bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Glutamine‐Supplemented Elemental Diet on Mucosal Adaptation following Bowel Resection in Rats
Authors: Michail Sonia , Mohammadpour Hamid , Park Jung H. Y. , Vanderhoof Jon A.
Published: January 2024

Summary: Glutamine is the major fuel for enterocytes and prevents mucosal atrophy in certain animal models. Previous studies in our laboratory have failed to show a trophic effect of glutamine on the small‐bowel mucosa following massive resection when added to a chow diet. However, the complexity of the chow diet might potentially interfere with the adequate evaluation of the trophic effect of a single agent such as glutamine. This study was therefore designed to determine whether the addition of glutamine to an elemental diet would augment mucosal adaptation following massive small intestinal resection in a rat model. Male Sprague‐Dawley rats were divided into two dietary groups, one receiving an amino acid‐based pediatric elemental diet supplemented with 2% glutamine, and the other receiving the diet supplemented with 2% glucose. One half of the animals in each dietary group received 80% jejunoileal resection, and the remainder were sham operated. Fifteen days postsurgery, mucosal weight, DNA, protein, and sucrase activities were determined in both the proximal and the distal small intestine. While both groups of resected animals developed marked increases in all parameters of adaptation, the glutamine‐supplemented group did not differ from the control diet group in any parameter. The addition of glutamine to an elemental diet had no enhancing effect on intestinal adaptation after bowel resection. These results are similar to those previously observed in our laboratory when glutamine was added to chow diet. The addition of glutamine to an elemental diet cannot be justified on the basis of its trophic effect in animals.
Upper Gastrointestinal Motor Abnormalities in Children with Active Celiac Disease
Authors: Cucchiara Salvatore , Bassotti Gabrio , Castellucci Giuseppe , Minella Raffaele , Betti Cesare , Fusaro Carla , Morelli Antonio , Bertotto Alberto , Auricchio Salvatore
Published: January 2024

Summary: Although from the clinical point of view a Gl motor disorder can be suspected in celiac disease, objective evidence for this is still lacking. We therefore conducted a study on children with active celiac disease to detect possible Gl motor abnormalities in this disease. Fourteen children (age range, 1–13 years) were studied; they underwent fasting and fed manometric recordings in the gastroduodenojejunal area. Four patients were re‐studied after a 6‐month gluten‐free diet. Data were compared with those obtained in eight control children. As compared with controls, celiac disease patients showed a shorter duration of activity fronts (p < 0.01) and a significant (p < 0.01) reduction of the postprandial antral motility index; furthermore, > 90% of the patients displayed marked fasting and/or fed motor abnormalities, suggesting a neuropathic disorder. Interestingly, gut dysmotilities disappeared in the four subjects, reassessed after the gluten‐free diet. It is concluded that celiac disease frequently affects the motor behavior of the gut and that its effects may be reversed by appropriate diet.
Real‐Time Ultrasound Reveals Gastric Motor Abnormalities in Children Investigated for Dyspeptic Symptoms
Authors: Cucchiara S. , Minella R. , Iorio R. , Emiliano M. , Az‐Zeqeh N. , Vallone G. , Bali M. A. , Alfieri E. , Scoppa A.
Published: January 2024

Summary: Real‐time ultrasonography (US) of the gastric antrum after ingestion of a mixed solid‐liquid meal was performed in 60 patients (median age, 8.2 years; range, 3–17) being investigated for symptoms suggesting upper intestinal dysfunction (vomiting, regurgitation, abdominal pain, early saticty, and anorexia) and in 13 controls (median age, 5 years; range, 3–15). The diagnostic work‐up allowed identification of 14 patients with esophagitis (group A) and 26 with Helicobacter pylori (HP) gastritis (group B); median age in group A was 9 years (range, 3–15) and in group B was 9.5 years (range, 3–17). Group A patients had significantly more prolonged gastric‐emptying times (median, 180 min; range, 110–270) than did controls (median, 150 min; range, 110–180; p < 0.01); however, group A times were not significantly longer than those of group B patients (median, 160 min; range, 90–265). In the remaining 20 patients (group C; median age, 7.1 years; range, 3–15) without a specific diagnosis, markedly delayed gastric emptying was detected (median, 237 min; range, 165–270; p < 0.01 vs. group B patients and vs. controls; p < 0.05 vs. group A patients); in this group, Gl manometry revealed findings of deranged motility of the gut. Distension of the antral area (percentage of increase vs. baseline values) 60 and 90 min after feeding was higher in group C (60 min: median, 185%; range, 70–614%; 90 min: median, 175%; range, 60–400%) than in both controls (60 min: median, 80%; range 26–148%; 90 min: median 90%; range 20–253%; p < 0.01) and HP patients (60 min: median, 120%; range, 35–311%; 90 min: median, 98%; range, 23–400%; p < 0.05); there was no significant difference versus esophagitis patients. The latter differed from controls only for the 60‐min postfeeding antral distension (p < 0.01), whereas HP patients did not differ from controls. In group C patients, symptomatic dyspeptic score correlated with both 60− and 90‐min fed antral distension (r = 0.61 and r = 0.64, respectively; p < 0.05), but no correlation was found with gastric‐emptying time. In group A patients, histologic score of esophagitis correlated with 60‐min postfeeding antral distension (r = 0.56; p < 0.05), whereas poor correlation was found with 90‐min postfeeding antral distension and with gastric‐emptying time. However, the latter significantly correlated with 90‐min fed antral distension in esophagitis patients (r = 0.70; p < 0.01). We conclude that US imaging of the antral area of the stomach reveals abnormalities of gastric motility in most children referred for dyspeptic symptoms; this technique should be included among the investigative tools in the diagnostic approach to these patients.
Plasma and Urine Riboflavin During Riboflavin‐Free Nutrition in Very‐Low‐Birth‐Weight Infants
Authors: Porcelli Peter J. , Rosser Mary L. , DelPaggio Dia , Adcock Eugene W. , Swift Larry , Greene Harry
Published: January 2024

Background

Very‐low‐birth‐weight (VLBW; birth weight <1500 g) infants receive enteral and parenteral nutriture that provides greater daily riboflavin (vitamin B2) than does term infant nutriture, and elevated plasma riboflavin develops in these infants after birth. The purpose of this study was to measure plasma and urine riboflavin concentrations in VLBW infants during riboflavin‐free nutrition. Our hypothesis was that elevated plasma riboflavin develops in VLBW infants because of high daily intake and immature renal riboflavin elimination.

Methods

Eighteen clinically healthy VLBW infants received parenteral nutrition and preterm infant formula during the first postnatal month. On postnatal days 10 and 28, the infants received specially prepared riboflavin‐free enteral and parenteral nutrition for the 24‐hour study period. Serial collections of plasma were made at time 0 and at 12 and 24 hours. Urine was collected continuously for the 24‐hour period in 4‐hour aliquots. Samples were analyzed for riboflavin concentration.

Results

During the 24‐hour riboflavin‐free study period on postnatal day 10, plasma riboflavin decreased 56% from 185 ± 37 ng/mL (mean ± SEM), and urine riboflavin decreased 75% from 3112 ± 960 mg/mL. Similarly, on postnatal day 28, plasma riboflavin decreased 79% from 184 ± 32 ng/mL, and urine riboflavin concentration decreased 91% from 5092 ± 743 ng/mL during the 24‐hour riboflavin‐free study period. Riboflavin half‐life (t½) was 18.5 hours on postnatal day 10 and decreased 48% by postnatal day 28. Riboflavin elimination was 145.1 ± 20.6 mg/kg per day on postnatal day 10 and increased 40% by postnatal day 28.

Conclusion

The VLBW infants who received parenteral nutrition and preterm infant formula had elevated plasma riboflavin on postnatal days 10 and 28. Plasma riboflavin t½ was shorter and renal riboflavin elimination was greater on postnatal day 28 than on postnatal day 10. Plasma riboflavin was normal after 24 hours of riboflavin‐free nutrition. The pattern of plasma and urine riboflavin in VLBW infants suggests a lower daily intake would maintain plasma riboflavin close to normal.
Fatty Acid Content of Plasma Lipid Fractions, Blood Lipids, and Apolipoproteins in Children Fed Milk Products Containing Different Quantity and Quality of Fat
Authors: Svahn Johan C. E. , Feldl Franziska , Räihä Niels C. R. , Koletzko Bertho , Axelsson Irene E. M.
Published: January 2024

Background

Differences in fatty acid content of plasma lipid fractions and serum lipid concentrations were investigated among young children fed different milk diets composed to achieve a recommended saturated fat intake.

Methods

Thirty‐eight healthy children were randomly assigned to one of four feeding groups at 12 months: 1) low‐fat milk (1.0 g/dL cow's milk fat); 2) standard‐fat milk (3.5 g/dL cow's milk fat); 3) partially vegetable fat milk (3.5 gtat/dL fat; 50% vegetable fat: rapeseed oil); and 4) full vegetable‐fat milk (3.5 gtat/dL fat; 100% vegetable fat: palm, coconut, and soy oil). Plasma fatty acids, blood lipids, and apolipoproteins were analyzed at 15 months, and dietary intakes at 12, 15, and 18 months.

Results

There were significantly lower percentage contributions of saturated fatty acids in plasma triglycerides in children fed low‐fat milk or milk with 50% or 100% vegetable fat than in children fed standard‐fat milk. Plasma polyunsaturated fatty acid levels were significantly higher in children fed milks with vegetable fat than in children fed standard‐fat milk. Plasma saturated and polyunsaturated fatty acids in triglycerides most closely reflected dietary intake. Blood lipid concentrations were lower in children fed milk with 50% vegetable fat.

Conclusions

Children fed milk with 50% or 100% vegetable fat, together with high vegetable‐fat and low milk‐fat dairy products have lower percentages of plasma saturated fatty acids and higher percentages of polyunsaturated fatty acids than children fed standard‐or low‐fat milk and dairy products.
Lower Proportion of CD45R0+ Cells and Deficient Interleukin‐10 Production by Formula‐Fed Infants, Compared With Human‐Fed, Is Corrected With Supplementation of Long‐Chain Polyunsaturated Fatty Acids
Authors: Field Catherine J. , Thomson Carrie A. , Van Aerde John E. , Parrott Arlene , Euler Art , Lien Eric , Clandinin M. Thomas
Published: January 2024

Background

The immune consequences of adding 20:4n‐6 and 22:6n‐3 fatty acids to preterm infant formula are not known.

Methods

The effect of feeding preterm infants (14–42 days of age) human milk (Human Milk group), infant formula (Formula group), or formula with added long‐chain polyunsaturated fatty acids 20:4n‐6 and 22:6n‐3 (Formula + LCP group) on isolated peripheral blood lymphocytes (by flow cytometry) and lipid composition (by gas–liquid chromatography) was determined. Lymphocytes were stimulated in vitro with phytohemagglutinin to measure soluble interleukin (sIL)‐2R and IL‐10 production (by enzyme‐linked immunosorbent assay).

Results

With age, the percentage of CD3+CD4+ T cells and the percentage of CD20+ cells increased in the Human Milk and Formula + LCP groups (P < 0.05), but not in the unsupplemented Formula group. Compared with the Formula group, CD4+ cells from the Formula + LCP and Human Milk groups expressed more CD45R0 (antigen mature) and less CD45RA (antigen naive) at 42 days of age (P < 0.05). At 42 days, IL‐10 production was lower (P < 0.05) in cells of the Formula group than in cells of the Human Milk group. Production of IL‐10 by the cells of the Formula + LCP group was not different from that produced by the Human Milk group cells. An age‐related decrease (P < 0.05) in sIL‐2R production by Formula + LCP lymphocytes was observed, but sIL‐2R production at 42 days in the Formula + LCP group did not differ significantly from that in the Human Milk group. Compared with Formula alone, adding LCP to formula resulted in a lower C18:2n‐6 and higher C20:4n‐6 content in lymphocyte phospholipids (P < 0.05).

Conclusions

Adding LCP to a preterm infant formula resulted in lymphocyte populations, phospholipid composition, cytokine production, and antigen maturity that are more consistent with that in human milk–fed infants. This may affect the ability of the infant to respond to immune challenges.
Lactose‐[13C]Ureide Breath Test: A New, Noninvasive Technique to Determine Orocecal Transit Time in Children
Authors: Van Den Driessche Mieke , Van Malderen Nele , Geypens Benny , Ghoos Yvo , Veereman‐Wauters Gigi
Published: January 2024

Background

The lactose‐[13C]ureide breath test (LUBT) is a novel, noninvasive test to determine orocecal transit time. Lactose ureide resists the action of brush border enzymes and is metabolized by colonic bacteria. The purpose of the present study was to adapt this breath test for children of various age groups and to determine whether it can be applied in infants, newborns, and preterms to study the development of small intestinal motility.

Methods

In a group of 20 children (3–17 years) in vitro stool analysis and in vivo LUBT results were compared. From each subject a blank stool sample and a sample produced after induction with unlabeled lactose ureide were incubated with 10 mg lactose‐[13C]ureide in small, closed bottles. Ten‐milliliter CO2 samples were aspirated from the bottles using a needle and a syringe every 30 minutes for 24 hours. All children performed the breath test after induction of 500 mg unlabeled lactose ureide three times the prior day. A liquid test meal (chocolate milk) with 250 mg lactose‐[13C]ureide was ingested. Breath samples were collected every 15 minutes for 10 hours. In a second group of 32 children (age range, 0–3 years) consisting of 6 children between 1 and 3 years of age, 6 infants between 6 and 12 months, 13 infants between 0 and 6 months, and 7 preterm infants, only the in vitro stool analysis was performed. Stools were collected for stool incubation, as described.

Results

The mean orocecal transit time in the group of 20 children aged 3 to 17 years was 255 minutes (range, 165–390 minutes). Stool incubations demonstrated a clear 13CO2 peak in all infants aged more than 8 months, indicating that their colonic bacterial enzymic activity hydrolyses lactose ureide. However, in all infants aged less than 6 months and in preterm infants, the 13CO2 signal was absent, indicating that those subjects were unable to hydrolyze lactose ureide.

Conclusion

Infants aged less than 6 months do not host the appropriate bacterial enzymic activity for splitting lactose ureide. The authors conclude that the LUBT can be applied in infants aged more than 8 months, after weaning to solid foods, to determine orocecal transit time.
Is Lactobacillus GG Helpful in Children With Crohn’s Disease? Results of a Preliminary, Open‐Label Study
Authors: Gupta Puneet , Andrew Haikaeli , Kirschner Barbara S. , Guandalini Stefano
Published: January 2024

Background

Lactobacillus GG is a safe probiotic bacterium known to transiently colonize the human intestine. It has been found to be useful in treatment of several gastrointestinal conditions characterized by increased gut permeability. In the current study, the efficacy of Lactobacillus GG was investigated in children with Crohn's disease.

Methods

In this open‐label pilot evaluation viewed as a necessary preliminary step for a possible subsequent randomized placebo‐controlled trial, four children with mildly to moderately active Crohn's disease were given Lactobacillus GG (1010 colony‐forming units [CFU]) in enterocoated tablets twice a day for 6 months. Changes in intestinal permeability were measured by a double sugar permeability test. Clinical activity was determined by measuring the pediatric Crohn's disease activity index.

Results

There was a significant improvement in clinical activity 1 week after starting Lactobacillus GG, which was sustained throughout the study period. Median pediatric Crohn's disease activity index scores at 4 weeks were 73% lower than baseline. Intestinal permeability improved in an almost parallel fashion.

Conclusions

Findings in this pilot study show that Lactobacillus GG may improve gut barrier function and clinical status in children with mildly to moderately active, stable Crohn's disease. Randomized, double‐blind, placebo‐controlled trials are warranted for a final assessment of the efficacy of Lactobacillus GG in Crohn's disease.
Ketamine Sedation for Pediatric Gastroenterology Procedures
Authors: Green Steven M. , Klooster Marquelle , Harris Troy , Lynch Elizabeth L. , Rothrock Steven G.
Published: January 2024

Background

Although the dissociative sedative ketamine is used commonly for pediatric procedural sedation in other settings, the safety of this agent in pediatric gastroenterology is not well‐studied. A 5‐year experience with ketamine sedation for pediatric gastroenterology procedures was reviewed to document the safety profile of this agent and to identify predictors of laryngospasm during esophagogastroduodenoscopy (EGD).

Methods

The study was a retrospective consecutive case series of children receiving ketamine administered by pediatric gastroenterologists skilled in basic airway management to facilitate pediatric gastrointestinal procedures during a 5‐year period. Patient's records were reviewed to determine indication, dosage, adverse effects, drugs, inadequate sedation, and recovery time for each sedation. A multiple logistic regression analysis was performed to identify predictors of laryngospasm during EGD. Outcome measures were descriptive features of sedation, including adverse effects and predictors of laryngospasm during EGD.

Results

During the study period pediatric gastroenterologists administered ketamine 636 times, primarily for EGD (86%) and primarily by the intravenous route (98%). The median loading dose and total dose were 1.00 mg/kg and 1.34 mg/kg, respectively. Inadequate sedation was noted in seven (1.1%) procedures. Adverse effects included transient laryngospasm (8.2%), emesis (4.1%), recovery agitation (2.4%), partial airway obstruction (1.3%), apnea and respiratory depression (0.5%), and excessive salivation (0.3%). There were no adverse outcomes attributable to ketamine. Nearly half (46%) the subjects had severe underlying illness (American Society of Anesthesiologists [ASA] class ≥3). All instances of laryngospasm occurred during EGD (9.5% incidence), and the only independent predictor of laryngospasm in this sample was decreasing age. The incidence of laryngospasm was 13.9% in preschool‐aged (≤6 years) children and was 3.6% in school‐aged (>6 years) children (difference 10.3%, 95% confidence intervals 5.5–14.9%). No dose relationship was noted with laryngospasm, and the risk did not increase with underlying illness.

Conclusion

Pediatric gastroenterologists skilled in ketamine administration and basic airway management can effectively administer this drug to facilitate gastrointestinal procedures. Transient laryngospasm occurred in 9.5% of children receiving ketamine for EGD, and its incidence was greater in preschool than in school‐aged children.
Could Local Anesthesia While Breast‐Feeding Be Harmful to Infants?
Authors: Giuliani Michele , Grossi Giovanni Battista , Pileri Mauro , Lajolo Carlo , Casparrini Giuseppe
Published: January 2024

Background

Few studies have been carried out on the levels and possible toxicity of local anesthetics in breast milk after parenteral administration. The purpose of this study is to determine the amount of lidocaine and its metabolite monoethylglycinexylidide (MEGX) in breast milk after local anesthesia during dental procedures.

Methods

The study population consisted of seven nursing mothers (age, 23–39 years) who received 3.6 to 7.2 mL 2% lidocaine without adrenaline. Blood and milk concentrations of lidocaine and its metabolite MEGX were assayed using high‐performance liquid chromatography. The milk‐to‐plasma ratio and the possible daily doses in infants for both lidocaine and MEGX were calculated.

Results

The lidocaine concentration in maternal plasma 2 hours after injection was 347.6 ± 221.8 μg/L, the lidocaine concentration in maternal milk ranged from 120.5 ± 54.1 μg/L (3 hours after injection) to 58.3 ± 22.8 μg/L (6 hours after injection), the MEGX concentration in maternal plasma 2 hours after injection was 58.9 ± 30.3 μg/L, and the MEGX concentration in maternal milk ranged from 97.5 ± 39.6 μg/L (3 hours after injection) to 52.7 ± 23.8 μg/L (6 hours after injection). According to these data and considering an intake of 90 mL breast milk every 3 hours, the daily infant dosages of lidocaine and MEGX were 73.41± 38.94 μg/L/day and 66.1 ± 28.5 μg/L/day respectively.

Conclusions

This study suggests that even if a nursing mother undergoes dental treatment with local anesthesia using lidocaine without adrenaline, she can safely continue breast‐feeding.
Omeprazole Maintenance Therapy for Gastroesophageal Reflux Disease After Failure of Fundoplication
Authors: Pashankar Dinesh , Blair Geoffrey K. , Israel David M.
Published: January 2024

Background

Recurrence of gastroesophageal reflux (GER) in children after failed fundoplication poses a therapeutic challenge. The authors report the experience with long‐term omeprazole for children with severe GER after failed fundoplication.

Methods

The authors reviewed the charts of all children who were treated with omeprazole for GER subsequent to failed fundoplication from 1990 to 1999. All underwent endoscopic and clinical assessment of the treatment at baseline, at 3–5 months, at 6–9 months, and annually.

Results

Eighteen children presented with GER, after a total of 27 fundoplications. Ten had corrected esophageal atresia, 6 had neurologica impairment, and 2 had hiatal hernia. The mean age of presentation of children with recurrence of GER was 7.8 years, and symptoms of GER occurred 4.9 years (range, 0.6–13) after last fundoplication. Fifteen patients had a mean follow‐up of 4.4 years for omeprazole. Ten patients had grade III/IV esophagitis and 5 had grade II esophagitis at presentation after fundoplication. Marked improvement was noted in symptoms of GER and severity of esophagitis while taking omeprazole. Remission of esophagitis was maintained while the patient was taking omeprazole and none had further surgery. There was no recurrence of peptic strictures in eight of nine children on omeprazole, after initial esophageal dilatations. Except for benign gastric polyps in three patients, no clinical adverse effects were observed.

Conclusions

Omeprazole is an effective long‐term drug for gastroesophageal reflux disease after failed fundoplication in children. Omeprazole was well‐tolerated by all children and should be tried before subsequent surgical intervention.
Residual Intestinal Disease After Milk Allergy in Infancy
Authors: Kokkonen Jorma , Tikkanen Sami , Savilahti Erkki
Published: January 2024

Background

The subsidence of cow's milk allergy (CMA) has been a subject of controversy. In this study the authors examined whether children with this condition in infancy developed full tolerance or whether they continue to have vague gastrointestinal (GI) symptoms relating to the consumption of milk or dairy products and/or signs of mucosal lesion in the GI tract.

Methods

The authors reexamined 56 10‐year‐old subjects who manifested CMA before 1 year of age, and compared the results with a group of 204 randomly selected age‐matched school children. Fifty‐three and 90 subjects respectively attended a reexamination and were evaluated for growth, lactose tolerance, and immunoglobulin A (IgA)‐ and IgG‐class antibodies to whole cow's milk. The subjects reporting milk‐related GI symptoms were encouraged to do a 4‐week blind elimination‐challenge test with 1 week of low‐lactose milk flour. Sixteen of the 25 children were able to complete the trial.

Results

Approximately half the study subjects (45%) reported milk‐related GI symptoms, whereas the respective figure among the control subjects was 10%. Three of six study subjects and seven of 10 control subjects, although completing the challenge, responded with intestinal symptoms. The growth of the former CMA subjects was retarded compared with the control subjects, and the difference in height was most striking in those subjects still reporting milk‐related GI symptoms. However, all subjects had normal hemoglobin and whole‐blood folic acid levels. The CMA subjects had significantly (P = 0.014) lower concentrations of milk antibodies compared with the control subjects. Lactose malabsorption, defined as high counts in a hydrogen breath test and related clinical symptoms, was found in eight CMA subjects (14%) and six control subjects (3%).

Conclusions

In a certain proportion of subjects with CMA in infancy, GI intolerance seems to persist even after small‐dose tolerance has been achieved. The intestinal symptoms and the increased prevalence of lactose intolerance may be caused by a disturbance of the surface epithelial cells—a state to which the authors refer as residual intestinal disease.
The Interrelationship of Malnutrition and Diarrhea in a Periurban Area Outside Alexandria, Egypt
Authors: Wierzba Thomas F. , El‐Yazeed Remon Abu , Savarino Stephen J. , Mourad Ali S. , Rao Malla , Baddour Manal , El‐Deen A. Nour , Naficy Abdullah B. , Clemens John D.
Published: January 2024

Background

In the developing world, children are often observed to have both diarrhea and malnutrition. This observation has led many researchers to speculate that diarrhea may produce malnutrition and that malnutrition may predispose to diarrhea. In this study, the interrelationship between diarrhea and malnutrition was investigated among 143 Egyptian children less than 3 years of age.

Methods

For 22 months, children were followed for diarrhea at twice weekly home visits and measured for nutritional status at approximately 3‐month intervals. Nutritional measurements were converted to z‐scores based on the National Center for Health Statistics/World Health Organization (NCHS/WHO) reference population.

Results

Three hundred fifty‐eight diarrheal episodes were reported with only 1% of episodes lasting 14 days or more. Stunting, wasting, and low weight‐for‐age were found in 19%, 3%, and 7%, of these children, respectively. When testing whether malnutrition predisposes to diarrhea, a weight‐for‐age z‐score of <−2 standard deviations was associated with increased incidence of diarrhea (RR = 1.7, P < 0.01) but not height‐for‐age or weight‐for‐height. Diarrhea itself was associated with a subsequent attack of diarrhea (RR = 2.1, P < 0.001). During short intervals of follow‐up (approximately 3 months), an association was detected between diarrhea episodes and growth faltering for height‐for‐age z‐score (−0.16, P < 0.05). This association was reduced, however, when analyzed during 6‐month intervals, if no diarrhea was reported in either the first or second half of this interval.

Conclusions

In a population with moderate malnutrition, both low weight‐for‐age and diarrhea itself are associated with increased diarrhea risk. Diarrhea alone does not appear to contribute substantially to malnutrition when children have diarrhea‐free time for catch‐up growth.
Ursodeoxycholic Acid Ameliorates Ibuprofen‐Induced Enteropathy in the Rat
Authors: Lloyd–Still John D. , Beno David W. A. , Uhing Michael R. , Jiyamapa‐Serna Vanida A. , Kimura Robert E.
Published: January 2024

Background

The objective of the study was to determine whether ursodeoxycholic acid (Ursodiol) is protective against ibuprofen (IBU)‐induced enteropathy.

Methods

Using the chronically catheterized rat model, IBU (60 mg/kg body weight per day) was infused via the gastric catheter twice daily. Pancreatic enzyme (PE; 10,000 U lipase/kg body weight per day) and Ursodiol (10 mg/kg body weight per day) in two doses were infused via the duodenal catheter. Rats were assigned to one of six treatment groups and were administered treatment for 20 days: control, IBU, PE, IBU + PE, IBU + Ursodiol, and IBU + PE + Ursodiol. The entire jejunum, ileum, cecum, and colon were available for histologic analysis using previously described techniques.

Results

Addition of Ursodiol to high‐dose IBU and normal doses of PE showed a significant reduction in the percentage of rats with ulcers (P < 0.05), total number of serositis events (P < 0.01), total number of severe ulcers (P < 0.001), and an absence of ulcers in the large intestine.

Conclusions

Ursodiol, the drug of choice for the treatment of cystic fibrosis liver disease, may offer a safe method of using high‐dose IBU in these patients by ameliorating the enteropathy.
Is There a Relation between Docosahexaenoic Acid Concentration in Mothers' Milk and Visual Development in Term Infants?
Authors: Jørgensen Marianne Hørby , Hernell Olle , Hughes Elizabeth L. , Michaelsen Kim Fleischer
Published: January 2024

Background

Docosahexaenoic acid (DHA), present in high concentrations in the brain and retina, has a role in visual development. DHA is present in human milk, but not in most infant formulas. It is, however, under discussion whether DHA should be added to formulas intended for term infants. The concentration of DHA in human milk, which is influenced by maternal diet, varies considerably, but it is unknown whether this variation affects visual development in term infants.

Methods

The authors investigated 39 4‐month‐old fully breast‐fed term infants in a cross‐sectional study. Visual acuity was measured by swept visual evoked potentials, milk DHA was determined by gas chromatography, and maternal fish intake was assessed by a frequency questionnaire.

Results

Frequency of fish intake correlated positively to the DHA level in breast‐milk (P = 0.001). Mothers who ate fish the day before sampling had a milk DHA level higher than expected from habitual fish intake (P = 0.002). If this was taken into account, 57% of the variation in milk DHA could be explained by fish intake. Multiple linear regression analysis revealed a significant association between visual acuity and milk DHA (P = 0.02, R2 = 0.09).

Conclusion

This finding suggests a cause‐and‐effect relationship between infant milk DHA intake and visual acuity. If these data are confirmed, there is a need to consider the optimal intake of DHA for the lactating mother.
Plasma Nitrate Concentrations in Children with Infectious and Noninfectious Diarrhea
Authors: Charmandari Evangelia , Meadows Nigel , Patel Mahesh , Johnston Atholl , Benjamin Nigel
Published: January 2024

Background

In patients with intact renal function and low dietary nitrate intake, plasma nitrate concentrations reflect endogenous nitric oxide production and are shown to be increased during inflammatory processes. The aim of this study was to compare plasma nitrate concentrations and hence endogenous nitric oxide production in children with infectious and noninfectious diarrhea and to determine whether plasma nitrate concentrations could serve as a discriminant test between acute and chronic diarrhea in children.

Methods

Three groups of patients were identified: 14 patients with acute gastroenteritis, 13 patients with chronic noninfectious diarrhea, and 14 patients with no evidence of gastrointestinal pathology and no underlying infectious process, who served as control subjects. Plasma nitrate concentrations were determined spectrophotometrically using the Greiss reaction before reduction to nitrite with a copper‐coated cadmium column.

Results

Mean plasma nitrate concentrations were 405.3 μmol/L ± 281.6 μmol/L (standard deviation) in patients with infectious diarrhea, 134.7 μmol/L ± 77.0 μmol/L in patients with chronic diarrhea, and 54.1 μmol/L ± 20.1 μmol/L in control subjects (F = 42.6, P < 0.0001; analysis of variance). Plasma nitrate concentrations were significantly higher in the infectious diarrhea group compared with the noninfectious diarrhea and control groups (Student–Newman–Keuls test, P < 0.5).

Conclusions

Although an optimal cutoff concentration cannot be defined, plasma nitrate concentrations in excess of 300 μmol/L are suggestive of an infectious process whereas values less than 100 μmol/L are indicative of noninfectious diarrhea.
Apoptotic Epithelial Cells in Biopsy Specimens from Infants with Streaked Rectal Bleeding
Authors: Kumagai Hideki , Masuda Tomoyuki , Maisawa Shunichi , Chida Shoichi
Published: January 2024

Background

Histologic studies of rectosigmoidal mucosal biopsies of infants with isolated blood‐streaked stool have shown many eosinophils and revealed aggregates of small dark granules (nuclear dust). However, no description of the nuclear dust has been made for this condition and the nature of the nuclear dust has not been thoroughly investigated. We determined the characteristics of these particles in biopsies from infants with streaked rectal bleeding.

Methods

Nineteen infants who were younger than 6 months old and had isolated rectal bleeding were studied, as were six age‐matched control infants. Rectosigmoidal mucosal biopsies were immunohistochemically assessed using anticarcinoembryonic antigen and macrophage‐associated antibodies and examined for apoptotic cells by modified in situ TdT‐mediated dUTP‐biotin nick‐end labelling. The number of apoptotic epithelial cells was compared between rectal bleeding and control groups.

Results

Immunohistochemistry showed that at least some of the nuclear dust consisted of apoptotic epithelial cells. Infants with rectal bleeding also showed nodular lymphoid hyperplasia (n = 16), abundant eosinophils (>20/high power field, n = 14) in the mucosa, and a significantly high number of apoptotic epithelial cells relative to the control group. Rectal bleeding disappeared at 6‐month follow‐up in 14 of 18 infants (one was lost to follow‐up) who were fed a different milk formula or breast‐fed (their mothers were restricted from having cow's milk and eggs).

Conclusions

The high number of apoptotic epithelial cells in rectosigmoidal mucosal biopsies of infants with streaked rectal bleeding is probably caused by accelerated epithelial cell turnover and apoptosis.
Thiamine, Riboflavin, Pyridoxine, and Vitamin C Status in Premature Infants Receiving Parenteral and Enteral Nutrition
Authors: Friel James K. , Bessie Jamie C. , Belkhode Suresh L. , Edgecombe Colin , Steele‐Rodway Merlee , Downton Geoff , Kwa Poh Gin , Aziz Khalid
Published: January 2024

Background

There is a paucity of data about water soluble vitamin status in low birthweight infants. Therefore, the authors' objective was to assess current feeding protocols.

Methods

The authors measured serum concentrations for riboflavin, pyridoxine, and vitamin C and functional assays for thiamine and riboflavin longitudinally in 16 premature infants (birthweight, 1,336 ± 351 g; gestational age, 30 ± 2.5 weeks) before receiving nutrition (time 1, 2 ± 1 days), during supplemental or parenteral nutrition (time 2, 16 ± 10 days) and while receiving full oral feedings (time 3, 32 ± 15 days). In plasma, vitamin C was measured colorimetrically, and riboflavin and pyridoxine were measured using high‐performance liquid chromatography. The erythrocyte transketolase test as a functional evaluation of thiamine and the erythrocyte glutathione reductase test for riboflavin were measured colorimetrically.

Results

At time 1, nutrient intake of vitamins were negligible because infants were receiving intravenous glucose and electrolytes only. Intakes differed between time 2 and time 3 for thiamine (510 ± 280 and 254 ± 115 μg · kg −1 · d −1 , respectively), riboflavin (624 ± 305 and 371 ± 193 μg · kg −1 · d −1 , respectively), and pyridoxine (394 ± 243 and 173 ± 85 μg/100 kcal, respectively), but not for vitamin C (32 ± 17 and 28 ± 12 mg · kg −1 · d −1 , respectively). Blood levels at times 1, 2, and 3 were for thiamine (4.9 ± 2.7%, 3.3 ± 6.6%, and 4.1 ± 9% erythrocyte transketolase test, respectively), riboflavin (0.91 ± 0.31, 0.7 ± 0.3, 0.91 ± 0.18 erythrocyte glutathione reductase test, respectively), riboflavin (19.5 ± 17, 23.3 ± 8.6, 17.6 ± 10 ng/mL, respectively), pyridoxine (32 ± 25, 40 ± 16, 37 ± 26 ng/mL, respectively), and vitamin C (5.2 ± 3, 5 ± 2.2, 10 ± 5 μg/mL, respectively) and did not differ at those times.

Conclusions

Current intakes of these vitamins, except for possibly vitamin C, during parenteral and enteral nutrition seem to result in adequate plasma concentrations and normal functional indices.
Large‐Volume Paracentesis in the Management of Ascites in Children
Authors: Kramer Robert E. , Sokol Ronald J. , Yerushalmi Baruch , Liu Edwin , MacKenzie Todd , Hoffenberg Edward J. , Narkewicz Michael R.
Published: January 2024

Background

Large‐volume paracentesis has been evaluated for both therapeutic and diagnostic purposes in the management of ascites in cirrhotic adults. There are no published data relating to the safety, efficacy, or methods of this procedure in children. The objective of this study was to characterize the authors’ initial experience with large‐volume paracentesis (> 50 ml/kg of ascites) for removal of tense abdominal ascites in the pediatric population.

Methods

Retrospective chart review was performed of 21 large‐volume paracentesis sessions in seven children (ages 6 months–18 years) with tense ascites that did not respond to other measures.

Results

Mean volume removed was 3,129 ± 2,966 ml (mean ± standard deviation) or 118 ± 56 ml/kg over 2.9 ± 3.7 hours by a 16‐gauge intravascular catheter in 6 sessions, by an 18‐gauge intravascular catheter in three sessions, and by a 15‐gauge fenestrated, stainless‐steel paracentesis needle in 12 sessions. Large‐volume paracenteses performed with the paracentesis needle had significantly shorter duration of drainage and faster flow rates than those performed with the intravascular catheter. The only complication encountered was decreased urine output in one session.

Conclusions

Large‐volume paracentesis is a safe and effective therapeutic method for managing tense abdominal ascites in children. The use of the paracentesis needle significantly improved the speed and efficiency of large‐volume paracentesis compared with the intravascular catheter.
Experience With an Anesthesiologist Interventional Model for Endoscopy in a Pediatric Hospital
Authors: Koh Jeffrey L. , Black Dennis D. , Leatherman Isabel K. , Harrison R. Dale , Schmitz Michael L.
Published: January 2024

Background

Endoscopy is now a routine part of the work‐up for many patients with gastrointestinal symptoms. Adults tolerate these procedures well, with either no sedation or a relatively light level. In contrast, children often require deep sedation or a general anesthetic to successfully perform these procedures. Therefore, pediatric endoscopies may require more time, personnel, and monitoring equipment to provide optimal conditions for the patient. The goals of this retrospective case series were to describe the anesthesia times and recovery duration of the different procedures, the types and amounts of medications commonly used, and the types and rates of complications experienced.

Methods

Patients (2,306) who underwent endoscopy in the Arkansas Children’s Hospital endoscopy suite during a 4‐year period were identified. A random sample of 720 charts was reviewed retrospectively.

Results

Patients ranged in age from younger than 1 year to 29 years. Patients most often had abdominal pain or multiple gastrointestinal symptoms. Sixty‐eight percent of patients underwent esophagogastroduodenoscopies; 30% colonoscopy or a combination of the two. Ninety‐five percent of patients received a propofol‐based anesthetic. Midazolam, fentanyl, and alfentanil were frequently used as supplemental agents. Complications occurred infrequently and were airway related. All complications were easily treated, with no adverse sequelae.

Conclusions

This model of anesthesiologist‐provided sedation/anesthesia for gastrointestinal endoscopy procedures has been extremely successful in the Arkansas Children’s Hospital and has served to heighten awareness of many issues surrounding sedation and anesthesia outside of the operating room, while ensuring a high level of care is provided.
6‐Mercaptopurine Metabolite Levels in Children With Inflammatory Bowel Disease
Authors: Gupta Puneet , Gokhale Ranjana , Kirschner Barbara S.
Published: January 2024

Objectives

Some authors suggest that efficacy of 6‐mercaptopurine (6‐MP) in patients with inflammatory bowel disease correlates with circulating 6‐thioguanine (6‐TG) levels more than 235 pmol/8 × 10 8 red blood cells. The authors evaluated the relation between 6‐MP metabolite levels and disease activity in children and adolescents with inflammatory bowel disease.

Methods

Clinical status and hematologic and hepatic parameters were determined in 101 children with inflammatory bowel diseasefrom a single center and compared with 6‐MP metabolite levels.

Results

There was a trend for higher 6‐TG levels among patients in remission than among those with active disease (217 vs. 173); however the difference was not statistically significant (P = 0.09). The likelihood of therapeutic response did not increase significantly at 6‐TG levels greater than 235 pmol/8 × 10 8 red blood cells (odds ratio 1.7;P = 0.1). In the current study, 58% of patients in remission had 6‐TG levels less than 235. However, serial measurements of 6‐MP metabolite levels in 50 patients with active disease showed that increasing 6‐TG levels correlated significantly with disease remission in patients followed up longitudinally (P = 0.04). Leukopenia was significantly associated with high 6‐TG levels (P = 0.03) but not with clinical response (P = 0.2).

Conclusions

These data suggest that the target range of 6‐TG levels previously described by others did not apply to 58% of the pediatric patients with IBD in remission. However, serial monitoring of 6‐MP metabolite levels in individual patients with active disease should allow dose escalation and induction of remission while minimizing the risk of toxicity.
Electrogastrographic Norms in Children: Toward the Development of Standard Methods, Reproducible Results, and Reliable Normative Data
Authors: Levy Joseph , Harris Jennifer , Chen Jiande , Sapoznikov Dan , Riley Benita , De La Nuez Wendy , Khaskelberg Anna
Published: January 2024

Background

Surface electrogastrography (EGG) is a noninvasive technique that detects gastric myoelectrical electric activity, principally the underlying pacemaker activity generated by the specialized interstitial cells of Cajal. Interest in the use of this methodology has grown because of its potential applications in describing functional gastrointestinal disorders, particularly as a tool in the evaluation of nausea, anorexia, and other dyspeptic symptoms.

Methods

Fifty‐five healthy volunteers (27 female), ranging in age from 6 to 18 years (mean, 11.7 years), were studied for a 1‐hour baseline preprandial period and a 1‐hour postprandial period after consumption of a standard 448‐kcal meal. Recordings were obtained with an EGG Digitrapper or modified Polygraph (Medtronic‐Synectics, Shoreview, MN). Spectral analysis by an autoregressive moving average method was used to extract numerical data on the power and frequency of gastric electrical activity from the EGG signal.

Results

The authors present normative data for healthy children and adolescents studied under a standardized protocol. Mean dominant frequency was found to be 2.9 ± 0.40 cycles per minute preprandially and 3.1 ± 0.35 postprandially, with 80% ± 13% of test time spent in the normogastric range (2–4 cycles per minute) before and 85% ± 11% after the test meal. The response of several key parameters to meal consumption was considered, and the effects of age, gender, and body mass index (BMI) on the EGG were sought.

Conclusions

There is a postprandial increase in the rhythmicity and amplitude of gastric slow waves, as other investigators have shown in adults. Key normative values are not dependent on age, gender, or BMI. The authors discuss limitations in the data set and its interpretability. The authors establish a normative data set after developing a standardized recording protocol and test meal and show that EGG recordings can be obtained reliably in the pediatric population. Development of similar norms by investigators using the EGG is crucial for future exploration of the validity and clinical application of the EGG. Differences in test conditions of signal detection and analytic methods influence EGG results substantially, and caution should be used when comparing results across centers.
The Prevalence and Clinical Characteristics of Celiac Disease in Juvenile Diabetes in Wisconsin
Authors: Aktay Atiye N. , Lee P. C. , Kumar Vijay , Parton Elaine , Wyatt David T. , Werlin Steven L.
Published: January 2024

Background

The relationship between celiac disease and juvenile diabetes has long been known. Only a single study in the United States, from Buffalo, New York, has reported the prevalence of celiac disease in a pediatric diabetic population. This study was conducted to determine the prevalence and clinical presentation of celiac disease in children and adolescents with juvenile diabetes in Wisconsin, U.S.A., using serum antiendomysial antibody as a screening test.

Methods

Two hundred eighteen patients with diabetes (113 males; age range, 4–21 years) and 117 age‐and gender‐matched control participants were tested for immunoglobulin A endomysial antibody. Patients with positive results were offered a small bowel biopsy. A questionnaire regarding abdominal pain, diarrhea, and growth failure was completed by the parents.

Results

Seventeen of 218 diabetic patients (7.7%) had positive endomysial antibody. All control participants had negative results for the endomysial antibody. Small bowel biopsy was performed in 14 patients. Ten patients had villous atrophy. In one patient without villous atrophy, a repeat biopsy 2 years later showed villous atrophy, and two patients had increased intraepithelial lymphocytes without villous atrophy. Seventy percent of the patients with celiac disease were asymptomatic. The reported symptoms were abdominal pain and diarrhea (n = 1) and growth failure (n = 2). Two patients with celiac disease had Down syndrome.

Conclusions

The prevalence of celiac disease in children with juvenile diabetes in Wisconsin is at least 4.6%, which is comparable with European and Canadian studies. Because patients without villous atrophy may have latent celiac disease, the prevalence may be even higher. All children with juvenile diabetes should be screened for celiac disease.