bluuebunny/crossref_metadata_2025 huggingface dataset:
Autonomic Abnormalities in Children With Functional Abdominal Pain: Coincidence or Etiology?
Authors: Chelimsky Gisela , Boyle John T. , Tusing Lora , Chelimsky Thomas C.
Published: January 2024

Background

There is increasing evidence that autonomic neuropathies may adversely affect gastrointestinal motility by involving the extrinsic nerves of the gut. The authors' hypothesize that functional abdominal pain in children is associated with generalized autonomic dysfunction.

Methods

The authors performed detailed autonomic testing in eight patients with functional abdominal pain, including deep breathing, Valsalva, tilting (to assess parasympathetic and sympathetic adrenergic function), and axon‐reflex function and thermoregulatory sweat testing to assess sympathetic cholinergic function. Patients also completed a questionnaire regarding other autonomic symptoms.

Results

Results of autonomic testing were abnormal in seven patients. Parasympathetic function was normal in all, and the abnormalities were restricted to sympathetic cardiac, vasomotor, and sudomotor function. Abnormal results of axon‐reflex testing in six were consistent with peripheral nervous system dysfunction. Five had decreased sweating over the abdomen, determined by thermoregulatory sweat testing. Five eight had nongastrointestinal autonomic symptoms, primarily palpitations and flushing.

Conclusions

Functional abdominal pain in the current patients is associated with generalized dysfunction of the autonomic nervous system. This dysfunction can be peripheral or central in different individuals but seems to be restricted to the sympathetic branch. The known function of the sympathetic nervous system as the motility “brake” suggests that pain could be a manifestation of unmodulated peristalsis, resulting in abdominal cramps.
Screening for Celiac Disease in Children With Recurrent Abdominal Pain
Authors: Fitzpatrick Kelly P. , Sherman Philip M. , Ipp Moshe , Saunders Norman , Macarthur Colin
Published: January 2024

Background

The clinical presentation of celiac disease—a life‐long gluten intolerance—may be characterized by chronic abdominal pain. The objective of this study was to determine if children with recurrent abdominal pain had a higher prevalence of antiendomysial antibodies (a serologic marker of celiac disease) compared with healthy children.

Methods

Children with recurrent abdominal pain and healthy control participants were recruited from the offices of community pediatricians. Serum samples were drawn and antiendomysial antibodies were measured in both groups. Demographic data included age, gender, height, and weight.

Results

A total of 200 children were recruited, of whom 173 (87%) had serum samples drawn. Of these, 92 were children with recurrent abdominal pain and 81 were control participants. Only 2 of the 173 samples (1.2%) were positive for antiendomysial antibody. The frequency of antiendomysial antibody positivity in children with recurrent abdominal pain was 1 in 92 (1%; 95% confidence interval, 0–6%) compared with 1 in 81 (1%; 95% confidence interval, 0–7%) in control participants.

Conclusions

This community‐based case‐control study found no association between recurrent abdominal pain and the prevalence of antiendomysial antibody. Therefore, these data do not support screening for celiac disease in the child with classic recurrent abdominal pain in the primary care setting.
Effects of Therapy With Lansoprazole on Intestinal Permeability and Inflammation in Young Cystic Fibrosis Patients
Authors: Hendriks Han J. E. , van Kreel Bernard , Forget Philippe P.
Published: January 2024

Background

Defective pancreatic bicarbonate secretion with low intestinal pH or intestinal inflammation of any origin increase intestinal permeability in cystic fibrosis (CF).

Methods

In this open study, the authors evaluated the effect of a proton‐pump inhibitor on intestinal permeability and inflammation in 14 young, pancreatic‐insufficient CF patients. Permeability was measured by a three‐sugar permeability test before and after 1 year of lansoprazole use, and urinary nitric oxide (NO) oxidation products were assessed before and during that year as a marker of inflammation.

Results

After 1 year of lansoprazole use, median urinary recovery percentages changed from 2.5% to 1.7% (P = 0.064), from 24.9% to 24.5% (no significance), and from 10.5% to 11.1% (no significance) for lactulose, mannitol, and l ‐rhamnose, respectively. Despite the fact that the median urinary excretion ratios decreased from 0.108 to 0.083 (P = 0.03) and from 0.246 to 0.176 (P = 0.016) for lactulose and mannitol and for lactulose and rhamnose, respectively, they both remained increased. Median urinary NO products‐to‐creatinine ratios were 0.287 for CF patients before lansoprazole and 0.130 for healthy control participants (P = 0.002). Although there was a tendency toward a decrease in the NO products‐to‐creatinine ratio during treatment, this was not significant at the end point.

Conclusions

Intestinal permeability is considerably increased in CF patients and is partly corrected after the use of a proton‐pump inhibitor for 1 year, which may point to a harmful effect of the acid luminal contents on the tight junctional related paracellular permeability pathway. The start and end values for the NO products‐to‐creatinine ratio in CF patients were not significantly different, but were considerably increased when compared with control participants (P = 0.002).
Contamination of Gastrostomy Feeding Systems in Children in a Home‐Based Enteral Nutrition Program
Authors: Bott L. , Husson M. O. , Guimber D. , Michaud L. , Arnaud‐Battandier F. , Turck D. , Gottrand F.
Published: January 2024

Background

There are few data concerning the risk of contamination of enteral feeding systems via gastrostomy in children, and none for conditions that pertain to home‐based care.

Methods

To investigate the risk of contamination of enteral feeding systems during the home‐based care of 20 children receiving gastrostomy tube feeding, five samples were taken for analysis: two samples before the enteral feeding period (gastrostomy, enteral feeding system) and three after this period (gastrostomy, distal giving set, liquid remained in container). Microorganisms were identified and counted. Different factors were studied to elucidate their role in bacterial colonization: acid suppressive therapy, gastrostomy tube or button, hanging feeding time, rate of enteral feeding, gastric pullulation and retrograde contamination, manipulation error, and use of open or closed enteral feeding systems.

Results

Overgrowth was defined as a microorganismal load exceeding 10 4 colony‐forming units (cfu)/mL. Overgrowth was present in 85% of gastrostomy samples before enteral nutrition started. Most microorganisms belonged to gastric flora. Some bacteria had an environmental origin or derived from cutaneous flora. Forty‐five percent of the lines showed overgrowth at the end of enteral nutrition period, mainly with the same microorganism found in the gastrostomy. Closed enteral bags remained sterile, even if manipulation error occurred. Duration, rate of enteral feeding, and acid suppression treatment were not risk factors for overgrowth.

Conclusions

Retrograde contamination of gastrostomy feeding systems occurs frequently. The preferential use of closed enteral feeding systems is recommended for home‐based enteral nutrition programs.
Gastric Electrical Activity and Gastric Emptying in Preterm Newborns Fed Standard and Hydrolysate Formulas
Authors: Riezzo G. , Indrio F. , Montagna O. , Tripaldi C. , Laforgia N. , Chiloiro M. , Mautone A.
Published: January 2024

Background

Because infant formulas containing hydrolyzed cow milk protein are used to reduce feeding intolerance and to improve gastric emptying, the effect on gastrointestinal motility of a hydrolysate formula was compared with that of a standard preterm formula.

Methods

Thirty‐six preterm newborns with a gestational age of 32.2 ± 2.3 weeks were assigned randomly to standard formula or hydrolyzed formula. Cutaneous electrogastrography and ultrasound examination of gastric emptying were performed simultaneously to evaluate gastrointestinal motility before and after the test meal. All recording sessions were performed 1 week after infants had reached full enteral feeding.

Results

No significant difference in gastrointestinal symptoms was noted in the newborns fed the different formulas. In particular, regurgitation and vomiting were observed in 78% versus 64% of preterm newborns after standard and hydrolyzed formula, respectively (Fisher exact test, not significant). No differences were found in terms of gastric electrical activity and gastric emptying time between the two groups.

Conclusions

It seems unnecessary to use hydrolysate formulas to improve motility in preterm infants.
Effect of Feeding Yogurt Versus Milk in Children With Acute Diarrhea and Carbohydrate Malabsorption
Authors: Boudraa Ghazalia , Benbouabdellah Malika , Hachelaf Wahiba , Boisset Michel , Desjeux Jehan‐François , Touhami Mahmoud
Published: January 2024

Background

The aim of this study was to compare the effect of infant formula and the same formula subjected to microbial fermentation (yogurt) on the duration of diarrhea in young children with acute watery diarrhea, with or without reducing substances in stools.

Methods

One hundred twelve well‐nourished children, aged 3 to 24 months, who were admitted to the hospital with acute watery diarrhea were included in a randomized trial. After appropriate rehydration, they were fed either an infant formula (group M, n = 56) or the same formula fermented with Lactobacillus bulgaricus and Streptococcus thermophilus (group Y, n = 56). The two feedings were comparable in lactose concentration (40 to 42 g/L), pH 4.5, flavor, and texture. The groups were subdivided into those with or without reducing sugars in stools at presentation. The presence of reducing sugars in stool was used as a marker of carbohydrate malabsorption.

Results

Group M and group Y had comparable clinical characteristics at admission, including the number of patients with reducing sugars in stools (n = 31 in group M and 27 in group Y). The success rate (cessation of diarrhea and appropriate weight gain 7 days after enrollment into the study) was similar in both groups (82% in group M vs. 84% group Y). Clinical failure was 3.6% in both groups. The percentage of patients withdrawn from the study for medical reasons (5.4% in group M vs. 7.1% in group Y) or withdrawn at the parents’ request (8.9% in group M vs. 5.4% in group Y) was similar. Duration of diarrhea and number of stools were significantly less in group Y compared with group M. Forty‐eight hours after inclusion, diarrhea was still present in 62% of group M versus in 35% of group Y (P < 0.002). In children with reducing sugars in stools, the rate of success (82%) was similar in groups M and Y, but the duration of diarrhea and number of stools per day were significantly decreased in group Y. Forty‐height hours after inclusion, diarrhea was still present in 75% of group M patients and in 20% of group Y patients who had reducing substances in the stool.

Conclusion

Young children with acute watery diarrhea, without malnutrition or associated disease, can be equally well treated with feeding of either infant formula or yogurt. Yogurt feeding is associated with a clinically relevant decrease in stool frequency and duration of diarrhea in children who have reducing sugars in stools.
Are Children with Cystic Fibrosis Who Are Treated With a Proton‐Pump Inhibitor at Risk for Vitamin B 12 Deficiency?
Authors: ter Heide Henriëtte , Hendriks Han J. E. , Heijmans Hiltje , Menheere Paul P. C. A. , Spaapen Leo J. M. , Bakker Jaap A. , Forget Pierre‐Philippe
Published: January 2024

Background

In a recent study, the authors demonstrated the beneficial effect of proton‐pump inhibitors (PPI) on fat malabsorption and bone mineral content in children with cystic fibrosis (CF). Prolonged use of PPI could result in vitamin B 12 deficiency as a consequence of impaired release of vitamin B 12 from food in a nonacid environment. The aim of this study was to evaluate the vitamin B 12 status of CF patients either treated with a PPI or not by measuring vitamin B 12 and homocysteine blood levels, the latter being a sensitive indicator of vitamin B 12 deficiency.

Methods

The study population consisted of 20 CF patients, 11 patients treated with a PPI for at least 2 years and 9 patients not treated with a PPI, and 10 healthy, age‐matched control participants. Homocysteine blood levels were measured by high‐performance liquid chromatography, and vitamin B 12 levels were measured by a competitive protein‐binding assay.

Results

Vitamin B 12 levels were significantly higher in both CF groups compared with the control participants (PPI+, P = 0.02; PPI−, P = 0.009). There was no significant difference in vitamin B 12 levels between both CF groups. Homocysteine levels were normal and similar in all groups.

Conclusions

Cystic fibrosis patients treated with a PPI for at least 2 years show no signs of vitamin B 12 deficiency.
Five‐ to 7‐Year‐Old Children With Helicobacter pylori Infection Are Smaller Than Helicobacter‐Negative Children: A Cross‐Sectional Population‐Based Study of 3,315 Children
Authors: Richter T. , List S. , Müller D. M. , Deutscher J. , Uhlig H. H. , Krumbiegel P. , Herbarth O. , Gutsmuths F. J. , Kiess W.
Published: January 2024

Objective

To test whether Helicobacter pylori‐positive children are smaller and weigh less than H pylori‐negative children.

Design

Cross‐sectional population‐based study.

Participants

In 3,315 5‐to 7‐year‐old preschool and school children, the putative influence of H pylori infection on growth was investigated. Standing height and weight were analyzed in relation to H pylori infection. The diagnosis of H pylori infection was established by (13) C‐urea‐breath test.

Results

The prevalence of H pylori infection in boys was 7.2% (95% confidence interval, 5.9–8.9; n = 1,550) and in girls was 6.1% (95% confidence interval, 4.9–7.3; n = 1,552) H pylori‐positive children were smaller than noninfected children (117.6 ± 5.5 cm vs. 118.9 ± 5.7 cm;P < 0.01). Although H pylori‐positive boys were 2.06 cm smaller than H pylori‐negative boys (117.4 ± 5.6 cm vs. 119.5 ± 5.7 cm;P < 0.001), the difference in girls was not significant (117.9 ± 5.3 cm vs. 118.4 ± 5.7 cm). When standing height was adjusted for age, the found differences were more pronounced. Differences between the infected and noninfected children with regard to body weight were not significant (22.4 ± 4.0 kg vs. 22.1 ± 4.0 kg), nor was there a significant difference with regard to body‐mass index. However, boys with H pylori infection had a lower weight than noninfected boys (21.6 ± 3.3 kg vs. 22.6 ± 4.0 kg;P < 0.01), but in girls, these differences were not observed (22.2 ± 4.0 vs. 22.8 ± 4.6 kg, respectively). When weight was adjusted for age, H pylori‐positive children also had a lower weight than H pylori‐negative children because of the lower weight of boys.

Conclusions

H pylori infection is associated with growth delay, growth retardation, or both in affected children.
Growth Hormone Effects in Intestinal Adaptation After Massive Bowel Resection in the Suckling Rat
Authors: Tellez L. Garcia‐Sancho , Gómez de Segura I. A. , Vazquez I. , De Miguel E. , Garcia‐Sancho L.
Published: January 2024

Background

Massive small bowel resection provokes intestinal malabsorption that leads to diminished growth in the suckling rat. Growth hormone is one of the several factors that can enhance the adaptive response of the intestines in the adult rat; however, whether it also enhances postresection intestinal adaptation in the suckling rat, thus reducing the adverse effects of resection on growth, is still unclear.

Methods

Seventy‐four 30‐day‐old suckling Wistar rats underwent 80% midgut bowel resection, laparotomy (sham operation), or no surgery. They were treated with either growth hormone or saline for 15 days and studied 15 or 45 days after surgery. Body weight was monitored and samples of bone and intestinal mucosa were obtained at the end of the study period for analysis.

Results

Resected rats lost body and bone weight regardless of growth hormone administration. Bowel resection provoked significant increases in the proliferation and size of the intestinal mucosa. Growth hormone significantly, but just barely, increased crypt height and mucosal mass at day 15 after surgery, but not at day 45. Lengthening of the intestines was the main effect of growth hormone.

Conclusions

The relatively small adaptive response of intestines to growth hormone is insufficient to promote body growth after intestinal resection in the suckling rat. This response is lower than that in older rats and may reflect an age‐related differential response to growth hormone.
Effect of Long‐term Omeprazole Treatment on Antral G and D Cells in Children
Authors: Pashankar Dinesh S. , Israel David M. , Jevon Gareth P. , Buchan Alison M. J.
Published: January 2024

Background

Long‐term omeprazole therapy is associated with hypergastrinemia. In the antrum, gastrin secretion from G cells is inhibited in a paracrine manner by somatostatin secreted from D cells. Omeprazole may alter the ratio of G to D cells; however, there are limited data concerning such an effect in humans and none in children. The authors studied the effect of long‐term omeprazole therapy on antral G‐ and D‐cell numbers in children.

Methods

Six children received omeprazole for 4 to 7 years for erosive reflux esophagitis. Endoscopic antral biopsy specimens obtained at baseline and at 1, 4, and 7 years of omeprazole administration were immunostained to assess G and D cell numbers per antral gland. The G‐ and D‐cell numbers were also assessed in an age‐matched control group consisting of 24 healthy children from six different age groups.

Results

The mean G‐cell number per unit area showed a significant increase at 4 years (85 ± 5.7 years) and at 7 years (89 ± 6.8 years) on omeprazole compared with baseline (56 ± 4.8 years) (P < 0.01). D‐cell numbers did not change. The ratio of G to D cells increased progressively, and the change from baseline was significant at 7 years taking omeprazole (P < 0.02). In the control group, G‐ and D‐cell numbers did not differ significantly within the six age groups.

Conclusions

Long‐term omeprazole therapy is associated with a significant increase in G‐cell numbers and in the ratio of G to D cells in children. These changes reflect the effect of omeprazole because there was no change in these parameters in the age‐matched control group.
Elevated Serum Hepatocyte Growth Factor in Children and Young Adults With Inflammatory Bowel Disease
Authors: Srivastava Maya , Zurakowski David , Cheifetz Peter , Leichtner Alan , Bousvaros Athos
Published: January 2024

Background

Elevated serum levels of several potent angiogenesis factors, including vascular endothelial growth factor and basic fibroblast growth factor have been described in children with active inflammatory bowel disease. Angiogenesis‐promoting cytokines may promote inflammation by increasing vascular permeability but also mediate tissue repair by activating fibroblasts. Hepatocyte growth factor (HGF) is another angiogenesis‐promoting cytokine that is increased in colon cancer tissues. We therefore evaluated serum HGF levels in individuals with Crohn disease and ulcerative colitis.

Methods

Serum samples were obtained from 60 patients with Crohn disease, 31 with ulcerative colitis, and 38 controls with functional abdominal pain and other gastrointestinal illnesses. Disease activity for Crohn disease patients was determined using the pediatric Crohn disease activity index, and for ulcerative colitis patients using the Kozarek score. The HGF levels were measured by enzyme‐linked immunosorbent assay.

Results

Serum HGF levels were significantly (P < 0.001) higher for Crohn disease patients (1439 ± 84 pg/mL) and ulcerative colitis patients (1384 ± 107 pg/mL) than for control patients (807 ± 50 pg/mL). Serum HGF levels also rose with increasing disease activity in individuals with both Crohn disease and ulcerative colitis.

Conclusion

Serum HGF is elevated in children and young adults who have Crohn disease or ulcerative colitis. Levels of serum HGF correlate directly with disease activity. The raised serum HGF suggests that HGF may mediate angiogenesis and vascular permeability in the mucosa of children with inflammatory bowel disease. Alternatively, the raised serum HGF may be an epiphenomenon of inflammation.
Inflammatory Bowel Disease Associated With Immune Thrombocytopenic Purpura in Children
Authors: Higuchi Leslie M. , Joffe Steven , Neufeld Ellis J. , Weisdorf Sally , Rosh Joel , Murch Simon , Devenyi Attila , Thompson John F. , Lewis Jeffery D. , Bousvaros Athos
Published: January 2024

Objective

Previous reports suggest an association between inflammatory bowel disease (IBD) and immune thrombocytopenic purpura (ITP) in adults. To date, only five children with both diseases have been described. The aim of the study was to describe the characteristics of children with IBD and ITP.

Methods

Cases were obtained from the pediatric gastroenterology community by means of the pediatric gastroenterology internet bulletin board in June 1999. Eight cases were submitted from seven medical centers. Medical records were reviewed by two pediatric gastroenterologists and a pediatric hematologist.

Results

The age range of the patients was 2.1 to 16.5 years, with a mean age of 9.6 ± 5.2 years. Four children had ulcerative colitis, three had Crohn disease, and one had indeterminate colitis. All had colonic involvement of IBD. Of eight patients, three had IBD first, three had ITP first, and two had both simultaneously. At ITP diagnosis, platelet count was less than 10,000/mL in five children, 17,000/mL in one child, and 50,000 to 60,000/mL in two children. Of the three children diagnosed with ITP first, two initially had rectal bleeding at the time of ITP diagnosis. Bone marrow evaluations, performed in six of eight children, were consistent with ITP. Six of the eight children had chronic ITP, including three children who were 5 years of age or younger. Therapy for ITP included steroids (n = 6), intravenous immunoglobulin (n = 6), Rh o (D) intravenous immunoglobulin (n = 2), and splenectomy (n = 1).

Conclusions

The authors describe the largest pediatric case series of children with IBD and ITP. More than 50% of the children had the chronic form of ITP. Most patients responded to conventional therapy for ITP and IBD.
Effect of Erythromycin on Gastroduodenal Contractile Activity in Developing Neonates
Authors: Jadcherla Sudarshan Rao , Berseth Carol Lynn
Published: January 2024

Background

The occurrence of phase III of migrating motor complexes in neonates is inversely related to gestational age, and it can be triggered in some infants by the motilin receptor agonist erythromycin. After intragastric erythromycin, the authors determined 1) the occurrence and characteristics of phase III of migrating motor complexes, 2) the antral and duodenal motor responses, and 3) the dose–response relation among preterm and full‐term infants.

Methods

Using an unbalanced, repeated measures design, 25 preterm and term infants were given two of three doses of intragastric erythromycin: 0.75, 1.5, and 3.0 mg/kg. Motor activity was recorded 3 hours before and 2 hours after each dose using a continuous water perfusion manometry system.

Results

Erythromycin failed to induce phase III of migrating motor complexes in infants younger than 31 weeks' gestation; however, it induced phase III in a dose‐dependent manner among infants whose gestational ages were 32 weeks and older (P < 0.05). Erythromycin significantly increased the amplitude and frequency of antral contractions in term infants and significantly increased the duodenal contraction amplitude in older preterm and term infants, but these effects were absent in younger preterm infants.

Conclusions

The ontogenic emergence of the motilin receptor–mediated induction of phase III occurs by 32 weeks' gestation, whereas the non‐motilin–mediated response of increased antroduodenal motor activity is not observed until term. Therefore, early use of erythromycin as a prokinetic agent may not be useful in very preterm infants, partially useful in older preterm infants, and useful in full‐term infants.
Erythromycin as a Prokinetic Agent in Preterm Infants
Authors: Costalos Christos , Gounaris Anthony , Varhalama Evangelia , Kokori Fedra , Alexiou N. , Kolovou Efi
Published: January 2024

Background

The macrolide antibiotic erythromycin is a prokinetic agent that stimulates gastrointestinal motility. The aim of the study was to determine the effect of erythromycin on the gastrointestinal motility of preterm infants.

Methods

Erythromycin 10 mg/kg, 8 hourly or a placebo, was given orally for 7 days in a double‐blind randomized, crossover study of 20 preterm infants with a median gestational age of 32 weeks (range, 26–34 weeks). Antral contractility was determined by using ultrasonography to measure the decrease in the gastric antral cross‐sectional area after a feed. The whole gut transit time was assessed by timing the transit of carmine red through the gut.

Results

Antral contractility lasted for a shorter period of time during erythromycin treatment than during placebo treatment (mean [standard deviation], 31 minutes [9.9 minutes] vs. 70 minutes [13 minutes];P < 0.01). Whole gut transit time was also shorter during erythromycin treatment (mean, 23.1 hours [12.9 hours] vs. 49.3 hours [29 hours];P < 0.01). All infants tolerated the drug well.

Conclusions

Oral erythromycin in food‐intolerant preterm infants enhances both antral contractility and whole gut transit time.
Zinc Absorption and Exchangeable Zinc Pool Sizes in Breast‐Fed Infants Fed Meat or Cereal as First Complementary Food
Authors: Jalla Sanju , Westcott Jamie , Steirn Marsha , Miller Leland V. , Bell Melanie , Krebs Nancy F.
Published: January 2024

Background

The aims of this study were to compare the absorption efficiency of zinc from rice cereal and meat, with and without human milk, in 7‐month‐old breast‐fed infants and to compare the size of exchangeable zinc pools in the infants according to the assigned complementary food.

Methods

Fractional absorption of zinc was measured in male infants using extrinsic labeling with a stable isotope of zinc in a test meal of either pureed beef (n = 9) or iron‐fortified infant rice cereal (n = 9). The effect on fractional absorption of the addition of human milk to each complementary food was measured in each infant with a second oral zinc isotope. Fractional absorption was measured using fecal monitoring of isotope excretion, and exchangeable zinc pool size was calculated from isotopic enrichment in urine.

Results

Fractional absorption of zinc did not statistically differ between the beef (0.41 ± 0.11) and cereal (0.36 ± 0.05) test meals, although the trend showed that beef had higher fractional absorption than cereal. The higher intake of zinc from the beef versus cereal test meal resulted in a 16‐fold greater amount of absorbed zinc (P = 0.0002). The addition of human milk caused significant decreases in fractional absorption of zinc (0.07 ± 0.02, P = 0.01) and absorbed zinc (0.04 ± 0.01 mg, P < 0.0001). The size of the exchangeable zinc pool did not differ according to group but was strongly correlated with mean daily zinc intake (r = 0.72, P = 0.003).

Conclusions

These results confirm that meat as a complementary food for breast‐fed infants can provide a rich source of dietary zinc that is well absorbed. The significant positive correlation between zinc intake and exchangeable zinc pool size suggests that increasing zinc intake positively affects metabolically available zinc.
Immune Status of Infants Fed Soy‐Based Formulas With or Without Added Nucleotides for 1 Year: Part 1: Vaccine Responses, and Morbidity
Authors: Ostrom Karin M. , Cordle Christopher T. , Schaller Joseph P. , Winship Timothy R. , Thomas Debra J. , Jacobs Joan R. , Blatter Mark M. , Cho Sechin , Gooch Willis M. , Granoff Dan M. , Faden Howard , Pickering Larry K.
Published: January 2024

Background

Immunologic development of soy‐fed infants has not been extensively studied. Early studies of soy flour–based formulas showed decreased immunoglobulin production when soy protein intake was limited. However, there were no significant differences in rotavirus vaccine responses between breast‐fed and soy protein isolate–based formula‐fed infants. Nucleotides added to milk‐based formula benefit infant immune status, but reports of the immunologic effects of adding nucleotides to soy‐based formula are not available. This study evaluated immune status and morbidity of infants fed soy protein isolate formulas with and without added nucleotides for 1 year.

Methods

Newborn, term infants enrolled in a masked 12‐month feeding trial were assigned randomly to groups fed soy formula with or without added nucleotides (n = 94, n = 92). A nonrandomized human milk/formula cohort (n = 81) was concurrently enrolled. Recommended immunizations were administered at 2, 4, and 6 months. Immune status was determined from antibody responses to Haemophilus influenzae type b, tetanus, diphtheria, and poliovirus vaccines at 6, 7, and 12 months. Parents and physicians reported morbidity data.

Results

All vaccine responses were within normal ranges. No response differences were observed between infants fed soy formula and those fed nucleotide‐supplemented soy. However, antibody to H. influenzae type b at 7 and 12 months was higher in infants fed nucleotide‐supplemented soy than in infants fed human milk/formula (P = 0.007, P = 0.008, respectively). Human milk/formula‐fed infants had higher poliovirus neutralizing antibody at 12 months than did soy‐fed infants (P = 0.016). Morbidity analyses showed that only physician‐reported diarrhea was different among groups (groups fed human milk/formula had less diarrhea than did soy groups, P = 0.011).

Conclusions

Term infants fed soy protein isolate–based formulas have normal immune development as measured by antibody responses to childhood immunizations.
Antibacterial Characteristics in the Feces of Breast‐Fed and Formula‐Fed Infants During the First Year of Life
Authors: Köhler Henrik , Donarski Silke , Stocks Beate , Parret Alison , Edwards Christine , Schroten Horst
Published: January 2024

Background

Human milk is known to protect infants from a number of infectious diseases. Much less is known about the bioactivity of milk‐derived factors in the intestine. In this study, potentially protective characteristics in the feces of breast‐fed and formula‐fed infants were compared.

Methods

The feces of 26 breast‐fed and 18 formula‐fed infants were collected during the first year of life. In each sample, the concentrations of total protein, immunoglobulin A, and sialic acid were measured. In addition, the effect of the fecal samples was measured on the adhesion of enteropathogenic Escherichia coli (EPEC) to Caco‐2 cells and on transepithelial electrical resistance (TER) during an infection.

Results

In the first month, sialic acid and immunoglobulin A were found in the feces of breast‐fed infants in substantially higher concentrations than in the feces of formula fed infants (sialic acid, 1197 ± 370 μg/ mL versus 31 ± 19 μg/ mL; immunoglobulin A, 0.11 ± 7 mg/mL versus 0.3 ± 1 mg/mL) and thereafter decreased to similar levels in half a year. Adhesion of EPEC to Caco‐2 cells was inhibited between 65% and 85% by stools from both groups. The decrease of TER during EPEC infection was unaffected by fecal samples of any origin or age.

Conclusion

Potentially protective factors are present in higher concentrations in the stools of breast‐fed infants than in stools of formula‐fed infants. Interestingly, feces from breast‐fed and formula‐fed infants inhibited bacterial adhesion to a similar level, but neither was able to preserve epithelial barrier function.
Anti‐CD20 Monoclonal Antibody (Rituximab) Treatment for Epstein‐Barr Virus‐associated, B‐cell Lymphoproliferative Disease in Pediatric Liver Transplant Recipients
Authors: Serinet Marie Odile , Jacquemin Emmanuel , Habes Dalila , Debray Dominique , Fabre Monique , Bernard Olivier
Published: January 2024

Objectives

Anti–B‐cell immunotherapy has been used with success in adults with posttransplant B‐cell lymphoproliferative disease (PTLD), but such treatment has rarely been reported in children. We report the outcome of anti–CD20 antibody (rituximab) therapy for Epstein‐Barr virus (EBV)–associated PTLD in six pediatric liver transplant recipients.

Methods

In these six patients, PTLD was diagnosed within 2 to 4 months after transplantation. The tumors were classified as monomorphic or polymorphic B‐cell infiltrate expressing CD20 antigen and EBV genome. Anti‐CD20 therapy was associated with withdrawal of tacrolimus or ciclosporine therapy in all patients. Intravenous rituximab was administered at 375 mg/m2 once a week for 3 to 4 consecutive weeks.

Results

Rituximab treatment was associated with decreased EBV load, disappearance of abnormal serum immunoglobulin concentration, and disappearance of tumoral masses, which occurred 1 to 2.5 months after treatment onset. Despite rituximab therapy, one patient was diagnosed subsequently with a cerebral tumor. Five patients experienced acute liver graft rejection episodes within 10 days to 2.5 months after beginning treatment. In these patients, immunosuppression was reintroduced, but three children experienced fatal chronic rejection, whereas two experienced complete tumor remission. Three children are alive and in complete remission, with normal liver tests, 15 months to 3 years after PTLD onset.

Conclusions

Rituximab therapy is an interesting approach for children with early EBV‐associated PTLD after liver transplantation. It does not prevent cerebral localization, and rapid resumption of immunosuppression may be advisable to prevent lethal chronic liver graft rejection.
HLA‐DQA1 and HLA‐DQB1 Genetic Markers and Clinical Presentation in Celiac Disease
Authors: Zubillaga Paul , Vidales Maria Concepcion , Zubillaga Itziar , Ormaechea Victor , García‐Urkía Nerea , Vitoria Juan Carlos
Published: January 2024

Background

Patients with celiac disease are diagnosed at any age and can exhibit a wide range of clinical manifestations. The reasons for this are unclear. The aim of this study was to investigate a possible correlation between the HLA‐DQA1 and HLA‐DQB1 genetic markers and clinical features of celiac disease.

Methods

A total of 133 patients with celiac disease were tested for the HLA‐DQA1 and HLA‐DQB1 genes. Their corresponding allele and haplotype frequency distributions were estimated from the phenotypes found. The results were correlated with data from the clinical records.

Results

The DQ2 molecule was found in 93% of the patients, and DQ2 or DQ8 was found in 98%. The DQA1*0201‐DQB1*0202 haplotype showed strong linkage disequilibrium. DQ2 homozygosis was significantly associated with female sex, earlier age at diagnosis, and shorter delay between onset of symptoms and diagnosis. Double‐dose DQB1*02 (01–02) allele was more frequent in patients with the classic presentation of the disease.

Conclusions

The genetic markers investigated may prove useful for diagnosing and managing celiac disease. With some clinical variables, correlations not previously described were found. These correlations have a moderate strength and, therefore, must be confirmed by other studies.
A Comparison of Oral Diazepam Versus Midazolam, Administered With Intravenous Meperidine, as Premedication to Sedation for Pediatric Endoscopy
Authors: Martinez Jose L. , Sutters Kimberly A. , Waite Steven , Davis Judy , Medina Elizabeth , Montano Nancy , Merzel David , Marquez Carol
Published: January 2024

Objectives

This study was performed to compare the effects of oral midazolam and oral diazepam, administered with intravenous (IV) meperidine, on pre‐procedural, procedural, and post‐procedural sedation and recovery in children undergoing diagnostic upper endoscopy. The costs of pre‐procedure sedation were compared for the two benzodiazepines.

Methods

A randomized, double‐blind study was conducted in 154 children (mean age 96.73 ± 59.34 months, 53% male) undergoing endoscopy. Oral midazolam (0.5 mg/kg, maximum dose of 20 mg) or oral diazepam (0.3 mg/kg, maximum dose of 10 mg) was given before IV insertion, and with IV meperidine (2 mg/kg, maximum dose of 100 mg) given to all patients just before upper endoscopy. Further “rescue” midazolam doses (to a maximum cumulative dose of 5 mg) were given as needed to achieve a pre‐procedure sedation score of ≥2. All patients received intravenous propofol for procedural sedation. Patients were evaluated for the efficacy and safety of pre‐procedural sedation, sedation during upper endoscopy, and recovery following completion of the procedure.

Results

There were no significant differences between study groups for level of pre‐procedural sedation, need for midazolam rescue in endoscopy, effectiveness of procedural sedation, occurrence of adverse events, and recovery parameters.

Conclusions

Oral midazolam and diazepam, in conjunction with IV administration of meperidine, provide comparable, effective, and safe premedication for children undergoing upper endoscopy. The cost of midazolam was substantially higher than diazepam.
Assessment of Three Methods of pH Probe Positioning in Preterm Infants
Authors: Emmerson Anthony JB , Chant Terri , May Judith , Vales Patricia
Published: January 2024

Background

In the assessment of gastroesophageal reflux, correct placement of the pH catheter is crucial. This is particularly so in very low birth weight infants where a small error in positioning could give rise to a potentially large error in results. Accepted modes of assessing correct positioning can be problematic in this population of infants and alternative methods were investigated.

Methods

A total of 26 preterm infants (<35 weeks gestation) were enrolled in this study. All infants were suspected of having GOR and pH monitoring was performed. Probe position was assessed using Strobel's formula, manometry and acid‐alkali interface and confirmed by chest x‐ray.

Results

There was a highly significant positive correlation between the calculation of the pH probe position using Strobel's formula and the position on x‐ray and a significant positive correlation between the acid/alkali interface and x‐ray position. There was no correlation between manometry and x‐ray position and this method was also shown to be problematic in its' application.

Conclusion

The data suggests that it is appropriate to use Strobel's formula as a method of accurate positioning of pH probes in preterm infants, thus avoiding the need for additional x‐rays. The acid/alkali interface, when obtainable, is a secondary, satisfactory method to confirm the position calculated by Strobel's formula.
Early Feeding Advancement in Very Low‐Birth‐Weight Infants With Intrauterine Growth Retardation and Increased Umbilical Artery Resistance
Authors: Mihatsch Walter Alexander , Pohlandt Frank , Franz Axel Rainer , Flock Felix
Published: January 2024

Background

To investigate whether intrauterine growth retardation (birth weight <10th percentile), increased umbilical artery resistance (resistance index >90th percentile measured by Doppler velocimetry), or brain sparing (increased umbilical artery resistance and decreased middle cerebral artery resistance index <5th percentile) were associated with early feeding intolerance in very low‐birth‐weight (VLBW, <1,500 g) infants.

Methods

From July 1999 to December 2000, 124 inborn VLBW infants were enrolled in a prospective trial evaluating early enteral nutrition after a standardized feeding protocol (daily feeding advancement, 16 mL/kg birth weight). Feeding tolerance was assessed as the age at which full enteral feeds (150 mL/kg daily) were achieved. Data are shown as median, 25th, and 75th percentiles.

Results

Full enteral feeds were achieved at 15 days (range, 12–21 days) of age for all infants. Intrauterine growth retardation (full enteral feeding achieved at 14 days; range, 12–21 days), increased umbilical artery resistance (full enteral feeding achieved at 14 days; range, 11–16 days), and brain sparing (full enteral feeding achieved at 15 days; range, 14–20 days) were not associated with early feeding intolerance.

Conclusion

Very low‐birth‐weight infants with intrauterine growth retardation, increased umbilical artery resistance, and brain sparing tolerated enteral feeding as well as appropriate‐for‐gestational‐age VLBW infants.
Water Load Test in Children
Authors: Sood Manu R. , Schwankovsky Lenore M. , Rowhani Anita , Zangen Tsili , Ziring David , Furtado Theresa , Hyman Paul E.
Published: January 2024

Objective

The purpose of this study was to estimate values for the water load test in healthy elementary school children.

Methods

We measured the volume of water consumed by 176 children (71 boys and 105 girls) using the water load test at school. Children completed a questionnaire, which included self‐efficacy and abdominal pain history. Then subjects drank water for 3 minutes or until full.

Results

Children drank 630 ± 260 ml. Water consumption correlated with age, weight, and height. Children who believed they could drink a lot, drank more than those who thought they could not, P < 0.01.

Conclusion

The water load test is a simple and inexpensive method to estimate onset of satiety and may be useful in future studies now that there are values for healthy children.
Comparison of Steatocrit and Fat Absorption in Persons With Cystic Fibrosis
Authors: Wagner Mary H. , Bowser Ellen K. , Sherman James M. , Francisco Mary Pat , Theriaque Douglas , Novak Donald A.
Published: January 2024

Background

Exocrine pancreatic insufficiency is a common problem in persons with cystic fibrosis causing malabsorption and poor growth. The 72‐hour fecal fat study is the best qualitative measure of fat malabsorption used in clinical practice. This test has several drawbacks, which include cost and logistics. The steatocrit has been proposed as a rapid method to assess fat malabsorption.

Objectives

The objective of this study was to determine whether the steatocrit is an accurate estimation of fat malabsorption in persons with cystic fibrosis.

Methods

Forty‐nine stool samples for steatocrit processing were obtained from 72‐hour fecal fat collections performed on twenty‐seven persons with cystic fibrosis. Stools were weighed and homogenized with sand and water. The emulsified specimen was pipetted into heparinized capillary tubes and centrifuged for 15 minutes. The length of the fatty layer was compared to the length of the solid layer plus the fatty layer in each tube to determine the steatocrit value. Four steatocrit mixtures were evaluated: (1) standard steatocrit, (2) dilute steatocrit, (3) acid steatocrit, (4) dilute acid steatocrit. Steatocrit values were compared with the coefficient of fat absorption determined from the 72‐hour fecal fat collection.

Results

The correlation coefficient of the steatocrit and the coefficient of fat absorption ranged from ‐.045 to ‐.491. Only the coefficient of fat absorption and the acid steatocrit had a significant correlation (P = 0.033).

Conclusion

The steatocrit is an imprecise measure of fat absorption and not clinically useful in estimating steatorrhea.
Small Bowel Intestinal Permeability in Australian Aboriginal Children
Authors: Kukuruzovic Renata H. , Brewster David R.
Published: January 2024

Objective

To show that the severity of diarrheal disease in Aboriginal children in tropical Australia is a consequence of underlying small intestinal mucosal damage.

Study Design

A prospective study of 338 Aboriginal admissions compared to 37 non‐Aboriginal children, both diarrhea cases and controls. Intestinal permeability was measured by lactulose‐rhamnose (L/R) ratios on a timed 90‐minute blood test.

Results

For diarrheal admissions, significantly more Aboriginal (vs. non‐Aboriginal children) had hypokalemia (70 vs. 10%), acidosis (65 vs. 29%), moderate to severe dehydration (52 vs. 19%) and a longer mean length of stay (mean 8.9 vs. 3.9 days). Mean L/R ratios (95% confidence intervals) in Aboriginal children (diarrhea vs. controls) were 16.5 (14.6–18.7) vs. 4.5 (3.8–5.3) compared to 7.7 (4.4–13.3) vs. 2.5 (1.8–3.4), respectively, in non‐Aboriginals. Abnormal permeability ratios (> 5.6) consistent with tropical‐environmental enteropathy syndrome were found in 36% (27/75) of Aboriginal controls compared to none of the non‐Aboriginal controls. On multiple regression, the factors associated with high L/R ratios were diarrheal severity (P < 0.001), acidosis (P = 0.007) and hypokalemia (P = 0.04).

Conclusions

An underlying tropical‐environmental enteropathy contributes to the severity of acute gastroenteritis in Aboriginal children. Diarrheal complications, such as acidosis, hypokalemia, and osmotic diarrhea are associated with high L/R ratios, reflecting greater small intestinal mucosal damage.
Whey Predominant, Whey Modified Infant Formula with Protein/energy Ratio of 1.8 g/100 kcal: Adequate and Safe for Term Infants From Birth to Four Months
Authors: Räihä N. C. R. , Fazzolari‐Nesci A. , Cajozzo C. , Puccio G. , Monestier A. , Moro G. , Minoli I. , Haschke‐Becher E. , Bachmann C. , Van't Hof M. , Fässler A.‐L. Carrié , Haschke F.
Published: January 2024

Background

Protein quality of breast milk is superior to that of formula proteins. To ensure that the protein intake is sufficient, starter formulas with conventional protein composition provide a protein/energy ratio of 2.2–2.5 g per 100 kcal to infants, which is much higher than that supplied with breast milk. Several studies have shown that formula‐fed infants have higher plasma or serum urea concentrations than breast‐fed infants do. We tested if feeding formulas with improved protein quality and a protein content corresponding to the minimum level that is consistent with international recommendations (1.8 g/100 kcal) allows patients to achieve normal growth and plasma urea concentrations.

Methods

Healthy term infants were enrolled into the study and were either breast‐fed or randomly assigned to three formula‐fed groups. Formula‐fed infants received either a standard formula with a protein/energy ratio of 2.2 g/100 kcal, whereas the two other groups received formulas with a protein/energy ratio of 1.8g/100 kcal differing mainly by their source of protein. Subjects received breast milk or these formulas ad libitum as the sole source of energy from birth to four months of age in a controlled blind design (except for the breast‐fed group). Anthropometric measurements (body weight and length) were obtained at birth, at 30, 60, 90, and 120 days. Energy and protein intakes were calculated from three‐day dietary records. Blood was collected for biochemical measurements at 30, 60, and 120 days.

Results

No differences were found between the four feeding groups for weight‐ and length‐gains or for body mass indices (BMI). No differences in energy intakes between the formula‐fed groups could be found, whereas protein intakes were less in infants fed the 1.8 g/100 kcal formulas. Plasma urea levels of the infants fed the 1.8 g/100 kcal formulas were closer to those found in the breast‐fed infants.

Conclusion

Improvement of the amino acid profile permits a whey predominant starter formula with 1.8 g protein per 100 kcal to meet the needs of normal term infants during the first four months of life.