bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of Nutritional Status in Cholestatic Children with Supplemental Nocturnal Enteral Nutrition
Authors: Moreno Luis A. , Gottrand Frédéric , Hoden Stéphane , Turck Dominique , Loeuille Guy A. , Farriaux Jean‐Pierre
Published: January 2024

Protein energy malnutrition is a common complication in cholestatic children in a hepatic transplant program, and may be detrimental to the postoperative outcome. Improvement of the nutritional status may be of obvious importance to improve the prognosis. This study compared oral nutrition with oral nutrition supplemented with nocturnal enteral feeding in children with prolonged cholestasis. In six children with prolonged cholestasis (conjugated bilirubin over 25 mg/L and/or GGT over 110 IU/L in infants aged less than 3 months or over 50 IU/L in older infants and/or alkaline phosphatase over 500 IU/L, for more than 3 months), we compared a 4 to 6 month period with oral nutrition and similar periods with 10 to 12 h nocturnal enteral feeding given at home as an energetic supplement. Energy intake during the second period was 180–200% of recommended dietary allowances. No ascites was found in the six patients during the study period. The Z scores of body weight, weight expressed as percent of ideal body weight (IBW), weight/height2, and arm circumference/head circumference were calculated at the beginning and at the end of each period. With only oral nutrition, a diminution in percentage of ideal W/H and a diminution in Z score for the body weight were observed in five of six patients. At the end of the second period, the average of all of the nutritional indexes was increased and the Z score for the body weight was also increased in four of six patients. Significant statistical differences (p < 0.05) were found in W as percentage of IBW and the Z score for log W/H2. Oral nutrition was insufficient to improve nutritional status in these children with prolonged cholestasis, whereas, despite complications of the underlying condition in two patients, nocturnal enteral feeding given as a complement to oral nutrition improved all of the nutritional indexes.
Energy and Respiratory Metabolism in Cystic Fibrosis
Authors: Kane Robert E. , Hobbs Patricia
Published: January 2024

The basal energy expenditure (BEE) in a group of adolescent and young adult patients with cystic fibrosis (CF) with mild lung disease was 97 ± 6% of that predicted by the Harris‐Benedict equation (which estimates BEE by age, sex, height, and weight). The BEE of a group with more severe lung disease was 117 ± 5% of that predicted by the Harris‐Benedict equation, due primarily to a 14% greater oxygen consumption (Vo2) and 24% greater CO2 production (Vco2) compared with milder lung disease (p < 0.05). The measured BEE in the patients with mild lung disease correlated well with the predicted BEE, but variably underestimated that of patients with more advanced lung disease. The influence of low carbohydrate (Pulmocare) and higher carbohydrate (Instant Breakfast) nutritional supplements on the energy and pulmonary metabolism was compared in 10 malnourished CF patients with moderate to severe lung disease. Their BEE before ingesting the supplements was 120% of that predicted by the Harris‐Benedict equation. Their Vco2 increased 9–19% for the 3 h after ingesting 500 kcal/M2 of Pulmocare, and 25–30% after ingesting Instant Breakfast (p < 0.05). The respiratory quotient (RQ) was significantly greater for Instant Breakfast than Pulmocare. The minute ventilation (VE) rose 10–13% for the 3 h after ingesting Pulmocare, versus 27–31% after ingesting Instant Breakfast, but the difference was not significant. The metabolic expenditure rose 13–16% for the 3 h after ingesting both formulas. We concluded that CF patients have increasing difficulty maintaining their nutrition as their pulmonary disease progresses, in part because of a 17–20% increase in their BEE. Pulmocare resulted in a lower Vco2 and RQ than Instant Breakfast, suggesting it is a reasonable nutritional supplement in CF patients with moderate to severe pulmonary disease.
Tumor Necrosis Factor‐α Is Not Elevated in Children with Inflammatory Bowel Disease
Authors: Hyams Jeffrey S. , Treem William R. , Eddy Evangeline , Wyzga Nancy , Moore Robert E.
Published: January 2024

Chronic undernutrition and high‐dose daily corticosteroid therapy are well‐accepted causes of growth failure in children with inflammatory bowel disease. Occasionally, children are seen with minimal gastrointestinal symptoms but in whom severe anorexia and profound growth impairment are evident. Recent observations that elevated serum levels of tumor necrosis factor‐α (TNF) in cachexia associated with a number of disease states have suggested a similar possible role in inflammatory bowel disease. Accordingly, we determined TNF levels in 45 children and adolescents with inflammatory bowel disease (18 ulcerative colitis, 27 Crohn's disease) at varying times during their clinical course and compared them to values obtained from a group of 25 children with functional bowel disease. No differences were noted in serum TNF levels between the children with inflammatory bowel disease and the control population. Values were generally within the range of the lower limit of detection of the assay. In the children with inflammatory bowel disease, there was no significant correlation between TNF levels and disease activity or growth parameters. Our observations suggest that elevated TNF levels are not associated with inflammatory bowel disease in children.
The Developmental Accumulation of γ‐Glutamyl Transferase in the Pancreas of the Rat
Authors: Chin Richard J. , Callaghan James W. , Githens Sherwood
Published: January 2024

The developmental accumulation of pancreatic exocrine secretory enzymes is well defined, but little is known of the development of other enzymes in the pancreas. This report focuses on the developmental accumulation of γ‐glutamyl transferase (GGT), a membrane‐bound ectoenzyme whose specific activity in the pancreas is the second largest among rat organs. GGT activity is large in organs with active glutathione metabolism. Pancreatic GGT specific activity increased 100‐fold from prenatal day 14 to birth, decreased 3‐fold until about postnatal week 2, and then increased until the adult value was reached 4 weeks after birth. There was a 500‐fold increase in specific activity from prenatal day 14 to the adult. The developmental accumulation pattern of GGT was very similar to that of the exocrine secretory enzyme amylase, which increased 1,300‐fold from prenatal day 14 to birth, decreased 8‐fold by postnatal week 1, and then increased to the adult level soon after week 4. The overall increase in amylase specific activity was 1,100‐fold. The similar developmental accumulation patterns of GGT and amylase suggested that their accumulation might be regulated in a similar fashion. Although the thymidine analogue 5‐bromodeoxyuridine inhibited the prenatal accumulation of amylase, as previously reported, it did not inhibit prenatal GGT accumulation. Therefore, the prenatal accumulation of GGT appears to be regulated differently than amylase. On the other hand, the postnatal levels of GGT appear to be controlled by glucocorticoids in a fashion similar to the previously reported control of amylase levels, since both enzymes could be induced to rise prematurely to adult levels by a series of three injections of the glucocorticoid dexamethasone beginning on days 7, 8, 9, 10, 11, or 12. A dose of 0.1 mg/kg of body weight was optimal. The specific activities of GGT and amylase were stimulated 7.5‐fold and 6.3‐fold, respectively, compared to saline‐injected controls, prematurely achieving values equal to and greater than the adult specific activities of these enzymes, respectively.
Gastroesophageal Reflux in Infants with a History of Near‐Miss Sudden Infant Death
Authors: Veereman‐Wauters Genevieve , Bochner Andre , Van Caillie‐Bertrand Micheline
Published: January 2024

From January 1984 through August 1986, 130 infants were referred to our department with a history of apnea, hypotonia, and cyanosis or pallor, suggesting near‐miss sudden infant death syndrome. Protocol consisted of medical history, clinical examination, overnight polygraphic recording, and cardiologic, gastrointestinal, metabolic, neurologic, and toxicologic workups. In 49 of these infants who needed vigorous stimulation or mouth to mouth resuscitation, the event occurred shortly after feeding. Combined, continuous esophageal pH monitoring and polygraphic recording in these 49 infants showed pathologic gastroesophageal reflux (GER) in 34 patients. An abnormal overnight polygraphic recording was observed in 8 of 34 infants with pathologic GER. Other investigations led to etiologic diagnoses in 42 of the remaining infants. Severe GER was frequently found in children with apnea after feeding but clearly is not the only mechanism involved. Infants with a history of apnea after a feeding should be investigated for GER and appropriately treated.
Measurement of Calbindin‐D9K in Small Intestinal Biopsy Specimens of Children
Authors: Staun Michael , Pærregaard Anders , Krasilnikoff Peter A.
Published: January 2024

The vitamin D dependent intestinal calcium‐binding protein (calbindin‐D9K) was measured by an enzyme‐linked immunoadsorbent assay in small intestinal biopsy specimens from 10 children (aged 15–126 months). The aim was to study the relationship between calcium‐binding protein and age, bone age, and height. The patients were examined due to complaints of chronic diarrhea, but no evidence of malabsorption was found. The amount of calbindin‐D9K per mg of soluble protein in the small intestinal biopsy specimens was higher than previously studied in normal adults. Calbindin‐D9K correlated inversely with chronological age, bone age, and height of the children (p = −0.87, p = −0.66, and p = – 0.66; p < 0.05). A direct correlation was found between calbindin‐D9K and intestinal alkaline phosphatase activity (p = 0.60; p < 0.05). The decline in calbindin‐D9K may indicate that the active vitamin D dependent intestinal calcium absorption decreases during childhood.
Stable Isotopic Measurement of Endogenous Fecal Calcium Excretion in Children
Authors: Abrams Steven A. , Sidbury James B. , Muenzer Joseph , Esteban Nora V. , Vieira Nancy E. , Yergey Alfred L.
Published: January 2024

Using a stable isotopic technique in which 42Ca was administered via a bolus injection, we measured endogenous fecal calcium excretion, Vf, in five healthy children, aged 3–14 years. The Vf averaged 1.4 ± 0.4 mg/kg/day, and was lower than urinary Ca excretion (Vu) in four of the five children. These results for Vf are consistent with previously reported results for Vf in healthy adults and much lower than those reported in premature infants. These results may be useful in understanding developmental changes in Ca metabolism and in interpreting dual tracer Ca isotope studies in children.
Sialylated Oligosaccharides in Human Milk and Feces of Preterm, Full‐Term, and Weaning Infants
Authors: Sabharwal Hemant , Sjöblad Sture , Lundblad Arne
Published: January 2024

The amount of free and glycosidically bound sialic acid was quantitated in the oligosaccharide fraction of breast milk from nine women in the 2nd‐3rd week of lactation. These amounts showed a certain individual variation but the amount of bound sialic acid was higher than the free sialic acid in each sample. A similar study on the feces from preterm and full‐term breast‐fed infants revealed that the amount of free sialic acid increased while the bound sialic acid decreased during maturation, which could possibly be a result of increasing activity of an intestinal sialidase in the newborn child. The fecal oligosaccharide patterns in one blood group A secretor breast‐fed infant were studied every 2 months during weaning until the age of 1 year. It was seen that the fecal oligosaccharide pattern disappears, along with the blood group A‐active compounds, with a corresponding decrease in the amount of breast milk in the diet.
Early Liver Transplantation Is Indicated for Tyrosinemia Type I
Authors: Freese Deborah K. , Tuchman Mendel , Schwarzenberg Sarah J. , Sharp Harvey L. , Rank Jeffrey M. , Bloomer Joseph R. , Ascher Nancy L. , Payne William D.
Published: January 2024

Liver transplantation is now accepted as the treatment of choice for tyrosinemia type I (hereditary tyrosinemia). In an effort to determine whether any factors in these patients would aid in predicting optimal timing of the transplant procedure, we evaluated several clinical, biochemical, and radiographic parameters in five successive patients undergoing liver transplant for tyrosinemia type I at the University of Minnesota. All five patients evidenced prolonged periods of clinical and metabolic stability with dietary therapy and four of five remained stable at the time of evaluation for transplantation. Nevertheless, all five suffered significant and unexpected complications of tyrosinemia prior to the time of liver transplant. Four developed renal stones, two were in liver failure, and one developed a neurologic crisis that left him completely paralyzed. Hepatocellular carcinoma was found in one of the five at transplant. We could identify no clinical, biochemical, or radiographic study that was predictive of the likelihood of significant complications of the disorder. Survival from the transplant procedure itself was 100%. The inability to predict or prevent significant complications of tyrosinemia and the favorable outcome from transplantation lead us to recommend liver transplant for all patients with tyrosinemia type I by 12 months of age.
Gastroesophageal Reflux in Children with Chronic Recurrent Bronchopulmonary Infection
Authors: Chen Pei‐Huai , Chang Mei‐Hwei , Hsu Shun‐Chien
Published: January 2024

To evaluate the role of gastroesophageal reflux (GER) as a possible cause of recurrent bronchopulmonary infection in Chinese children, 23 patients were studied prospectively with 24‐h pH monitoring. Their ages ranged from 3 to 25 months. The patients studied were chosen by the criterion of repeated, radiographically documented bronchopulmonary infection with a frequency of two or more episodes in the most recent 6 months, or a single episode with a protracted course longer than 3 months. Twenty‐one of the 23 showed abnormal GER on 24‐h pH monitoring. Twenty children received medical therapy, 17 of whom were followed regularly for 14–29 months. Eleven had subsidence or improvement of symptoms at follow‐up. Follow‐up pH monitoring was performed in 5 of the 11 patients, and showed improvement. Six failed to show improvement with medical therapy. Follow‐up pH monitoring revealed increased reflux in two of them. Three of the six received fundoplication and had marked improvement of reflux and symptoms postoperatively. Clinical resolution corresponded well to 24‐h pH monitoring. GER may be considered one of the possible contributing factors in any child with chronic recurrent bronchopulmonary infection, and antireflux therapy might be beneficial. Twenty‐four hour pH monitoring was the best single test for diagnosing GER and determining the severity of the disease.
The Role of the Exocrine Pancreas in Early‐Onset Vitamin B12 Malabsorption in Gluten‐Challenged Celiac Children
Authors: Hjelt Karsten
Published: January 2024

The fractional absorption of vitamin B12 (FAB12) was measured by a double‐isotope technique specially adapted for children. In six celiac children on a strict gluten‐free diet and with a normal small intestinal biopsy, the FAB12 performed in the fasting patient averaged 30% (23–40%). After gluten challenge for a mean of 2 months (range 1–4), when mucosal damage was demonstrated by biopsy, the average fasting FAB12 in these patients decreased to 10% (0–17%) (p < 0.05). However, when the FAB12 test was repeated by means of stimulation by a B12‐free meal 1–3 weeks later, while the patients were still on a diet containing gluten, a significant increase was observed (mean 21%, range 14–27%) (p < 0.05). In four of the six patients the B12 absorption was further evaluated by repeating the FAB12 test by means of intravenous cholecystokinin (CCK) stimulation (n = 3) or by administration of exocrine pancreas enzyme supplementation (EPES) (n = 2) or cobinamide (n = 1). These tests all showed FAB12 values within the range of the meal‐stimulated FAB12. Moreover, in eight gluten‐free celiac children with normal biopsies, no difference was found between fasting and meal‐stimulated FAB12 values. Therefore, it is likely that the early‐onset B12 malabsorption observed in the gluten‐challenged celiac child with upper‐small‐intestinal mucosal damage is in part due to an insufficient stimulation of the exocrine pancreas when using the standard fasting B12 absorption test. These results indicate that a B12 absorption test with meal stimulation is preferable to the standard fasting test in children with small‐intestinal mucosal damage.
Urinary Hydroxyproline
Authors: Greer Frank R. , Chen Xiaorong , McCormick Ann
Published: January 2024

There is little information on urinary hydroxyproline (UHP) excretion in premature infants. We hypothesized that UHP excretion would positively correlate with growth in premature infants, and that there would be correlations between UHP excretion and serum alkaline phosphatase concentration as well as bone mineral content (BMC). Twenty‐six premature infants (birth weight, < 1,300 g; gestational age, ≤ 32 weeks) received one of four oral feedings. Seven received mother's own milk (HM), and eight received mothers own milk fortified with 0.85 g/dl of bovine whey, 90 mg/dl of Ca, and 45 mg/dl of P. Six and five infants received Similac, 20 cal/oz (SIM) and Similac Special Care, 20 cal/oz, respectively. Measurements of UHP, serum alkaline phosphatase, BMC (photon absorptiometry), and growth were made during the 1st 7 weeks of life. The lowest UHP excretion was in the HM group. For all infants, there was a significant correlation between UHP excretion (mg/day) and absolute weight (r = 0.64, p < 0.001), as well as rate of weight gain (r = 0.50, p < 0.01). The UHP excretion (milligrams per day) also correlated with absolute length (r = 0.41, p < 0.01) and rate of gain in length (centimeters per week) (r = 0.70, p < 0.001). The UHP excretion did not correlate significantly with BMC or serum alkaline phosphatase concentration. We conclude that UHP excretion is increased in the growing premature infant compared to older infants and adults and is a good marker for somatic growth in this population. Total UHP excretion is not a useful marker for bone turnover and ongoing bone mineralization in these infants.
Synthesis and Accumulation of Protein and Carbohydrases Along the Rat Villus Column
Authors: Castillo Ricardo O. , Kwong Linda K. , Tsuboi Kenneth K.
Published: January 2024

Summary: Enterocytes of the intestinal mucosa of infant and adult rats continuously proliferate in the crypt, mature as they migrate along the villus column, and are discharged from the villus tip. We examined the synthesis patterns of total protein, lactase‐phlorizin hydrolase, sucrase‐isomaltase, and maltase‐glucoamylase as well as the accumulation of these enzymes in cells during migration along the villus. Labeled leucine was administered intraperitoneally to suckling and young adult rats, and radioactivity was determined in protein and digestive carbohydrase pools of developing villus cells separated sequentially from tip to base of the villus column. The developing cells were found to continuously accumulate protein and carbohydrases as they ascended the villus column. In addition, incorporation of radioactivity into total protein and carbohydrase pools occurred at generally constant rates along the length of the villus. These studies showed that the differentiated enterocyte of both infant and young adult rat intestine exhibits a pattern of continuous growth while migrating the length of the villus column and maintains synthesis of protein and digestive carbohydrases at generally constant rates during this time.
Adherence of Medium‐Chain Fatty Acids to Feeding Tubes of Premature Infants Fed Formula Fortified with Medium‐Chain Triglyceride
Authors: Mehta Nitin R. , Hamosh Margit , Bitman Joel , Wood D. Larry
Published: January 2024

Summary: Adherence of medium‐chain triglyceride (MCT) oil to feeding tubes during gavage feeding of Enfamil formula was quantitated. Infants were fed similar volumes of either unfortified formula (n = 11) or MCT oil‐fortified formula (0.5 ml/oz); either the MCT oil was mixed with the formula before feeding (n = 11) or the MCT oil was delivered into the feeding tube and then was followed by formula (n = 11). The fat residue in the feeding sets was quantitated by gravimetry, and individual fatty acids were characterized by gas‐liquid chromatography. The data show that only trace amounts of lipid (0.23 ± 0.04%) adhered to feeding sets during feeding of unfortified formula. Significantly more lipid (p < 0.0005) adhered when formula was fortified with MCT oil, and the method of feeding greatly affected lipid adherence, i.e., 1.52 ± 0.21% when the MCT oil was followed by formula versus 10.20 ± 1.76% when the MCT oil was mixed with formula before feeding. Analysis of the fat residue of fortified formula showed that >90% was composed of C8:0 and C10:0, the major fatty acid components of MCT oil. We suggest that care be exercised when fortifying infant formula with MCT oil.
The Effect of Glucocorticosteroids on Serum, Liver, and Lung Vitamin A and Retinyl Ester Concentrations
Authors: Georgieff Michael K. , Radmer William J. , Sowell Anne L. , Yeager Pat R. , Blaner William S. , Gunter Elaine W. , Johnson Dana E.
Published: January 2024

Vitamin A and its active metabolites are important factors in promoting normal respiratory epithelial differentiation and growth. Glucocorticoids, often used to treat chronic lung diseases in infancy and childhood, are known to increase serum retinol concentrations. To determine the effects of exogenous steroids on serum retinol and retinal‐binding protein concentrations (as well as on liver and lung total vitamin A, retinol, and retinyl ester concentrations), 32 weanling Sprague‐Dawley rats were divided into four equal experimental groups. Eight animals were vitamin A sufficient and received 7 days of intraperitoneal dexamethasone at 0.5 mg/kg/day (group SD), 8 were vitamin A sufficient and received placebo (group SP), 8 were made vitamin A deficient and subsequently received dexamethasone (group DD), and 8 were vitamin A deficient and received placebo (group DP). Dexamethasone increased serum retinol concentrations in the SD group (2.27 ± 0.20 μmol/L) when compared with control (SP, 1.64 ± 0.46 n,mol/L, p < 0.001) as well as with pretreatment baseline values (1.21 ± 0.23 μmol/L, p < 0.001). Lung total vitamin A, retinol, and individual retinyl esters were depleted by 56 ± 19% in the SD group, whereas liver values were depleted by 36 ± 23%. In the vitamin A‐sufficient groups the relative percentages of four major retinyl esters (palmitate, stearate, oleate, and linoleate) did not change in either tissue after steroid exposure. The vitamin A‐deficient groups had no detectable tissue vitamin A, and dexamethasone did not increase serum retinol concentrations in the DD group. Serum retinol‐binding protein concentrations were significantly higher in both steroid‐treated groups when compared with control. Dexamethasone increases serum retinol and retinol‐binding protein concentrations in vitamin A sufficient rats, apparently at the expense of both lung and liver total vitamin A, retinol, and retinyl ester concentrations. We speculate that the liver and lungs are two sources for the increase in serum retinol reported with glucocorticosteroids.
Infectious Gastroenteritis Does Not Act as a Triggering Mechanism for the Synthesis of Serum IgG Antibody to β‐Lactoglobulin
Authors: Brüssow Harald , Sidoti Josette , Rahim Hassan , Dirren Henri , Freire Wilma
Published: January 2024

β‐Lactoglobulin (BLG)‐specific serum IgG antibody was measured by enzyme‐linked immunosorbent assay in 1,392 serum samples from newborn to 5‐year‐old Ecuadorian children enrolled into a representative nutrition and health survey. At a 1:100 serum dilution, 62% of the children showed specific antibody (blank‐corrected optical density ≥ 0.1). This prevalence did not change with increasing age. More specifically, we did not observe a prevalence or titer increase of BLG‐specific antibody in age groups where the majority of these Ecuadorian children experienced infection with rotavirus (8–24‐month age groups) and enterotoxigenic Escherichiacoli (8–12‐month age group). In addition, BLG‐specific antibody did not differ between children who did or did not experience an episode of diarrhea 15 days before blood sampling. We observed a small but statistically significant difference in BLG‐specific antibody between subsamples of Ecuadorian children regularly or only occasionally ingesting milk. Titers were higher in the group consuming more milk.
Persistent Diarrhea
Authors: Roy S. K. , Akramuzzaman S. M. , Akbar M. S.
Published: January 2024

The study was undertaken to better understand the role of total gut transit time (TGTT) on the absorption of nutrients in patients with persistent diarrhea. Twenty‐six boys aged 3–18 months with persistent diarrhea and 25 age‐matched healthy controls were studied. Their TGTT was measured with charcoal markers during their treatment with a diet made up with rice powder, soya oil, glucose, and egg white. Coefficients of absorption of nutrients were estimated in a 72‐h balance study. The median TGTTs in patients and controls were 5 and 11.6 h, respectively. Among the patients, the TGTT correlated significantly with absorption of total energy (p < 0.01), absorption of fat (p < 0.01), stool frequency (p < 0.01), and stool weight during the 1st 24 h (p < 0.01). Coefficients of absorption of energy, fat, and carbohydrate were significantly different among the patients above or below the median transit time (5 h). None of these relationships was present among the healthy controls. The TGTT was negatively associated with the duration of clinical recovery. The results of this study suggested that intestinal transit time is an important factor for absorption of nutrients that may influence clinical recovery in patients with persistent diarrhea.
Effect of Iron Deficiency on Small Intestinal Permeability in Infants and Young Children
Authors: Berant Moshe , Khourie Marwan , Menzies Ian S.
Published: January 2024

Small intestinal absorptive function can be disturbed in iron deficiency. We examined the permeability behavior of the small intestinal mucosa toward lactulose and rhamnose in 26 otherwise healthy children with iron deficiency. Their (mean ± SD) age was 21 ± 8.6 months; hemoglobin 7.9 ±0.9 g/dl, mean corpuscular volume (MCV) 60.1 ± 3.4 fl, serum iron 2.72 ± 0.66 μmol/L, serum ferritin 7.3 ± 1.6 μg/L. After an isotonic oral load of both sugars, their 5‐h urinary excretion was measured by gas‐liquid chromatography/mass spectrometry. The ratio of the percentage of urinary recovery of the sugars [lactulose/rhamnose(%)] was determined as the permeability index. The tests were repeated in the same subjects after 3 months of iron supplementation, and achievement of an iron sufficient state. In the iron‐deficient state, the permeability index was significantly higher than the standard normal value (0.15 ± 0.05 versus <0.07; p < 0.01), but was not different from normal when the children had attained a normal iron status. The major factor for the alteration of the permeability index in the children with iron deficiency was a significantly lower urinary recovery of rhamnose (which passes the small intestinal epithelium by a transcellular route); the recovery of lactulose (which passes through a paracellular route) was not affected by iron deficiency. Our study indicates that iron deficiency in infants and young children can alter permeability characteristics of the small intestinal mucosa. Iron status should therefore be considered when interpreting permeability tests in the young.
Iron Absorption and Iron Deficiency in Infants and Children with Gastrointestinal Diseases
Authors: de Vizia Basilio , Poggi Vincenzo , Conenna Rodolfo , Fiorillo Amedeo , Scippa Luigi
Published: January 2024

Iron status, iron absorption, and intestinal blood loss were studied in 199 children undergoing diagnostic evaluation for suspected malabsorption. Evaluation of iron status included hematological indices, serum ferritin, and transferrin saturation. Iron absorption was assessed by the increment of serum iron after an oral iron load. Iron deficiency was common among patients affected by malabsorptive states, such as celiac disease (84%), cow's milk intolerance (76%), Crohn's disease (72%), and giardiasis (64%), whereas it was less common among patients with postinfectious enteritis (41%) and chronic nonspecific diarrhea (11%). Intestinal blood loss was seen only in patients with Crohn's disease and cow's milk intolerance, irrespective of iron nutritional status. On the other hand, iron malabsorption was very common, affecting 85–95% of the iron‐deficient patients in all diagnostic groups, except in chronic nonspecific diarrhea. Iron malabsorption was less common among patients with adequate iron nutritional status than in those with iron deficiency. Iron malabsorption appears to play a major role in the pathogenesis of iron deficiency in patients with malabsorption. The iron absorption test shows greater sensitivity as a screening test for upper intestinal malabsorption than the D‐xylose absorption test.
Intestinal Uptake and Transmission of Macromolecules into the Blood in the Young Guinea Pig
Authors: Ekström G. M. , Weström B. R.
Published: January 2024

The developmental changes in the ability of the small intestinal epithelium to take up and transfer into blood the macromolecules bovine serum albumin (BSA), bovine immunoglobulin G (BIgG), and fluorescein isothiocyanate‐labeled dextran 70,000 (FITC‐dextran) were studied in guinea pigs 0–14 days of age. In addition, in the same animals, the activities of the proteases cathepsin B and D within the intestinal mucosa were measured. Four hours after gavage feeding, 0‐day‐old guinea pigs showed an uptake of the markers into the enterocytes throughout the small intestine. In 2‐day‐old guinea pigs, the markers were only detected in the enterocytes in the distal part. All three macromolecules passed into the blood in these young animals. In 7‐day‐old guinea pigs, no epithelial marker uptake was observed, but low levels of BSA and FITC‐dextran could still be detected in serum. Neither epithelial uptake nor transfer of the markers to the blood could be found in the animals that were 14 days of age. The activity of cathepsin B and D in the intestinal mucosa showed a tendency to increase with age, and for all ages the activity in the distal part was higher than in the proximal part. The results showed that the small intestine in guinea pigs at birth is capable of macromolecular uptake and transfer into the circulation. This ability decreased with age eventually leading to intestinal closure after 1 week. The histological findings implied that intestinal closure was a consequence of a replacement of fetal absorptive cells with adult cells lacking this ability.
Nutritional Status and Growth in Children with Chronic Hepatitis B
Authors: Vegnente A. , Guida S. , Di Costanzo V. , Fusco C. , Iorio R. , Toscano P.
Published: January 2024

As reported for other chronic liver diseases, hepatitis B virus (HBV) chronic infection might result in malnutrition. In order to establish whether this disease could be responsible of malnutrition and hence influence growth, 75 children, chronically infected with HBV, have been followed up for 4 years. Thirty‐one of them had chronic active hepatitis (CAH), 25 chronic persistent hepatitis (CPH), 14 chronic lobular hepatitis (CLH), and five cirrhosis (three active, two inactive). The nutritional status was evaluated every 12 months, with careful physical and laboratory examinations. General nutritional status was estimated according to Waterlow criteria (13,14). At our first observation, 50 children were following a balanced diet with a caloric intake adequate for age and weight, whereas 25 were on a low‐fat diet, begun in the belief of its therapeutic value. For seven patients of this second group, the caloric intake was below the daily requirement. The latter group showed a growth failure in weight when they were first seen at our center and gained weight when the dietary intake was normalized. However, no biochemical feature of malnutrition was observed in all the 75 children. At the end of the follow‐up period, the nutritional status was satisfactory for all of them.
Detection of Hepatitis B Virus DNA in the Liver of Children with Chronic Hepatitis B by In Situ Hybridization and Its Relation to Other Viral Markers
Authors: Wirth Stefan , Hueter Anke , Blaha Ingeborg , Mundlos Stefan , Keller Klaus‐Michael , Zabel Bernhard
Published: January 2024

The aim of the study was to detect hepatitis B virus (HBV) DNA by in situ hybridization (ISH) with a 35S‐labeled radioactive probe in frozen liver biopsy tissue sections of 63 hepatitis B virus surface antigen (HBsAg)‐positive children. The results were compared to other markers of viral replication. HBV DNA was detected in 48 children. Of the 15 negative cases, four had hepatitis B envelope antigen (HBeAg), 10 anti‐HBe, and one neither HBeAg nor anti‐HBe. Free HBV DNA in serum and liver was positive in one patient. Forty of the positive children were HBeAg‐ and six anti‐HBe‐positive; two were negative for both. Of 45 36 had HBV DNA in serum. In 38 of 47 HBV DNA and in 31 of 42 HBeAg could be detected in the liver. The HBV DNA signals were located mainly over the cytoplasm of hepatocytes. The distribution of HBV DNA in the tissue was classified as homogeneous, inhomogeneous with focal patches, and focal. It is concluded that in situ hybridization is a reliable method for detection of HBV DNA in liver tissue of children with chronic hepatitis B. The technique, which can be applied to small amounts of liver tissue, provides informations about the distribution of replicative viral sequences, complementing laboratory data, liver histochemistry, and histology.
Plasma Gastrin‐34 Increases During and Immediately After Breast‐Feeding in 3‐Day‐Old Infants
Authors: Marchini Giovanna , Redham Ingrid , Uvnäs‐Moberg Kerstin
Published: January 2024

We examined whether plasma gastrin concentration increases during breast‐feeding in infants. The peptide concentration was measured cross‐sectionally before, during, and after breast‐feeding in healthy, 3‐day‐old infants (n = 72). Somatostatin, a modulator of gastrin release, was also analyzed. Both peptides were measured by radioimmunoassay and were further characterized by high‐performance liquid chromatography (HPLC). The (mean ± SD) concentration of gastrin rose significantly from 63 ± 24 pmol/L before feeding to 92 ± 32 pmol/L (p < 0.01) and 95 ± 21 pmol/L (p < 0.01), 5 and 10 min after the initiation of sucking, respectively. The gastrin concentration was 102 ± 35 pmol/L (p < 0.01) immediately after feeding. Plasma somatostatin concentration was unaffected by feeding. As assessed by HPLC, circulating gastrin before, during, and after feeding was found to correspond to gastrin‐34, whereas circulating somatostatin was found to correspond to somatostatin‐14. We conclude that in contrast to earlier studies, plasma gastrin concentration increases during and immediately after breast‐feeding in infants.
In Vitro Hydrogen Production by Enteric Bacteria Cultured from Children with Small Bowel Bacterial Overgrowth
Authors: Khin‐Maung‐U  , Tin‐Aye  , Ku‐Tin‐Myint  , Tin‐Oo  , Myo‐Khin  , Thackway Stephen A. , Connor Susan J. , Bolin Terry D. , Duncombe Vic M.
Published: January 2024

Lactulose breath hydrogen test and Enterotest string test were carried out simultaneously on 19 children 3–5 years old. Bacteria isolated from the jejunal fluid in upper small intestines of these children were incubated with lactulose at neutral pH. Anaerobes were present in all but one child, and in 15 children they were present in numbers greater than 5 log10 organisms per ml. Most of these bacteria did not produce hydrogen in vitro. Hydrogen production (>100 ppm) was observed with the following bacteria: Bacteroides (5%), Clostridia (8%), anaerobic corynebacteria (5%), Escherichia coli (67%), Lactobacillus (8%), Staphylococcus (8%), and Streptococcus (9%). The following bacteria did not produce hydrogen in vitro: Actinobacter, Actinomyces, anaerobic cocci, Bifidobacterium, Fusobacterium, micrococci, Neisseria, Sarcina, and Veillonella. This study suggests that in the diagnosis of small bowel bacterial overgrowth using lactulose breath hydrogen test, it is important to consider that patients with a flat breath hydrogen response to a carbohydrate challenge during the first 60 min may be infected with enteric bacteria which are not capable of producing H2.
Bacterial Ileocecitis Caused by Escherichia Coli O157
Authors: Tarr Phillip I. , Weinberger Edward , Hatch Edwin I. , Christie Dennis L.
Published: January 2024

Escherichia coli O157:H7 is most commonly linked to hemorrhagic colitis and the hemolytic uremic syndrome. Diagnostic ultrasound was used to demonstrate terminal ileum abnormalities suggestive of bacterial ileocecitis, a recently described entity that resembles acute appendicitis, in a patient whose stool culture yielded E. coli O157:H7. This case extends the spectrum of disease caused by E. coli O157:H7 and expands the number of organisms that can cause bacterial ileocecitis.
Mosaic Expression of Brush‐Border Enzymes in Infants with Chronic Diarrhea and Malnutrition
Authors: Nichols Buford L. , Carrazza Francisco , Nichols Veda N. , Putman Margaret , Johnston Pamela , Rodrigues Maraci , Quaroni Andrea , Shiner Margot
Published: January 2024

The chronic diarrhea observed in young malnourished infants that is sensitive to dietary glucose and other carbohydrates is associated with variable degrees of patchy mucosal villous atrophy. To explore intrinsic mucosal function in the pathogenesis of this alimentary intolerance, we have conducted an immunohistologic investigation of brush‐border enzyme proteins of clinically obtained, mucosal biopsy samples. We used a group of monoclonal antibodies against human brush‐border aminopeptidase, sucrase/isomaltase (SI), maltase, and lacase enzyme proteins. SI was strongly and uniformly exssed in crypts and villi of 11 of the 14 subjects; in 3 ects, however, SI was expressed in a mosaic pattern. Maltase and lactase were occasionally absent, but more commonly were expressed in a mosaic distribution. The mosaic expression of brush‐border enzyme proteins has been reported in congenital enzyme deficiencies associated with normal intestinal histology. We report the mosaic expression of brush‐border enzyme proteins as a functional alteration associated with a pathological lesion of the mucosa in infants with chronic diarrhea. Our observation challenges the existing concept of ontogenic regulation of brush‐border enzyme activity.
Selective Decontamination of the Digestive Tract Contributes to the Control of Disseminated Intravascular Coagulation in Severe Liver Impairment
Authors: van Saene Hendrick K. F. , Stoutenbeek Christiaan P. , Faber‐Nijholt Roeleke , van Saene Joris J. M.
Published: January 2024

A premature nconate with severe Coxsackic B1 hepatitis acquired in utero developed disseminated intravascular coagulation a few days after birth. The neonate did not respond to conventional treatment. Eradication of aerobic gram‐negative bacilli (Enterobacteriaccae) from the gut with oral nonabsorbable polymyxin E and tobramycin (selective decontamination of the digestive tract) was followed by clinical improvement; disseminated intravascular coagulation was controlled. After an unstable convalescence, the neonate recovered and was discharged in good general condition. A correlation between oral feeding, gut carriage of Enterobacteriaceae, fecal endotoxin pool, and platelet counts was observed. The eradication of gut carriage of aerobic gram‐negative bacilli was associated with a significant decrease of the intestinal endotoxin pool and paralleled the recovery from thrombocytopenia. Selective decontamination is discussed as a method of possible value for controlling systemic endotoxin‐induced symptoms in the critically ill with intestinal endotoxemia.
Milk Protein Quality in Low Birth Weight Infants
Authors: Priolisi A. , Didato M. , Gioeli R. , Fazzolari‐Nesci A. , Räihä N. C. R.
Published: January 2024

Growth rates tweight, length, and head circumference) and selected biochemical indexes of protein metabolism (serum urea, acid‐base status, and plasma amino acid concentrations) were determined in low birth weight (LBW) infants appropriate for gestational age (birth weight < 1,650 g) fed three formulas differing only in the whey‐to‐casein ratios: 60/40, 50/50, and 35/65. A group of infants fed exclusively human milk protein (HMP)‐fortified human milk was used as a control. All diets provided similar daily protein and energy intakes, which were 3.5 g/kg and 122 kcal/kg in the human milk‐fed infants and 3.3 g/kg and 121 kcal/kg in the formula‐fed infants. Neither weight gain nor rate of growth in length and head circumference differed between the feeding groups and reached intrauterine or better rates in all groups. Values for serum urea and acid‐base status were normal and also did not differ among the groups. At the end of the study, plasma threonine concentrations were significantly higher in all formula‐fed infants than in the infants fed human milk. The highest plasma threonine concentration was found in the infants receiving the whey‐predominant formula. Plasma concentrations of valine, methionine, and phenylalanine were also significantly higher in all formula‐fed groups when compared with the human milk group. Plasma total essential amino acid concentrations were also significantly higher in the formula‐fed infants than in the human milk fed. The results show that protein quality does not affect growth rate or biochemical indexes of metabolic tolerance in LBW infants fed adequate protein and energy intakes. However, further modifications of formula proteins are necessary if the goal of formula feeding is to achieve similar plasma amino acid patterns as in infants fed exclusively HMP.
Doppler Assessment of Human Neonatal Gut Blood Flow Velocities
Authors: Coombs R. C. , Morgan M. E. I. , Durbin G. M. , Booth I. W. , McNeish A. S.
Published: January 2024

Duplex pulsed Doppler ultrasound was used to study changes in gut blood flow velocities during the first week of life in a group of 14 term babies. There was a significant increase in fasting peak systolic velocity in the superior mesenteric artery between days 1 and 2 with a further upward trend until day 5; no such changes were seen in the coeliac axis. Fasting velocities were 20% lower in breast‐fed babies than bottle‐fed babies. Following feeds, there was a significant increase in velocity in the superior mesenteric artery that was 35% greater in the bottle‐fed than breast‐fed babies. Changes in the coeliac axis were qualitatively similar but substantially smaller. The peak velocity in both vessels occurred 50 min after a feed. We conclude that Doppler ultrasound can be readily used to measure gut blood flow velocities in the human newborn. It provides a noninvasive technique for investigating adaptive postnatal changes in the splanchnic circulation, and, in particular, the response to feeds.
Abnormal Gut Blood Flow Velocities in Neonates at Risk of Necrotising Enterocolitis
Authors: Coombs R. C. , Morgan M. E. I. , Durbin G. M. , Booth I. W. , McNeish A. S.
Published: January 2024

Duplex pulsed Doppler ultrasound was used to determine blood flow velocities in the coeliac axis and superior mesenteric artery in three groups of neonates: a group at high risk of developing necrotising enterocolitis (n = 27) and two control groups, i.e., a nonasphyxiated, appropriately grown group of preterm infants (n = 18) and a group of nonasphyxiated term infants (n = 14). Subjects were studied on the first, second, and fourth days of life. The median peak systolic velocities in the superior mesenteric artery were between 20 and 51% lower in the at‐risk group than in the term control group on all 3 days of measurement (p < 0.05 – p < 0.002). The ratio of peak systolic velocity in the coeliac axis to that in superior mesenteric artery, an index of relative downstream vascular resistance in the superior mesenteric artery, was 42–65% greater in the at‐risk group compared with the other two groups on days 1 and 2 (p < 0.05 – p < 0.001) and significantly greater than the term group on day 4 (73%, p < 0.002). These data demonstrate that neonates at risk of developing necrotising enterocolitis have abnormal gut blood flow velocities. Furthermore, they provide evidence that an alteration in the splanchnic circulation may be an important factor in the final common pathway that links diverse risk factors for necrotising enterocolitis with clinical disease.
Invited Review
Authors: Heyman M. , Desjeux J. F.
Published: January 2024

We discussed various physiological and pathological situations in which the epithelial permeability to food antigens is degraded. Most of the changes observed are quantitative, and alter the degradative and direct transport pathways. How these changes in permeability lead to oral tolerance, systemic immune response, or hypersensitivity is a question that remains to be answered. Bearing in mind that enterocytes may function as antigen‐presenting cells, intracellular processing during epithelial transport might play a major role in initiating the immune response, and conversely, lymphoepitheliai interactions might be one of the keys to the regulation of intestinal epithelial function.
Production of Short Chain Fatty Acids by the Intestinal Microflora During the First 2 Years of Human Life
Authors: Midtvedt Ann‐Christine , Midtvedt Tore
Published: January 2024

We have followed the establishment of one group of intestinal microflora‐associated characteristics, namely, the production of short chain fatty acids (SCFAs), in 30 healthy children, by gas chromatography analysis of fecal samples taken at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months of age. Acetic and propionic acids were the principal SCFAs at 1 and 3 months. Successively, the production of iso‐ and n‐butyric, valeric, and caproic acids was established. At 2 years, the absolute amounts of all SCFAs with the exception of n‐valeric acid had reached adult values. However, not all children had achieved a typically adult range of stool SCFAs by the end of the study. Both absolute and relative amounts of SCFAs were influenced by exposure to foods other than breast milk and exposure to antibiotic therapy. After standardization for exposure to foods other than breast milk, a positive age factor could be seen between 0 and 1 month of age for total amounts produced of SCFAs, acetic, propionic, and n‐butyric acids. After this time, however, no clear age factor could be distinguished.
Malabsorption of Different Lactose Loads in Children with Human Immunodeficiency Virus Infection
Authors: Zuin G. , Fontana M. , Monti S. , Marchisio P. , Beretta P. , Principi N.
Published: January 2024

Thirty children infected with human immunodeficiency virus (HIV) (18 PI and 12 P2, according to the classification system of the Centers for Disease Control) and 54 noninfected children were evaluated for lactose malabsorption with use of the hydrogen breath test after different lactose loads. Lactose malabsorption after load of 2 g/kg occurred in 75% of P2, 67% of PI, and in 46% of noninfected children. With a lower lactose load (1 g/kg), the prevalence of malabsorption was significantly higher among P2 children than PI and noninfected cases. A similar figure was obtained after the lowest load (0.5 g/kg). Infected children with lactose malabsorption were significantly younger than noninfected malabsorbers (mean age ± SD; 50.3 ± 22 vs. 63.5 ± 20.9 months) when the load of 2 g/kg was used. The use of lower lactose loads seems to be helpful in finding the dose that can be tolerated. This finding could have nutritional importance and could lead to better dietary management.