bluuebunny/crossref_metadata_2025 huggingface dataset:
Possible Antioxidant Effect of Vitamin A Supplementation in Premature Infants
Authors: Schwarz Kathleen B. , Cox Jeanne M. , Sharma Savitri , Clement Liliana , Humphrey Jean , Gleason Christine , Abbey Helen , Sehnert Shelley S. , Risby Terence H.
Published: February 2024

Background

Increased lipid peroxidation caused by oxygen free radicals is thought to be one of the common pathogenetic mechanisms for the so‐called oxygen radical diseases of prematurity. Since in vitro studies have shown that various forms of vitamin A can exert antioxidant effects that are more potent than those of vitamin E (treatment with which has been ineffective in these diseases), the purpose of this prospective, controlled study was to determine whether administration of supplemental vitamin A to premature infants deficient in this vitamin would have an antioxidant effect in vivo.

Methods

Fourteen infants (1181 ± 35 g; gestational age 29 ± 0.04 weeks) with a serum retinol concentration at 7 ± 2 days of age in the deficient range, lower than 0.7 μmol/l (<20 μg/dl), were enrolled in the study. Infants were randomized to receive the standard amount of vitamin A or standard plus supplemental (2.6 μmol/l [2500 IU] orally each day) vitamin A, beginning at 1 week of age. Antioxidant effects of supplementation were assessed by a decrease in lipid peroxidation, quantified by the ethane content of expired air.

Results

Three weeks after study enrollment, total daily vitamin A intake in the infants receiving supplements was 4.565 ± 0.236 μmol (4354 ± 225 IU) versus 1.879 ± 0.317 μmol/l (1792 ± 302 IU) in infants receiving standard amounts of the vitamin. In spite of the difference in intake of vitamin A, 3 weeks after study enrollment, serum retinol concentrations did not differ between the infants given supplements and those receiving standard amounts of vitamin A, 0.70 ± 0.21 versus 0.66 ± 0.07 μmol/l (20 ± 6 μg/dl versus 19 ± 2 μg/dl, respectively). In the infants receiving supplemental vitamin A, breath ethane values declined from baseline values. There was an inverse correlation between the number of weeks of supplementation and breath ethane values, whereas there was no significant correlation between the duration of the study and breath ethane values in the infants not given supplements.

Conclusions

Our data suggest that supplementation with vitamin A in a small group of vitamin A‐deficient preterm infants was associated with an antioxidant effect. Although no immediate clinical benefits were associated with supplementation, the data provide the rationale for future investigations of possible antioxidant effects of (larger amounts?) of vitamin A in higher risk premature infants born with subnormal serum retinol concentrations.
Esophageal Strictures in Children with Recessive Dystrophic Epidermolysis Bullosa: Experience of Balloon Dilatation in Nine Cases
Authors: Fujimoto Takao , Lane Geoffrey J. , Miyano Takeshi , Yaguchi Hitoshi , Koike Mika , Manabe Motomu , Ogawa Hideyo , Mizushima Akira , Suzuki Genichi
Published: February 2024

Background:

Recessive dystrophic epidermolysis bullosa is a rare disorder characterized by extreme vulnerability of the squamous epithelium and mucous membranes. Minor trauma such as is caused by swallowing solid food is followed by blistering and scarring. Stricture formation at the pharyngoesophageal junction (C6 or C7) is the severest complication of this disease.

Methods:

We evaluate the effectiveness of Microvasive Rigiflex balloon dilatation and extensive nutritional support as a primary treatment for this condition. Nine of 21 recessive dystrophic epidermolysis bullosa patients developed esophageal strictures at the level of the pharyngo‐esophageal junction (C6). We treated them with intensive nutritional therapy followed by balloon dilatation, which produces longitudinal pressure and provides prompt relief from esophageal stricture. Eleven balloon dilatations have been performed in 9 patients.

Results:

All patients had poor physical development and were severely malnourished; extensive nutritional support was required before treatment could begin. Balloon dilatation was performed once in seven patients and twice in two patients. No recurrent stricture formation was observed after balloon dilatation.

Conclusion:

Intensive nutritional support followed by balloon dilatation is the first choice of treatment for esophageal strictures complicating recessive epidermolysis bullosa. By following this regime, invasive surgery can be avoided.
Measured Consumption of Commercial Infant Food Products in German Infants: Results From the DONALD Study
Authors: Kersting Mathilde , Alexy Ute , Sichert‐Hellert Wolfgang , Manz Friedrich , Schöch Gerhard
Published: February 2024

Background:

Commercial food products intended for infants form an important part of the diet. Such products are defined as special dietetic food by food legislation. However, quantitative consumption data in the context of the current European Community (EC) food regulations have not been available up to now.

Methods:

Six hundred eighty 3‐day weighed diet records from 3‐, 6‐, 9‐, and 12‐month‐old infants involved in the DONALD (Dortmund Nutritional and Anthropometrical Longitudinally Designed) Study were evaluated regarding overall and individual consumption of commercial infant food (CIF). Here, CIF was allocated to the food categories of the current EC directives.

Results:

Four hundred eighteen varieties of infant food were recorded. The total CIF (formulae; beikost [any food or drink other than breast milk or infant and follow‐on formulae]) reached percentages of the total food intake (including breast milk) of 51% (47%; 4%), 62% (33%; 29%), 53% (20%; 32%), and 37% (13%; 24%) at the ages of 3, 6, 9 and 12 months, respectively. Approximately 55% (95%) of the 3‐month‐old infants (range, 6‐12 months) consumed some sort of CIF, but the highest amounts were observed at 6 months and the highest numbers of consumers at 9 months. Depending on the definition of “high consumers” of CIF, the individual consumption quantities (in grams per kilogram per day) differed by a maximum of 60% but high consumers were always found in the 6‐month‐old group.

Conclusion:

The high proportions of CIF in the diet during a critical developmental period call for a guaranteed high nutritional and safety quality of CIF and for realistic data on consumption patterns.
Effects of Protein Restriction in Early Life on Growth and Function of the Gastrointestinal Tract of the Rat
Authors: Weaver Lawrence T. , Desai Mina , Austin Steven , Arthur Helen M. L. , Lucas Alan , Hales C. Nicholas
Published: February 2024

Background:

Undernutrition during early life may have both immediate and later consequences. This study was undertaken to measure the long‐term effects of perinatal undernutrition on the growth and function of the gastrointestinal tract.

Methods:

Pregnant rats were assigned to one of four groups that received isocaloric diets restricted in protein during pregnancy or lactation and during both or neither. Thereafter, their pups were followed until aged 1 year.

Results:

At 21 days the body weights of the young of those born of dams with postnatal protein restriction were halved, with comparable reductions in the weights of the stomach and caecum, compared with those of control animals. The lengths of the small and large intestines and mucosal weights of the foregut were also significantly reduced. Lactase activities were significantly increased and sucrase and maltase activities significantly reduced. By 42 days all the effects were less marked, and at 1 year the dimensions of the organs of the gastrointestinal tract and the composition and enzyme levels of the mucosa were all insignificantly different relative to body weight.

Conclusions:

Prenatal protein restriction alone had no significant long‐term negative effects on body weight, growth, or mucosal hydrolase activity of the gastrointestinal tract. Postnatal protein restriction had a marked effect on these indices in early life and delayed the changes in mucosal hydrolases usually seen at weaning. In contrast with other organs and their functions, long‐term growth of the gut and activity of small intestinal hydrolases are preserved in the face of perinatal protein restriction.
Prevalence of Helicobacter pylori Infection Detected by Serology and 13C‐Urea Breath Test in HIV‐1 Perinatally Infected Children
Authors: Lionetti Paolo , Amarri Sergio , Silenzi Francesco , Galli Luisa , Cellini Monica , de Martino Maurizio , Vierucci Alberto
Published: February 2024

Background:

Conflicting results have been reported in adults with human immunodeficiency virus (HIV‐1) who were investigated for Helicobacter pylori infection. Most studies indicate a lower prevalence than is found in the general population. The purposes of this study were to evaluate H. pylori prevalence by noninvasive methods in a population of children perinatally infected with HIV‐1 and to correlate H. pylori prevalence with HIV‐1‐related clinical and immunologic status.

Methods:

H. pylori infection was studied in 45 children perinatally infected with HIV‐1 by performing serologic testing of anti‐H. pylori immunoglobulin G antibodies and the 13C‐urea breath test.

Results:

Eight children with HIV‐1 (17.7%) were positive by serology, and nine (20%) were positive by 13C‐urea breath test. No significant differences related to age, previous antibiotic treatment, immunoglobulin administration, antiretroviral treatment, abdominal pain, CD4+ cell count, number of HIV‐1 RNA copies, and frequency of severe immunodepression were noted between children with positive 13C‐urea breath test results and those with negative results. Children with positive results were significantly more likely to have severe clinical manifestations.

Conclusions:

The results show, by both serology and 13C‐urea breath test, a prevalence of H. pylori infection comparable with the prevalence in the normal population of the same age. H. pylori prevalence has probably been underestimated in patients with HIV. Results of serologic and histologic analyses for H. pylori require cautious interpretation, especially in severely immunodeficient patients.
No Evidence of Hepatitis G Virus in Fulminant Hepatic Failure in Children
Authors: Perez Roger G. , Zein Nizar N. , Freese Deborah K. , Perrault Jean J. , Steers Jeffery L. , Sharp Harvey L. , Persing David H.
Published: February 2024

Background:

The cause of fulminant hepatic failure in children remains unknown, but a viral origin has been suspected in most cases. The recently discovered blood‐borne virus, hepatitis G, has been suggested as a possible causative agent.

Method:

Six consecutive children who underwent liver transplantation for fulminant hepatic failure were studied. The children were tested for hepatitis G virus antibodies and hepatitis G virus RNA by polymerase chain reaction after excluding other causes of fulminant hepatic failure.

Results:

No evidence of hepatitis G virus infection was found in these patients.

Conclusion:

Hepatitis G virus is unlikely to be a common cause of fulminant hepatic failure in pediatric patients from the upper midwestern United States.
The Role of Cisapride in the Treatment of Pediatric Gastroesophageal Reflux
Authors: Vandenplas Yvan , Belli Dominique C. , Benatar Avram , Cadranel Samy , Cucchiara Salvatore , Dupont Christophe , Gottrand Fréderique , Hassall Eric , Heymans Hugo S. A. , Kearns Gregory , Kneepkens C. M. Frank , Koletzko Sybille , Milla Peter , Polanco Isabel , Staiano Anna‐Maria
Published: February 2024

Background:

Cisapride is a gastrointestinal prokinetic agent that is used worldwide in the treatment of gastrointestinal motility‐related disorders in premature infants, full‐term infants, and children. Efficacy data suggest that it is the most effective commercially available prokinetic drug.

Methods:

Because of recent concerns about safety, a critical and in‐depth analysis of all reported adverse events was performed and resulted in the conclusions and recommendations that follow.

Results:

Cisapride should only be administered to patients in whom the use of prokinetics is justified according to current medical knowledge. If cisapride is given to pediatric patients who can be considered healthy except for their gastrointestinal motility disorder, and the maximum dose does not exceed 0.8 mg/kg per day in 3 to 4 administrations of 0.2 mg/kg (not exceeding 40 mg/d), no special safety procedures regarding potential cardiac adverse events are recommended. However, if cisapride is prescribed for pateints who are known to be or are suspected of being at increased risk for drug‐associated increases in QTc interval, certain precautions are advisable. Such patients include those:(1) with a previous history of cardiac dysrhythmias, (2) receiving drugs known to inhibit the metabolism of cisapride and/or adversely affect ventricular repolarisation, (3) with immaturity and/or disease causing reduced cytochrome P450 3A4 activity, or (4) with electrolyte disturbances. In such patients, ECG monitoring to quantitate the QTc interval should be used before initiation of therapy and after 3 days of treatment to ascertain whether a cisapride‐induced cardiac adverse effect is present.

Conclusions:

With rare exceptions, the total daily dose of cisapride should not exceed 0.8 mg/kg divided into 3 or 4 approximately equally spaced doses. If higher doses than this are given, the precautions above are advisable. In any patient in whom a prolonged QTc interval is found, the dose of cisapride should be reduced or the drug discontinued until the ECG normalizes. If the QTc interval returns to normal after withdrawal of cisapride, and the administration of cisapride is considered to be justified because of its efficacy and absence of alternative treatment options, cisapride can be restarted at half dose with control of the QTc interval. Unfortunately, at present, normal ranges of QTc interval in children are unknown. However, a critical analysis of the literature suggests that a duration of less than 450 milliseconds can be considered to be within the normal range and greater than 470 milliseconds as outside it.
Oropharyngeal Dysfunction and Gastroesophageal Dysmotility Are Present in Girls and Women with Rett Syndrome
Authors: Motil Kathleen J. , Schultz Rebecca J. , Browning Kerrie , Trautwein Lynn , Glaze Daniel G.
Published: February 2024

Background:

Feeding impairment frequently complicates the course of children with neurologic disorders and places them at risk for malnutrition and growth failure. Although feeding abnormalities have been reported in female patients with Rett syndrome, the mechanisms that account for these findings have not been elucidated fully. This study was designed to characterize the clinical features of oropharyngeal and gastroesophageal dysfunction and their impact on the dietary intake and nutritional status of female subjects with Rett syndrome.

Methods:

The clinical features of oropharyngeal and gastroesophageal dysfunction in 13 female patients with Rett syndrome, (age range, 3.7 to 25.7 years) were characterized by an oral feeding assessment, swallowing function study, and upper gastrointestinal series. Growth, nutritional status, and body composition were determined by stadiometry and anthropometry. Dietary intakes were determined from 3‐day food records.

Results:

Oropharyngeal dysfunction and gastroesophageal dysmotility were present in 100% and 69%, respectively, of the study patients with Rett syndrome. The scope and severity of these abnormalities were apparent only by videofluoroscopy. Abnormalities of oropharyngeal function included poor tongue mobility, reduced oropharyngeal clearance, and laryngeal penetration of liquids and solid food during swallowing. Esophageal dysmotility included absent primary or secondary waves, delayed emptying, atony, the presence of tertiary waves, spasm, and gastroesophageal reflux. Gastric dysmotility included diminished peristalsis or atony. Lower dietary energy intakes were associated with persistence of residue in the valleculae and pyriform sinuses and less body fat.

Conclusion:

The prevalence of oropharyngeal dysfunction and gastroesophageal dysmotility warrants early diagnostic evaluation and intervention strategies to improve the nutritional status of girls and women with RS.
Influence of Jejunal Morphology Changes on Exocrine Pancreatic Function in Celiac Disease
Authors: Nousia‐Arvanitakis Sandra , Karagiozoglou‐Lamboudes Thomais , Aggouridaki Christine , Malaka‐Lambrellis Eva , Galli‐Tsinopoulou Assimina , Xefteri Mary
Published: February 2024

Background:

Concurrent exocrine pancreatic dysfunction may be one of the factors implicated in malabsorption in untreated celiac disease, as shown by studies on bicarbonate and pancreatic enzyme secretion. The purpose of this study was to evaluate exocrine pancreatic function in relation to jejunal morphology in celiac disease.

Methods:

Thirty‐six patients fulfilling the ESPGHAN criteria for celiac disease, aged 3 to 18 years and 36 control subjects matched for age and sex were investigated. The design of the study included measurement of serum pancreatic isoamylase by a chromogenic method after selective inhibition of sialic isoamylase in the untreated phase in patients consuming a gluten‐containing diet and after gluten elimination for a period of 1 year; fecal human elastase activity determined by enzyme‐linked immunosorbent assay in patients consuming a gluten‐free diet and again after gluten challenge for 6 months; correlation of serum pancreatic isoamylase and fecal elastase to the jejunal morphology, classified by criteria described by Marsch; the enzymes in the control group; and ultrasonography of the pancreas in both groups.

Results:

Enzyme values obtained from celiac disease patients with normal mucosa were significantly higher than those obtained from patients with villous atrophy (p < 0.001) and comparable to those obtained from the control group. Serum pancreatic isoamylase activity increased to normal after gluten elimination, and human elastase activity decreased to values below 200 µg/g of stool after gluten challenge. Enzyme activity was related inversely to the degree of intestinal damage. The echogenicity of the pancreas was normal, regardless of enzyme activity or gut morphology.

Conclusions:

Exocrine pancreatic function is abnormal in celiac disease when mucosal atrophy is present. Exocrine pancreatic function parameters are associated with the changes of intestinal mucosal morphology in three consecutive phases of the disease.
Evaluation of the Development of Intestinal Function in Rats Reared on Hydrolyzed or Native Protein‐Based Milk Formula
Authors: Kinouchi Toshi , Koizumi Kyoko , Kuwata Tamotsu , Yajima Takaji
Published: February 2024

Background:

In recent years, hydrolyzed protein has often been used as a protein source in food products, including infant formula. In the current study, the effects of different protein sources in milk formula on the development of intestinal function in artificially reared rats were examined.

Methods:

Rat pups were artificially reared on casein‐whey protein‐based, whey protein‐based, or hydrolyzed whey protein‐based milk formula, and the intestinal lactase and maltase activities and the capacity of intestinal immunoglobulin (Ig)G uptake in these rats during the suckling period were determined.

Results:

There were no significant differences in the activities of disaccharidases among the three groups. In the rats reared on hydrolyzed whey protein milk formula, the plasma and jejunal concentrations of human IgG 2 hours after intragastric administration of human IgG were significantly lower than those of rats reared on milk formulas containing native proteins.

Conclusions:

The present results suggest that the presence of native protein in milk formula and maternal milk may be important for jejunal IgG uptake in suckling rats an the possibility that the presence or absence of native protein in milk formula can modify some developmental processes of the small intestine in suckling animals.
Fat Mass in Infants and Toddlers: Comparability of Total Body Water, Total Body Potassium, Total Body Electrical Conductivity, and Dual‐Energy X‐ray Absorptiometry
Authors: Butte Nancy , Heinz Carolyn , Hopkinson Judy , Wong William , Shypailo Roman , Ellis Kenneth
Published: February 2024

Background:

Accurate assessment of body composition in infants and children is fundamental to understanding normal growth and development. Validation of methods applicable to pediatric populations is needed. In the absence of a gold standard, this study was conducted to compare methods using total body water, total body potassium, total body electrical conductivity, and dual‐energy x‐ray absorptiometry measurements for the estimation of body fat mass in infants and toddlers.

Methods:

Repeated body composition measurements were performed on 76 healthy term infants at 0.5, 3, 6, 9, 12, 18, and 24 months of age. Total body water was determined by deuterium dilution and converted to fat‐free mass. Total body electrical conductivity was used to measure fat mass. Total body potassium was estimated by whole‐body counting and converted to fat‐free mass. Dual‐energy x‐ray absorptiometry was used to estimate fat mass at 0.5, 12, and 24 months only. Data were analyzed by repeated measures analysis of variance, followed by Bonferroni multiple comparisons at 5%.

Results:

Significant differences among methods were encountered at each age (p = 0.001‐0.05). The rank order of the methods and the magnitude of the method differences were a function of age, not of gender or infant feeding mode. Wide limits of agreement imply that the methods are not interchangeable for group or individual measurements.

Conclusions:

Methods using total body water, total body potassium, total body electrical conductivity, and dual‐energy x‐ray absorptiometry to estimate body fat mass in infants and toddlers are not interchangeable and require further development and validation.
Shwachman's Syndrome: Pathomorphosis and Long‐term Outcome
Authors: Cipolli Marco , D'Orazio Ciro , Delmarco Antonella , Marchesini Cristina , Miano Angelo , Mastella Gianni
Published: February 2024

Background:

Shwachman's syndrome is the second most common cause of inherited/congenital pancreatic insufficiency after cystic fibrosis. The main associated features are usually cyclic neutropenia, metaphyseal dysostosis, and growth retardation. Other organs or functions may be involved in this syndrome, showing a wide range of abnormalities and symptoms. There are reports of Shwachman's syndrome in childhood, but little is known about the long‐term clinical course of these patients. This article reports on the pathomorphosis and long‐term follow‐up of 13 patients with Shwachman's syndrome diagnosed in infancy focusing, in particular, on modifications of the exocrine pancreatic function over time.

Methods:

Exocrine pancreatic function was evaluated by duodenal intubation followed by a pancreatic stimulation test. Nutritional, biochemical, hematologic, radiologic, and psychological evaluations were performed at various intervals. Six patients were included in long‐term follow‐up evaluation.

Results:

At diagnosis, growth retardation was present in all patients, and all subjects showed pancreatic insufficiency. Hematologic features (intermittent neutropenia, anemia and thrombocytopenia), respiratory infection during the first years of life, and skeletal abnormalities were also frequently observed. Other associated features at diagnosis included hepatic involvement and occasional renal dysfunction. In the six patients followed up, a significant growth improvement was observed. In five of them the pancreatic stimulation test showed values of lipase within reference range outputs, whereas fat balance or fecal fat losses were normal in all but one subject. Of seven subjects assessed by psychological evaluation, IQ test results were markedly abnormal in one and bordered on abnormality in the others.

Conclusions:

The present data on Shwachman's syndrome diagnosed in infancy underline the possibility of improvement or normalization of exocrine pancreatic function with age, suggesting the need for periodic checks on pancreatic activity in these subjects. It also indicates the possibility of diagnosis of this syndrome in the absence of pancreatic insufficiency; decreasing frequency of infections over time; and the usefulness of early neuropsychological evaluation.
Celiac Disease in Relation to Immunologic Serum Markers, Trace Elements, and HLA‐DR and DQ Antigens in Swedish Children with Down Syndrome
Authors: Hansson Tony , Annerén Göran , Sjöberg Olof , Klareskog Lars , Dannæus Anders
Published: February 2024

Background:

An association between Down syndrome and celiac disease has been reported. This study was conducted to determine the association between childhood celiac disease and Down syndrome in the county of Uppsala, Sweden.

Methods:

All 76 children with Down syndrome (1‐18 years) were screened for the occurrence of anti‐gliadin antibodies (AGA) and anti‐endomysium antibodies (EMA). Twelve children with suspected celiac disease were investigated further.

Results:

Increased levels of both IgA and IgG AGA were found in 26% of the children and of EMA in and 5 of 76. Celiac disease was diagnosed in at least three of the children (3.9%; 95% confidence interval 0%‐8.3%), and it could have been present in as many as eight. Three of the five EMA‐positive children with suspected celiac disease had the HLA phenotype DR3, DQ2.

Conclusions:

The results show that determination of EMA is more useful as a screening test for celiac disease and for follow‐up than is AGA in children with Down syndrome. The present study also confirms that celiac disease is overrepresented among Swedish children with Down syndrome and that celiac disease should be considered in all persons with Down syndrome.
Testing for Serum IgG Antibodies to Helicobacter pylori Cytotoxin‐Associated Protein Detects Children with Higher Grades of Gastric Inflammation
Authors: Luzza Francesco , Contaldo Antonio , Imeneo Maria , Mancuso Maria , Pensabene Licia , Giancotti Laura , La Vecchia Anna M. , Costa Maria C. , Strisciuglio Pietro , Docimo Corrado , Pallone Francesco , Guandalini Stefano
Published: February 2024

Background:

Little information is available about the relationships between Helicobacter pylori cytotoxin‐associated protein (CagA) and clinicopathologic features in children. The purpose of this study was to test whether determining serum IgG antibodies to CagA is a useful tool for detecting more severe disease.

Methods:

One hundred twenty‐seven consecutive children (age, range, 0.75‐17.8 years; median, 9.4 years) referred for gastroscopy were included in the study. Antral and corpus biopsies were taken for gastric histology and H. pylori detection. Major symptoms and endoscopic findings were recorded. A serum sample was drawn from each child and assayed for IgG antibodies CagA by a commercial enzyme‐linked immunosorbent assay.

Results:

Sixty‐three (50%) children had no evidence of H. pylori infection, 28 (22%) were H. pylori positive/CagA positive, and 36 (28%) were H. pylori positive/CagA negative. There were no differences in clinical diagnosis and occurrence of any predominant symptom according to H. pylori and CagA status. Findings of antral nodularity were more frequent (p = 0.003) in H. pylori‐positive/CagA‐positive children than in H. pylori‐positive/CagA‐negative children. The gastritis score was significantly higher in H. pylori‐positive/CagA‐positive children than in H. pylori‐positive/CagA‐negative children (5.7 ± 1.9 vs. 3.8 ± 1.6, respectively; p = 0.0003), either in the antral (p = 0.0002) or in the corpus (p = 0.001) mucosa. Inflammation (p = 0.0001) and activity (p = 0.0001) scores were both higher in H. pylori‐positive/CagA‐positive children than in H. pylori‐positive/CagA‐negative children, but the H. pylori density score was not significantly different (p = NS). In no case was normal gastric mucosa found in H. pylori‐positive/CagA‐positive children. Lymphocytic gastritis (p = 0.0008) and lymphoid follicles (p = 0.000003) were a more frequent finding in H. pylori‐positive children than in H. pylori negative children, irrespective of CagA status.

Conclusion:

Testing for serum IgG to CagA detects higher grades of gastric inflammation among children with H. pylori infection. It may be useful in targeting H. pylori‐positive/CagA‐positive children for antimicrobial therapy while reducing the need for endoscopy and gastric biopsy.
Serum Levels of Hepatitis C Virus RNA in Infants and Children with Chronic Hepatitis C
Authors: Azzari Chiara , Resti Massimo , Bortolotti Flavia , Moriondo Maria , Crivellaro Carlo , Lionetti Paolo , Vierucci Alberto
Published: February 2024

Background:

The role of serum hepatitis C virus (HCV) load in infectivity, disease activity, and response to interferon treatment has been investigated in adults, and controversial results have been obtained. Little is known about HCV load in infants and children with HCV infection.

Purpose:

To investigate the relation between HCV load in serum and features of associated liver disease in infants and children with HCV infection.

Methods:

Hepatitis C viral load was investigated in serial samples in 43 children with chronic HCV infection, including 32 patients aged 4 to 16 years infected by different routes and 11 vertically infected infants observed prospectively since birth.

Results:

Overall viremia ranged between 2.7 and 6.9 log copies/ml (median, 5.56 log/ml) and fluctuated slightly during the follow‐up. Median HCV RNA levels did not significantly differ among infants, children, and adolescents. Viral load was also independent of sex, route of infection, clinical manifestation, alanine aminotransferase levels, and liver histology. All 11 perinatally infected children became chronic HCV carriers, whatever their initial viral load; retrospective testing of sera taken in the first day of life in three infants showed high viremia levels.

Conclusions:

Viremia levels observed in children were similar to those reported in adults, were independent of age, biochemical activity of liver disease, and chronicity of infection. They were also relatively stable, suggesting that serial measurement of viral load is useless in untreated infants and children. The detection of viremia at birth in children in whom chronic hepatitis developed later suggests the possibility of in utero infection.
Linear Growth and Skeletal Maturation in Subjects with Treated Celiac Disease
Authors: Gemme Gerolamo , Vignolo Marina , Naselli Arturo , Garzia Patrizia
Published: February 2024

Background:

The aim of this study was to report on the long‐term growth and development in a group of treated patients with celiac disease.

Methods:

The study includes 26 patients (11 boys and 15 girls) with typical celiac disease who were younger than 2.5 at diagnosis and were followed by means of a growth longitudinal monitoring from the introduction of a gluten‐free diet (mean age, 1.7 ± 0.5 years) until adulthood, over a median period of 15.3 years. Growth indicators used were: height, skeletal age, weight and BMI.

Results:

At the time of admission, the patients had a general tendency to short stature, underweight and retarded skeletal maturation. They did not catch up completely in height and skeletal age after a dietary treatment period of 3 years. Most of them were seen to be slightly below average height for age during childhood and adolescence with skeletal maturity retardation, even if a fairly large interindividual variation of height profiles was evident.

Conclusions:

Notwithstanding the early treatment, the careful follow‐up, and the good adhesion to the dietary rules of the patients under study, slight negative effects of the disease on growth were not avoided.
The Long‐term Effect of Early Mineral, Vitamin D, and Breast Milk Intake on Bone Mineral Status in 9‐ to 11‐Year‐Old Children Born Prematurely
Authors: Backström Maria Christina , Mäki Ritva , Kuusela Anna‐Leena , Sievänen Harri , Koivisto Anna‐Maija , Koskinen Matti , Ikonen R. Sami , Mäki Markku
Published: February 2024

Background:

Although the short‐term benefits of mineral supplementation in preterm infants has been established, the long‐term benefits are less clear. The purpose of the study was to evaluate effects of early‐life mineral, vitamin D, and breast milk intake on bone mineral status in children 9 to 11 years of age who were born prematurely.

Methods:

Seventy preterm infants born 1985 through 1987 were randomized into four groups: to receive a vitamin D dose of 500 or 1000 IU/day and calcium‐ and phosphorus‐supplemented or unsupplemented breast milk. At 3 months of age, radial bone mineral content was determined by single‐photon absorptiometry and vitamin D metabolites were assessed. At 9 to 11 years of age, the bone mineral status of the radius and lumbar spine was assessed using dual energy x‐ray absorptiometry.

Results:

At the age of 3 months, the preterm infants with diets supplemented with minerals had 36% higher bone mineral content than the preterm infants whose diet was not supplemented with minerals. At the age of 9 to 11 years, in contrast, bone mineral status was comparable among the groups, irrespective of different mineral supplementation during the neonatal period. Interestingly, the lumbar bone mineral apparent density was positively related to lactation in mineral‐supplemented children. There was neither short‐term nor long‐term benefit to bone mineral status of a vitamin D dose of 1000 IU/day compared with 500 IU/day.

Conclusions:

The short‐term benefit to bone mineral density in preterm infants of mineral supplementation of the early diet is obvious, but, in the long term, the effects seem to disappear. The results also imply that a relatively long period of breast‐feeding may be needed to optimize long‐term bone mineral acquisition in the lumbar spine.
Impact of Inflammatory Bowel Disease on Educational Achievements and Work Prospects
Authors: Mayberry John F.
Published: February 2024

Young people with inflammatory bowel disease can hope to achieve educational qualifications comparable with those of their peers and to find a supportive educational environment to encourage them. In contrast, at work they can expect discrimination and lack of support, although such treatment may not be overt.
Development of a Quality‐of‐Life Index for Pediatric Inflammatory Bowel Disease: Dealing with Differences Related to Age and IBD Type
Authors: Griffiths Anne M. , Nicholas David , Smith Claire , Munk Marla , Stephens Derek , Durno Carol , Sherman Philip M.
Published: February 2024

Background:

A child‐ and adolescent‐generated IBD quality‐of‐life index was designed to be descriptive (to be used to assess the overall impact of IBD on individual patients), and evaluative (to be used as an outcome measure in clinical trials).

Methods:

Item‐generation and item‐reduction interviews with 82 patients with IBD aged 8 to 17 years (61 with Crohn's disease, 21 with ulcerative colitis; 36 girls, 45 boys) generated a list of ways in which their lives were affected by IBD. These issues were incorporated into an item‐reduction questionnaire, which was administered to 117 patients (87 Crohn's disease, 30 ulcerative colitis). Patients indicated on a visual analog scale how important an item was to them and how often it bothered them. Mean and median importance‐plus‐frequency scores for each issue were calculated for the entire group and among patients in subgroups according to age and IBD type.

Results:

Ulcerative colitis and Crohn's disease affect the lives of children and adolescents differently. Bowel symptoms are more troubling and disabling to patients with ulcerative colitis, whereas systemic symptoms and body image concerns are greater for patients with Crohn's disease. The impact of Crohn's disease on ability to function in school and leisure activities is greater. Worries about future health problems and about the effects of IBD on the family are shared. Crohn's disease and ulcerative colitis trigger emotional responses of unfairness and frustration, but anger and embarrassment are more prevalent in ulcerative colitis. Disparities between age groups are fewer and less marked than those between types of IBD.

Conclusion:

In selection of items to be retained in a pediatric IBD quality‐of‐life measure, the variation in concerns with disease type must be considered. A single index to assess IBD‐related quality of life must include items of major importance to one subgroup of patients, even if not important to all. Alternately, a core of common concerns could be supplemented by disease‐specific modules, thereby increasing the content validity of the tool for all patients.
Lactobacillus GG Administered in Oral Rehydration Solution to Children with Acute Diarrhea: A Multicenter European Trial
Authors: Guandalini Stefano , Pensabene Licia , Zikri Mona Abu , Dias Jorge Amil , Casali Luigi Gobio , Hoekstra Hans , Kolacek Sanja , Massar Karin , Micetic–Turk Dusanka , Papadopoulou Alexandra , de Sousa Jaime Salazar , Sandhu Bhupinder , Szajewska Hanna , Weizman Zvi
Published: February 2024

Background:

The probiotic Lactobacillus GG is effective in promoting a more rapid recovery of acute, watery diarrhea in children with rotavirus enteritis. Very limited information is available, however, on the potential role of such agents in nonrotaviral diarrheal episodes. Furthermore, no evidence is available concerning the efficacy of Lactobacillus GG administered in the oral rehydration solution during oral rehydration therapy. A multicenter trial was conducted to evaluate the efficacy of Lactobacillus GG administered in the oral rehydration solution to patients with acute‐onset diarrhea of all causes.

Methods:

Children 1 month to 3 years of age with acute‐onset diarrhea were enrolled in a double‐blind, placebo‐controlled investigation. Patients were randomly allocated to group A, receiving oral rehydration solution plus placebo, or group B, receiving the same preparation but with a live preparation of Lactobacillus GG (at least 1010 CFU/250 ml). After rehydration in the first 4 to 6 hours, patients were offered their usual feedings plus free access to the same solution until diarrhea stopped.

Results:

One hundred forty children were enrolled in group A, and 147 in group B. There were no differences at admission between the groups in age, sex, previous types of feeding, previous duration of diarrhea, use of antibiotics, weight, height, weight–height percentile, prevalence of fever, overall status, degree of dehydration, and percentage of in‐versus outpatients. Duration of diarrhea after enrollment was 71.9 ± 35.8 hours in group A versus 58.3 ± 27.6 hours in group B (mean ± SD;P = 0.03). In rotavirus‐positive children, diarrhea lasted 76.6 ± 41.6 hours in group A versus 56.2 ± 16.9 hours in groups B (P < 0.008). Diarrhea lasted longer than 7 days in 10.7% of group A versus 2.7% of group B patients (P < 0.01). Hospital stays were significantly shorter in group B than in group A.

Conclusions:

Administering oral rehydration solution containing Lactobacillus GG to children with acute diarrhea is safe and results in shorter duration of diarrhea, less chance of a protracted course, and faster discharge from the hospital.
Eosinophilic Gastroenteritis
Authors: Kelly Kevin J. , Simpson Hugh A. , Anderson John A.
Published: February 2024

The goal to create a standardized diagnostic classification scheme of food‐related gastrointestinal hypersensitivity disease syndromes included the diagnosis of eosinophilic gastroenteritis. This article reviews the history of this diagnosis and the current concepts of this complex disorder. The common symptoms from the literature are discussed. Because no standards for this diagnosis exist, the wide variety of diagnostic criteria from the literature are presented. No consistent immunologic abnormalities have been associated with the diagnosis of eosinophilic gastroenteritis in the literature. A review of the current immunologic concepts associated with the diagnosis of eosinophilic gastroenteritis is presented. The history of this disorder, which spans more than 6 decades is also discussed. The contributions made by the original authors during this period are presented. Attention was directed to the variety of clinical features associated with this disorder, but particular attention was paid to the evolution of the pathophysiologic mechanisms proposed. Some of the difficulties associated with the prospective study of patients with eosinophilic gastroenteritis are also discussed. The establishment of appropriate control populations, as well as the fundamental difficulties encountered with the establishment of the certainty of the link between abnormal immunohistochemical findings, and initial clinical symptoms are presented and discussed. A new classification system is proposed for food‐related gastrointestinal hypersensitivity disease syndromes. Age, symptoms, and the region of the gastrointestinal tract involved were the variables that were considered most important by consensus opinion. Finally, recommendations to refocus our collective investigative efforts are presented.
Food‐Induced Eosinophilic Proctocolitis
Authors: Lake Alan M. , Simpson Hugh A. , Anderson John A.
Published: February 2024

Food‐induced eosinophilic proctocolitis appears in the first 2 months of life with blood‐tinged stools. Aside from occasional apparent pain on defecation and a few infants with moderate eczema, systemic features are absent. Indeed, aside from the diaper, the infant is generally described as well. Thus, in contrast to the infant with enterocolitis, features such as emesis, failure to thrive, significant anemia, and dramatic diarrhea are not seen. In contrast to infants with the other food‐induced inflammatory diseases of the bowel, most symptomatic infants are exclusively breast fed. Proctoscopic examination reveals focal erythema, erosions, and/or the nodularity of lymphoid nodular hyperplasia of the rectosigmoid. Biopsies of the rectum and lower sigmoid reveal a characteristic infiltration of the mucosa and lamina propria with eosinophils, usually in excess of 6 to 10 per high powered field. Elimination of the offending protein from the diet of the infant, through use of an extensively hydrolyzed casein‐based formula or the elimination of the protein from the diet of the mother of the breast‐feeding infant, leads to clinical resolution of the bleeding within 72 to 96 hours. By 1 year of age the infants routinely tolerate an unrestricted diet, and the long term prognosis is excellent.
Use of Intrahepatic Chemotherapy to Treat Advanced Pediatric Hepatic Malignancies
Authors: Gerber David A. , Arcement Chris , Carr Brian , Towbin Rich , Mazariegos George , Reyes Jorge
Published: February 2024

Background:

To evaluate the effect of intrahepatic arterial chemotherapy (IAC) on children with primary hepatic malignancies.

Method:

A nonrandomized inception cohort of 11 pediatric patients was referred for treatment of advanced primary hepatic malignancies at Children's Hospital of Pittsburgh. None of the patients was a candidate for resection before the initiation of IAC. Tumor response to treatment was observed by determining serum α‐fetoprotein (AFP) levels and by abdominal computed tomographic scan. The patients received hepatic artery infusions of cisplatin and/or doxorubicin. The last five also received gelfoam embolization.

Results:

Eight of 11 patients had multiple IAC treatments. Eight patients had AFP‐producing tumors, and five of the eight had dramatic reductions in serum levels after IAC treatment. Five of the 11 patients underwent successful orthotopic liver transplantation after receiving IAC therapy, and the five explanted specimens showed varying degrees of tumor necrosis. One‐year survival in patients in the authors' center is 67% for those with hepatoblastoma and 40% for those with hepatocellular carcinoma. Three‐year survival is 60% and 30% for patients with hepatoblastoma and hepatocellular carcinoma, respectively.

Conclusion:

Intrahepatic arterial chemotherapy therapy can halt the progression and possibly down‐stage advanced pediatric hepatic malignancies. This therapy can also be used as a successful adjunct in altering a patient's chance for successful liver transplantation.
Long‐term Outcome After Partial External Biliary Diversion for Intractable Pruritus in Patients With Intrahepatic Cholestasis
Authors: Ng Vicky Lee , Ryckman Frederick C. , Porta Gilda , Miura Irene K. , de Carvalho Elisa , Servidoni Maria F. , Bezerra Jorge A. , Balistreri William F.
Published: February 2024

Background:

Chronic intrahepatic cholestasis is associated with severe pruritus that is often refractory to maximal medical management and leads to significantly impaired quality of life. The hypothesis in this study was that partial external biliary diversion (PEBD) can substantially improve intractable pruritus secondary to intrahepatic cholestasis with subsequent improvement of functional quality of life.

Methods:

Parents' and/or patients' clinical rating of pruritus, growth percentiles, biochemical parameters, and liver biopsies performed before and after surgery were compared in a retrospective medical record review.

Results:

Eight children underwent PEBD from 1990 through 1997. Complete follow‐up data were available for seven patients. Before surgery, all patients had intense pruritus, which was not responsive to maximal medical therapy. Specimens obtained in preoperative liver biopsies showed moderate (n = 1), minimal (n = 6), or no (n = 1) portal fibrosis. After PEBD, all patients received ursodeoxycholic acid (10–15 mg/kg/dose two to three times daily) until resolution of pruritus. Of the seven patients with complete follow‐up data, six had complete resolution of pruritus and sustained resolution up to 8 years after surgery. The patient with mild to moderate residual pruritus was the youngest to undergo PEBD. Growth improved from below the 5th percentile before surgery to the 5th through the 25th percentiles for five of six patients with more than 6 years' follow‐up. All families reported improved quality of life, defined by school attendance and ability to resume normal activity with peers. There has been no clinical evidence of progression of liver disease.

Conclusion:

Partial external biliary diversion is effective in the long‐term treatment of pruritus refractory to medical therapy and provides a favorable outcome in a select group of patients with chronic intrahepatic cholestasis without cirrhosis.
Impaired Accommodation of the Proximal Stomach in Children With Recurrent Abdominal Pain
Authors: Olafsdottir Edda , Gilja Odd Helge , Aslaksen Aslak , Berstad Arnold , Fluge Gjermund
Published: February 2024

Background:

A new ultrasonographic method was applied in children with recurrent abdominal pain, to study accommodation of the proximal stomach to a meal.

Methods:

After an overnight fast, 20 patients with recurrent abdominal pain (age, 7–14 years) and 23 healthy control subjects (age, 7–13 years), were scanned by a 5‐MHz transducer positioned in the epigastrium, to monitor the size of the proximal stomach before and after a test meal of meat soup.

Results:

Children with recurrent abdominal pain had a significantly smaller sagittal area of the proximal stomach at 10 and 20 minutes after the meal than in healthy control subjects (P = 0.01 for both) and significantly higher emptying fraction of the proximal stomach at 10 minutes after the meal than in healthy control subjects (P = 0.02). There was no significant difference in emptying of the distal stomach between the patients and healthy control subjects. Children with recurrent abdominal pain experienced more symptoms (pain, bloating) in response to the test meal than did healthy control subjects.

Conclusion:

The results support the view that recurrent abdominal pain in children may be a motility disorder that can be detected in the proximal stomach as an impairment of adaptive relaxation in response to a meal. This new ultrasonographic method may become a valuable diagnostic tool in patients with recurrent abdominal pain.