bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring of Serum α‐Fetoprotein Levels in Children with Chronic Hepatitis B Virus Infection
Authors: Vajro Pietro , Fontanella Angiola , De Vincenzo Anna , Lettera Patrizia , Greco Luigi , Coppa Anna , D'Armiento Maria
Published: January 2024

Changes in serum α‐fetoprotein (αFP) levels were investigated by radioimmunoassay during the follow‐up (17 ± 12 months, two to three times per year) of 50 children with chronic hepatitis B virus infection (mean age of 8 years, 30 males) and of 35 healthy age‐ and sex‐matched controls. Eleven of 50 were healthy carriers; 7 had chronic persistent hepatitis, 29 had chronic active hepatitis, and 3 had cirrhosis‐associated chronic active hepatitis. Serum αFP levels in controls were found to be always lower than 5 ng/ml (0.1–4.4 ng/ml, x ± SD of 1.34 ± 1.32 ng/ml). Statistical analysis after logarithmic transformation showed a significant difference between mean levels (ng/ml) in controls and in patients [geometric mean = 0.83 C.L. (95% confidence limits of 1.19/0.58) vs. 3.43 (95% C.L. of 4.79/2.45); p = 0.0001]. Mean values of serum αFP levels at entry were higher than those found at the end of the follow‐up period [geometric mean = 3 (95% C.L. of 4.69/1.92) vs. 1.48 (95% C.L. of 2.13/0.95); p = 0.038]. Only three patients repeatedly showed high αFP levels (76.7, 122.8, and 1,600 ng/ml at entry): αFP values became normal after a mean follow‐up of 17 ± 7.8 months as well as liver enzymes, with no changes in serum “e” antigen‐antibody and anti‐delta antibody status being observed. Mean values of serum αFP levels in HBeAg‐positive patients were significantly higher than in HBeAg‐negative patients both at entry and during the follow‐up (p = 0.05). Serum logarithmic αFP values were significantly correlated with log aminotransferases (alanine aminotransferase: r = 0.38 and p < 0.0001; aspartate aminotransferase: r = 0.36 and p < 0.0001) and log γ‐glutamyl transpeptidase (r = 0.32 and p < 0.0001). Although serum αFP levels were found to be higher in patients with the most severe histological damage, they did not allow the accurate discrimination of histological categories in individual patients.
pH‐Adjusted Formula and Gastroesophageal Reflux
Authors: Sutphen James L. , Dillard Vivian L.
Published: January 2024

To facilitate the detection of postcibal gastroesophageal reflux (GER), we have constructed an infant formula from modular carbohydrate, fat, and protein components with a pH of 4 and a nutrient composition identical to standard infant formula, in comparison to standard infant formula and sugar solutions, this pH‐adjusted formula demonstrates a significantly greater amount of gastroesophageal reflex during the first postcibal hour. We speculate that the greater caloric density and slower gastric emptying of regular infant formula promotes greater gastroesophageal reflux than is observed with regular dextrose feedings. This effect is obscured unless the pH of the formula is adjusted. Use of this weakly acid formula in conjunction with postcibal esophageal pH probe recording facilitates the detection and, during simultaneous apnea monitoring, potential association of symptoms with postcibal gastroesophageal reflux.
Evaluation of Jejunal Function in Wolman's Disease
Authors: Kikuchi Masahiro , Igarashi Kiyoshi , Noro Tomoyo , Igarashi Yutaka , Hirooka Minoru , Tada Keiya
Published: January 2024

Findings in a 1‐month‐old male infant with Wolman's disease, a rare autosomal defect characterized by intractable diarrhea and severe malabsorption, are described. Investigations in this case focused on the digestive and absorptive functions of the jejunum using histological, biochemical, and electrophysiological methods. The intestinal villi were found to be distorted and club‐shaped as a result of the infiltration of foam cells into the lamina propria of the mucosa. The microvilli of the epithelial cells were found on electron microscopy to be markedly shortened and irregular, and had a severe impairment of disaccharidase activity. Documentation of the loss of the sugar‐ and amino acid‐evoked potential differences in the jejunum confirmed the severity of intestinal malabsorption. These observations indicate that the intestinal damage in Wolman's disease is so severe as virtually to exclude the absorption of any form of enteral nutrition. Despite the administration of i.v. hyperalimentation, the infant died of hepatic failure at the age of 6 months.
Clinical Application of a Simple HPLC Method for the Sugar Intestinal Permeability Test
Authors: Catassi C. , Pierani P. , Natalini G. , Gabrielli O. , Coppa G. V. , Giorgi P. L.
Published: January 2024

A new high pressure liquid chromatography (HPLC) method has been used to measure urinary sugar levels for the intestinal permeability test with cellobiose and mannitol (C/M test). Urinary specimens have been prepared by simple filtration through a Millipore membrane. The method is highly sensitive (minimal detectable concentration of urinary sugars = 0.01 mg/ml) and reproducible (coefficient variation between samples = 0.47% for cellobiose and 0.25% for mannitol). By this method a C/M test has been performed in a large series of gastroenterological patients. High values of mean urinary C/M percentage recovery ratio (C/M%) were found in 30 children with active gluten‐sensitive enteropathy compared with controls (0.42 ± 0.66 versus 0.014 ± 0.005). In 44 treated celiacs and 34 children with chronic nonspecific diarrhea the mean C/M%s were 0.027 ± 0.018 and 0.021 ± 0.012, respectively. The results of this study confirm that the C/M test is a valuable investigation in the diagnostic studies of children with chronic diarrhea. The simple HPLC method described for the determination of urinary sugar levels should allow a wider diffusion of this test.
Clinical Trial of Home Available, Mixed Diets Versus a Lactose‐Free, Soy‐Protein Formula for the Dietary Management of Acute Childhood Diarrhea
Authors: Alarcon Pedro , Montoya Ramon , Perez Fernando , Dongo Juan W. , Peerson Janet M. , Brown Kenneth H.
Published: January 2024

A randomized clinical trial was completed to study the severity, duration, and nutritional outcome of acute diarrhea in 85 Peruvian children between 5 and 24 months of age who received a soy‐protein‐isolate, lactose‐free formula (group SF) or one of two mixtures of home‐available foods, all in amounts up to 110 kcal/kg of body weight/day. The mixed diets contained either wheat flour, pea flour, carrot flour, sucrose, and vegetable oil (group WP) or potato flour, dried whole milk, carrot flour, sucrose, and oil (group PM). The characteristics of the children in each group were generally similar initially. There were no differences in treatment failure rate by diet group. Fecal outputs were similar in all groups during the first day of treatment, averaging 60 to 65 g/kg/day. However, stool outputs were greater for the PM group than for other groups on days 3 and 4, and were less for the SF group than the other groups on days 5 and 6. The estimated median durations of diarrhea in the WP group (52 h) and PM group (53 h) were significantly less than in the SF group (154 h, p = 0.005). Energy intakes, energy absorption, and nitrogen retention (% of intake) were generally similar in all dietary groups, although there were minor differences in the absorption of specific macronutrients. Children in all groups gained weight during hospitalization, and there were no significant differences by diet group in the change in anthropometric status during treatment. We conclude that these locally available, low‐cost staple food mixtures offer a safe and nutritionally adequate alternative to a commercially produced lactose‐free formula for the dietary management of young children with acute diarrhea in this setting.
An Evaluation With Piglets of Bovine Milk, Hydrolyzed Bovine Milk, and Isolated Soybean Proteins Included in Infant Milk Formulas. II. Stomach‐Emptying Rate and the Postprandial Change in Gastric pH and Milk‐Clotting Enzyme Activity
Authors: Moughan Paul J. , Cranwell Peter D. , Smith William C.
Published: January 2024

The piglet was used as a model for the human infant to determine the effect of the protein source of a milk formula on stomach‐emptying rate and the postprandial changes in gastric pH and milk‐clotting enzyme activity. Three liquid milk formulas containing either intact bovine milk protein, hydrolyzed bovine milk protein, or isolated soybean protein as the sole source of dietary protein were given to five 37‐day‐old piglets that had undergone surgery for the preparation of a simple gastric fistula. At set times after commencement of a meal, the stomach contents were removed via a gastric cannula and weighed; then pH and milk‐clotting enzyme activity were determined. The isolated soybean protein‐based formula tended to empty from the stomach more slowly than did the bovine milk‐based formulas. Maximum difference (p < 0.05) was found at 3 h postfeeding, where 30% of the ingested soybean formula dry matter remained in the stomach; comparable values for the intact bovine milk‐based formula and hydrolysate were 22 and 12%, respectively. The type of protein did not significantly (p > 0.05) affect the postprandial change in gastric pH or gastric milk‐clotting enzyme activity. Gastric pH increased sharply after feeding, from pH 1.5 at 0 h to pH 5.2 at 1 h, and then fell gradually over the following 4 h to pH 1.84.
Effects of Different Levels of Intravenous α‐Linolenic Acid and Supplemental Breast Milk on Red Blood Cell Docosahexaenoic Acid in Very Low Birth‐Weight Infants
Authors: Rhodes Philip G. , Reddy N. Sagar , Downing Greg , Carlson Susan E.
Published: January 2024

Preterm infants weighing <1,500 g were started on total parenteral nutrition (TPN) if unable to tolerate full enteral feedings. They were randomly assigned to receive intravenous lipids containing either 4.2 or 9.0% α‐linolenic acid to assess the effect on red blood cell (RBC) phospholipid polyenoic fatty acid composition, particularly docosahexaenoic acid (22:6n3) (DHA). DHA ultimately comes from α‐linolenic acid (18:3n3), although there is evidence in human preterm infants that they require preformed DHA. After 1 week of TPN, infants were started on gradually increasing amounts of enteral feeding, breast milk, if elected by mothers, or premature milk formula (Preemie Enfamil). RBC phospholipid fatty acids were measured weekly. Results were evaluated comparing samples from week 1 and week 6. Supplying 9% α‐linolenic acid in intravenous lipids did not prevent a fall in DHA by 6 weeks; however, infants receiving breast‐milk feeding did not have a significant decrease in DHA. Studies are needed to evaluate supplying DHA in intravenous lipids.
Recurrent Pancreatitis in Three Patients with Chronic Idiopathic Intestinal Pseudo‐obstruction
Authors: Heitlinger Leo A. , McClung H. Juhling , Murray Robert D. , Li B. U. K.
Published: January 2024

Chronic idiopathic intestinal pseudo‐obstruction is a syndrome with substantial morbidity and mortality associated both with the syndrome and with its therapy. Standard therapy has included prokinetic agents and intravenous nutritional support when oral feedings are inadequate to maintain nutriture. We report three children with chronic intestinal pseudo‐obstruction who experienced one or more attacks of pancreatitis. Two patients developed pseudocysts. One patient died. All three patients underwent cholecystectomy; one had stones, one had acalculous cholecystitis, and one had a normal gallbladder. All patients received prokinetic agents and total parenteral nutrition as therapy for their pseudo‐obstruction. Candidate mechanisms to explain the etiology for pancreatitis in chronic intestinal pseudo‐obstruction include biliary dysmotility associated with pseudo‐obstruction and excessive cholinergic stimulation due to therapy with prokinetic agents.
Salmonella typhimurium Appendicitis
Authors: Kazlow Philip G. , Freed Jeffrey , Rosh Joel R. , Reiner Mark , Dische Renata , Benkov Keith , LeLeiko Neal S.
Published: January 2024

A child with signs and symptoms of acute gastroenteritis developed localization of her pain to the right lower quadrant. A clinical diagnosis of appendicitis was made and an inflamed appendix was found at surgery. The postoperative period was marked by high spiking fevers and profuse nonbloody diarrhea. Cultures of the appendix and the stool revealed Salmonella typhimurium. Nontyphoidal Salmonella organisms are a rare cause of acute suppurative appendicitis. Intraoperative cultures of the appendix and peritoneal fluid as well as postoperative cultures of the diarrheal fluid were crucial in elucidating the cause of this patient's unusual course.
Endoscopic Removal of Inflammatory Esophagogastric Polyps in Children
Authors: Glassman Mark , Bostwick Howard E. , Godine Louise , Newman Leonard J.
Published: January 2024

Two adolescent patients with inflammatory esophagogastric polyps (IEPs) are presented. In each case, the patients complained of chest pain and dysphagia. In one patient, there was no histological evidence of esophagitis in association with the IEPs. Their clinical course suggests that the presentation of IEPs in adolescents is indistinguishable from and may result in secondary gastroesophageal reflux and esophagitis. In each case, endoscopic polypectomy was utilized effectively as the mode of therapy.
Effect of Intravenous Calcium Infusions on Serum Chemistries in Neonates
Authors: Venkataraman Pankaja S. , Sanchez Gerardo J. , Parker Michael K. , Altmiller Dale
Published: January 2024

In 36 newborn infants admitted to the Children's Hospital of Oklahoma, we studied the hypotheses that intravenous bolus infusions of Ca as calcium gluconate over 10 min may (a) result in acute metabolic acidosis, (b) increase serum osmolality, (c) increase serum free bilirubin, and (d) decrease serum phosphorus concentrations. All infants received 18 mg/kg of elemental calcium, as either a 5 or 10% solution of calcium gluconate. Blood ionized calcium (iCa) rose significantly with i.v. bolus Ca infusion (p < 0.005) and blood pH and serum P declined significantly (p < 0.05) with i.v. bolus Ca infusion in infants. Serum free bilirubin was not significantly altered. Serum osmolality rose significantly from baseline with bolus infusion of Ca as a 10% calcium gluconatc solution and did not change significantly with bolus infusion of a diluted 5% solution. In neonates, intravenous bolus calcium infusion (a) decreases blood pH, (b) infusion of 10% but not 5% calcium gluconate increases serum osmolality, (c) serum free bilirubin concentrations were not altered, and (d) serum phosphorus concentrations were decreased.
Effect of Breast Feeding on the Plasma Cholesterol and Growth of Infants
Authors: Jooste P. L. , Rossouw L. J. , Steenkamp H. J. , Rossouw J. E. , Swanepoel A. S. P. , Charlton D. O.
Published: January 2024

The effect of breast‐feeding on plasma cholesterol, body weight, and body length was studied longitudinally in a large free‐living cohort of infants (n = 512) from birth until the age of 1 year. Of the cohort, 21.4% were exclusively breast‐fed for at least 3 months, 39.3% received bottle‐feeding, and 39.3% received a combination of breast‐ and bottle‐feeding. At birth the plasma cholesterol was similar in the three groups. After 3 months the mean plasma cholesterol and proportion of hypercholesterolemic infants in the breast‐fed group were significantly (p < 0.001) higher than that of the other two groups. These differences had disappeared at the age of 1 year. Breast‐fed infants weighed less at 3 and 12 months, but body length was similar to those of the other groups. These results suggest that breast‐feeding elevates plasma cholesterol by a direct mechanism and that the effect persists only as long as the breast‐feeding is continued.
The Effect of Sugar Cereal With and Without a Mixed Meal on Glycemic Response in Children with Diabetes
Authors: Wang Susan R. , Chase H. Peter , Garg Satish K. , Hoops Sandy L. , Harris Mary A.
Published: January 2024

The effect of sucrose consumption on glycemic control in children with insulin‐dependent diabetes mellitus is unclear. Eight young subjects, 7–16 years of age, with a duration of diabetes of 2–8 years participated in this study. All subjects consumed four different breakfasts—oatmeal (OM) alone, oatmeal–sucrose (OMS), oatmeal–protein (OMP), and oatmeal with protein and sucrose (OMPS)—on four different days. Addition of sucrose resulted in a slightly greater area under the tolerance curve in 50% of the subjects; however, in 38% of subjects, the area decreased. The peak glucose level was lowest for OM, but there was no statistical difference in the peak levels of the four test meals. The most significant effect on glucose response was a delay in the peak time when protein was added to the meals. Peak times for OM and OMS (mean of 38 min) when fed alone were significantly (p < 0.05, ANOVA) shorter when compared to the peak time for OMP and OMPS (mean of 54 min). The average recovery time for OMP was longest. Other indices (tolerance index and change of rise in blood glucose) measured were not significantly different among the test meals. This study demonstrates that adding limited sucrose to OM cereal has little effect on the blood glucose response in children with diabetes. Addition of protein and fat clearly delays the glycemic response.
Assessment of Preclinical Vitamin A Deficiency in Children with Persistent Diarrhea
Authors: Usha N. , Sankaranarayanan A. , Walia B. N. S. , Ganguly N. K.
Published: January 2024

To explore the relationship between vitamin A deficiency and persistent diarrhea among young children, we studied the vitamin A status of 23 children < 5 years of age with persistent diarrhea by performing conjunctival impression cytology (CIC) and the relative dose–response test (RDR) as a measure of liver reserve of vitamin A. The control group consisted of 23 age‐ and sex‐matched children who were otherwise healthy in whom CIC was performed and fasting plasma retinol values were determined. The criteria for vitamin A deficiency in CIC were paucity of goblet cells and scanty, abnormal epithelial cells. None of these children had ocular manifestations of vitamin A deficiency. Among the children with persistent diarrhea, CIC characteristic of vitamin A deficiency was found in 17 (group 1) and CIC results were normal in six (group 2). In group 1, the serum retinol levels were 1 ± 1 μg/dl, and RDR was 88 ± 14. In group 2, the serum retinol levels were 8 ± 4 μg/dl (p < 0.001) and the RDR was 16 ± 12 (p < 0.001). In the control group, the CIC results were normal in all the children and the plasma retinol levels in these children were 19 ± 8 μg/dl. In conclusion, 17 of 23 children with persistent diarrhea had abnormal CIC results, significantly low serum retinol levels, and significantly high RDR results, although they had not yet manifested xerophthalmia. Even in the six children with persistent diarrhea and normal CIC results, the serum retinol levels were ≤ 15 μg/dl and the median RDR was 21, which indicates a depleted liver reserve.
The Adaptive Response of Rectal Electrolyte Absorption to Impaired Sodium Balance in Young Children
Authors: Finkel Yigael , Jenkins Huw R. , Booth Ian W.
Published: January 2024

Rectal electrolyte transport was measured in nine children (median age 160 days) with ilcostomies, using a nonequilibrium dialysis technique. Rectal sodium absorption and potassium secretion were significantly higher in children with a subnormal sodium balance compared with children with a positive sodium balance. Rectal sodium absorption and potassium secretion were unchanged after ileostomy closure. These data indicate that rectal electrolyte transport in children can adapt to even modestly impaired sodium balance.
Childhood Protein‐Losing Enteropathy Associated with Helicobacter pylori Infection
Authors: Cohen Herman A. , Shapiro Rivka Preminger , Frydman Moshe , Varsano Itzchak
Published: January 2024

Helicobacter pylori

was found in a gastric biopsy specimen of a child with protein‐losing gastropathy. Through erythromycin therapy, clinical and ultrasonographic recovery was associated with the disappearance of the pathogen on repeated biopsy. The association of H. pylori with protein‐losing gastropathy has been reported only once in children, to our knowledge. Although the causative correlation between the pathogen and the disease has not been proven yet, we suggest that future cases of protein‐losing gastropathy be studied for the presence of H. pylori and followed up by ultrasonographic investigation and urea breath test. Appropriate treatment should be given to suspected cases.
Bile Acid Stimulation of Cyclic AMP and Ion Transport in Developing Rabbit Colon
Authors: Potter Gregory D. , Sellin Joseph H. , Burlingame Susan M.
Published: January 2024

Bile acids elicit Cl secretion and increases in short circuit current (Isc) in rabbit distal colon in vitro in adult but not newborn animals. In this investigation we found that concentrations of taurodeoxycholic acid (TDC) as low as 50 μM significantly increase cyclic AMP (cAMP) in adult but not newborn colon. Further, blocking the increases of cAMP in adult colon with 3,4,5‐trimethoxybenzoate 8‐(N,N‐dimethylamino) octyl ester (TMB‐8), partially inhibited the effect of TDC on Cl secretion. TMB‐8 did not block the effect of increases in cAMP seen with vasoactive intestinal peptide (VIP), the‐ophylline, or forskolin. When newborn colon was exposed to 1 mM TDC, limited Cl secretion was elicited. Increased cAMP is not seen in newborn colon where TDC‐induced secretion is absent. Thus, increases in cAMP may represent one part of the coupling of TDC stimulation to Cl secretion.
Comparison of Glucose/Electrolyte and Maltodextrin/Glycine/Glycyl—Glycine/Electrolyte Oral Rehydration Solutions in Acute Diarrhea in Children
Authors: Khin‐Maung‐U  , Myo‐Khin  , Nyunt‐Nyunt‐Wai  , Mu‐Mu‐Khin  , Mya‐Thi  , Thein‐Thein‐Myint
Published: January 2024

Male children (N = 101) 6–35 months of age presenting with acute watery diarrhea for 48 h at home before hospitalization were admitted into a randomized, double‐blind clinical trial. Fifty‐one children were treated with standard oral rehydration solution (ORS) (World Health Organization [WHO] formulation containing citrate) and 50 were treated with an improved ORS formulation (containing, in addition to the standard formula, 20 g maltodextrin instead of glucose, and 4 g glycine and 4 g glycyl‐glycine). None were given antibiotics. No i.v. infusions were given. Rotavirus was detected by enzyme‐linked immunosorbent assay in stools of 43 children. Clinical characteristics of children in the two treatment groups were comparable. Improved ORS did not produce significant reduction in the volume of diarrhea stools. Children given improved ORS had greater weight gain than that observed in children treated with standard ORS, but the differences were not statistically significant except at the end of the first 24 h. Among children with rotavirus diarrhea, no significant differences were observed between the 23 children who received improved ORS and the 20 who received standard ORS.
Occurrence of Acute Diarrhea in Atopic and Nonatopic Infants
Authors: Ruuska Tarja
Published: January 2024

A cohort of 336 infants was followed from birth for a total of 717 child‐years for development of atopy and occurrence of acute diarrhea. During follow‐up 94 (28%) of the infants developed atopic eczema or gastrointestinal allergy associated with food allergens, or both. Infants with food allergy had significantly (p = 0.0074) more episodes of acute diarrhea than infants with no atopy, but there was no apparent temporal correlation between the occurrence of acute diarrhea and appearance of gastrointestinal allergy or atopic eczema. Serum IgE levels in children up to 2 years of age who had diarrhea and atopic eczema were lower than those in atopic eczema children with no diarrhea, but infants with gastrointestinal allergy who had acute diarrhea tended to have higher IgE levels than those without diarrhea. Breastfeeding over 6 months of age reduced the incidence of diarrhea in the first year of life in both atopic and nonatopic infants, but had no significant effect on the total incidence of diarrhea during the 2 year follow‐up, as infants breast‐fed longer had more diarrhea in the second year of life. Prolonged breast‐feeding also reduced the severity of diarrhea in atopic infants aged 7–12 months but not for older infants.
Medium Chain Triglyceride in the Therapy of Gastroesophageal Reflux
Authors: Sutphen James L. , Dillard Vivian L.
Published: January 2024

Carbohydrate solutions that empty rapidly from the stomach have been shown to produce less gastroesophageal reflux (GER) during the postcibal period than more slowly emptying formulas. These observations have not been extended to complete infant formulas containing fat, carbohydrate, and protein constituents. Medium chain triglyceride has been shown to significantly accelerate gastric emptying compared to long chain triglyceride for preterm infants when investigated in commercial infant formulas. Using a previously reported acidified formula model coupled with esophageal pH probe testing, we have documented in a group of 28 infants that modification of formula by enrichment with medium chain triglyceride produced no improvement in rates of GER during the first 2 h after feeding.
Use of Ass' Milk in Multiple Food Allergy
Authors: Iacono G. , Carroccio A. , Cavataio F. , Montalto G. , Soresi M. , Balsamo V.
Published: January 2024

We report a study of realimentation techniques in 9 unweaned infants with multiple food hypersensitivity. The patients had presented severe symptoms of cow's milk allergy and successive attempts using milk containing soy protein and/or a semielemental formula in their alimentation did not improve their clinical condition, due to the onset of hypersensitivity to these allergens as well. After a short period of parenteral alimentation the infants were refed per os with ass' milk (250 ml/kg/day) + medium chain triglycerides (40 ml/L milk). This food was well tolerated by all patients. No negative clinical reactions were recorded and during hospitalisation average weight increase was 39.8 g/day. The follow‐up of the patients showed that ass' milk was tolerated without any problems up to an age ranging from 15 to 20 months, when cow's milk was reintroduced in some patients.
Antral and Duodenal Motor Responses to Duodenal Feeding in Preterm and Term Infants
Authors: Berseth Carol Lynn , Ittmann Patricia I.
Published: January 2024

In the fasting state, antral motor activity is similar in preterm and term infants, but the antral responses to feeding have not been compared in preterm and term infants. The purpose of this study was to use low‐compliance, continuous perfusion manometry to compare antral and duodenal feeding responses in 13 preterm and nine term infants within the first 14 days of life. Confirming our previous studies, fasting antral motor activity was similar in preterm and term infants, but duodenal activity differed. Individual duodenal cluster activity was of shorter duration in preterm than in term infants (p < 0.01). Motor activity in antrum and duodenum changed in both groups of infants in response to an intraduodenal milk infusion of 4 ml/kg/2 h; however, the nature of the change varied in the two regions. In term infants, the number of antral pressure waves, the duration of antral clusters, and the antral motility index decreased by one third or more during feeding when compared with fasting (all p < 0.05). In contrast to the decrease in antral activity in response to feeding, the duodenal motility index and cluster activity increased significantly during feeding compared with fasting (both p < 0.05). The divergent response of antral and duodenal motor activity in response to feedings was also seen in preterm infants. Antral pressure waves, the duration of antral clusters, and the antral motility index were decreased during feeding (all p < 0.005 or less). Conversely, the preterm duodenal motility index and the duration of cluster activity increased during feeding compared with fasting (p < 0.05 or more). The suppression of antral motor activity in response to feeding is dissimilar to that described in adults fed solids and may be nutrient related. Since these antral responses occurred in response to duodenal feedings, they may have been mediated by hormones or local reflexes that are intact as early as 26 weeks' gestation.
Relationship of Common Laboratory Parameters to the Activity of Crohn's Disease in Children
Authors: Hyams Jeffrey S. , Mandel Francine , Ferry George D. , Gryboski Joyce D. , Kibort Phillip M. , Kirschner Barbara S. , Griffiths Anne M. , Katz Aubrey J. , Boyle John T.
Published: January 2024

The Pediatric Crohn's Disease Activity Index (PCDAI) has been proposed as a simple instrument to aid in the classification of patients by disease severity. The PCDAI includes subjective patient reporting of symptoms, physical examination, nutritional parameters, and several common laboratory tests (hematocrit, erythrocyte sedimentation rate, albumin). In this report we examine the relationship of each of the laboratory parameters to the PCDAI, as well as to a modified Harvey‐Bradshaw Index score and physician global assessment of disease activity. Data were gathered from the clinical and laboratory observations from 133 children and adolescents at 12 pediatric gastroenterology centers in North America. A statistically significant relationship (p < 0.05) was noted between each of the laboratory tests and the PCDAI for patients with either disease limited to the small bowel or in those with colonic in volvement. For patients with disease limited to the small bowel, a statistically significant (p < 0.05) relationship was also noted between the three laboratory parameters and the modified Harvey‐Bradshaw Index and global assessment. For patients with large‐bowel involvement, the erythrocyte sedimentation rate was statistically related to the modified Harvey‐Bradshaw Index and global assessment (p < 0.01), as was hematocrit to global assessment (p < 0.01). Although the laboratory parameters used in the PCDAI appear to generally reflect disease activity in most patients, no single laboratory test is adequate to reflect disease activity in all patients. Future work will need to identify additional laboratory measures to reflect the inflammatory process and serve as important adjuncts in the assessment of disease activity.
Extensive Hepatic Necrosis in a Premature Infant
Authors: Bemtnel L. A. , Hack W. W. M. , Seldenrijk C. A. , Kneepkens C. M. F.
Published: January 2024

A fatal case of fulminant hepatic failure that occurred in the neonatal period is reported in a premature infant born after 27‐weeks' gestation. Immediately after birth the infant had severe hypoxia and hypotension resulting from birth asphyxia, hypovolemic shock, and septicemia. At autopsy, histological appearance of the liver showed virtually total hepatocellular necrosis without features of fibrosis. Although the exact cause of hepatocellular injury cannot be fully ascertained, it is assumed that hypoxia and hypotension must have been the predominant factors leading to massive hepatic necrosis.
Comparison of Methods of Assessing 24‐Hour Intraesophageal pH Recordings in Children
Authors: Friesen Craig A. , Hayes Romy , Hodge Charles , Roberts Charles C.
Published: January 2024

Prolonged intraesophageal pH recording, an important test in the evaluation of children with suspected gastroesophageal reflux (GER) disease, may be performed and evaluated by markedly different methodologies. Twenty‐four‐hour intraesophageal pH recordings from 67 consecutive infants were evaluated by three scoring methods: early postprandial, late postprandial, and total recording. In addition, the scoring methods were evaluated for their ability to identify 20 infants with clinically defined GER‐induced acute life‐threatening events (ALTEs). There were significant positive correlations between each pair of scoring systems (early postprandial with late postprandial, early postprandial with total recording, and late postprandial with total recording). However, our data indicate that the three methods identify different groups of patients. The early and late postprandial methods disagreed in designating “normal” versus “abnormal” in approximately 20% of patients. The total recording method was more likely to label patients as normal than either of the other methods; it yielded normal results in approximately one half of patients abnormal by either the early or the late postprandial methods. Patients with GER‐induced ALTEs were identified by the early postprandial method in 90% of cases, the late postprandial method in 95% of cases, and the total recording method in only 45% of cases. By applying three different scoring methods to the same 24‐h intraesophageal pH recording, we demonstrated less‐than‐perfect correlation among the methods. Long‐term follow‐up is needed to determine if these differences are of clinical significance. We feel that effort should be directed toward standardizing the approach to intraesophageal pH monitoring in infants.
Changes in Fatty Acid Profiles of Red Blood Cell Membranes Mediated by Dietary Nucleotides in Weanling Rats
Authors: Jiménez Jesús , Boza Julio , Suárez María Dolores , Gil Angel
Published: January 2024

Dietary nucleotides have been described to play multiple physiological roles. We examined the effect of feeding, for 4 weeks, nucleotide‐supplemented diets (N‐50 and N‐250) on red blood cell (RBC) membrane fatty acid composition in weanling rats. Long‐chain polyunsaturated fatty acids (LC‐PUFA) of the n‐6 series, especially arachidonic acid, increased in total RBC phospholipids in N‐50 and N‐250 groups. Concentrations of LC‐PUFA of the n‐3 series were preserved or slightly decreased. Saturates and monoenates also decreased. Phosphatidyleth‐anolamine and sphingomyelin followed the variations observed for total phospholipids. Phosphatidylcholine showed a different response; saturated fatty acids increased while n‐6 LC‐PUFA decreased. Dietary nucleotides seem to affect the conversion of essential fatty acids to their long‐chain derivatives in weanling rats in a similar way to that occurring in newborn infants during early life. These results show that the rat may be a valid model with which to study the biochemical mechanisms by which dietary nucleotides affect fatty acid desaturation.
Veno‐occlusive Disease of the Liver After Combined Adjuvant Chemotherapy for a 1‐Year‐Old Boy with Rhabdomyosarcoma
Authors: Adachi Naoto , Matsuda Ichiro
Published: January 2024

A tumor in the left thigh of a 1‐year‐old boy was diagnosed as rhabdomyosarcoma (stage 1). The tumor was excised and vincristine (1.5 mg/m2 given twice), actinomycin D (15 μg/kg given five times), and cyclo‐phosphamide (600 mg/m2 given once) were prescribed. On the 12th day after initiating this chemotherapy, his liver rapidly enlarged and ascites, pleural effusion, and disturbance of consciousness due to hepatic failure successively appeared. Before these clinical signs appeared, laboratory data demonstrated enhanced coagulation and fibrinolysis such as thrombocytopenia refractory to platelet transfusion and a marked increase in fibrinogen and fibrin degradation product (FDP). Hepatic veno‐occlusive disease (VOD) was suspected, and based on the laboratory data indicating enhanced coagulation, anticoagulant (gabexate mesylate; FOY), diuretic, and supportive therapy for hepatic failure was begun. The clinical course was favorable and recovery was complete in 2 months, with no sequelae. We propose that platelet count, coagulation factor levels, and FDP may be useful for the early detection of VOD, and an anticoagulant drug such as FOY is worthy of consideration for the prevention and treatment of VOD.
Tryptophan Fortification of Adapted Formula Increases Plasma Tryptophan Concentrations to Levels Not Different from Those Found in Breast‐Fed Infants
Authors: Fazzolari‐Nesci A. , Domianello D. , Sotera V. , Räihä N. C. R.
Published: January 2024

Several recent studies have demonstrated significantly lower plasma total tryptophan concentrations in formula‐fed than in breast‐fed infants. We have measured preprandial plasma amino acid concentrations in infants breast‐fed or fed a formula with a protein concentration of 1–57 g/dl and with a whey/casein ratio of 60:40 or a formula with a protein concentration of 1.37 g/dl and a whey/casein ratio of 40:60 and fortified with 10 mg/dl (15 mg/100 kcal) of tryptophan. Healthy term infants (10 per group) were either breast‐fed from birth or randomly assigned to one of the two study formulas. At 4 and 12 weeks of age, anthropometric measurements were performed and blood samples were obtained. During the study period of 12 weeks, all infants showed normal growth (weight, length, and head circumference) and there were no statistically significant differences between the groups. The plasma concentrations of the essential amino acids phenylalanine, threonine, valine, and lysine were significantly lower in the breast‐fed group than in both formula‐fed groups. For tyrosine, methionine, leucine, histidine, isoleucine, and arginine, no significant differences could be found between the feeding groups. Concentration of total plasma tryptophan was significantly higher in the breast‐fed group than in the group fed the tryptophan‐unfortified formula, but no statistically significant difference could be found between the plasma tryptophan concentration in the breast‐fed group versus the group fed the tryptophan‐fortified formula. The results indicate that tryptophan fortification of adapted formula is necessary to achieve plasma total tryptophan concentrations similar to those found in breast‐fed infants. The data also confirm that a formula with reduced protein concentration will support normal growth and will produce a plasma amino acid profile not much different from that of a conventional type of formula.
Basal and Meal‐Stimulated Pepsinogen Secretion in Preterm Infants
Authors: Weisselberg Batia , Yahav Jacob , Reichman Brian , Jonas Anita
Published: January 2024

In order to establish longitudinal normal values for basal and meal‐stimulated pepsinogen secretory function in preterm infants, we studied 44 preterm infants with gestational ages of 28–36 weeks during the period of nasogastric tube feeding. Three age groups were evaluated: gestational ages of 28–30, 31–33, and 34–36 weeks. Basal pepsinogen did not change with postnatal age in any of the groups. Significant meal‐stimulated pepsinogen secretion appeared during the third postnatal week in infants of 28–30 weeks of gestation. In the groups of infants of 31–33 and 34–36 weeks of gestation, significant meal‐stimulated pepsinogen secretion was apparent in the first postnatal week. This study suggests that maturation of pepsinogen secretion appears at 31 weeks of gestation, independent of early feeding.
Efficient Assimilation of Lactose Carbon in Premature Infants
Authors: Kien C. Lawrence , Kepner Jonathan , Grotjohn Karen A. , Gilbert Merry M. , McClead Richard E.
Published: January 2024

Previous studies have shown that there is minimal fecal excretion of carbohydrate energy in premature infants with high breath H2 concentrations, implying that the colon plays an important role in salvaging lactose energy. The present study extends this work by using a stable isotope method for serial assessment of lactose carbon excretion. Thus, in nine premature infants (30–32 weeks of gestation and 11–36 days of age), we conducted 23 longitudinal studies of breath hydrogen concentration and the cumulative fecal excretion of 13C derived from a single dose of [D‐1‐13C]lactose. The ranges of values (X ± SD) for breath hydrogen concentration and lactose absorption were respectively 4–440 ppm/5% CO2 (92 ± 100) and 82–100% tracer dose (98.4 ± 3.9). In 21 studies, lactose carbon excretion was <2% of the dose. There was a significant correlation between postnatal age and breath hydrogen concentration (R = 0.48; p = 0.02). These studies suggest that colonic fermentation activity is adequate for efficient colonic salvage of lactose even during the second week of life.
Gastric Emptying Using Three Different Formulas in Infants with Gastroesophageal Reflux
Authors: Tolia Vasundhara , Lin Chuan‐Hao , Kuhns Lawrence R.
Published: January 2024

The role of delayed gastric emptying (GE) in the pathogenesis of gastroesophageal reflux (GER) in infants is controversial at present. GE has been shown to be altered by the composition and osmolality of the feedings. This prospective study was undertaken to assess the changes in the GE and the percentage of time GER was detected by scintigraphy using three different formulas on consecutive days in infants with GER. Twenty‐eight infants under 1 year of age diagnosed to have GER by extended intraesophageal pH monitoring (pH being <4.0 for >5% of the duration of the test), underwent scintigraphy on three consecutive days using the same volume per single feeding of a casein‐predominant, soy, or a wheyhydrolysate formula in a randomized order. The formulas were isocaloric. Gastric emptying and percentage of GER into the esophagus were estimated for 60 min following these feedings. Mean GER percent during the study was 20.39, 17.68, and 16.34 on casein‐predominant, soy, and whey‐hydrolysate formulas, respectively, and was not significantly different. Mean values of GE were 39.7%, 44.6%, and 48.5% on casein, soy, and whey formula, respectively. No significant difference in GE was also observed between casein‐predominant and soy formula. However, a significant difference was observed (p < 0.05) on GE between casein‐predominant and whey‐hydrolysate feedings. Our data suggest that formula selection may be important in the treatment of conditions associated with delayed gastric emptying.
Indocyanine Green Test Is a Reliable Indicator of Postoperative Liver Function in Biliary Atresia
Authors: Kubota Akio , Okada Akira , Fukui Yuichi , Kawahara Hisayoshi , Imura Kenji , Kamata Shinkichi
Published: January 2024

In order to evaluate liver function in postoperative biliary atresia (BA) patients, the indocyanine green (ICG) clearance test was performed. Nineteen patients, ranging in age from 2 to 9 years, were classified into three groups. Group I were those who had no jaundice throughout the postoperative period (n = 9), Group II were those who had recurrent or intermittent jaundice (n = 7), and Group III were those who had persistent jaundice after hepatic portojejunostomy (n = 3). Forty‐four volunteers of comparative age and sex served as controls to establish a normal range of ICG‐K values in infants and children. The normal minimal ICG‐K value in those 2‐9 years of age was defined as 0.19. ICG‐K values in BA patients were 0.262 ± 0.073 (Group I), 0.150 ± 0.060 (Group II), and 0.054 ± 0.011 (Group III). All nine patients with ICG‐K below the normal level had esophageal varices, and seven of nine had a history of gastrointestinal hemorrhage. Two patients with ICG‐K values within the normal range had esophageal varices, and none had a history of gastrointestinal hemorrhage. Five of nine patients with ICG‐K values below normal had low serum albumin levels, and all had low prealbumin levels. Of those with ICG‐K within the normal range, none had low serum albumin or prealbumin levels. On the other hand, serum bilirubin and other liver function tests did not accurately reflect clinical findings. In conclusion, the ICG test using the ICG‐K value was confirmed to be a reliable indicator of postoperative liver function in BA patients.
Patterns of Hepatitis B Virus DNA Integration in Liver Tissue of Children with Chronic Infections
Authors: Goto Yasuhiro , Yoshida Jun , Kuzushima Kiyotaka , Terashima Makoto , Morishima Tsuneo
Published: January 2024

Although an integration of hepatitis B virus (HBV) DNA in children with chronic HBV infection has been documented at early phases of the disease, the incidence of this process is not known. Therefore we examined nine liver DNA specimens from chronic HBV carriers ages 5‐14 years and one sample from a neonate delivered of a carrier mother, in order to determine the HBV DNA patterns of these patients at different ages and phases of chronic infection. The integrated HBV DNA was detected by Southern blot hybridization and analyzed by molecular cloning. Southern blot showed a smear pattern of HBV DNA integration in four of six chronic hepatitis patients (ages 5‐14), as well as in one asymptomatic carrier (age 12). Multiple and random integrations occurred during chronic infections in childhood. The neonate did not, however, show signs of any integrations, suggesting that integration starts after HBV multiplication. A band pattern that suggested clonal growth of integrated liver cells was found in a chronic active hepatitis patient (age 9) and in one of two hepatocellular carcinoma patients (age 11). Molecular cloning in two cases with chronic active hepatitis showed that the HBV genome structure was preserved in five of six HBV DNA inserts. Our findings confirm that HBV DNA integration can occur at early stages of chronic HBV infection. In Japanese children, the process of integration seems to be common regardless of HBeAg/anti‐HBe status. Thus, repetitive liver biopsies in chronic hepatitis B are useful not only to provide prognostic information referring to the histological progress of the disease but also to reflect the change of HBV DNA pattern in liver tissue during follow‐up.
Tumor Necrosis Factor and IL‐1β Expression in Pediatric Patients with Inflammatory Bowel Disease
Authors: Olson Allan D. , Ayass Mouhib , Chensue Stephen
Published: January 2024

The local release of inflammatory mediators are intricately linked with initiation and propagation of the inflammatory reaction in ulcerative colitis (UC) and Crohn's disease. We have used immunohistochemical staining of colonic biopsies to determine the cell of origin and the location of the cells which synthesize of TNF‐α and IL‐1β in patients with UC and Crohn's colitis. Patients were chosen from children aged 7–16 years, who had UC or Crohn's diagnosed following review of colonic biopsies taken during colonoscopy. The patients reviewed had not received treatment for inflammatory bowel disease. Paraffin embedded colonic biopsies were sectioned, deparaffinized, and stained with mouse monoclonal IgG antibodies directed against human recombinant TNF‐α and IL‐1β. The colonic lamina propria of all biopsies from patients with UC or Crohn's colitis was expanded with a mixed mononuclear, polymorphonuclear, lymphocytic, and plasmacytic infiltrate. Mononuclear cells distributed throughout the interstitium, stained prominently for both TNF‐α and IL‐1β. Plasmacytes, polymorphonuclear leukocytes, small lymphocytes, and foamy macrophages did not stain for either TNF‐α or IL‐1β. Transmigrating mononuclear cells in crypt epithelium also stained brightly for both TNF‐α and IL‐1β. Colonic epithelial cells did not stain for either TNF‐α or IL‐1β. We conclude that (a) expression of both TNF‐α and IL‐1β is significantly increased in colonic biopsies from patients with both UC and Crohn's colitis, (b) mononuclear cells appeared to be the primary source for TNF‐α and IL‐1β in patients with UC and Crohn's colitis, and (c) mononuclear cells synthesizing TNF‐α or IL‐1β are distributed throughout both the intestinal crypts and interstitium.