bluuebunny/crossref_metadata_2025 huggingface dataset:
Chylous Ascites in Infants and Children
Authors: Cochran William J. , Klish William J. , Brown Marilyn R. , Lyons Jane M. , Curtis Tom
Published: January 2024

Successful treatment of an infant with chylous ascites secondary to “congenital leaky lymphatics” is described, followed by a literature review of cases of pediatric chylous ascites. The infant was placed on home total parenteral nutrition for 10 weeks, during which time the chylous ascites resolved and did not recur with the introduction of a normal diet. Forty cases of pediatric chylous ascites have been reported since 1960, with an age range from birth to 18 years. The presenting signs and symptoms were secondary to abdominal distension in over 80% of cases. The chylous ascites was secondary to trauma, which included child abuse (19%), obstruction (27%), or lymphatic abnormalities (54%). Most studies described were not helpful in making the diagnosis, except for lymphangiography and exploratory laparotomy. Many patients were treated with a high protein, low fat diet, with or without medium chain triglycerides, with variable success. Total parenteral nutrition (TPN) was the primary therapeutic modality in five patients, and in all but one of the cases there was complete resolution of the chylous ascites over 3 to 10 weeks with no significant side effects. Total parenteral nutrition, including home TPN, is a safe and effective therapeutic modality for some cases of chylous ascites.
Ornithine Transcarbamylase and Disaccharidase Activities in Damaged Intestinal Mucosa of Children—Diagnosis of Hereditary Ornithine Transcarbamylase Deficiency in Mucosa
Authors: Cathelineau L. , Briand P. , Rabier D. , Navarro J.
Published: January 2024

Ornithine transcarbamylase (OTC) and disac‐charidase activities were measured in the intestinal mucosa from 182 children. Sixty‐nine had normal mucosa, whereas the others had different degrees of mucosal damage. Brush border disaccharidases are significantly decreased in all degrees of villous atrophy. In contrast, OTC is not affected in moderate atrophy and only slightly decreased in severe atrophy. Consequently, the OTC‐to‐lactase ratio increases with the degree of atrophy and permits discrimination between normal and damaged mucosa. The assay of OTC activity in intestinal mucosa for the diagnosis of hereditary deficiency in male hemizygote patients generally provides nonambiguously low results, whereas in heterozygote females the amount of residual activity is in the range of the results found in damaged mucosa.
Calcium Absorption during Development
Authors: Toverud Svein U. , Dostal Lori A.
Published: January 2024

During the period of natural weaning in the rat (beginning during the third week) the mechanisms of calcium absorption from the duodenum change from an efficient nonsaturable process, which is insensitive to vitamin D, to a combination of a less efficient nonsaturable process and a saturable vitamin D‐dependent component. The stimulatory effect of vitamin D on active calcium transport requires the development of mucosal receptors for 1,25‐(OH)2D3 and increasing circulating levels of 1,25‐(OH)2D3. Concurrent increases in the concentration ##of the cytosolic calcium‐binding protein (CaBP) support the suggestion that the CaBP mediates, in part, the effect of 1,25‐(OH)2D3 on active calcium transport. The decline in the efficiency of nonsaturable calcium absorption during the third week coincides with, but is probably not due to, the loss of pinocytotic capacity of the small intestine. The time of appearance of the receptors for 1,25‐(OH)2D3 and the decline in nonsaturable calcium absorption are under glucocorticoid control as are several other maturational events in the intestine at this time.
Measurement of Total Body Potassium in Premature Infants by Means of a Whole‐Body Counter
Authors: Spady Donald W. , Filipow Larry J. , Overton Thomas R. , Szymanski Waldemar A.
Published: January 2024

This paper describes a whole‐body counter (WBC) specially designed to measure total body potassium (TBK) in infants under 4,500 g. The counter is a “shadow shield” design and consists of a single 10 cm μ 10 cm μ 45 cm NaI(Tl) crystal, positioned lengthwise and shielded from environmental background radiation by a minimum of 10 cm of lead. The standard error of counting for a 2,000‐s counting period is 19.9% for a 1,000‐g infant and 11.9% for a 2,000‐g infant. TBK of stillborn pigs, measured by the WBC, agreed to an average of 3% of TBK determined by carcass analysis in the same animals. A total of 118 measurements of TBK have been made in 50 premature infants ranging in weight between 1,100 and 3,600 g and in age between 2 and 75 days. The observed relationship of TBK with weight is described by the equation: TBK (mEq) = 0.0433Wt (g) + 1.57 r = 0.92. Potassium retention per gram weight gain is estimated to be 0.043 mEq. The obtained TBK values agree well with values published by other workers but extend the range of measurement to 1,100 g.
Effect of Iron Fortification of Infant Formula on Trace Mineral Absorption
Authors: Haschke F. , Ziegler E. E. , Edwards B. B. , Fomon S. J.
Published: January 2024

This study was designed to examine whether iron fortification of infant formulas has an effect on utilization of other nutrients, particularly the trace elements zinc and copper. Metabolic balance studies were performed with seven normal infants who were between 43 and 420 days of age. Two formulas of nearly identical composition except for iron concentration (10.2 and 2.5 mg/L) were fed. Each infant had four balance studies performed, two while being fed formula 10.2 and two while being fed formula 2.5, in an alternating sequence. No effect of formula iron concentration was evident on absorption and/or retention of nitrogen, fat, calcium, and magnesium. Although absorption of phosphorus was significantly (p < 0.05) less with formula 10.2 than formula 2.5, the difference was trivial. No effect on absorption of zinc was seen. However, absorption of copper was only 13.4% (SD 13.0) of intake when formula 10.2 was fed, compared with 27.5% (SD 15.3) of intake when formula 2.5 was fed. The difference was statistically significant (p < 0.01). We conclude that iron in amounts present in iron‐fortified formulas has a measurable effect on copper utilization. Because the magnitude of the effect is relatively small, we doubt that the finding is clinically relevant.
Morphometric Studies and Eosinophil Cell Counts in the Duodenal Mucosa of Children With Chronic Nonspecific Diarrhoea and Cow's Milk Allergy
Authors: Challacombe D. N. , Wheeler E. E. , Campbell P. E.
Published: January 2024

Morphometric studies and eosinophil counts in the lamina propria of the duodenal mucosa have been performed in patients with chronic nonspecific diarrhoea and with persistent diarrhoea due to a cow's milk allergy, using a semiautomatic image analysing system. The results have shown that the mean eosinophil count was significantly higher in both of these groups of patients compared with a control group (p < 0.001), and some of the patients with chronic nonspecific diarrhoea had partial villous flattening. These findings in patients with chronic nonspecific diarrhoea could be related to the pathogenesis of this disorder.
Ultrasonic Homogenization of Expressed Human Milk to Prevent Fat Loss During Tube Feeding
Authors: Martinez F. E. , Desai I. D. , Davidson A. G. F. , Nakai S. , Radcliffe A.
Published: January 2024

Effective use of expressed human milk in infant feeding requires proper handling, processing, storage, and administration in order to maintain its unique nutritional properties. One of the problems with expressed human milk is the separation of fat during processing, storage, and administration to the infant. Administration by continuous nasogastric infusion, either by intermittent gravity flow or by continuous mechanical pump, resulted in significant loss of fat and variation in the constitution of the milk delivered. Homogenization by ultrasonic treatment prevented changes in fat concentration during infusion and essentially eliminated loss of this nutrient during administration. The conditions necessary to achieve fat dispersion and stabilization of fat particles in human milk by ultrasonic treatment are described.
Efficacy of Oral Rehydration Solutions in a Rat Model of Secretory Diarrhea
Authors: Rolston D. D. K. , Borodo M. M. , Kelly M. J. , Dawson A. M. , Farthing M. J. G.
Published: January 2024

Controversy continues regarding the ideal composition of glucose/electrolyte solutions used for oral rehydration of infants and children with acute diarrhea. We have used cholera toxin‐treated rat small intestine as a model of secretory diarrhea to assess the efficacy of oral rehydration solutions by intestinal perfusion. All solutions tested reversed net water secretion hut a hypo‐tonic bicarbonate‐free solution was more effective than other solutions, including the World Health Organization oral rehydration solution (p < 0.003). Net sodium secretion persisted with all solutions tested but there was a significant linear relationship between sodium concentration of the solution perfused and net sodium transport (r

= 0.75, p < 0.05). Cholera toxin treatment alone and in combination with perfusion of oral rehydration solutions significantly reduced plasma sodium concentration and osmolulity (p < 0.05), the effects being most marked with low sodium solutions. Although direct parallelism between observations in this animal model of secretory diarrhea and human diarrheal disease has not been established as yet, the model may be useful in assessing clinical efficacy of new oral rehydration solutions and in systematic analysis of the relative benefits of their individual components.
A Description of the Changing Body Composition of the Growing Premature Infant
Authors: Spady Donald W. , Schiff David , Szymanski Waldemar A.
Published: January 2024

Data from studies of two similar groups of premature infants were used to describe the changing body composition (BC) of a “typical” premature infant, 3 to 4 weeks old, gaining weight from 1,200 to 2,000 g and being fed its mother's expressed breast milk at a metabolizable energy intake of 93.6 kcal/kg/day. Serial measurements had been made of total body water (TBW), the extracellular fluid space (ECF), nitrogen balance, and gross energy balance in one group of premature (n = 17) infants and of total body potassium (TBK) in another group (n = 23); all infants studied weighed between 900 and 2,300 g. Equations relating TBW, ECF, and TBK to body weight were derived for estimating the content of these substances at body weights between 1,200 and 2,000 g. Protein content at 1,200 g body weight was estimated from measured TBK and N:K ratio (determined from the reference fetus) at this weight. Subsequent protein content was determined from average N accretion, determined from data of N balance, and carbohydrate and ash content were estimated from reference data. The remainder of the body weight was assumed to be fat. At l,200 g, the proposed BC of the premature infant is 72.1% water, 10.7% protein, 14.9% fat, 1.9% ash, and 0.4% carbohydrate. At 2,000 g comparable figures are 67.8% water, 11.6% protein, 18.2% fat, 1.9% ash, and 0.5% carbohydrate. The description also provides estimates of the body cell mass (BCM) and intracellular fluid (ICF), the relationship of K to the BCM and ICF, and the energy balance of the growing premature infant.
Cecal Polyp and Appendiceal Intussusception in a Child with Recurrent Abdominal Pain
Authors: Bailey David J. , Courington Kenneth R. , Andres Joel M. , Bagwell Charles E. , Hitchcock Charles L.
Published: January 2024

A 7‐year‐old boy developed recurrent abdominal pain. He was eventually discovered to have an inverted appendix via colonoscopy. At surgery, a polyploid intracecal mass was palpated at the base of the partially invaginated appendix. Resection of the cecal mass (histologically, a juvenile polyp) and appendix was easily accomplished. The types of clinical presentation and treatment of children with appendiceal intussusception are discussed.
Syndromic Paucity of the Intrahepatic Bile Ducts
Authors: Deprettere Andre , Portmann Bernard , Mowat Alex P.
Published: January 2024

The clinical, biochemical, and histological features of 27 children with syndromic paucity of the interlobular bile duets are described. All presented in the first 5 months of life, 21 with jaundice, two with spontaneous bleeding due to vitamin K malabsorption in addition to jaundice, two with pruritus, and two with failure to thrive. Interlobular bile ducts were abundant in liver biopsies from five (18% of cases) in the first 6 months of life. The degree of portal fibrosis and cellular infiltrate was mild in all except three patients. Clinically significant heart lesions occurred in 52% but only 22% had peripheral pulmonary stenosis. Characteristic facial appearances were present in only 70% embryotoxon and vertebral anomalies were present in 56 and 33% respectively. Two infants died of cardiovascular complications, one of alimentary bleeding and one of progressive liver disease. Complications of vitamin K deficiency occurred in 15%, vitamin D deficiency in 30% and vitamin E deficiency in 37%. Survivors at ages of 19 months to 16.5 years had considerable morbidity with pruritus occurring in 70% jaundice in 48%. Nanthomas in 30%, 74% having hepatomegaly aznd 63% splenomegaly. All had abnormal biochemical tests of liver function. 90% had growth retardation, and 50% developmental delay. We conclude that differentiation from extrahepatic biliary atresia can be difficult if biliary flow cannot be demonstrated. Prevention of fat‐soluble vitamin deficiency is essential, further research is required to decrease the morbidity associated with this syndrome in infancy.
Variation in Zinc, Calcium, and Magnesium Concentrations of Human Milk within a 24‐Hour Period from 1 to 6 Months of Lactation
Authors: Karra Mihira V. , Kirksey Avanelle
Published: January 2024

Longitudinal changes in nutrient levels of human milk have been observed with the progression of lactation, but less is known about changes at different feedings during a 24‐h period. In this study, calcium, magnesium, and zinc levels were examined in milk obtained from 49 women at every breast feeding during one 24‐h period each month for the first 6 months of lactation. Magnesium and zinc concentrations showed significant diurnal variation at each stage of lactation examined, whereas calcium levels were relatively constant. Maximum variations of 7.5, 17, and 48% were observed within a 24‐h period in mean levels of calcium, magnesium, and zinc, respectively. Irrespective of variability, zinc and magnesium concentrations in a single milk sample obtained between 10:00 a.m. and 2:00 p.m. were highly correlated with the mean value of samples collected at each feeding during a 24‐h period.
Acidification of Endosomes Is Not Important for the Entry of Rotavirus into the Cell
Authors: Keljo David J. , Kuhn Michael , Smith Angela
Published: January 2024

Rotavirus causes enteritis in both man and animals. The mechanism by which this protein‐enveloped virus enters the cell to initiate infection is not known. Many viruses depend on the acidification of endosomes for entry into the cell. We studied the importance of the acidification of endosomes for the initiation of two early phases of rotavirus infection, virus RNA and peptide synthesis. Monensin, nigericin, chloroquine and ammonium chloride at a variety of concentrations caused no specific inhibition of virus RNA or peptide synthesis. We conclude that the acidification of endosomes is not important for the entry of rotavirus into the cell.
Ectopic Gastric Mucosa in Rectum
Authors: Menchaca Marines Mario C. , Posselt Hans‐Georg , Waag Karl Ludwig
Published: January 2024

A 3‐year‐old boy with rectal bleeding and colicky abdominal pain is described in whom heterotopic gastric mucosa in the rectum was found. Increased uptake of 99mTc‐pertechnetate was demonstrated in two sites: rectum and left colon. However, gastric mucosa could be identified by endoscopic and histologic examination in the rectum only. The patient was asymptomatic after the operation and during follow‐up, over 14 months.
Eosinophilic Gastroenteropathy in Childhood
Authors: Whitington Peter F. , Whitington Gene L.
Published: January 2024

Eosinophilic gastroenteropathy (EG) is an uncommon, idiopathic disease in children that is characterized by eosinophilic inflammation of the intestine. Over a 7‐year period 17 infants and children with EG were evaluated; the retrospective review of their clinical data constitutes the basis of this report. A scale developed for grading the degree of mucosal eosinophilia was used in the evaluation of the intestinal histopathology; all patients had eosinophilic infiltration that was far more severe than that seen in other intestinal disorders of childhood. Peripheral eosinophilia was observed in 12 patients. However, two more had evidence of rapid turnover of eosinophils with significantly increased numbers of precursors in bone marrow and intense intestinal infiltration. Serum IgE correlated with the severity of the disease; extreme elevations were associated with chronic severe illness similar to that commonly reported in adults. Evidence of viral infection in two patients and dietary responsiveness in two infants bring to question the specificity of diagnosis on histology alone. Treatment with oral cromolyn sodium and/or prednisone was effective, but some patients have remained dependent upon therapy.
Relationship of Endomysial Antibodies to Jejunal Mucosal Pathology
Authors: Rossi Thomas M. , Kumar Vijay , Lerner Aaron , Heitlinger Leo A. , Tucker Neil , Fisher John
Published: January 2024

Serum immunoglobulin A class antibodies reactive to the endomysial lining of the smooth muscle bundles of the gastrointestinal tract have recently been reported to be specific and sensitive indicators of celiac disease (CD). A total of 203 subjects were examined for serum endomysial antibodies (EmA) and in 103 small bowel biopsies were obtained. EmA were detected in 43 cases including 26 CD patients evaluated during the gluten challenge phase of diagnosis by European Society for Pediatric Gastroenterology and Nutrition criteria, 11 of 53 symptomatic patients, and 6 asymptomatic family members. All patients with detectable antibody at the time of biopsy exhibited grade III‐IV villous atrophy. Disaccharidase activities performed in 19 cases revealed severe deficiencies. EmA were not detected in 160 subjects including 42 infants and children with chronic nonspecific diarrhea. Eighteen of these possessed grade II‐III villous atrophy with moderate disaccharidase deficiency and 24 were found to have normal histology and enzymes. The EmA were also not detected in 3 CD patients who were well maintained on a gluten‐free diet for > 1 year and 25 asymptomatic family members exhibiting normal histology and enzymes. An additional 90 infants and children with other gastrointestinal and liver diseases were also negative for the serum EmA. Fourteen of these patients underwent biopsies and were demonstrated to have normal histology.
Gastroesophageal Reflux Incidence and Respiratory Dysfunction During Sleep in Infants
Authors: Vandenplas Yvan , Deneyer Michel , Verlinden Marleen , Aerts Tonny , Sacre Liliane
Published: January 2024

We studied the effects of positional treatment and cisapride (a new prokinetic agent) on the incidence and duration of gastroesophageal reflux in 22 infants (4–26 weeks old) in asleep, awake, fasted, and postcibal periods. In addition to gastroesophageal reflux (assessed by 24‐h continuous esophageal pH monitoring), all infants presented with a disrupted irregular sleep pattern (“respiratory dysfunction”) (assessed by a simultaneously performed cardiopneumogram). Reflux was particularly prominent during the sleep and fasted periods. Investigations (cardiopneumogram and esophageal pH monitoring) in the study population were repeated under treatment conditions (cisapride) after 13–16 days. All pH monitoring data with regard to the total investigation time decreased significantly (p < 0.001). The treatment‐related differences were largest in the asleep and fasted periods, but treatment data were not completely within normal ranges (established in age‐matched asymptomatic infants), as they were for the awake periods. Associated symptoms of gastroesophageal reflux (belching, cough, nocturnal wheezing, irritability, and restlessness at night) were evaluated before and during treatment by history. A combination of positional treatment and cisapride seemed effective (objectivated by pH monitoring data and clinical improvement); cisapride did not cause adverse reactions. The disrupted sleep pattern improved significantly or disappeared (p < 0.001) in all infants. These data suggest that in a number of young infants, gastroesophageal reflux may be associated with a disturbed, irregular sleep of poor quality, which is characterized by a typical breathing pattern (multiple, irregularly repeated, short apneas).
Turning off the Diarrhea
Authors: Molla A. M. , Molla Ayesha , Rohde Jon , Greenough W. B.
Published: January 2024

Ninety‐three boys aged 5 years or less who had diarrhea due to Vibrio cholerae were randomly assigned to treatment with glucose oral rehydration salt (ORS) or rice‐based ORS. For the first 24 h, ORS only was given to all the patients. During the next 24 h, ORS and normal food were given. The efficacy of the two types of ORS was compared in terms of ORS intake, stool output, change in hematocrit reading, serum specific gravity, and increase in body weight. At the end of the first 24 h of treatment, a 50% reduction in ORS intake and stool output was observed in the 47 patients randomly assigned to receive rice ORS as compared with the 46 patients who received glucose ORS. During the second 24 h of treatment, a significant reduction in the stool output was noticed in the glucose ORS group, making the efficacy of glucose ORS equal to that of rice ORS. The study suggests that normal food can impart some of the superiority of “super” ORS to standard glucose ORS with regard to reduction of stool volume.
Protracted Diarrhea
Authors: Neto Ulysses Fagundes , de Castro Ferreira Valeria , Patricio Francy R. S. , Mostaco Vera Lucia , Trabulsi Luis Rachid
Published: January 2024

The etiology of the protracted diarrhea is ill‐defined, but in the underdeveloped countries acute gastroenteritis might be the most common triggering factor, especially due to certain enteropathogenic bacteria, such as enteropathogenic E. coli (EPEC) and Salmonella. We investigated the role of these agents in the genesis of protracted diarrhea in 29 infants with a mean age of 4.6 months. The patients underwent the following tests: stool culture, culture of the jejunal secretion, and small bowel and rectal biopsies. The stool culture was positive for some enteropathogenic bacteria in 17 (58.6%) patients: EPEC serotypes 0126, 0125, 055, 026, 0111, 0127, 0114, 0158, and 0119 and Salmonella were identified. The jejunal secretion culture revealed bacterial proliferation in 15 (51.7%) patients, and the following bacteria were isolated: EPEC 0142, Proteus, Klebsiella, Enterobacter, EPEC 0114, Pseudomonas, EPEC 0111, Salmonella, and EPEC 0119. The small bowel biopsy showed subtotal villous atrophy in 13 (44.8%) patients, and the rectal biopsy revealed colitis in 13 (44.8%) patients. These findings stress the importance of those enteropathogenic bacteria in the genesis of protracted diarrhea in underdeveloped countries mainly due to food intolerance leading to aggravation of the nutritional status.
Hepatobiliary Scintigraphy and the String Test in the Evaluation of Neonatal Cholestasis
Authors: Rosenthal Philip , Miller John H. , Sinatra Frank R.
Published: January 2024

We evaluated [99mTc]diisopropylphenyl‐carbamoylmethylimidodiacetic acid ([99mTc]DISIDA) cholescintigraphy with measurement of duodenal fluid radioactivity collected by the string test in patients with neonatal cholestasis. Twenty‐six infants with prolonged jaundice and acholic stools were studied prospectively. Twelve patients had neonatal hepatitis, 12 biliary atresia, and one each Alagille syndrome and α1‐antitrypsin deficiency liver disease. All infants except the biliary atresia patients and four of the neonatal hepatitis patients revealed bowel activity on scan 6 h after tracer administration. At 24 h, three of these latter patients with neonatal hepatitis and two of the patients with biliary atresia revealed bowel activity. String radioactive counts for neonatal hepatitis ranged from 99,574 to 967,205 cpm (374,504 ± 232,210 cpm; mean ± SD) and for biliary atresia from 8,342 to 370,346 cpm (117,149 ± 98,698 cpm; mean ± SD). While neither test alone was capable of correctly differentiating among all patients, those patients with biliary atresia had either a negative hepatobiliary scan at 24 h or string radioactive count below 197,007 cpm. Disparity between the hepatobiliary scan and the string radioactive counts mandates further diagnostic investigation. These data suggest that simultaneous administration of the string test with hepatobiliary scintigraphy is advantageous in the evaluation of infants with chole‐static jaundice.
Uptake of Copper from Brass Vessels by Bovine Milk and Its Relevance to Indian Childhood Cirrhosis
Authors: O'Neill N. C. , Tanner M. S.
Published: January 2024

To mimic the infant feeding practice associated with Indian childhood cirrhosis (ICC), bovine milk was stored for 6 h in indigenous brass vessels. The milk copper concentration rose from 27 + 4 to 621 + 65 μg/dl, whereas zinc concentration was not significantly changed. Copper in bovine milk was associated with casein (67%), whey proteins (7%), < 10 kDa molecules (11%), and fat (7%). Addition of copper sulphate to a concentration of 600 μg/dl produced a 102‐fold rise in copper content of the casein fraction, a 47‐fold increase for whey, and 15‐fold for the < 10 kDa fraction. Analysis by sepharose gel chromatography confirmed that casein was the major copper‐binding fraction in control and copper‐loaded milk. To mimic intragastric conditions, the pH of copper‐loaded milk was lowered to 4.5 to precipitate casein, resulting in a rise in < 10 kDa bound copper (10.7 + 4.0 to 104.3 + 7.5 μg Cu/100 ml) and whey‐bound copper (53.1 + 4.5 to 118.4 + 19.1 μg Cu/100 ml). Copper/casein complex (3 μg Cu/mg protein, pH 6.6) was dialysed against low‐MW metal chelating agents, including picolinate and citrate, which are present in the duodenum. Picolinate I mM and citrate I mM were able to remove 84% and 29% of copper, respectively. Thus, copper, though not zinc, is avidly taken up from brass and bound largely to casein, from which it is partly liberated by acid precipitation and almost completely removed by picolinate chelation. Milk is an effective carrier of copper from brass utensil to infant enterocyte.
Changes in Human Milk at 0600, 1000, 1400, 1800, and 2200 h
Authors: Lammi‐Keefe Carol J. , Ferris Ann M. , Jensen Robert G.
Published: January 2024

Milk from six mothers was collected every 4 h from 0600 to 2200 h. Total lipid and cholesterol, lactose, glucose, protein N, indicator acids 12:0, 14:0, and 18:2, and α‐ and γ‐tocopherols were analyzed. Total calories were calculated. Although considerable variation was seen in the lipid content, this was not significant and was apparently due to individuality. Differences in the other lipid components were not significant and were generally related to the total lipid content. Except for protein N (p < 0.05), none of the other components varied significantly. Based upon these data and the results of others, the time of sampling of human milk should be matched to the population being studied to obtain consistent results, at least with lipids.
Association of Juvenile and Adenomatous Polyposis with Pulmonary Arteriovenous Malformation and Hypertrophic Osteoarthropathy
Authors: Prieto G. , Polanco I. , Sarria J. , Larrauri J. , Lassaletta L.
Published: January 2024

The juvenile form is the usual type of colonic polyp seen during childhood. However, mixed forms associating juvenile and adenomatous polyps have been reported. A syndrome including the association of generalized juvenile polyposis, pulmonary arteriovenous malformation, and hypertrophic osteoarthropathy has been described in three cases; however, this is the first report of the association of mixed juvenile and adenomatous polyposis, pulmonary arteriovenous malformation, and hypertrophic osteoarthropathy.
Impact of Orthotopic Liver Transplantation on Mortality from Pediatric Liver Disease
Authors: Lloyd‐Still John D.
Published: January 2024

In 1983 we assessed the implications for hepatic transplantation programs by studying mortality from liver disease in a tertiary care children's hospital. The current study reviews the impact of orthotopic liver transplantation (OLT) on survival for the period 1984–1989. Findings showed that deaths from liver disease decreased from 9.2 to 3.8 per year. Twenty‐eight infants and children were referred and underwent OLT, with a 64% survival rate. Deaths from biliary atresia, which used to account for 24% of the total, have been reduced to 4.3%. Deaths from liver failure in infancy (which decreased from 49% to 39%) still present formidable challenges for transplantation. The implications of these findings are discussed.
Carcinoma of the Colon in Children
Authors: Taguchi Tomoaki , Suita Sachiyo , Hirata Yuzo , Ishii Eiichi , Ueda Koji
Published: January 2024

We report a case of sigmoid colon carcinoma in a 14‐year‐old girl. She had been suffering from several nonspecific abdominal symptoms for about 1 year before a definite diagnosis was made. While undergoing an operation, the main tumor was found to be unresectable. She died of Candida‐induced septicemia on the 26th day after the operation. There have been 40 cases of colon carcinoma reported in the Japanese literature in patients 15 years of age or younger. We reviewed the 40 Japanese cases along with our case, and compared these to other children and adult studies. The prognosis is quite unfavorable in children because of the poor histological character and the delayed diagnosis. Serum carcinoembryonic antigen measurement might be one means for early diagnosis.
Spontaneous Rupture of a Choledochal Cyst
Authors: Treem William R. , Hyams Jeffrey S. , McGowan George S. , Sziklas John
Published: January 2024

Summary: A healthy 3‐year‐old black girl had acute onset of abdominal pain, vomiting, and elevated aminotransferase, amylase, and lipase levels. Sonographic evaluation suggested a choledochal cyst, but hepatobiliary scintigraphy clearly showed an extrahepatic biliary leak. Exploratory laparotomy confirmed bile peritonitis and a ruptured choledochal cyst. Other cases with this unusual presentation is reviewed in the literature. An anomalous insertion of the pancreatic duct into the common duct appears to facilitate reflux of pancreatic secretions into the biliary tree and may contribute to formation and even perforation of a choledochal cyst.
Breath Methane Excretion in Hong Kong Chinese Children
Authors: Leung D. T. Y. , Robertshaw A. M. , Tadesse K.
Published: January 2024

The factors which determine whether an individual is a methane excretor or a nonexcretor are not clearly understood. Genetic makeup, ethnic origin, diet, environment, or an interaction of all these factors have been implicated. In order to delineate the incidence, the age of onset, and environmental factors that may influence the excretion of methane in our community, we investigated a total of 425 Chinese children in Hong Kong (204 females, 221 males). End‐expiratory breath samples were collected after an overnight fast and measured by gas‐chromatography using a flame ionization detector. Thirty one children (7.3%) excreted at least 1 ppm methane above the ambient level (median = 6.4, range = 1.8–26.0 ppm). There was no difference in methane excretion status and pattern between the sexes or between children who lived at home and those who lived at an institution. There was a general increase in the number of methane excretors with age, but a statistically significant increase was reached only after 14 years of age. The amount of methane excreted was unrelated to age and there were no excretors detected under the age of 5 years. It is concluded that the methane excretion pattern of these children was generally similar to those previously reported from other regions, but the incidence is much lower and the age of onset appears to be more gradual.
Gastroesophageal Reflux with Drifting Onset in Infants
Authors: Sondheimer Judith M. , Hoddes Eric
Published: January 2024

We have characterized the gastroesophageal reflux (GER) episodes which occurred during sleep in 28 infants with pathologic gastroesophageal reflux and 10 symptomatic age‐matched controls without gastroesophageal reflux. We describe three kinds of episodes during the sleeping period‐awake episodes which occur completely during electroencephalogram (EEG)‐defined wakefulness associated with clinical evidence of the waking state (62 episodes), episodes occurring during EEG‐defined sleep which have a rapid drop in pH at their onset (119 episodes), and episodes occurring during EEG‐defined sleep in which the esophageal pH drifts down slowly over a period up to 30 min (113 episodes). Only 9 of the 10 control subjects experienced any reflux episodes during monitoring. The total number of episodes of reflux in controls (34) was less than the total number in reflux subjects (260). Controls did, however, experience all three types of reflux episode. Awake episodes all had a rapid drop in pH at their onset and were characterized by a short acid clearance time (2.0 ± 0.3 min in reflux patients and 1.0 ± 0.2 min in controls). The sleep episodes with rapid onset had longer mean acid clearance time than the awake episodes, significantly so in GER subjects (20.1 ± 6.8 min in reflux subjects and 2.6 +1.3 min in controls). Body movement was noted at the onset of 93.4% of rapid‐onset sleep episodes in reflux subjects and 88.9% in controls. Body movement was also common at the termination of rapid‐onset sleep episodes (77.8% of rapid‐onset episodes in reflux subjects and 80.0% in controls). The drift‐onset sleep episodes in GER subjects were characterized by a low frequency of body movements at their onset (body movement seen in 34.9% of drift‐onset episodes), a higher minimum pH (3.6 ±0.1 versus 2.8 ± 0.2 drift‐onset vs. rapid‐onset episodes), a tendency to start in the deeper EEG sleep stages when compared to rapid‐onset sleep episodes, and a decreased frequency of movement arousal. Mean acid clearance time of drift‐onset sleep episodes was similar to rapid‐onset sleep episodes in GER subjects (15.3 ± 6.1 min). Similar characteristics were noted in the few episodes of drift‐onset reflux observed in the control subjects except that drift episodes had significantly greater mean acid clearance time than rapid‐onset episodes (19.4 ± 9.9 min). We conclude that sleep reflux episodes with drifting onset are a significant part of total reflux occurring during the sleeping period. The similarities between rapid‐ and drift‐onset sleep episodes with respect to acid clearance time, and presence of movement at the termination suggests that the mechanisms of clearance of these two episodes may be similar. The differences in onset characteristics between these two episode types, however, suggests the possibility that they may be initiated by different mechanisms
Gastrointestinal Blood Loss in Older Infants
Authors: Fuchs George , DeWier Marianne , Hutchinson Sharon , Sundeen Mary , Schwartz Samuel , Suskind Robert
Published: January 2024

Concerns that consumption of whole cow milk (WCM) by older infants may result in excessive gastrointestinal blood loss and subsequent iron deficiency led us to perform a prospective, randomized study in 104 infants. Infants were assigned to receive WCM beginning at 6 months or one of three formulas beginning at 4‐6 months of age and followed until 12 months of age. Gastrointestinal blood loss was similar for all groups, as determined by both qualitative (Hemoccult II) and quantitative testing (HemoQuant). There was no association between concentration of fecal hemoglobin and volume of WCM consumed or iron status by 12 months of age. Of eight infants (seven WCM, one formula) who became iron‐depleted, none had excessive fecal hemoglobin excretion. When pooled and analyzed regardless of feeding group, fecal hemoglobin increased with age and was greater at 11 and 12 months than at younger ages. We conclude that although infants fed WCM are at increased risk of developing iron depletion, the iron insufficiency is not due to gastrointestinal blood loss. We further conclude, based on our sample of normal infants age 4‐12 months, that fecal hemoglobin concentrations of 0.5‐0.8 mg/g stool correspond to the upper limits of normal, values much lower than in adults.
Helicobacter pylori‐Associated Gastritis in Kuwait
Authors: Radhakrishnan S. , Nakib B. Al , Kalaoui M. , Patric J.
Published: January 2024

Information is limited concerning the prevalence of Helicobacter pylori infection in asymptomatic children. Since January 1989, we have endoscoped 60 children for recurrent abdominal pain or for obtaining small‐intestinal biopsy (their ages were a mean of 6.6 (range 9 months‐13 years); there were 37 boys and 23 girls. Antral biopsies were obtained from all subjects and these were studied for the presence of gastritis and stained for H. pylori using modified Gram's stain. All biopsies were cultured for H. pylori. Children endoscoped for small‐intestinal biopsy (n = 18) were used for comparison. Of the 42 children who had abdominal pain, 24 snowed histological gastritis and 13 had H. pylori on microscopy (31% H. pylori associated gastritis). In the compared group, five showed histological gastritis, and all had H. pylori on microscopy (27.7%). Culture was positive in 15; sensitivity was 85.7%. Six children, three pairs of siblings, had H. pylori gastritis supporting environmental etiology. Two had coinfection with intestinal giardiasis. Seven children were treated with daily oral amoxycillin (50 mg/kg) and tinidazole (20 mg/kg) for 6 weeks. In 3 (42.3%) H. pylori colonization cleared with healing of gastritis and resolution of symptoms. These results indicate that H. pylori gastritis is equally prevalent in symptomatic and asymptomatic children (31 and 27.7%, respectively; p > 0.05) in our population. It seems that the combination of oral amoxycillin and tinidazole is a poor choice in the treatment of H. pylori associated gastritis in Kuwaiti children.
Down's Syndrome and Celiac Disease
Authors: Castro M. , Crinò A. , Papadatou B. , Purpura M. , Giannotti A. , Ferretti F. , Colistro F. , Mottola L. , Digilio M. C. , Lucidi V. , Borrelli P.
Published: January 2024

Patients with Down's syndrome (DS) or celiac disease (CD) have altered immune systems. Autoimmune diseases have been described in both conditions; the coexistence of DS and CD has been occasionally reported, but a clear relationship has not been definitely established. In this study we determined IgA antigliadin antibodies (IgA‐AGA) in 155 children with DS, and the results were compared with those of the control groups formed by 320 children affected by upper‐respiratory tract infections and 115 children with gastrointestinal symptoms but with normal jejunal mucosa. High IgA‐AGA levels were found in 26% of DS patients, in 1% of the first control group and in 10% of the second control group. Such differences are statistically significant. Twenty‐one DS patients with high IgA‐AGA levels and gastrointestinal symptoms underwent jejunal biopsy, and total villous atrophy was found in seven of them (33.33%). HLA‐DR and ‐DQ antigens were also determined in 75 DS patients (20 with high and 55 with normal IgA‐AGA levels), and the percentages of the different phenotypes were compared in the two groups and with those of a control group. No statistically significant difference was found, but DR3, DR7, and DQ2 alleles were always present in DS patients with jejunal atrophy. Our study confirms the data reported in the literature about higher levels of IgA‐AGA in DS patients and the relatively high incidence of CD in this group of patients.
HBV Infection in Pediatric Liver Transplantation
Authors: Lykavieris Panayotis , Fabre Monique , Yvart Jeannine , Alvarez Fernando
Published: January 2024

When hepatitis B virus (HBV) infection precedes orthotopic liver transplantation (OLT), an important issue is to avoid post‐OLT HBV infection of the transplanted liver. When HBV infection is found after OLT, the main objective is to prevent the complication of cirrhosis. A study of HBV infection in 162 liver‐transplanted children followed at Hôpital de Bicêtre is presented here. One hundred forty‐one of these children were completely vaccinated against HBV; 89% of them still disposed of protective titers of serum antibodies to hepatitis B surface antigen (anti‐HBs) (>10 IU/L) 6–60 months after OLT. Four children had a HBV‐associated liver disease that required OLT. In these children a passive immunoprophylaxis maintaining serum anti‐HBs levels >100 IU/L allowed three of them to remain free of serum hepatitis B surface antigen (HBsAg) and HBV‐DNA during follow‐up at 10, 20, and 36 months. Four other children have been found to be HBsAg+ after OLT, but it was not clear whether the source of HBV was a reactivation or a de novo infection. Low doses of cyclosporin and prednisone were administered, in order to avoid the complications of HBV infection. Liver needle biopsies in three of these patients 37, 42, and 46 months after OLT showed a moderate chronic active hepatitis and mild fibrosis. Immunostaining for HBs and hepatitis B core (HBc) antigens indicated active viral replication. In conclusion, this study showed that HBV‐associated liver disease is not a common indication for OLT in children; response to HBV vaccine is good in children with chronic liver disease; postvaccination anti‐HBs titers are not particularly affected by post‐OLT immunosuppression; post‐OLT immunoprophylaxis avoided HBV infection of the transplanted liver in most HBV‐infected children; and low immunosuppressive doses prevented rapid development of cirrhosis in HBV‐infected children.
The Diagnostic and Therapeutic Role of Endoscopic Retrograde Cholangiopancreatography in Children
Authors: Brown Christopher W. , Werlin Steven L. , Geenen Joseph E. , Schmalz Michael
Published: January 2024

We performed 121 endoscopic retrograde cholangiopancreatographies (ERCPs) in 92 patients (60 girls and 32 boys), aged 4 months to 19 years, as part of diagnostic evaluation for suspected pancreatic or biliary tract disease or as therapeutic intervention. ERCP was successful in 116 attempts. The most common indications were recurrent pancreatitis (35 children), nonresolving acute pancreatitis (20), unexplained elevated amylase or lipase (19), postcholecystectomy syndrome (14), and elevated biliary tract enzymes (12). One hundred and one ERCPs were performed for more than one indication. The most common findings included chronic pancreatitis (26 cases), pancreas divisum (14), dilated pancreatic duct (10), gallstones or sludge (8), and abnormal common bile duct (8). Complications were uncommon and usually minor. ERCP is a safe and helpful procedure in the evaluation of suspected pancreatic and biliary tract disease in children and frequently allows for nonoperative treatment of these disorders.
Zinc Supplementation in Very‐Low‐Birth‐Weight Infants
Authors: Friel James K. , Andrews Wayne L. , Matthew J. Derek , Long David R. , Cornel Anna M. , Cox Margaret , McKim Edna , O. Zerbe Gary
Published: January 2024

Inadequate zinc intake may lead to poor growth and developmental outcome in very‐low‐birth‐weight (VLBW; < 1,500 g) infants. Fifty‐two infants (mean birth weight, 1,117 287 g; mean gestational age, 29 ± 2.9 weeks) were randomly allocated to two groups. SUPP infants received a regular term formula plus zinc supplements (4.4 mg/L; final content, 11 mg/L); PLAC infants received the same formula plus placebo (final content, 6.7 mg/L). Infants started their formula at 1,853 ± 109 g, and consumed the formula for 6 months. All subjects were evaluated at 3, 6, 9, and 12 ± 0.75 months corrected‐for‐gestational‐age. At each evaluation, weight, length, and head circumference were measured, a Griffiths developmental assessment was performed, and a blood sample was taken. Higher plasma zinc levels (p < 0.05) were found in the SUPP group at 1 and 3 months, and improved linear growth velocity was found in the SUPP group over the study period for the whole group as well as for girls alone. Maximum motor development scores were higher (p = 0.018) in the SUPP (98 ± 10) than the PLAC (90 ± 8) group, indicating that increased zinc intake in early infancy may be beneficial to VLBW infants.
Slow‐Release 5‐Aminosalicylic Acid Therapy in Children with Small Intestinal Crohn's Disease
Authors: Griffiths A. , Koletzko S. , Sylvester F. , Marcon M. , Sherman P.
Published: January 2024

Pharmacologic agents effective in the treatment of Crohn's disease confined to the small intestine are limited. The therapeutic efficacy of oral mesalazine in small bowel inflammation, although theoretically promising, remains unproven. In an open‐labeled initial trial, timed‐release 5‐aminosalicylic acid (5‐ASA), administered al a daily dosage of 30.6 ± 9.0 mg/kg (mean ± SEM) to children with active Crohn's disease involving the small intestine, was associated with improvement on the Harvey index in six of 12 patients treated for 8.1 ± 3.9 weeks. In a subsequent prospective, double‐blind study 14 children, ages 9.3 to 16.1 years, with active Crohn's disease limited radiologically in the small intestine were randomized to receive either timed‐release 5‐ASA [50 mg/kg/day (maximum 3 g/day)] or placebo for 8 weeks. Following a 4‐week washout period, patients crossed over to receive the other study drug for a further 8 weeks. Six children completed the entire 20‐week trial. The van Hees index improved among patients receiving 5‐ASA for 8 weeks (Δ = ‐ 18 ± 6.4) but deteriorated among patients given placebo (Δ = + 14 ± 4.1) (p < 0.05). Mean Crohn's Disease Activity Index (CDAI) decreased marginally after 8 weeks of 5‐ASA treatment (Δ = ‐ 48 ± 38.2) but not with placebo (Δ = ‐ 3.0 ± 7.9) (p = 0.31). Of the eight noncompleters, more patients dropped out of the study because of lack of therapeutic response to placebo (n = 5) than to 5‐ASA (n = 2). No serious adverse clinical effects were observed during either trial, but one adolescent girl reported mild hair loss that was promptly reversed after the drug was discontinued. These results indicate that timed‐release 5‐ASA may be beneficial in the medical therapy of children with active small bowel Crohn's disease.
The Cyclic Vomiting Syndrome
Authors: Fleisher David R. , Matar Maria
Published: January 2024

This study reviews 71 patients who presented between 1968 and 1988 with recurrent, self‐limited episodes of nausea and vomiting separated by symptom‐free intervals and were diagnosed with cyclic vomiting syndrome (CVS). The length and symptomatology of episodes tended to be stereotyped and characteristic for each patient over time. The disorder may persist from months to decades. There is a coincident relationship between CVS, migraine, and irritable bowel syndrome. The differential diagnosis includes many diseases which may mimic CVS. Management involves a responsive, collaborative doctor‐patient relationship, sensitivity to stresses caused by the illness and to feelings and attitudes that may predispose to attacks, use of antiemetic agents to abort or shorten attacks, treatment of complications, and use of prophylactic agents in patients whose episodes are of sufficient frequency and severity to warrant their trial.