bluuebunny/crossref_metadata_2025 huggingface dataset:
Autoimmune Hepatitis Associated with Anti‐Actin Antibodies in Children and Adolescents
Authors: Maggiore Giuseppe , Veber Florence , Bernard Olivier , Hadchouel Michelle , Homberg Jean Claude , Alvarez Fernando , Hadchouel Paul , Alagille Daniel
Published: January 2024

The clinical, biochemical, morphological, and evolutive features of autoimmune hepatitis associated with serum smooth muscle antibodies of anti‐actin specificity were retrospectively analyzed in 31 children and adolescents. Cirrhosis was present at diagnosis in all but six patients, including nine of the 12 diagnosed within 6 months from the onset. In 15 children, one or more associated diseases of an immune‐mediated mechanism were present, including chronic arthritis, sclerosing cholangitis, inflammatory bowel disease, and cutaneous vasculitis. All patients were treated with prednisone and azathioprine with normalization or improvement of liver function tests: 28 children are currently alive after a mean follow‐up of 4 years, 10 months. Treatment was inter rupted in four patients only. Two patients died of liver failure in spite of immunosuppressive therapy before the era of liver transplantation. In spite of prolonged therapy, five other patients ultimately required liver transplantation during adolescence or early adulthood. These results (a) further define a group of autoimmune hepatitis in children characterized by the presence of serum anti‐actin antibodies; (b) indicate that immunosuppressive therapy improves liver function, although in most cases it must be continued for a long period to maintain remission; and (c) suggest that progressive liver failure may occur in early adulthood and may require liver transplantation.
Acute Segmental Obstructing Enteritis in Children
Authors: Lee Hung‐Chang , Huang Fu‐Yuan , Hsu Chyong‐Hsin , Sheu Jin‐Cherng , Shih Shin‐Lin
Published: January 2024

We studied a group of 15 children with acute segmental enteritis associated with intestinal obstruction. The disease is characterized by fever, leukocytosis, copious bilious vomiting, and severe abdominal pain with signs of intestinal obstruction. Exploration revealed varying degrees of segmental ischemic change in the small bowel, but surgery seemed to be unnecessary in most cases. Antibiotics were effective in nonoperative cases. The clinical illness lasted 10–14 days. The disease was self‐limited, and no mortality was found in our series. To our knowledge, this is the first report of this disease entity in Chinese children.
Enteroaggregative Escherichia coli
Authors: Chan K. N. , Phillips A. D. , Knutton S. , Smith H. R. , Walker‐Smith J. A.
Published: January 2024

Enteroaggregative Escherichia coli (EAggEC) has been found to be associated with acute and persistent diarrhoea in children in developing countries. Its clinical significance in developed countries has not been examined in much detail. In a survey of faecal samples from children with diarrhoea presenting to a children's hospital in East London between August and December 1988, EAggEC strains were isolated in 8 of 297 (2.7%) consecutive stool samples collected from 289 children and in 5 of 34 typed E. coli isolates during 1988. Of the 13 children found to be excreting EAggEC, 8 had acute diarrhoea and 5 had chronic diarrhoea of more than 14 days' duration; 5 children had mixed infections. Compared to other organisms found during the same period, EAggEC were isolated as frequently as many other better‐known pathogens such as enteropathogenic E. coli, Campylobacter, Salmonella, Shigella, Giardia lamblia, and Cryptosporidium. We conclude that EAggEC may be an important pathogen in developed countries.
Gastric Mucosal Cell Densities in Helicobacter pylori Positive and Negative Dyspeptic Children and Healthy Controls
Authors: Ashorn M. , Ruuska T. , Karikoski R. , Välipakka J. , Mäki M.
Published: January 2024

SummaryThe densities (cells/mm2) of gastric inflammatory cells were determined. Fifty‐four dyspeptic children, of whom 12 had proven Helicobacter pylori infection, were compared with 13 healthy children. The mean antral lymphocyte density for healthy children was 604 cells/ mm2 (95% confidence interval [95% CI], 414–793); for plasma cells, 411 (95% CI, 274–548); for neutrophils, 0; and for eosinophils, 4 (95% CI, 4–13). H. pylori positive children had significantly higher mean densities of all cell types: lymphocytes, 1,738 (p < 0.001); plasma cells, 1,640 (p = 0.001); neutrophils, 371 (p = 0.023); and eosinophils, 263 (p < 0.01). Successful eradication of H. pylori resulted in reduced numbers of all cells. The gastric body cell densities paralleled those of the antrum. Of the dyspeptic children negative for H. pylori, 43% had antral gastritis, 43% had body gastritis, and 29% had pangastritis, as determined morphometrically. Gastritis in these patients was defined as mononuclear cell densities > 2,016 cells/mm2 in the antrum and >1,994 cells/mm2 in the gastric body (mean + 2 SD for controls) or the presence of neutrophils. A poor correlation was observed between routine histologic description and morphometric evaluation of gastritis in H. pylori‐negative dyspeptic children. Standardized morphometric cell‐density determination of gastritis may be the method of choice in evaluating chronic superficial gastritis in children.
Fecal Short‐Chain Fatty Acids in Children with Inflammatory Bowel Disease
Authors: Treem William R. , Ahsan Naheedt , Shoup Marie , Hyams Jeffrey S.
Published: January 2024

SummaryNutrition of colonic epithelial cells (colonocytes) is maintained by luminal short‐chain fatty acids (SCFAs), chiefly by n‐butyrate. The importance of SCFAs for the maintenance of colonic epithelium has been demonstrated in animal models of colitis produced by rectal instillation of an inhibitor of SCFA oxidation and in patients with diversion colitis in whom a segment of colonic epithelium was deprived of contact with luminal SCFAs. We measured fecal SCFAs and lactate in children with ulcerative colitis (UC; n = 17) and with Crohn's disease with ileocolonic involvement (CD; n = 22) and age‐matched controls (n = 12) by a vacuum‐distillation, gas chromatographic method. Fecal SCFA concentrations were correlated with scores of clinical disease activity. Patients with UC and CD had a decrease in the fecal concentration of acetate (p < 0.05) and an increase in n‐butyrate (p < 0.01) compared with controls. No significant changes in fecal lactate were seen. A comparison of inactive‐ or mild‐UC patients with moderateor severe‐UC patients yielded major differences in SCFA concentrations with n‐butyrate increased in inactive and mild UC well above control values and total SCFA and acetate decreased in moderate and severe UC below control levels. Raised concentrations of fecal n‐butyrate may reflect impaired utilization of this SCFA in the colon of patients with mild UC and Crohn's disease with colonic involvement. Whether this defect is primary or secondary to inhibitors in the colonic lumen, due to impaired transport of n‐butyrate into the cell or defective metabolism within the cell, or specific to inflammatory bowel disease remains to be explored.
Crohn's Disease in Children 10 Years Old and Younger
Authors: Gryboski Joyce D.
Published: January 2024

SummaryIn order to examine the presentation and course of Crohn's disease (CD) versus those of ulcerative colitis (UC) in children ±10 years of age, a retrospective review of children ±10 years old with inflammatory bowel disease singled out 40 patients and compared their findings with those of 38 children with UC. The mean age at onset was 7.5 years for CD, as compared with 5.9 years for UC. A family history of inflammatory bowel disease was present in 13 patients (32%). Abdominal pain (97%), diarrhea (78%), and weight loss (88%) were the major initial complaints, with growth retardation present in 12 (30%) children. At onset, four children had diffuse small‐bowel disease, nine had terminal ileal disease, 15 had ileocolitis, and 12 had colitis; at the end of the study two had diffuse small‐bowel disease, four had terminal ileal disease, 25 had ileocolitis, and seven had colitis. Extraintestinal manifestations increased with duration of disease. Although the number of recurrences did not differ greatly between groups, those with ileocolitis and colitis needed longer steroid therapy and more days in hospital than did those with only small‐bowel disease. Operation was required in 42.5% of children with CD, as compared with 5% of those with UC, with six CD children (35%) requiring later reoperation for recurrent disease or fistula and abscess. Two children died from causes unrelated to their disease (gastric volvulus, carcinoma of the breast). The number of operations, duration of steroid therapy in the course of a year, and days in hospital for children with CD exceeded those for a similar group of children with UC. The quality of life noted at the end of the study period was considered only fair in the majority (70%) of CD patients, in contrast to those with UC, 75% of whom considered life good after 2 years of illness.
Heat Treatment of Infant Formula
Authors: Boehm Günther , Räihä Niels C. R.
Published: January 2024

Several different types of heat treatment are used in the production of commercial infant formulas. The extent of heat treatment can have different physico‐chemical effects on the milk proteins and will affect their solubility and digestibility. In the present study, 40 very‐low‐birth‐weight infants were randomized at the age of 2 weeks to be given one test feed of either fresh, human milk protein‐fortified human milk, a conventional canned sterilized liquid formula, a spray‐dried powder formula, or an ultra‐high‐temperature (UHT)‐treated liquid formula. The mean volume of the nasogastric test feed was adjusted so that protein intake was the same in each study group (0.45 g/kg). Venous blood samples were taken pre‐prandially and at 30, 60, and 120 min after the test meal, α‐amino‐nitrogen in serum was assayed by the ninhydrin reaction. The concentration of α‐amino‐nitrogen rose rapidly after the fortified human milk feed, reaching a peak at 30 min. After the peak was reached, the serum values progressively declined, reaching baseline values at 120 min after the start of the test meal. The areas under the curve for all formulas were significantly different from that found for fortified human milk. At 30 min, all formulas had significantly lower α‐amino‐nitrogen values than fortified human milk; at 60 min, all formulas had significantly higher mean concentrations than fortified human milk. At 120 min, none of the formula‐fed infants had reached baseline values; in particular, canned sterilized formula was still significantly above baseline values. By extrapolation, it was estimated that baseline was not reached before ±180 min after the test meal. These results demonstrate that heat treatment of infant formula has significant effects on in vivo amino acid absorption in very‐low‐birth‐weight infants.
Fortification of Human Milk
Authors: Moro G. E. , Minoli I. , Ostrom M. , Jacobs J. R. , Picone T. A. , Räihä N. C. R. , Ziegler E. E.
Published: January 2024

Human milk fed to very‐low‐birth‐weight infants must be fortified with protein, minerals, and vitamins. We tested a new fortification regimen in which the amount of fortifier was adjusted on the basis of frequent determinations of serum urea nitrogen (SUN). A newly formulated fortifier based on bovine milk proteins was employed either in the new fashion (regimen ADJ) or in the conventional fixed proportion (regimen FIX). Using the fixed proportion, the study also compared the new fortifier with a fortifier based on human milk protein (regimen HMP). Twelve infants were studied with each of the three regimens; nearly all completed 3 weeks of study. Protein intake was generally higher in ADJ than FIX; the difference was significant (p < 0.01) during week 2. Weight gain was somewhat (but not significantly) greater in regimen ADJ (32.3 g/d or 18.8 g/kg/d) than in regimen FIX (30.0 g/d or 18.3 g/kg/d). SUN was higher in ADJ than in FIX, and several other serum chemical values (calcium, phosphorus, potassium) tended to be higher, probably reflecting higher intakes of these nutrients with ADJ than with FIX. Plasma concentrations of several amino acids were higher in ADJ than FIX, but none, including threonine, were outside the physiological range. In comparing regimen FIX to regimen HMP, infants on FIX received similar intakes of protein and showed slightly but not significantly more rapid weight gain. Concentrations of SUN were lower with FIX, but other serum chemical values, including amino acids, were generally similar to HMP. We conclude that use of the new adjustable fortification regimen is feasible and safe and that it should be studied further. It produced the expected increases in nutrient intakes and growth. The new bovine milk‐based fortifier appears to be equivalent to the human milk‐based fortifier.
Repeatability of the Sugar‐Absorption Test, Using Lactulose and Mannitol, for Measuring Intestinal Permeability for Sugars
Authors: van Elburg R. M. , Uil J. J. , Kokke F. T. M. , Mulder A. M. , van de Broek W. G. M. , Mulder C. J. J. , Heymans H. S. A.
Published: January 2024

Differential sugar‐absorption tests for measuring intestinal permeability for sugars have been studied in a variety of gastrointestinal diseases. Their use in general practice has been hampered by a lack of data on reference values and repeatability of the test and the laboratory assay. In this study, we determined the reference values of the sugar‐absorption test, using lactulose and mannitol as probe molecules, for children and adults. The repeatability of the test is good; linear relationship: slope, 0.825 [95% confidence interval (CI), 0.571, 1.152); intercept, 0.005 (95% CI, −0.004, 0.010). The repeatability of the laboratory assay for the sugar‐absorption test is excellent; linear relationship: slope, 1.014 (95% CI, 0.870, 1.094); intercept, 0.002 (95% CI, −0.005,0.010). The validation of the sugar‐absorption test makes the test useful as a simple, noninvasive, reliable intestinal permeability test for sugars, which can be of use for clinical practice. Taking possible interfering factors into account, the sugar‐absorption test can be used as a diagnostic test for enteropathy of different etiologies and evaluation of therapeutic interventions in both children and adults. Studies with the sugar‐absorption test may clarify the role of intestinal permeability in the pathophysiology of a variety of gastrointestinal diseases.
Utility of Duplex Doppler Ultrasound in Evaluating Portal Hypertension in Children
Authors: Kozaiwa Kousuke , Tajiri Hitoshi , Yoshimura Norikazu , Ozaki Yoshikazu , Miki Kazunori , Shimizu Kazuo , Harada Tokuzo , Okada Shintaro
Published: January 2024

We measured the maximal velocity of the blood flow in the main portal trunk by duplex Doppler ultrasound in children suffering from a variety of liver diseases. The maximal velocity of the main portal vein in children with chronic active hepatitis and liver cirrhosis was decreased significantly as compared to those in control children (p < 0.01). The maximal velocity of the main portal trunk and K indocyanine green (ICG) had no significant correlation (r = 0.25, n = 27). The patient with the lowest portal velocity had esophageal and gastric varices with red color sign. We conclude that the measurement of the maximal velocity of the main portal trunk with duplex Doppler ultrasound is useful in evaluating portal hypertension in children.
Intestinal Permeability. Changes during the First Month
Authors: Catassi C. , Bonucci A. , Coppa G. V. , Carlucci A. , Giorgi P. L.
Published: January 2024

Summary: The aim of the study was to investigate the effect of age and feeding pattern on intestinal permeability during the first month of life. The subjects were 72 full‐term, healthy neonates who were (a) exclusively breast‐fed (BF group, n = 36) or (b) artificially fed (CM group, n = 36) with either an adapted formula (AF group, n = 17) or a partly hydrolyzed (hypoantigenic) formula (HA group, n = 19). A lactulose/mannitol (lac/man) intestinal permeability test was performed at 1 and 7 days (steady‐state method, n = 72), then at 30 days of life (single oral load, n = 47). Urinary lactulose and mannitol were measured by HPLC. The mean lac/man urinary ratio dropped from 1.27 ± 0.73 (day 1) to 0.34 ± 0.36 at day 7 and to 0.22 ± 0.21 at day 30. At 7 days BF infants showed a significantly lower lac/man urinary ratio (0.22 ± 0.25) than the CM group (0.47 ± 0.41). The human neonate shows a developmental pattern of sugar intestinal permeability that resembles gut closure observed in other mammals. Intestinal permeability decreases faster in breast‐fed babics than in those fed with adapted or HA formulas.
Vitamin A and E Supplementation in Breast‐Fed Newborns
Authors: Delvin Edgard E. , Salle Bernard L. , Reygrobellet Bernadette , Mellier Georges , Claris Olivier
Published: January 2024

Background

Vitamins A and E are two potent antioxidant nutrients that play a significant role in immune function. In contrast to the numerous studies of vitamin A and E status in children, adolescents, and adults, information on term infants, particularly breast‐fed infants, is scarce. The goals of the present investigation were to examine the vitamins A and E nutritional status of term breast‐fed infants at birth and to assess retinol and tocopherol plasma levels during a 3‐month supplementation trial.

Methods

The study was a prospective, blinded comparison of a supplementation protocol with a placebo in a group of consecutively recruited term newborns. The supplemented group received 3000 IU vitamin A and 5 IU vitamin E orally. The placebo group received a solution of similar viscosity and organoleptic characteristics. Vitamin A and E were separated by reverse‐phase high‐performance liquid chromatography on a C18 Spectrasyl column and quantified by ultraviolet spectrophotometry.

Results

Vitamin A and E levels steadily increased with age in both groups of infants. However, levels at 3 months were higher in the supplemented than in the control group.

Conclusion

The data show that supplementation with 3000 IU vitamin A and 5 IU vitamin E for 3 months increases circulating vitamin levels in newborn term babies compared with those in nonsupplemented infants.
Guidelines for Evaluation and Treatment of Gastroesophageal Reflux in Infants and Children
Authors: Rudolph Colin D. , Mazur Lynnette J. , Liptak Gregory S. , Baker Robert D. , Boyle John T. , Colletti Richard B. , Gerson William T. , Werlin Steven L.
Published: January 2024

Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems encountered by both primary and specialty medical providers. Clinical manifestations of GERD in children include vomiting, poor weight gain, dysphagia, abdominal or substernal pain, esophagitis and respiratory disorders. The GER Guideline Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulated a clinical practice guideline for the management of pediatric GER. The GER Guideline Committee, consisting of a primary care pediatrician, two clinical epidemiologists (who also practice primary care pediatrics) and five pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method.

The Committee examined the value of diagnostic tests and treatment modalities commonly used for the management of GERD, and how those interventions can be applied to clinical situations in the infant and older child. The guideline provides recommendations for management by the primary care provider, including evaluation, initial treatment, follow‐up management and indications for consultation by a specialist. The guideline also provides recommendations for management by the pediatric gastroenterologist.

This document represents the official recommendations of the North American Society for Pediatric Gastroenterology and Nutrition on the evaluation and treatment of gastroesophageal reflux in infants and children. The American Academy of Pediatrics has also endorsed these recommendations. The recommendations are summarized in a synopsis within the article. This review and recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.
Accidental Caustic Ingestion in Children: Is Endoscopy Always Mandatory?
Authors: Lamireau Thierry , Rebouissoux Laurent , Denis Delphine , Lancelin Frantz , Vergnes Pierre , Fayon Michael
Published: January 2024

Background

Patients who have experienced severe caustic injury to the gastrointestinal tract are at high risk of esophageal strictures. Early endoscopy is usually recommended systematically in children after caustic ingestion to assess the severity of the initial digestive lesions. The aim of this study was to determine the predictive value of clinical symptoms and ingested‐substance types as markers of severe esophagogastric lesions and to define indications for endoscopy.

Methods

Ingested‐product types, clinical symptoms, endoscopic data and outcome were prospectively recorded in 85 children admitted after accidental caustic ingestion.

Results

Forty‐eight children (57%) had no symptoms; the others presented with vomiting, hematemesis, drooling, respiratory distress, and/or oropharyngeal lesions. Endoscopy showed no or minimal lesions in 63 cases (74%). None of the children developed digestive sequelae. Severe esophagogastric lesions were present in 22 cases (26%), mostly caused by lye ingestion (14 of 22) but also by strong acids (4 of 22); 9 of the 22 children (41%) developed esophageal stenosis. Vomiting, drooling, and oropharyngeal lesions did not predict severe endoscopic lesions. Hematemesis, respiratory distress, or presence of at least three of the symptoms was associated with severe lesions (positive predictive value = 1). The absence of symptoms was always associated with no or minimal lesions (negative predictive value = 1).

Conclusions

In conclusion, endoscopy is not recommended for children living in developed countries who are asymptomatic after accidental caustic ingestion.
Colonic Diversion for Intractable Constipation in Children: Colonic Manometry Helps Guide Clinical Decisions
Authors: Villarreal Jorge , Sood Manu , Zangen Tsili , Flores Alejandro , Michel Reynaldo , Reddy Narasimha , Di Lorenzo Carlo , Hyman Paul E.
Published: January 2024

Background

Colonic manometry helps discriminate functional and behavioral causes for childhood constipation from colonic neuromuscular disease.

Methods

Of 375 colonic manometries performed for clinical indications, 12 could not be interpreted because of chronic colonic dilation. Based on colonic manometries that showed either no contractions or an absence of the gastrocolonic response or an absence of high‐amplitude propagating contractions, the authors recommended diverting colostomies or ileostomies in 12 chronically constipated children (mean age, 4 years; range, 2–14 years, 5 boys). Before study, medical treatment was ineffective in all children. These children had persistently dilated colons with pathologic diagnoses of intestinal neuronal dysplasia (n = 4), hypoganglionosis (n = 2), hollow visceral myopathy (n = 1), and normal (n = 5).

Results

Six to 30 months after diversion, the authors restudied all the children. Eleven of 12 diverted colons were no longer dilated. In two patients, abnormal motility involving the entire colon was unchanged from the initial study, small bowel motility was abnormal, and we recommended no further surgery. In two cases, the colon remained abnormal but small bowel motility was normal, and we recommended subtotal colectomy and ileoproctostomy. In four cases, the left colon remained abnormal, but the right colon was normal, and we recommended reanastomosis after left hemicolectomy. In four cases, motility in the diverted colons was normal, including a gastrocolonic response and high‐amplitude propagating contractions, and the authors recommended reanastomosis. Defecation problems resolved in 10 of 12 when followed up 5 to 30 months after treatment.

Conclusion

These data suggest that in some cases of intractable childhood constipation associated with colonic distention, temporary diversion improved colonic motility. Colonic manometry may be used to predict which patients will benefit from resection or reanastomosis.
Total Dose Intravenous Infusion of Iron Dextran for Iron‐Deficiency Anemia in Children With Inflammatory Bowel Disease
Authors: Mamula Petar , Piccoli David A. , Peck Susan N. , Markowitz Jonathan E. , Baldassano Robert N.
Published: January 2024

Background

Iron‐deficiency anemia is a frequent complication in children with inflammatory bowel disease (IBD). Parenteral iron therapy is rarely prescribed because of concern about potential side effects. The aim of this study was to retrospectively evaluate the safety and efficacy of total dose intravenous (TDI) iron therapy.

Methods

Charts of all the pediatric patients with IBD who received TDI iron therapy between February of 1994 and February of 2000 were reviewed.

Results

Seventy patients (20 with ulcerative colitis and 50 with Crohn disease) received a total of 119 TDI iron dextran infusions. Thirty‐four patients qualified for the efficacy analysis. The average increase in hemoglobin concentration was 2.9 g/dL, (P < 0.0001). Eleven immediate hypersensitivity reactions developed in 10 patients (9% of the total number of infusions). None of the reactions was life threatening and none required hospitalization.

Conclusions

Total dose intravenous infusion of iron dextran, when appropriately used, is a safe and potentially efficacious treatment for children with inflammatory bowel disease and iron deficiency anemia who are unresponsive to or noncompliant with oral iron therapy.
Gastrointestinal Malformations, Associated Congenital Abnormalities, and Intrauterine Growth
Authors: Tárnok András , Méhes Károly
Published: January 2024

Background

In contrast with other malformations, congenital anomalies of the gastrointestinal tract have been scarcely investigated.

Methods

The prevalence of gastrointestinal malformations with special reference to associated disorders and intrauterine growth was retrospectively analyzed in the newborn infants admitted to the Neonatal Intensive Care Unit of the Department of Pediatrics, University of Pécs, Hungary, in the 14‐year period between 1987 and 2000.

Results

Of 4,241 neonates with gastrointestinal malformations, 241 (5.68%) had a total of 304 malformations (excluding Hirschsprung disease). In 133 patients, the gastrointestinal anomalies were observed as one of multiple malformations; a specific syndrome or association was diagnosed in 36 cases. Skeletal disorders were the most frequently associated anomalies. Intrauterine growth retardation was found in a large number of patients with both isolated and multiple gastrointestinal malformations (38.9% and 30.8%, respectively).

Conclusions

Gastrointestinal malformations often are complicated by skeletal anomalies and intrauterine growth retardation. The association among these disorders requires further investigation. However, from a practical point of view, this association should be considered in treating affected patients.
13C‐Urea Breath Test With Infrared Spectroscopy for Diagnosing Helicobacter pylori Infection in Children and Adolescents
Authors: Kawakami Elisabete , Machado Rodrigo Strehl , Reber Marialice , Patrício Francy Reis S.
Published: January 2024

Background and Objective

Studies support the accuracy of 13C‐urea breath test for diagnosing and confirming cure of Helicobacter pylori infection in children. Three methods are used to assess 13CO2 increment in expired air: mass spectrometry, infrared spectroscopy, and laser‐assisted ratio analysis. In this study, the 13C‐urea breath test performed with infrared spectroscopy in children and adolescents was evaluated.

Methods

Seventy‐five patients (6 months to 18 years old) were included. The gold standard for diagnosis was a positive culture or positive histology and a positive rapid urease test. Tests were performed with 50 mg of 13C‐urea diluted in 100 mL orange juice in subjects weighing up to 30 kg, or with 75 mg of 13C‐urea diluted in 200 mL commercial orange juice for subjects weighing more than 30 kg. Breath samples were collected just before and at 30 minutes after tracer ingestion. The 13C‐urea breath test was considered positive when delta over baseline (DOB) was greater than 4.0%.

Results

Tests were positive for H. pylori in 31 of 75 patients. Sensitivity was 96.8%, specificity was 93.2%, positive predictive value was 90.9%, negative predictive value was 97.6%, and accuracy was 94.7%.

Conclusions

13C‐urea breath test performed with infrared spectroscopy is a reliable, accurate, and noninvasive diagnostic tool for detecting H. pylori infection.
Use of Quantitative Ultrasound to Assess Osteopenia in Children With Crohn Disease
Authors: Levine Arie , Mishna Leora , Ballin Ami , Givoni Shlomo , Dinari Gabriel , Hartman Corina , Shamir Raanan
Published: January 2024

Background and Aims

Children with Crohn disease are at increased risk for osteopenia and osteoporosis. Early development of osteopenia can increase the lifetime risk for fractures and may be amenable to early intervention. The gold standard for measuring bone mineral density (BMD) and fracture risk is dual x‐ray absorptiometry (DXA), but this involves some radiation and specialized programs for measuring BMD in children. Bone density Z scores were evaluated with quantitative ultrasound (QUS) using a novel portable device and were compared with DXA in children with Crohn disease.

Methods

Thirty‐five children with documented Crohn disease (mean age 14.3 ± 2.3 years) had speed of sound measured at the left radius and left tibia. Normative values for QUS Z scores were calculated from a cohort of 1,110 healthy children. A subgroup of 26 children with Crohn disease underwent both QUS and DXA. Z scores were calculated and compared for both groups.

Results

The mean Z score using lumbar spine DXA was −1.04 ± 1.51 SD, compared with −0.15 ± 1.49 SD, using the lowest Z score for QUS (P < 0.05). Using height adjusted DXA, 50% of children with Crohn disease had osteopenia, whereas QUS detected only 19.2% of these children (P < 0.05). Significantly fewer cases of osteopenia were detected using QUS at Z scores up to −2 SD.

Conclusions

Quantitative ultrasound performed on the radius and tibia may not be sensitive enough to pick up osteopenia in children with Crohn disease.
Celiac Disease in India: Are They True Cases of Celiac Disease?
Authors: Poddar Ujjal , Thapa Babu Ram , Nain Chander Kanwal , Prasad Arun , Singh Kartar
Published: January 2024

Background

In a developing country, many conditions other then celiac disease (CD) can give rise to villous atrophy. We therefore assessed the role of immunoglobulin A (IgA)–antigliadin antibody (AGA) in addition to the ESPGHAN criteria in the diagnosis of CD in 104 Indian children.

Methods

Consecutive children with suspected CD were evaluated over 3 years with an intention to diagnose CD. Complete hemogram, d‐xylose absorption test, endoscopic duodenal biopsy, and IgA–AGA titers were performed in all. CD was diagnosed on the basis of modified ESPGHAN criteria irrespective of IgA–AGA positivity (>5 U/mL), and those diagnosed were put on gluten‐free diet and were monitored regularly. Children with suspected CD who had a normal duodenal biopsy result were taken as controls.

Results

The mean age of 50 children with CD was 6.3 ± 2.6 years, with a male to female ratio of 3:2. The mean duration of symptoms was 3.4 ± 2.2 years. Predominant symptoms were pallor in 96%, failure to thrive in 92%, and diarrhea in 80%. On follow‐up (19.6 ± 8 months), symptoms subsided within 16 ± 9.8 days, and patients showed significant weight gain (mean weight at diagnoses and at last follow‐up visit were 66% and 86% of expected, respectively;P< 0.001) and height gain (mean height at diagnoses and at last follow‐up visit were 88% and 94% of expected, respectively;P= nonsignificant). The control group comprised 47 children with a mean age of 6.9 ± 3 years. On comparing CD with controls, diarrhea, anemia, low weight, and stunting were significantly (P< 0.001) more frequent in patients with CD. Sensitivity and specificity of AGA at a cutoff value of 5 U/mL were 94% and 91.5% and at 10 U/mL 88% and 100%, respectively. Follow‐up AGA test was performed in 42 of 47 positive cases. All showed significant decrease in AGA titer, and 29 (70%) had a negative test result.

Conclusions

Indian children with CD are true cases of CD. They present late, diarrhea is absent in 20% of cases, and AGA test results show 88% of children without false‐positive results at a cutoff value of 10 U/mL. However, AGA test with 94% sensitivity at a cutoff value of 5 U/mL can be used as screening test to select suspected cases for further workup.
Linear Programming: A Mathematical Tool for Analyzing and Optimizing Children's Diets During the Complementary Feeding Period
Authors: Briend André , Darmon Nicole , Ferguson Elaine , Erhardt Juergen G.
Published: January 2024

During the complementary feeding period, children require a nutrient‐dense diet to meet their high nutritional requirements. International interest exists in the promotion of affordable, nutritionally adequate complementary feeding diets based on locally available foods. In this context, two questions are often asked: 1) is it possible to design a diet suitable for the complementary feeding period using locally available food? and 2) if this is possible, what is the lowest‐cost, nutritionally adequate diet available? These questions are usually answered using a “trial and error” approach. However, a more efficient and rigorous technique, based on linear programming, is also available. It has become more readily accessible with the advent of powerful personal computers. The purpose of this review, therefore, is to inform pediatricians and public health professionals about this tool. In this review, the basic principles of linear programming are briefly examined and some practical applications for formulating sound food‐based nutritional recommendations in different contexts are explained. This review should facilitate the adoption of this technique by international health professionals.
Body Composition and Components of Energy Expenditure in Children With End‐ Stage Liver Disease
Authors: Greer Ristan , Lehnert Megan , Lewindon Peter , Cleghorn Geoffrey J. , Shepherd Ross W.
Published: January 2024

Background

Better understanding of body composition and energy metabolism in pediatric liver disease may provide a scientific basis for improved medical therapy aimed at achieving optimal nutrition, slowing progression to end‐stage liver disease (ESLD), and improving the outcome of liver transplantation.

Methods

Twenty‐one children less than 2 years of age with ESLD awaiting liver transplantation and 15 healthy, aged‐matched controls had body compartment analysis using a four compartment model (body cell mass, fat mass, extracellular water, and extracellular solids). Subjects also had measurements of resting energy expenditure (REE) and respiratory quotient (RQ) by indirect calorimetry. Nine patients and 15 control subjects also had measurements of total energy expenditure (TEE) using doubly labelled water.

Results

Mean weights and heights were similar in the two groups. Compared with control subjects, children with ESLD had higher relative mean body cell mass (33 ± 2% vs 29 ± 1% of body weight, P < 0.05), but had similar fat mass, extracellular water, and extracellular solid compartments (18% vs 20%, 41% vs 38%, and 7% vs 13% of body weight respectively). Compared with control subjects, children with ESLD had 27% higher mean REE/body weight (0.285 ± 0.013 vs 0.218. ± 0.013 mJ/kg/24h, P < 0.001), 16% higher REE/unit cell mass (P < 0.05); and lower mean RQ (P < 0.05). Mean TEE of patients was 4.70 ± 0.49 mJ/24h vs 3.19 ± 0.76 in controls, (P < 0.01).

Conclusions

In children, ESLD is a hypermetabolic state adversely affecting the relationship between metabolic and nonmetabolic body compartments. There is increased metabolic activity within the body cell mass with excess lipid oxidation during fasting and at rest. These findings have implications for the design of appropriate nutritional therapy.
Lecithin Decreases Human Milk Fat Loss During Enteral Pumping
Authors: Chan Melissa M. , Nohara Masaru , Chan Benjamin R. , Curtis Julie , Chan Gary M.
Published: January 2024

Background

The fat content of human milk provides the majority of calories for infants. However, large fat losses in human milk have been observed using enteral pump systems, causing poor growth in infants. The fat may adhere in the pump system. Lecithin, a phospholipid, has been used in the food industry as a lipophilic emulsifier of fats.

Objective

The purpose of this study was to evaluate the effects of lecithin on the delivery of human milk fat from an enteral pump. It is hypothesized that the addition of lecithin would decrease the fat loss during human milk delivery.

Methods

Six mothers at a mature stage of lactation (>4 weeks of lactation) donated human milk. The human milk samples were stored separately at −20°C before analysis and evaluated individually. The fat content of the milk samples was estimated by the creamatocrit method, in which the samples were centrifuged in a standard hematocrit tube and the fat layer read with vernier calipers and expressed as a percentage of the length of the milk column to the nearest 0.5%. The accuracy of this method is 92%. The Kangaroo 324 Feeding Pump (Sherwood Medical, St. Louis, MO) was used as the continuous pump system. The human milk samples were divided into either control samples without lecithin or with lecithin (1 or 0.5 g soy lecithin dissolved in 50 mL milk). All samples were pumped at 10 to 50 mL/h for at least 4 hours. The pumped milk was collected in an iced container, and creamatocrits were determined in duplicate.

Results

There was significant fat loss in the control milk samples compared with the milk samples with added lecithin. The average fat loss was 58% ± 13% for control samples and 55% ± 26% for the milk with 0.5 g soy lecithin. Milk with 1 g soy lecithin averaged 2% ± 2% fat loss. The pumping rate had no effect on fat loss. The greatest fat loss (70% ± 6%)occurred during the first 4 hours of pumping.

Conclusions

The addition of 1 g soy lecithin per 50 mL milk decreased the human milk fat loss during intermittent pumping and may help infants receive more calories from human milk administered by pump.
Incidence and Risk Factors of Oral Antibiotic‐Associated Diarrhea in an Outpatient Pediatric Population
Authors: Turck Dominique , Bernet Jean‐Paul , Marx Jacques , Kempf Hélène , Giard Patrick , Walbaum Olivier , Lacombe André , Rembert Françoise , Toursel Francis , Bernasconi Paul , Gottrand Frédéric , McFarland Lynne V. , Bloch Karine
Published: January 2024

Background:

Little information is available on the epidemiologic characteristics of antibiotic‐associated diarrhea (AAD) in children. The authors' aim was to evaluate the incidence of AAD in an outpatient pediatric population and to identify risk factors.

Methods:

Children aged 1 month to 15.4 years treated with oral antibiotics for a proven or suspected infection were enrolled from an ambulatory pediatric practice during an 11‐month period. Parents recorded the daily frequency and characteristics of stools using a diary during the antibiotic treatment and for 1 week after it was stopped. An episode of diarrhea was defined by at least 3 soft or liquid stools/d for at least 2 consecutive days. Risk factors for AAD—age, type of antibiotic treatment, type of combined treatment, and site of infection— were analyzed.

Results:

Of 650 children included, 11% had an episode of AAD, lasting a mean of 4.0 ± 3.0 days, beginning a mean of 5.3 ± 3.5 days after the start of antibiotic treatment. No child was hospitalized because of AAD. The incidence of AAD was higher in children less than 2 years (18%) than in those more than 2 years (3%; P < 0.0001). The incidence of AAD was particularly high after administration of certain antibiotics (amoxicillin/clavulanate, 23%; P = 0.003 compared with other antibiotics). The type of combined treatment and site of infection did not influence the onset of AAD.

Conclusions:

Antibiotic‐associated diarrhea was common in these outpatient children, especially for those aged less than 2 years and after the prescription of certain antibiotics, particularly, the combination of amoxicillin/clavulanate. JPGN 37:22‐26, 2003.
Psychological Distress Associated With Home Parenteral Nutrition in Swedish Children, Adolescents, and Their Parents: Preliminary Results
Authors: Engström Ingemar , Björnestam Berit , Finkel Yigael
Published: January 2024

Objectives

Home parenteral nutrition (HPN) is life saving in some patients with intestinal failure. Clinical experience suggests that there may be psychologic problems in HPN children, including food refusal on reintroduction of food, parent–child conflict, sibling rivalry, and disruption of family routine. The aim of this study was to investigate the psychologic distress in children with HPN and the social integration of their parents.

Methods

The parents were asked to fill in three questionnaires anonymously– one regarding the HPN procedures; the Child Behavior Checklist, which provides a standardized description of children's behavioral problems, as reported by their mothers; and the Interview Schedule for Social Interaction (ISSI), which in its short form comprises 30 questions about social network and social support.

Results

The Child Behavior Checklist questionnaires were returned from 20 families (80% response), and the ISSI questionnaires were returned from 21 families (84% response). Children and adolescents with HPN are quite distressed psychologically. The subscale within ISSI that measures social integration was significantly higher in the HPN group, whereas the subscale that measures adequacy of social integration did not differ between the groups. Both subscales measuring attachment were significantly lower in the HPN group.

Conclusions

This study shows that children and adolescents with HPN are quite distressed psychologically, even though the exact reason for this may be somewhat unclear. The social integration of the parents is high, whereas attachment, which deals with deeper, emotional relations, is negatively affected.
Bone Mineral Density in Children With Untreated and Treated Celiac Disease
Authors: Kavak Umut S. , Yüce Aysel , Koçak Nurten , Demir Hülya , Saltik İnci Nur , Gürakan Figen , Özen Hasan
Published: January 2024

Objectives

Osteopenia is a common complication in adults with celiac disease. The effect of a gluten‐free diet on bone mineral density is a matter of controversy. The aim of this study was to investigate bone mineral density in children with celiac disease at diagnosis and in patients treated for 1 year.

Methods

Bone mineral density and bone mineral content were measured in 34 children with untreated celiac disease at diagnosis and in 28 patients on a gluten‐free diet for 1 year. The results were compared with those of 64 gender‐ and age‐matched healthy control subjects. Serum calcium, phosphate, alkaline phosphatase, 25 ‐hydroxy vitamin D, and intact parathormone levels were determined in treated and untreated patients.

Results

The mean values of bone mineral density and bone mineral content of untreated patients with celiac were significantly lower than the control group (P = 0.006 and P = 0.005, respectively) and treated patients (P = 0.015 and P = 0.011 respectively). Treated patients had mean bone mineral density and bone mineral content values not significantly different from those of healthy control subjects. Minor hypocalcemia was detected in 17.6% of the patients with new diagnoses and 3.6% of the treated patients. Of the untreated patients, 29.4% had high intact parathormone concentrations; in untreated patients, the total was 14.3%. Untreated patients had significantly lower serum calcium and significantly higher intact parathormone levels than did treated patients. The other bone metabolism parameters were similar in the two celiac groups.

Conclusion

Children with celiac disease are at risk for reduced bone mineral density. A strict gluten‐free diet improves bone mineralization, even in 1 year. Early diagnosis and treatment of celiac disease during childhood will protect the patient from osteoporosis.
Does Breast Feeding Influence Liver Biochemistry?
Authors: Jørgensen Marianne Hørby , Ott Peter , Juul Anders , Skakkebæk Niels Erik , Michaelsen Kim Fleischer
Published: January 2024

Objective

It is assumed that early feeding can affect liver biochemistry because breast‐fed infants have a higher risk of hyperbilirubinemia than formula‐fed infants. The authors sought to determine how feeding mode affected liver biochemistry in healthy term infants.

Methods

Healthy term infants were followed up during infancy with a monthly questionnaire about feeding mode. Blood samples were obtained at 2, 6, and 9 months. Liver biochemistry (serum albumin, alkaline phosphatase, lactic dehydrogenase, aspartate aminotransferase [AST], and bilirubin), total insulin‐like growth factor 1 (IGF‐I), and insulin growth factor binding protein 3 (IGFBP‐3) were determined at all ages.

Results

Mean AST and bilirubin were significantly higher in breast‐fed infants at 2 and 6 months. In addition, mean albumin levels were higher in breast‐fed infants at 2 months. Alkaline phosphatase, IGF‐I, IGFBP‐3, and lactic dehydrogenase levels did not differ between the feeding groups. AST levels did not correlate significantly with bilirubin, albumin, alkaline phosphatase, or lactic dehydrogenase values. There was a strong positive association between AST and IGF‐I at 2 months (r = 0.47, P = 0.004).

Conclusion

Cytomegalovirus infection, vitamin K deficiency, and macromolecular forms of AST could be an explanation for a higher AST level among breast‐fed infants. However, no other clinical or paraclinical sign of liver disease was seen, all infants were given oral vitamin K, and the AST did not rise to levels comparable to those seen in individuals with macromolecular AST. The authors speculate the most likely explanation of the elevated AST is induction of hepatocytes by factors in human milk. This is supported by the higher albumin levels in breast‐fed infants and the positive association between AST and IGF‐I.