bluuebunny/crossref_metadata_2025 huggingface dataset:
Background Levels of Carbon‐13 Reduced in Breath and Stool by New Infant Formula
Authors: Boutton T. W. , Hopkinson J. M. , Benton D. A. , Klein P. D.
Published: January 2024

Summary: Studies of the absorption and bioavailability of nutrients naturally enriched with 13C require accurate measurements of small increases of 13C in respiratory CO2 and stool carbon. The sensitivity of these measurements would be increased if the natural background of 13C in these exereta were reduced. We have developed a 13C‐depleted infant formula based on lactose, whey, and casein from New Zealand cows that consume only C3 vegetation naturally low in 13C. This formula, designated CNRC3 was produced by a commercial infant formula manufacturer and was comparable with a 60:40 whey/casein product. To test the ability of the formula to reduce baseline levels of 13C in infant excreta, 10 formulafed infants 28–60 days old and free of metabolic disorders were enrolled in the 9‐day study. Two stool samples were collected daily. Infants received their usual formula on days 1 and 2 and were switched to CNRC3 formula for days 3–9. On days 2 and 9, seven breath samples were collected at 30‐min intervals with a face mask. Breath and stool samples were analyzed for 13C content by gas isotope ratio mass spectrometry. Infants consuming their commercial formula had breath × 13C values of −21.1 × 0.6%, over the 3‐h collection period; stool values were −22.9 × 0.4%. After 7 days on the CNRC3 formula, 13C values of breath declined by 5.6% to −26.7 × 0.7%; stool values declined by 3.0% to −25.6 × 0.5%. The reduced background of 13C achieved by the CNRC3 formula can improve resolution of excess 13C from naturally enriched substrates in infant breath by ~50% and in stool by ~30%
Plasma Amino Acid Concentrations in Children Receiving Long‐Term Parenteral Nutrition
Authors: Dahlström Karl Anders , Ament Marvin E. , Laidlaw Stewart A. , Kopple Joel D.
Published: January 2024

Plasma amino acid concentrations were measured in 15 children aged 4–65 months who received home parenteral nutrition (PN) and in 10 normal controls. In seven patients (Group I). PN was the only source of nutrition. Eight patients (Group II) ingested 30%–70% of their total energy requirements and received the remainder intravenously. Group I and Group II patients received PN for 25.6 × 14.4 (SD) and 25.7 × 19.1 months, respectively. In comparison to controls. Group I had significantly decreased plasma concentrations of total essential amino acids, the three branched chain amino acids. cystine, tyrosine, and the three major urea cycle amino acids. Group II children displayed decreased plasma concentrations of two branched chain amino acids. leucine and valine, as well as cystine and tyrosine. Taurine was decreased in both groups. The presence of liver disease did not have a major effect on amino acid levels. These data indicate that children receiving long‐term parenteral nutrition will develop abnormalities in their plasma amino acid concentrations even though they appear to receive adequate amounts of amino acids in their intravenous solutions. Further studies will be necessary to assess whether modifying the intravenous intake of amino acids will normalize plasma amino acid concentrations in these children.
In Vitro Intestinal Processing of Prostaglandin F2α in Rats
Authors: Bedrick Alan D. , Johnson Susanne M. , Koldovsky Otakar
Published: January 2024

Cytoprotective prostaglandins (PGs) such as PGF2α are present in milk and can be absorbed intact from the gastrointestinal tract. Developmental differences in gastrointestinal PG metabolism in vivo have been previously reported. To evaluate the role of small intestinal tissue. detailed analysis of PG processing in vitro of small intestinal segments of suckling and weanling rats using everted sacs was performed. Sacs were incubated in Krebs‐Ringer bicarbonate buffer, pH 7.4, at 37°C. Bathing mucosal fluid contained [H]PGF2α. Proximal and middle intestinal segment everted sacs of suckling rats exhibited greater transfer of radioactivity in comparison with those of weanling rats. Whereas in suckling rats transfer of radioactivity decreased from proximal to distal regions of the intestine, no segmental differences were seen in weanlings. Maturational differences were also present in the capacity for PG catabolism. Suckling rat everted sacs had a greater proportion of radioactivity present as intact, unmetabolized PGF2α present in sac tissue and serosal fluid in all intestinal segments in comparison with those of weanling rats. Weanling everted sacs contained greater amounts of less polar metabolites. These results indicate that there are quantitative and qualitiative age‐related differences in transfer and processing of exogenous PGF2α in small intestinal tissue of developing rats.
Doxycycline‐Induced Hemorrhagic Esophagitis
Authors: Kato Seiichi , Kobayashi Mayumi , Sato Hiroshi , Saito Yasutoshi , Komatsu Kazuhisa , Harada Yoshinori
Published: January 2024

Esophagitis induced by medications has been recognized in adults but rarely in children. A child with hemorrhagic esophagitis resulting from taking doxycycline tablets for treatment is described and the pathophysiology of this condition is diseussed. In pediatric cases treated by tablets or capsules, the possibility of medication‐induced esophagitis should always be considered.
Lactose Malabsorption and Recurrent Abdominal Pain in Italian Children
Authors: Ceriani R. , Zuccato E. , Fontana M. , Zuin G. , Ferrari L. , Principi N. , Paccagnini S. , Mussini E.
Published: January 2024

The role of lactose malabsorption (LM) was investigated in 32 children (mean age 8.13 ± 2.46 years) with recurrent abdominal pain (RAP). LM was detected in 75% of them by a lactose breath hydrogen test (LBHT) after a 2‐g/kg (max 50‐g) load. Of the 18 malabsorbers who participated in a 3‐month lactose‐free diet (LFD), 14 were judged “improved” and reported lower pain frequency (p < 0.001). The malabsorbers who improved versus the not improved had comparable past lactose ingestion but were distinguishable on the basis of their lactose absorption capacity (0.36 vs. 0.81 g/kg; p < 0.01), as subsequently determined by multiple LBHTs with 25‐, 12.5‐, and 6‐g loads. The ratio between past lactose ingestion and lactose absorption was 1.89 in the improved and 0.55 in the not improved groups (p < 0.01), retrospectively indicating lactose as a possible cause of the symptoms in the improved group. The reintroduction of lactose in amounts not exceeding the absorption capacity into the diet of each malabsorber who had improved with LFD caused relapse in none of the 14 subjects monitored for 2–6 months. In conclusion, LM seems an important cause of symptoms in Italian children with RAP. Assessment of the lactose absorption threshold of each subject of LBHTs provides a basis for reintroduction of “calibrated” amounts of lactose‐containing foods (e.g., milk) into the diet.
Digestive and Absorptive Phase Anomalies Associated with the Exocrine Pancreatic Insufficiency of Cystic Fibrosis
Authors: Roy Claude C. , Weber Andrée M. , Lepage Guy , Smith Lesley , Levy Emile
Published: January 2024

The pancreas has an enormous reserve capacity, and significant malabsorption usually signals complete absence of exocrine function. However, there is evidence that acid lipases of nonpancreatic origin play an important compensatory role. Complete duodenal hydrolysis of fat requires a series of complex interdependent physicochemical events involving pancreatic lipase, colipase, phospholipase A2, and bile salts in an environment where the pH must be close to neutrality. Lipolytic products must then be shuttled through the unstirred water layer to the surface of the microvillus membrane by ionized bile salts, which must be present in sufficient concentrations to form micelles. In pancreatic insufficiency, there is not only a defective lipolytic phase but also an impaired micellar phase. The output of bile salts is decreased because of increased fecal loss. Furthermore, a significant percentage of bile salts precipitate because the duodenum is acidic and there is a large predominance of glycine conjugates. Although much less work has been done on the absorptive phase of patients with pancreatic insufficiency, there is tentative evidence that defective phospholipid absorption, essential fatty acid deficiency, and protein malnutrition could impair the absorptive phase, particularly chylomicron formation. Although significant advances have been made in our understanding of factors responsible for malabsorption associated with pancreatic insufficiency, much remains to be done for the further delineation of defects. It is hoped that this will lead to further refinements of enzyme preparations and to new strategies of intervention.
Nutritional Requirements in Cystic Fibrosis
Authors: Dodge John A.
Published: January 2024

Food intake is often low in cystic fibrosis (CF), although the patient usually needs more than the standard recommended daily allowance (RDA). Clinics giving food supplementation from an early age report improved survival and nutritional status. Nutritional improvement has been facilitated by improved forms of pancreatin. An additional calorie intake in CF is required to compensate for losses due to malabsorption and to allow for catch‐up growth when necessary. With advanced pulmonary disease there are additional requirements for infection and increased work of breathing. There is also evidence for an increased basal metabolic activity in CF, perhaps related to the fundamental intracellular biochemical disorder. Together these factors add to a daily need for 120%‐150% RDA for optimum growth and homeostasis.
Acquired Monosaccharide Intolerance in Infants
Authors: Nichols Veda N. , Fraley J. Kennard , Evans Kim D. , Nichols Buford L.
Published: January 2024

To determine the frequency with which acquired monosaccharide intolerance (AMI) occurs in infants <3 months of age, we performed a prospective descriptive study of infants admitted to the hospital for diarrhea. We searched for differences between the characteristics and causes of AMI in these infants and those of a cohort of similar‐aged infants admitted with acute diarrhea (AD). Five hundred fifty‐five infants <3 months of age admitted with diarrhea were enrolled. Nine percent of those infants had AMI, 40% had other forms of chronic diarrhea, and 51% had AD. The mean age at hospital admission was 32 days for the infants with AMI and 44 days for the infants with AD. The mean weight loss of AMI infants was 0.3 g/day since birth, and the mean weight gain was 14.3 g/day for AD infants. The mean dehydration by difference in weights at admission and 48 h postadmission was 5% for AMI and 3% for AD infants. Bacterial and viral causes of the diarrhea were similar. At admission to the hospital, infants in whom AMI subsequently developed were younger, more malnourished, had more prolonged diarrhea, and were more dehydrated than the AD infants. Malnutrition stands out as a significant antecedent factor that contributes to the development of AMI.
Stimulatory Effects of Short‐Chain Fatty Acids on Colonic Absorption in Newborn Piglets in Vivo
Authors: Murray Robert D. , McClung H. Juhling , K. Li B. Ulysses , Ailabouni Anton
Published: January 2024

This study examined the absorption of short‐chain fatty acids (SCFA) and their effects on colonic conservation of water and sodium. Newborn York piglets, 2–23 days of age and exclusively suckled, were studied comparing absorption from a control/electrolyte solution with that from a SCFA solution. The results indicated that SCFA absorption is highest at birth, with a rapid decline over 72 h to a lower and relatively stable level. During the control perfusions, water and sodium absorption increased with age. The addition of SCFA to the perfusate stimulated both water and sodium uptake in the first 2 weeks. After the 14th day, sodium absorption continued to be enhanced by SCFA, but water movement remained unchanged from control levels. Right and left colon responses were similar. The results suggest that although luminal SCFA levels may be limited early in life, the presence of SCFA has stimulatory effects on the absorption of sodium and water from the colon in newborns.
Intestinal Lymphangiomas
Authors: Neidich Gary A. , Mills Kim , Ohrt David W.
Published: January 2024

Intestinal obstruction developed in a 4‐month‐old child in association with an ileal lymphangioma. Intestinal lymphangiomas have only rarely been reported in the literature. This case report documents an additional case and also points out an association with intestinal obstruction. The clinical and pathologic details of lymphangiomas are also reviewed.
Dietary Origin of Retained H+ in Infants with Acquired Monosaccharide Intolerance
Authors: Carrazza Francisco R. , Carrazza Maria Z. , Nichols Veda N. , Nichols Buford L.
Published: January 2024

Net external acid balance was studied in 12 malnourished infants with chronic diarrhea (some of whom had acquired monosaccharide intolerance). When the infants achieved an adequate energy intake from a formula that contained either glucose or glucose polymers, seven developed metabolic acidosis and Five remained free of acidosis. During the study, the acidotic infants produced a significant excess of acid (3.7 ± 2 vs. 0.5 ± 2 mEq/kg/day, p < 0.005). The amount they excreted in urine (2.9 ± 2 mEq/kg/day), however, was similar to that excreted by nonacidotic infants (2.7 ± 2 mEq/kg/day) and indicated renal inability to reduce the excess acid load. The net effect was hydrogen ion (H + ) retention ( + 0.8 ± 0.8 vs. −2.2 ± 0.8 mEq/kg/day, p < 0.001). Good correlation existed between the net acid balance and the acid‐base measurement in the blood. We speculate that (a) the increased acid load was a consequence of colonic bacterial production of volatile fatty acids from carbohydrate malabsorbed from the small bowel and (b) the renal incapacity to excrete H + probably was secondary to potassium and phosphate depletion.
Serum and Rectal Mucosal Copper Status in Acute and Chronic Diarrhea
Authors: Sachdev H. P. S. , Mittal N. K. , Yadav H. S.
Published: January 2024

Serum and rectal mucosal copper content was estimated in children (6–18 months old) with acute diarrhea (group I: n = 50), chronic diarrhea (group II: n = 25), extraintestinal infections (group III: n = 15), and apparently healthy controls (group IV: n = 20). The sex and nutritional status of various groups was comparable. The mean serum copper levels in acute diarrhea and infected control groups were comparable, but significantly (p < 0.001) greater in comparison to chronic diarrhea and healthy control groups. The tissue copper in group II was significantly (p < 0.001) lower than other groups, which were comparable. There was a significant negative correlation between serum copper and diarrheal duration (r = −0.615; p < 0.001). Repeat estimation at discharge in 38 patients (25 in group I and 13 in group II) revealed a significant (p < 0.05) reduction in the serum and tissue copper content during this period. Among the 23 infants (16 in group I and 7 in group II) evaluated 2–3 weeks after discharge, there was an increase in copper values of tissue alone (p < 0.05) in group I and both serum and tissue (p > 0.05) in group II. It is concluded that elevation of serum copper in acute diarrhea is a nonspecific response to infection; infants with chronic but not acute diarrhea are copper depleted at presentation; and with the continuation of diarrhea, there is a progressive depletion of copper.
Evaluation of Infant Feeding in Acute Gastroenteritis
Authors: Armitstead Jane , Kelly Deidre , Walker‐Smith John
Published: January 2024

Sixty‐eight bottle‐fed babies under 9 months of age with mild acute gastroenteritis were observed to evaluate current feeding regimens following acute gastroenteritis in infancy. All babies were fed for 24 h with a glucose‐electrolyte mixture (GEM) and then randomly assigned to either a gradual reintroduction to their normal milk, i.e., slow regrade; immediate return to full‐strength formula; or a rapid regrade to a hypoallergenic whey hydrolysate formula. All groups were well matched for age, sex, ethnic origin, nutritional state, and degree of hydration. There was no significance difference in stool frequency or reducing substances, vomiting, and duration of hospital stay between the three groups. Many infants (6/24) refused to take the whey hydrolysate formula, presumably because of unpalatability. Weight gain was more rapid when full‐strength milk was given. Clinical relapse developed in 12 (17%) of patients. An enteric pathogen was detected in eight of this group and cow's milk protein intolerance in three (one from each feeding group). No infant had clinically significant lactose intolerance, in marked contrast to previous experience at Queen Elizabeth Hospital. In this group of previously healthy, well‐nourished babies with mild acute gastroenteritis, there was no advantage in regrading slowly to milk or a hypoallergenic formula. An immediate return to normal formula 24 h after GEM feeding was well tolerated and simpler for parents.
Effect of Esophageal Ligation on the Growth of Fetal Rabbits
Authors: Jacobs David G. , Wesson David E. , Mago‐Cao Hernan , Muraji Toshihiro , Konuma Kunio , Mancer Kent , Kent Geraldine , Heim Tibor
Published: January 2024

Controversy continues regarding the nutritional value to the fetus of swallowed amniotic fluid. To clarify this issue further, esophageal ligations were performed to prevent deglutition in utero in 63 fetal rabbits during the final trimester of pregnancy. Compared with sham‐operated littermate controls, the fetuses that were ligated for periods of 4, 5, or 6 days showed significant reductions in weight of 6.1, 18.9, and 9.2%, respectively. These results compare well with the magnitude of weight reduction seen clinically in patients with esophageal atresia. Significant but less consistent reductions were also noted in crown‐rump length and biparietal diameter. No significant differences were seen in either body composition or gastrointestinal tract histology. These results indicate that swallowed amniotic fluid does play a role in fetal nutrition and may be particularly important in the later stages of gestation when placental function is limited.
Vitamin K1 and K2 in Infant Human Liver
Authors: Kayata Sahar , Kindberg Carl , Greer Frank R. , Suttie John W.
Published: January 2024

It is not known to what extent humans store vitamin K in liver. We measured hepatic concentrations of vitamin K1 (phylloquinone) and K2 (menaquinones) in 11 human livers (eight infants and three adults). Relatively small amounts of vitamin K were found in the liver at any age compared to other fat soluble vitamins. Vitamin K1 was the predominant form with much smaller concentrations of vitamin K2. Long‐chain menaquinones (vitamin K2) were readily identified in most liver specimens. Hepatic vitamin K2 concentrations also increased with increasing age. These observations have implications for vitamin K supplementation in infants.
Glucose Intolerance with Low‐, Medium‐, and High‐Carbohydrate Formulas During Nighttime Enteral Feedings in Cystic Fibrosis Patients
Authors: Kane Robert E. , Black Philip
Published: January 2024

Ten young adult cystic fibrosis (CF) patients over 16 years of age (average 21.4 years) began nighttime enteral feedings as a method of nutritional rehabilitation to regain and maintain body weight. Patients received nighttime feedings of 1,000 kcal/M2 of a low‐ (Pulmocare), medium‐ (Ensure Plus), or high‐carbohydrate (Vivonex) formula for at least 2 nights each with pancreatic enzyme therapy. Five of ten young adult CF patients developed nocturnal hyperglycemia (serum glucose >300 mg/dl) and glucosuria (1–3% glucose) with varying degrees of polyuria during enteral feedings. No patient developed ketonuria despite serum glucoses at times >600 mg %. There was no difference between the hyperglycemic and nor‐moglycemic groups in median age, percent of ideal body weight, NIH score, Brasfield scores, pulmonary function tests, or family history of diabetes. All normoglycemic and four of five hyperglycemic patients had normal fasting blood sugars. The percent hemoglobin A1c was greater in the glucose intolerant group than the normoglycemic patients (11.2 ± 0.8% vs. 6.8 ± 1.1%, mean ± SE, p < 0.005). Twelve to 15 units of NPH insulin prior to initiation of feedings provided adequate therapy in most hyperglycemic patients. There was no apparent difference in the elevation of early morning serum glucoses with the low‐ medium‐ and high‐carbohydrate formulas. We concluded that hyperglycemia requiring insulin therapy was common in young adult CF patients using nighttime enteral feedings. A hemoglobin A1c appeared to be a useful screening test before initiating such therapy.
Predictors of Breast Milk Intake in Rural Northern Thailand
Authors: Imong Stella M. , Jackson Dorothy A. , Wongsawasdii Lumduan , Ruckphaophunt Somsri , Tansuhaj Antika , Chiowanich Pien , Woolridge M. W. , Drewett R. F. , Baum J. D. , Amatayakul Kosin
Published: January 2024

A random sample of 52 mothers and infants from a rural area of Northern Thailand were studied in their homes for 48 h. Infants were breast fed on demand. Daytime feeds were test weighed with electronic averaging balances and nighttime intake estimated using a new method, Indirect Test Weighing (23,24). All feeds, both day and night, were timed to the nearest minute. Other variables measured by direct observation were infant weight, and supplementary food and water intake. Mean 24‐h breast milk intake was 579 g (range 78–1,011 g) with a median between day coefficient of variation of 8.8%. The proportion of 24‐h breast milk intake consumed at night ranged from 8 to 91%, and increased with increasing infant age. Significant positive associations were found between breast milk intake, and sucking time and infant weight. There were significant negative associations between breast milk intake and age, and supplementary food and water intake.
Cerebral Thromboembolic Disease in Pediatric and Adult Inflammatory Bowel Disease
Authors: Markowitz Robert L. , Ment Laura R. , Gryboski Joyce D.
Published: January 2024

Cerebral and retinal vascular disease are rare complications of inflammatory bowel disease. Most reports are of adult patients, with only seven instances described in children. The eighth case, a 14‐year‐old boy with ulcerative colitis and cerebral venous thrombosis is reported in whom the diagnosis was confirmed by magnetic resonance imaging. The adult and pediatric literature is also reviewed.
Intestinal Permeability Changes in Acute Gastroenteritis
Authors: Isolauri E. , Juntunen M. , Wiren S. , Vuorinen P. , Koivula T.
Published: January 2024

The effects of early home management of acute diarrhea followed by rapid in‐hospital realimentation on intestinal permeability were studied in 41 children aged 3–25 months with acute gastroenteritis (73% rotavirus). After oral rehydration, a 100 ml oral load containing 4 g of lactulose and 0.8 g of mannitol was administered, and an aliquot of urine excreted in the subsequent 5 h was analyzed with gas‐liquid chromatography. The mean lactulose/mannitol recovery ratio was significantly higher than in 28 nondiarrheal controls, which was due to decreased mannitol excretion. The gastroenteritis patients who had received uninterrupted feeding in addition to adequate fluid replacement before hospitalization had a normal urinary lactulose/mannitol ratio, with a mean of 0.04, and a 95% confidence interval (CI) of [0.03, 0.07], whereas in fasted children with inadequate or adequate fluid replacement, the respective mean ratios were 0.24, 95% CI of [0.14, 0.43], and 0.14, 95% CI of [0.09, 0.20] (F = 12.63, p < 0.001). The fasting‐associated rise was caused by increased lactulose excretion. At retesting of gastroenteritis patients after 2 days of in‐hospital realimentation, the lactulose/mannitol ratios did not differ significantly from the level on admission. The study indicated that fasting maintains the increased intestinal permeability associated with acute gastroenteritis whereas early feeding at home may promote reduction of permeability and hasten recovery.
Developmental Changes in the Intra‐acinar Distribution of Succinate Dehydrogenase, Glutamate Dehydrogenase, Glucose‐6‐Phosphatase, and NADPH Dehydrogenase in the Rat Liver
Authors: Sokal E. M. , Trivedi P. , Portmann B. , Mowat A. P.
Published: January 2024

Hepatocytes differ in their metabolism depending on their position in the liver acinus. To assess how such specialization changes during development, we used quantitative cytochemistry to measure succinate dehydrogenase (SDH), glutamate dehydrogenase (GDH), glucose‐6‐phosphatase (G6P), and NADPH dehydrogenase (ND) activities specifically in periportal and perivenular hepatocytes in developing rats, aged between 1–114 days. Important and distinct changes were observed in each zone for each enzyme during development. An intraacinar gradient of distribution was present from day 1 for SDH and G6P and from day 5 for GDH and ND. It was being similar to the adult value for SDH but less pronounced for the remaining enzymes. The SDH and G6P activity was greater in periportal cells, and the GDH and ND activity was greater in perivenular cells. The more pronounced distribution with age was due, for G6P, to an initial specific periportal increase combined with a mild perivenular decrease and for GDH to a greater perivenular than periportal increase. The ND first increased simultaneously in both zones, but from day 20 the perivenular increase became prevalent. The SDH changes were parallel in both zones. All zonal enzyme activities changed distinctly after weaning. To what extent the changes in activities and metabolic zonation observed in our study reflect a response to specific metabolic demands of the liver or can be modified by environmental factors remains to be investigated.
Endoscopic Small Intestinal Biopsy in Infants and Children
Authors: Kirberg Arturo , José Latorre Juan , Hartard María Elena
Published: January 2024

Forty‐seven endoscopic small intestinal biopsies were performed in children with chronic diarrhea and malabsorption and suspected celiac disease. The purpose of this study was to reach the distal duodenum or proximal jejunum with large channel panendoscopes in order to get adequate samples for histopathological diagnosis. Patients younger than 8 years of age were anesthetized with ketamine. Time required for the full procedure was < 10 min in most cases. There were no failures or complications. In all 47 endoscopic examinations, histologically adequate specimens of small bowel mucosa were obtained. These results suggest that this is a safe, quick, and easy method to obtain high‐quality samples for histopathological diagnosis of enteropathies.
Total Body Potassium in Cystic Fibrosis
Authors: Shepherd R. W. , Holt T. L. , Greer R. , Cleghorn G. J. , Thomas B. J.
Published: January 2024

To further evaluate the nature of malnutrition, define at‐risk groups, and confirm the efficacy of nutritional supplementation on body composition in cystic fibrosis (CF), we have conducted longitudinal and cross‐sectional studies of total body potassium (TBK) in 161 unselected CF subjects aged 1 month to 17 years. TBK was determined by measurement of 40K in a whole body counter, reflecting body cell mass (BCM), the vital work‐performing and growing cellular component of the body. Compared with normal TBK data for age and sex from pooled measurements of 1,629 healthy children aged 1 week to 17 years, CF infants (n = 12) diagnosed by newborn screening were depleted in TBK at diagnosis and showed catch‐up with therapy by 1 year; CF children aged 2–17 years (n = 140) showed a tendency for inadequate accretion of TBK (and thus BCM) with increasing age, although the normal correlation between TBK and weight and height was maintained in the majority suggesting a pattern of nutritional stunting of growth; and malnourished CF children (n = 9) showed significant catchup in TBK with long‐term nutritional rehabilitation (85–98% of TBK predicted for weight and height). These studies suggest that potentially serious, but possibly correctable deficits, in the growth of the body cell mass as measured by TBK occur commonly in CF. These deficits may be established very early in life and if not corrected lead to progressive nutritional growth retardation with increasing age.
Effect of High Calcium and Phosphorus Intake on Mineral Retention in Very Low Birth Weight Infants Chronically Treated with Furosemide
Authors: Rowe Jonelle C. , Carey Dennis E. , Goetz Cynthia A. , Adams Nancy D. , Horak Eva
Published: January 2024

The treatment of premature infants with the diuretic furosemide appears to be a contributory factor in the development of metabolic bone disease presumably because of furosemide‐induced hypercalciuria. In this study, we measured calcium and phosphorus balance in furosemide‐treated very low birth weight infants (VLBW) infants with bronchopulmonary dysplasia (BPD) who were fed a specialized premature formula containing increased amounts of calcium and phosphorus. Furosemide‐treated infants received 166 + 37 mg/kg/day and retained 80 + 34 mg/kg/day of calcium, and 87 + 19 mg/kg/day and retained 52 + 14 mg/kg/day of phosphorus. The amounts retained were ~65% of the calcium and 72% of the phosphorus requirements for in utero mineral accretion. Compared to a group of similarly fed VLBW infants without BPD and not treated with the diuretic, the furosemide‐treated infants excreted a larger percent of the calcium intake in the urine but had similar total urinary calcium and phosphorus losses (mg/kg/day) and serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) levels. From the latter two findings, we suggest that the extra mineral content of the formula may have promoted bone mineralization and prevented the occurrence of secondary hyperparathyroidism.
Low‐Dose Methotrexate‐Induced Changes in Intestinal Permeability Determined by Polyethylene Glycol Polymers
Authors: Lifschitz Carlos H. , Mahoney Donald H.
Published: January 2024

The impact of chemotherapeutic agents on small bowel mucosa has not been investigated adequately in children. To determine the effect of low‐dose methotrexate (MTX) on the permeability and mucosal integrity of the small bowel, we administered low molecular weight polyethylene glycol (PEG) to 19 children who were in the maintenance phase of treatment of acute lymphocytic leukemia. PEG was administered before and after the children received their weekly oral or intramuscular doses of MTX. PEG recoveries from a 6‐h urine collection were calculated by a mathematical formula to determine the polymer with maximal recovery (PCD0) and the polymer whose recovery was 50% of PCDo (N1/2). Compared with pre‐MTX levels, a significant increase was observed in the polymer with maximal recovery (PCDo) in 15/19 children after MTX administration (p < 0.015) which indicated increased transmucosal passage of PEG. A decrease in the PEG parameter (N1/2) was observed in 11/38 studies, and may have indicated diminished enterocyte cell mass. These changes indicate that treatment with MTX results in an increase in intestinal permeability by the paracellular pathway, which may affect the absorption of other molecules.
The Use of Oral Hydration in the Treatment of Children with Acute Diarrhea in Primary Care
Authors: Delucchi M. A. , Guiraldes E. , Hirsch T. , Näñez N. , Schele C. , Gutiérrez H. , Torres‐Pereyra J.
Published: January 2024

The use of oral rehydration solutions (ORSs) for treating children with diarrhea is spreading in hospitals in Chile, but it has not yet been incorporated into routine primary care programs. We sequentially compared the effectiveness of an ORS, with 60 mmol/L of Na+, with the standard treatment for diarrhea used in primary care centers, in a study with 285 diarrheal children under 2 years of age who consulted a health center in a low‐income periurban neighborhood of Santiago. When compared with the control group, the patients treated with ORS showed a significantly higher percentage weight gain in the first few days after treatment was begun, required fewer medical visits for follow‐up treatment at other facilities (8.4 vs. 15.5%; p < 0.05), and experienced fewer episodes of subsequent clinical dehydration that needed rehydration (oral or intravenous) in emergency services (2.8 vs. 10.6%; p < 0.01). In addition, there were no metabolic complications in either group. Our results reinforce the feasibility, efficaciousness, and safety of programs that use ORS at the primary care level and indicate that this is an effective method of preventing metabolic complications and reducing hospitalizations of children with acute diarrhea.
Altered Glycine and Taurine Conjugation of Bile Acids following Aluminum Administration to Rats
Authors: Klein Gordon L. , Lee Thomas C. , Heyman Melvin B. , Rassin David K.
Published: January 2024

Aluminum contaminates components of intravenous nutrient solutions and accumulates in the liver with parenteral feeding. Abnormalities in hepatic function associated with aluminum accumulation include increased serum bile acid concentration and glucuronyl transferase activity and reduced mixed function oxidase levels and bile flow. Whether there are other biochemical responses of the liver to aluminum is unclear. We report the effects of aluminum administration on bile acid conjugation in rats given aluminum intravenously as follows: group I, 1 mg/kg/day for 14 days; group II, 5 mg/kg/day for 14 days; and group III, 5 mg/kg/day for 7 days. Taurine‐conjugated bile acids were reduced and glycine/ taurine elevated in all groups compared with pair‐fed controls. Glycine/taurine was greater in group II versus III and varied directly with serum bile acid concentration. These findings suggest that aluminum administration is associated with decreased taurine conjugation of bile acids, a phenomenon that may be associated with cholestasis.
Rickets in a Very Low Birth Weight Infant
Authors: Cooke Richard J.
Published: January 2024

A report on a case of rickets in a very low birth weight infant (VLBWI) is presented. The infant had no high‐risk factors for rickets and was fed a specialized preterm formula with vitamin D supplementation (200 IU daily) by 10 days of age. Feeds were advanced so that an enteral intake of 120 cal/kg/day was achieved by the 20th day of life. Mean calcium, phosphorus, and vitamin D intakes between the 20th and 61st days of life were 185 mg/kg/day, 93 mg/kg/day, and 367 IU/day, respectively. On the 62nd day of life, a diagnosis of rickets was made. and a nutrient balance study was performed. Urinary calcium excretion was low (1.3 mg/kg/day), suggesting calcium deficiency. However/retention of calcium (127 mg/kg/day) and phosphorus (76 mg/kg/day) was occurring at intrauterine rates. Thus, while calcium absorption was adequate at 10 weeks of age, the same was not true earlier in life. We suggest that there is a limiting role of calcium absorption on bone mineralization during early life in the VLBWI.
Ultrasonographic Prediction of the Presence and Severity of Esophageal Varices in Children
Authors: De Giacomo Costantino , Tomasi Gabriele , Gatti Carlo , Rosa Giulia , Maggiore Giuseppe
Published: January 2024

Twenty‐eight consecutive children with either chronic liver disease or portal vein obstruction were investigated to study the presence of gastroesophageal collaterals due to portal hypertension by ultrasound and endoscopy. Sonographic measurements of the ratio of the lesser omentum thickness to aortic diameter (LO/Ad) and of portal vein diameter to body surface (Pv/m2) were significantly higher in children with esophageal varices than in those without varices. With a lower limit for the LO/Ad ratio of 1.3, no false negatives and only three false positives (91% predictive value of esophageal varices) could be detected. The combination of LO/Ad and Pv/m2 would exclude the possibility of detecting esophageal varices if the LO/Ad ratio is <1.8 and the Pv/m2 is <12 mm. All children with an LO/Ad ratio <1.9 had varices. Even in the presence of an overlap between children with small and large varices, it is possible to identify with high probability a child with large varices if the LO/Ad ratio is <2.5. This study confirms the value of ultrasound in the diagnosis and management of children with portal hypertension and suggests an algorithm to screen children with small and large varices.
Lipid Abnormalities in Pediatric Hepatic Allograft Recipients
Authors: Hyams Jeffrey S. , Treem William R. , Andrews Walter S. , Herbert Peter N.
Published: January 2024

Lipid profile analyses were performed on serum samples from six children (ages 4–17 years) who had previously been subjected to orthotopic liver transplantation. All six patients were receiving prednisone and cyclosporine and four were additionally receiving azathioprine. Marked elevations in serum triglycerides (>95%) were seen in 3/6 patients, while a notable decrease (<5%) in HDL‐cholesterol was noted in 4/6 patients. Total serum cholesterol was normal in all patients. Postheparin lipase activity determined in the serum of one patient revealed a significant decrease compared with control values. These observations suggest the need for studying large numbers of liver transplant recipients to determine the prevalence of lipid abnormalities and to consider their potential contribution to the development of premature atherosclerotic disease.
Prediction of Total Daily Fecal Excretion During Acute Childhood Diarrhea
Authors: Lembcke Jorge , Gastañaduy Arturo S. , Brown Kenneth H.
Published: January 2024

Clinical data from 133 male patients between 3 and 36 months of age were reviewed to identify factors that could predict high rates of fecal excretion during acute diarrhea. Diarrheal severity after hospitalization was measured by separate 4‐h quantitative collections of feces during 6 days; the number of these 4‐h collection periods with any stool output was used as an estimate of the number of bowel movements each day. The number of 4‐h periods with any stool output was highly correlated with total fecal excretion expressed as grams per kilogram of body weight per day (p < 0.001). The age of the patient, type of diarrhea, and type of diet had little effect on the relationship between stool “number” and amount. The number of bowel movements, as estimated during this study, was a highly sensitive (>90%) and reasonably specific (>70%) predictor of children at risk of high fecal excretion rates (>50 g/kg/day or >100 g/kg/day) during acute diarrhea.
A Noninvasive Method for Determining Patterns of Milk Intake in the Breast‐Fed Infant
Authors: Lau Chantal , Henning Susan J.
Published: January 2024

A noninvasive adaptation of the test‐weighing method has been devised for continuously monitoring milk intake in breast‐fed infants. This procedure consists of counting the number of swallows from videotaped sessions of individual feeds and correlating them to the corresponding pre‐ and postnursing weights of the infants. The method has been tested on four nursing sessions in twins aged 1 1/2 to 2 1/2 months. A high correlation was found between swallow counts and weight gain of the babies. The patterns of milk intake as monitored by these two parameters were similar. This method has the advantage of not disrupting the natural nursing process because test‐weighing during the feeding session is not necessary. In addition, it allows for longitudinal studies and uses relatively simple equipment, i.e., a balance and a video camera. It is further suggested that monitoring swallowing in the manner described herein may be a valuable addition to studies on sucking behavior in human infants. Finally, it is noted from the data presented that the pattern of milk transfer in a mother breast‐feeding twins is different from that observed in mothers breast‐feeding singletons who were monitored by means of a cross‐sectional test‐weighing procedure.
Thiamine Status in Urban Adolescents
Authors: Cromer Barbara A. , Wyatt David T. , Brandstaetter Lisa A. , Spadone Sheryl , Sloan Howard R.
Published: January 2024

To evaluate thiamine status in an urban adolescent population, we performed two investigations. In Study I, we compared whole blood thiamine levels in 101 healthy adolescents from varied racial backgrounds with those that had been obtained previously in 146 healthy white adults from a different geographic locale. Blood thiamine values were significantly lower in the adolescents as a group, but the differences were entirely due to the lower levels in the black adolescents. To explore further these differences (Study II), we compared thiamine status in 34 adolescents with that of their parents using measures of both whole blood thiamine content and of erythrocyte transketolase activity. White adolescents had significantly higher total whole blood thiamine values than black adolescents, and white parents had significantly higher thiamine values than black parents by both total whole blood assay and level of transketolase activity. There were no differences in thiamine status between adolescents and parents of the same race. Racial composition is an important variable to consider in population surveys of thiamine status.
Clinical Zinc Deficiency During Zinc‐Supplemented Formula
Authors: Naveh Yehezkel , Mandel Hanna , Berant Moshe
Published: January 2024

A 2 1/2‐month old preterm infant had failure to gain weight with high caloric intake, and had generalized persistent dermatitis and mild diarrhea. The patient was being fed zinc‐supplemented cow's‐milk‐based formula (Osterfeed). High caloric intake of 8 weeks' and topical treatment of 11 weeks' duration were futile. A thorough investigation revealed low serum zinc concentration. Administration of zinc sulfate 150 mg/day resulted in brisk weight gain and complete clearing of skin lesions. The infant maintained normal levels of zinc 4 months after zinc therapy was discontinued, while being fed unmodified cow's milk and a diet of corn flour. The probability that zinc‐supplemented formulas do not meet the high zinc requirements of premature infants is raised. The importance of plasma or serum zinc examination in preterm infants with slow growth velocity or failure to gain weight despite adequate caloric intake, with or without skin lesions and diarrhea, is emphasized.
The Role of α‐Macroglobulin in Experimental Intestinal Ischemia
Authors: Levine Jeremiah J. , Dietzek Alan , Davidson Murray , Pillari George , Cohen Jon R.
Published: January 2024

Intestinal ischemia can lead to mucosal damage and presumably increased intestinal permeability. α‐Macroglobulin (α‐MG) is a plasma protein responsible for the inhibition and clearance of systemic proteases, including those derived from the intestinal lumen. In this study, we sought to determine the relationship between intestinal ischemia and α‐MG in dogs using a nonsurgical model of ischemia. In addition, we sought to detect plasma α‐MG complexes after ischemic injury. We found that α‐MG levels were significantly reduced 24 h after induction of occlusion compared with those values obtained immediately after vascular occlusion. The onset of the decline in α‐MG coincided with the onset of full‐thickness intestinal damage. α‐MG levels in the control animals were unchanged. However, α‐MG complexes were not elevated in the experimental dogs after ischemia. We suggest that the decline in α‐MG levels reflects a response to excessive protease uptake across a damaged intestine, leading to increase formation of α‐MG‐protease complexes, which are then rapidly cleared. The absence of detectable systemic complexes suggests that in ischemia, clearance is effective in removing the complexes from the bloodstream. α‐MG appears to play an important role in protecting against proteolytic damage in prolonged intestinal ischemia.
Crohn's Disease in Cystic Fibrosis
Authors: Behrens R. , Segerer H. , Böwing B. , Bender S. W.
Published: January 2024

We report on three patients suffering from cystic fibrosis (CF) who developed gastrointestinal symptoms of Crohn's disease (CD). Two patients developed enteroenteric or enterocutaneous fistulas. The diagnosis of CD is based on typical endoscopic, radiologic, and histological features of epithelioid granulomas in two children.
Microscopic Colitis
Authors: Mashako Mamba Nyenya Léonard , Sonsino Elise , Navarro Jean , Mougenot Jean‐François , Gargouri Abdellatif , Boige Nathalie , Cezard Jean‐Pierre
Published: January 2024

From a retrospective study on children who underwent colonoscopy or rectosigmoidoscopy with multiple level biopsies, we selected five patients whose rectocolonic endoscopic aspect was normal and contrasting with the presence of a microscopic colitis on biopsies. These five children had chronic diarrhea (mean duration of 14 months), associated with vomiting (three cases), abdominal pain (two cases), anorexia (two cases), abdominal distension (two cases), and weight loss (four cases). Symptomatic treatment was used in all children: lopera‐mide (one case), trimebutine (three cases), and aluminium and magnesium silicate (two cases). One child received sulfasalazine for 2 months. After 1 year, all patients had normal stools. Rectosigmoidoscopy was performed in four patients and was normal. Biopsies obtained in three cases were normal in two cases and showed a persistent microscopic colitis in one case. Microscopic colitis may be a distinct cause of chronie diarrhea in children.
A Characterization of Immunoreactive Somatostatin in Human Milk
Authors: Holst N. , Jenssen T. G. , Burhol P. G.
Published: January 2024

In the present work, somatostatin‐like immunoreactivity (SLI) in human milk was characterized. In the early postpartum period, SLI levels were highest on the first day after delivery, and then gradually declined. From the fifth day postpartum, SLI levels in milk seemed unchanged. On the fifth day after delivery, milk SLI was significantly (p < 0.01) higher than plasma SLI (126.3 ± 11.7 vs. 17.6 ± 1.1 pmol/L). The results indicate an active transport from blood or synthesis of somatostatin within the mammary gland. Gel filtration studies of skimmed milk, as well as milk exposed to urea and HCl, and aspirated milk from the human premature newborn, revealed that the main portion of milk SLI either represents somatostatin covalently bound to a larger protein, or more likely, a high molecular weight variant of somatostatin.
Neonatal Serum Protein Levels as Indicators of Nutritional Status
Authors: Raubenstine Deborah A. , Ballantine Thomas V. N. , Greecher Coleen P. , Webb Susan L.
Published: January 2024

Twenty‐one infants were studied to compare cord serum protein concentrations (SPCs) with samples drawn 3 days after birth. The results were compared with anthropometric measurements of the infants to determine the usefulness of serum studies in predicting the nutritional status of the newborn. SPCs of 19 serum protein subfractions were measured by laser nephelometry. In 17 of 19 proteins, the cord blood and newborn blood levels were highly correlated. C1Q and haptoglobin were the exceptions. The SPC was converted to serum protein mass (SPM) as follows: SPM =[(SPC) x (birth weight) x (0.85) x (1 ‐ hematocrit)]. Blood volume is approximately 0.85 dl of blood/kg of body weight and since these proteins are largely intravascular, it was postulated that the estimated total protein mass would be a more accurate index of nutritional state. Six proteins (C3, C4, prealbumin, retinol binding protein, transferrin, and albumin) were highly correlated with the anthropometry (arm circumference, skin fold thickness, length, weight, etc.). This study indicates that umbilical cord blood may be used to estimate a newborn's nutritional status. Transport proteins such as albumin, transferrin, retinol binding protein, and prealbumin are commonly used to assess adult nutritional status, and may be used in infants after estimating the total mass of the protein in the serum.