bluuebunny/crossref_metadata_2025_split huggingface dataset:
Very Early Onset Nonorganic Failure to Thrive in Infants
Authors: Tolia Vasundhara 
Published: January 2024

SummaryNonorganic failure to thrive (NOFTT) occurs in absence of any gastrointestinal, endocrine, or other chronic diseases. It is usually associated with psychosocial deprivation, although behavior problems may also contribute to its occurrence in absence of maternal pathology. We report seven infants and children between the ages of 13 and 30 months at the time of presentation, who failed to consume adequate calories and suffered from delayed growth. All were born at term after normal pregnancies with birth weights and lengths between the 50th and 95th percentiles except in one. None had any history of perinatal problems. Decreased intake was encountered almost immediately after birth, with lack of interest in consuming adequate calories. The evaluations performed did not reveal any specific etiology for the decreased intake. None had any developmental delay nor were there any psychiatric conditions in mothers. Changes in formulas or psychologic intervention were unsuccessful in modifying feeding habits except in two infants. All were supplemented with enteral supplements (Pediasure‐five, Ensure‐one, and Osmolite‐one). Three did not consume enough orally and needed nasogastric tube infusions with eventual placement of gastrostomy tubes in two, and the third one has continued with nasogastric infusions. A significant increase in caloric intake caused improvement in growth percentiles. Height and weight percentiles improved in all and crept into the normal curve in four and five patients, respectively. Head circumference of two stayed at <5th percentile despite nutritional rehabilitation. Attempts at weaning off the supplements actually resulted in weight loss in all. Our data suggest that there is a critical need for early, aggressive nutritional intervention in such infants.
The Relationship between Stool Hardness and Stool Composition in Breast‐ and Formula‐Fed Infants
Authors: Quinlan P. T. , Lockton S. , Irwin J. , Lucas A. L. 
Published: January 2024

Summary“Constipation” and “hard stools” are associated with formula feeding of both term and preterm infants and, in the latter, can lead to life‐threatening complications. This study tested the hypothesis that stool hardness is related to excretion of fatty acid (FA) soaps in term infants, and in the extreme to milk bolus obstruction in premature infants. Stools (n = 44) were collected from 20 formula‐fed and 10 breast‐fed infants aged 6 weeks and were classified using visual charts for stool hardness on a 5‐point scale (1, watery; 5, hard). Stools were analysed for nitrogen, minerals, and lipid, the latter divided between the soap and nonsoap fractions. We explored the relationship between stool hardness or solids content and stool constituents, relative to both wet and dry weight. Calcium and FA soaps were the dominant factors significantly related to stool solids and hardness score across the breast‐ and formula‐fed groups. An 8% increase in stool dry weight FA soap content corresponded to a 1‐point change in stool hardness score. Stools from formula‐fed infants had a higher solids content and were classified as significantly harder than those from breastfed infants (hardness scores, 4.0 ± 0.5 versus 2.6 ± 0.7, mean ± SD) and on both a wet‐ and dry‐weight basis contained severalfold higher levels of minerals and lipid and considerably less carbohydrate. Differences in lipids between formula‐ and breast‐fed infants' stools were due almost entirely to FAs (mainly C16:0 and C18:0) excreted as soaps (27.7 ± 7.5% compared to 3.1 ± 4.1% of dry weight), suggesting the groups differed markedly in their handling of saturated FAs. An inspissated stool sample from a premature infant requiring surgical disempaction of an obstructed small intestine was found to be enriched in FA and calcium relative to the preterm formula. FA soaps, predominantly saturated, accounted for one third of the stool dry weight. These data support the hypothesis that calcium FA soaps are positively related to stool hardness; we speculate that this may, at least in part, explain the greater stool hardness in formula‐ versus breast‐fed infants and milk bolus obstruction in preterm infants. This conclusion is consistent with the physical properties of calcium FA soaps.
Bowel Habits of Normal Thai Children
Authors: Osatakul Seksit , Yossuk Panitan , Mo‐suwan Ladda 
Published: January 2024

SummaryBowel habits were assessed in 400 healthy Thai children aged 1–72 months. The study was undertaken principally because information concerning the bowel habits of children living on a non‐Western diet is lacking. Ninety‐four percent of the children moved their bowels at least once a day. Mean frequency of bowel actions per day was maximal in the newborn period (3.3 stools) and declined to once a day from ages of 48 to 72 months. Most infants younger than 2 months old produced running stools; however, a change in stool consistency from runny to formed was evident in most children by 4 months of age. With increasing age, children produced larger stools: mean volume of stool was 16.6 ± 2.3 ml at 1 month of age and increased to 35.4 ± 7.6 ml at 48–72 months. In comparison with Western children, it seems that Thai children pass larger, softer, and more frequent stools. That difference in the bowel habits between the two ethnic groups may reflect the difference in the amount of natural fiber in their diets.
Cysteine Supplementation and Reduction of Total Parenteral Nutrition—Induced Hepatic Lipid Accumulation in the Weanling Rat
Authors: Narkewicz Michael R. , Caldwell Sherrie , Jones Gayle 
Published: January 2024

SummaryTotal parenteral nutrition (TPN)‐induced hepatic steatosis is the most common complication of TPN administration to humans. The mechanism of TPN‐induced hepatic steatosis has not been studied in young mammals. The goal of this study was to determine the mechanism of TPN‐induced hepatic steatosis in the weanling rat and the effect of supplementation of TPN with choline and/or cysteine on TPN‐induced hepatic steatosis. In the weanling rat, we investigated the effect of TPN administration on histologic hepatic steatosis, total hepatic lipid, hepatic acetyl‐CoA‐carboxylase (ACC—the rate limiting enzyme in fatty acid synthesis) specific activity, and total plasma lipids. TPN administration resulted in a threefold increase in hepatic lipid as compared with control and sham animals (TPN 138 ± 12 mg/g liver versus control 57 ± 1), an increase in histologic steatosis (TPN 3.7 versus control 1.3), and a decline in total plasma lipid (TPN 2.1 ± 0.3 g/L versus control 4.1 ± 0.3). TPN‐induced hepatic steatosis in the weanling rat was not associated with an increase in ACC specific activity (TPN 2.10 ± 0.33 nmol/min/mg protein versus control 2.85 ± 0.23). Supplementation of the TPN with choline (15 mg/day) did not significantly lessen hepatic steatosis; however, supplementation of TPN with cysteine (2.5 mg/day) or with cysteine and choline did result in a significant lessening of hepatic lipid content and of histologic steatosis and a normalization of total plasma lipid. Tritiated glycerol incorporation into media lipids secreted by hepatocytes isolated from TPN‐treated animals was 45% of that from cysteine‐supplemented animals, suggesting a defect in hepatic lipid secretion associated with TPN‐induced hepatic steatosis in the weanling rat that is partially corrected by cysteine supplementation.
Striking Differences in the Incidence of Childhood Celiac Disease Between Denmark and Sweden
Authors: Weile Birgitte , Cavell Bertil , Nivenius Kerstin , Krasilnikoff Peter A. 
Published: January 2024

SummaryAmong 771 children (381 Swedish and 390 Danish) investigated between 1972 and 1989 because of suspected celiac disease (CD), 179 proved to have the disease. Surprisingly only 24 CD patients were found among the Danish children, compared with 155 in the Swedish group, despite the close ethnic, geographical, and cultural background of the two populations. The Swedish CD children were diagnosed at an earlier age than the Danish children (mean, 1.5 vs. 5.5 years). The symptoms of the Swedish patients were dominated by failure to thrive (93 vs. 71%), whereas a higher proportion of the Danish CD patients suffered from stomach pain (21 vs. 5%). Breast‐feeding habits were comparable. The estimated content of gliadin in the officially recommended diets of the two countries in 1987 differed substantially, the Swedish diet containing more than 40 times more gliadin than the Danish (4,400 vs. 100 mg) at the age of 8 months, and 4 times more (3,600 vs. 900 mg) at the age of 12 months. The Danish infant diet differed significantly from the Swedish in containing a larger amount of the lower gluten‐containing rye flour. The earlier introduction of food items with a high gluten content in the Swedish compared with the Danish diet seems to be an obvious explanation for the great difference in incidence and symptomatology of CD between the two populations.
Etiology and Epidemiology of Persistent Diarrhea in Northeastern Brazil
Authors: Fang Guodong D. , Lima Aldo A. M. , Martins Ceci V. , Nataro James P. , Guerrant Richard L. 
Published: January 2024

Summary:With the improved therapy for acute diarrhea, persistent diarrhea (> 14 days) is emerging as a major problem in developing countries. However, the etiologies and pathogenesis of persistent diarrhea remain poorly understood. We conducted a prospective case‐control study in children <3 years old presenting to the hospital with persistent diarrhea in Fortaleza, Brazil. Over the study period (August 1988 to March 1991), 56 children seen with persistent diarrhea, 52 children seen with acute diarrhea, and 42 controls attending the same hospital/clinic for illnesses other than diarrhea were enrolled. A potential pathogen was found in 91% of children with persistent diarrhea and 90% of those with acute diarrhea versus 45% of controls (both p‘s < 0.01). Thirty‐four percent of persistent (19/56) and 38% of acute (20/52) diarrhea cases versus 2% (1/42) of controls (both p’s < 0.01) had multiple pathogens. Enteroaggregative Escherichia coli (EAggEC) were found in 68% (38/56) of children with persistent diarrhea versus 31% (13/42) of controls (p < 0.01) and in 46% (24/52) of those with acute diarrhea. Furthermore, when the EAggEC were subdivided into aggregative adherence (AA) gene probe positive (18/56; 32%) and negative (20/56; 36%), both subgroups were still significantly different from controls [6/42 (14%) and 7/42 (17%), respectively; both p‘s < 0.05]. EAggEC were the sole pathogen in 17 of 56 (30%) of patients with persistent diarrhea [vs. 11/94 (11.7%) in those with acute diarrhea and controls; p < 0.01], and AA gene probe‐positive EAggEC were the sole pathogen in 20% of children with persistent diarrhea, whereas only 6% of those with acute diarrhea and 7% of controls had AA probe‐positive E. coli (persistent diarrhea vs. acute diarrhea and controls; p < 0.03) Cryptosporidia were found in 25% (14/56) of children with persistent diarrhea (vs. 5% of controls; p < 0.02). Of 32 children with persistent diarrhea who had quantitative small bowel cultures, 13 (41%) had ≥ 104/ml EAggEC (2 had AA probe‐positive EAggEC) in the upper small bowel. Of 10 EAggEC isolated from the small bowel of seven patients with persistent diarrhea, 6 significantly colonized and caused diarrhea in the rabbit‐reversible ileal tie model. Both AA gene probe‐positive and AA gene probe‐negative EAggEC and Cryptosporidium are important potential pathogens in young children with persistent diarrhea and warrant further study to improve our understanding of their pathogenesis and control.
Effect of a Fermented Infant Formula Containing Viable Bifidobacteria on the Fecal Flora Composition and pH of Healthy Full‐Term Infants
Authors: Langhendries J. P. , Detry J. , Van Hees J. , Lamboray J. M. , Darimont J. , Mozin M. J. , Secretin M. C. , Senterre J. 
Published: January 2024

Summary:We assessed the growth, tolerance, and acceptability as well as fecal flora composition and stool pH of 20 healthy full‐term infants fed with a fermented whey‐adapted infant formula containing viable bifidobacteria (106/g of powder) during the first 2 months of life. This fermented infant formula, first biologically acidified by Streptococcus thermophilus and Lactobacillus helveticus, was compared to a whey‐adapted, nonacidified, low‐phosphate infant formula in a double‐blind, randomized controlled study. The results were compared to a control group (n = 14) of fully breast‐fed infants. The fermented whey‐adapted formula containing viable bifidobacteria induced a prevalence of colonization with bifidobacteria at 1 month of age similar to that of breast‐fed infants (12/20 versus 8/14) but significantly higher than in the group fed the standard infant formula (4/20). The mean bacterial count of bifidobacteria was similar in all colonized infants; however, fecal pH was significantly lower in the breast‐fed infants than in the nonacidified bottle‐fed infants. This kind of infant formula was well tolerated and promoted a normal growth during the first 2 months.
Plasma Endothelin‐1 Levels of Children with Cirrhosis
Authors: Nozue Tomio , Kobayashi Akio , Uemasu Fujio , Takagi Yasuo , Endoh Hiroomi , Sako Akiko 
Published: January 2024

Summary:We measured plasma concentration of endothelin‐1 in three children with Byler's disease, five with biliary atresia after portoenterostomy, and nine controls. No patients had ascites or hepatorenal syndrome. Plasma endothelin‐1 levels were significantly higher in patients with Byler's disease than in the controls (5.19 ± 0.90 versus 1.81 ± 0.19 pg/ml, respectively; p < 0.01), but were normal in operated biliary atresia. Urinary concentrations of N‐acetyl‐β‐L‐glucosaminidase (NAG) were significantly higher in the patients with Byler's disease than in controls. Plasma endothelin‐1 level correlated significantly with serum concentration of bile acid (r = 0.91; p < 0.01) and urinary concentration of NAG (r = 0.92; p < 0.01). We conclude that plasma endothelin‐1 levels are high in patients with severe biliary cirrhosis and that endothelin‐1 may partially contribute to development of renal injury in cirrhosis.
Effects of Dietary Supplementation with Fructooligosaccharides on Colonic Microbiota Populations and Epithelial Cell Proliferation in Neonatal Pigs
Authors: Howard Michael D. , Gordon Dennis T. , Pace Lanny W. , Garleb Keith A. , Kerley Monty S. 
Published: January 2024

Summary:Two experiments were conducted with neonatal pigs to determine the effects of feeding fructooligosaccharides on cecal and colonic microbiota, proliferation of cecal and colonic epithelial mucosa, and short‐chain fatty acid concentrations in the cecum. Experiment 1 consisted of feeding neonatal pigs diets containing either 0 or 3 g fructooligosaccharides/L of formula for 15 days and then examining the large intestine for changes in cecal and proximal colonic microbiota; cecal pH; short‐chain fatty acid concentrations; morphology of cecal, proximal, and distal colonic epithelial mucosa; gross necropsy; and his‐topathology. Supplementation with fructooligosaccharides (FOS) did not alter cell counts of viable bifidobac‐teria organisms or total anaerobic microbiota, cecal pH, or concentrations of short‐chain fatty acids. Cecal mu‐cosal cell density and labeled cells increased with FOS consumption. Proximal colonic mucosal crypt height, leading edge, labeled cells, proliferation zone, and labeling index increased with FOS consumption. Distal colonic mucosal crypt height, leading edge, cell density, labeling index, and labeled cells increased with FOS consumption. Gross necropsy and histopathology found no significant lesions. In Experiment 2, neonatal pigs were fed diets containing either 0 or 3 g fructooligosaccharides/L of formula for 6 days. Fecal samples were collected on the first full day of feeding and on days 3 and 6 after initiation of feeding. On days 1 and 3, concentrations of bifidobacteria were similar between diets; however, on day 6, pigs consuming FOS tended to have greater numbers of bifidobacteria (p = 0.08). These data suggest dietary consumption of FOS will enhance bifidobacteria populations and prevent colonic epithelial mucosa atrophy in neonates fed an elemental diet.
The Association of Syndromic Paucity of the Interlobular Bile Ducts and Congenital Mechanical Obstruction of the Small Intestine
Authors: Chiu Hsiu‐Hui , Chang Mei‐Hwei , Chen Chi‐Long , Hsu Hong‐Yuan , Ni Yen‐Hsuan 
Published: January 2024

Summary:Three patients with congenital mechanical intestinal obstruction and features of syndromic paucity of the interlobular bile ducts (SPILBD) are presented. Two of them have siblings with syndromic paucity of the interlobular bile ducts. Two patients had jejunoileal atresia, while the other had a meconium plug with intestinal perforation. All subjects underwent surgery for intestinal ob‐ struction within the first 24 h of life. Progressive disappearance of the bile ductules was observed in one case. We believe that an insult such as vascular insufficiency to both bile ductal epithelium and the small intestine may be the cause of this congenital disorder.
A Multicenter Long‐Term Safety and Efficacy Trial of Preterm Formula Supplemented with Long‐Chain Polyunsaturated Fatty Acids
Authors: Vanderhoof Jon , Gross Steven , Hegyi Thomas ,   Multicenter Study Group
Published: January 2024

ABSTRACTBackgroundThe tissue accretion of long‐chain polyunsaturated fatty acids is compromised in infants born prematurely. Human milk contains long‐chain polyunsaturated fatty acids, but most preterm infant formulas do not. The long‐term effects of preterm formula supplemented with arachidonic acid and docosahexaenoic acid, in proportions typical of those in human milk, were therefore investigated.MethodsIn this double‐blind, randomized study, 288 preterm infants received experimental formula (n = 77), unsupplemented (control) formula (n = 78), or human milk (n = 133) until 48 weeks postconceptional age (PCA). Term formula, without supplemental long‐chain polyunsaturated fatty acids, was administered from 48 to 92 weeks PCA to formula‐fed infants and to infants weaned from human milk. Anthropometric and fatty acid data were assessed by using analysis of variance.ResultsAt 92 weeks PCA, no statistically significant anthropometric measurement differences were found except for midarm circumference, which was smaller in human milk–fed infants than in those fed formula. Phospholipid concentrations were similar in the experimental and human milk–fed groups, and docosahexaenoic acid levels were significantly greater than in the control group. The types and incidences of adverse events were similar among the feeding groups.ConclusionsThe results of this study demonstrate the efficacy and long‐term safety of preterm formula supplemented with long‐chain polyunsaturated fatty acids.
Liver Abnormalities During Growth Hormone Treatment
Authors: Salerno Mariacarolina , Di Maio Salvatore , Ferri Pasqualina , Lettiero Teresa , Di Maria Federica , Vajro Pietro 
Published: January 2024

ABSTRACTBackgroundOccasional and transient increase in liver enzymes is reported during growth hormone (GH) treatment in girls with Turner syndrome (TS).MethodsRetrospectively, the specific role of GH treatment on liver and muscular enzymes was evaluated in 78 patients (48 boys; age range 4.0–20.8 years) affected by GH deficiency (GHD) who had been treated with GH for at least 1 year (range: 1–15 years). All patients had normal serum levels of liver and muscular enzymes before GH therapy was started.ResultsA clinically asymptomatic and mild increase in serum transaminase levels was observed in 6 of 78 patients with GHD during GH treatment; 3 (3.8%) of the patients showed an isolated, transitory and self‐limiting increase in serum liver transaminase levels which was noticed 6 to 12 months after GH treatment was started, and normalized spontaneously within 3 to 6 months, without stopping the therapy. Three additional patients showed a transitory mild increase both in aspartate aminotransferase (AST) and creatine phosphokinase (CK) which also normalized spontaneously within 3 to 6 months. The increase in transaminase levels was not related to the brand of GH preparations nor to the dosage administered.ConclusionsA mild, transient, self‐limiting increase in serum transaminase may occur during GH treatment. Concomitant determination of CK serum levels may quickly differentiate muscular from hepatic hypertransaminasemia. Except for persistent cases, this condition does not generally require further investigations.
Unusual Early Presentation of Gilbert Syndrome in Pediatric Recipients of Liver Transplantation
Authors: Vajro Pietro , DeVincenzo Anna , Lucariello Stefania , Migliaro Fiorella , Sokal Etienne , Bernard Olivier , Vilei Teresa , Muraca Maurizio 
Published: January 2024

ABSTRACTBackgroundGilbert syndrome as a rule becomes manifest in adolescence or in early adulthood; it may be transferred by the donor to orthotopic liver transplant (OLT) recipients.MethodsWe examined the frequency of Gilbert syndrome in 46 OLT pediatric recipients who had a follow‐up of 1 year or more. Diagnostic criteria included unexplained chronic or recurrent unconjugated hyperbilirubinemia; its increase after reduced caloric intake plus prolonged fasting, without changes of the proportion of conjugated bilirubin; and high relative amounts of serum unconjugated bilirubin IXa and prevalence of the monoglucuronide over the diglucuronide.ResultsOf the 46 patients, 42 had normal bilirubin values. Only four otherwise healthy OLT recipients showed hyperbilirubinemia and normal conjugated fractions. Liver donors had been four men. Hyperbilirubinemia persisted with a fluctuating pattern for the whole follow‐up after OLT in all. Total bilirubin level in blood samples obtained after reduced caloric intake and prolonged fasting became notably higher than basal values, whereas the proportion of conjugated bilirubin remained stable. High relative amounts of unconjugated bilirubin IXa and prevalence of the monoglucuronide over the diglucuronide were found. Finally, DNA from liver donors' lymphocytes was available for one jaundiced and two nonjaundiced patients: tests for abnormalities in the promoter region of the gene for the enzyme bilirubin uridine diphospho‐glucuronosyltransferase were in agreement with a diagnosis of GS in the former one.ConclusionsGilbert syndrome may have an unusual early presentation in pediatric OLT recipients.