bluuebunny/crossref_metadata_2025 huggingface dataset:
A Packaged Rice‐Based Oral Rehydration Solution for Acute Diarrhea
Authors: Barclay Denis V. , Gil‐Ramos Joaquina , Mora José O. , Dirren Henri
Published: January 2024

Summary: In a 12‐month community study in Ecuadorian preschool children, we compared a packaged rice‐based oral rehydration solution (R‐ORS) that contained 160 g of rice flour and 12 g of sucrose per liter as well as electrolytes and α‐amylase, and required cooking before consumption, to the standard glucose‐electrolyte oral rehydration solution (G‐ORS) for the treatment of acute non‐cholera diarrhea. The reconstituted R‐ORS had energy and protein contents of 620 kcal/L and 12g/L, respectively, and an osmolarity of 230 mosm/L. In all, 156 cases were treated with the R‐ORS and 144 with the standard G‐ORS. Cases treated with R‐ORS had a significantly shorter duration of diarrhea (p < 0.0001; median; 34 h versus 48 h), a lower number of stools (p < 0.001; median; four versus seven), and a greater weight gain after 4 days of treatment (p < 0.05; mean; 1.6% versus‐0.2%) than those treated with G‐ORS. ORS and total liquid intakes tended to be higher with the R‐ORS. The two ORS were equivalent for the correction of mild dehydration and the maintenance of normal hydration status.
The Trophic Action of Human Growth Hormone on Human Duodenal Mucosa Cultured In Vitro
Authors: Challacombe D. N. , Wheeler E. E.
Published: January 2024

The influence of human growth hormone (hGH) on crypt cell proliferation in cultured explants of human duodenal mucosa has been studied, using a stathmokinetic technique with crypt microdissection. The addition of hGH (0.004 μ/ml) to paired duodenal explants from eight patients significantly increased epithelial crypt cell proliferation (p < 0.001), showing that hGH has a trophic action on the human duodenal mucosa in vitro.
Improved Energy Intakes Using Amylase‐Digested Weaning Foods in Tanzanian Children with Acute Diarrhea
Authors: Darling Jonathan C. , Kitundu Jesse A. , Kingamkono Rose R. , Msengi Abel E. , Mduma Benedicta , Sullivan Keith R. , Tomkins Andrew M.
Published: January 2024

Amylase from germinating cereal grains enables the preparation of porridge with a higher energy density than conventional weaning foods. This food can be combined with fermentation, which inhibits pathogen growth. These food technologies are inexpensive, can be implemented at the household level, and are therefore particularly appropriate for use in developing countries. In a controlled clinical trial, 75 children aged 6–25 months admitted to hospital with acute diarrhea were rehydrated and then randomly allocated to three corn porridge dietary groups: conventional, amylase‐digested (AMD), and fermented and amylase‐digested (FAD). The study diets were given ad libitum five times daily, and all intakes except breast milk were weighed. Mean daily energy intakes over 4 days in the conventional AMD, and FAD groups, respectively, were 32.4 (95% CI 28.7–36.6), 46.0 (CI 39.6–53.4), and 37.3 (CI 31.8–43.9) kcal/kg/day. The energy intake in the AMD group was 42% higher than the conventional group (p = 0.003). There were no significant differences between the groups for duration of diarrhea, frequency of stooling, or vomiting. Starch digestion using amylase from germination is an effective way of improving energy intake in children with acute diarrhea.
Early Proliferative Events Following Intestinal Resection in the Rat
Authors: Sacks Alan I. , Warwick Ginger J. , Barnard John A.
Published: January 2024

Partial resection of the small intestine results in compensatory proliferation and adaptation in the remaining small intestinal mucosa. The molecular mechanisms governing the proliferative response are not known, nor has the timing of events associated with proliferation been adequately defined, particularly during the period just after resection. We designed experiments to characterize early (within 24 h) proliferative events associated with proximal intestinal resection and sought to determine the cell type that first responds to proliferative stimuli. Twenty‐one day old male Sprague‐Dawley rats underwent a 70% proximal intestinal resection or transection (control). Poly(A) RNA was isolated from the distal (ileal) remnants. Northern blots showed a marked induction of the immediate early genes zif‐268, nup‐475, and c‐myc 1–3 h following resection, but not following transection. Immunohistochemical analysis of c‐myc expression in ileal crypt epithelial cells showed a biphasic induction that was most marked 6 h after resection and less prominent 24 h after resection. Immunostaining with 5‐bromodeoxyuridine (5‐BrdU) was restricted to ileal crypt nuclei and was maximal 24 h after resection. All these events were observed in the absence of nutrient intake. Taken together, these data show that a potent nutrient‐independent stimulus for intestinal epithelial cell proliferation occurs within minutes of partial small intestinal resection and that the first targets of this stimulus are crypt epithelial cells in the residual intestine.
Effect of Three Levels of Vitamin D Intake in Preterm Infants Receiving High Mineral‐Containing Milk
Authors: Koo Winston W. K. , Krug‐Wispe Susan , Neylan Michael , Succop Paul , Oestreich Alan E. , Tsang Reginald C.
Published: January 2024

Very low‐birth weight (VLBW) infants fed high‐calcium and high‐phosphorus (10.74 and 6.93 mmol/MJ; 180 and 90 mg/100 kcal, respectively) infant formulas were randomized to one of three levels of vitamin D intake to approximate 200, 400, and 800 IU/day. Sixty‐two infants completed the study (24 to 29 days), with actual mean daily vitamin D intakes of 161, 361, and 766 IU, respectively. Outcomes were not different by group: gains in body weight, length and head circumference, serum calcium, magnesium, phosphorus, alkaline phosphatase, osteocalcin, 25‐hydroxyvitamin D, 1,25‐dihydroxyvitamin D, and urine calcium:creatinine and magnesium:creatinine ratios. There were no radiographic fractures and/or rickets. A subset of 19 infants was followed between 173 and 380 days to determine descriptively if there was any delayed effect of earlier manipulation of vitamin D intake. They were fed standard infant formulas with a vitamin D content of 400 to 420 IU/L. No significant differences were present among the three groups, and data were combined. Serum 25‐hydroxyvitamin D increased (p < 0.05), osteocalcin decreased (p < 0.05), and 1,25‐dihydroxyvitamin D decreased (p = 0.06) at follow‐up. Thus, for VLBW infants fed high‐calcium and high‐phosphorus milk, an average daily vitamin D intake as low as 160 IU maintains normal and stable vitamin D status and normal physical growth, biochemical and hormonal indexes of bone mineral metabolism, and skeletal radiographs versus randomized infants receiving about 400 or 800 IU of vitamin D per day. On follow‐up, vitamin D status remained normal for ≥ 6 months while infants received <400 IU of vitamin D per day.
Human Milk K‐Casein and Inhibition of Helicobacter pylori Adhesion to Human Gastric Mucosa
Authors: Strömqvist Mats , Falk Per , Lennart Hansson Sven Bergström , Lönnerdal Bo , Normark Staffan , Hernell Olle
Published: January 2024

Readily digested caseins, which account for almost half of the protein content in human milk, are important as nutritional protein for breast‐fed infants. It has also been advocated that part of the antimicrobial activity of human milk resides in the caseins, most likely the glycosylated K‐casein. To explore this possibility, we purified K‐casein from human milk to homogeneity by a two‐step size‐exclusion chromatography procedure. Purified human K‐casein, in contrast to K‐casein purified from bovine milk, effectively inhibited the cell lineage‐specific adhesion of fluoroisothiocyanate‐labeled Helicobacter pylori to human gastric surface mucous cells. The inhibitory activity was abolished by metaperiodate oxidation and considerably reduced by preincubation with α‐L‐ fucosidase but not with α‐N‐acetylneuraminidase or endo‐β‐galactosidase. These results strongly support the view that fucose containing carbohydrate moieties of human K‐casein are important for inhibition of H. pylori adhesion and, thus, infection. They also suggest that breastfeeding may protect from infection by H. pylori during early life and that species‐specific glycosylation patterns, as illustrated by human and bovine K‐casein, partly determine both the narrow host spectrum of this human gastric pathogen and the capacity to resist infection.
ENERGY EXPENDITURE IN CONGENITAL HEART DISEASE
Authors: Taminiau Jan A. J. M. , Broekhoff C. , Houwen R. H. J. , de Meer K.
Published: January 2024

Barton et al. studied body composition and energy expenditure in eight infants <6 months of age with severe congenital heart disease. All infants were awaiting surgery because of poor symptom control and failure to thrive despite the best possible medical management. Total daily energy expenditure (TDEE) in these infants was measured with the doubly labeled water method. Barton et al. found that TDEE in the patients with congenital heart disease was similar to TDEE in age‐ and sex‐matched reference children measured with the same technique (Br J Nutr 1989;62:621–9). However, when expressed on a weight basis, TDEE was significantly increased in the cardiac patients versus the reference children (426 ± 12 vs. 280 ± 60 kJ/kg/day or 101 ± 3 vs. 67 ± 14 kcal/kg/day). Although the energy intake calculated from dietary records in these patients seemed reasonable for their body weights (483 kJ/kg/day or 115 kcal/ kg/day), it was only 82% of the estimated average requirement. It was therefore not surprising that the mean weight gain in these patients (14.5 g/day) was considerably lower than expected. The total body fat in the infants was also severely diminished in comparison with controls. It was estimated that a gross energy intake of 600 kJ/kg/day (or 143 kcal/kg/day) is necessary for normal growth in patients with severe congenital heart disease during the first months of life. Barton and co‐workers were able to measure TDEE in four patients after surgery; in these infants, TDEE remained elevated (mean, 381 kJ/kg/day or 91 kcal/ kg/day), but the values in individual patients were not consistent with preoperative measurements.
Absorption of Milk‐Borne Insulin‐Like Growth Factor‐I Into Portal Blood of Suckling Rats
Authors: Philipps Anthony F. , Dvořák Bohuslav , Kling Pamela J. , Grille James G. , Koldovský Otakar
Published: January 2024

Background

Insulin‐like growth factors (IGFs) are potent mitogens that have been implicated in control of growth and development during the perinatal period. These hormones are also present in biologically significant quantities in mammalian milks. Although one site of action of these IGFs may be at the intestinal level, current information about whether they pass intact into the circulation is conflicting.

Methods

To test the hypothesis that milk‐borne IGFs are absorbed into blood in receptor‐active form, suckling rats were given either recombinant human (rh)125I‐IGF‐I or ‐II (4 × 106 counts per minute [cpm]), and the activity present in portal and cardiac blood was examined at 5, 10, 20, and 30 minutes after ingestion for presence of appropriate molecular weight peptides in these samples. In selected samples, purified radioactive samples were tested for their ability to bind competitively to crude membranes bearing IGF receptors.

Results

The results of these studies indicate that rh125I‐IGF‐I is absorbed in receptor‐active form into the portal circulation and that maximal amounts are present 20 to 30 minutes after ingestion. Estimation of the presence of intact hormone was made on the basis of the elution profile of samples when run on gel chromatography as well as reversed‐phase high‐performance liquid chromatography. Isolated samples from portal blood also bound competitively to placental membranes bearing IGF receptors. In contrast, rh125I‐IGF‐II could not be demonstrated in receptor‐active form in portal blood. Chromatography showed appropriate sized peaks with greater activity in portal than cardiac samples, but competitive binding was not appreciated.

Conclusions

It is likely that at least milk‐borne IGF‐I is absorbed intact and may exert effects on liver and other peripheral tissues. In addition, this study lends further credence to the possibility of an enterohepatic circulation for IGF‐I.
Vitamin A Supplementation in Acute Diarrhea
Authors: Yurdakök Kadriye , Özmert Elif , Yalçin S. Songül , Laleli Yahya
Published: January 2024

Background

Vitamin A supplementation reduces the severity of subsequent diarrheal episodes. This study was conducted to examine the effect of single oral high‐dose vitamin A supplementation on the duration of acute diarrhea in 6‐to 12‐month‐old infants who are not malnourished.

Method

In this double‐blind, randomized, placebo‐controlled study, infants who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Diarrheal Diseases Training and Treatment Unit with acute diarrhea were randomly assigned either to a group receiving a single oral dose of 100,000 IU vitamin A or placebo. There were 60 infants in each group. All infants were followed up until the diarrheal episode ended. Serum vitamin A levels were determined both at admission and 2 weeks later.

Results

No effect of vitamin A supplementation could be demonstrated on either the total duration of diarrhea (7.4 ± 3.2 days in the treatment group vs. 7.8 ± 3.1 days in the placebo group) or on its duration after intervention (3.8 ± 2.3 days in the treatment group vs. 3.9 ± 1.9 days in the placebo group;P > 0.05 for both comparisons). Serum vitamin A levels were not significantly different at admission (23.5 ± 9.7 μg/dL in the treatment group vs. 24.1 ± 9.7 μg/dL in the placebo group;P > 0.05) nor at the end of a follow‐up period of 2 weeks (treatment: 33.3 ± 13.7 μg/dL, placebo: 35.2 ± 11.2 μg/dL;P > 0.05). However, the increase in serum vitamin A levels at the end of the 2‐week follow‐up interval for infants in both the treatment and placebo groups were found to be significant compared with levels at admission (P < 0.01). The mean weight gain in both groups were similar by the end of the first month (6.9 ± 5.0% in the treatment group vs. 6.3 ± 4.2% in the placebo group;P > 0.05).

Conclusion

No effect of oral vitamin A supplementation on serum vitamin A levels, duration of diarrhea, or weight gain during an acute diarrheal episode could be demonstrated in our study group of infants between 6 and 12 months of age who had no malnutrition.
Pressure Pain Threshold in Children With Recurrent Abdominal Pain
Authors: Duarte Marco Antônio , Goulart Eugênio Marcos Andrade , Penna Francisco José
Published: January 2024

Background

Experimental studies on humans have shown that recurrent pain is associated with altered pain perception. We measured the pressure pain threshold in regions of the body surface in a group of children who had recurrent abdominal pain and in a group of children with chronic or recurrent disease but with no pain.

Methods

Each group consisted of 45 boys and 55 girls ranging in age from 5 to 15.8 years. The regions of the body were the trapezius, deltoid, and supraspinous muscles, nine areas on the abdominal wall, and the median part of the tibias. Using an algometer, pressure was applied through a rubber disc with a surface area of 1 cm2 at a rate of 0.5 kg/cm2/s. The pressure values recorded with the algometer when the children communicated that they started to feel pain were considered as pressure pain thresholds.

Results

The pain thresholds were reduced in all regions investigated in children with recurrent pain. The median thresholds for all regions of the patients with and without pain were 1.60 and 2.2 kg/cm2, respectively. The diseases of children with pain did not influence the pain thresholds.

Conclusion

There was an association between recurrent abdominal pain and a lower pressure pain threshold, with no influence of the type of disease, and there was a central nervous system alteration in the perception of pain in these patients.
Energy Supplements Rich in Linoleic Acid Improve Body Weight and Essential Fatty Acid Status of Cystic Fibrosis Patients
Authors: Steinkamp Gratiana , Demmelmair Hans , Rühl‐Bagheri Ina , von der Hardt Horst , Koletzko Berthold
Published: January 2024

Background

Patients with cystic fibrosis who have steatorrhea frequently are underweight and have essential fatty acid (EFA) depletion, which is associated with a poor clinical course. It has been stated that poor EFA status is difficult to correct in patients with cystic fibrosis, and an impaired EFA metabolism with reduced synthesis of long‐chain polyunsaturated fatty acids has been proposed. In this study, the effects of an oral energy supplement rich in linoleic acid were investigated in patients with cystic fibrosis who had a body weight below 95% of normal for height.

Methods

Thirty‐six patients (16 girls) more than 4 years of age were randomized either to a control group (n = 20, age 13.3 ± 3.8 years, mean ± SD) receiving intensive dietary counseling only, or an intervention group (n = 16, age, 10.4 ± 4.3 years) treated for 3 months with dietary counseling plus 628 ± 254 mL (=kcal) per day of an energy supplement rich in fat (31% of energy) and linoleic acid (16% of energy).

Results

In contrast to the control group, the patients with supplemented diets achieved significant increases of energy intake (2189 ± 731 kcal/day vs. 2733 ± 762 kcal/day), weight for height (82.8% ± 8.6% vs. 84.8% ± 9.6% of normal), and body fat (5.1 ± 1.7 kg vs. 5.8 ± 2.2 kg) as well as the initially low values of plasma phospholipid linoleic acid (11.8% ± 1.1% vs. 17.6% ± 1.6% of total phospholipid fatty acids) and its main metabolite arachidonic acid (4.4% ± 0.4% vs. 5.9% ± 0.3%).

Conclusions

Patients with cystic fibrosis with low body weight and poor EFA status benefit from EFA‐rich energy supplements and can synthesize arachidonic acid from the precursor linoleic acid.
Influence of a β‐Glucan–Enriched Bedtime Snack on Nocturnal Blood Glucose Levels in Diabetic Children
Authors: Rami Birgit , Zidek Thomas , Schober Edith
Published: January 2024

Background

The high prevalence of low nocturnal blood glucose levels is a major problem in the treatment of children with diabetes.

Methods

The effect of a β‐glucan–enriched bedtime snack on nocturnal blood glucose levels was examined in comparison with an equicaloric conventional snack in 38 children with diabetes during a 12‐night study period.

Results

A significant influence of the type of bedtime snack on the blood glucose course until 2 AM could be observed (P < 0.05). However, there was no difference in the prevalence of nocturnal hypoglycemic blood glucose levels, which was 27% at 2 AM.

Conclusion

Silent nocturnal hypoglycemia is common in children with diabetes. The introduction of a fiber‐enriched bedtime snack may flatten the blood glucose curve before midnight but cannot prevent low 2 AM blood glucose. Other therapeutic strategies that reduce the risk of asymptomatic and symptomatic nocturnal hypoglycemia would be beneficial to many children with diabetes.
Smectite in the Treatment of Acute Diarrhea: A Nationwide Randomized Controlled Study of the Italian Society of Pediatric Gastroenterology and Hepatology (SIGEP) in Collaboration With Primary Care Pediatricians
Authors: Guarino Alfredo , Bisceglia Massimo , Castellucci Giuseppe , Iacono Giuseppe , Casali Luigi Gobio , Bruzzese Eugenia , Musetta Antonella , Greco Luigi ,   SIGEP Study Group for Smectite in Acute Diarrhea.
Published: January 2024

Background

Childhood gastroenteritis is associated with considerable health costs. The natural clay dioctahedral smectite increases intestinal barrier function and is effective against infectious diarrhea in children in developing countries. The purpose of this work was to investigate the efficacy of smectite in Italian children with acute diarrhea of mild to moderate severity.

Methods

A national, prospective, randomized, case‐controlled study was performed in collaboration with primary care pediatricians. Children seen by pediatricians for acute gastroenteritis were treated with oral rehydration solution (ORS) alone or ORS with smectite. Parents returned a form in which total duration of diarrhea, incidence of vomiting and fever, persistence of diarrhea for more than 7 days and hospital admissions were recorded.

Results

Eight hundred four children with acute diarrhea were randomly assigned to treated or control groups. Administration of smectite was associated with significant reduction of the duration of diarrhea, as judged by stool frequency and consistency. The incidence and duration of vomiting and fever were not different. Diarrhea lasted more than 7 days in 10% of treated and in 18% of control children (P < 0.01). Hospital admission was necessary in seven treated and six control children. No side effects were observed.

Conclusions

Smectite reduces the duration of diarrhea and prevents a prolonged course. It may therefore consistently reduce the costs of gastroenteritis.
An Infant Formula Free of Glycomacropeptide Prevents Hyperthreoninemia in Formula‐Fed Preterm Infants
Authors: Rigo Jacques , Boehm Günther , Georgi Gilda , Jelinek Jürgen , Nyambugabo Kindja , Sawatzki Günther , Studzinski Fréderic
Published: January 2024

Background

Hyperthreoninemia is a well‐known phenomenon in infants fed a whey protein‐predominant formula. Sweet whey is commonly used for the production of these whey‐predominant infant milk formulas. Sweet whey contains not only whey proteins but also the threonine‐rich glycomacropeptide (GMP). In the current study, an experimental formula based on acid whey without GMP and a formula based on sweet whey with GMP (threonine content 17.2 % higher than in the experimental formula) but otherwise with identical composition were tested with particular respect to threonine metabolism.

Methods

Fourteen preterm infants appropriate for gestational age were enrolled in this randomized cross‐over study. After a feeding period of at least 7 days, the nutrition of each infant was switched to the other formula for the second feeding period. At the end of each feeding period, the concentrations of creatinine and amino acids in the plasma and in the urine were measured.

Results

In the plasma, the threonine concentration was significantly lower in the group fed the experimental GMP‐free formula than in the group fed the sweet whey formula (P < 0.001). Renal excretion of all essential amino acids was generally very low and less than 2% of the intake, indicating that the kidneys had no marked homeostatic function with respect to plasma amino acid. The plasma concentrations of the threonine metabolites glycine and serine, and that of urea were not influenced by diet.

Conclusion

Feeding a whey protein‐predominant bovine milk produced from acid whey protein reduces significantly the hyperthreoninemia commonly found in formula‐fed preterm infants. Thus, acid whey formulas should be recommended for feeding preterm infants.
Effect of Preterm Formula With and Without Long‐Chain Polyunsaturated Fatty Acids on the Urinary Excretion of F2‐Isoprostanes and 8‐Epi‐Prostaglandin F2α
Authors: Stier Christian , Schweer Horst , Jelinek Jürgen , Watzer Bernhard , Seyberth Hannsjörg W. , Leonhardt Andreas
Published: January 2024

Background

The objective of this study was to evaluate the effect of conventional and long‐chain polyunsaturated fatty acids (LCP)‐enriched preterm formula on the endogenous formation of F2‐isoprostanes and 8‐epi‐prostaglandin (PG) F2α as possible markers of lipid peroxidation in preterm infants during their first weeks of life.

Methods

In a prospective, randomized, double‐blind study, infants received either formula enriched with LCP (n = 8), standard preterm formula (n = 7), or (expressed) breast milk (n = 8). Urine was sampled at study entry and after the study period of 3 weeks. The formation of F2‐isoprostanes and 8‐epi‐PGF2α was evaluated by measuring the urinary excretion by gas chromatography–mass spectrometry.

Results

No differences in the urinary excretion of F2‐isoprostanes and 8‐epi‐PGF2α were observed at the end of the study period.

Conclusions

This result suggests that supplementation of a preterm formula with LCP for a period of 3 weeks does not stimulate lipid peroxidation in preterm infants.
Technetium‐99m HMPAO‐Labeled Leukocyte Imaging Compared with Endoscopy, Ultrasonography, and Contrast Radiology in Children with Inflammatory Bowel Disease
Authors: Alberini Jean–Louis , Badran Abdul , Freneaux Eric , Hadji Said , Kalifa Gabriel , Devaux Jean–Yves , Dupont Christophe
Published: January 2024

Background

The purpose of this study was to evaluate retrospectively the value of leukocyte‐labeled scintigraphy, ultrasonography, and contrast radiography compared with endoscopy in children suspected of having inflammatory bowel disease (IBD).

Methods

Twenty‐eight children (17 boys; mean age, 10.2 years) with IBD based on standard colonoscopic, histologic, and radiologic criteria (16 with Crohn's disease, 5 with ulcerative colitis, 5 with nonspecific colitis, 1 with granulomatous disease, and 1 with Behçet's disease) were included. Endoscopic, ultrasonographic, and contrast radiologic examinations were realized for 28, 23, and 19 children respectively.

Results

Sensitivity and specificity were 75% and 92% for leukocyte‐labeled scintigraphy, 39% and 90% for ultrasonography, and 58% and 83% for contrast radiography. The authors noted discontinuous uptake for 14 of 15 true‐positive results for patients with Crohn's disease and continuous uptake for 4 of 4 true‐positive results for patients with ulcerative colitis. A negative correlation between scan activity index and Lloyd–Still clinical score was found for 11 patients with Crohn's disease (r = −0.77).

Conclusions

Leukocyte‐labeled scintigraphy, a noninvasive and reproducible technique, is a useful tool in the diagnosis and therapeutic strategy of IBD, and provides information on the presence, the intensity, and the extent of the disease, particularly in the terminal ileum. Leukocyte‐labeled scintigraphy may not replace colonoscopy with biopsies for diagnosis confirmation. Its reliability seems higher than that of ultrasonography.
Duodenal Tube Test in the Diagnosis of Biliary Atresia
Authors: Larrosa–Haro Alfredo , Caro–López Angélica María , Coello–Ramírez Pedro , Zavala–Ocampo Jesús , Vázquez–Camacho Gonzalo
Published: January 2024

Background

Biliary atresia (BA) is the main cause of severe liver damage in infants. Successful surgical treatment is related directly to an early and rapid diagnosis. The aim of this study was to determine specificity, sensitivity, and predictive value of the duodenal tube test (DTT) in the diagnosis of BA in a series of infants with cholestatic jaundice.

Methods

This was a descriptive study of a series of infants with cholestatic jaundice created to validate the sensitivity, specificity, and predictive value of the DTT in the diagnosis of BA. A total of 254 patients were identified from 1988 to 1998. The study cohort included 137 male infants (53.9%), and the mean age on admission was 8.3 weeks ± 2.47 weeks (standard deviation). Study protocol included liver function tests, liver ultrasound, metabolic screening and serology for viral hepatitis, and toxoplasma, rubella, cytomegalovirus, herpes, and others. A nasoduodenal tube was placed at the distal duodenum and the fluid was collected for 24 hours. DTT was considered bile positive when yellow biliary fluid was observed; the test was concluded at this time. When no yellow biliary duodenal fluid was observed, the collection was continued for 24 hours and, if negative, was reported as bile negative. The patients with a bile‐positive DTT were not explored surgically, and the cholestasis workup was completed. Laparotomy and a surgical cholangiogram were indicated in patients with bile‐negative DTT. If BA was verified, portoenterostomy was performed. The gold standard for BA diagnosis was the following: obstruction of the biliary tract confirmed by laparotomy and a surgical cholangiogram, and clinical outcome in patients without laparotomy (followed for a minimum of 18 months).

Results

The results are as follows. BA: bile‐positive DTT, n = 3; bile‐negative DTT, n = 108. No BA: bile‐positive DTT, n = 134; bile‐negative DTT, n = 9. The following values were also determined: sensitivity, 97.3%; specificity, 93.7%; positive predictive value, 92.3%; and negative predictive value, 98.5%. The final diagnoses were as follows: BA, n = 111 (43.7%); neonatal hepatitis syndrome, n =103 (40.6%); cholestasis associated with inspissated bile syndrome, n = 13 (5.1%); choledochal cyst, n = 11 (4.3%); galactosemia, n = 9 (3.5%); cirrhosis of unknown etiology, n = 5 (2%), and Alagille syndrome, n = 2 (0.8%).

Conclusions

The data obtained from this series validate the DTT as a useful clinical tool for the differential diagnosis of the infant with cholestasis, particularly for indicating laparotomy and cholangiogram to substantiate BA. This diagnostic test is quick and simple, and offers the clinician valuable information with which to determine whether surgical intervention is necessary.
Relation Between Serum Insulinlike Growth Factor‐1, Insulinlike Growth Factor Binding Protein‐2, and Insulinlike Growth Factor Binding Protein‐3 and Nutritional Intake in Premature Infants With Bronchopulmonary Dysplasia
Authors: Price Wayne A. , Lee Edward , Maynor Angela , Stiles Alan D. , Clemmons David R.
Published: January 2024

Background

The usefulness of serum insulinlike growth factor (IGF)‐system–peptide measurement to assess the adequacy of nutritional intake in premature infants with chronic lung disease bronchopulmonary dysplasia (BPD) was assessed.

Methods

Twenty‐nine premature infants had serial measurements taken of their serum IGF‐1, insulinlike growth factor binding protein (IGFBP)‐2, and IGFBP‐3 concentrations between 2 and 6 weeks of age. Regression analyses were used to examine the relation between nutritional parameters and IGF‐1, IGFBP‐2, and IGFBP‐3 concentrations in premature infants with and without BPD.

Results

The group of infants with BPD (n = 12) did not differ from infants without BPD (n = 17) in gestational age or weight at entry, but gained less weight during the study period. In infants without BPD, IGF‐1 correlated positively with protein intake (r = 0.50) and caloric intake (r = 0.41) over the 3 days before sample collection and with weight change over the previous week (r = 0.46). In contrast, infants with BPD showed a significant correlation between IGF‐1 and weight change (r = 0.54) only. There was a significant negative correlation between IGFBP‐2 and protein intake in infants without BPD (r = −0.50) and in infants with BPD (r = −0.41). Negative correlations between IGFBP‐2 and both weight change (r = −0.64) and caloric intake (r = −0.43) over the previous week were found only in the group of infants without BPD. IGFBP‐3 correlated positively with weight changes and protein intake in both groups but correlated with caloric intake only in the group without BPD. Multiple regression analyses were used to determine significant independent variables associated with IGF‐1, IGFBP‐2, and IGFBP‐3. In infants without BPD, significant independent predictors of IGFBP‐2 were 7‐day weight change and 2‐day protein intake; 3‐day caloric intake was the only significant independent predictor for IGFBP‐3. For infants with BPD, 3‐day weight gain was the only independent variable associated with serum IGF‐1. Protein intake in the week before sample collection was an independent predictor of IGFBP‐2 and 3‐day weight change and 2‐day protein intake were independent predictors of IGFBP‐3.

Conclusions

These results confirm that changes in serum IGF‐1, IGFBP‐2, and IGFBP‐3 reflect the nutritional status of premature infants and demonstrate that the relation between these proteins and nutritional intake differs in premature infants with and without BPD. Refinement of these observations by future studies may permit a more accurate determination of the protein and caloric intake sufficient for growth and repair after injury in premature infants with lung disease.
Nutritional Efficacy of Preterm Formula With a Partially Hydrolyzed Protein Source: A Randomized Pilot Study
Authors: Picaud Jean‐Charles , Rigo Jacques , Normand Sylvie , Lapillonne Alexandre , Reygrobellet Bernadette , Claris Olivier , Salle Bernard L.
Published: January 2024

Background

Decreased nitrogen levels, calcium intestinal absorption rates, and plasma amino acid imbalances were reported for preterm infants who were fed partially hydrolyzed preterm formulas. In this pilot study, we evaluated a new formula with modified nitrogen and calcium sources.

Methods

During their second week of life, 16 preterm infants were randomly assigned to one of two groups: 9 were fed the new partially hydrolyzed formula and 7 were fed a conventional formula. Nutrient balance was performed at the end of the first month of life. Amino acid concentrations and anthropometric parameters were measured at theoretical term.

Results

Birth weight and gestational age (mean ± SD) were similar in the two groups (28.9 ± 7.0 weeks and 1183 ± 242 g vs. 27.7 ± 1.0 weeks and 1139 ± 162 g). Median nitrogen absorption rates (85% vs. 89%;P = 0.03) and biological values (59% vs. 69%;P = 0.13) were lower for infants who were fed the new formula than for those fed the conventional formula. After correction for difference in nitrogen intake, there was no significant difference in nitrogen retained between the two groups (P = 0.11). Plasma amino acid concentrations were also similar in the two groups. Median calcium absorption tended to be higher in the new‐formula group than in the conventional‐formula group (54% vs. 45%, P = 0.19). At theoretical term, infants fed the conventional formula were heavier than infants fed the new formula (3559 ± 362 g vs. 3193 ± 384 g, P = 0.04).

Conclusions

Because nitrogen content is 10% higher in hydrolyzed‐protein formula than in entire‐protein formula, appropriate nitrogen retention, plasma amino acid profile, and mineral use can be achieved with the new partially hydrolyzed formula. Further studies with larger groups are needed to evaluate the effect on growth.
An Epidemiological Survey of Hepatitis C Virus Infection in Italian Children in the Decade 1990–1999
Authors: Bortolotti Flavia , Iorio Raffaele , Resti Massimo , Verucchi Gabriella , Giacchino Raffaella , Vegnente Angela , Vajro Pietro , Marazzi Maria Grazia , Marcellini Matilde , Barbera Cristiana , Zuin Giovanna , Zancan Lucia , Maggiore Giuseppe ,   Italian Observatory for the Epidemiology of Hepatitis C Virus Infection
Published: January 2024

Background

A retrospective–prospective survey of Italian children with hepatitis C virus (HCV) infection was planned in 1998 to explore the epidemiologic features of infection during the past decade.

Methods

Anti‐HCV–positive patients (or HCV RNA–positive infants) aged 1 month to 16 years, consecutively observed in 20 pediatric Institutions, were considered. An anonymous epidemiologic questionnaire based on clinical records was used.

Results

From 1990 through March 1999, 606 patients were observed (296 boys, average age 5.8 years). Maternal infection (46% of cases) and blood transfusions (34%) were the most frequent risk factors. Of 279 infected mothers, 61% did not recall a putative source of infection (by history, many could possibly have had exposure through routes such as therapeutic injections with nondisposable material), whereas 94 (34%) admitted drug abuse, including 49 (17%) coinfected with human immunodeficiency virus (HIV). Only 157 (26%) children were born after 1991: 90% of their mothers were infected (11% were HIV coinfected vs. 25% mothers of older children, P < 0.01).

Conclusions

Maternal infection is a prominent source of pediatric HCV infection in Italy. The fact that most mothers had a history of covert exposure to HCV, probably through percutaneous routes that are no longer operating, and that the number of those with HIV coinfection has decreased suggests that the frequency of pediatric infection could decrease in the future.
Extremely Short Small Bowel Induces Focal Tubulointerstitial Fibrosis
Authors: Hebiguchi Tatsuzo , Kato Tetsuo , Yoshino Hiroaki , Mizuno Masaru , Wakui Hideki , Komatsuda Atsushi , Imai Hirokazu
Published: January 2024

Background

Arginine becomes an essential amino acid after massive resection of the small bowel as a result of decreased biosynthesis of citrulline in the remaining small bowel. It is also reported that nitric oxide (NO) is synthesized from l ‐arginine by NO synthase (NOS), and NO is involved in the regulation of blood flow in the kidney. The authors observed a patient with an extremely short small bowel, showing focal tubulointerstitial fibrosis. The experiment was designed to clarify whether massive small bowel resection (SBR) produces focal tubulointerstitial fibrosis in the kidney.

Methods

An experimental study was performed using 4‐week‐old rats with 90% proximal SBR either with or without arginine supplementation for 6 weeks after surgery.

Results

In rats without arginine supplementation, low plasma levels of citrulline and arginine increased urinary excretion of orotate, and focal tubulointerstitial fibrosis was observed 6 weeks after 90% SBR. The data from plasma amino acid chromatography and increased excretion of urinary orotate suggested the presence of arginine deficiency. The kidney pathology was similar to that of our patient. Rats with arginine supplementation after 90% SBR and pair‐fed control rats without 90% SBR showed almost normal glomeruli and tubulointerstitium.

Conclusions

Experimental study strongly suggests that arginine deficiency causes focal tubulointerstitial fibrosis in the kidney after massive SBR.
Phenotypic and Genetic Analysis of Diarrhea‐Associated Escherichia coli Isolated From Children in the United Kingdom
Authors: Knutton Stuart , Shaw Robert , Phillips Alan D. , Smith Henry R. , Willshaw Geraldine A. , Watson Peter , Price Elizabeth
Published: January 2024

Background

A hospital‐based study was performed to (1) compare phenotypic and genotypic diagnostic tests for enteropathogenic Escherichia coli, enteroaggregative E. coli, and diffuse‐adhering E. coli (collectively termed adherent E. coli) and (2) to assess the importance of these different classes of adherent E. coli as causes of infant diarrhea in the United Kingdom in comparison with other enteropathogens.

Methods

E. coli isolated from 1,496 infants with diarrheal disease and from 546 age‐related controls were screened for enteropathogenic E. coli, enteroaggregative E. coli, and diffuse‐adhering E. coli using HEp‐2 cell adherence assays and DNA probes.

Results

Marked discrepancies between the phenotype and genotype of isolates indicate significant heterogeneity among enteroaggregative E. coli and diffuse‐adhering E. coli strains. Depending on the assay used, adherent E. coli were isolated as the only putative pathogen in 23% to 27% of diarrhea cases, a significantly higher incidence than in the control group. Individually, enteroaggregative E. coli (8.5–8.6% of cases) and diffuse‐adhering E. coli (10.4–11.3% of cases), but not enteropathogenic E. coli (4.5–7.5% of cases), were significantly associated with diarrhea.

Conclusions

These studies indicate that adherent E. coli may be an important cause of diarrhea in infants in the United Kingdom; they also emphasize the need for more specific virulence‐based tests for these putative classes of “diarrheagenic” (diarrhea causing) E. coli.
Influence of Oral Inoculation With Plasmid‐Free Human Escherichia coli on the Frequency of Diarrhea During the First Year of Life in Human Newborns
Authors: Figueiredo Paulo Pimenta , Vieira Enio Cardillo , Nicoli Jacques Robert , Nardi Regina Drummond , Raibaud Pierre , Duval‐Iflah Yvonne , Penna Francisco José
Published: January 2024

Background

This study was carried out to determine whether early inoculation of the plasmid‐free human Escherichia coli into human newborns would reduce the frequency of acute diarrhea during a 1‐year period. The plasmid‐free E. coli strain isolated from the fecal microbiota of a healthy adult was nontoxigenic in vivo and in vitro and sensitive to all usual antibiotics.

Methods

In the experimental group, 51 healthy newborns were inoculated orally with 10 6 viable cells of the bacteria within 2 hours after birth. In the control group, the same number of newborns received the heat‐killed bacteria. The clinical trial was double blind, and the newborns were randomly assigned to the experimental and control groups.

Results

Six months and 1 year after bacterial inoculation, infants in the experimental group showed a higher mean body weight (7.59 ± 1.15 kg and 9.88 ± 1.31 kg, respectively;P < 0.05) when compared with the control group (7.03 ± 1.09 kg and 8.92 ± 1.38 kg, respectively). At the end of the clinical trial, 48% (23/48) of the infants in the experimental group had shown at least one diarrhea episode during the 1‐year period, as opposed to 71% (34/48) in the control group. These values were significantly different (P = 0.037), showing a 32.3% protective effect of inoculation.

Conclusions

The present study shows that protection against diarrhea was obtained by oral inoculation with a single dose of plasmid‐free human E. coli soon after birth.
Hepatobiliary and Pancreatic Complications of Ascariasis in Children: A Study of Seven Cases
Authors: Bahú Maria da Graça Soares , Baldisseroto Matteo , Custodio Carolina Moraes , Gralha Clarissa Zavagna , Mangili Alexandre Rampinelli
Published: January 2024

Objectives

This study presents seven cases of severe hepatobiliary and pancreatic complications of ascariasis in children. The authors describe the clinical, laboratory, and imaging findings, as well as the patients’ clinical evolution.

Methods

These cases were studied within a period of approximately 1 year and included children younger than 11 years (mean age, 4.4 years). The authors reviewed their medical history and evaluated the results of their main diagnostic examinations.

Results

All of the patients had vomiting, abdominal pain, pallor, and abdominal distension at presentation. Passage of Ascaris lumbricoides in stool occurred in five cases, emesis with worms in three, fever in three, and hepatomegaly in two. Five patients had pancreatitis, of which two were necrohemorrhagic and one had pseudocyst of the pancreas. In three patients, A. lumbricoides was present in the pancreatic duct. Two patients had hepatic abscess (28.6%), and one of them also had cholangitis. One of the patients with pancreatitis also had signs of cholecystitis at presentation.

Conclusions

Ultrasonography was the imaging diagnostic method of choice and demonstrated the presence of A. lumbricoides in the biliary and the pancreatic ducts, as well as signs of pancreatitis, cholecystitis, and hepatic abscess. Endoscopic retrograde cholangiopancreatography, used to confirm the diagnosis, was a fundamental procedure in the treatment, allowing the removal of worms from the biliary duct in four of seven patients.
Pediatric “PSC‐IBD”: A Descriptive Report of Associated Inflammatory Bowel Disease Among Pediatric Patients With PSC
Authors: Faubion W. A. , Loftus E. V. , Sandborn W. J. , Freese D. K. , Perrault J.
Published: January 2024

Background

Inflammatory bowel disease (IBD) in adults with primary sclerosing cholangitis (PSC) is characterized by pancolonic involvement, a high frequency of rectal sparing, and an increased risk of pouchitis and colorectal neoplasia. The clinical features of IBD in pediatric patients with PSC have not been well described. The aim of this study was to characterize the frequency, clinical features, and natural history of IBD in pediatric patients diagnosed with PSC.

Methods

A retrospective chart review was performed for all patients 18 years of age or younger diagnosed with PSC seen at the Mayo Clinic between 1975 and 1999. Endoscopic and histologic features and surgical and postsurgical outcomes were recorded.

Results

Fifty‐two children with PSC were identified. Forty‐three patients (84%) were also diagnosed with IBD. In 36 of 43 cases, there was a sufficient diagnostic evaluation to allow a detailed review. Thirty‐two of 36 patients (89%) had ulcerative colitis and 4 of 36 patients (11%) had Crohn’s disease. In 4 of 36 patients (11%), IBD was asymptomatic. Although the most frequent endoscopic presentation of IBD was universal colitis, endoscopic rectal sparing was frequently noted (27% of colonoscopic studies). Of the four patients diagnosed with Crohn disease, in none did perianal, fistulizing, or stricturing disease develop. Proctocolectomy was performed in six patients (17%); three operations were performed for dysplasia. Pouchitis complicated four of the five ileal pouch–anal anastomoses procedures.

Conclusions

Among pediatric patients (1) PSC without IBD is uncommon; (2) asymptomatic IBD may be associated with PSC; (3) because the time to dysplasia may be accelerated, once the diagnosis of IBD is made in the setting of PSC, heightened endoscopic surveillance may be indicated; (4) pouchitis occurs frequently in these patients.
Laparoscopic and Thoracoscopic Esophagomyotomy for Children With Achalasia
Authors: Mehra M. , Bahar R. J. , Ament M. E. , Waldhausen J. , Gershman G. , Georgeson K. , Fox V. , Fishman S. , Werlin S. , Sato T. , Hill I. , Tolia V. , Atkinson J.
Published: January 2024

Background

Minimally invasive esophagomyotomy, consisting of a laparoscopic or thoracoscopic approach, has become a preferred surgical treatment for adults with achalasia. This multicenter study reports on the clinical status of children who have undergone minimally invasive esophagomyotomy for achalasia.

Methods

Symptomatology for achalasia was assessed in 22 pediatric patients who underwent minimally invasive esophagomyotomy for achalasia between 1995 and 2000. All patients were evaluated for duration of hospitalization, postoperative resumption of feeds, postoperative complications, and symptomatic relief. Participants were assigned pre‐and postoperative symptom severity scores ranging from 0 (no symptoms) to 3 (severe).

Results

The median age of the 10 females and 12 males at time of surgery was 11.3 years ± 3.4 (standard deviation). Transabdominal laparoscopic esophagomyotomy with fundoplication was performed in 18 patients, and thoracoscopic esophagomyotomy without fundoplication was performed in 4. Two patients required conversion from transabdominal laparoscopic esophagomyotomy to open esophagomyotomy because of intraoperative esophageal perforation. The mean duration of postsurgical follow‐up was 17 ± 16 (standard deviation) months (range, 1–54 months). Mean duration of hospitalization (days ± standard error or mean) was less for transabdominal laparoscopic esophagomyotomy than for converted open esophagomyotomy (2.7 ± 0.3 vs. 9.0 ± 3.0 days;P < 0.05) or for thoracoscopic esophagomyotomy (4.8 ± 1.7 days;P = not significant). Mean time to resumption of soft feedings (days ± standard error or mean) occurred sooner after transabdominal laparoscopic esophagomyotomy than after converted open esophagomyotomy (2.0 ± 0.2 vs. 5.5 ± 0.5 days;P < 0.001) or after thoracoscopic esophagomyotomy (4.0 ± 1.3 days;P = not significant). Patients experienced significant pre‐to postoperative improvement in mean severity score with regard to dysphagia (2.6 vs. 0.4;P < 0.001) and regurgitation (1.7 vs. 0.2;P < 0.001).

Conclusions

Minimally invasive esophagomyotomy can provide excellent symptomatic relief from dysphagia and regurgitation for children with achalasia.