bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Domperidone in Infants and Children with Gastroesophageal Reflux
Authors: Bines Julie E. , Quinlan Jo‐Ellen , Treves S. , Kleinman Ronald E. , Winter Harland S.
Published: January 2024

This study sought to define the therapeutic efficacy of domperidone in infants and children with gastroesophagcal reflux. A double‐blind, placebo‐controlled trial was performed in seventeen children (ages 5 months to 11.3 years) with moderate to severe gastroesophagcal reflux who had not responded to standard nonpharmacological therapy. Subjective and objective measures (weight gain, esophageal pH probe study, radionuclide gastric emptying scan) of gastroesophageal reflux were evaluated. Therapy with domperidone for 4 weeks was effective only in reducing the total number of reflux episodes in the two‐hour postprandial period (p < 0.01); however, it did not result in symptomatic improvement or significant improvement in other measures of gastro‐esophageal reflux or gastric emptying. After therapy for 8 weeks symptomatic improvement was reported in some patients who had denied improvement after 4 weeks of therapy, suggesting that more than 4 weeks of therapy may be required for some patients to obtain a clinical response. Mild self‐limited diarrhea was reported by six patients (four domperidone, two placebo). We conclude that domperidone is tolerated by most infants and children with gastroesophageal reflux; however, 4 weeks of therapy was only minimally effective in producing objective improvement of gastroesophageal reflux and did not result in symptomatic improvement. Further studies of longer duration are needed to resolve the question raised by this study: that domperidone may be beneficial for patients with gastroesophageal reflux when given for more than four weeks.
Levels and Molecular Forms of Gastrin and Somatostatin in Plasma and in Gastric Contents of Infants After Section Delivery
Authors: Marchini Giovanna , Uvnäs‐Moberg Kerstin
Published: January 2024

We measured the pH of the gastric contents, as well as the gastrin‐ and somatostatin‐like immunore‐activity in both plasma and gastric content samples, obtained from 23 infants delivered at term by elective cesarean section (ECS). In addition, we characterized the molecular forms of gastrin and somatostatin by high performance liquid chromatography. The median pH value of the gastric contents was found to be 6.78 (range 4.93–7.35). The median gastrin concentration in plasma was 54 pmol/L (range 29–190 pmol/L), which was significantly higher (p < 0.0005) than the concentration recorded in the gastric contents, 6 pmol/L (range 0–680 pmol/L). The median somatostatin concentration in plasma was 12 pmol/L (range 4–40 pmol/L), which was significantly lower (p < 0.0001) than the concentration found in the gastric contents, 128 pmol/L (range 15–488 pmol/L). Gastrin‐ and somatostatin‐like immunoreactivity in both plasma and gastric contents were found to correspond to nonsulfated gastrin‐34 and somatostatin‐14, respectively. These data suggest that acid secretion is absent or low in infants immediately following ECS, although gastrin and somatostatin are being released into the circulation as well as into the gastric lumen. The different ratio between the concentration in plasma and gastric contents of gastrin (10:1) compared with that of somatostatin (1:10) might be related to the fact that gastrin exerts endocrine actions preferentially, whereas somatostatin is presumed to exert local paracrine effects on the gastric mucosa.
Hepatitis B Virus DNA in Liver Tissue of Chronic HBsAg Carriers in Childhood and Its Relationship to Other Viral Markers
Authors: Wirth Stefan , Keller Klaus‐Michael , Schaefer Elmar , Zabel Bernhard
Published: January 2024

The aim of the study was to examine the state of hepatitis B virus (HBV) DNA in liver tissue of 103 children with chronic hepatitis B aged 0.5–18 years to detect free and integrated viral sequences by Southern blot hybridization. HBV DNA was found in 74 patients. Seventy‐two were seropositive for hepatitis B e antigen (HBcAg) and two had anti‐HBe antibodies. Integrated sequences could be demonstrated in two children. One of them had only integrated HBV DNA and was anti‐HBe seropositive. The other one presented both free and integrated viral sequences and developed seroconversion from HBeAg to anti‐HBe 5 months after biopsy. In 29 hepatitis B surface antigen (HBsAg) carriers, no HBV DNA could be detected in the liver. Ten were HBeAg and 19 anti‐HBe seropositive. HBV DNA in serum was found in 65 of the 74 Southern blot‐positive and only in two cases of the Southern blot‐negative patients. In conclusion, most of the HBeAg‐positive children had free HBV DNA in their liver tissue and all patients with anti‐HBe except one were negative. According to our results, HBV DNA integration into the liver cell genome can occur at an early stage of chronic disease but is not a frequent event.
Milk‐Stimulated PGE2 Production by Isolated Gastric Cells
Authors: Ducroc R. , Wirbel A. , Garzon B. , Vilar J. , Brunel‐Riveau B. , Geloso J. P.
Published: January 2024

The effects of a milk diet on gastric acid secretion of rats fed raw bovine milk for 4 days were examined using dispersed gastric cells. Parietal cell acid secretion was estimated by the accumulation of 14C‐aminopyrine (AP), an index of secretory function. Basal AP accumulation was significantly increased (60%) by the milk diet. There was a marked upward shift in the dose‐response curve of histamine (HA; 10−8 to 10−3M) in milk‐fed rats, indicating enhanced sensitivity of parietal cell‐H2 receptor to exogenous HA. In contrast, the dose‐dependent inhibition of HA‐induced AP accumulation by prostaglandin (PG) E2 was significantly reduced, indicating that the parietal cells of milk‐fed rats were less sensitive to exogenous PGE2. The PGE2 content of bovine milk was low (<20 pg/ml), but the production of endogenous PGE2 by the gastric cells was dramatically increased by the milk diet and exhibited maximal control production rate in the presence of 10 μM arachidonic acid. The increased responsiveness to histamine and the decreased responsiveness to PGE2 indicated that the milk diet induced low histamine and high PGE2 availability in the vicinity of the parietal cell basolateral membrane. This regulation, which involves stimulation of PGE2 production in the gastric mucosa, may underly the inhibition of acid secretion observed in vivo in chronically milk‐fed adult rats.
Comparison of Two Preterm Formulas With or Without Addition of Medium‐Chain Triglycerides (MCTs). I
Authors: Sulkers E. J. , v Goudoever J. B. , Leunisse C. , Wattimena J. L. D. , Sauer P. J. J.
Published: January 2024

Medium‐chain triglycerides (MCTs) are included in the fat blend of several preterm formulas because of their complete absorption and rapid oxidation. The effects of two different fat blend compositions on nitrogen and fat balances and macronutrient oxidation were investigated in 28 healthy very‐low‐birth weight infants at 4 weeks of age. A preterm formula with a traditional corn oil/MCT blend containing 38% MCTs (MCT group) was compared to a new fat blend, designed to resemble human milk more, containing 6% MCTs (LCT group). There were no differences in nitrogen absorption or in excretion. Median nitrogen retention was 74% (MCT) vs. 71% (LCT) of intake. Fat absorption was higher (p < 0.05) in the MCT group (88%) vs. 79% in the LCT group (median values). MCTs did not stimulate fat oxidation as measured by indirect calorimetry, so fat deposition was also higher on the MCT formula. As weight gain was not different between groups, the percentage of weight gain consisting of fat accretion was significantly (p < 0.005) higher with the MCT formula (24% vs. 21%). On the other hand, there was no increase in percent protein accretion (both 15% of weight gain). We conclude that the existence of a slightly lower fat absorption in the healthy growing neonate fed a LCT formula compared with a MCT formula does not impair growth or nitrogen retention, but merely induces a slight decrease in the high relative fat accretion encountered in the preterm neonate.
Cytokeratin Immunohistochemical Examination of Liver Biopsies in Infants with Alagille Syndrome and Biliary Atresia
Authors: Treem W. R. , Krzymowski G. A. , Cartun R. W. , Pedersen C. A. , Hyams J. S. , Berman M.
Published: January 2024

Identifying bile duct epithelium is sometimes difficult with standard histologie techniques. The availability of antibodies to specific cy tokeratin (CK) intermediate filaments has allowed identification of CK expressed by bile duct epithelium. Formalin‐fixed, paraffin‐embedded liver tissue from five infants (aged 1–12 months) with Alagille syndrome and five infants with biliary atresia (aged 1.5–11 months) were pepsin digested then reacted with a combination of anti‐cytokeratin monoclonal antibodies using an avidin‐biotin immunoper‐oxidase technique. Liver tissue obtained at autopsy from infants without primary liver disease (aged 22 weeks gestation to 24 months) was treated similarly for comparison. Control specimens showed progression from prominent immunoreactivity of the ductal plate cells at the rim of the portal tract (22–24 weeks gestation) to incorporation of tubular ductal structures into portal tract mesenchymal tissue (26–34 weeks gestation) and formation of intensely immunoreactive mature discrete interlobular ducts with progressive loss of cytokeratin immunoreactivity of the ductal plate cells (1–24 months). In contrast, biopsies from infants with Alagille syndrome showed few immunoreactive interlobular ducts. Biopsies from infants with Alagille syndrome less than 2 months old showed only immunoreactivity of single ductal plate cells or small ductules at the periphery of the portal tracts. Biopsies from some infants greater than 3 months old showed increased numbers of immunoreactive cells in groups and anastomosing bands lacking true lumens and extending into the fibrous bridges between adjacent portal areas (neoductular proliferation). Biopsies from infants with biliary atresia showed strongly immunoreactive interlobular bile ducts and prominent peripheral ductules. Neoductular proliferation was already present in the earliest biopsies, and as fibrosis and cirrhosis increased, interlobular duct staining decreased, and ductal plate cells extending into fibrous bands became more immunoreactive. Anti‐cytokeratin monoclonal antibodies appear to be a useful tool for identification of bile duct epithelium in infants with a paucity of interlobular bile ducts and biliary atresia. Compared to age‐matched controls and patients with biliary atresia, infants with Alagille syndrome may fail to fully develop interlobular ducts. In both Alagille syndrome and biliary atresia, chronic cholestasis is a stimulus for proliferation of epithelium at the limiting plate which expresses a bile ductular cytokeratin pheno‐type.
Esophagitis of Likely Traumatic Origin in Newborns
Authors: Deneyer M. , Goossens A. , Pipeleers‐Marichal M. , Hauser B. , Blecker U. , Sacre L. , Vandenplas Y.
Published: January 2024

We describe 17 full‐term newborns presenting with vague symptoms related to the upper gastrointestinal tract (anorexia, poor feeding, retching, regurgitation, and incessant crying) during their stay in the maternity unit. After an esophagogastroduodenoscopy performed between days 2 and 5 of life, the babies could clearly be divided into two groups. Twelve babies (group 1) had an extremely severe esophagitis (circular ulcerations), without gastroduodenitis. In the remaining five babies (group 2), the upper gastrointestinal tract was unaffected. Allergic, infectious, metabolic, and toxic etiologies were excluded. Esophageal pH monitoring data were within normal ranges in all. All babies of group 1 were treated as follows: prone anti‐Trendelenburg position, cisapride, and cimetidine syrup. Symptoms and lesions disappeared within 48–72 h. Reendoscopy after 72 h showed an almost normal esophagus with greatly improved histology. These observations highlight four points of interest: (a) the existence of an extremely severe ulcerative esophagitis in apparently healthy newborns, (b) the very rapid clinical and histological recovery, (c) the difficulties in predicting esophagitis on clinical grounds, and (d) the mysterious origin despite thorough assessment. The distribution of the lesions (more severe in the upper esophagus), the early onset (almost at birth), the very rapid healing, and the absence of gastric and duodenal lesions are in favor of a possible “traumatic” origin (pharyngeal, esophageal, and gastric suction at birth). Finally, because the condition described is transient, questions arise regarding the necessity of treatment, and we currently do not recommend overtreating newborns presenting with similar symptoms and/or endoscopie findings.
Midazolam as a Sedative in Esophageal Manometry
Authors: Fung Kam Pui , Math Mahantayya V. , Ho Chin Onn , Yap Kian Mo
Published: January 2024

Midazolam 0.5 mg/kg was given intravenously as a sedative to 19 infants and children undergoing esophageal manometry after oral choral hydrate treatment. The lower esophageal sphincter pressure and motility were measured by manometry before and after midazolam injection. Midazolam did not change the lower esophageal sphincter pressure, blood pressure and respiratory rate of the subjects (p > 0.18), and the motility patterns. However, the mean heart rate increased by 5 beats/min after midazolam injection (p < 0.05). One infant developed transient apnea, reversed promptly by intravenous flumazenil. Sedation occurred within l min after intravenous injection of the drug. No other side effects were noted. Midazolam is a relatively safe and effective sedative for accurate lower esophageal sphincter pressure measurement and esophageal manometry when a mild sedative such as choral hydrate does not work.
Efficacy of Massive Dose Oral Gentamicin Therapy in Nonbloody Persistent Diarrhea with Associated Malnutrition
Authors: Bhatnagar Shinjini , Bhan Maharaj K. , Sazawal Sunil , Gupta Usha , George Chechamma , Arora Narender K. , Kashyap Dharmendra K.
Published: January 2024

Overgrowth of aerobic and anaerobic bacteria in the upper small intestine is a common finding in persistent diarrhea. We hypothesized that a large dose of broad spectrum, nonabsorbable oral antibiotic would hasten recovery from persistent diarrhea by eradicating aerobic bacterial overgrowth. Sixty‐eight patients were randomly assigned to treatment with either oral gentamicin (n = 33) or placebo (n = 35) for a period of 6 days. The two groups were comparable in their clinical features, stool weights, duodenal and fecal microflora, during an initial 24 h observation period before randomization. The proportion of patients recovering within 6 days post‐treatment was similar in the antibiotic (45.2%) and placebo (50%) groups. The stool weights in the two groups during 24–72, 72–120, and 120–168 h of the study did not differ significantly. The percent mean weight gain (g) at 168 h post‐treatment in the antibiotic (1.0± 5.1) and placebo (1.4± 5.3) groups also did not differ significantly (p = 0.8). A similar proportion of antibiotic‐ (61.3%) and placebo‐ (60.7%) treated patients had started to gain weight by the last day of the study. We conclude that oral gentamicin was no more effective than placebo in reducing purge rates, in achieving earlier recovery from diarrhea, and in promoting the earlier onset of weight gain in this study.
Short‐Chain Fatty Acid Absorption in Patients with Cystic Fibrosis
Authors: Vaisman Nachum , Tabachnik Elvan , Sklan David
Published: January 2024

Patients with cystic fibrosis (CF) often exhibit malabsorption despite the use of supplemental pancreatic enzymes. Unabsorbed carbohydrates and amino acids can serve as substrates for large intestine anaerobic fermentation, thus increasing excretion of short‐chain fatty acids (SCFA) in the feces. Nine patients with CF on regular pancreatic enzyme supplementations in the age range of 5–11 years and one older patient were studied. Three‐day stool samples were collected, as were 72–h food records. Stools were analyzed for gross energy, total nitrogen, fat content, and SCFA concentration. A significant difference was found between CF and normal controls in total caloric excretion due to fat malabsorption. No significant difference was found between CF and normal controls in protein or SCFA excretion. Fat excretion as percentage of fat intake was significantly increased in CF patients: 35.3± 10.2% versus 8.0± 3.0%, respectively. These data suggest that carbohydrate supplementation could be more widely used to increase caloric intake in CF patients without causing secondary osmotic diarrhea.
Gliadin‐Specific and Cow's Milk Protein‐Specific IgA in Human Milk
Authors: Juto Per , Holm Stefan
Published: January 2024

The presence of gliadin‐specific IgA and IgG antibodies in colostrum and serum of 140 newly delivered mothers was assessed by enzyme‐linked immunosorbent assay. In addition, cow's milk protein (CMP)‐specific IgA was determined in the colostrum samples. From 14 of the mothers longitudinal milk samples were obtained after 1 and 2 months of lactation and from 12 mothers after 3 months. Gliadin‐specific IgA was found in 97.1% and gliadin‐specific IgG in 9.3% of the colostrum samples. Gliadin‐specific IgA was detected in mature samples but at significantly lower levels after 1, 2, and 3 months of lactation (p < 0.01) as compared with colostrum. Gliadinspecific IgA was found in 2.8% of the serum samples and gliadin‐specific IgG in 40%; however, the levels of both isotypes were low. CMP‐specific IgA was found in 78.1% of the colostrum samples. It is concluded that IgA antibodies to two common food proteins are frequently found in human milk and that food‐specific IgA present in milk may play a role in adapting the infant's immune reactions to food antigens in the gut.
Low Bone Mineral Content in Summer‐Born Compared with Winter‐Born Infants
Authors: Namgung Ran , Mimouni Francis , Campaigne Barbara N. , Ho Mona L. , Tsang Reginald C.
Published: January 2024

Possible seasonal differences in newborn bone mineral content (BMC) have not been studied. Adult studies show seasonal variations with lower BMC in winter versus summer. Assuming that BMC variations may relate in part to vitamin D status, we hypothesized that newborn BMC would be lower in winter than summer. BMC of one third distal radius was measured in 55 healthy term newborns using a single beam photon absorptiometer [coefficient of variation (CV) for phantom standard 2.1%]. Infants were enrolled during summer (July‐September, 1988) and winter (January‐March, 1989) for a longitudinal nutrition study. Contrary to our hypothesis, there was a 12% lower BMC in summer versus winter (mean ± SD 75.94 ± 17.42 vs. 86.55 ± 17.54 mg/cm, respectively; p = 0.035). The difference remained significant after controlling for possible race and gender effects (p = 0.02). We conclude that BMC is lower in summer‐ compared with winter‐born infants. Since any seasonal effects on fetal bone are presumably related to effects through the mother, we speculate that if maternal vitamin D status influences fetal bone mineralization, the effect (possible sunshine deprivation in winter) may operate especially in early pregnancy, thus resulting in lower BMC, evident at birth in summer.
Liver Involvement in Infants with PiSZ Phenotype of α1‐Antitrypsin Deficiency
Authors: Pittschieler Klaus , Massi Guido
Published: January 2024

Between July 1985 and June 1989, 19,432 new‐borns were screened during the first days of life to determine their Pi (protease inhibitor) phenotype. Fourteen infants were identified to be carriers of the PiSZ phenotype. Their clinical and biochemical follow‐up data were recorded at 2, 5, and 12 months of age; only one case underwent a liver biopsy due to repeated abnormal liver enzymes. Three of 14 PiSZ infants showed some hepatic dysfunction at 2 and 5 months of age, but at 12 months all patients had normal liver function tests. None of them had clinical, biochemical, or morphological signs of neonatal cholestasis. The clinical and biochemical data related to the liver involvement are similar to those of the PiMZ phenotype, though the serum levels of α1‐antitrypsin in PiSZ carriers match those of the PiZZ group.
A Randomized Double‐Blind Clinical Trial of a Maltodextrin‐Containing Oral Rehydration Solution in Acute Infantile Diarrhea
Authors: Santos Ocampo Perla D. , Bravo Lulu C. , Rogacion Jossie M. , Battad Grace R.
Published: January 2024

A double‐blind, randomized controlled study was used to compare the efficacy and safety of an oral rehydration solution either with minimally hydrolyzed maltodextrins or the standard recommended glucose. One hundred twenty pediatric patients with acute watery diarrhea (60 in each group) were studied, but only 116 patients were included in the final analysis. After rehydration, outcome variables did not differ significantly at p < 0.05. Mean duration of diarrhea was 52.5 ± 32.2 h for the control group (median, 50.8 h) and 57.2 ± hours for the study group (median, 45.3 hours). Comparisons of the mean stool output, weight gain, and ORS intake on the 24th h and from admission to discharge were not statistically significant. Differences in laboratory parameters consisting of mean serum sodium, potassium, total C02, hematocrit, plasma total solids, urine specific gravity, and random blood sugar were likewise not significant. Differences in stool pH and reducing sugars were statistically significant; however, the observed values were still within normal range. All laboratory values improved upon rehydration. Replacement of glucose with maltodextrins did not offer added advantages in reducing the duration and severity of diarrhea.
Horizontal Transmission of Hepatitis B Virus in Children
Authors: Hsu Shun‐Chien , Chang Mei‐Hwei , Ni Yen‐Hsuan , Hsu Hong‐Yuan , Lee Chin‐Yun
Published: January 2024

Horizontal transmission of hepatitis B virus (HBV) is responsible for about half of the hepatitis B surface antigen (HBsAg) carriers in Taiwan. To investigate the routes and risk factors of horizontal HBV transmission, 131 HBsAg carrier children of HBsAg seronegative mothers were compared with 98 age‐matched children seronegative for all hepatitis B markers. Possible factors influencing transmission of HBV, including family size, age at attending kindergarten, frequency of intramuscular injection during infancy and at the toddler stage, contact with HBsAg carriers, and HBV status of parents, siblings and caretakers were studied by questionnaire survey. Intramuscular injection frequency during infancy and at the toddler stage and prevalence of HBsAg positivity among siblings were significantly higher in carrier children than in the control group. Other factors studied were not different in these two groups. The results indicated that unsterilized, multiple intramuscular injections and intrafamilial spread among siblings might be the major routes of horizontal HBV transmission in children in Taiwan.
Helicobacter pylori Infection in Children
Authors: Mitchell H. M. , Bohane T. D. , Tobias V. , Bullpitt P. , Daskalopoulos G. , Carrick J. , Mitchell J. D. , Lee A.
Published: January 2024

Children (227) undergoing endoscopy for upper gastrointestinal symptoms were investigated for the presence of Helicobacter pylori infection. The histological response to H. pylori infection and the presence of antral nodularity and peptic ulceration were noted. Symptomatic adults (258) undergoing endoscopy were also investigated for the presence of nodularity. H. pylori infection was detected historically in 32 of 227 (14.1%) children. Of those children infected with H. pylori, half (50%) had antral nodular gastritis. Of 139 H. pylori positive adults 22 (15.8%) showed nodularity. The active component of the histological response was found to be minimal or lacking in the majority of children infected with H. pylori. Twelve of the 227 children (5.3%) had peptic ulcer disease. Of these, nine were duodenal and three gastric ulcers. Of the nine children with duodenal ulceration three (33%) were infected with H. pylori. As a result of this study we conclude that (a) although antral nodularity occurs more frequently in children it is not exclusive to childhood, (b) the polymorphonuclear response in children is less than that reported in adults, and (c) peptic ulcer disease is rare in children and the present study would suggest that in children it is less frequently associated with H. pylori infection than in adults.
Pancreatic Function and Congenital Duodenal Anomalies
Authors: Sarles J. , Guys J. M. , Sauniere J. F.
Published: January 2024

Six children operated on for congenital anomalies of the duodenum were investigated to find out if pancreatic dysfunction was associated with the duodenal malformation, even in the absence of clinical evidence of pancreatic insufficiency. None of the children had diarrhea and none requested nutritional support. Pancreatic function was assessed by enzyme activities (lipase, trypsin, and chymotrypsin) bicarbonate and calcium measurements in pancreatic juice obtained through a nasoduodenal tube under stimulation by secretin and cerulein. Results showed no significant modification in hydro‐electrolytic secretion, but impairment of enzymatic secretion was seen. The physiopathological relationship between duodenal anomalies and pancreatic dysfunction is discussed.
A New Protector Device for Safe Endoscopic Removal of Sharp Gastroesophageal Foreign Bodies in Infants
Authors: Bertoni Giorgio , Pacchione Dario , Sassatelli Romano , Ricci Enrico , Mortilla Maria G. , Gumina Cono
Published: January 2024

The accidental ingestion of sharp foreign bodies into the upper‐gastrointestinal tract is not uncommon in children. Endoscopic extraction of these objects poses technical difficulties, and a number of dangerous complications can occur. We present two cases of successful retrieval of large, sharp gastroesophageal foreign bodies in small children using a new, commercially available endoscopic end protector hood that prevents exposure of the esophageal and pharyngeal wall to injuries and laceration by the foreign body. This device is simple to use, versatile, and effective and advances the safe endoscopic removal of a variety of gastroesophageal foreign bodies in pediatric patients.
Trans Fatty Acid Content of Human Milk in Spain
Authors: Boatella Josep , Rafecas Magda , Codony Rafael , Gibert Anna , Rivero Montserrat , Tormo Ramón , Infante Damaso , Sánchez‐Valverde Fälix
Published: January 2024

The C18 fatty acid fraction of 38 samples of mature human milk from Spanish women was analyzed using capillary gas chromatography. The average content of trans fatty acids found in these samples represented 0.95% of total fatty acids. This value is lower than the percentage found in human milk from other developed countries in which the consumption of hydrogenated fat is higher. Trans fatty acid content in human milk has been related to the types of fats and oils present in the diets of the nursing mothers. According to the results obtained in this survey, we can also conclude that the amount of trans forms in breast milk lipids is lower than the trans content found in infant formulas in Spain.
Vitamin K1 Concentration in Breast‐Fed Neonates After Oral or Intramuscular Administration of a Single Dose of a New Mixed‐Micellar Preparation of Phylloquinone
Authors: Schubiger G. , Tönz O. , Grüter J. , Shearer M. J.
Published: January 2024

The plasma disposition of a new mixedmicellar preparation (KONAKION MM, Roche) of phylloquinone (vitamin K1) has been studied in 25 healthy, fully breast‐fed, newborn babies, randomized to receive a single dose of either 1.5 mg i.m. (11 babies) or 3 mg p.o. (14 babies). Venous blood samples were collected at 25 h, 4 days, and 24 days. After p.o. administration, the median plasma phylloquinone concentration increased to 89 ng/ml after 24 h, then decreased to 51 ng/ml after 4 days; the respective concentrations after i.m. injection were 146 ng/ml and 34 ng/ml. The higher plasma phylloquinone level in the i.m. group after 24 h was not statistically significant compared with that of the p.o. group, but the reversed higher concentration in the p.o. group after 4 days was significant (p < 0.01). After 24 days the median plasma phylloquinone had decreased to 0.44 ng/ml (range 0.19–1.44) and 1.05 ng/ml (range 0.37–1.87) in the p.o. and i.m. groups, respectively. There was a significant difference between these plasma concentrations (p < 0.01). They were within or above the reference adult fasting range (0.17–0.68 ng/ml). The narrow range of plasma concentrations at 24 h and 4 days suggests a greater consistency of absorption from this micellar preparation than from other emulsion‐based preparations. Further studies are required to assess the long‐term protection of a single oral dose against late hemorrhagic disease of the newborn. Until such time, breast‐fed babies given this preparation orally should receive (an) additional dose(s).
Evaluation of Antibodies to Hepatitis C Virus in a Long‐Term Prospective Study of Posttransfusion Hepatitis Among Thalassemic Children
Authors: Lai Maria Eliana , De Virgilis Stefano , Argiolu Francesca , Farci Patrizia , Mazzoleni Anna P. , Lisci Vitalia , Rapicetta Maria , Clemente Maria G. , Nurchis Pierpaolo , Arnone Michele , Balestrieri Angelo , Cao Antonio
Published: January 2024

During an 8‐year prospective study of post‐transfusion hepatitis conducted at the Thalassemic Center of Cagliari (Italy), including 135 newly diagnosed thalassemic children on long‐term transfusion maintenance, 83 children (61%) developed non‐A, non‐B hepatitis (NANBH). Resolution of NANBH was observed in 17 (20%) cases, and chronicity in 57 (69%), whereas the remaining 9 (11%) experienced one or two additional bouts of acute NANBH. Of the 83 children with NANBH, 75 (90%) showed anti‐hepatitis C virus (HCV) seroconversion when tested by second‐generation enzyme‐linked immunosorbent assay (ELISA), whereas first‐generation ELISA showed anti‐HCV in only 59 (71%) cases (p = 0.003). Moreover, the newly developed assay allowed an earlier detection of anti‐HCV response in most of the patients who seroconverted by both assays, reducing significantly the mean onset‐seroconversion interval (5 ± 9.4 weeks vs. 14.5 ± 20.8 weeks, p < 0.05). It was significantly more sensitive for the identification of HCV infection, not only in resolving NANBH, but also in NANBH progressing to chronicity (79 vs. 35%, respectively, p = 0.008; and 93 vs. 79%, p = 0.028). The pattern of antibody response with first‐generation assay was characterized by clearance of anti‐HCV with time, in most of the patients who recovered, and by persistence of anti‐HCV in the majority of those who progressed to chronicity, whereas second‐generation ELISA usually showed persistence of anti‐HCV over time, regardless to the outcome of the disease. The pattern of anti‐HCV observed by first‐generation assay in children who experienced multiple episodes of acute NANBH was generally characterized by clearance of anti‐HCV after recovery, followed by reappearance and rise of the antibody titer concomitant with the new episode of acute hepatitis, whereas second‐generation assay revealed again the persistence of the antibody in most cases. This study shows that HCV is the major cause of NANBH among polytransfused thalassemics. Whether some posttransfusion NANBH without detectable anti‐HCV (10%) may be caused by viruses other than HCV remains to be clarified.
Portal Hypertensive Gastropathy in Children
Authors: Hyams Jeffrey S. , Treem William R.
Published: January 2024

We endeavored to determine the frequency and clinical characteristics of portal hypertensive gastropathy (PHG) in children with cirrhotic and noncirrhotic portal hypertension. Medical records of all patients with portal hypertension undergoing upper GI endoscopy during a 7‐year period were retrospectively reviewed. PHG was defined as absent, mild, or severe by previously established criteria. Twenty‐two patients with portal hypertension (17 cirrhotic, 5 noncirrhotic) were identified. In the group of 17 cirrhotic patients, PHG was noted in four at initial endoscopy (three mild, one severe) and in seven (two mild, five severe) during follow‐up. Severe PHG was seen in one patient with noncirrhotic portal hypertension at presentation; in two patients, mild PHG developed during follow‐up. In the 14 patients in whom PHG was noted, gastric mucosal disease developed in nine in whom no sclerotherapy was performed and in five patients treated with sclerotherapy. The size of varices, history of variceal bleeding, and presence or absence of hypersplenism did not appear to be related to the development of PHG. None of seven patients with mild PHG and two of seven patients with severe PHG bled from their gastric mucosa. We conclude that PHG is commonly observed in children with cirrhotic and noncirrhotic portal hypertension. Mild PHG appears to have little clinical significance, while severe PHG may cause bleeding. PHG may develop with or without sclerotherapy.
Quality‐Protein Maize with a High Fat Content as a Weaning Food
Authors: Graham George G.
Published: January 2024

Few advances would contribute more to the growth and well‐being of infants and children in the developing world than the making available of acceptable staple foods that are easy to grow and process, nutritionally complete enough to serve as the major weaning food, and safe without refrigeration. High‐fat quality‐protein maize (QPM), grown in Mexico, had > 10% of its energy as well‐balanced protein and >15% as fat. When it was fed to six recovering malnourished infants to provide 85–88% of dietary energy, all of 9.8% protein calories, and all of 13.5% fat calories, it was easily consumed and tolerated. In comparison with a fiber‐free, casein‐based diet, fecal wet and dry weights of children consuming two varieties of high‐fat QPM were three to four times greater, and apparent digestibilities of energy were 86 ± 3 and 86 ± 4 versus 97 ± 1%, of carbohydrate 88 ± 3 and 89 ± 5 versus 100%, and of nitrogen (N) 77 ± 4 and 75 ± 4 versus 89 ± 2% of intake. High “biological values,” 43 ± 10 and 46 ± 13 versus 43 ± 10% of absorbed N, led to comparable apparent N retentions: 33 ± 8 and 35 ± 9 versus 38 ± 9% of intake. Results were similar to those from earlier studies with Peruvian QPM with a typical fat content. Fat absorptions from QPMs were nearly complete, equal to those from separated vegetable oils in the casein diet. Breath H2s were suggestive of significant colonic salvage of incompletely digested maize carbohydrates.
Epigastric Impedance Recording for Measuring Gastric Emptying in Children
Authors: Smith Heather L. , Hollins Graham W. , Booth Ian W.
Published: January 2024

Epigastric impedance recording was used to measure gastric half‐emptying time (t1/2) of orange squash in 45 healthy infants and children. The relationship between age, body size, and composition and the impedance increase after gastric filling was investigated, together with the effects on half‐emptying time of adding fat, increasing viscosity, and increasing osmolality in the test meal. The mean t1/2 for orange squash was 13.5 min. The increase in impedance per unit volume ingested showed a significant inverse relationship with age (r = −0.62, p < 0.001), and with various anthropometric variables (r ranged from −0.48 to −0.80, p < 0.01). No relationship was observed between t1/2, and age, sex, body size, or composition. Addition of 1.25% triglyceride or a 600‐fold increase in viscosity of the test meal were both accompanied by a significant lengthening of t1/2 (p = 0.005 and p < 0.001, respectively), but t1/2 did not alter with a fourfold increase in test meal osmolality. The test was well tolerated by all subjects, but its usefulness is limited by susceptibility to movement artefact, and also the necessity to use simple, liquid test meals.
Comparison of Methods for Estimating Fecal Carbohydrate Excretion in Premature Infants
Authors: Kien C. Lawrence , McClead Richard E. , Kepner Jonathan , Grotjohn Karen
Published: January 2024

Our previous studies have suggested that there is minimal fecal excretion of carbohydrate‐derived energy in premature infants fed lactose or glucose‐polymer as the source of carbohydrate. In these studies, carbohydrate energy excretion was equated with the non‐nitrogenous, nonfat energy. Although these studies provided consistent results, this methodological approach cannot distinguish actual excretion of dietary carbohydrate from carbohydrate in the form of large molecular compounds derived from infant or bacterial cells (which in fact comprise 90% of the measured value). Therefore, in this study we compared the absorption of carbohydrate energy to the fractional absorption of 13C derived from [D‐l‐13C]‐lactose in 10 premature infants 30–32 weeks gestational age fed either a commercial premature infant formula containing a mixture of carbohydrates (50% lactose: 50% glucose polymer) or the same formula in which lactose was the sole carbohydrate. The two methods provided comparable estimates of carbohydrate absorption (96 and 94%, respectively), although there were significant discrepancies in two infants. These studies provide evidence of external validity for the two methods
Simple and Rapid Macronutrient Analysis of Human Milk for Individualized Fortification
Authors: Polberger S. , Lönnerdal B.
Published: January 2024

Feeding human milk exclusively to the very‐low‐birth‐weight infant may lead to insufficient intakes of protein and energy. Although the milk is therefore often supplemented with protein and additional calories, there is usually no prior information on its macronutrient composition. If such data were available, it would be possible to individualize the fortification of the milk. To find simple, rapid, and inexpensive methods of enriching it, we evaluated existing macronutrient assays of human milk. Thirty frozen samples of early human milk (3–20 days of lactation) were analyzed for contents of protein (Kjeldahl, Lowry, and Bio‐Rad protein assays), fat (Folch, total lipids assay, and creamatocrit), and carbohydrates (lactose and orcinol assays). The methods were modified to minimize cost and time. From these data, we find it appropriate to recommend the use of the Lowry (or, alternatively, the Bio‐Rad) protein assay, the total lipids assay, and the orcinol carbohydrate assay for reasonably accurate determinations of the protein and energy contents of human milk. Because the variation in the carbohydrate content of human milk is very small, a more simple alternative approach would be to include only an average carbohydrate value for an estimate of energy content. These low‐cost methods can be used in all laboratories affiliated to neonatal units taking care of preterm infants. Such individualized fortification should serve to further improve the nutritional management of very‐low‐birth‐weight infants.
Influence of Breast‐Feeding on the Infant's Intellectual Development
Authors: Temboury M. C. , Otero A. , Polanco I. , Arribas E.
Published: January 2024

The objective of this study was to analyze the effects of breast‐feeding on the intellectual development of the infant, controlling for possible confounding factors. A prospective study of cohorts was carried out in a group of 229 healthy infants, studied from birth to 2 years of age. The infants were divided into two groups: group 1,99 infants who were bottle‐fed; and group 0, 130 who were breast‐fed. All other characteristics in both groups were similar. Psychomotor development was measured between 18 and 29 months using the Bayley scales. Lower results on the Index of Mental Development were associated with bottle‐fed infants, lower‐middle and lower social class, elementary education of the mother, temper tantrums, and having siblings. Lower results on the Index of Motor Development were associated only with lower and lower‐middle social class.
Serum Concentrations of Albumin, C‐Reactive Protein, α2‐Macroglobulin, Prealbumin, Fibronectin, Fibrinogen, Transferrin, and Retinol Binding Protein in 55 Patients with Hepatic Glycogen Storage Diseases
Authors: Labrune Ph. , Benattar C. , Ammoury N. , Chalas J. , Lindenbaum A. , Odièvre M.
Published: January 2024

Hepatic glycogen storage diseases are hereditary metabolic disorders involving the metabolism of glycogen. This study was designed to investigate the serum protein status in such diseases. Fifty‐five patients with glycogen storage disease types I, III, VI, and IX, whose ages ranged from 1 month to 27 years, were included in this work. C‐reactive protein, fibrinogen, α2‐macroglobulin, albumin, transferrin, fibronectin, retinol binding protein, and prealbumin serum concentrations were measured in each patient. In patients affected with type I glycogen storage disease, serum concentrations of α2‐macroglobulin, fibrinogen, C‐reactive protein, and transferrin were significantly increased. In patients with types III, VI, and IX glycogen storage diseases, the concentration of α2‐macroglobulin was the only one that was significantly increased. Thus, even though this study raises more questions than it answers, it seems likely that the hepatic synthesis of some proteins may be increased in patients affected by hepatic glycogen storage diseases. This may indicate some degree of mild hepatic dysfunction in such metabolic disorders. However, further investigations are required to elucidate the discrepancies observed among the different types of diseases.
Differential Diagnosis of Extrahepatic Biliary Atresia from Neonatal Hepatitis
Authors: Lai Ming‐Wei , Chang Mei‐Hwei , Hsu Shun‐Chien , Hsu Hey‐Chi , Su Cheng‐Tau , Kao Chuan‐Lian , Lee Chin‐Yun
Published: January 2024

SummaryThe clinical presentations of cholestasis in infancy caused by neonatal hepatitis and biliary atresia are very similar. Diagnosis may be difficult on many occasions, but the surgical treatment of biliary atresia should be performed as early as possible. We established a 3‐day workup protocol for the differential diagnosis of biliary atresia and neonatal hepatitis and compared the diagnostic accuracy, sensitivity, specificity, and predictive values of various methods. One hundred and twenty‐six infants, including 84 with neonatal hepatitis (age, 65.1 ± 24.1 days) and 42 with biliary atresia (age, 60.3 ± 31.1 days), were studied prospectively from July 1982 to December 1990. The diagnostic accuracy of various methods was as follows: liver histology, 96.8%; color of duodenal juice, 91.6%; peak radioisotope count in duodenal juice, 84.2%; ultrasonographic examination of the hepatobiliary system, 80.2%; and persistence of clay‐colored stool, 80.2%. After stepwise logistic regression, the diagnostic methods of significance were liver biopsy, color of duodenal juice, abdominal ultrasonography, and stool color. However, stool color and the onset of jaundice could not differentiate severe neonatal hepatitis from biliary atresia. The diagnostic methods of significance then were liver biopsy and duodenal juice color. With this 3‐day protocol, no biliary atresia was missed although four cases of neonatal hepatitis were misdiagnosed, resulting in unnecessary laparotomy; we found an overall diagnostic accuracy of 96.8%. We conclude that this 3‐day diagnostic protocol is very helpful in the differential diagnosis of neonatal hepatitis and biliary atresia. Liver histologic examination is the most reliable single test for the differential diagnosis.
Antenatal Diagnosis of Choledochal Cyst
Authors: Bancroft John D. , Bucuvalas John C. , Ryckman Frederick C. , Dudgeon David L. , Saunders Roger C. , Schwarz Kathleen B.
Published: January 2024

SummaryWe report five infants in whom antenatal diagnosis of choledochal cyst was established by ultrasonography, and we review the seven previously reported cases. All but one infant had cystic dilatation of the common bile duct (type 1 cysts), and all infants were diagnosed during the second or third trimester. Eight of 12 infants (67%) developed jaundice in the first few days of life, but only 25% had a palpable abdominal mass. Seven of nine infants (78%) demonstrated complete obstruction of the distal common bile duct on intraoperative cholangiography. Liver histology was available for six patients. Five of six had cirrhosis or fibrosis with bile duct proliferation. All of the infants with fibrosis or cirrhosis had distal common bile duct obstruction. Despite liver biopsy findings of extensive fibrosis plus ascites with failure to thrive in one of our patients, all five patients demonstrated clinical and biochemical improvement following surgical excision and porto‐ or choledochoenterostomy. All were free of symptoms by 6 months of age. Congenital choledochal cyst should be considered in the differential diagnosis of any sonolucent abdominal mass of the fetus. Neonates with distal common bile duct obstruction and fibrosis in association with presumed choledochal cyst should have prompt surgical exploration, intraoperative cholangiography, and close postoperative follow‐up. The long‐term outcome with prompt surgical correction is excellent.
Detection of Gastroesophageal Reflux by Electrical Impedance Tomography
Authors: Ravelli Alberto M. , Milla Peter J.
Published: January 2024

SummaryIn children with vomiting, dyspepsia, and feeding problems, gastroesophageal reflux (GOR) and altered gastric emptying are common. We have used electrical impedance tomography (EIT) to study children with suspected gastric emplying disorders. Abnormalities of the gastric emptying curve suggestive of GOR were seen in some, with marked negative or positive shifts related to sharp increases or decreases in intragastric resistance. These findings could represent fluid leaving or entering the stomach, as might occur in GOR. To confirm the origin of the abnormal EIT curves, we devised and in vitro tank test system, and we performed simultaneous 2‐h EIT and intraoesophageal pH monitoring after a glucose meal on six patients. In vitro, reflux of ±25 ml produced clearly detectable changes on the emptying curves. In vivo, the overall correlation between the times of 42 GOR episodes lasting ±1 min detected by pH study and the times of 38 negative peaks due to ±15% changes of the maximum intragastric resistivity detected by simultaneous EIT was significant; the correlation was highly significant in four of six patients. When the peaks were used to define GOR episodes on EIT gastric emptying curves, the two methods still showed good agreement. Retrospective examination of 50 patients who had undergone both EIT and 24‐h intraoesophageal pH study during their diagnostic workup showed that EIT had a sensitivity of 94.6% and a specificity of 76.9% (with positive and negative predictive values of 0.92 and 0.83, respectively) for the detection of pathological GOR. We have shown, for the first time that EIT not only allows gastric emptying to be measured but can also detect GOR. Therefore, EIT can be used as a noninvasive screening test in patients with vomiting, dyspepsia, and feeding problems.