bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Long‐term Effect of Early Mineral, Vitamin D, and Breast Milk Intake on Bone Mineral Status in 9‐ to 11‐Year‐Old Children Born Prematurely
Authors: Backström Maria Christina , Mäki Ritva , Kuusela Anna‐Leena , Sievänen Harri , Koivisto Anna‐Maija , Koskinen Matti , Ikonen R. Sami , Mäki Markku 
Published: February 2024

ABSTRACTBackground:Although the short‐term benefits of mineral supplementation in preterm infants has been established, the long‐term benefits are less clear. The purpose of the study was to evaluate effects of early‐life mineral, vitamin D, and breast milk intake on bone mineral status in children 9 to 11 years of age who were born prematurely.Methods:Seventy preterm infants born 1985 through 1987 were randomized into four groups: to receive a vitamin D dose of 500 or 1000 IU/day and calcium‐ and phosphorus‐supplemented or unsupplemented breast milk. At 3 months of age, radial bone mineral content was determined by single‐photon absorptiometry and vitamin D metabolites were assessed. At 9 to 11 years of age, the bone mineral status of the radius and lumbar spine was assessed using dual energy x‐ray absorptiometry.Results:At the age of 3 months, the preterm infants with diets supplemented with minerals had 36% higher bone mineral content than the preterm infants whose diet was not supplemented with minerals. At the age of 9 to 11 years, in contrast, bone mineral status was comparable among the groups, irrespective of different mineral supplementation during the neonatal period. Interestingly, the lumbar bone mineral apparent density was positively related to lactation in mineral‐supplemented children. There was neither short‐term nor long‐term benefit to bone mineral status of a vitamin D dose of 1000 IU/day compared with 500 IU/day.Conclusions:The short‐term benefit to bone mineral density in preterm infants of mineral supplementation of the early diet is obvious, but, in the long term, the effects seem to disappear. The results also imply that a relatively long period of breast‐feeding may be needed to optimize long‐term bone mineral acquisition in the lumbar spine.
Development of a Quality‐of‐Life Index for Pediatric Inflammatory Bowel Disease: Dealing with Differences Related to Age and IBD Type
Authors: Griffiths Anne M. , Nicholas David , Smith Claire , Munk Marla , Stephens Derek , Durno Carol , Sherman Philip M. 
Published: February 2024

ABSTRACTBackground:A child‐ and adolescent‐generated IBD quality‐of‐life index was designed to be descriptive (to be used to assess the overall impact of IBD on individual patients), and evaluative (to be used as an outcome measure in clinical trials).Methods:Item‐generation and item‐reduction interviews with 82 patients with IBD aged 8 to 17 years (61 with Crohn's disease, 21 with ulcerative colitis; 36 girls, 45 boys) generated a list of ways in which their lives were affected by IBD. These issues were incorporated into an item‐reduction questionnaire, which was administered to 117 patients (87 Crohn's disease, 30 ulcerative colitis). Patients indicated on a visual analog scale how important an item was to them and how often it bothered them. Mean and median importance‐plus‐frequency scores for each issue were calculated for the entire group and among patients in subgroups according to age and IBD type.Results:Ulcerative colitis and Crohn's disease affect the lives of children and adolescents differently. Bowel symptoms are more troubling and disabling to patients with ulcerative colitis, whereas systemic symptoms and body image concerns are greater for patients with Crohn's disease. The impact of Crohn's disease on ability to function in school and leisure activities is greater. Worries about future health problems and about the effects of IBD on the family are shared. Crohn's disease and ulcerative colitis trigger emotional responses of unfairness and frustration, but anger and embarrassment are more prevalent in ulcerative colitis. Disparities between age groups are fewer and less marked than those between types of IBD.Conclusion:In selection of items to be retained in a pediatric IBD quality‐of‐life measure, the variation in concerns with disease type must be considered. A single index to assess IBD‐related quality of life must include items of major importance to one subgroup of patients, even if not important to all. Alternately, a core of common concerns could be supplemented by disease‐specific modules, thereby increasing the content validity of the tool for all patients.
Lactobacillus GG Administered in Oral Rehydration Solution to Children with Acute Diarrhea: A Multicenter European Trial
Authors: Guandalini Stefano , Pensabene Licia , Zikri Mona Abu , Dias Jorge Amil , Casali Luigi Gobio , Hoekstra Hans , Kolacek Sanja , Massar Karin , Micetic–Turk Dusanka , Papadopoulou Alexandra , de Sousa Jaime Salazar , Sandhu Bhupinder , Szajewska Hanna , Weizman Zvi 
Published: February 2024

ABSTRACTBackground:The probiotic Lactobacillus GG is effective in promoting a more rapid recovery of acute, watery diarrhea in children with rotavirus enteritis. Very limited information is available, however, on the potential role of such agents in nonrotaviral diarrheal episodes. Furthermore, no evidence is available concerning the efficacy of Lactobacillus GG administered in the oral rehydration solution during oral rehydration therapy. A multicenter trial was conducted to evaluate the efficacy of Lactobacillus GG administered in the oral rehydration solution to patients with acute‐onset diarrhea of all causes.Methods:Children 1 month to 3 years of age with acute‐onset diarrhea were enrolled in a double‐blind, placebo‐controlled investigation. Patients were randomly allocated to group A, receiving oral rehydration solution plus placebo, or group B, receiving the same preparation but with a live preparation of Lactobacillus GG (at least 1010 CFU/250 ml). After rehydration in the first 4 to 6 hours, patients were offered their usual feedings plus free access to the same solution until diarrhea stopped.Results:One hundred forty children were enrolled in group A, and 147 in group B. There were no differences at admission between the groups in age, sex, previous types of feeding, previous duration of diarrhea, use of antibiotics, weight, height, weight–height percentile, prevalence of fever, overall status, degree of dehydration, and percentage of in‐versus outpatients. Duration of diarrhea after enrollment was 71.9 ± 35.8 hours in group A versus 58.3 ± 27.6 hours in group B (mean ± SD;P = 0.03). In rotavirus‐positive children, diarrhea lasted 76.6 ± 41.6 hours in group A versus 56.2 ± 16.9 hours in groups B (P < 0.008). Diarrhea lasted longer than 7 days in 10.7% of group A versus 2.7% of group B patients (P < 0.01). Hospital stays were significantly shorter in group B than in group A.Conclusions:Administering oral rehydration solution containing Lactobacillus GG to children with acute diarrhea is safe and results in shorter duration of diarrhea, less chance of a protracted course, and faster discharge from the hospital.
Eosinophilic Gastroenteritis
Authors: Kelly Kevin J. , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTThe goal to create a standardized diagnostic classification scheme of food‐related gastrointestinal hypersensitivity disease syndromes included the diagnosis of eosinophilic gastroenteritis. This article reviews the history of this diagnosis and the current concepts of this complex disorder. The common symptoms from the literature are discussed. Because no standards for this diagnosis exist, the wide variety of diagnostic criteria from the literature are presented. No consistent immunologic abnormalities have been associated with the diagnosis of eosinophilic gastroenteritis in the literature. A review of the current immunologic concepts associated with the diagnosis of eosinophilic gastroenteritis is presented. The history of this disorder, which spans more than 6 decades is also discussed. The contributions made by the original authors during this period are presented. Attention was directed to the variety of clinical features associated with this disorder, but particular attention was paid to the evolution of the pathophysiologic mechanisms proposed. Some of the difficulties associated with the prospective study of patients with eosinophilic gastroenteritis are also discussed. The establishment of appropriate control populations, as well as the fundamental difficulties encountered with the establishment of the certainty of the link between abnormal immunohistochemical findings, and initial clinical symptoms are presented and discussed. A new classification system is proposed for food‐related gastrointestinal hypersensitivity disease syndromes. Age, symptoms, and the region of the gastrointestinal tract involved were the variables that were considered most important by consensus opinion. Finally, recommendations to refocus our collective investigative efforts are presented.
Food‐Induced Eosinophilic Proctocolitis
Authors: Lake Alan M. , Simpson Hugh A. , Anderson John A. 
Published: February 2024

ABSTRACTFood‐induced eosinophilic proctocolitis appears in the first 2 months of life with blood‐tinged stools. Aside from occasional apparent pain on defecation and a few infants with moderate eczema, systemic features are absent. Indeed, aside from the diaper, the infant is generally described as well. Thus, in contrast to the infant with enterocolitis, features such as emesis, failure to thrive, significant anemia, and dramatic diarrhea are not seen. In contrast to infants with the other food‐induced inflammatory diseases of the bowel, most symptomatic infants are exclusively breast fed. Proctoscopic examination reveals focal erythema, erosions, and/or the nodularity of lymphoid nodular hyperplasia of the rectosigmoid. Biopsies of the rectum and lower sigmoid reveal a characteristic infiltration of the mucosa and lamina propria with eosinophils, usually in excess of 6 to 10 per high powered field. Elimination of the offending protein from the diet of the infant, through use of an extensively hydrolyzed casein‐based formula or the elimination of the protein from the diet of the mother of the breast‐feeding infant, leads to clinical resolution of the bleeding within 72 to 96 hours. By 1 year of age the infants routinely tolerate an unrestricted diet, and the long term prognosis is excellent.
Use of Intrahepatic Chemotherapy to Treat Advanced Pediatric Hepatic Malignancies
Authors: Gerber David A. , Arcement Chris , Carr Brian , Towbin Rich , Mazariegos George , Reyes Jorge 
Published: February 2024

ABSTRACTBackground:To evaluate the effect of intrahepatic arterial chemotherapy (IAC) on children with primary hepatic malignancies.Method:A nonrandomized inception cohort of 11 pediatric patients was referred for treatment of advanced primary hepatic malignancies at Children's Hospital of Pittsburgh. None of the patients was a candidate for resection before the initiation of IAC. Tumor response to treatment was observed by determining serum α‐fetoprotein (AFP) levels and by abdominal computed tomographic scan. The patients received hepatic artery infusions of cisplatin and/or doxorubicin. The last five also received gelfoam embolization.Results:Eight of 11 patients had multiple IAC treatments. Eight patients had AFP‐producing tumors, and five of the eight had dramatic reductions in serum levels after IAC treatment. Five of the 11 patients underwent successful orthotopic liver transplantation after receiving IAC therapy, and the five explanted specimens showed varying degrees of tumor necrosis. One‐year survival in patients in the authors' center is 67% for those with hepatoblastoma and 40% for those with hepatocellular carcinoma. Three‐year survival is 60% and 30% for patients with hepatoblastoma and hepatocellular carcinoma, respectively.Conclusion:Intrahepatic arterial chemotherapy therapy can halt the progression and possibly down‐stage advanced pediatric hepatic malignancies. This therapy can also be used as a successful adjunct in altering a patient's chance for successful liver transplantation.
Long‐term Outcome After Partial External Biliary Diversion for Intractable Pruritus in Patients With Intrahepatic Cholestasis
Authors: Ng Vicky Lee , Ryckman Frederick C. , Porta Gilda , Miura Irene K. , de Carvalho Elisa , Servidoni Maria F. , Bezerra Jorge A. , Balistreri William F. 
Published: February 2024

ABSTRACTBackground:Chronic intrahepatic cholestasis is associated with severe pruritus that is often refractory to maximal medical management and leads to significantly impaired quality of life. The hypothesis in this study was that partial external biliary diversion (PEBD) can substantially improve intractable pruritus secondary to intrahepatic cholestasis with subsequent improvement of functional quality of life.Methods:Parents' and/or patients' clinical rating of pruritus, growth percentiles, biochemical parameters, and liver biopsies performed before and after surgery were compared in a retrospective medical record review.Results:Eight children underwent PEBD from 1990 through 1997. Complete follow‐up data were available for seven patients. Before surgery, all patients had intense pruritus, which was not responsive to maximal medical therapy. Specimens obtained in preoperative liver biopsies showed moderate (n = 1), minimal (n = 6), or no (n = 1) portal fibrosis. After PEBD, all patients received ursodeoxycholic acid (10–15 mg/kg/dose two to three times daily) until resolution of pruritus. Of the seven patients with complete follow‐up data, six had complete resolution of pruritus and sustained resolution up to 8 years after surgery. The patient with mild to moderate residual pruritus was the youngest to undergo PEBD. Growth improved from below the 5th percentile before surgery to the 5th through the 25th percentiles for five of six patients with more than 6 years' follow‐up. All families reported improved quality of life, defined by school attendance and ability to resume normal activity with peers. There has been no clinical evidence of progression of liver disease.Conclusion:Partial external biliary diversion is effective in the long‐term treatment of pruritus refractory to medical therapy and provides a favorable outcome in a select group of patients with chronic intrahepatic cholestasis without cirrhosis.
Impaired Accommodation of the Proximal Stomach in Children With Recurrent Abdominal Pain
Authors: Olafsdottir Edda , Gilja Odd Helge , Aslaksen Aslak , Berstad Arnold , Fluge Gjermund 
Published: February 2024

ABSTRACTBackground:A new ultrasonographic method was applied in children with recurrent abdominal pain, to study accommodation of the proximal stomach to a meal.Methods:After an overnight fast, 20 patients with recurrent abdominal pain (age, 7–14 years) and 23 healthy control subjects (age, 7–13 years), were scanned by a 5‐MHz transducer positioned in the epigastrium, to monitor the size of the proximal stomach before and after a test meal of meat soup.Results:Children with recurrent abdominal pain had a significantly smaller sagittal area of the proximal stomach at 10 and 20 minutes after the meal than in healthy control subjects (P = 0.01 for both) and significantly higher emptying fraction of the proximal stomach at 10 minutes after the meal than in healthy control subjects (P = 0.02). There was no significant difference in emptying of the distal stomach between the patients and healthy control subjects. Children with recurrent abdominal pain experienced more symptoms (pain, bloating) in response to the test meal than did healthy control subjects.Conclusion:The results support the view that recurrent abdominal pain in children may be a motility disorder that can be detected in the proximal stomach as an impairment of adaptive relaxation in response to a meal. This new ultrasonographic method may become a valuable diagnostic tool in patients with recurrent abdominal pain.
Efficacy of Bismuth‐Based Triple Therapy in Children With Abdominal Pain and Helicobacter pylori Gastritis
Authors: Shamaly Hussein , Berkowitz Drora , Rosenthal Eldad , Naveh Yehezkel 
Published: February 2024

ABSTRACTBackground:To evaluate the effect of a therapeutic regimen of 7 days versus 14 days on the clinical manifestations of Helicobacter pylori gastritis in children.Methods:Ninety children (age 2–19 years) who had abdominal pain and/or recurrent vomiting were determined to have H. pylori gastritis by endoscopy, histology, and a Giemsa stain positive for H. pylori. The patients were randomized to receive amoxicillin, metronidazole, and bismuth subcitrate for 7 days (group A; 45 children) or 14 days (group B; 45 children) and were observed clinically for 19 ± 11.5 months. Resolution of all abdominal and gastrointestinal symptoms was considered a good response.Results:A good response was obtained in 36 (80%) children from group A, and in 37 (82%) from group B. A recurrence of symptoms occurred in four (11%) of the responders from group A, and in six (15.2%) from group B.Conclusions:A 7‐day course of bismuth‐based triple therapy for H. pylori gastritis in children appears to be clinically as effective as a 14‐day regimen. The feasibility of a shorter therapeutic regimen may enhance patient compliance and provide a better chance of clinical benefit.
Differences in Dietary Intake and Activity Level Between Normal‐Weight and Overweight or Obese Adolescents
Authors: Garaulet Marta , Martínez Adelia , Victoria Florentina , Pérez–Llamas Francisca , Ortega Rosa Ma , Zamora Salvador 
Published: February 2024

ABSTRACTBackground:To investigate the prevalence of overweight and obesity in an adolescent group representative of a rural Mediterranean area and to determine possible associations with energy and nutrient intakes and levels of physical exercise.Methods:A representative sample of adolescents was drawn from the secondary school of Torre Pacheco (Murcia), a rural Mediterranean area located in the southeast of Spain. The population selected (331 adolescents aged 14–18 years), was divided into two groups: normal‐weight subjects with a body mass index less than 23 kg/m2 and overweight or obese subjects with a body mass index of 23 kg/m2 or more. Weight, height, abdominal and hip perimeters, triceps skinfold, and upper arm circumference were measure. A prospective 7‐consecutive‐days food record and physical activity questionnaire were completed.Results:Overweight boys and girls had an apparently lower energy intake (P = 0.001 and P = 0.042, respectively), and carbohydrate intake (P = 0.000, P = 0.032) than their normal‐weight counterparts, but they tended to underreport more often. Overweight boys derived a greater percentage of their energy from fat (P = 0.049) and less from carbohydrate (P = 0.016) than their normal‐weight counterparts. Among girls, the percentage of energy derived from fat increased with body mass index (r = 0.210, P = 0.008), whereas fiber intake decreased (r = −0.145;P = 0.041). Overweight and obesity were negatively related to physical activity level only among boys (P = 0.033).Conclusion:There is a high prevalence of overweight and obesity in the adolescent population studied (48.2% in boys and 30.7% in girls). The study shows an association between overweight and obesity and nutrient intake and activity level.
Ethnic Differences in Intestinal Disaccharidase Values in Children in Finland
Authors: Kolho Kaija‐Leena , Savilahti Erkki 
Published: February 2024

ABSTRACTBackground:Intestinal disaccharidase activities tend to be low in villous atrophy, but there are only a few reports of enzyme activities in children with normal villous architecture.Methods:In the current study the data were reviewed on disaccharidase activities in duodenal biopsy specimens of normal villous structure in 223 children undergoing upper gastrointestinal endoscopy in 1997 and 1998. The ancestry was Finnish in 188 children (median age 8.0 years; range, 0.2–18 years), African in 27 children (median age 5.0 years; range, 1–13 years), and other in eight children.Results:The mean activities of lactase, sucrase, and maltase were significantly higher in Finnish children than in children of African origin (P < 0.0001, P < 0.002, and P < 0.02, respectively). Lactase activity decreased with increasing age (P < 0.001), but age had no significant effect on maltase and sucrase activities. Among Finnish children, 31% (59/188) had lactase activity below the established reference range of 20 units (units are micromoles of substrate hydrolyzed per minute at 37°C per gram of protein) and one child had a probable sucrase‐isomaltase deficiency. When these 60 children with low enzyme activities were excluded, the geometric means were lactase, 35.7 units (95% confidence interval [CI], 32.8–38.6 units); maltase, 241 units (95% CI, 225–258 units); and sucrase, 57.5 units (95% CI, 53.5–61.6 units). Among the children of African origin, lactase activity was decreased in 67% (18/27). All three enzyme activities were decreased in parallel more often among the African children (8/27) than among the Finnish children (9/188;P < 0.002).Conclusions:Ethnicity has a strong effect on disaccharidase values in children with normal villous structure. African children have lower activities of lactase, sucrase, and maltase in duodenal specimens than do children of Finnish origin.
Feeding Tolerance in Premature Infants Fed Fortified Human Milk
Authors: Moody Gloria J. , Schanler Richard J. , Lau Chantal , Shulman Robert J. 
Published: February 2024

ABSTRACTBackground:To evaluate feeding tolerance in premature infants immediately after the addition of human milk fortifier (HMF) to their expressed human milk diet.Methods:Data on milk intake, feeding tolerance, and related assessments and growth milestones from a prospective study of feeding strategies in premature infants were analyzed. The database was searched for the first day HMF was added to the feeding of infants receiving human milk exclusively. The following assessments were tabulated for the 5 days before and the 5 days after the addition of HMF: milk intake, the number of episodes of abdominal distension, gastric residual volume (GRV) more than 2 ml/kg and more than 50% of the volume fed in the prior 3 hours, bile‐stained gastric residual, emesis or regurgitation, blood in the stool, the number of abdominal radiographs, the number of episodes of apnea and bradycardia, changes in findings in the clinical examination, and the number of hours feeding was withheld. The time to achieve full tube feeding, complete oral feeding, and hospital discharge were recorded.Results:Seventy‐six exclusively human milk–fed premature infants (birth weight, 1065 ± 18 g; gestational age, 27 ± 0.1 weeks; mean ± SEM) who received HMF beginning 22 ± 0.8 days of age were evaluated. There were significant increases in milk intake and in the number of episodes of GRV more than 2 ml/kg and emesis after the addition of HMF. There were no differences in the number of hours feeding was withheld or any other assessment after the addition of HMF. Infants with increases in GRV more than 2 ml/kg and/or emesis after the addition of HMF were not more likely to be delayed in the time to achieve full tube feeding, complete oral feeding, or hospital discharge than infants who did not experience these events.Conclusion:These data suggest that, when all feeding and related assessments and the time to achieve important growth milestones are considered, the addition of HMF does not adversely affect the outcome of the premature infant.