bluuebunny/crossref_metadata_2025 huggingface dataset:
Calcium Metabolism in Children Recovering from Severe Protein‐Energy Malnutrition
Authors: Caballero Benjamin , Solomons Noel W. , Torun Benjamin , Pineda Oscar
Published: January 2024

Twenty preschool children with severe edematous protein‐energy malnutrition (PEM) were studied during the first 45 days of recovery. All children received 4 g/kg/day of protein and 150 kcal/kg/day of energy from a milk‐based recovery formula, providing 130–140 mg/kg/ day of calcium (Ca). Children were randomized to two treatment groups, one receiving intact milk formula and the other a lactose‐free preparation. Both groups showed a high efficiency of intestinal calcium absorption, sustained even after the normalization of weight for height and lean body mass. The presence or absence of lactose in the diet did not affect intestinal calcium absorption, and increased stool volume in the early period of recovery in the children receiving intact milk was not associated with higher fecal Ca losses. Urinary Ca excretion was within the range reported for healthy children under a normal diet. These results suggest that therapeutic amounts of calcium should be delivered to children with PEM well beyond the normalization of body weight and lean body mass.
Effects of the Composition and Caloric Value of Infant Formulas on Intake and Hormone Levels
Authors: Zoppi G. , Mantovanelli F. , Casali L. Gobio , Astolfi R. , Cecchettin M.
Published: January 2024

Seventy‐six normal full‐term infants have been observed from birth to the fourth month of life. Thirty‐six were breast‐fed; the others were fed four different feeds (conventional or adapted formulas) containing different amounts of calories, protein, fat, and carbohydrate. The control mechanism of volume intake appears to be well functioning in infants fed human milk and adapted formulas providing conventional calorie concentrations. The other formulas were associated with either a high BUN or high base insulin concentrations. It is concluded that uncontrolled amounts of milk should be fed only to breast‐fed infants and those receiving adapted formulas but not to those fed formulas that provide high calorie or protein concentrations.
Growth, Biochemical Status, and Mineral Metabolism in Very‐Low‐Birth‐Weight Infants Receiving Fortified Preterm Human Milk
Authors: Modanlou Houchang D. , Lim Mary O. , Hansen James W. , Sickles Virginia
Published: January 2024

We compared the growth, biochemical status, and mineral status of 30 very‐low‐birth‐weight infants randomly assigned to receive preterm human milk (Group I, 10 infants) from their own mothers, fortified preterm human milk (Group II, 8 infants), or a high‐caloric‐density premature formula (Group III. 12 infants). Added to the infant's own mother's milk, a human milk fortifier at full strength provided additional protein (60:40 whey/casein, 0.7 g/dl), calories (4 kcal/oz), and minerals. Volume of intake, feeding tolerance, and complications were similar in the three groups. Infants receiving fortified preterm human milk showed growth, biochemical status, and mineral status similar to those receiving high‐caloric‐density formula, but infants receiving fortified preterm human milk grew faster (12.0 ± 3.2 vs. 8.9 ±1.1 days/300 g. p < 0.05), had higher serum protein (4.6 ± 0.5 vs. 4.2 ± 0.2 g/dl, p < 0.05). and tended to have better mineral status (higher serum calcium, lower alkaline phosphatase, and higher serum phosphorus, none individually significant) than infants receiving preterm human milk alone. This study supports previous observations that fortified preterm human milk provides nutritional advantages for very‐low‐birth‐weight infants.
Red Cell Destruction and Bilirubin Production in Adult Rats with Short‐Term Biliary Obstruction
Authors: Salomon William L. , Vreman Hendrik J. , Kwong Linda K. , Stevenson David K.
Published: January 2024

The rate of total bilirubin production and the concomitant relative rate of early‐labeled bilirubin (ELB) formation were studied in adult Wistar rats with short‐term common bile duct ligation. The pulmonary excretion rate of CO (Veco), an index of total bilirubin production, was measured preoperatively and postoperatively on day 3 and on day 5 or 6. While the Veco measurements of control and experimental animals were similar preoperatively, the postoperative Veco measurements of the experimental animals averaged 30% higher than those of control animals. On postoperative day 3, the relative rate of ELB formation was measured by the recovery of excreted 14CO after the administration of 14C‐labeled 8‐aminolevulinic acid (ALA) or glycine as nonerythropoietic or total heme synthesis precursor, respectively. No significant differences were found in the 14CO recovered from either compound during the study period between the experimental and control animals. The half‐life of 51Cr‐labeled transfused red blood cells was decreased by nearly 50% in bile duct ligated rats compared to that in the sham operated ones. We conclude that hemolysis is a major factor contributing to the increase in total bilirubin production even after short‐term biliary obstruction in the rat.
Long‐Term Neuropsychological Outcome in Children Undergoing Portal‐Systemic Shunts for Portal Vein Obstruction Without Liver Disease
Authors: Alagille Daniel , Carlier Jeanne‐Charlotte , Chiva Matty , Ziadé Richard , Ziadé Marianne , Moy Françhise
Published: January 2024

Forty‐two children with portal vein obstruction (cavernoma) and without liver disease had a portosystemic surgical shunt performed at different ages. All of them had severe gastrointestinal hemorrhage prior to surgery. To evaluate the long‐term neurological and psychological effects of shunt procedures in children with normal liver function, they were studied up to 24 years postoperatively with psychometric testing. A comparison with two control groups as to the impact of surgery, family situation, and neonatal events was considered. Twenty‐four children with portal vein obstruction who were not operated on and 19 children splenectomized for hematological reasons acted as the control groups. No differences were observed in schooling and employment. Psychometric tests were almost identical in shunted patients and in the control groups. Minimal portal systemic encephalopathy appeared to be undetectable clinically either by electroencephalogram or by venous ammonia levels. The results of psychometric tests appear to show no loss of intellectual and psychological capacity in patients operated on for portal obstruction. Only visual memory and spatiotemporal tests showed slightly worse results in those children who underwent this procedure. Further longitudinal studies are required to substantiate these findings.
The Use of Nifedipine for the Treatment of Achalasia in Children
Authors: Maksimak Martin , Perlmutter David H. , Winter Harland S.
Published: January 2024

Four adolescents with achalasia were treated with nifedipine. All the patients' symptoms improved dramatically. On manometric evaluation, following oral nifedipine, the lower esophageal sphincter pressure decreased approximately 50%. No change in esophageal peristaltic activity was noted. Side effects were minimal; two patients had mild headache initially. Nifedipine, which is commonly used in adult patients with achalasia, may be beneficial for short‐term symptomatic relief in children until more definitive therapy can be performed.
Diurnal and Within‐Feed Variations in Lipase Activity and Triglyceride Content of Human Milk
Authors: Freed Lois M. , Neville Margaret C. , Hamosh Paul , Hamosh Margit
Published: January 2024

This study examined the diurnal and withinfeed variations in the two lipases of human milk, bile‐salt‐stimulated lipase (BSSL) and lipoprotein lipase (LPL). In addition, all milks were also analyzed for triglyceride content. As compared to BSSL, LPL activity was more variable both among mothers and among different samples from the same mother (largest variation, 0–2.8 U/ml milk). The only significant variation in lipase activity was in LPL activity during a 24‐h period (0.96 × 0.113, 0.52 × 0.21, and 0.57 × 0.092 U/ml milk at 0801–1600, 0001–0800, and 1601–2400 h, respectively) (p < 0.05). Triglyceride content showed no significant diurnal variation but did increase significantly during a single feeding (31 × 9.4, 52 × 11.7, and 72 × 14.8, pimoles triglyceride/ml milk for fore‐, mid‐, and hind‐milks, respectively) (p < 0.05). There was no correlation between either LPL or BSSL activity and triglyceride content of the milks. Our data indicate that milk obtained for banking or research purposes will contain similar levels of BSSL activity irrespective of diurnal or within‐feed timing of milk collections.
Growth and Differentiative Maturation of the Rat Enterocyte
Authors: D'Harlingue Arthur E. , Kwong Linda K. , Morrill Judi S. , Sunshine Philip , Tsuboi Kenneth K.
Published: January 2024

Cells of the intestinal mucosa of the infant and adult rat maintain a pattern of continuous growth, accumulating structural and functional proteins and lipids while migrating the length of the villus column. Cells of jejunal and ileal segments were fractionated sequentially from villus tip to inner crypt and distribution patterns were determined for DNA, total protein, cholesterol, phospholipid, and disaccharidases. Patterns of increasing ratios of protein, lipids, and disaccharidases to DNA were maintained to villus tips, with only slight fall‐off of enzymes observed. Distribution profiles of disaccharidases, when computed relative to protein (as seen in previous reports), show distortion of the true cellular distribution pattern of these enzymes as determined by the DNA content of the fractions. Wide variation in cell protein concentrations was evident between jejunal and ileal segments in pre‐ and postweaned rats. Ileal cells of the suckling rat contained particularly high protein concentrations, which appeared to be largely transitory in nature and related to food intake. Cholesterol and phospholipids were found to be concentrated in the microvillus membrane and account for a significantly large fraction of the cellular content of these lipids.
Diagnostic Red Blood Cell Scintigraphy in GI Tract Bleeding From an Intestinal Hemangioma
Authors: Maeda Masato , Yamashiro Yuichiro
Published: January 2024

99mTc‐labeled red blood cell (RBC) scintigraphy in vivo established the diagnosis of intestinal hemangioma in a 6‐year‐old girl suffering from gastrointestinal (GI) tract bleeding who had undergone an operation for removal of hemangioma at the nail bed. Other examinations, double‐contrast barium meal study and angiography, were unsuccessful in making the diagnosis. Intestinal hemangioma is rare in childhood, but a useful technique such as RBC scintigraphy should be performed to find the bleeding point of the GI tract, especially in case the patient has another obvious hemangioma.
Factors Affecting Antibody Response of Newborns to Repeated Administrations of the Rotavirus Vaccine RIT 4237
Authors: Cadranel S. , Zeglache S. , Jonckheer T. , Zissis G. , Andre F. E. , Bogaerts H. , Delem A.
Published: January 2024

The safety and immunogenicity of repeated doses of RIT 4237. an oral live attenuated rotavirus vaccine of bovine origin, as well as the influence of gastric acidity and maternal antibodies on the vaccine “take rate” were studied in newborns. The vaccine was given orally on the first day of life, at 1 month, and at 2 months of age. Fifty‐seven newborns entered the study but only 36 completed the trial. No adverse reaction was observed after vaccination. Immune responses were evaluated by titrating pre‐and postvaccination serum antibodies to RIT 4237 by a neutralization technique. Eight of 43 (18.6%) tested infants responded to the first dose of vaccine. Subsequently another six and 11 infants responded to the second and third dose, respectively. The total cumulative response after the third dose was 23 of 36 vaccinees (63.9%). The geometric mean neutralizing antibody titers was lower in responders than in nonre‐sponders before the first dose of vaccine indicating that maternal antibodies interfered with vaccine “take.” Since the RIT 4237 strain is acid sensitive, gastric pH was measured at the time of each vaccination. Mean pH values in responders were not significantly different than those found in nonresponders. Therefore, vaccine failures cannot be due to inactivation of the rotavirus vaccine in the stomach but instead they can be attributed to high levels of maternal antibodies. At each vaccination, additional subjects seroconverted. Therefore, a multiple dose scheme is advisable to obtain an optimal immune response.
Effects of Dietary Nucleotides on the Fatty Acid Composition of Erythrocyte Membrane Lipids in Term Infants
Authors: DeLucchi C. , Pita M. L. , Faus M. J. , Molina J. A. , Uauy R. , Gil Angel
Published: January 2024

Human milk contains relatively high amounts of acid‐soluble nucleotides, mainly CMP, AMP. UMP. IMP, and UDP sugars, and lacks orotate. On the contrary, cow's milk and adapted formulas contain high amounts of orotate and very low amounts of CMP and AMP. Nucleotides may he modulators of metabolic functions in gut and liver. To evaluate the possible role of dietary nucleotides in newborn fatty acid metabolism, we studied the polyunsaturated fatty acid (PUFA) composition of erythrocyte membrane phospholipids in 58 term infants at 30 days of age. Twenty of them were fed human milk (HM). 19 an adapted formula (MF). and 19 with the same formula supplemented with nucleotides (NMF) in an amount similar to that present in HM. Relative content of omega 6 and 3 PUFA >18 carbon atoms was significantly reduced especially in phosphatidylethanol‐amine and phosphatidylserine for infants fed regular MF compared with those fed HM or NMF. Unsaturation index of red blood cell phospholipids showed a similar effect. These results suggest that dietary nucleotides play a role in the in vivo desaturation and elongation of essential fatty acids to long chain PUFA during early life for the human newborn.
Duodenal Bile Acids Among Children
Authors: Kocoshis Samuel A. , Schletewitz Katherine , Lovelace George , Laine Roger A.
Published: January 2024

Duodenal bile acids, identified by gas‐liquid chromatography (GLC) and gas chromatography‐mass spectrometry (GC‐MS), were correlated with quantitative aerobic and anaerobic duodenal culture in 26 children with enteropathies. Four patients whose duodenal fluid contained either ≥106 gram‐negative aerobes or ≥106 aerobic lactobacilli per milliliter had a significantly greater molar percentage of keto‐bile acids (32.3 ± 8.4%) than did 19 controls (0.72 ± 1.50%) chosen because duodenal fluid contained ≤104 bacteria per milliliter or three other patients with ≤106 anaerobes (6.1 ± 4.6%). As expected, free bile acids were seen in greater quantities (10.75 ± 3.25%) among the patients with anaerobic overgrowth or aerobic Lactobacillus overgrowth than among the controls (1.6 ± 1.0%) or the other three aerobic overgrowth patients (2.2 ± 1.4%). Incubation of glycocholate or glycochenodeoxycholate for 60 h with Eubacterium tortuosum from one patient or Escherichia coli from another produced the types of bile acids found in the duodenum of those patients. Successful antibacterial therapy improved gastrointestinal function and normalized duodenal bile acids not only among patients with anaerobic overgrowth but also among those with pure aerobic overgrowth. These data suggest that pure aerobic bacterial overgrowth syndrome occurs in children, and that altered duodenal bile acid composition may play a pathophysiologic role in this disorder.
Watery Diarrhea, Hypokalemia, Achlorhydria Syndrome in an Infant
Authors: Smith Sally S. , Shulman Dorothy I. , O'Dorisio Thomas M. , McClenathan Daniel T. , Borger James A. , Bercu Barry B. , Root Allen W.
Published: January 2024

An 8‐week‐old infant presented with vomiting and failure to thrive due to small bowel obstruction caused by a diffusely enlarged pancreas. Surgical bypass of the obstruction was followed by secretory diarrhea, hypokalemia, and dehydration. Plasma vasoactive intestinal peptide (VIP) (823 pg/ml), pancreatic polypeptide (4,500 pg/ml), and neurotensin (680 pg/ml) concentrations were markedly elevated. No neoplastic process was identified. Therapy with the long‐acting somatostatin analogue SMS 201–995 was followed by decline in VIP concentrations (900 to 200–300 pg/ml), decrease in stool frequency, and normalization of serum electrolytes. During 12 months of somatostatin analogue therapy, length and weight progressed along the 3rd percentile on the Tanner growth chart.
Peptic Ulcer Disease in Childhood
Authors: Murphy M. Stephen , Eastham Edmund J.
Published: January 2024

Information concerning the natural history of peptic ulcer disease commencing in childhood is limited. We have followed up 19 individuals in whom this diagnosis had been made in childhood 14–27 years previously. Strict diagnostic criteria were used. A high incidence of morbidity persisting into adult life was found. On investigation 9 (47%) had had a proven ulcer since entering adult life. Ten (53%) were no longer prone to recurring abdominal pain, but four of these had undergone vagotomy and pyloroplasty (three after the age of 21) for intractable symptoms. Thus, only six patients (31%) had made a lasting and spontaneous recovery. Serious complications had occurred at some time in the past in 10 cases (53%). Overt gastrointestinal bleeding had occurred in eight (42%), and this had been after the age of 18 years in three. Duodenal perforation occurred in one subject, and severe pyloric stenosis in another, both of whom were aged 21 years. One subject developed a penetrating duodenal ulcer at the age of 24 years. Seven (37%) had undergone surgery, and in two of these cases more than one operation had been performed. Fifty‐eight percent of complications suffered and 89% of surgical operations performed involved patients of 21 years or older. These findings firmly reinforce the opinion that the disorder frequently persists into adult life. The impact of modern means of medical therapy, such as the H2 receptor antagonists, has not yet been fully evaluated.
Carboxyhemoglobin Concentration as an Index of Bilirubin Production in Neonates with Birth Weights Less Than 1,500 Grams
Authors: Fischer Allen F. , Inguillo Dorothy , Martin Darrel M. , Ochikubo Clark G. , Vreman Hendrik J. , Stevenson David K.
Published: January 2024

A randomized double‐blind study of the efficacy of oral vitamin E supplementation as a prophylactic treatment for hyperbilirubinemia was undertaken in pre‐term infants weighing < 1,500 g. Hemoglobin (Hb) levels, blood carboxyhemoglobin saturation (HbCOc), end‐tidal carbon monoxide concentration (ETCO), and serum total bilirubin levels were determined in each subject on the first and third days of the study. We found no differences between the vitamin E‐treated and placebo‐treated groups with respect to Hb, HbCOc, ETCO, or serum bilirubin levels on day 1 or 3. In addition, we reanalyzed our data to compare those infants who had low vitamin E levels at birth with those who had vitamin E levels >0.4 mg/dl on day 1. We still observed no differences in Hb, HbCOc, ETCO, or serum bilirubin levels on day 1 or 3. The results of our study suggest that supplemental oral vitamin E therapy has no major effect on bilirubin production during the first 3 days of life in premature infants weighing <1,500 g at birth.
Changing Patterns of Free Fatty Acids in Breast Milk During Storage
Authors: Lavine Margery , Clark Richard M.
Published: January 2024

Milk was collected from eight mothers. Total lipid and free fatty acids were determined on collection. The samples were divided into aliquots and stored at 25, 4, or −11°C for 6, 12, 24, or 48 h. Additional samples were stored at ‐ 11 or −70°C for 1, 2, 4, 6, or 8 weeks. The effect of temperature, length of storage, and total milk lipid on the release of individual fatty acids during storage was determined. There was no measurable lipolysis in milk stored at −70°C. In the other samples both storage temperature and length of storage significantly affected lipolysis of milk lipids. The accumulation of free fatty acids in the milk increased with the length of storage and with increased storage temperature. Total lipid was not a significant factor in the release of fatty acids during the initial 48 h of storage. In samples stored for >48 h at −11°C, total lipid was positively correlated with the release of fatty acids. The pattern of free fatty acids in milk changed as storage progressed with an increase in the proportion of free 18:2, 20:4, and the other long‐chain polyenoic acids. This may have implications for infant nutrition as these fatty acids are required for normal growth and development of the neonate.
Effect of Short‐Term Food Deprivation on Luminal Protein Digestion in Suckling and Weanling Rats
Authors: Britton John R. , Koldovsk Otakar
Published: January 2024

Although previous studies have described the effects of long‐term undernutrition on the process of protein digestion, little data exist regarding the impact of short‐term food deprivation on digestive processes. To evaluate the effect of short‐term food deprivation on luminal proteolytic activity in the rat, we incubated [125I]bovine casein in vitro at 37°C with fluid flushed from the lumen of stomach and small intestine of 12‐day‐old suckling and 31‐day‐old weanling rats that were either fed or food deprived for 12 h/100 g body weight (3 h for sucklings, 12 h for weanlings), followed by measurement of radioactivity in trichloroacetic acid soluble material. Assays were performed at pH 3.2 for stomach and 7.4 for small intestine. In the suckling, gastric luminal proteolytic activity was minimal in both fed and food‐deprived animals; jejunal and midjejunal proteolysis was not significantly affected by food deprivation, but the hydrolytic capacity of fluid from the ileum was reduced to 20% of that of fed animals. In the weanling, food deprivation increased gastric proteolytic activity two‐ to threefold but decreased proteolysis in jejunum and midjejunum. Time‐ course studies revealed that these effects were further accentuated by food deprivation for 24 h/100 g body weight in both age groups. It is concluded that short‐term food deprivation may affect luminal proteolytic capacity and that individual segments of the developing rat gastrointestinal tract respond differently to food deprivation. Presumably, direct and indirect effects of digesta may contribute to these differences.
Effect of Amino Acid Containing Dialysis Solutions on Plasma Amino Acid Profiles in Children with Chronic Renal Failure
Authors: Hanning Rhona M. , Balfe J. Williamson , Zlotkin Stanley H.
Published: January 2024

Our previous studies demonstrated that, over single peritoneal dialysis cycles, amino acid‐based dialysis solutions (AAD) were effective in dialyzing children with chronic renal failure (CRF) and offered metabolic advantages over traditional glucose dialysis solutions. The AAD, however, resulted in undesirable elevations of certain plasma amino acids, notably methionine. To further investigate the relationship between dialysate and plasma amino acid levels, we assessed the plasma amino acid response to a new AAD with relatively low methionine content (Vamin‐based) over separate 5‐h cycles with 1.3 and 2.3% AAD in eight patients with CRF (age 1–9 years) on continuous ambulatory peritoneal dialysis (CAPD). There was a net absorption of 70–73% of the amino acids, the net absorption of individual ammo acids corresponding with the AAD composition. Plasma amino acid levels rose with AAD, peaking by 1h postinfusion. Although most amino acids fell to preinfusion levels at the end of the cycle (including methionine). isoleucine with the 1.3% AAD and isoleucine, leucine, phenylalanine, and lyrosine with the 2.3% AAD remained significantly elevated. Having demonstrated in children that amino acids are absorbed from the peritoneal cavity in proportion to the AAD profile, modification of the current AAD is suggested.
Dysfibrinogenemia in Obstructive Liver Disease
Authors: Levy Joseph , Pettei Michael J. , Weitz Jeffrey I.
Published: January 2024

Acquired dysfibrinogenemia was documented in a 4‐year‐old child with obstructive jaundice of 1‐month duration, secondary to a choledochal cyst involving the distal common bile duct. It was characterized by decreased thrombin coagulable protein with elevated immunoassayable fibrinogen resulting in abnormal thrombin and reptilase times. The liver morphology was compatible with extrahepatic obstruction, without evidence of cirrhosis or hepalocyte abnormality. All the coagulation abnormalities promptly resolved alter surgical correction of the obstruction. Dysfibrinogenemia has been associated with serious liver disease in adults, including tumors, chronic active hepatitis, and cirrhosis, but never with isolated obstructive jaundice. This report documents a case of acquired dysfibrinogenemia due to extra‐hepatic biliary obstruction and also emphasizes the importance of the consideration of this disorder in coagulation abnormalities associated with hepatobiliary disease.
Idiopathic Hepatic Copper Toxicosis in a Child
Authors: Maggiore Giuseppe , Giacomo Costantino Do , Sessa Fausto , Burgio G. Roberto
Published: January 2024

A 10‐year‐old Italian boy with chronic liver disease and copper overload is described. Biological and histopathological findings are similar to those described in children with Indian childhood cirrhosis. This report suggest that a disease akin to Indian childhood cirrhosis but different from Wilson disease can be found in non‐Indian children probably representing a new, possibly inherited, disease of copper metabolism leading to copper overload in the liver.
Neonatal Hemochromatosis
Authors: Jonas Maureen M. , Kavveblum Yosef Aaron , Fojaco Rita
Published: January 2024

We describe a premature neonate with severe hepatic dysfunction from birth which progressed to fatal hepatic failure at 3 months of age. The diagnosis of a familial disorder, neonatal hemochromatosis, was made, and therapy was attempted with deferoxamine. Features of iron metabolism are presented, and this infant's illness is contrasted with other liver diseases of infancy associated with hepatic iron overload.
Immunosuppressive Therapy of HBsAg‐Positive Chronic Active Hepatitis in Childhood
Authors: Giusti G. , Piccinino F. , Sagnelli E. , Ruggiero G. , Galanti B. , Gallo C.
Published: January 2024

We analyzed retrospectively the effect of immunosuppressive therapy in 139 children with HBsAg‐positive chronic active hepatitis (CAH) observed in four liver units in Italy from 1974 to 1982. All children had been observed for at least 12 months. Of these 139 patients, 38 were treated with steroids (prednisolone or prednisone from 1 to 2 mg/kg daily), 78 with combination therapy (prednisolone or prednisone 1 mg/kg daily in combination with azathioprine, 2 mg/kg daily) and 23 were not treated. The outcome of the disease was assessed by evaluating clinical, biochemical, and histological parameters on the basis of preselected criteria. Untreated patients deteriorated more frequently than those treated with steroids (34.8% versus 13.2%, p < 0.05) or those receiving combination therapy (34.8% versus 10.3%, p < 0.01). Remission or improvement was observed more frequently in steroid‐treated and combination‐treated patients than in the untreated ones (p < 0.001 and p < 0.01, respectively). At the end of the study, only one untreated patient had died of liver failure. Remission was observed in about 10% of patients in the two groups of treatment, but in the untreated one, this event never occurred. Although this study is retrospective and presents some shortcomings, the data clearly indicate that steroid and combination therapy are not deleterious, and are possibly helpful, to children with HBsAg‐positive CAH. Considering that this treatment clearly ameliorates the course of the disease in some patients, and that no other treatment has been conclusively demonstrated to be efficient in favorably modifying the course of the illness, we suggest that prednisolone alone or in combination with azathioprine still be considered for treating children with severe HBsAg‐positive CAH without cirrhosis.
Acute Non‐A, Non‐B Hepatitis in Childhood
Authors: Bortolotti F. , Cadrobbi P. , Armigliato M , Crivellaro C. , Cavinato G. , Realdi G
Published: January 2024

A prospective study of acute symptomatic viral hepatitis in childhood was started at the Department of Infectious Diseases of Padua (Italy) in 1978. During an 8‐year period, 93 consecutive patients (aged 3 months to 12 years) fulfilled the diagnostic criteria, including five (5.5%) cases classified as non‐A, non‐B hepatitis. This figure is lower than that generally reported in adult patients, probably because of a lower exposure of children to blood and contaminated materials. Two of the five children with non‐A, non‐B hepatitis had received blood transfusions, while three had no history of parenteral exposure. Although the outcome of the illness was favorable in all five patients, a variety of clinical features could be observed: two children had a mild, short‐lasting disease, anicteric in one case, while three had a polyphasic pattern of transaminases with delayed biochemical resolution, including one patient with deep jaundice and severe early phase features. These findings suggest that in children, as well as in adults, non‐A, non‐B hepatitis is probably a heterogeneous entity induced by different agents with different modes of transmission.
Age and Diet Effects on Fecal Bile Acids in Infants
Authors: Hammons J. L. , Jordan W. E. , Stewart R. L. , Taulbee J. D. , Berg R. W.
Published: January 2024

Fecal bile acid patterns and concentrations have been determined for 28 infants who were followed from average ages of 3–11 months. Half were solely breast‐fed and half were solely formula‐fed at the beginning of the study. Breast‐fed infants were found to have significantly (p < 0.05) lower concentrations of cholic acid than the formula‐fed group, up to an average age of 5 months. Concentrations of deoxycholic and lithocholic acids were directionally lower in breast‐fed infants at all ages. Concentrations of chenodeoxycholic acid were similar for both groups throughout the study. At the end of the study, breast‐fed infants were excreting 17% of their total bile acids in the form of secondary acids, compared to 33% for formula‐fed infants. This pattern persisted long after the infants began weaning. Formula‐fed infants were found to have lithocholic acid in their stools at a significantly (p < 0.05) earlier age than breast‐fed infants. Appearance of deoxycholic acid was at similar ages for both groups. Both of these secondary acids were found to occur at much younger ages (approximately 2 months) than has been previously reported. These observed differences are attributed to the distinct intestinal microbial populations encouraged by the different diets.
Incidence of Gastroesophageal Reflux in Sleep, Awake, Fasted, and Postcibal Periods in Asymptomatic and Symptomatic Infants
Authors: Vandenplas Yvan , De Wolf Daniel , Deneyer Michel , Sacre Liliane
Published: January 2024

The incidence of gastroesophageal reflux (GER) in infants has been shown to be dependent on different factors, e.g., position, feeding, age. Using continuous esophageal pH monitoring, we examined 30 asymptomatic (15 were 1.5–2.5 months old; 15 were 2.5–4.5 months old) and 20 symptomatic infants (1.5–4.5 months old) for GER. The occurrence of GER was analyzed in different periods of interest: awake, asleep, fasted, and postcibal periods. The increasing incidence of GER we reported previously in asymptomatic infants according to their age appeared to be due to an increased occurrence in the awake (and postcibal) periods. In symptomatic infants, however, the increase was noticed mostly during the sleep (fasted) periods as far as the reflux index, the duration of the longest reflux episode, and the number of reflux episodes of >5 min are concerned.
Handling of Gliadin Peptides B1‐B4 and of Cow's Milk Proteins by Rat Jejunum Gut Sacs
Authors: Melter Michael , Belitz Hans‐Dieter , Gellermann Barbara , Wieser Herbert , Stern Martin
Published: January 2024

The rat everted gut sac was used as a model of intestinal protein and peptide handling to study small intestinal binding and uptake of different gliadin peptide fractions (B1, B2, B3, B4) in comparison with bovine serum albumin (BSA), α‐lactalbumin (α‐LA), and a BSA peptide fraction (BSA‐P). Not only binding curves, but also uptake curves of BSA, α‐LA, and BSA‐P were run in parallel between 1 and 30 min. Binding and uptake obviously depended on molecular weight. BSA‐P binding was found to be highest of all. Binding of BSA was significantly lower. After 20 and 30 min, significantly more α‐LA and BSA‐P were taken up than was BSA. There was no difference in handling of the gliadin peptide fractions tested by the gut mucosal surface. Binding of B1‐B4 was significantly higher than binding of BSA and was significantly lower than binding of BSA‐P. No difference was found between binding of B1‐B4 and a‐LA. There was a consistently higher uptake of all gliadin peptide fractions, independent of molecular weight. Slopes for uptake curves of B1‐B4 were steeper than those of BSA, α‐LA, and BSA‐P. Crossing of uptake over binding curves was consistently observed with gliadin fractions, but never with cow's milk proteins/peptides. Differences in uptake between gliadin peptide fractions and cow's milk proteins/peptides might be based on a specific interaction between gliadin peptides and the gut surface.
The Effect of Feeding Four Different Formulae on Stool Weights in Prolonged Dehydrating Infantile Gastroenteritis
Authors: Rajah Rashid , Pettifor John M. , Noormohamed Madni , Venter André , Rosen Eric U. , Rabinowitz Leslie , Stein Harry
Published: January 2024

Prolonged diarrhea following an acute episode of dehydrating gastroenteritis in infants is often treated by the empirical removal of both cow's milk protein and lactose from the feed, as they both have been implicated in the prolongation of diarrhea. In order to assess the efficacy of this policy and to determine whether there are any advantages in using a lactose‐free semi‐elemental feed in this situation, infants with prolonged dehydrating gastroenteritis from a developing community in South Africa were studied. Male black children between the ages of 6 weeks and 2 years with prolonged dehydrating gastroenteritis (requiring intravenous fluids for longer than 72 h to maintain hydration) were randomly assigned to receive one of four feeds if the stool weight was greater than 30 g/kg body weight/24 h on the fourth day of admission. The four formula feeds were a partially modified cow's milk formula; a lactose‐free, casein‐containing formula; a lactose‐free, soy‐protein‐containing formula; and a lactose‐free, whey‐hydrolysate‐containing formula. Stool weights were measured for the following 3 days. Seventy‐two children were enrolled into the study. Stool weights were similar in the four groups at the start of the trial, and fell significantly over the trial period in those groups receiving the lactose‐free feeds. Mean stool weight in the cow's milk formula group did not change. Thus, it appears that the continued feeding of a cow's milk‐based lactose‐containing formulae to infants with prolonged dehydrating gastroenteritis adversely affects their recovery. Whether the responsible factor was the presence of lactose or a fraction of cow's milk protein could not be determined in this study. Furthermore, the use of a semi‐elemental feed does not appear to have any advantages over the cheaper lactose‐free formulae in this situation.
L‐Carnitine Supplementation of a Soybean‐Based Formula in Early Infancy
Authors: Novak Milan , Monkus Ellen F. , Buch Maria , Silverio John , Clouston Ofelia M. , Cassady Janet C.
Published: January 2024

The absence of carnitine in the diet of normal infants results in marked reduction of plasma carnitine levels. In order to evaluate the effects of L‐carnitine supplementation of soybean formula, plasma and urine levels of free carnitine and acylcarnitine were compared in infants receiving carnitine‐free soybean protein‐based formula and the same formula supplemented with 50 and 250 nmol/ml L‐carnitine. In infants receiving soybean formula with 50 nmol/ml L‐carnitine, the plasma levels of free carnitine were not significantly different from those in infants receiving formula with 250 nmol/ml L‐carnitine; however, urine levels of free carnitine were significantly increased when the infants received formula with 250 nmol/ml L‐carnitine. In normal full‐term infants, supplementation of soybean formula with 50 nmol/ml L‐carnitine was sufficient to maintain normal plasma levels that were comparable to breast‐fed infants.
Endotoxemia in Protein‐Energy Malnutrition
Authors: Klein Kenneth , Fuchs George J. , Kulapongs Panja , Mertz Gregory , Suskind Robert M. , Olson Robert E.
Published: January 2024

The plasma endotoxin levels of 16 severely malnourished Thai children were determined by the Limulus amebocyte lysate assay. Endotoxemia was present in seven children (44%) on admission to the hospital and was associated with the coexistence of vitamin A deficiency. Protein‐energy malnutrition is associated with the presence of endotoxemia.
Infrared Analysis for Determining Macronutrients in Human Milk
Authors: Michaelsen Kim F. , Pedersen Steen B. , Skafte Lisbeth , Jæger Per , Peitersen Birgit
Published: January 2024

Infrared (IR) analysis is widely used for routine analysis of cow milk in dairies. The aim of this study was to evaluate the precision and accuracy of an IR analyzer (Milko‐scan 104) for measuring protein, fat, carbohydrate, and, indirectly, the energy content of human milk. The results of the IR analysis were compared with those of the following reference methods: protein—Kjeldahl (nitrogen minus nonprotein nitrogen); fat—Roese Gottlieb; carbohydrate—lactose enzymatic assay; energy—bomb calorimetry. The precision (repeatability coefficient of variation) of the IR results was high for all four components: protein 0.4%, fat 1.0%, carbohydrate 0.2%, and energy 0.1%. There was a close linear covariation between IR results and reference results. [Protein content was determined with an error (SD) of 0.01 g/100 ml and fat with an error of 0.03 g/100 ml.] The covariation between IR carbohydrate results and the results of the lactose assay was poor, probably because the oligosaccharides in the milk were included in the results from the IR analysis and not in the results from the lactose assay. IR analysis is a valuable method in research, especially in epidemiological surveys, in which large numbers of samples are analyzed, and for continuous monitoring of the nutritional value of human milk in milk banking programs.
[15N]Methacetin Urine Test to Measure Liver Function
Authors: Krumbiegel P. , Teichmann B. , Faust H. , Braun W.
Published: January 2024

A simple, noninvasive test is proposed to measure the activity of the hepatocellular monooxygenase system in vivo. Elimination rates of the stable isotope 15N are measured in urine after an oral dose of the 15N‐labeled phenacetin homologue [15N]methacetin. Different forms of obtaining and expressing results are investigated in order to determine optimum methodology and differentiation for clinieal application in pediatrics. The best dis criminating power and reliability of results are seen with the measurement of 15N elimination half‐life. For follow‐up, a more easily measured parameter eliminated dose over 9 h is sufficient. In the latter case, only total nitrogen and 15N contents of a collective urine sample are measured.
Endoscopic Laser Therapy for Gastrointestinal Bleeding from Congenital Vascular Lesions
Authors: Noronha Peter A. , Leist Michael H.
Published: January 2024

Endoscopic laser therapy may be useful in controlling upper gastrointestinal bleeding due to vascular abnormalities. This report presents the case of an 11‐year‐old boy with an unusual vasculocutaneous disorder complicated by chronic recurrent bleeding that necessitated frequent blood transfusions. Of a number of investigative tests, only endoscopy was diagnostic in determining that the bleeding was secondary to multiple gastric vascular lesions. Moreover, laser photocoagulation of the identified lesions resulted in a dramatic decrease in both transfusion requirements and hospitalization.
Case Control Study on Nutritional Risk Factors in Celiac Disease
Authors: Greco L. , Auricchio S. , Mayer M. , Grimaldi M.
Published: January 2024

This study explored whether risk or protective nutritional factors have a role in childhood celiac disease. The effect of bottle feeding and early introduction of gluten to the diet was evaluated in a case control study. For each case, about 10 controls were recruited: sample size was determined as required for the evaluation of the study hypothesis. Patients were significantly less breast fed than were controls. Bottle‐fed children had an earlier introduction of gluten to the diet than did controls, but when early gluten introduction was analyzed across strata of breast‐fed or bottle‐fed children, no risk was attributed to it. Bottle feeding appeared to be a significant risk factor in children who received gluten early as well as in those who received gluten later. Breast‐feeding rates for patients and controls were equal at birth, but lower for patients by the age of 1 month: from then onward, there was a constant difference between patients and controls regarding the percentage still at breast. Interruption of breast feeding was a risk factor in celiac disease, but early gluten introduction did not appear to be a similar risk factor in the present study.
Hypertrophic Gastritis in Association with Sepsis and Death in a Two‐Month‐Old Infant
Authors: Ana Votava Fedor Raiyĉ , Tambiĉ Lana , Manojlović Snjeĉana
Published: January 2024

The article reports the case of a 2‐month‐old infant with Ménétrier's disease. Clinical manifestations, laboratory data, and roentgenologic diagnostics of this disease are presented. The child died with the clinical signs of cardiorespiratory insufficiency, and the diagnosis of Ménétrier's disease was established postmortem.
Severity and Extent of Upper Small Bowel Mucosal Damage in Cow's Milk Protein‐Sensitive Enteropathy
Authors: Iyngkaran N. , Yadav M. , Boey C. G. , Lam K. L.
Published: January 2024

A series of 31 infants, 28 with cow's milk protein sensitive enteropathy (CMPSE) and 3 controls, was studied for severity and extent of mucosal damage of the upper small bowel in relation to the development of clinical symptoms. Following challenge with the offending cow's milk, 18 infants (Group I) developed severe mucosal changes at both the proximal and distal small bowel mucosa and all of these infants presented with clinical symptoms. The other 10 infants (Group 2) who did not develop clinical symptoms following the challenge had less severe damage to the distal small bowel mucosa as compared to the proximal region. The histological score of both the proximal and distal postchallenge biopsies were significantly lower in Group 2 as compared to Group I infants. The mucosal disaccharidase and alkaline phosphatase levels were depleted in both the proximal and distal biopsies following challenge but the depletion was greater in the proximal than the distal biopsies. It is suggested that the extent and severity of mucosal damage to the proximal duodenum and jejunum have a critical bearing on the development of clinical symptoms.
Use of Salivary Levels to Predict Clearance of Caffeine in Patients with Cystic Fibrosis
Authors: Bianchetti M. G. , Kraemer R. , Passweg J. , Jost J. , Preisig R.
Published: January 2024

Summary: The quantification of liver function is possible using the approach of salivary caffeine clearance. Hepatopathy sometimes complicates cystic fibrosis (CF), thus suggesting the use of this diagnostic tool in CF as well. Since in CF some compounds are poorly absorbed or abnormally metabolized, and the function of salivary glands or renal tubuli partly imparired, caffeine was measured in urine, blood, and saliva after a single oral dose of 3 mg/kg in CF patients. The urinary excretion rate of caffeine was normal in five CF patients. The caffeine levels in plasma or saliva, measured 4 to 5 h and 16 to 17 h after caffeine intake, were normal in 34 nonhepatopatic CF patients. The calculated salivary caffeine clearance was comparable in the 34 nonhepatopatic CF patients (1.88 × 0.46 ml/min/kg) and in the control group (1.88 × 0.44 ml/min/kg). In CF patients, no correlation was found between caffeine clearance and body weight, height, relative underweight, dosage of pancreatic enzymes, or Chrispin‐Norman x‐ray score. The salivary caffeine clearance was reduced in seven hepatopathic CF patients (1.32 × 0.63 ml/min/kg, p < 0.01): nevertheless, the salivary caffeine clearance was reduced (boundary line at 1.1 ml/min/kg) in three CF patients with proven liver cirrhosis but not in four with hepatosplenomegaly and altered liver tests. These data indicate an unaltered caffeine metabolism in CF and open the way for the use of this diagnostic procedure in CF and open the way for the use of this diagnostic procedure in CF as well. This test might be valuable in CF patients with clinical or laboratory findings suggesting liver involvement.
Hypernatremic Diarrheal Dehydration Treated with Oral Glucose‐Electrolyte Solution Containing 90 or 75 mEq/L of Sodium
Authors: Guzmán C. , Pizarro D. , Castillo B. , Posada G.
Published: January 2024

Summary: Of 33 infants with hypernatremic dehydration (serum Na' of ≥ 150 mEq/L) 7 were excluded, 6 because severe alteration of the level of consciousness or shock precluded oral rehydration and 1 because he was given glucose‐electrolyte solution plus water. We studied the remaining 27 infants. Twenty (group A) were treated with the World Health Organization‐recommended oral rehydration solution (90 mEq/L Na') and seven (group B) were treated with Pedialyte‐RS (Abbott Laboratories Ltd.: 75 mEq/L Na'). The rehydrating solutions were administered in a volume equivalent to twice the clinically estimated fluid deficit. Initial serum sodium was 156.7 × 0.9 mEq/L for group A and 155.8 × 1.8 mEq/L for group B (mean × SEM). The mean time to achieve rehydration was 14.3 and 16.6 h for groups A and B, respectively. Twenty‐four hours after commencing oral rehydration. Serum Na' had decreased to 144.8 × 1.8 mEq/L for group A and 144.5 × 0.9 mEq/L for group B. In two patients in group A, the serum Na', which, had not decreased to <150 mEq/L at 24 h, did so at 48 h. Only in one case (group A) did the serum Na' increase. This patient had high stool output and failed to become rehydrated after 24 h of unsuccessful oral rehydration. None of the patients had seizures or persistent CNS dysfunction. We conclude that the slow administration of oral rehydration solutions containing either 90 or 75 mEq/L Na' is a safe and effective treatment of hypernatremic dehydration.