Only eight of 47 celiac children had an evident anemia at the time of the first peroral bowel biopsy. In addition, 51% of the patients with atrophic mucosa and 56% of the children on a gluten‐containing diet had serum iron levels <50 μg/dl; 35% of patients of both groups had serum ferritin levels <12 μg/L. On the contrary, only a small number of children with normal mucosa on a gluten‐free diet showed a laboratory, subclinical picture of iron deficiency. The results of our study can therefore be summarized in three major items: (a) Low levels of both serum iron and ferritin can frequently be found during active CD. (b) Regular determination of serum iron levels appears to be useful in controlling the state of iron stores in such patients, as well as in deciding whether and when to recommend temporary iron supplementation, (c) Serum ferritin tests did not offer more information than the easier and cheaper serum iron determinations.
Gastrin 17 and Gastrin 34, Before and After a Meal, in Newborn Infants
Authors: Gemelli M. , Mami C. , Manganaro R. , Artemisia A. , Nibali S. Conti , Magazzù G. , Lombardo G.
Published: January 2024

In 89 healthy full‐term newborn infants, we studied the different contribution of gastrin 17 (G17) and gastrin 34 (G34) to neonatal hypergastrinemia and the G17 and G34 response to a meal in the first days of life. Serum concentrations of G17 and G34 were measured by radioimmunoassay specific for the NH2‐terminus of G17 and G34 in 23 newborn infants in the cord blood and in 66 newborn infants before or 20 min after bottle‐feeding. Basal serum G17 and G34 values were also obtained in 38 healthy fasting adults. Mean (±SEM) G17 levels in the cord blood were not different from those of the adult controls (29.28 ± 4.16 versus 31.00 ± 2.62 pg/ml) and increased significantly either at 12 h (48.06 ± 7.32 pg/ml, p < 0.025) or on the 4th day of life (80.56 ± 9.99 pg/ml, p < 0.01). Serum G34 levels in the cord blood were significantly higher than in adult controls (163.22 ± 11.19 versus 126.68 ± 5.57 pg/ml, p < 0.005) and increased at 12 h of life (225.22 ± 25.95 pg/ml, p < 0.02), but no increase was found on the 4th day of life (204.87 ± 18.08 pg/ml). Neither postprandial G17 nor G34 increases were found on the 1st or on the 4th day of postnatal life. The study supports the following conclusions: (a) neonatal hypergastrinemia is mainly due to G34 fraction; (b) the increased levels of gastrin on the 4th day of life are due to G17 fraction; (c) bottle‐feeding does not stimulate either G17 or G34 release in the first 4 days of life.
Juvenile Polyps and Ulcerative Colitis
Authors: Gryboski Joyce D. , Barwick Kenneth W.
Published: January 2024

Four children with ulcerative colitis, three of whom were in clinical remission of their disease, experienced rectal bleeding due to solitary juvenile polyps. Only one of the four polyps was detected radiologically. Two children passed their polyps spontaneously, one was identified at colonoscopy, and the fourth caused colocolic
Long‐Term Effects of Early Kwashiorkor Compared with Marasmus. III. Fine Motor Skills
Authors: Galler Janina R. , Ramsey Frank C. , Salt Patricia , Archer Esther
Published: January 2024

Children with histories of marasmus (n ‐ 53) or kwashiorkor (n ‐ 50) in the first year of life and healthy comparison children (n ‐ 50) were tested for fine motor skills by the Purdue pegboard test at ages 11–18 years. The performance of children with histories of marasmus was impaired on two of the four test measures. However, the performance of children with a history of kwashiorkor was impaired on three measures. The presence of soft neurologic signs measured 6 years earlier in the same children was significantly correlated with current pegboard performance, implying that early malnutrition has effects on nervous system function that arc evident at least through IX years of age.
Amino Acid Abnormalities in Infants with Extrahepatic Biliary Atresia and Cirrhosis
Authors: Weisdorf Sally A. , Freese Deborah K. , Fath John J. , Tsai Michael Y. , Cerra Frank B.
Published: January 2024

We measured fasting plasma amino acids in 26 children aged 6 months to 5 years with extrahepatic biliary atresia and cirrhosis and compared them with lasting values in 95 normal control children aged 4 months to 12 years. We found that the cirrhotic children had elevations of total free plasma amino acids implying reduced hepatic metabolism of amino acids and that the molar ratio of the branched chain amino acids (isolencine, leucine, and valine) to the aromatic ammo acids (phenylalanine and lyrosine) was significantly depressed. Methionine was also markedly elevated, and taurine concentrations were significantly decreased. Manipulation of the amino acid distribution in dietary protein to normalize plasma amino acids prior to orthotopic hepatic transplantation may be helpful in improving amino acid utilization.
Disorders of Upper Esophageal Sphincter Motility in Children
Authors: Staiano Annamaria , Cucchiara Salvatore , De Vizia Basilio , Andreotti Maria Rosaria , Auricchio Salvatore
Published: January 2024

Dysfunction of the upper esophageal sphincter was found in five out of 44 children with gastroesophageal reflux. Three of the five children had mental retardation associated with Silver Russell syndrome. 5p syndrome, or minimal change myopathy. The five patients had swallowing disorders. vomiting and failure to thrive: four also had pulmonary aspiration. Esophageal manometry showed incomplete upper esophageal sphincter relavation in two patients, upper esophageal sphincter relaxation incoordinated with pharngeal contractions in two other patients, and both incomplete and incoordinated upper esophageal sphincter relaxation in the last patient. Intensive and successful treatment of gastroesophageal reflux did not improve swallowing or symptoms of pulmonary aspiration in lour children. The fifth patient underwent ericopharyngeal myotomy, with complete resolution of respirators and swallowing symptoms. It is suggested that a dysfunction of the upper esophageal sphincter, either primary or secondary to neuromuscular disorders, may play a role in the swallowing disorders and respiratory symptoms of pediatric patients.
Gastric Intrinsic Factor Hypersecretion Stimulated by Pentagastrin in Cystic Fibrosis
Authors: Naimi D. , Guéant J. L. , Hambaba L. , Vidailhet M. , Monin B. , Nicolas J. P.
Published: January 2024

The gastric pentagastrin‐stimulated secretions of acid (peak acid output) and of unsaturated intrinsic factor in eight cystic fibrosis patients (1.4 ‐ 0.5 mEq kg h and 0.27 ‐ 0.12 mmol kg h. respectively) were significantly enhanced (p 0.05) when compared with six normal controls (0.27 ‐ 0.16 mEq kg h and 0.10 ‐ 0.02 nmol kg h respectively). Despite the gastric hypersecretion of intrinsic factor, no significant physicochemical modification of this glycoprotein was observed in cystic fibrosis when using gel filtration and isoelectrofocusing. Haptocorrin (a cobalamin glycoproteic binder that does not promote the assimilation of cobalamin) also increased in gastric juice alter stimulation. Since the sequestration of cobalamin to haptocorrin is pH dependent, the gastric acid hypersecretion observed in cystic fibrosis may explain that the malabsorption of crystalline cobalamin is much more frequent in cystic fibrosis than in chronic pancreatitis.
Effect of pH on Fecal Recovery of Energy Derived from Volatile Fatty Acids
Authors: Kien C. Lawrence , Liechty Edward A.
Published: January 2024

We assessed the effect of pH on volatilization of short‐chain fatty acids during lyophilization. Acetic, propionic, valeric, and butyric acids were added to a fecal homogenate in amounts sufficient to raise the energy density by 18–27%. Fecal homogenate samples were either acidified (pH 2.8–3.2). alkalinized (pH 7.9–8.7), or left unchanged (4.0–4.8) prior to lyophilization and subsequent bomb calorimetry. Alkalinizing the fecal samples prevented the 20% loss of energy derived from each of these volatile fatty acids observed in samples either acidified or without pH adjustment. These data suggest that in energy balance studies involving subjects with active colonic fermentation, fecal samples should be alkalinized prior to lyophilization and bomb calorimetry.
Effect of Total Parenteral Nutrition, Constant Rate Enteral Nutrition, and Discontinuous Oral Feeding on Plasma Cholecystokinin Immunoreactivity in Children
Authors: Léonard Mashako Mamba Nyenya , Bernard Christine , Cezard Jean Pierre , Chayvialle Jean Alain , Navarro Jean
Published: January 2024

Plasma cholecystokinin (CCK) levels were measured by radioimmunoassay in 100 children (mean age: 20 months) on various types of artificial nutrition. Of the 81 children men total parenteral nutrition (TPN). 32 were studied while on cyclic TPN (cTPN). 66 while on partial fractioned feeding completed by parenteral nutrition. 25 while on constant rate enteral nutrition, and 18 while on total discontinuous oral feeding. The remaining 19 control cases were on normal alimentation. Plasma CCK levels during TPN (21.4 ± 1.6 pg ml), cTPN (21.8 ± 2.7 pg ml), and constant rate enteral nutrition (26.4 ± 2.8 pg ml) were not significant different from each other and were similar to preprandial total discontinuous feeding (21 ± 2 pgml) and control (22.6 ± 3.5 pg ml) levels. The postprandial CCK level increased significantly in partial fractioned feeding (33.6 ± 3.3 pg ml. p 0.02) but remained half that of postprandial total discontinuous oral feeding (75.6 ± 6.6 pg ml. p 0.001) and postprandial controls (75 ± 7 pg ml. p 0.001). Thus, basal and stimulated CCK levels are similar in children and adults, and the use of long‐term artificial nutritional techniques does not modify the feeding stimulation of CCK. Plasma CCK levels during TPN and constant rate enteral nutrition are similar to fasting values, indicating a possible role for CCK in the biliary sludge.
Comparison of Bilirubin Production in Japanese and Caucasian Infants
Authors: Fischer Allen F. , Nakamura Hajime , Uetani Yoshiyuki , Vreman Hendrik J. , Stevenson David K.
Published: January 2024

Bilirubin production, as indexed by serum carboxyhemoglobin (HbCOc), was studied in a group of normal term Japanese infants and Caucasian controls during the second to third day of life. Stringent entry criteria were employed in order to eliminate infants with hemolysis or other known causes of increased bilirubin production. The mean HbCOc of the Japanese infants (0.69 ± 0.15% sat) was significantly higher than that of the Caucasian infants (0.58 ± 0.17% sat). The serum total bilirubin was also significantly higher in Japanese infants (11.1 ± 3.0 mg/dl versus 8.0 ± 2.2 mg/dl). This difference may be attributable to environmental and/or genetic factors.
Simultaneous pH Recordings from Multiple Esophageal Sites in Children with and without Distal Gastroesophageal Reflux
Authors: Sondheimer Judith M. , Haase Gerald M.
Published: January 2024

We made continuous, simultaneous recordings of esophageal pH from three sites in the esophageal body, for 18–24 h, in 11 children with normal prolonged distal esophageal pH studies (Group I) and in 14 children with abnormal distal esophageal pH recordings (Group II). A flexible catheter housing four antimony microelectrodes was used, and data were stored in a portable recorder. A computer allowed for evaluation of the percent of time esophageal pH was <4.0, number of reflux episodes per hour, acid clearance time, and the duration of longest reflux episode. Recordings made while subjects were upright or recumbent could be distinguished and analyzed separately. In the recumbent position, comparison of pH recordings from distal, middle, and proximal esophageal pH electrodes in Group I showed significant decreases in the percent of time spent with pH <4.0, reflux episodes per hour, acid clearance time, and duration of longest reflux episode in the proximal esophageal sites, with a near negligible total acid exposure in the most proximal electrode. In Group II subjects, however, comparison of recumbent recordings from distal, middle, and proximal esophagus indicates that the proximal esophagus is highly exposed to acid reflux and that the decrease in acid exposure from distal to proximal esophagus in reflux patients is not proportionally as great as that of Group I. The data suggest that in the recumbent position, the ability of the subjects with abnormal reflux scores to protect the upper esophagus is less than that of subjects with normal amounts of distal esophageal acid exposure.
The Endorectal Pull‐Through Procedure in Children and Young Adults
Authors: Perrault Jean , Telander Robert L. , Zinsmeister Alan R. , Kaufman Bruce
Published: January 2024

At our institution, proctocolectomy with rectal mucosectomy and ileoanal anastomosis with endorectal pull‐through is now the procedure of choice for young patients with chronic ulcerative colitis and familial polyposis. We have followed up 66 patients (37 male and 29 female, with a median age of 16 years) for at least 6 months after closure of the temporary ileostomy. The patients were seen regularly in follow‐up or were sent a comprehensive questionnaire to assess their condition. Twenty‐two patients had the construction of a J‐pouch. and 44 had a straight ileo‐anal pull‐through. Stool frequency, day (median 4 to 7 stools) and night (median 1 to 3 stools), was similar in the two groups. Voluntary continence was excellent in both groups during waking hours. Occasional night‐time incontinence in small volumes, mild perianal itching, and minimal bleeding from irritation were similar in both groups. Most of the patients could distinguish gas from stool. When medication was used, bulk agents were usually chosen, with a nonspecific anti‐diarrheal agent taken occasionally. A few patients with the straight ileo‐anal pull‐through expressed some dissatisfaction early during the follow‐up period: however, all but two patients expressed satisfaction later. Of the 66 patients, 41 had at least one complication during the postoperative period; however, in 26 the complications were minor. The more severe complications included small bowel obstruction (11 patients requiring surgical decompression), infection (one patient requiring surgery), and transient neuropathy (three patients).
Food Proteins and Maturation of Small Intestinal Microvillus Membranes (MVM). I. Binding Characteristics of Cow's Milk Proteins and Concanavalin A to MVM from Newborn and Adult Rats
Authors: Stern Martin , Gellermann Barbara
Published: January 2024

To study maturational changes of food protein and lectin binding to rat small intestinal microvillus membranes (MVM), MVM were prepared from newborn and adult animals by a modified CaCl2 precipitation technique. Radiolabeled cow's milk proteins [α‐lactalbumin, α‐casein, β‐lactoglobulin, bovine serum albumin (BSA)] and the lectin concanavalin A (Con A) were used for incubations. Binding assays were done using miniature ultracentrifugation for separation of unbound material. Binding of Con A to MVM from newborn and adult rats was strong, specific, and saturable. Binding of Con A was inhibited by cold Con A and by the sugar ligand polymer mannan. Adult MVM bound more Con A than newborn preparations. Unlike Con A, binding of cow's milk proteins by MVM was weak, nonspecific, and noninhibitable. Newborn MVM bound more cow's milk proteins than adult controls. This was true for all the proteins tested (p < 0.001). Binding rose with decreased molecular weight of cow's milk proteins, but molecular weight was not the only determining factor for binding. Trypsin treatment of MVM caused a marked increase of BSA binding in adult but not in newborn preparations. This finding indicated the importance of protein components of MVM for cow's milk protein binding. Maturational changes in protein‐lipid interactions and membrane fluidity possibly influence nonspecific cow's milk protein binding to MVM. Differences in binding between newborns and adults were not directly related to maturational shifts in membrane glycosylation that are indicated by differential Con A binding. Increased cow's milk protein binding in newborn individuals might increase the potential risk to develop an adverse reaction to food proteins.
Case Report
Authors: Adam G. , Brereton R. J. , Agrawal Meena , Lake B. D.
Published: January 2024

A boy, and 10 months later his sister, presented in the neonatal period with meconium ileus. Both became jaundiced and were found to have biliary atresia and Niemann‐Pick disease, type C. The causes of the meconium ileus were not established. Both died before the age of 6 weeks.
Anaphylactic Shock Due to Cow's Milk Protein Hypersensitivity in a Breast‐Fed Infant
Authors: Lifschitz Carlos H. , Hawkins Hal K. , Guerra Celine , Byrd Nancy
Published: January 2024

A newborn infant developed anaphylactic shock three times, once after ingesting his mother's milk and once after ingesting a formula containing casein hydrolysate. Symptoms resolved after cow's milk was withdrawn from the mother's diet and lactation was resumed. The case demonstrates that anaphylactic shock may occur in breast‐fed infants and emphasizes the need to consider allergic phenomena even in these infants.
Gastric Emptying in Infants
Authors: Hyman Paul E. , Abrams Candy E. , Dubois Andre
Published: January 2024

In a double‐blind, placebo‐controlled, randomized study we measured the effect of 1 mg/kg intravenous metoclopramide on the gastric emptying of a 15 ml/kg 5% glucose meal, using a phenol red dye dilution technique. In a group of nine infants referred for multiple daily episodes of regurgitation, metoclopramide doubled the rate of gastric emptying (p < 0.02). In six infants with prolonged gastroparesis following abdominal surgery, metoclopramide more than doubled the rate of gastric emptying (p < 0.05). In contrast, in seven infants with gastroparesis related to prematurity, metoclopramide did not significantly change gastric emptying. No extrapyramidal side effects of metoclopramide occurred during the study.
Effect of Feeding Volume on Early Postcibal Gastroesophageal Reflux in Infants
Authors: Sutphen James L. , Dillard Vivian L.
Published: January 2024

Using esophageal pH monitoring, we have investigated the effect of feeding volume on early (1 h) postcibal gastroesophageal reflux (GER) in a population of 50 infants referred for evaluation. Two feedings with the volume of both feedings specified (9 and 18 ml/kg) were given to one group of infants. A second group was given one feeding ad libitum and another specified at 9 ml/kg. Volume of intake was a very significant determinant of both the total duration and the maximum single continuous episode of GER during early postcibal esophageal pH monitoring in both groups by paired analyses. This effect was observed in infants with significant GER (n = 44) and in a subgroup of infants who were normal (n = 6).