bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional Fat Distribution in Children Born Preterm Evaluated at School Age
Authors: Giannì Maria L , Mora Stefano , Roggero Paola , Amato Orsola , Piemontese Pasquina , Orsi Anna , Vegni Chiara , Puricelli Valeria , Mosca Fabio 
Published: March 2009

ABSTRACTChildren born preterm may have aberrant adiposity. At school age, we evaluated body fat and fat distribution in 45 former preterm infants (birth weight ≤1800 g and gestational age <34 weeks) and 40 children born at term using dual‐energy x‐ray absorptiometry. Children born preterm exhibited lower total body fat mass and total body fat mass index compared with children born at term. Fat mass indexes in the limbs but not the trunk were lower in children born preterm than in children born at term. In conclusion, children born preterm, evaluated at school age, may be at risk for altered regional adiposity.
Seasonal Variation in the Presentation of Abdominal Pain
Authors: Saps M , Blank C , Khan S , Seshadri R , Marshall BM , Bass LM , Di Lorenzo C 
Published: March 2009

ABSTRACTBackground:Anxiety and depression, conditions frequently associated with childhood chronic abdominal pain (AP), are characterized by seasonal exacerbations. A seasonal pattern characterized by a higher frequency of consultations for AP during winter has been suspected but has never, to our knowledge, been demonstrated. We hypothesize the presence of a seasonal variation in AP consultations with a winter predominance.Aims:To determine the seasonal distribution of AP consultations among centers across time and geographic latitude.Patients and Methods:This was a retrospective cohort study. The number of outpatient consultations from primary care clinics and every pediatric specialty clinic that resulted in a diagnosis of AP and the total number of outpatient consultations (2001–2004) from 6 tertiary care institutions (Chicago, Pittsburgh, Wilmington, Pensacola, Orlando, Jacksonville) was determined. Rates of consultations were compared across time and between cities. Four time periods of interest, with 2‐ and 3‐month definitions, were arbitrarily selected. Seasonal rates across time were compared separately for each of the 2‐month (January–February vs June–July) and 3‐month periods (January–March vs June–August). Logistic regression models for each city were used to determine variations in the rate of outpatient AP cases by season or by year.Results:A total of 3,929,522 outpatient consultations and 73,591 AP consultations were analyzed. The rates of AP consultations were consistently higher in the winter months at all of the sites. The results differed between sites at northern and southern latitudes.Conclusions:There seems to be a seasonal variation in consultation patterns for AP at the tertiary care level. A possible role of daylight hours, climate, latitude, and stress is proposed.
Design of Predictive Models for Positive Outcomes of Upper and Lower Gastrointestinal Endoscopies in Children and Adolescents
Authors: Noble Angela J , Drouin Eric , Tamblyn Robyn 
Published: March 2009

ABSTRACTObjectives:To develop models to accurately determine the outcomes of diagnostic endoscopies performed in children and adolescents without known gastrointestinal disease.Materials and Methods:Retrospective chart review of all endoscopies performed in children 2 to 18 years of age without known gastrointestinal disease from January 1 to December 31, 2000. The association between age, presenting symptoms, physical examination findings, laboratory investigations, and endoscopy outcomes was assessed. Predictive models for positive outcomes on endoscopy were estimated for upper and lower endoscopies separately by use of multiple logistic regression. Receiver operating curves were constructed to evaluate the performance of the models. A model with a sensitivity of 95% and specificity of 40% was considered clinically significant.Results:Positive findings on endoscopy were found in 191 (55%) of 346 and in 120 (59%) of 204 upper and lower endoscopies, respectively. Age above 13 years, vomiting, and hypoalbuminemia were significant predictors of positive upper endoscopies. Rectal bleeding, hypoalbuminemia, and elevated erythrocyte sedimentation rate were significant predictors of positive lower endoscopies. Extrapolating from the receiver operating curves, a sensitivity of 95% corresponded to a specificity of 10% for the upper endoscopy model and 30% for the lower endoscopy model.Conclusions:In our population of children and adolescents, several clinical characteristics were predictive of positive upper and lower endoscopy outcomes. Predictive models composed of these clinical variables were statistically, but not clinically, significant. The inclusion of additional clinical characteristics that could be assessed in prospective studies will likely improve the clinical significance of endoscopy outcome prediction.
20 Years of Scientific Training of Dutch Medical Students in an American Academic Division for Pediatric Gastroenterology and Nutrition: Impact on Career Development
Authors: Rings Edmond HHM , Escher Johanna C , Büller Hans A , Heymans Hugo SA 
Published: March 2009

ABSTRACTObjectives:To evaluate the impact on career development of a program for scientific training of Dutch medical students in an American academic division for pediatric gastroenterology and nutrition.Materials and Methods:A survey was undertaken of medical students who were trained in the division of pediatric gastroenterology and nutrition at Tufts University and later at Children's Hospital, Harvard Medical School, Boston, MA. Characteristics of the students, the training period, the scientific output, and their career development were evaluated.Results:A questionnaire was sent to 54 students, of which 39 (72%) responded. The mean time of their rotation was 12.2 ± 12.1 months. Twenty‐five students published 33 scientific manuscripts. Fifteen students obtained a doctorate degree and 4 are involved in a doctorate program. Six theses were directly related to the scientific content of the rotation and were performed under the supervision of American mentors. A total of 59% of the students hold a position as medical specialist, which is a substantially higher percentage than the national average of all graduated medical doctors. Thirty‐five percent of them practice pediatrics (of whom 38% practice pediatric gastroenterology) and 22% practice gastroenterology. Seventy‐eight percent of the medical specialists hold an academic position.Conclusions:Dutch medical students who are scientifically trained in a US academic division for pediatric gastroenterology and nutrition—where specialists approached all of the students with a special program to involve them in biomedical research—have a great chance to establish a scientific career track and to become a medical specialist.
Validation of a Nutrition Risk Screening Tool for Children and Adolescents With Cystic Fibrosis Ages 2–20 Years
Authors: McDonald Catherine M 
Published: March 2009

ABSTRACTObjectives:According to the 2002 Cystic Fibrosis (CF) Foundation nutrition consensus report, children with CF should grow normally. Cross‐sectional data from the foundation's patient registry concluded that a body mass index at or greater than the 50th percentile is associated with better lung function. A consistent, evidence‐based screening process can identify those individuals with CF having nutrition risk factors associated with a decrease in pulmonary function, target early intervention, and prevent further decline. A tool for screening nutrition risk is described to identify those children with CF who would benefit from more extensive nutrition intervention.Methods:The proposed screening tool is a risk‐based classification system with 3 categories: weight gain, height velocity, and body mass index. The CF Foundation recommendations regarding these parameters are incorporated, with risk points assigned when minimum body mass index, weight gain, and/or height gain standards are unmet.Results:An interrater measure of agreement determined a satisfactory level of reliability (κ = 0.85). Patient records (n = 85) were reviewed to determine nutrition status category (no risk or at risk) of this tool compared with the CF Foundation 2002 Nutrition Consensus, yielding sensitivity and specificity at 84% and 75%, respectively. A second comparison was made with combined, independent nutrition risk factors not included in the screening tool. The sensitivity and specificity of the screening tool compared with the combined risk factors were 86% and 78%, respectively.Conclusions:This tool for screening nutrition risk for CF is reliable and valid, with consistent, reproducible results, free from subject or observer bias.
Can Optimal Combinations of Local Foods Achieve the Nutrient Density of the F100 Catch‐up Diet for Severe Malnutrition?
Authors: Ferguson Elaine L , Briend André , Darmon Nicole 
Published: March 2009

ABSTRACTObjectives:F100 is a fortified milk‐based food used as a standard therapy for severe malnutrition. Our aim was to assess whether optimal combinations of local foods in Ghana, Bangladesh, and Latin America could achieve the nutrient density levels of F100 and, if that was unachievable, to identify the key limiting nutrients.Materials and Methods:In all of the analyses, a published list of population‐specific foods (n = 59) and maximum food portions were used. The nutrient densities of individual foods were calculated to identify nutrient‐dense foods and potential limiting nutrients. The feasibility of formulating diets that achieved the nutrient density of F100, for each region individually and for all regions combined, was explored by the use of linear programming analysis (4 models), which minimized the total grams of food while respecting model constraints on diet energy and nutrients, phytate:zinc molar ratio, and maximum food portion sizes.Results:For vitamin E, riboflavin, zinc, and copper, fewer than 5 foods achieved the nutrient density of F100. All 4 linear programming model solutions were unfeasible, indicating that in all regions, community‐based home‐prepared rehabilitation diets for severely malnourished children will not achieve the nutrient densities of F100. In model solutions, the densities of vitamin E, riboflavin, zinc, copper, calcium, thiamin, and niacin were unachievable, indicating they are potential key problem nutrients.Conclusions:Optimal combinations of local foods are unlikely to achieve the nutrient density of F100, especially for vitamin E, riboflavin, thiamin, niacin, zinc, calcium, and copper. Before home‐prepared rehabilitation diets with nutrient densities lower than those of F100 are promoted, it is important to establish their clinical efficacy.
Sex, Psychosocial Factors, and Reported Symptoms Influence Referral for Esophagogastroduodenoscopy and Biopsy Results in Children With Chronic Abdominal Pain
Authors: Puzanovova Martina , Rudzinski Erin , Shirkey Kezia C , Cherry Rebecca , Acra Sari , Walker Lynn S 
Published: March 2009

ABSTRACTObjectives:To identify symptoms and psychosocial factors that predicted referral for esophagogastroduodenoscopy (EGD) and discriminated between patients with positive versus negative biopsy findings.Patients and Methods:Children age 8 to 16 years old and parents completed validated questionnaires assessing gastrointestinal symptoms and psychosocial characteristics. Biopsy results of esophagus, stomach, and duodenum were reviewed.Results:From the total sample of 461 patients (mean age 11.87 years, 62% girls), 127 (28%) underwent EGD with biopsy (mean age 12.1 years, 57% girls). Upper abdominal gastrointestinal symptoms predicted EGD referral, and psychosocial characteristics did not. From the total of 127 patients who underwent EGD, complete biopsy results were available for 124 patients and were negative at all sites for 34.7% of patients (n = 43), equivocal for 20.2% (n = 25), and positive at 1 or more sites for 45.2% (n = 56). Boys were more likely than girls to have positive biopsy results (56.6% vs 36.6%, P < 0.03) because of the higher rate of positive esophageal biopsy results (47.2% vs 26.8%, P < 0.04). Among boys, vomiting (P < 0.02) and family stress (P < 0.04) predicted positive esophageal biopsy findings. Among girls, depressive symptoms predicted positive biopsy findings (P = 0.015).Conclusions:Upper abdominal symptoms, sex, stress, and depressive symptoms predict positive EGD biopsy findings in patients with chronic abdominal pain. Research on mechanisms linking these factors to mucosal damage in the gut is warranted.
Crypt Fission Peaks Early During Infancy and Crypt Hyperplasia Broadly Peaks During Infancy and Childhood in the Small Intestine of Humans
Authors: Cummins Adrian G , Catto‐Smith Anthony G , Cameron Donald J , Couper Richard T , Davidson Geoffrey P , Day Andrew S , Hammond Paul D , Moore David J , Thompson Fiona M 
Published: March 2009

ABSTRACTBackground:Postnatal growth of the small intestine occurs by crypt hyperplasia and by the less recognised mechanism of crypt fission. How the small intestine grows is largely extrapolated from animals and is poorly described in humans.Aim:To investigate crypt fission and crypt hyperplasia as mechanisms of intestinal growth in humans.Patients and Methods:Proximal intestinal samples were taken from 3 neonates at surgical anastomosis, and duodenal biopsies were taken at endoscopy from 16 infants (mean age 0.7, range 0.3–1.7 years), 14 children (mean age 7.9, range 2.4–16.2 years), and 39 adults. Morphometric measures of villous area, crypt length (measure of crypt hyperplasia), and percentage of bifid crypts (measure of crypt fission) were assessed by a microdissection technique.Results:Mean crypt fission rates in neonates, infants, children, and adults were 7.8%, 15%, 4.9%, and 1.7%, respectively. In particular, crypt fission peaked at 18% in 5 infants from 6 to 12 months of age. Mean crypt length was 123 μm in neonates, 287 μm in infants, 277 μm in children, and 209 μm in adults. Thus, crypt hyperplasia had a broad peak during infancy and childhood.Conclusions:We conclude that crypt fission was present predominantly during infancy, and crypt hyperplasia occurred during both infancy and childhood.
Association of Raised Liver Transaminases With Physical Inactivity, Increased Waist–Hip Ratio, and Other Metabolic Morbidities in Severely Obese Children
Authors: Lee Yung Seng , Kek Betty Lay Kee , Poh Larry Kok Seng , Saw Seang Mei , Loke Kah Yin 
Published: March 2009

ABSTRACTObjective:To identify factors associated with raised alanine transaminase, aspartate transaminase, and γ‐glutaryl transferase in severely obese childrenPatients and Methods:In all, 201 children with early‐onset obesity and greater than 140% ideal weight for height were recruited. Anthropometric and body fat measurements, fasting blood tests, and oral glucose tolerance tests were performed.Results:The mean and standard deviation (SD) for age was 11.1 (3.0) years, for weight for height 170.5% (22.7%), and for percentage body fat was 40.7% (5.2%). Elevated liver transaminases were present in 53 subjects (26.4%), who were therefore at risk for nonalcoholic fatty liver disease, and was associated with male sex (odds ratio [OR] 2.144, 95% confidence interval [CI] 1.033–4.448), Chinese ethnicity (OR 2.062, 95% CI 1.038–4.096), reduced physical activity (OR 2.389, 95% CI 1.163–4.909), insulin resistance (P < 0.05), elevated triglyceride levels (P = 0.029), and increased waist–hip ratio (P = 0.005). Stepwise logistic regression analysis of the main factors as covariates revealed Chinese ethnicity, waist–hip ratio, reduced physical activity, and homeostasis model assessment index were significant predictors. Alanine transaminase/aspartate transaminase were not well correlated with percentage body fat and weight for height. Subjects with type 2 diabetes mellitus and impaired glucose tolerance were more likely to have raised hepatic transaminases (OR 6.176, 95% CI 1.326–28.754). The severity of metabolic syndrome correlated with increasing aspartate transaminase, alanine transaminase, and γ‐glutaryl transferase (P < 0.01).Conclusions:Insulin resistance, truncal adiposity, and physical inactivity are major determinants potentially modifiable to reduce risk of nonalcoholic fatty liver disease. Increasing physical activity levels were associated with decreasing insulin resistance and transaminases, despite lack of correlation with waist–hip ratio, which supports the direct benefit of regular physical activity in preventing nonalcoholic fatty liver disease.
Biliary Atresia: Swiss National Study, 1994–2004
Authors: Wildhaber Barbara E , Majno Pietro , Mayr Johannes , Zachariou Zacharias , Hohlfeld Judith , Schwoebel Marcus , Kistler Walter , Meuli Martin , Le Coultre Claude , Mentha Gilles , Belli Dominique , Chardot Christophe 
Published: March 2009

ABSTRACTObjectives:To determine the epidemiology of biliary atresia (BA) in Switzerland, the outcome of the children from diagnosis, and the prognostic factors.Patients and Methods:The records of all patients with BA born in Switzerland between January 1994 and December 2004 were analyzed. Survival rates were calculated with the Kaplan‐Meier method, and prognostic factors evaluated with the log rank test. Median follow up was 58 months (range, 5–124).Results:BA was diagnosed in 48 children. Incidence was 1 in 17,800 live births (95% confidence interval 1/13,900–1/24,800), without significant regional, annual, or seasonal variation. Forty‐three children underwent a Kasai portoenterostomy (PE) in 5 different Swiss pediatric surgery units. Median age at Kasai PE was 68 days (range, 30–126). Four‐year survival with native liver after Kasai PE was 37.4%. Liver transplantation (LT) was needed in 31 in 48 children with BA, including 5 patients without previous Kasai PE. Four patients (8%, all born before 2001) died while waiting for LT, and 29 LT were performed in 27 patients (28 in Geneva and 1 in Paris). All of the transplanted patients are alive. Four‐year overall BA patient survival was 91.7%. Four‐year survival with native liver was 75% in patients who underwent Kasai PE before 46 days, 33% in patients operated on between 46 and 75 days, and 11% in patients operated on after 75 days (P = 0.02).Conclusions:Overall survival of patients with BA in Switzerland compares favorably with current international standards, whereas results of the Kasai operation could be improved to reduce the need for LTs in infancy and early childhood.
Intestinal Metabolism and Transport of Drugs in Children: The Effects of Age and Disease
Authors: Johnson Trevor N , Thomson Mike 
Published: March 2009

ABSTRACTThe presence of cytochrome P450 enzymes in the small bowel results in the reduced bioavailability of several drugs. Recently, there has been much research on the interplay between these enzymes and transporter proteins such as P‐glycoprotein. Intestinal drug metabolism not only has an effect on drug disposition but also may have a role in protecting the host from xenobiotics. Although there is some information on how both the enzymes and transporters develop in the small bowel with age, there is little information regarding the clinical effects of these changes. In addition to developmental changes, the influence of gastrointestinal disease and nutrition are additional covariates in the intestinal metabolism of drugs.
Long‐term Treatment of Primary Sclerosing Cholangitis in Children With Oral Vancomycin: An Immunomodulating Antibiotic
Authors: Davies Yinka K , Cox Kathleen M , Abdullah Bisher A , Safta Anca , Terry Annie B , Cox Kenneth L 
Published: March 2009

ABSTRACTBackground:Primary sclerosing cholangitis is a rare chronic cholestatic condition of unknown etiology, frequently associated with inflammatory bowel disease and characterized by diffuse fibrosing and inflammatory destruction of the intra‐ and/or extrahepatic biliary duct system.Patients and Methods:The study involved 14 children with primary sclerosing cholangitis confirmed by either liver biopsy, endoscopic retrograde cholangiopancreatography, and/or magnetic resonance cholangiogram. In each of the 14 cases, liver histology showed characteristic features consistent with primary sclerosing cholangitis. Eleven children had intrahepatic biliary beading and strictures (6 by endoscopic retrograde cholangiopancreatography; 5 by magnetic resonance cholangiogram). Biochemical tests of liver function including alanine aminotransferase, aspartate aminotransferase, and γ‐glutamyl transpeptidase and the erythrocyte sedimentation rate were elevated for a mean 17 ± 22 months before vancomycin treatment was initiated. All of the patients were shown to have inflammatory bowel disease histologically; 13 of those patients had clinical evidence of colitis. Oral vancomycin was given to all 14 patients.Results:All 14 patients showed improvement in their alanine aminotransferase (P = 0.007), γ‐glutamyl transpeptidase (P = 0.005), erythrocyte sedimentation rate (P = 0.008), and clinical symptoms with oral vancomycin treatment. There was less improvement noted in the patients with cirrhosis when compared with the patients without cirrhosis.Conclusions:Before this study, there has not been an effective long‐term treatment for sclerosing cholangitis to prevent the usual progression of this disease to cirrhosis. This study showed that oral vancomycin could be an effective long‐term treatment of sclerosing cholangitis in children, especially those without cirrhosis.
Celiac Disease
Authors: Polanco Isabel 
Published: March 2009

ABSTRACTCeliac disease is an immunologically mediated enteropathy of the small intestine, characterized by lifelong intolerance to the gliadin and related prolamines from wheat and other cereals, that occurs in genetically predisposed individuals. Symptoms result from structural damage to the mucosa of the small intestine, which may cause malabsorption with positive autoantibodies in the sera. Normal mucosal architecture is restored after the use of a gluten‐free diet and the normalization of the autoantibodies. Villous atrophy and high levels of autoantibodies reappear when gluten is reintroduced into the diet (gluten challenge).
Digestive, Hepatic, and Nutritional Manifestations in Latin American Children With HIV/AIDS
Authors: Velasco‐Benítez Carlos Alberto 
Published: March 2009

ABSTRACTThe HIV/AIDS infection is increasing in Latin America and the Caribbean regions, according to the World Health Organization (WHO). In Latin America, most cases are in Brasil, Mexico, and Colombia. Some causes of the HIV/AIDS infection in Latin America are poverty, limitations on the access to antiretroviral drugs, poor response from governmental and health authorities, migration, and scantiness of research resources. In the pediatric population, perinatal transmission is the main contact mechanism. Several digestive, hepatic, and nutritional manifestations allow the classification of HIV infection in children, according to the Centers for Disease Control and Prevention. Improvement in knowledge of the epidemiology, pathogenesis, physiopathology; and management of HIV enteropathy and on nutritional care practices of infected HIV children is recommended.