bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth and Biochemical Response of Premature Infants Fed Pooled Preterm Milk or Special Formula
Authors: Cooper Peter A. , Rothberg Alan D. , Pettifor John M. , Bolton Keith D. , Devenhuis Sophia
Published: February 2024

This study compared growth of a group of very low birth weight infants fed a formula specifically developed for such infants (Formula) with another group fed expressed breast milk (EBM). The Formula contained 2.4 g/dl of protein (lactalbumin: casein ratio, 60:40); 4.1 g/dl of fat (40% medium‐chain triglycerides); 8.8 g/dl of carbohydrates; and 81 kcal/dl, with more calcium, phosphorus, and electrolytes than are in human milk. Premature babies with birth weights between 1,200 and 1,500 g and gestational age less than 36 weeks were eligible for the study and were fed either pooled EBM or Formula until they reached a weight of 1,800 g. Twenty infants fed EBM and 19 infants fed Formula completed the trial. Weight gain was faster in the Formula‐fed infants after a caloric intake of 100 kcal/kg/day was achieved (Formula 27.7 g/day vs. EBM 17.2 g/day; p<0.001). Time to reach 1,800 g was 27 days for the Formula group and 39 days for those on EBM (p<0.001). Increments in head circumference and skinfold thickness were also greater in the Formula‐fed group. Laboratory studies in the two groups of infants showed higher alkaline phosphatase levels, which were not due to vitamin D deficiency, in the EBM‐fed infants.
Gastric Handling of Medium‐Chain Triglycerides and Subsequent Metabolism in the Suckling Rat
Authors: Levy E. , Goldstein R. , Stankievicz H. , Hager E. , Freier S.
Published: February 2024

We have previously shown that preduodenal lipases account for 50% of the lipolytic capacity of 14‐day‐old rats. The present investigation was designed to study the kinetics of and optimal conditions for absorption of fat in the stomach of suckling rats and its subsequent distribution in the body. After the simultaneous instillation of medium‐chain triglycerides (MCT) containing 1.25 μCi 2,3‐[3H]trioctanoate and of long‐chain triglycerides containing 1.25 μCi 1‐[14C]glycerol trioleate into the stomach ligated at the pylorus, we were able to show that gastric absorption of fat is limited to MCT. Two and a half minutes after injection, 88.6% of the radioactivity in the wall of the stomach was associated with free fatty acids, proving that lipolysis had preceded the absorption of the majority of the MCT. The remainder of the radioactivity was found in mono‐, di‐, and triglycerides as well as with cholesterol ester and phospholipids.

In the plasma, peak radioactivity was attained within 2.5 min and a steady state ensued which lasted at least 30 min. Over this time period, specific radioactivity continued to rise in the liver, suggesting that hepatic uptake proceeded at the same rate as gastric absorption. Uptake could also be demonstrated in the three other organs tested, the lungs, the heart, and the kidneys. Absorption of MCT at pH 3 was only 20% of absorption at pH 6, which is the physiological pH in the suckling rat stomach within the first 10 min after a feed. Both at pH 3 and at pH 6, the addition of sodium taurocholate increased absorption of MCT over threefold. It is likely that the absorption of MCT by the stomach is a physiological event in the suckling rat.
Effects of Intrauterine Malnutrition on Brain Free Amino Acids of Young Rats, After Nutritional Recovery During Lactation Period
Authors: Petean Trindade Cleíde Enoir , de Nóbrega Fernando José , de Souza Queiróz Tonete Suzana , Aiello Sartor Maria Eneida , Curi Paulo Roberto
Published: February 2024

The effect of protein‐calorie malnutrition during gestation on the brain amino acids of rat pups was studied following nutritional recovery during lactation. The brain amino acids of rat pups born to dam rats malnourished during gestation were studied after these rat pups received proper nutrition during lactation. Pregnant rats were fed a 1% protein diet with total caloric intake restricted to half that of controls. After birth, the offspring of rats fed on deficient diets were nurtured up to the 28th day postpartum by foster mothers receiving adequate diets. At this time, the offspring were killed. The control group consisted of offspring from pregnant rats fed a diet with adequate protein (21%) and calories during the entire gestation and lactation period. Quantitation of brain amino acids in the pups at 28 days postpartum showed lower concentrations of essential and nonessential amino acids in the rats malnourished during gestation. Concentrations of histidine, glycine, and α‐aminobutyric acid were all reduced. These findings demonstrate that the brains of rat pups malnourished during gestation show persistent decreases in specific brain amino acids after adequate postpartum nutrition.
Early Effects of Bethanechol on the Esophageal Motor Function of Infants with Gastroesophageal Reflux
Authors: Sondheimer Judith M. , Arnold Georgianne L.
Published: February 2024

Lower esophageal sphincter (LES) pressure, as well as esophageal peristaltic amplitude, duration, and velocity were measured in 16 infants with gastroesophageal reflux before administration of subcutaneous bethanechol, and at 10, 20, and 30 min after. Seven infants received 0.1 mg/kg, and 9 received 0.2 mg/kg. Significant increases in LES pressure occurred at both doses and lasted for 20 min. The amplitude and duration of peristaltic contractions were increased only after the larger bethanechol dose, and the increases were of greater magnitude in the distal esophagus than in the middle esophagus. The velocity of peristalsis decreased significantly in both the lower and middle esophagus, but only after the larger dose of bethanechol. Bethanechol had no effect on any motor function of the upper third of the esophagus. The changes in esophageal peristalsis produced by bethanechol may improve the efficiency of distal esophageal acid clearance and thus may be responsible in part for the therapeutic effect of bethanechol in infants with gastroesophageal reflux.
Ultrastructural and Biochemical Changes in Human Jejunal Mucosa Associated with Enteropathogenic Escherichia coli (0111) Infection
Authors: Taylor C. J. , Hart A. , Batt R. M. , McDougall C. , McLean L.
Published: February 2024

A case of prolonged diarrhoea following Escherichia coli 0111 gastroenteritis is reported. Electron microscopy of the jejunal biopsy revealed effacement of the brush border and attachment of bacteria by pedestal formation. Specific activities of brush border enzymes showed marked depression of disaccharidases, zinc‐resistant α‐glucosidase, and alkaline phosphatase. In contrast, marker enzymes for basolateral membranes and endoplasmic reticulum were unaffected. The biochemical changes support the pathogenic mechanism suggested by ultrastructural studies previously reported.
Antibody Response in Serum and Intestine in Children up to Six Months After a Naturally Acquired Rotavirus Gastroenteritis
Authors: Hjelt Karsten , Grauballe Per C. , Andersen Lene , Schiøtz Peter O. , Howitz Peter , Krasilnikoff Peter A.
Published: February 2024

The aim of this study was to provide detailed information about the local and systemic antibody response and their relationship following a rotavirus gastroenteritis. Rotavirus‐specific immunoglobulins were analyzed by enzyme‐linked immunosorbent assay (ELISA). The study included 49 children referred to hospital with rotavirus gastroenteritis and 16 children with nonrotavirus gastroenteritis. The concentrations of rotavirus immunoglobulin A (IgA) in serum increased within the first 2 weeks and those of rotavirus IgG within the first month after the onset of diarrhea. Thereafter, they remained unchanged during the 6‐month observation period. Rotavirus ScIg (i.e., antirotavirus immunoglobulin‐containing secretory component) appeared in serum almost exclusively within 7–14 days after onset (i.e., 85% of the samples). After the first 2 weeks, rotavirus IgA could be detected in the majority of fecal samples, even up to 6 months after the disease. However, rotavirus ScIg was absent in the majority of fecal samples. The severity of illness correlated only with the increase of rotavirus IgG in serum. Conclusively, there is a longstanding immune response after a naturally acquired rotavirus gastroenteritis. Moreover, with the present methods, measurements of rotavirus IgA and IgG in serum can be safely used for serodiagnosis, even when samples are taken with 6‐month interval. It is suggested that trials with rotavirus vaccines include measurements of rotavirus IgA and ScIg in serum and rotavirus IgA in feces.
Dietary Fructose in the Management of Intractable Diarrhea of Infancy
Authors: Clark Joseph H. , Bullock Linda , Fitzgerald Joseph F.
Published: February 2024

Carbohydrate digestion/absorption was evaluated in 11 infants with intractable diarrhea while they were receiving a carbohydrate‐free soy‐isolate formula. Seven patients were fed within 48 h of admission. Enteral feedings were initiated in the remainder after they had gained 1 kg while receiving parenteral nutrition. All feedings were initially administered by continuous nasogastric infusion. Nine patients were initially fed formula with polymeric glucose; two received fructose as the carbohydrate source, based on a documented history of polymeric glucose intolerance. Five of the nine developed watery, acidic stools while receiving polymeric glucose. All were switched to fructose, which resulted in improvement in stool pH and consistency. Glucose tolerance was normal 1 month after discharge in all seven fructose‐requiring infants. Three of six infants have shown a persistent inability to hydrolyze sucrose. Several putative mechanisms of polymeric glucose intolerance are discussed, as well as the apparent association with primary sucrase‐isomaltase deficiency in three of the patients. Fructose is an effective alternative carbohydrate source in infants unable to tolerate polymeric glucose, and early initiation of fructose may obviate the need for total parenteral nutrition and prolonged bowel rest.
Clinical and Radiological Diagnosis of Crohn's Disease in Children
Authors: Macfarlane P. I. , Miller V , Ratcliffe J. F.
Published: February 2024

Diagnosis of Crohn's disease in children may be delayed because of obscure presention and inappropriate investigation. The clinical and radiological features in 35 children with Crohn's disease were reviewed retrospectively. The distal ileum and proximal colon were the most common sites of disease. Intestinal symptoms and signs were often overshadowed by nonspecific complaints. Proximal small bowel disease was characterised by oedema, clubbing, anaemia, and stunting of growth. The delay in diagnosis was less than in other series, although most prolonged in the group with proximal disease. We have identified a group of clinical features that strongly suggests Crohn's disease. In these patients, we believe a small bowel enema is justified. Small bowel enema, although invasive, is more effective than barium meal and follow‐through for demonstrating Crohn's disease. Severity of radiological changes did not correlate with clinical assessment. Neither bowel stricture nor fistula was found. Radiology of the colon was insensitive and colonoscopy is better for assessing colonic disease.
Laboratory Assessment of Disease Activity in Childhood Crohn's Disease and Ulcerative Colitis
Authors: Macfarlane P. I. , Miller V , Wells F. , Richards B.
Published: February 2024

The erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), and serum orosomucoid were measured in children with Crohn's disease and ulcerative colitis in various states of disease activity. Results were matched with a clinical assessment to determine the correlation between laboratory test values and disease activity. Regression analysis showed that serum orosomucoid reflected disease activity better than ESR in both diseases. Orosomucoid but not ESR discriminated between disease in remission and mild disease in ulcerative colitis. No test invariably predicted presence or absence of active disease. Orosomucoid and ESR were complementary, but CRP was of no additional value. The usefulness of orosomucoid and ESR as objective measures of inflammatory activity was not masked by corticosteroid medication.
Effect of Gestational Age Upon Prealbumin and Retinol Binding Protein in Preterm and Term Infants
Authors: Sasanow Sharon R. , Spitzer Alan R. , Pereira Gilberto R. , Heaf Louisa , Watkins John B.
Published: February 2024

The relationships between maternal and umbilical cord levels of prealbumin and retinol binding protein (RBP) were studied in 68 mothers and in their appropriate‐for‐gestational‐age neonates delivered between 25 and 42 weeks gestation. Arterial and venous concentrations of prealbumin and RBP in cord sera were also studied in a subsample of eight infants. In cord sera, prealbumin and RBP levels increased with gestational age (prealbumin, r = 0.47; RBP, r = 0.40, p < 0.01), and were significantly different in neonates born at term compared to those born prematurely (mean ± SD, prealbumin 12.0 ± 3.9 mg/dl vs. 8.8 ± 2.3 mg/dl, p < 0.001; RBP, 2.3 ± 0.8 vs. 1.8 ± 0.5 mg/dl, p < 0.005). No significant differences between arterial and venous concentrations of prealbumin and RBP were observed in cord blood. In maternal blood, serum prealbumin and RBP concentrations did not increase with length of gestation (25–42 weeks). Maternal prealbumin was not correlated significantly with infants' cord serum levels; the correlation coefficient for RBP was 0.29, p < 0.05. Maternal prealbumin and RBP serum levels were approximately twice the values seen in neonates born both at term and prematurely. Although the difference between premature and full‐term cord levels of prealbumin and RBP may reflect an increase in hepatic protein synthesis that occurs with maturation of the fetus and/or a change in placental function after 37 weeks gestation, neither of these factors sufficiently explains the variance in neonatal prealbumin and RBP levels.
Absorption of Selenium From Milk Protein and Isolated Soy Protein Formulas in Preschool Children
Authors: Solomons Noel W. , Torun Benjamin , Janghorbani Morteza , Christensen Merrill J. , Young Vernon R. , Steinke Fred H.
Published: February 2024

Absorption of selenium as the stable isotopic tracer [74Se]selenite was measured in four preschool children who were receiving liquid formula diets based on casein, isolated soy protein, and a 50:50 combination of the two protein sources. The children were in continuous ambulatory balance studies within the Clinical Research Center during three consecutive 11‐day collection periods. The enrichment of the 74Se/76Se ratio in feces was measured by radiochemical neutron activation analysis, with fractional absorption estimated therefrom. Mean fractional absorption of selenium (± SD) from the formulas based on milk, isolated soy protein, and milk‐soy were 64.2 ± 14.6, 73.4 ± 19.0, and 45.0 ± 10.9%, respectively, with the combined formula having a significantly lower intestinal uptake for added selenite than the casein formula. Stable isotopes of selenium are safe and potentially useful tools for examining its bioavailability in the diets of young children.
Two‐Hour Lactose Breath Hydrogen Test
Authors: Abramowitz Aron , Granot Esther , Tamir Israel , Deckelbaum Richard J.
Published: February 2024

Current requirements for the lactose breath hydrogen test (LBHT) include serial expired air samplings and multiple hydrogen (H2) determinations. One hundred thirty‐two consecutive LBHTs were evaluated to determine whether multiple samplings are indeed necessary for detection of lactose malabsorption. Expired air samples were collected at 0, 30, 60, 90, 120, 150, and 180 min following ingestion of lactose. Fifty‐five LBHTs were positive for lactose malabsorption. All tests showed abnormally elevated breath H2 concentrations at 120 min. The mean value of the change in parts per million (Δ ppm) of H2 at 120 min (51.1 ± 4.7 SEM) was higher than at any other time point. If only the 120‐min samples were examined without subtracting the initial concentrations, four of the 77 negative tests (5.2%) would have been falsely positive. Thus, the values of H2 at 0 and 120 min were sufficient to define lactose malabsorption in all cases. We conclude that just as a single blood sample now suffices for determining xylose malabsorption, so expired air sampling at only 0 and 120 min during the LBHT is a reliable method for detecting lactose malabsorption and diminishes the need for acquiring and analyzing multiple samples.
Effect of Bethanechol and Metoclopramide on Upper Gastrointestinal Motility in the Kitten
Authors: Hillemeier Craig , McCallum Richard , Oertel Robin , Gryboski Joyce
Published: February 2024

Gastroesophageal reflux (GER) during infancy is a disorder of unknown etiology which may be associated with abnormalities of upper gastrointestinal motor function. Bethanechol, a muscarinic agonist, and metoclopramide, a dopamine antagonist, have been utilized as pharmacologic agents in an attempt to improve upper gastrointestinal motility in this disorder. We have studied the effect of these agents on upper gastrointestinal motility in an infant model, the kitten. Bethanechol is found to greatly increase lower esophageal sphincter (LES) pressure and have no effect on esophageal peristaltic amplitude or gastric emptying of a liquid meal. Metoclopramide causes a small and nonsignificant increase in LES pressure, has no effect on esophageal peristalsis, and increases the rate of gastric emptying of a liquid meal. These results suggest that these two agents may have specific actions on the infant's upper gastrointestinal tract.
Effect of a Maternal Fast on the Urea Cycle Enzymes of the Ovine Fetus
Authors: Lemons James A. , Snodgrass Philip J.
Published: February 2024

Activities of five urea cycle enzymes were measured in maternal and fetal sheep liver during the normal fed state and following 5 days of fasting. Six ewes and 10 fetuses were studied in both the fed and fasted periods at 132 days gestation (term: 147 days) for liver protein and enzyme levels. Results indicated that protein content increased during fasting in both the maternal and fetal liver. Fetal liver weight was decreased during fasting from 108 ± 8.5 to 71 ± 8.2 g (mean ± SD) (p < 0.001). Fed state fetal enzyme activities per gram liver were 50–125% of maternal values. After fasting, four of the five fetal enzymes increased approximately twofold to fivefold (per gram tissue) (ornithine transcarbamylase did not change). Only one enzyme (argininosuccinase) increased significantly in maternal liver. Total liver activities gave similar results. These data indicate that the in vivo studies that demonstrate a doubling in fetal urea production in the fasted sheep in later gestation are associated with parallel increases in the fetal hepatic activities of several enzymes that are responsible for urea synthesis.
Modification of the Adult Blakemore Tube for Use in Children with Bleeding Esophageal Varices
Authors: Kline Jeffrey J.
Published: February 2024

A modification of the adult‐sized Blakemore tube is described for emergency use in children with bleeding esophageal varices. Inexpensive, readily available, heat‐labile tubing was used to adapt the esophageal balloon for use in small children, keeping possible complications at a minimum.
Esophagitis and Findings of Long‐Term Esophageal pH Recording in Children with Repeated Lower Respiratory Tract Symptoms
Authors: Baer Maija , Mäki Markku , Nurminen Juha , Turjanmaa Väinö , Pukander Juhani , Vesikari Timo
Published: February 2024

Esophagoscopy was performed on 116 children with recurrent lower respiratory tract symptoms; esophagitis of various degrees was detected in 45% of the cases. The presence of verified esophagitis correlated with endoscopic findings of bile‐stained gastric contents, suggesting a role of bile reflux in the pathogenesis. Esophageal pH recordings covering an 18‐24‐h period were performed on 22 patients with esophagitis and 19 patients without esophagitis. Gastroesophageal reflux (GER) during the sleeping period was detected in 95% of children with esophagitis, as compared to 42% in children with no esophagitis (p < 0.001). The percentage of time with esophageal pH below 4 of the total registration time was significantly greater (p < 0.05) in children with esophagitis (9.5%) than in those with no esophagitis (4.0%)—the difference being due to a greater share of nocturnal GER of the recording time. These criteria could be applied to a search for clinically significant GER in children with recurrent lower respiratory tract symptoms and to select patients for esophagoscopy.
Comparative Reliability of d‐Xylose Absorption and Serum β‐Carotene Measurements in Small Intestinal Disease
Authors: Amira Ken‐Dror Yehezkel Naveh , Zinder Oren , Berkovich Drora
Published: February 2024

Comparative reliability of d‐xylose absorption and serum β‐carotene measurements was studied in 63 healthy and sick children suspected of having proximal small intestinal disease. Group 1 included children with newly diagnosed celiac disease (CD) who were on a normal diet (xylose, n = 46; carotene, n = 43); group 2 included children with CD in remission (xylose, n = 17; carotene, n = 15); group 3 included children with CD in remission, but who were exposed to a gluten‐containing diet for an average of 1.4 years (xylose, n = 19; carotene, n = 17); and group 4 included 17 healthy children, insofar as this study is concerned, in whom serum carotene was examined. The means of serum xylose of groups 1 and 3 were significantly lower than the mean of group 2 (p < 0.001 in both cases). d‐Xylose had a sensitivity of 76.9% and a specificity of 100%. The mean serum carotene concentration for group 2 patients with CD in remission was equal to the mean of group 4, which included healthy children. The means of groups 1 and 3 were significantly lower than the means of groups 2 and 4 (p < 0.001 in all cases). Serum β‐carotene had a sensitivity of 95% and a specificity of 87.5%. The use of these two serum tests in combination would give a specificity of 100% and a sensitivity of 94.1%. Although 1‐h serum xylose was as efficient as serum β‐carotene in newly diagnosed children with CD, carotene was superior to xylose in patients with CD who were challenged with gluten (group 3), and therefore the measurement of carotene, which has the higher sensitivity, may be useful in the detection of children with CD who lack strict adherence to the gluten‐free diet.
Enteropathogens Associated with Acute Diarrhea in Hospitalized Infants
Authors: Figueroa Guillermo , Araya Magdalena , Ibañez Silvia , Clerc Nadine , Brunser Oscar
Published: February 2024

Thirty‐five infants of low socioeconomic status who were living in urban Santiago were hospitalized for acute diarrhea were prospectively evaluated for the presence of enteropathogens associated with the episode. Some degree of malnutrition was evident in 20 infants (57.1%); 15 of these (75%) were under 6 months of age. Mean duration of the hospital stay was 11.8 days for well‐nourished patients and 15.7 days for the malnourished patients. One or more enteropathogens were found in 60% of the cases studied: in 17 cases (48.6%) these were bacteria and in four cases (11.4%) it was rotavirus. Parasites were not detected. In three patients, two different pathogens were demonstrated. Among the bacteria, 12 isolates (34.3%) were enteropathogenic E. coli (EPEC) and two (5.7%) were Shigella. Campylobacter jejuni was also isolated from two different cases (5.7%) and Salmonella from one case (2.9%). The recovery of pathogens was independent of the nutritional status. Mean age of detection of EPEC was 3.2 months among well‐nourished infants and 6.2 months among the malnourished (p < 0.001). Half of the EPEC strains isolated were multiresistant to antibiotics. One of these strains transferred some of its resistance in vitro to E. coli K 12. Ampicillin and kanamycin were the antibiotics to which EPEC showed the greatest resistance. The other bacterial pathogens were mostly sensitive to antibiotics. Campylobacter jejuni, together with Shigella, was the second most frequent pathogen isolated during episodes of diarrhea. Campylobacter should be included in the routine study of diarrheal episodes in our setting.
Mineral Homeostasis in Very Low Birth Weight Infants Fed Either Own Mother's Milk or Pooled Pasteurized Preterm Milk
Authors: Pettifor John M. , Stein Harry , Herman Allen , Ross Paddy F. , Blumenfeld Tanya , Moodley Gopal P.
Published: February 2024

As part of a randomised controlled study to assess the effect of pasteurization of breast milk on the growth of very‐low‐birth‐weight infants, the longitudinal changes in serum calcium, phosphorus, alkaline phosphatase, 25‐hydroxyvitamin D, and bone‐gla‐protein concentrations were investigated. Infants fed untreated own mother's milk grew more rapidly than those fed pasteurized pooled preterm milk and had higher serum alkaline phosphatase and lower phosphorus values. Serum calcium and 25‐hydroxyvitamin D (25‐OHD) concentrations were similar in the two groups. Despite the provision of 750 IU vitamin D daily from the 2nd week of life, serum 25‐OHD values remained low in a number of infants in both groups, suggesting that either malabsorption of vitamin D or hepatic immaturity might be responsible for the persistently low values. Bone‐gla‐protein rose significantly after birth and was correlated with alkaline phosphatase values, but not with 25‐OHD or phosphorus values. The study supports previous work that indicates that the low phosphorus content of breast milk is probably responsible for biochemical evidence of inadequate bone mineralization and that despite vitamin D supplementation, 25‐OHD values do not rise adequately. Thirty‐six infants were reexamined between 4 and 11 months after birth. The 25‐OHD values had risen significantly in all infants except one who had vitamin D deficiency rickets.
Reliability of a New Technique for the Determination of Vitamin B12 Absorption in Children
Authors: Hjelt Karsten
Published: February 2024

The fractional vitamin B12 absorption (FAB12) was determined in 39 patients with various gastrointestinal diseases by a double‐isotope technique, employing a single stool sample test (SSST), as well as a complete stool collection. The age of the patients ranged from 2.5 months to 16.2 years (mean 5.0 years). The test dose was administered orally and consisted of 0.5‐4.5 μg of 57CoB12 (approximately 0.05 μCi), carmine powder, and 2 mg 51CrCl3 (approximately 1.25 μCi) as the inabsorbable tracer. The whole‐body radiation to a 1‐year‐old child averaged only 20 mrad. The stool and napkin was collected and homogenized by addition of 300 ml “chromium sulfuric acid.” A 300‐ml sample of the homogenized stool and napkin, as well as 300 ml chromium sulfuric acid (75% v/v) containing the standards, were counted in a broad‐based well counter. The FAB12 determined by SSST employing the stool with the highest content of 51Cr (which corresponded to the most carmine‐colored stool) correlated closely to the FAB12 based on complete stool collection (r = 0.98, n = 39, p < 0.001). The reproducibility of FAB12 determined by SSST was assessed from double assays in 19 patients. For a mean value of 12%, the SD was 3%, which corresponded to a coefficient of variation (CV) of 25%. The excretion of 57Co and 51Cr in the urine was examined in six patients with moderate to severe mucosal damage and was found to be low. The gut transit time, as determined by the excretion time of ≥ 50% of the orally administered 51Cr, ranged from 4 to 100 h (mean 36 h, n = 39), and it was less than 12 h and 24 h in 7 and 13 patients, respectively. Conclusively, the SSST proved to be a very suitable technique for measurements of B12 absorption, even in children with mucosal damage of the intestine and short gut transit time. Further‐more, the method fulfilled the following requirements; (a) minimal cooperation and control of possible errors, (b) small radiation dose, (c) direct measurement of the B12 absorption, and (d) no need for flushing with B12.
Relapsing Pseudomembranous Colitis
Authors: Holmes Ronald , Byrne William J.
Published: February 2024

Pseudomembranous colitis secondary to C. difficile and its toxin(s) is a well‐recognized disease in children and usually responds to treatment with oral vancomycin. There are well‐documented reports of relapse in adults after initial successful treatment with vancomycin. This report documents relapse in a child who developed diarrhea following treatment of pseudomembranous colitis. Stool cultures were negative for C. difficile at the end of the initial course of treatment, but the organism was isolated from the stool when the diarrhea recurred. The symptoms improved following a second course of treatment with vancomycin and have not recurred during 8 months of followup monitoring.
Delayed Gastric Emptying and Chronic Diarrhea in a Patient with Oculodentodigital Dysplasia Syndrome
Authors: Levine Douglas S.
Published: February 2024

A patient with oculodentodigital dysplasia (ODDD) syndrome was evaluated because of complaints of intermittent diarrhea of many years duration. Gastrointestinal manifestations have not been routinely described in patients with ODDD, which is a hereditary disorder characterized by abnormal eye findings, defective tooth enamel, various phalangeal aberrations, a distinctive facial appearance, and skeletal dysplasias. Steatorrhea was documented, but the usual methods for investigating this were thwarted ?? motility. A combined endoscopic‐fluoroscopic, guidewire‐directed intubation procedure was performed to permit study of the small bowel. Pancreatic function was normal, and culture of an aspirate from the jejunum revealed a mixed bacterial flora. Treatment for presumed small bowel bacterial overgrowth with antibiotics and a reduced fat diet brought relief of diarrheal symptoms and produced weight gain. The clinical approach to this particular patient and the relationship between the ODDD syndrome and the deseribed gastrointestinal anomalies are disecossed.
Oral Therapy of Neonates and Young Infants with World Health Organization Rehydration Packets
Authors: Bhargava S. K. , Sachdev H. P. S. , Gupta B. Das , Mohan Man , Singh H. P. , Daral T. S.
Published: February 2024

Summary: The World Health Organization (WHO) recommends an oral rehydration solution (ORS) that has been linked with a risk of hypernatremia in young infants when extra water or dilute milk is withheld. A controlled, randomized study was therefore undertaken in 50 male infants aged 0–3 months to evaluate the relative safety, efficacy, and practicability of two methods of obviating this risk without negating the concept of a universal rehydrating packet. Twenty‐five infants in Group A were re‐ hydrated with a 2:1 regimen (two parts, i.e., 60 ml, WHO‐ORS followed by one part, i.e., 30 ml, plain water in an alternating manner) whereas 25 infants in Group B received diluted WHO‐ORS (1.5 L water instead of 1 L). In two patients, one in each group, oral therapy failed and they were excluded from analysis. Sub‐Group Ac was comprised of 15 cases in Group A in whom the rehydrating instructions were followed correctly. Diluted WHO‐ORS provided as safe and effective rehydration as the 2:1 regimen administered properly (sub‐Group Ac). Both methods adequately corrected and maintained the hydration status and serum sodium levels, but a few infants in each group had subnormal serum K+/HCO3‐ levels during therapy. Rehydrating instructions in Group A were misinterpreted in nine (37.5%) cases. Excessive ORS intake in five infants resulted in hypernatremia (three cases, 12.5%), periorbital edema (three cases, 12.5%), excessive irritability (two cases, 8.3%), and mild pedal edema (one case, 4.2%). Excessive water intake in comparison to ORS in four infants was responsible for delayed rehydration (three cases, 12.5%) and asymptomatic hyponatremia and hypokalemia (two cases, 8.3%). It is concluded that diluted WHO‐ORS is as efficient as the 2:1 regimen for correcting and maintaining the serum sodium and hydration status. However, complications can arise from improper administration of the latter by illiterate users; and both methods are deficient with respect to K+ and HOC3‐ requirements.
Formula Intake of 1− and 4‐Month‐Old Infants
Authors: Montandon Corinne M. , Wills Cathy , Garza Cutberto , O'Brian Smith E. , Nichols Buford L.
Published: February 2024

Summary: This study was designed to estimate energy intake in exclusively formula‐fed infants. Formula intake of twenty‐four 1− and 4‐month‐old infants was studied for 5 consecutive days; six boys and six girls were in each age group. Intake was estimated by laboratory‐determined weights of formula consumed, spilled, and regurgitated. Two additional methods were used to estimate intake in the first nine infants during the 1st day of observation: test‐weighing the infant at each feeding and mother's weighing of formula consumed, regurgitated, and spilled at each feeding. No consistent differences were detected among methods, but test‐weighing appeared to have the greatest feed‐to‐feed variability. Intake was estimated to be 747 ± 100 g or 125.5 ± 17 kcal/kg, and 958 ± 131 g or 94.0 ± 13 kcal/kg for 1− and 4‐month‐old infants, respectively. The day‐to‐day variability (expressed as the coefficient of variation) was 13 and 15% (CV, g/kg) for 1− and 4‐month‐old infants, respectively. Between‐infant variability of intake was ∼8% (CV, g/kg) for both age groups. Energy intakes of 1‐month‐old formula‐fed infants were similar to published values of breast‐fed infants of similar age, but the energy intakes of 4‐month‐old formula‐fed infants were significantly higher than values published for 4‐month‐old breast‐fed infants.
Specific Milk Immune Response of Rural and Urban Guatemalan Women to Oral Immunization with a Food Protein
Authors: Cruz J. R. , Hanson L. Å.
Published: February 2024

Summary: Forty‐nine lactating women from Guatemala, 18 from a rural community and 31 from Guatemala City, were immunized orally with a protein extract from Vigna sinensis. Oral vaccination during the 1st week post‐partum induced the appearance of short‐lived, specific antibodies in milk in 59% of the subjects. No differences in rates of lactoconvertion were found either between socioeconomic groups or between malnourished and well‐nourished women.
Myoinositol in Small Preterm Infants
Authors: Bromberger Pat , Hallman Mikko
Published: February 2024

Summary: Serum myoinositol (henceforth called inositol) concentration was measured in 12 preterm infants (birth weight 800–1,700 g, gestational age 27–32 weeks) from birth to 10 postnatal weeks. The diet was analyzed for inositol concentration and the daily intake was correlated with serum inositol. There were striking differences in the inositol concentration of infant feedings: preterm colostrum 4.22 ± 0.51 mM; term colostrum 2.91 ± 0.21 mM; mature milk 1.81 ± 0.20 m M; infant formulas 0.09–0.39 m M; parenteral nutrition 0.15 ± 0.13 m M. The high fetal serum inositol often fell during the first 2 weeks. After 2 weeks, serum inositol correlated significantly with inositol intake (R = 0.601, p < 0.004). On breast milk serum inositol concentrations (0.56 ± 0.07 m M) were higher than on formula feedings (0.36 ± 0.03 m M). Since according to animal studies inositol is important during prenatal growth and differentation, the present data justify further study on importance of dietary inositol in preterm infants.
Hepatic and Serum Levels of Zinc, Copper, and Magnesium in Childhood Cirrhosis
Authors: Göksu Nesrin , Özsoylu Şinasi
Published: February 2024

Summary: Serum and hepatic zinc (Zn), copper (Cu), and magnesium (Mg) contents were determined in 21 children with morphologically proven liver cirrhosis: 11 with cryptogenic cirrhosis (CC) and 10 with secondary biliary cirrhosis (SBC). These determinations were also carried out in eight patients with idiopathic portal hypertension. Serum levels of Zn, Cu, and Mg in 23 healthy children and hepatic contents of these minerals in 22 patients without liver pathology were evaluated. All determinations were carried out by atomic absorption spectrophotometry by using special tubes, needles, and syringes in appropriate conditions. Tissue Zn and Mg contents were decreased, but the Cu level was elevated significantly in childhood cirrhosis; in almost all patients with SBC and half of the CC cases. Serum levels of these minerals generally did not correlate to tissue levels in childhood cirrhosis.
Atypia of Hepatic Histiocytes Induced by Renografin‐60
Authors: Finley Allen J. , Ishak Kamal G.
Published: February 2024

Summary: Recurrent bouts of abdominal pain in a 12‐year‐old patient were diagnosed as due to intermittent obstruction of the choledochus. The condition was corrected by choledochostomy. Incidental liver biopsy showed atypia of intrahepatic histiocytes. However, electron microscopy identified associated foreign bodies suspected of being an iodinated compound. Six months later a repeat liver biopsy and extensive search showed no carcinoma present. The hepatic atypia was thought to have been induced by diatrizoate meglumine/diatrizoate sodium (Renografin‐60), an iodinated compound (E. R. Squibb, Princeton, NJ, U.S.A.) used during percutaneous transhepatic cholangiography.
Celiac Disease Presenting as Chronic Hepatitis in a Girl
Authors: Maggiore Giuseppe , De Giacomo Costantino , Scotta Maria S. , Sessa Fausto
Published: February 2024

Summary: A case of celiac disease presenting as an asymptomatic chronic persistent hepatitis in an 11‐year‐old girl is reported. Liver biopsy performed because of long‐standing elevation of serum transaminase levels showed a mild portal fibrosis with mononuclear infiltrate. Immunofluorescence staining did not reveal deposits of immunoglobulins or complement in the liver specimen. Although the girl was totally asymptomatic, she had steatorrhea, a delayed bone age, and an abnormal D‐xylose test. A jejunal biopsy showed villous atrophy and increased intraepithelial lymphocytes. On a gluten‐free diet the level of transaminases fell to normal within I month and remained normal. According to biological remission, a second intestinal biopsy performed after 1 year of gluten‐free diet revealed a normal intestinal mucosa. Our report suggests that an underlying chronic intestinal disorder, and particularly celiac disease, must be ruled out when evaluating a child with elevated levels of serum transaminase.
Malabsorption of Liposoluble Vitamins in a Child with Bile Acid Deficiency
Authors: Vanderpas Jean B. , Koopman Berend J. , Cadranel Samuel , Vandenbergen Claudine , Rickaert Fabienne , Quenon Marianne , Wolthers Bert G. , Brauherz Georges , Vertongen Françoise , Tondeur Michel
Published: February 2024

A male born to first cousins presented at 12 months with hypocalcemic convulsions, rickets, epistaxis due to vitamin K deficiency, and extremely low serum levels of beta‐carotene and vitamin A. Liver function was altered moderately (glutamic‐oxaloacetic transaminase, 55 U/L; glutamic‐pyruvic transaminase, 37 U/L; lactate dehydrogenase, 255 U/L; alkaline phosphatase, 437 U/L). To correct the deficiencies, 8000 IU vitamin D/day, 10,000 IU vitamin A/day, and intramuscular administration of vitamin K1 were required. At 9 years, he presented signs of neuromuscular affection, and the serum vitamin E level (measured for the first time) was extremely low. Classic lipid malabsorption syndromes (abetalipoproteinemia, chronic cholestasis, mucoviscidosis, coeliac disease, Whipple's disease) were excluded by appropriate examinations. Composition of duodenal bile acids was characterized by undetectable levels of cholic acid metabolites, and only chenodeoxycholic acid metabolites were present. Serum total bile acid concentration was normal, with an atypical low cholic acid/chenodeoxycholic acid ratio and abnormal presence of 3β‐OH‐δ5‐cholenic acid and 6‐OH‐bile acids. Urinary bile acid composition was also characterized by elevated 6‐OH‐bile acids. Known enzymopathies of the bile acid synthetic pathway were excluded (cerebrotendinous xanthomatosis, cerebro‐hepato‐renal syndrome of Zellweger, coprostanic acidemia). Bile acid pool sizes were determined by using stable isotopes: cholic acid pool size [2.90 (N, 32 ± 16) μM/kg] and chenodeoxycholic acid pool size [10.8 (N, 32.6 ± 9.9) μM/kg] were extremely low; fractional turnover rates of both bile acids were in a normal range. Treatment with chenodeoxycholic acid markedly improved the absorption of fat soluble substances and normalized hepatic function. A partial enzyme defect in the metabolism of the steroid nucleus is proposed.
Acarboxy Prothrombin (PIVKA‐II) as a Marker of Hepatoblastoma in Infants
Authors: Motohara Kunihiko , Endo Fumio , Matsuda Ichiro , Iwamasa Teruo
Published: February 2024

We evaluated plasma PIVKA‐II (protein induced by vitamin K absence or antagonist‐II, acarboxy prothrombin) levels in three infants with hepatoblastoma as a tumor marker. PIVKA‐II levels were highly elevated in all three patients. Vitamin K administration, performed in two patients, resulted in only moderate reduction of PIVKA‐II levels. Chemotherapy against tumor cells reduced the PIVKA‐II levels without exception. Immunohistochemical study of the liver tissue indicated the presence of PIVKA‐II in the hepatoblastoma cell. These findings suggest that elevated PIVKA‐II in these patients was not due to nutritional vitamin K deficiency, but to excess production of tumor cells. A measurement of plasma PIVKA‐II may be useful as a new marker of hepatoblastoma.
Intestinal Obstruction in Crohn's Disease in Childhood
Authors: Kirchmann Hiltrud M. A. , Bender Steffen W.
Published: February 2024

Out of 540 children and adolescents from the Multicenter Pediatric Crohn's Disease Study Group, 42 patients presented with decompensated intestinal obstruction. In 26 patients only one intestinal obstruction occurred, and in 16 children up to five intestinal obstructions occurred. Conservative measures were successful in 37 of 72 episodes of intestinal obstruction (51.4%), while 19 of 42 patients underwent emergency surgery (45.2%) and 16 of 42 (38.1%) were operated on following conservative treatment. From analysis of clinical, intraoperative, and histological findings in surgically treated patients, criteria for emergency surgery and elective surgery of intestinal obstruction in Crohn's disease are derived. One patient with adenocarcinoma of the large bowel, presenting with recurrent obstruction, signals caution in delaying proper diagnosis.
Effect of Somatocrinin and a Somatostatin Antiserum on Liver Growth in the Rat
Authors: Dubreuil P. , Brazeau P. , Morisset J.
Published: February 2024

This study examines the effects of somatocrinin (GRF) and somatostatin antiserum (ASS) alone, and in combination, on liver growth. Twenty‐four‐day‐old rats were injected s.c. twice daily for 14 days with either saline or GRF (4 and 20 μg · kg‐1)‐ASS was given i.p. every 2 days. GRF alone had no effect on liver weight, but produced hyperplasia and increased RNA content. ASS alone had no effect on RNA, DNA, and protein contents. Potentiation of the effects of GRF by ASS was observed on liver weight and DNA content. Indeed, this combined treatment resulted in increased organ weight and hyperpiasia at an intermediary level of GRF. These data indicate that a strong interaction exists between GRF and ASS on the control of liver growth, possibly through the release of growth hormone (GH).
Evaluation of Hexosaminidase Activity as a Potential Biochemical Marker in Serum for Necrotizing Enterocolitis
Authors: Shattuck Karen E. , Richardson C. Joan , Rassin David K. , Lobe Thom E.
Published: February 2024

The presence of increased serum activity of the lysosomal hydrolase hexosaminidase has been suggested to be potentially useful in the diagnosis of neonatal necrotizing enterocolitis (NEC). In the present study, serum activity of hexosaminidase was measured in 19 neonates with NEC and compared to developmental patterns of enzyme activity determined in 61 neonates without NEC. Infants with NEC were studied at intervals starting at the onset of disease and continuing until 6 weeks after diagnosis. In normal infants, serum activity of hexosaminidase increases with increasing gestational and postnatal ages. However, infants with NEC had relatively lower serum hexosaminidase activity than these control infants of similar gestational and postnatal ages. Necrotizing enterocolitis is not associated with increased serum activity of hexosaminidase.
Disaccharidase Activities and Intestinal Absorption in Infants with Congenital Intestinal Obstruction
Authors: Serrano J. , Zetterström R.
Published: February 2024

The results of studies on disaccharidase activities and on intestinal absorption in cases of complete and incomplete congenital small bowel obstruction are presented. Assays of the activities of maltase, isomaltase, sucrase, trehalase, and lactase have been performed on biopsy specimens taken at the time of surgery. In specimens taken from above the site of obstruction, the activities are reduced for all disaccharidases, and are particularly low for trehalase and lactase. There was no difference between the cases with complete and incomplete obstruction. Distal to a complete obstructionrehalase and lactase were reduced, whereas in cases of incomplete obstruction, the activities of all disaccharidases were within what is considered normal in the reference material. Two months after surgery, the disaccharidase activities were found to be normal: One month after surgery, the absorption of glucose and vitamin A was markedly impaired in cases with complete obstruction, whereas that of D‐xylose was not significantly reduced from normal. In cases with incomplete obstruction, the results did not differ from those found in normal infants. The fact that failure to thrive is common during the first months after birth in patients with congenital intestinal atresia, even when surgery is successful, may be explained by deficient intestinal absorption, particularly in patients with complete obstruction.
Serum Calcium and Phosphate Disturbances During Rehydration in Acute Dehydrating Gastroenteritis
Authors: Mohanlal Dhirenda , Pettifor John M. , Moodley Gopal P.
Published: February 2024

Alterations in serum ionized and total calcium, magnesium, and phosphate concentrations, during recovery from acute dehydrating gastroenteritis, were studied. Fifteen children with acute dehydrating gastroenteritis had serum concentrations of ionized and total calcium, magnesium, phosphate, sodium, potassium, chloride, urea, creatinine, and albumin, as well as acid‐base status, evaluated during rehydration and up to 72‐h postadmission. The total serum calcium corrected for albumin did not change significantly during rehydration and remained within the normal range. Although serum ionized calcium fell significantly at 24 and 72 h, its concentration was not sufficiently decreased to cause symptomatic hypocalcemia. Serum ionized calcium correlated significantly with pH (r −0.57), bicarbonate (r = −0.63), and albumin (r = +0.65), but not with total serum calcium, magnesium, and phosphate. Serum magnesium remained within the normal range during the study period. Serum phosphate was increased on admission (2.64 ± 0.77 mmol/L), decreased by 12 h (to 0.84 ± 0.32 mmol/L), and then followed by a gradual increase. This study suggests that changes in serum ionized calcium in dehydrating gastroenteritis are not of clinical significance. However, changes in serum phosphate concentration need further evaluation.