bluuebunny/crossref_metadata_2025 huggingface dataset:
Hiatal Hernia in Pediatric Gastroesophageal Reflux
Authors: Gorenstein Arkadi , Cohen Amram J. , Cordova Zohar , Witzling Michaela , Krutman Boris , Serour Francis
Published: January 2024

Background

This study compares esophageal pH‐monitoring parameters of children with gastroesophageal reflux (GER) with or without hiatal hernia (HH) and determines the outcome of those with GER and HH.

Methods

Among 718 children with GER, 45 children (6%) with associated HH were retrospectively studied. They were divided into those with neurologically normal development (NN, n = 35) and those with neurologic disorders (ND, n = 10). The pH‐monitoring parameters of 27 of these (60%) were compared with pH‐monitoring parameters of 27 control children who had GER without HH.

Results

Esophageal clearance was longer in patients with HH compared with those without HH (P < 0.05). All 35 NN patients underwent a trial of conservative treatment, which failed in 9 patients (25.7%). Surgery was the initial treatment in 8 ND patients. Follow‐up was available in 20 NN and 10 ND patients. Nine of 11 conservatively treated NN patients improved. All NN (n = 9) and ND (n = 8) patients who underwent surgery improved. Conservative treatment failed in 2 NN and in 2 ND patients.

Conclusions

Presence of HH in children with GER is associated with prolonged exposure of the esophagus to acid and a high failure rate of nonoperative treatment. However, medical treatment should be tried in NN children despite the significant failure rate.
Renal Excretion of Calcium and Phosphorus in Premature Infants With Incipient Late Metabolic Acidosis
Authors: Kalhoff H. , Diekmann L. , Rudloff S. , Manz F.
Published: January 2024

Background

Premature infants receiving alimentation with cow milk–based formulas run a considerably high risk of incipient late metabolic acidosis, an early stage developing of manifest late metabolic acidosis. Is bone metabolism involved in pathophysiologic mechanisms characterizing this early stage of retention acidosis?

Methods

Urinary ionography was performed in 10 premature infants with spontaneous development of incipient late metabolic acidosis (indicated by urine pH < 5.4 on 2 consecutive days) and 10 pair‐matched premature infants with normal values of urine pH; both groups were receiving full oral nutrition with the same standard formula. Moreover, in 37 premature infants with incipient late metabolic acidosis who were randomly allocated to oral therapy with 2 mmol · kg −1 · d −1 of either NaHCO 3 or NaCl over a period of 7 days, urinary excretion of calcium and phosphorus was assessed on day 1 and day 7.

Results

Incipient late metabolic acidosis was accompanied by increased phosphaturia in premature infants receiving full oral nutrition. Seventeen premature infants receiving NaCl therapy (19 treatment periods) showed increased calciuria from day 1 to day 7, whereas, in 20 premature infants receiving NaHCO 3 therapy (23 treatment periods), calcium or phosphorus excretion in urine did not increase.

Conclusions

The data of urinary calcium and phosphorus excretion in premature infants support the hypothesis that bone mineralization may already be impaired in the early stage of incipient late metabolic acidosis.
Prevalence of TT Virus in Healthy Children and Thalassemic Pediatric and Young Adult Patients
Authors: Kondili Loreta A. , Pisani Giulio , Beneduce Francesca , Morace Graziella , Gentili Giuliano , Ballati Guiduccio , Rapicetta Maria
Published: January 2024

Background

The recently discovered TT virus (TTV) has been shown to be highly prevalent in patients with cryptogenetic chronic liver disease and fulminant hepatitis. To study the frequency of TTV and to evaluate the possible association with liver disease, 37 pediatric and young adult patients with thalassemia, and 36 healthy children were included in the study. The sera of 100 blood donors selected randomly in the same period were also tested for TTV DNA.

Methods

The TTV amplification by polymerase chain reaction (PCR) was performed using a first set of primers that recognize an internal sequence into N22 and a second set of primers amplifying a sequence within 5´NCR (5´ noncoding region).

Results

The first set of primers revealed TTV DNA in 73% of thalassemic patients, in 8% of healthy children, and in 5% of healthy blood donors. With the second set of primers, the prevalence of TTV DNA was, respectively, 100% in thalassemic patients, 44.5% in healthy pediatric patients, and 87% in healthy blood donors. All individuals who tested positive for TTV by the first set of primers were also positive by the second primer set. The TTV infection seemed not to be the cause of altered transaminase levels. Sequencing of TTV clones from thalassemic patients showed the presence of different TTV variants in the same serum.

Conclusion

The prevalence of TTV in polytransfused children is similar to that detected in blood donors. Moreover, TTV can be detected in healthy children of all ages. The presence of TTV seems to have no clinical significance.
Niemann‐Pick Disease Type C in Neonatal Cholestasis at a North American Center
Authors: Yerushalmi Baruch , Sokol Ronald J. , Narkewicz Michael R. , Smith Debra , Ashmead Josephine W. , Wenger David A.
Published: January 2024

Objective

To determine the frequency of Niemann‐Pick disease type C (NPC) among children being evaluated for neonatal cholestasis during a 2‐year period.

Methods

Medical records were reviewed from all infants with cholestasis and all patients with NPC evaluated at our center from January 1997 through December 1998.

Results

Forty neonates with cholestasis were evaluated, including three patients diagnosed with NPC (age at diagnosis, 5–21 months) who were originally labeled as having idiopathic neonatal cholestasis (INH). Two adolescents (ages 14 and 16 years) were also diagnosed with NPC during this period, one who originally had neonatal hepatitis and cirrhosis, and the other who had hepatosplenomegaly throughout childhood. Three of the patients with NPC were Hispanic. At time of NPC diagnosis, infants had mildly delayed motor development and persistent splenomegaly with or without hepatomegaly, and the adolescents had ataxia, dysarthria, hepatosplenomegaly, and paresis of vertical gaze. The diagnosis of NPC was established by demonstrating defective cellular cholesterol esterification in cultured skin fibroblasts in three patients and a specific genetic mutation in three patients. Niemann‐Pick disease type C was found in 27% of infants initially diagnosed with INH and 8% of all infants evaluated for cholestasis.

Conclusion

Niemann‐Pick disease type C should be considered in all infants with cholestasis, particularly those with splenomegaly or who are of Hispanic descent. Electron microscopy and lipid analysis of liver biopsy specimens obtained during the evaluation of neonatal cholestasis may suggest this diagnosis.
Influence of Dietary Cholesterol on Vitamin D Metabolism in Formula‐Fed Preterm Neonates
Authors: Picaud Jean‐Charles , Boucher Philippe , Lapillonne Alexandre , Berthouze Magali , Delvin Edgar , Boehm Günther , Claris Oliver , Laborie Sophie , Reygrobellet Bernadette , Lapillonne Helene , Glorieux Francis H. , Salle Bernard L.
Published: January 2024

Objectives

Supplementation of preterm formulas with cholesterol could help to mimic the fat composition of human milk. However, this could possibly influence vitamin D 25‐hydroxylation because this reaction is catalyzed in part by the mitochondrial cytochrome P‐450, the enzyme responsible for the 27‐hydroxylation of cholesterol. The purpose of this study was to verify whether the addition of cholesterol to preterm formulas could interfere with vitamin D metabolism in preterm neonates.

Methods

In a prospective study, 30 preterm neonates were randomly assigned to a low (< 0.03 g/L), medium (0.15 g/L), or high (0.30 g/L) cholesterol‐content preterm formula until theoretical term (i.e., 40 weeks post‐conceptional age). Anthropometric data and serum hydroxy‐vitamin D and 1,25 dihydroxy‐vitamin D concentrations were measured at study entry and theoretical term. In a subgroup of 14 subjects, serum cholesterol and lymphocyte 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase mRNA were also assessed.

Results

(median [25th, 75 th centiles]): At theoretical term, there were no significant differences in serum hydroxy‐vitamin D concentrations among the three groups, even after adjustment for confounding variables (65 [50, 78] nmol/L, 79 [59, 86] nmol/L, and 67 [43, 103] nmol/L, respectively, P = 0.65) or 1,25 dihydroxy‐vitamin D (P = 0.88). Furthermore, there were no significant differences in 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase mRNA copy numbers.

Conclusions

In preterm neonates fed formulas with a cholesterol content similar to or higher than that of human milk, we did not observe deleterious effects on vitamin D metabolism. However, long‐term effects of cholesterol supplementation require further studies.
Effects of Intrauterine Growth Restriction and Intraamniotic Insulin‐like Growth Factor‐I Treatment on Blood and Amniotic Fluid Concentrations and on Fetal Gut Uptake of Amino Acids in Late‐Gestation Ovine Fetuses
Authors: Bloomfield Frank H. , van Zijl Pierre L. , Bauer Michael K. , Harding Jane E.
Published: January 2024

Objectives

To investigate, in the late‐gestation ovine fetus: 1) amino acid concentrations in blood and amniotic fluid, 2) the effects of intrauterine growth restriction (IUGR) induced by placental embolization on these concentrations, 3) fetal gut uptake of glutamine in healthy and IUGR fetuses, and 4) the effects of intraamniotic insulin‐like growth factor‐I (IGF‐1) treatment on these parameters.

Methods

Fetuses were randomly assigned to control (n = 9), IUGR + saline (n = 9), or IUGR + IGF‐1 (n = 11) groups. IUGR was induced by uteroplacental embolization from 114 to 119 days (term = 145 days). IUGR fetuses received daily intraamniotic injections of saline or IGF‐1 (20 μg/d) from 120 to 130 days.

Results

Baseline amino acid concentration was higher in fetal blood than amniotic fluid for all essential amino acids except lysine and histidine, but was lower for serine, alanine, and methylhistidine. Embolization reduced total amino acid concentration in blood and amniotic fluid by approximately 15%. Concentrations were reduced for serine, glutamine, and methylhistidine in blood and for serine in amniotic fluid, but were increased for glycine, alanine, and asparagine in blood and for alanine in amniotic fluid. Glutamine was taken up by the fetal gut (glutamine:oxygen quotient of 0.65) and citrulline was released by the gut. IGF‐1 treatment did not alter amino acid concentration in blood or amniotic fluid, but reduced gut uptake of glutamine from blood and the gut glutamine:oxygen quotient by 15%. Citrulline release was unchanged.

Conclusions

These data suggest that amniotic fluid amino acids are not simply filtered from fetal blood and may provide an important pool of nutrients for the fetus. They demonstrate for the first time that glutamine is taken up by the fetal gut. IGF‐1 treatment may promote gut utilization of amino acids from the amniotic fluid pool.
Routine Handling of Milk Fed to Preterm Infants Can Significantly Increase Osmolality
Authors: Fenton Tanis R. , Belik Jaques
Published: January 2024

Background

The purpose of these studies was to evaluate the changes in osmolality which occur in human breast milk or formula after two modifications; these changes are sometimes used in preparing these milks for consumption by premature infants, namely, the addition of fortifiers and the addition of exogenous lactase enzyme.

Methods

The osmolality of expressed, previously frozen human breast milk, breast milk fortified with commercial fortifiers, liquid formulas, powdered formulas, or glucose polymers was measured. Osmolality was measured before and after warming (15 minutes at 37°C) or after refrigeration at 4°C for 12 hours with subsequent warming. In a second group of experiments, the osmolality of expressed breast milk and three lactose‐containing formulas was measured before and after incubation with lactase (Lactaid ®) at 4°C for 2, 6, and 24 hours.

Results

Warming of breast milk mixed with some of the additives was associated with a significant increase in osmolality. The additives which increased osmolality included liquid glucose polymers, two commercially available powdered human milk fortifiers, and three formulas which contain glucose polymers (a protein hydrolysate infant formula powder, powdered lactose free formula, and a powdered preterm formula). Maximum increase in osmolality of breast milk occurred with the addition of 20 ml/100ml liquid glucose polymers (Polycose, Ross Laboratories) which resulted in a 21% increase in osmolality after refrigeration and warming. The addition of liquid glucose polymers and of powdered preterm formulas containing glucose polymers (Enfacare, Mead Johnson, 9.5 g/100ml and Nutramigen, Mead Johnson, 6 g/100ml) resulted in a final osmolality of over 425 mOsmol/L. The addition of lactase and subsequent incubation under refrigeration resulted in significant increases in osmolality that ranged from 25 to 66% in fortified breast milks and lactose‐containing formulas. Incubation of these milks at 37° for 15 minutes produced about 50% greater increase in osmolality than observed after 2 hours of incubation under refrigeration.

Conclusions

Routine warming of breast milk with glucose polymer containing additives, or the addition of lactase enzyme to lactose containing feedings, can increase osmolality to levels that exceed current guidelines for premature infant feedings.
Serum Soluble Interleukin‐2 Receptor, Interleukin‐6, and Tumor Necrosis Factor‐α Levels in Children with Celiac Disease: Response to Treatment
Authors: Romaldini Ceres C. , Barbieri Dorina , Okay Thelma S. , Raiz Roberto , Cançado Eduardo L. R.
Published: January 2024

Objectives

T‐cell mediated immune response to dietary gluten and cytokines release are important for the enteropathy seen in celiac disease. We investigated the serum levels of soluble interleukin‐2 receptor, interleukin‐6, and tumor necrosis factor‐α in celiac children before and after gluten exclusion.

Methods

Cytokine levels were determined using enzyme immunoassay in serum from 12 untreated celiac patients, 16 treated celiac patients on a gluten‐free diet for at least two years, and from 26 control children. Eight of 12 untreated patients were also investigated at 6 and 12 months after gluten exclusion. Serum IgA antiendomysium antibodies were also assayed by indirect immunofluorescence.

Results

Soluble interleukin‐2 receptor and interleukin‐6 levels were significantly increased in untreated celiac patients compared with treated and control children. There was no difference in the tumor necrosis factor‐α levels between the groups. Soluble interleukin‐2 receptor levels were the only ones significantly decreased at 12 months after gluten exclusion. However, soluble interleukin‐2 receptor and interleukin‐6 levels at 12 months were significantly higher compared with controls. Antiendomysium antibodies had a diagnostic sensitivity of 100% and the titers decreased significantly after 12 months of gluten exclusion. A significant positive correlation was found between antiendomysium antibody titers with both soluble interleukin‐2 receptor and interleukin‐6 values.

Conclusions

The serum soluble interleukin‐2 receptor and interleukin‐6 levels may be used as a noninvasive measure of celiac disease activity and response to treatment.
Dexamethasone Changes the Composition of Insulin‐like Growth Factor Binding Proteins in the Newborn Mouse Ileum
Authors: Gordon Phillip V. , Moats‐Staats Billie M. , Stiles Alan D. , Price Wayne A.
Published: January 2024

Background

Early postnatal glucocorticoid exposure accelerates the maturation of the bowel mucosa but results in bowel wall thinning in the newborn mouse ileum and increases the risk of focal ileal perforation in extremely premature infants. We have previously demonstrated a redistribution of insulin‐like growth factor‐I (IGF‐I) from the submucosa in control animals to the distal villi of those treated with early postnatal dexamethasone, implicating IGF‐I as an important mediator of dexamethasone's capacity to alter tissue growth. To investigate the possibility that IGF binding proteins (IGFBPs) might contribute to this process, we characterized the localization and abundance of IGFBP peptides and mRNAs in the same model.

Methods

Newborn mice received daily intraperitoneal injections of dexamethasone (l μg/g) or phosphate‐buffered saline and then were euthanized on day 3 of life. Their ileums were harvested and prepared for microscopy. Tissue sections of ileum from both treatment conditions were processed in parallel for immunolocalization of each of the six IGFBP peptides and for in situ hybridization of each of the six IGFBP transcripts.

Results

Transcripts for IGFBP‐1, ‐2, and ‐3 were highly abundant and ubiquitous the ileal mucosa, whereas transcripts for IGFBP‐4, ‐5, and ‐6 were less abundant in epithelial cells. There were no differences in abundance between control and dexamethasone‐treated ileum with regard to mRNA localization or abundance for IGFBP‐1, ‐2, ‐3, and ‐6. In contrast, mRNA transcripts for IGFBP‐4 and ‐5 were modestly increased with dexamethasone treatment (although only IGFBP‐4 was significant). Strikingly different patterns of IGFBP immunolocalization were observed between control and dexamethasone‐treated animals. IGFBP‐1, ‐2, ‐3, and ‐5 were not detected in control ileum, whereas IGFBP‐4 and ‐6 were both present in the mucosa. In contrast, dexamethasone treatment resulted in dramatic mucosal increases in IGFBP‐2, ‐3, ‐4, and ‐5, paralleling the changing distribution of IGF‐I that we previously reported.

Conclusion

Taken together, these findings further implicate the IGF system as an important participant in dexamethasone‐induced maturation in the newborn mouse ileum.
Disaccharidase Activities in Dyspeptic Children: Biochemical and Molecular Investigations of Maltase‐Glucoamylase Activity
Authors: Karnsakul Wikrom , Luginbuehl Ursula , Hahn Dagmar , Sterchi Erwin , Avery Stephen , Sen Partha , Swallow Dallas , Nichols Buford
Published: January 2024

Background

Maltase‐glucoamylase enzyme plays an important role in starch digestion. Glucoamylase deficiency is reported to cause chronic diarrhea in infants, but its role in dyspeptic children is unknown.

Methods

Glucoamylase and other disaccharidase specific activities were assayed from duodenal biopsy specimens in 44 children aged 0.5–18 years (mean, 10 ± 5 years) undergoing endoscopy to evaluate dyspeptic symptoms. All subjects had normal duodenal histology. Intestinal organ culture was used to evaluate synthesis and processing of maltase‐glucoamylase. Sequencing of the maltase‐glucoamylase coding region was performed in subjects with low activity or variation of isoform in organ culture.

Results

Twenty‐two of the dyspeptic children had one or more disaccharidases with low specific activity. Twelve subjects (28%) had low activity of glucoamylase. Eight subjects had low activities of glucoamylase, sucrase, and lactase. Low glucoamylase activity was not correlated with the isoform phenotype of maltase‐glucoamylase as described by metabolic labeling and sodium dodecyl sulfate electrophoresis. Novel nucleotide changes were not detected in one subject with low glucoamylase activity or in two subjects with variant isoforms of maltase‐glucoamylase peptides.

Conclusion

Twelve of 44 dyspeptic children had low specific activity of duodenal maltase‐glucoamylase. Eight of these children had low specific activity of all measured disaccharidases.
Antimicrobial Prophylaxis for Gastrointestinal Procedures: Current Practices in North American Academic Pediatric Programs
Authors: Snyder John , Bratton Barbara
Published: January 2024

Background

Guidelines for the use of antibiotic prophylaxis in children are based on a small number of studies that assess the risk of infection associated with performing endoscopic procedures. The American Heart Association (AHA) and the American Society of Gastroenterological Endoscopy (ASGE) have established guidelines that identify conditions and procedures that place a child at greater risk for infectious complications. Because data on bacteremia and sepsis associated with endoscopy in children are very limited, we reviewed the practices of 15 large academic pediatric gastroenterology services to see if patterns of practice and safety could be determined.

Methods

A questionnaire was sent to 15 academic gastroenterology centers in the United States and Canada asking about antibiotic prophylaxis for endoscopic procedures for children with six conditions. These included three conditions related to congenital heart disease based on negligible, moderate, and high risk for endocarditis; immune compromise; the presence of a central venous line; and the presence of a ventriculo‐peritoneal shunt. Six procedures were evaluated, including esophagogastroduodenoscopy with biopsy, flexible sigmoidoscopy or colonoscopy with biopsy, endoscopic retrograde cholangiopancreatography, esophageal sclerotherapy, esophageal dilation, and percutaneous endoscopic gastrostomy (PEG) tube placement.

Results

The patterns of reported practice generally conform to the AHA and ASGE guidelines. The six conditions and six procedures yielded 36 response categories for the participating centers. The majority of centers reported routine use of antibiotic prophylaxis in about half (17) of the response categories, which represented three distinct situations. These included children with congenital heart disease having moderate or high risk for bacterial endocarditis for almost all procedure categories and children undergoing PEG tube placement regardless of underlying condition. In all other combinations of underlying conditions and procedures, the majority of centers did not use routine prophylaxis. The majority of centers did not use antibiotic prophylaxis for cardiac conditions with a negligible risk of infectious complication or for children with immunocompromise, central venous lines, or ventriculo‐peritoneal shunts for any procedure except PEG placement.

Conclusions

These results indicate that the routine use of antibiotic prophylaxis is limited in pediatric academic centers to a few very specific conditions and procedures. The results also provide indirect evidence that the risk of infectious complications associated with endoscopic procedures appears to be exceedingly low.
Prevalence of Factor V G1691A (Leiden), Prothrombin G20210A, and Methylene Tetrahydrofolate Reductase C677T Thrombophilic Mutations in Children With Inflammatory Bowel Disease
Authors: Kader Howard A. , Berman Wallace F. , Al‐Seraihy Amal S. , Ware Russell E. , Ulshen Martin H. , Treem William R.
Published: January 2024

Background

Patients with inflammatory bowel disease (IBD) have an increased incidence of thromboembolic events. This risk may be caused by an increased frequency of thrombophilic mutations such as factor V Leiden G1691A (FVL), prothrombin G20210A (PT), or methylene tetrahydrofolate reductase C667T (MTHFR). Prevalence rates of heterozygous mutations in FVL, PT, and MTHFR are reported for whites (1.8%, 1.3%, 26.6%, respectively), blacks (0.8%, 0.3%, and 12.4%, respectively), and Hispanics (1.2%, 2.4%, and 41.5%, respectively). We sought to determine the prevalence of these thrombophilic mutations in a large cohort of children with IBD.

Methods

Children aged 21 years or younger with IBD were genotyped for FVL, PT, and MTHFR mutations by polymerase chain reaction amplification and restriction enzyme digestion. Prevalence rates were compared with established rates in the respective populations.

Results

Of 92 patients enrolled, 89 (62 with Crohn disease, 24 with ulcerative colitis, and 3 with indeterminate colitis) had genotype results available. The mean age was 13.3 ± 4.2 years (range, 2–21 years). Statistical analysis was performed on 89 FVL, PT, and MTHFR allele pairs. Polymerase chain reaction genotyping identified 5 patients with heterozygous FVL mutations, 3 patients heterozygous for the PT mutation, and 36 patients heterozygous and 4 patients homozygous for the MTHFR mutation. The thrombophilic allele mutation frequencies in our sample were not significantly different from predicted weighted average values: FVL, 2.8% versus 1.5%; PT, 1.7% versus 1.1%; and MTHFR, 24.7% versus 24.4%. In 24 patients with a family history of thrombosis, 1 was heterozygous for FVL and for MTHFR, 1 was heterozygous for FVL and homozygous for MTHFR, 2 were heterozygous for PT, and 9 were heterozygous MTHFR. There was no significant correlation between family history of thrombosis and presence of a thrombophilic mutation. The four patients with homozygous mutations for MTHFR, two of whom also were heterozygous for FVL, did not have either a personal history of thrombosis or a family history of thrombotic events. Two patients had thrombotic events without mutations in these genotypes: one had protein S deficiency and the other had no identifiable cause.

Conclusions

The presence of genetic mutations that predispose to hypercoagulable states does not appear to correlate with the prevalence of IBD or to thromboembolic events in patients with IBD. There was no statistical difference between the proportions of the mutated allele frequency in our study patients and the general population.
Slight Decrease in Bone Mineralization in Cow Milk–Sensitive Children
Authors: Hidvégi Edit , Arató András , Cserháti Endre , Horváth Csaba , Szabó András , Szabó Antal
Published: January 2024

Background

Patients with cow milk allergy (CMA) are potentially at risk for osteopenia because their milk‐free diet usually contains a low calcium content. In our study, different parameters of bone mineralization in children with CMA were investigated.

Patients and Methods

Twenty‐seven CMA patients (mean age, 4.3 years; range, 3–8 years) were enrolled in the study. During a mean milk‐free diet period of 11.8 months, children were fed extensively hydrolyzed or soy‐based formulas. After a milk challenge test, 7 patients showed allergic symptoms, and the other 20 children had transient CMA. From the sera of all patients, the levels of sodium, potassium, chloride, calcium, phosphate, and magnesium ions, as well as alkaline phosphatase (AP), parathyroid hormone (PTH), osteocalcin, and beta‐crosslaps, were determined. These values were compared with those of 20 healthy age‐matched controls. Bone mineral density was measured as well.

Results

The AP and PTH concentrations were higher in CMA patients than in the control group (AP: 610.2 U/L vs. 499.7 U/L, P < 0.01; PTH: 1.56 pmol/L vs. 0.83 pmol/L, P < 0.03), but all values were in the normal range. The osteocalcin concentration was similar in both groups, and the beta‐crosslaps concentration was lower in CMA patients than in controls (0.92 vs. 1.47 ng/mL, P < 0.001). The mean Z score of bone mineral density in patients with CMA was −0.6. In 10 cases, the Z score was less than the −1 SD value. On the basis of the Z score, CMA patients were divided into two groups. The PTH concentration was significantly elevated in the group with lower Z score (2.24 pmol/L vs. 1.16 pmol/L;P < 0.03).

Conclusion

The results suggest that, in children with CMA who are on a cow milk–free diet, slight disturbances of bone mineralization can be observed by osteodensitometry.
Helicobacter pylori Seropositivity among Adolescents in Novosibirsk, Russia: Prevalence and Associated Factors
Authors: Reshetnikov Oleg V. , Denisova Diana V. , Zavyalova Larisa G. , Häivä Veli‐Mies , Granberg Christer
Published: January 2024

Objectives

We have reported previously that Helicobacter pylori infection is widespread among adults in Siberia, in whom prevalence rates range from 70% to 90%. The present study was undertaken to determine the seroprevalence of H. pylori infection and its relation to social factors in a community‐based population of adolescents in Novosibirsk, Western Siberia.

Methods

All students in forms 9 to 11 of four randomly selected secondary schools participated. A total of 423 students (180 boys, 243 girls; age, 14–17 years) completed structured questionnaire concerning their lifestyle, and sera were tested for H. pylori using enzyme‐linked immunosorbent assay (Pyloriset®–New EIA‐G; Orion Diagnostica, Finland). Personal information, including parental history, educational level, occupation, and smoking habits, were collected via a questionnaire.

Results

Overall, the seroprevalence of H. pylori infection was 56.3%. Age, sex, smoking, alcohol consumption, number of children and pets in the household, and family history of gastric diseases were not associated with H. pylori positivity. The predictors of infection were dwelling without running hot water supply and sewage (odds ratio [OR] = 2.4; 95% confidence interval [CI], 1.2–4.8), father's occupation as a manual worker (OR = 2.7; 95% CI, 1.5–5.0), mother's occupation as a manual worker (OR = 1.8; 95% CI, 1.0–3.0), father's lower educational attainment (OR = 2.1; 95% CI, 1.2–3.6), and father's smoking (OR = 1.8; 95% CI, 1.1–3.2).

Conclusions

The prevalence of H. pylori seropositivity among adolescents in Russia is higher than in developed countries. The infection is associated with lower socioeconomic status.
Cardiopulmonary Compromise Associated With Milk and Molasses Enema Use in Children
Authors: Walker Melanie , Warner Brad W. , Brilli Richard J. , Jacobs Brian R.
Published: January 2024

Objective

Constipation is a common childhood problem that frequently confronts pediatric practitioners. When enema treatment is indicated to treat constipation, milk and molasses enemas are sometimes used. Side effects and adverse outcomes have been described with many types of enemas, but not with milk and molasses. The purpose of this study is to describe five children who acutely decompensated after receiving milk and molasses enemas.

Methods

Retrospective review of the medical records of children with constipation who received milk and molasses enema with subsequent PICU admission at Cincinnati Children's Hospital Medical Center between 1994 and 2000.

Results

Five children developed significant hemodynamic deterioration after receiving milk and molasses enemas. One of these children died and the others recovered after aggressive resuscitation.

Conclusions

Milk and molasses enema administration can be associated with significant hemodynamic compromise. These risks appear similar to those risk observed with the use of other enema preparations.
Helicobacter pylori in Children and Adolescents: Increase of Primary Clarithromycin Resistance, 1997–2000
Authors: Crone J. , Granditsch G. , Huber W.‐D. , Binder C. , Innerhofer A. , Amann G. , Hirschl A. M.
Published: January 2024

Background

The authors evaluate the prevalence of Helicobacter pylori resistance in 117 children and demonstrate the changes over a 4‐year period.

Methods

In 117 children and adolescents, H. pylori‐positive gastritis was revealed by diagnostic upper endoscopy. Biopsies from the antrum and body of the stomach were tested by histology, urease test, and culture. H. pylori was isolated using standard culture techniques, and susceptibility to amoxicillin, clarithromycin, and metronidazole was tested using the E‐test (AB‐Biodisk, Sweden).

Results

Endoscopy revealed gastric ulcers in 2 of 117 subjects, duodenal ulcers in 6 of 117, and erosive gastritis or duodenitis in 23 of 117. Almost all patients showed antral nodularity. Histology always showed chronic gastritis with different degrees of activity. During the 4‐year study period, the authors noticed an increase of primary clarithromycin‐resistant H. pylori strains, from 14.3% to 27.6% (mean, 20.3%). Metronidazole resistance varied between 5% and 25%. No resistance to amoxicillin was found.

Conclusion

Eradication of H. pylori should take place only after testing of susceptibility. The general use of clarithromycin in children should be restricted to better‐defined indications. Resistance to clarithromycin of H. pylori may also become a future problem for the treatment of adults.
Detection of Small Bolus Volumes Using Multiple Intraluminal Impedance in Preterm Infants
Authors: Peter Corinna S. , Wiechers Cornelia , Bohnhorst Bettina , Silny Jiri , Poets Christian F.
Published: January 2024

Background

Multiple intraluminal impedance (MII) is a new technique that allows detection of reflux and swallows via changes in impedance caused by a liquid bolus inside the esophagus. The method is independent of pH. The authors studied the ability of this technique to detect the small bolus volumes potentially occurring in young infants.

Methods

Ten preterm infants (median gestational age at birth, 33 weeks; range, 25–36 weeks; age at study, 9 days; range, 2–39 days) underwent 10 instillations each of 0.1 mL to 0.5 mL saline while MII was recorded via a 2.4‐mm nasogastric catheter. MII signals were analyzed for swallows, defined as a decrease in impedance starting within 1 minute. From the liquid instillation in the most proximal channel and extending downward, impedance changes during these induced swallows were compared with those occurring during spontaneous swallows.

Results

All 100 liquid instillations resulted in a typical impedance pattern, occurring after a median interval of 4.4 seconds (range, 1.8–8.9 seconds). The decrease in impedance was more pronounced than after spontaneous swallows (30% vs. 24%, P < 0.03) and extended downward more rapidly (12.3 cm/s vs. 5.8 cm/s, P < 0.01).

Conclusion

Bolus transport of small liquid volumes can be detected via MII.
Gastrostomy in Infants With Neonatal Pulmonary Disease
Authors: Guimber D. , Michaud L. , Storme L. , Deschildre A. , Turck D. , Gottrand F.
Published: January 2024

Objective

To report our experience of enteral feeding via gastrostomy in children with severe chronic neonatal lung disease, failure to thrive, and oral aversive behavior after initial hospitalization.

Population

Thirteen patients were studied. All children had chronic lung disease of neonatal onset and were severely malnourished. They received enteral nutrition via a gastrostomy at a median age of 13 months (range: 8–35).

Results

Z‐scores for weight‐for‐height increased significantly, from −3.4 to −1.9 after four months of enteral nutrition. Caloric intake increased significantly from 100% to 140% of the recommended daily allowance for age. Pulmonary status remained stable for all patients and oxygenation was normal. There was an aggravation of oral aversive behavior in 7 of the 13 children, especially those children who were ventilated and hospitalized for a long time (median duration: 195 days). The median follow‐up of patients after gastrostomy was 30 months (range: 8–54) and only six patients could be weaned from enteral nutrition.

Conclusion

Enteral nutrition via gastrostomy is efficient, and provides the means to improve caloric intake and nutritional status. Gastrostomy is a safe and convenient technique that should be considered early in the course of treatment for infants presenting with malnutrition related to neonatal pulmonary disease.
Prevalence of Celiac Disease and Follow‐up of EMA in Children and Adolescents With Type 1 Diabetes Mellitus
Authors: Crone J. , Rami B. , Huber W. D. , Granditsch G. , Schober E.
Published: January 2024

Background:

The prevalence of celiac disease (CD) in children with diabetes mellitus type 1 (DM) is significantly higher than in the nondiabetic population. Most patients with DM and associated CD do not experience typical gastrointestinal symptoms of CD. There is no agreement on the necessity of screening and management of silent CD for patients with DM or on the time scale for screening. Only few data on follow‐up evaluation of children with DM and CD‐related antibodies are available.

Methods:

One hundred fifty‐seven patients with DM (mean age, 14.8 years; range, 4‐21 years; male, 83) were screened with endomysial antibodies (EMA) between 1993 and 2001. A follow‐up period of at least 3 years, with at least 2 EMA measurements, was possible. Group 1 comprised 37 patients whose first measurement was at the onset of DM. Group 2 comprised 120 patients whose first measurement was during the course of the disease. In patients with positive EMA, small bowel biopsy was performed. Thyroid peroxidase (TPO), thyroglobulin (TgA), glutamate decarboxylase (GAD), antiinsulin (IAA), and islet cell antibodies (IA2) were measured in all patients.

Results:

EMA was positive in 16 patients, in 5 at onset of DM and in 11 during the course of DM (mean duration, 33.6 months; range, 11‐105 months). Biopsy results showed normal mucosa in seven patients, increased intraepithelial lymphocyte counts in one, and flat mucosa in eight. There was no significant difference between EMA‐positive and EMA‐negative patients regarding height, weight, HbA1c level, frequency of hypoglycemia or hyperglycemia, TPO, TgA, GAD, IAA, or IA2.

Conclusion:

This study emphasizes the high prevalence of CD in patients with DM. Although several patients already had positive EMA titers at the onset of DM, seroconversion may also occur during the course of the disease. Screening for CD with EMA or tissue transglutaminase should be included in the initial investigation of DM, but should also be repeated over time to detect late seroconversion. JPGN 37:67‐71, 2003.
Increased Levels of Bovine Serum Albumin Antibodies in Patients With Type 1 Diabetes and Celiac Disease‐Related Antibodies
Authors: Rodríguez‐Juan Cristina , Sala‐Silveira Lucía , Pérez‐Blas Mercedes , Valeri Anna P. , Aguilera Noemí , López‐Santalla Mercedes , Fuertes Ana , Martín‐Villa José M.
Published: January 2024

Objectives

To detect the presence of antibodies against bovine serum albumin in a cohort of Spanish patients with type 1 insulin‐dependent diabetes.

Methods

Antibodies were measured using an in‐house enzyme‐linked immunosorbent assay test in 80 patients with type 1 diabetes, subdivided according to the presence or absence in their serum of celiac disease‐related antibodies. For comparison, 30 patients with celiac disease (nondiabetic), 13 patients with autoimmune thyroiditis, and 45 healthy volunteers were used.

Results

Thirty‐one percent of patients with diabetes yielded a positive result, with a mean value of 26.1 ± 21.8 arbitrary units (AU). If the group was split into those with celiac disease‐related antibodies and those lacking them, the percentages were 53% and 25%, respectively, with a mean value of 39.6 ± 28.4 AU and 22.4 ± 18.3 AU (P = 0.003), respectively. Seventy‐three percent of celiac patients showed bovine serum albumin antibodies with a mean level of 38.8 ± 27.7 AU, comparable to that of patients with diabetes with celiac antibodies, but higher than the group lacking them (P = 0.001). Although 46% of patients with autoimmune thyroiditis had positive results, the level detected (22.1 ± 8.7 AU) was significantly lower than that recorded in patients with type 1 diabetes who had celiac disease antibodies (P = 0.04) and celiac patients (P = 0.04). Healthy volunteers showed no antibodies against bovine serum albumin.

Conclusions

These data suggest that bovine serum albumin antibodies appears in patients with a compromised epithelial permeability, and they reflect a general defect in the process of immunologic tolerance associated with a predisposition to autoimmunity, rather than immunity specific to β cells.
Natural History of Intestinal Failure, Investigated Through a National Network‐Based Approach
Authors: Guarino Alfredo , De Marco Giulio ,   Italian National Network for Pediatric Intestinal Failure
Published: January 2024

Objectives

Intestinal failure (IF) is a condition whose treatment requires advanced knowledge and techniques and a multidisciplinary approach. Intestinal failure is the endpoint of many intestinal diseases and may result in full recovery, in life‐long parenteral nutrition, or in the death of the child. The aim of this study was to evaluate the natural history of IF in children using a national network of resources.

Methods

Italian centers of pediatric gastroenterology merged in a national network, developing a collaborative management approach for children with IF. A consensus definition of IF was achieved. A database was set up to investigate the cause, epidemiologic factors, and natural history of IF.

Results

One hundred nine children were enrolled in 5 years. The cause of IF was: short bowel syndrome (n = 48), disorders of motility (n = 16), structural enterocyte defects (n = 14), multiple food intolerance (n = 10), autoimmune enteropathy (n = 7), and others or unknown (n = 14). The eventual outcome was closely related to the primary cause, ranging from full and permanent intestinal sufficiency in children with multiple food intolerance to high death rate or total dependance upon parenteral nutrition in those with structural enterocyte defects. Intermediate outcomes were observed for the other causes. Four children received intestinal transplantation.

Conclusions

The network approach for IF provides an effective model to optimize resources and to investigate prospectively the natural history of IF. Based on the work on this series, a European network for IF could be an effective model for fulfilling the diagnostic and management needs, including intestinal transplantation.
Varicella in Pediatric Liver Transplant Patients: A Retrospective Analysis of Treatment and Outcome
Authors: Pacini‐Edelstein Susan J. , Mehra Mini , Ament Marvin E. , Vargas Jorge H. , Martin Martin G. , McDiarmid Sue V.
Published: January 2024

Background

Varicella is a common childhood disease that can cause morbidity and mortality among immunosuppressed patients. There have been few previous studies monitoring the course of pediatric liver transplant patients with acute varicella. The aim of this study was to evaluate the treatment, outcomes, and complications of pediatric liver transplant patients admitted with acute varicella infection.

Methods

A retrospective chart review was carried out based on discharge diagnoses of orthotopic liver transplant and varicella among pediatric patients (age range, birth–18 years) admitted to the UCLA Medical Center between 1985 and 2001.

Results

Five hundred fifty‐six pediatric patients received liver transplantations between 1985 and 2001. Twenty‐two of these patients were admitted to the UCLA Medical Center with varicella (11 females, 11 males). No patients were treated on an outpatient basis. Mean age of the patients was 6 years (range, 1–16 years). None of these patients received the varicella vaccine before hospitalization. On admission, 5 of 22 patients (23%) had received varicella zoster immunoglobulin within 96 hours of exposure. The mean length of hospitalization was 6 days (range, 2–11 days). All immunosuppression dosages were reduced during the admissions. None of the patients had been treated with high‐dose corticosteroids for acute rejection before the onset of the varicella infection. Patients were treated until defervescence with intravenous acyclovir and until their varicella lesions crusted. Patients were discharged with oral acyclovir to complete a 10‐day course (including the intravenous treatment). No patients had complications from the varicella infection. A complication of an elevated serum creatinine for one patient was noted with the intravenous acyclovir treatment. This patient had associated headache and nausea that resolved when the creatinine level returned to normal.

Conclusions

There were no complications or dissemination of varicella infection among our pediatric liver transplant patients. Further prospective randomized trials are required to evaluate the management of pediatric liver transplant patients infected with varicella.
Autoantibodies in Mothers of Children with Neonatal Liver Disease
Authors: Burch Joanna M. , Sokol Ronald J. , Narkewicz Michael R. , Reichlin Morris , Frank Mark Barton , MacKenzie Todd , Lee Lela A.
Published: January 2024

Objectives

Neonatal lupus erythematosus (NLE) is associated with maternal anti‐Ro/La autoantibodies. It is characterized by heart block and/or cutaneous skin lesions, and occasionally liver disease. This study was performed to determine whether idiopathic neonatal cholestasis (INC) represents NLE without its cardiac or cutaneous findings.

Methods

Sera were obtained for autoantibody analysis from mothers of children with INC (N = 11), biliary atresia (N = 25), other liver disease excluding viral hepatitis (liver disease control subjects, N = 14), and healthy children (normal control subjects [NC], N = 22).

Results

The characteristic serologic findings of NLE, high titer antibodies to Ro and/or La, were absent in mothers from all groups. An unexpected finding was the prevalence of autoantibodies in mothers of infants with liver disease of any type. The frequency of maternal antinuclear antibodies at ≥ 1:120 dilution was greater than the estimated frequency in the general population (22% vs. 9%, P = 0.044). The frequency of maternal low titer autoantibodies to 52 kD Ro detected by ELISA was significantly greater than in the NC group (31% vs. 5%, P = 0.014).

Conclusions

The majority of cases of INC do not represent NLE. The frequent presence of autoantibodies in mothers of infants in all neonatal liver disease groups raises the possibility that maternal serologic autoimmunity is associated with neonatal liver disease.
Adult Height and Weight of Breast‐Fed and Bottle‐Fed Israeli Infants
Authors: Zadik Zvi , Borondukov Ela , Zung Amnon , Reifen Ram
Published: January 2024

Background

Breast‐fed infants grow more slowly than bottle‐fed infants. This growth deceleration sometimes alarms health care personnel to the point of considering other forms of nutrition.

Objectives

To evaluate the final adult anthropometric outcome associated with breast or formula feeding during infancy.

Design

Height and weight data were collected from eight well‐baby clinics representing various ethnic origins, lifestyles, and socioeconomic backgrounds. Children were measured every 1 to 2 months for the first 6 months, every 3 months until 2 years of age, and yearly thereafter, until they reached their final height. Longitudinal data were collected from 1960 healthy children (961 boys). Overall, 613 of the children were breast fed for 1 year and 218 for 6 months.

Results

The magnitude of the decline in Z scores of breast‐fed vs. bottle‐fed infants, between birth and 1 year of age was not as great for height as for weight −0.2 and −0.3 respectively, and disappeared at 2 years of age. The weight for height decreased between birth and the end of the first year in breast‐fed children by 0.3 (Z score). Children switched to bottle feeding exhibited a growth spurt. However, there was no difference in the final heights or weights of breast‐fed children compared with bottle‐fed children 165.3 ± 6.2 (n = 134) versus 164.9 ± 6.4 (n = 195) in females, respectively, and 175.3 ± 6.8 (n = 122) versus 175.8 ± 7.1 (n = 162) in males, respectively. Adult obesity in this sample population (n = 637) was correlated with maternal obesity. Maternal BMI SD correlated with offspring BMI SD at 18 years of age (r = 0.873, P < 0.001) but not with breast feeding. Adult BMI was similar between the breast‐fed and bottle‐fed groups.

Conclusions

Despite their slower growth rate, breast‐fed children reach the same final height as bottle‐fed children. Breast‐fed infants should be monitored according to specifically designed growth charts. Obesity in adult life is correlated with factors not related to breast feeding.