bluuebunny/crossref_metadata_2025 huggingface dataset:
Three‐Year Growth and Developmental Follow‐Up of Very Low Birth Weight Infants Fed Own Mother's Milk, A Premature Infant Formula, or One of Two Standard Formulas
Authors: Cooper Peter A. , Rothberg Alan D. , Davies Victor A. , Horn Juana , Vogelman Lloyd
Published: January 2024

A cohort of 40 very low birth weight (VLBW) infants was followed until they reached 3 years of age. These infants were originally part of a feeding trial in the early postnatal period whereby they were fed either their own mother's milk, a standard whey‐predominant formula, a casein‐predominant formula, or a premature formula. Those fed the latter formula grew significantly better while in the hospital and had no biochemical derangements. At 3 years of age, there were no significant intergroup differences with respect to growth or development. There was a positive correlation between head growth in hospital and weight at 3 years, but there were no other significant relationships between early postnatal growth and growth parameters at 3 years. Socioeconomic status was the only predictor of developmental scores at 3 years of age. No adverse effects from early metabolic acidosis or alterations of amino acid profiles during the neonatal period were detectable at 3 years of age. However, the small sample size of this study may have missed true differences in outcome measures at 3 years, and larger studies are required to examine these questions further.
Nutrient Balance in the Preterm Infant. 3. Effect of Balance Duration on Outcome Measurements
Authors: Cooke Richard J. , Paule Chuck , Ruckman Karen
Published: January 2024

To determine the effect of balance duration on outcome measurements 18 84‐h balances were performed in a group of formula‐fed preterm infants (birth weight = 1,362 ± 125 g; gestational age = 32.3 ± 1.7 weeks). Each 84‐h balance was broken into contiguous 48− and 36‐h periods. Comparisons (paired t tests, paired variance tests, and linear regression analysis) were made between the 48‐h and 36‐h (paired t and F tests) and between the 48‐h and 84‐h collections (simple linear regression). Nitrogen absorption (mean ± SD) during 48‐h collection (365 ± 58 mg/kg/day and 87 ± 3%) was not significantly different from that of the 36‐h collection (381 ± 66 mg/ kg/day and 84 ± 4%). Nitrogen retention during the 48‐h collection (301 ± 59 mg/kg/day, 72 ± 6%) also was not significantly different from that of the 36‐h collection (318 ± 64 mg/kg/day, 72 ± 6%). Moreover, nitrogen absorption and retention during the 48‐h collection were significantly related (p < 0.0001 for linear regression comparisons) to that of the 84‐h collection. Similar observations were noted for calcium, phosphorus, magnesium, zinc, and copper absorption and retention. We conclude that a 48‐h collection may be used in place of an 84‐h collection without compromising the accuracy of the balance data in the enterally fed preterm infant.
Cervical Esophageal Perforation Diagnosed by Endoscopy in a Premature Infant
Authors: Vandenplas Yvan , Delree Marc , Bougatef Adel , Sacre Liliane
Published: January 2024

A case of cervical esophageal perforation in a premature infant by an orogastric polyvinyl chloride (PVC) tube is reported. Perforation appeared as an esophageal atresia, suspected because of the inability to aspirate gastric secretions. Initially, atresia was confirmed by an esophagogram, but endoscopy revealed a “double esophagus” with a normally located and developed esophagus and a blind mediastinal fistula starting at the opposite side of the glottis. The “double esophagus” was confirmed by an esophagogram, followed by a contrast study in the pharynx. Esophageal perforation in the neo‐nate is an iatrogenic disease that may mimic esophageal atresia. We recommend endoscopy instead of contrast studies for suspected esophageal atresia.
Crohn's Disease Lesions in the Upper Gastrointestinal Tract
Authors: Mashako Mamba Nyenya Léonard , Cezard Jean Pierre , Navarro Jean , Mougenot Jean Francois , Sonsino Elise , Gargouri Abdellatif , Maherzi Ahmed
Published: January 2024

The incidence of Crohn's disease (CD) lesions in the upper gastrointestinal (GI) tract of both adults and children is frequently underestimated. In this prospective study, a total of 31 children suspected of having Crohn's disease were systematically examined to identify upper digestive tract lesions. They all underwent barium transit endoscopy with multiple‐level biopsies. Typical clinical symptoms suggestive of upper GI tract involvement were found in 5 children (16%), radiological signs in only one child (3%), endoscopic lesions in 13 children (42%), and specific granulomas in 12 children (39%). In eight of these 12 children, the biopsies were taken from macroscopically normal areas of the esophagogastroduodenal mucosa. One of the 31 children had no abnormal radiological and endoscopic features suggestive of CD on the distal small bowel and the colon. There was no correlation between the clinical, radiological, and histological data. Endoscopy plus biopsy provided a positive diagnosis in 39% of cases and a confirmation of the diagnosis in 87% of cases. Endoscopic and histological evidence of CD of the upper GI tract is often present despite an absence of clinical symptoms or radiological changes. Upper GI tract endoscopy with multiple biopsies may be important in the evaluation of this condition and even in some cases for the establishment of the diagnosis.
Amyloidosis in Children with Inflammatory Bowel Disease
Authors: Kahn E. , Markowitz J. , Simpser E. , Aiges H. , Daum F.
Published: January 2024

Reactive systemic or secondary amyloidosis occurs in 1–29% of adults with Crohn's disease, but only sporadic cases of amyloidosis have been recognized in children with inflammatory bowel disease. We therefore have studied operative specimens (ileal, ileocolonic, and colonic) from 46 children (30 with Crohn's disease and 16 with ulcerative colitis) to determine the frequency of amyloid deposits. Sections of bowel, skin, and lymph nodes (n = 940) were stained by Congo red and examined by light microscopy and by polarized light. Amyloid deposits were found in only one of 46 subjects, an 18‐year‐old girl who had had Crohn's disease for 6 years. Intestinal amyloid deposits, present 16 months before the clinical diagnosis of amyloidosis, were patchy and seen predominantly in the intestinal mucosa. We conclude that amyloidosis is rare in children requiring surgery for Crohn's disease and ulcerative colitis. Examination of Congo red‐stained sections can detect even subclinical amyloidosis. The amyloid deposits in our patient, which were both patchy and consistently mucosal, suggest that multiple endoscopic biopsy samples, not necessarily containing submucosa, are sufficient for diagnosis.
α1‐Antitrypsin Deficiency (Pi SZ) and Biliary Atresia
Authors: Tolaymat Naser , Figueroa‐Colon Reinaldo , Mitros Frank A.
Published: January 2024

We report an infant who presented at 2 days of age with conjugated hyperbilirubinemia. Serological, radiographic, and surgical investigations revealed the concurrence of α‐l‐antitrypsin deficiency, protease inhibitor type SZ, and extrahepatic biliary atresia.
Potassium Secretion in Response to Taurodeoxycholic Acid in the Newborn Rabbit Colon
Authors: Potter Gregory D. , Sellin Joseph H. , Burlingame Susan M. , DeSoignie Roland C.
Published: January 2024

The newborn colon fails to secrete Cl in response to concentrations of dihydroxy bile acid that cause Cl secretion in adult colonic tissue in vitro. Bile acids also cause secretion of potassium in adult tissues, but there is no information concerning bile acid effects on potassium transport in newborn colon. We mounted newborn rabbit distal colon in Using chambers specially designed for newborn colon and measured potassium transport. Basal potassium transport was secretory. Taurodeoxycholic acid, 100 μM. (TDC) decreased Jknet from −0.76±0.07 to −0.94±0.11 μEq cm‐2h‐1, p < 0.05, without increasing Isc. Serosal ouabain, 0.1 mM, abolished the secretory response to TDC. Mucosal Ba2+, a potassium channel blocker in many epithelia, did not inhibit K secretion. Similar serosal exposure to TDC in adult colon tissues decreased JKnet, from −0.09 ± 0.29 to ‐ 1.63 μEq cm‐2 h‐1, p < 0.01, and increased Isc. We conclude that, although the chloride secretory response to dihydroxy bile acids is absent in the newborn, K secretion is elicited in the newborn, similar to the adult colon.
Role of 99mTc‐Disofenin in Duodenal and Gastric Aspirates in the Evaluation of Persistent Neonatal Cholestasis
Authors: Tolia V. , Kuhns L. , Dubois R. S.
Published: January 2024

A prospective study was undertaken on 49 infants with prolonged neonatal cholestasis to determine whether the specificity, sensitivity, and accuracy of 99mTc‐disofenin scintigraphy can be improved by performing simultaneous radioactivity measurements on duodenal and gastric aspirates along with routine imaging. Specificity of routine scintigraphy was improved by this modification from 45.7 to 76.4%. Accuracy of the test was also superior in improving from 55% with routine scintigraphy to 78.4% by counting additional radioactivity on both duodenal and gastric aspirates. We suggest that this modified technique be applied in the evaluation of infants with conjugated hyperbilirubinemia so that invasive procedures such as open liver biopsy and operative cholangiogram may be avoided.
Neurovascular and Thromboembolic Complications of Inflammatory Bowel Disease in Childhood
Authors: Lloyd‐Still John D. , Tomasi Lawrence
Published: January 2024

Vascular complications occurred in 3.3% (6 of 180) of children with chronic inflammatory bowel disease. Clinical disease activity was severe in four of six patients who presented with these symptoms. In contrast to adults, in whom deep‐vein thrombotic complications predominate, the majority of children had involvement of the CNS including encephalopathy, arteritis, arterial occlusion, and thromboembolism. One patient died 31/2 years later from progressive intestinal and neurological deficits; morbidity included blindness, epilepsy, and developmental delay. Hematological parameters varied widely. Prevention is not always possible, but risk factors include: (a) family history of collagenosis (83% incidence), (b) severe inanition and immobility, (c) delayed hospitalization, and (d) clinical presentation with cutaneous vasculitis. Therapy must be individualized.
Failure to Label Baboon Milk Intrinsically with Iron
Authors: Figueroa‐Colón Reinaldo , Elwell James H. , Jackson Evelyn , Osborne James William , Fomon Samuel J.
Published: January 2024

The widely held belief that 50% of the iron in human milk is absorbed is based on studies that have used an extrinsic radioactive iron tag. To determine the validity of an extrinsic tag, it is necessary to label the milk intrinsically with one isotope and to compare absorption of this isotope with absorption of another isotope added as the extrinsic tag. We chose the baboon as a model and infused 59Fe intravenously. In each of three attempts we failed to label the milk intrinsically.
Atropine Therapy and Paralytic Ileus in an Infant
Authors: Marshall William F. , Rosenthal Philip , Merritt Russell J.
Published: January 2024

Signs of intestinal obstruction developed in a 2‐month‐old infant with trisomy 21 during atropine therapy. Radiographic evaluation strongly suggested Hirschsprung's disease, but rectal biopsy yielded normal histologic results. Following cessation of atropine use, the symptoms resolved completely. This case report demonstrates the association between atropine therapy and intestinal ileus. Caution is advised when using topical atropine therapy in children, especially those with Down's syndrome.
Differential Effects of Epidermal Growth Factor and Hydrocortisone in Human Fetal Colon
Authors: Ménard Daniel , Corriveau Lina , Arsenault Pierre
Published: January 2024

The influence of epidermal growth factor (EGF) and hydrocortisone on the functional development of human fetal colon was studied in organ cultures. Fetal colon (14 to 17 weeks gestation) was cultured for 5 days at 37°C in serum‐free Leibovitz L‐15 medium alone or supplemented with 1, 10, and 100 ng of EGF/ml or with 50 ng of hydrocortisone/ml of culture medium. The overall morphology of the colonic explants was not altered by the hormonal addition. In the continuous presence of EGF (1, 10, and 100 ng/ml) for 5 days, a significant decrease of [3H]thymidine incorporation into DNA was observed. At the brush border level, the addition of EGF induced a significant drop in sucrase, maltase, and alkaline phos‐phatase activities. These enzymic modifications occurred between the third and fifth day of culture, whereas variation in DNA synthesis was already evident within 24 h. The addition of hydrocortisone at a dose affecting the small intestine (50 ng/ml) did not significantly influence colonic DNA synthesis nor the digestive enzymic activities. These observations show for the first time that EGF, but not hydrocortisone, influences the proliferation and differentiation of human fetal colonic mucosa.
Salmonella typhimurium–Associated Severe Protracted Diarrhea in Infants and Young Children
Authors: Khoshoo V. , Raj P. , Srivastava R. , Bhan M. K.
Published: January 2024

Eleven (13.8%) children (4–14 months; mean of 7.8 ± 3.6 months) presenting with protracted diarrhea (duration >21 days) and weight loss had associated infection with Salmonella typhimurium. All had documented weight loss of 16–25% and progressive clinical deterioration. On admission, they had high purging rates (>4 ml/kg/h), hyponatremia (5/11), mucosal injury, and malabsorption as measured by 1 h blood D‐xylose, fecal α,‐antitrypsin, and oral fat tolerance test. Diarrhea was secretory in 8 of 11 and fecal sodium was high (54–142 mEq/L; mean of 102 ± 27 mEq/L). The organism showed multiple drug resistance. All patients received antibiotics (amikacin and nalidixic acid/norfloxacin) for 10–14 days, which was followed by rapid improvement in clinical status and absorption studies. The two youngest patients died. Due to ethical reasons, an untreated control group was not included. Use of appropriate antibiotics may benefit children with S. typhimurium‐associated severe protracted diarrhea and rapid progressive weight loss.
Feeding Lactose‐Intolerant Children with a Powdered Fermented Milk
Authors: Gendrel Dominique , Dupont Christophe , Richard‐Lenoble Dominique , Gendrel Christine , Chaussain Michèle
Published: January 2024

Fresh yogurt has been proposed as a milk substitute for lactase‐defitient patients. We investigated the possibility that a dried, low‐fat milk fermented by yogurt microorganisms would be effective. Processing of a fermented milk by spray‐drying led to a powder with persistence of lactase activity (11.7 units/g) without storage at 4°C and stable at room temperature (20–23°C). The tolerance and absorption of 10.5 g of lactose in a volume of 150 ml was studied in 25 Gabonese lactase‐deficient children aged 5–14 years in the form of a standard humanized milk formula followed 1 week later by the powdered fermented milk formula. Results of the breath hydrogen test showed that in 24 of 25 cases, lactose absorption was normal with a maximal rise of hydrogen over baseline of under 13 ppm after ingestion of the powdered fermented milk. The rise was above 20 ppm in the 25 children with the same load of lactose in the form of the standard formula and one‐third had symptoms of lactose intolerance. This powdered fermented milk preparation should be considered as a valid approach in programs of nutritional support targeted to countries with a high prevalence of lactase deficiency.
Carnitine Status and Blood Ammonium Levels in Low Birth Weight Infants
Authors: Nakamura Toshiro , Nakamura Shinji , Kondo Yuichi , Ikeda Tetsuo , Ogata Takayuki , Endo Fumio , Matsuda Ichiro
Published: January 2024

Forty‐three low birth weight infants appropriate for gestational age (AGA) were monitored to evaluate carnitine status in relation to blood ammonium levels. The infants were grouped into three depending on blood ammonium level on postnatal day 7:62.9 ± 3.8 μmol/L in group 1 (N =13), 38.9 ± 8.4 μmol/L in group 2 (N =23), and 24.5 ± 2.9 μmol/L in group 3 (N =9). Plasma free carnitine levels decreased in all three groups (p < 0.001) and plasma short chain acylcarnitine increased only in group 1 (p < 0.002), compared to findings in normal infants. The blood ammonium level positively and negatively correlated to plasma short chain acylcarnitine (p < 0.002) and plasma free carnitine levels (p < 0.002), respectively. The reabsorption rate of free carnitine in renal tubules (RRFC) was decreased at rates of 37.5, 27.5, and 25% of infants in groups 1, 2, and 3, respectively. The acylcarnitine/free carnitine clearance ratio (RAFCC) was decreased in groups 1 (p < 0.01) and 2 (p < 0.05) compared with group 3. Thus, an accumulation of short chain acyl moieties and insufficiency in renal absorption of free carnitine are putative causes of lowered plasma free carnitine in infants with higher blood levels of ammonium. The possibility that the carnitine status regulates blood ammonium levels in low birth weight infants warrants continued investigation.
Physicochemical Characterization and Biological Activity of Intrinsic Factor in Cystic Fibrosis
Authors: Monin B. , Guéant J. L. , Gérard A. , Michalski J. C. , Vidailhet M. , Grignon G. , Nicolas J. P.
Published: January 2024

Absorption of crystalline labeled cobalamin is strongly decreased in cases of cystic fibrosis. In order to determine if this is due to an alteration or a lack of activation of intrinsic factor by proteases, the physicochemical properties and biological activity of intrinsic factor have been studied. Intrinsic factor was purified 800‐fold from stimulated gastric juice of cystic fibrosis patients with a yield of 64.2%. Cystic fibrosis intrinsic factor had an estimated Mr of 57,000 in SDS‐polyacrylamide gel electrophoresis. Its carbohydrate content resembled that of normal human intrinsic factor, except that the ratio fucose/sialic acid was higher (6.1 and 1.6, respectively) and that the content in N‐acetylgalactosamine was decreased. The same alterations in carbohydrate composition were observed for He purified from cystic fibrosis saliva. Purified intrinsic factor from cystic fibrosis gastric juice was biologically active in vitro in the presence of ileal solubilized receptor as well as in vivo (Schilling test). The fate of iodinated cystic fibrosis intrinsic factor in guinea pig ileum studied by high‐resolution radioautography was similar to that of normal intrinsic factor. In conclusion, despite modifications of the carbohydrate content of the molecule, the biological activity of intrinsic factor is not altered in cases of cystic fibrosis. The malassimilation of crystalline cobalamin observed in cystic fibrosis is due to a mechanism independent from intrinsic factor secretion.
Effect of Zinc‐Deficient Diet of Varying Duration on Intestinal Disaccharidase Activity in the Rat
Authors: Naveh Yehezkel , Diamond Eric , Waldner Eli , Bogden John D.
Published: January 2024

To determine whether zinc has a specific role on weight gain and intestinal disaccharidase activity, 42 male Sprague‐Dawley rats were assigned to one of seven groups (n =6 each). These were a baseline control group (O) that was killed to analyze initial intestinal disaccharidase (sucrase and maltase) activity, a second group (A) fed a zinc‐deficient diet for 1 week, a third group (B) pair‐fed control for A, a fourth group (C) fed a zinc‐deficient diet for 2 weeks, a fifth group (D) pair‐fed control for C, a sixth group (E) fed a zinc‐deficient diet for 3 weeks, and a seventh group (F) pair‐fed control for E. All experimental groups received distilled deionized drinking water, whereas control groups received zinc‐enriched (25 μg of zinc/ml) distilled deionized water. Water was given ad libitum. After killing, the mucosa of the proximal half of the small intestine was analyzed for protein and disaccharidase activity, and liver, kidney, and heart were analyzed for zinc concentration. Protein content and disaccharidase activity of the jejunal mucosa in the experiment and control groups did not differ significantly. However, animals on the zinc‐deficient diet demonstrated mildly depressed growth rates that were proportional to the duration of the experiment, and significantly lower zinc concentration in the kidney in the experimental groups. The data indicate that administration of a zinc‐deficient diet for up to 3 weeks did not result in significant changes in intestinal mucosa protein content or in disaccharidase activity.
IgA Anti‐gliadin Antibodies in the Monitoring of Gluten Challenge in Celiac Disease
Authors: Valletta E. A. , Trevisiol D. , Mastella G.
Published: January 2024

The aim of this study was to evaluate the reliability of serum IgA anti‐gliadin antibodies (IgA‐AGA) in the monitoring of gluten challenge and in the prediction of mucosal relapse in children with celiac disease (CD) in order to reduce the challenging procedure to a minimum. Serial evaluations of serum IgA‐AGA titers and 1‐h blood xylose levels were performed in 17 children with celiac disease during gluten challenge. Jejunal biopsy was generally done after two consecutive measurements of positive IgA‐AGA. The morphological appearance of the mucosa and intraepithelial lymphocyte infiltration were also evaluated. A serum positive for IgA‐AGA was observed in 16 of 17 patients between the 15th and 35th day of challenge. The challenge was concluded in all children after 20–45 days from the introduction of a glutencontaining diet after histological confirmation of CD. Plasma xylose test was less reliable in this respect. We conclude that IgA‐AGA measurement by gluten challenge is likely to simplify and allow earlier diagnostic confirmation of celiac disease in children, without intestinal biopsy.
Efficacy and Safety of a Diazepam and Meperidine Combination for Pediatric Gastrointestinal Procedures
Authors: Nahata Milap C. , Murray Robert D. , Zingarelli Josephine , K. Li B. Ulysses , McClung H. Juhling , Lininger Barbara
Published: January 2024

Little has been published about outpatient sedation for pediatric patients. We designed a study to evaluate the efficacy and adverse effects of diazepam and meperidine in combination for sedation in ambulatory pediatric patients undergoing endoscopy, colonoscopy, or liver biopsy. Thirty patients (7 months‐20 years) were observed. Each patient received a single combined dose of intravenous diazepam and meperidine. The standard dose was 0.1 mg/kg for diazepam and 2.0 mg/kg for meperidine. In patients weighing >100 lb, set doses of meperidine (100 mg) and diazepam (5 mg) were used. The time to achieve sedation and the vital signs were measured; cooperation, emotional state, and drowsiness were rated before, during, and after procedures. The amnesic effect was noted, as were any adverse effects. Diazepam and meperidine were effective in 26 of 30 patients, with sedation generally produced within 2–3 min. Cooperation and emotional state improved significantly following drug administration (p < 0.05). When a prospective 24‐h telephone follow‐up study was instituted in 40 consecutive patients receiving diazepam and meperidine no significant adverse effects were noted. Only 20% of patients old enough to be questioned remembered the procedure. Diazepam and meperidine in combination appear to be effective and safe in pediatric patients undergoing gastrointestinal procedures. Prolonged monitoring of patients does not appear necessary in this patient population.
Episodic Vomiting Due to Intermittent Duodenal Intussusception
Authors: Johnston J. Martin , Harnsberger Janet K.
Published: January 2024

Cyclic vomiting is a psychosomatic syndrome, but it is also a diagnosis of exclusion. Before such a diagnosis can be made, an organic basis for the episodes of vomiting must be ruled out. We describe a case of episodic vomiting in a school‐aged girl. Endoscopic examination eventually confirmed a diagnosis of intermittent duodenal intussusception due to an enteric duplication. Removal of the duplication abolished the episodes of vomiting. The differential diagnosis of episodic vomiting is discussed, and the literature on intussusception is reviewed. Endoscopy should be considered in a child with a history of episodic vomiting.
Breath Methane Production in Children With Constipation and Encopresis
Authors: Fiedorek Stephen C. , Pumphrey Cindy L. , Casteel Helen B.
Published: January 2024

Breath methane excretion is uncommon in children compared with adults. Certain intracolonic conditions, however, have been associated with enhanced methane generation. We hypothesized that encopretic and constipated children, who have abnormal colonic transit times, more likely would excrete methane than healthy children. To determine the prevalence of methane excretion among children with encopresis or simple constipation, we performed breath methane analysis on such patients and age‐, race‐, and sex‐matched control subjects. Encopretic patients (mean age, 8.3 ± 3.0 years) had daily, involuntary passage of feces and clinical evidence of constipation. Constipated patients (mean age, 7.1 ± 2.9 years) had a history of hard stools and at least one of the following symptoms: infrequent defecation, dyschezia, hematochezia, difficult stool expulsion, or abdominal pain during bowel movements. Methane excretion was present in 26 of 40 (65%) encopretic patients versus 6 of 40 (15%) control patients (P < 0.001). In contrast, 3 of 27 (11%) constipated patients were methane excreters, versus 2 of 27 (7%) controls (P = 0.4). Fourteen asymptomatic encopretic patients were retested after successful therapy; eight were methane excreters initially, but five of eight did not excrete methane after treatment. We conclude that methane is produced in a large number of children with encopresis. Treatment appears to alter metha‐nogenesis in such patients. The prevalence of methane producers among constipated children is not different from the prevalence in healthy subjects. Methanogenesis in encopretic patients may be enhanced by prolonged colonic transit time or abnormal intracolonic conditions.
X‐Ray Microanalysis of Rotavirus‐Infected Mouse Intestine
Authors: Spencer A. J. , Osborne M. P. , Haddon S. J. , Collins J. , Starkey W. G. , Candy D. C. A. , Stephen J.
Published: January 2024

Neonatal mice were infected at 7 days of age with rotavirus [epizootic diarrhea of infant mice (EDIM) virus] and killed at 24‐h intervals postinfection (PI). Cytoplasmic concentrations of Na, Mg, P, S, Cl, K, and Ca intestinal epithelial cells from infected and age‐matched control animals were measured by x‐ray microanalysis. In villus tip cells, Ca concentration increased at 24–96 h PI; Na concentration increased at 24–72 h PI; Ca and Na concentrations were near normal by 168 h PI. K concentration decreased 24–72 h PI, and Cl concentration decreased 48–96 h PI. In crypt cells, changes were observed without a discernible pattern: at 96 h PI, Na, Mg, S, and Cl concentrations increased and K concentration decreased; at 120 h PI, the concentrations of all elements except Na and Ca increased. In villus base cells, the mean concentrations of all elements except Ca peaked at 48–72 h PI and at 120 h PI. Na and Cl concentrations increased dramatically in some cells from 48 h PI onward. All the above concentration values were obtained from freeze‐dried specimens and expressed in millimoles per kilogram of dry weight. Conversion of a limited number of data, pertaining to villus base cells, from dry weight to wet weight was possible. This conversion revealed that villus base cells in infected animals were more hydrated than corresponding cells from control animals. Also, the Na and Cl concentrations in mmol/kg H2O were significantly higher in villus base cells from infected animals than in those from corresponding controls: 137 ± 7 versus 38 ± 4 (Na) and 121 ± 5 versus 89 ± 6 (Cl). Wet weight concentrations of other elements were either the same (Mg) or lower (P, S, and K) after infection with virus. From these studies, a new concept of the pathophysiology of rotavirus‐induced diarrhoeal secretion is proposed: stimulation of villus base cells to rapid cell division is accompanied by transient accumulation of Na and Cl; excess NaCl is secreted into the lumen, which is the driving force for fluid loss.
Cow's Milk Protein‐Induced Colitis in the Breast‐Fed Infant
Authors: Pittschieler Klaus
Published: January 2024

A 3‐month‐old boy is described who developed an inflammatory proctocolitis during exclusive breast feeding. The major symptom was bloody diarrhea. No growth failure or constitutional symptoms were present. Bacterial, viral, and parasitic infection was excluded. The colonoscopic findings of focal ulceration, edema, and increased friability and the histologic picture with a marked eosinophilic infiltration were indicative of an allergic intestinal reaction. The infant responded favorably to the withdrawal of the mother's milk and the initiation of hydrolyzed casein formula. The challenge with cow's milk led to a clinical relapse resembling the initial manifestation.
Effects of Postweaning Protein Malnutrition on Intestinal Inositol Phosphatase Activities in Normally Weaned and Neonatally Undernourished Rats
Authors: Rao R. K. , Ramakrishnan C. V.
Published: January 2024

Postweaning protein malnutrition imposed on normally weaned or neonatally undernourished rats fed a low‐protein diet induced retardation of body and small intestinal growth. A sparing effect on intestinal growth as compared to body growth was observed during protein malnutrition. Postweaning protein malnutrition in normally weaned rats resulted in a significant elevation of specific activities of inositol triphosphatase and phytase in duodenum and jejunum without affecting the activity in ileum. On the other hand, protein malnutrition imposed on neonatally undernourished rats resulted in a significant decrease of enzyme activities in small intestinel segments. These results suggest altered activity of intestinal inositol phosphatase in post weaning protein malnutrition with the direction of effects dependent on the neonatal nutritional status.
Hyperosmolal Formula in Neonatal Piglets
Authors: Szabo Joanne S. , Rayford Phillip L. , Uthman Edward , Lobe Thom E.
Published: January 2024

Ingestion of hyperosmolal formula (HOF) by neonatal piglets has been shown to cause significant time‐dependent reduction in phase 3 myoclectric activity, which persists in the terminal ileum. To determine whether a single hyperosmolal meal leads to elevated concentrations of gastrointestinal (GI) hormones that inhibit intestinal motility and/or promote bacterial proliferation and disruption of intestinal mucosa, we studied 20 healthy neonatal piglets following feeding with an increased HOF (872 ± 32 mOsmol/kg, n = 10) and commercial pig milk formula (481 ± 41 mOsmol/kg, n = 10). Gastrin, secretin, cholecystokinin, and motilin concentrations were determined by radioimmunoassay during fasting and postprandial periods (15, 30, 45, 120, 180, and 240 min). Gastrin concentrations were significantly increased at 15 and 30 min following a hyperosmolal meal (p < 0.01), but there were no statistical differences in GI hormone concentrations between groups. These transient elevations of gastrin concentrations are associated with significant postprandial reductions in phase 3 small intestinal myoelectric activity (SIMEA) that we have observed. Aerobic bacterial titers were not significantly different between proximal and distal small intestinal segments or between experimental groups, and anaerobic bacteria were seldom recovered. Thus, SIMEA was not sufficiently altered to produce significant bacterial proliferation. Small intestinal histology, assessed by light microscopy, showed normal proximal and distal small intestinal mucosa in 8 of 10 piglets from each group. Therefore, orogastric instillation of a single hyperosmolal feed does not result in intestinal mucosal damage. Further studies are warranted to determine the effects of hyperosmolal feeds when additional risk factors exist in the neonate.
Acetylcholinesterase‐Stained Suction Rectal Biopsies in the Diagnosis of Hirschsprung's Disease
Authors: Schofield Deborah E. , Devine William , Yunis Eduardo J.
Published: January 2024

Conflicting reports in the literature regarding the sensitivity and specificity of the acetylcholinesterase (AChE) stain in establishing or excluding the diagnosis of Hirschsprung's disease (HD) prompted this review of 497 rectal biopsies performed on 455 children. Using hematoxylin and eosin (H&E) to stain formalin‐fixed, paraffin‐embedded tissue sections is our preferred method of identifying ganglion cells. In this series, however, there were eight children with HD, and nine without HD in whom the AChE‐stained portion of the sample provided invaluable diagnostic information not obtained from the concomitant, formalin‐fixed, H&E‐stained portion of the sample. The AChE stain also provided at least suggestive evidence of HD in some of the anal or anorectal biopsy specimens.
Short‐Term Malnutrition in Neonatal Rabbits
Authors: Baker Susan S. , Baker Robert D. , Campbell Cara
Published: January 2024

Oxygen‐derived free radicals are an important component of gastrointestinal injury in necrotizing en‐terocolitis (NEC). To assess the effect of a 72‐h fast on the ability of neonatal small bowel to metabolize free radicals, the activity of superoxide dismutase (SOD), catalase, and the glutathione cycle were quantitated in mucosal scrapings from proximal and distal small bowel of fed and fasted neonatal rabbits. Hexose monophosphate shunt activity, quantitated in enterocytes from fed and fasted neonatal rabbits, was significantly less, p < 0.01, in fasted animals. SOD activity was lower in distal small bowel from fasted animals than fed. The two mechanisms available to metabolize H2O2, catalase and the glutathione cycle, were significantly lower in both proximal and distal small bowel from fasted animals than in those from fed animals. To determine if fasting caused decreased enzyme activity at the level of gene expression, gastrointestinal tract DNA, RNA and protein, and specific mRNA levels for catalase, glutathione peroxidase (GPx), and SOD were quantitated. DNA, total RNA, and mRNA for SOD were lower in mucosal scrapings from fasted animals. However, mRNA for catalase, and GPx were not lower in fasted animals. Thus, a 72‐h fast in neonatal rabbits causes a regional‐specific decrease in SOD activity, which may be explained by decreased transcription. Changes in transcription do not completely account for regulation of catalase and glutathione cycle enzymes.
Transport of Water and Electrolytes by Rotavirus‐Infected Mouse Intestine
Authors: Starkey W. G. , Collins J. , Candy D. C. A. , Spencer A. J. , Osborne M. P. , Stephen J.
Published: January 2024

The movement of water and transport of Na+ and Cl by mid‐small intestine (M‐SI) of rotavirus‐infected neonatal mice was investigated by an in vitro perfusion technique. The concentrations of Na+, K+, and Cl in the luminal contents of upper, middle, and lower small intestine and colon of infected mice were determined by flame photometry (Na+, K+) and an ion selective microelectrode (Cl). In M‐SI, maximal disturbance of water transport occurred at 72 h postinfection (PI): Infected tissue exhibited net water secretion. Water transport was also impaired at 144 h PI. Net secretion of Cl occurred at 72 h PI, with some evidence of a second phase of reduced magnitude at 120–144 h PI. The magnitude and statistical significance of changes in Na+ transport were both less than those for Cl, but the pattern of change was similar to that for Cl. Luminal concentrations of Na+ were elevated between 48 and 144 h PI in the small intestine; this was particularly so in distal regions. Luminal Cl concentration was maximally elevated to a considerable degree at 72 h PI and remained high at 96 h PI throughout the small intestine; thereafter, Cl concentration returned to near normal. K+ concentration was unchanged in the small intestinal lumen; in the colon, however, K+ concentrations were depressed 72–168 h PI. In the light of previous data from this laboratory, the present data are interpreted as evidence for a secretory component in rotavirus‐induced diarrhea.
Normal Energy Intake Range in Children with Chronic Nonspecific Diarrhea
Authors: Ciampolini Mario , Vicarelli Donatella , Seminara Salvatore
Published: January 2024

An increase in energy intake often occurs at weaning. The increase may be due partly to prompting by the caregiver to accelerate the child's weight gain and partly motivated by the palatability of common weaning foods. Increased food intakes initiated during weaning and continued into the second year of life may be associated with chronic, nonspecific diarrhea in selected children. An educational project was designed to reduce intakes augmented by either cause. Reductions were achieved by the regulation of energy‐dense foods in the child's diet and reliance on the child's appetite control to determine meal size. The educational intervention was applied prospectively under nonblinded, controlled conditions. Children, 1 to 2 years of age, with chronic nonspecific diarrhea were assigned randomly to either a treatment or control group. Compliance, food consumption, preprandial glycemia, and outdoor activities were reported by the children's mothers in four 7‐day diaries; symptoms related to the children's clinical condition and anthropometric and biochemical indices of nutritional status were noted at the beginning and end of a 7‐month period. Forty‐four of 53 children in the experimental group maintained compliance, and 44 of 47 children in the control group completed the follow‐up. Energy intake decreased significantly by almost one‐third in the experimental group. Growth, skinfold thickness measurements, and outdoor activities were similar between experimental and control groups over the 7‐month period. Diarrheal episodes occurred in 6, 1, and 2 children in the experimental group at 1.5, 3, and 7 months and in 22, 18, and 15 children in the control group, respectively (p < 0.002). Twenty of 32 parameter of clinical status were more advantageous in the experimental group compared to 9 of 32 in the control group in a comparison of the mean values in the two groups at the final examination (p < 0.05). Serum folate (p < 0.001) also was significantly higher in the experimental group. The described intervention appeared to achieve lower energy intakes in a safe and reproducible manner. It may be a useful tool to prevent overeating and control signs and symptoms associated with chronic, nonspecific diarrhea.
Hypertransaminasemia as the First Symptom in Infant Celiac Disease
Authors: Leonardi Salvatore , Bottaro Gaetano , Patané Rosario , Musumeci Salvatore
Published: January 2024

Two infants admitted for evaluation of hyper‐transaminasemia had high levels of anti‐gliadin IgA and IgG antibodies and histological changes of the duodenal mucosa typical of celiac disease. Although the cause of the liver involvement could not be exactly identified, both the hypertransaminasemia and the histological changes of the mucosa disappeared after a short period of gluten‐free diet. Even though two cases are not enough for definite conclusions, the authors suggest that an unexplained increase in transaminases would require an evaluation for celiac disease.
Pathogenesis of Small‐Intestinal Mucosal Lesions in Chronic Diarrhea of Infancy
Authors: Shiner Margot , Putman Margaret , Nichols Veda N. , Nichols Buford L.
Published: January 2024

In an effort to increase our understanding of the pathogenesis of chronic protracted diarrhea in infants, we examined 44 jejunal mucosal specimens. Only 3 of the 44 specimens showed a normal mucosa (grade 1). Partial villous atrophy was seen in 17 mucosal specimens (grade 2) with marked patchiness in all of the specimens. Subtotal or total villous atrophy (grade 3) was found in the remaining 24 mucosal biopsies. Plasma cells and macrophages were variably increased and intraepithelial lymphocytes were moderately increased in grades 2 and 3. Eight of ten mucosal biopsy specimens embedded in plastic material and cut at 1–2‐mm thickness, showed bacteria of unidentified nature, situated either above the microvillous layer or on the mucosal surface. Both adherent and nonadherent bacteria could be identified in the same specimen. We concluded that severe pathological mucosal changes are common in young infants with protracted diarrhea and that the presence of bacteria may be more common than has previously been documented.
Gastrointestinal Manifestations of Hemolytic Uremic Syndrome
Authors: Grodinsky S. , Telmesani A. , Robson W. L. M. , Pick G. , Scott R. B.
Published: January 2024

A restrospective study of 76 children with hemolytic uremic syndrome (HUS) who were admitted to the Alberta Children's Hospital in Calgary, Alberta between January 1982 and December 1988 was undertaken to explore the gastrointestinal manifestations of the syndrome. The children (mean age of 4.0 ± 3.1 years) presented primarily during the summer months with a microangiopathic hemolytic anemia (Hgb 94 ± 26 g/L), thrombocytopenia (platelets 87 ± 83 x 109/L), and acute renal failure (oligoanuria with a BUN of 26 ± 15 mmol/L, and a creatinine of 294 ± 90 μmol/L). Forty‐three children required dialysis for 10 ± 17 days. The duration of hospitalization was 17 ± 17 days. Four children died of complications attributable to HUS. The following symptoms and gastrointestinal manifestations of HUS were noted: fever (33%), vomiting (80%), abdominal discomfort/tenderness (59%), diarrhea (100%), hemorrhagic colitis (79%), rectal prolapse (13%), colonic stricture (3%), colonic perforation (1%), intussusception (1%), indirect hyperbilirubinemia (49%), and elevated hepatocellular enzymes (58%). Of the last 29 children studied, 19(66%) had elevated levels of amylase and lipase in the presence of acute renal failure, and six (21%) had a marked elevation of lipase (more than four times normal) with additional supportive evidence of pancreatitis. The additional supportive evidence included persistent elevation of lipase after the resolution of acute renal failure in four children, a marked increment in lipase in association with abdominal pain and an abnormal ultrasound of the pancreas after the initiation of oral feeding in a fifth child, and pancreatic exocrine and endocrine necrosis at autopsy in a sixth child. This study reviews the gastrointestinal manifestations of HUS in a large series of patients and presents data to suggest that pancreatitis is a relatively common complication of HUS.
Halothane Hepatitis in Children
Authors: Hassall Eric , Israel David M. , Gunasekaran Thirumazhisai , Steward David
Published: January 2024

Halothane hepatitis is now a well‐recognized distinct entity in adults, but there prevails an often‐taught “axiom” that halothane hepatitis “does not occur” in children. We describe 2 children who developed cholestatic hepatitis following halothane anesthesia. The first patient had no antecedent liver disease, and presented with anorexia, abdominal pain and delayed onset of jaundice after multiple halothane exposures. Halothane‐specific antibodies were positive, and liver tests resolved completely. The second patient had antecedent liver disease and presented with delayed onset of unexplained high fevers for 10 days following a single halothane exposure. Gradually increasing cholestasis ensued in the absence of other causes of liver disease. Halothane antibodies were negative. These cases illustrate different clinical presentations of halothane hepatitis, such as delayed onset of jaundice or fever following halothane exposure. The difficulties in making a definitive diagnosis and the need to exclude other causes of liver disease are detailed. Risk factors and other presentations are discussed. While halothane hepatitis appears to be an uncommon entity in children, it does occur, and may present with manifestations less than fulminant hepatic failure. A high index of suspicion and a detailed history of the time sequence of events are necessary as the diagnosis is primarily clinical. Halothane‐specific antibodies are helpful if positive. In any child developing unexplained jaundice or high fevers following halothane anesthesia, further exposures should be avoided and halothane‐specific antibodies obtained.
Increased Serum Levels of Interleukin‐2 and Soluble Interleukin‐2 Receptor in Celiac Disease
Authors: Penedo‐Pita Manuel , Peteiro‐Cartelle Javier
Published: January 2024

IgA anti‐gliadin antibodies (AGA), interleukin‐2 (IL‐2), and soluble interleukin‐2 receptor (sIL‐2R) were analyzed in serum from 28 children with symptoms of celiac disease and villous atrophy in at least their first small bowel biopsy. We also assayed IL‐2 and sIL‐2R in 45 healthy children and IgA anti‐gliadin antibodies in 145 healthy children. The serum levels of IL‐2, sIL‐2R, and AGA were significantly increased in celiac patients. The increase of IL‐2 and sIL‐2R levels suggests indirectly T‐cell activation in these patients. Receiver operating characteristic (ROC) curves were performed to compare the diagnostic performances of the three parameters. Such an analysis revealed that only AGA was useful to discriminate between patients with a gluten‐free diet (second biopsy negative) and patients receiving a gluten‐containing diet (third biopsy positive).
Rotavirus‐Induced Changes in the Microcirculation of Intestinal Villi of Neonatal Mice in Relation to the Induction and Persistence of Diarrhea
Authors: Osborne Michael P. , Haddon Susan J. , Worton Kim J. , Spencer Anthony J. , Starkey William G. , Thornber Dawn , Stephen John
Published: January 2024

Using a histochemical peroxidase technique, under conditions that preferentially stain erythrocytes, we have shown changes in the microcirculation of villi of neonatal mice infected with murine rotavirus. Between 18 and 48 h postinfection (PI), throughout all areas of the small intestine there occurred, sequentially, a marked ischemia and atrophy of villi. By 72 h PI, villi had recovered their normal height and showed incipient hyperemic microcirculation. At 96 h PI, hyperemic microcirculation was most marked. Between 120 and 144 h PI, a second phase of villus atrophy occurred, which was more attenuated and confined to the upper and middle regions of the intestine. This phase was not accompanied by a widespread ischemia of villi: a minority of villi were short and ischemic but many appeared hyperemic. Recovery of villus microcirculation occurred at 168 h PI, which coincided with recovery from diarrhea. These changes in villus microcirculation are discussed in relation to the pathology and pathophysiology of rotavirus infection. We make two novel suggestions. First, the reduction in red cells flowing through villi in the early stages of the infection instigates hypoxia and hence atrophy of villi. The ensuing but ephemeral increase in rate of cell division, necessary for the reconstitution of villi, induces hypersecretion. Second, the increase in numbers of erythrocytes found in villi during their regrowth phase and throughout the remaining time course of the infection perturbs the countercurrent system, lowering the osmolality of the hyperosmotic zone located at villus tips, thereby impairing water absorption and prolonging diarrhea.