bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastroesophageal Reflux Associated with Respiratory Abnormalities During Sleep
Authors: Sacré Liliane , Vandenplas Yvan 
Published: February 2024

Summary:To determine whether gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea in certain infants, we analyzed the frequency of prolonged central apnea (>15 s) and of numerous irregularly repeated short apneas (5‐15 s) (“respiratory dysfunction”) in infants with an apparent life‐threatening event (ALTE) (group 1, n = 62), in control infants (group 2, n = 387), and in infants with GER pathologic findings (group 3, n = 60). Finally, the incidence of GER was analyzed in 76 infants with a respiratory dysfunction during sleep (group 4). Gastroesophageal reflux was investigated using 24‐h esophageal pH monitoring; respiration during sleep was investigated by polysomnography. The pH monitoring data and results of sleep investigation were analyzed in a double‐blind study. A great number of infants who had an ALTE appeared to suffer from GER (42%, 26 of 62 infants), especially if the ALTE occurred while the infant was awake (52%, 14 of 27 infants). In the control infants, pH monitoring data were abnormal in 8.5%; respiratory dysfunction was observed in 5%. In those with a respiratory dysfunction, GER was detected in 75% (15 of 20 infants). In those with GER, respiratory dysfunction was observed in 45% (15 of 33 infants). In groups 3 and 4, respiratory dysfunction was associated with abnormal pH data in 40‐43%. If, in the infants with a respiratory dysfunction, the GER pathologic symptoms were treated efficiently (normalization of pH data), respiratory dysfunction disappeared in 92%. If GER was resistant to therapy, respiratory dysfunction persisted in 81% (13 of 16 infants). Results failed to show any causal relationship between prolonged apnea and GER. We conclude that GER in infancy is often associated with a typical breathing pattern during sleep characterized by multiple irregularly repeated short apneas. The recognition of this breathing pattern in (control) infants screened for risk of sudden infant death syndrome should result in GER investigations. We recommend studying GER in all infants with an ALTE.
Area Under pH 4
Authors: Vandenplas Y. , Franckx‐Goossens A. , Pipeleers‐Marichal M. , Derde M. P. , Sacré‐Smits L. 
Published: February 2024

Summary:Twenty‐four‐hour continuous esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Agreement has been achieved that acid gastric content reflux into the esophagus constitutes a major cause of reflux esophagitis; we therefore calculated the “area under pH 4” (A) in 560 consecutive pH monitorings in infants 1‐12 months old and related this parameter (A) to the reflux index (RI): RI < 10%: A 185 ± 295 (mean ± 1 SD); RI 10‐19%: A 1,046 ± 1,206; RI 20‐29%: A 1,967 ± 2,038; RI 30‐39%: A 3,307 ± 2,955; RI > 40%: A 7,977 ± 7,227. A higher RI is associated with a greater area under pH 4 (p < 0.001); the high SD obtained in each group, however, illustrates the great variability in surface (or acidity of the reflux episodes) in all groups. Esophagoscopy and biopsy were performed in 112 infants (20%). Specificity in the prediction of (mild) esophagitis was higher for the area under pH 4 (88%) compared with the RI (50%). The sensitivity of both parameters was comparable (96 versus 93%). Our results strongly suggest that in young infants, the acidity of the reflux episodes (the area under pH 4) is a determining factor in the prediction of esophagitis. These data need to be confirmed by more studies before general application of this parameter can be advised.
Effects of Topical Anesthetic Agents on Campylobacter pylori
Authors: Czinn Steven J. , Carr Howard S. , Speck William T. 
Published: February 2024

Summary:The susceptibility of Campylobacter pylori was determined for the two topical anesthetic agents commonly used prior to gastroscopy. Campylobacter pylori proved to be extremely sensitive to the anti‐infective activity of benzocaine, the active ingredient in most commonly used topical anesthetic agents, with minimum inhibitory concentrations of 0.14 mg/ml. However, lidocaine‐containing agents did not interfere with the growth of this microorganism. Specifically, in patients with histologic evidence of C. pylori, the bacterium was recovered from significantly more patients anesthetized with lidocaine than with benzocaine. Thus, the use of benzocaine‐containing topical anesthetic agents limits recovery of Campylobacter pylori from clinical specimens and might account for the low colonization rates reported in some recent publications (1‐4,8).
Lymphangioendothelioma of the Liver in a Neonate
Authors: Peters M. E. , Gilbert‐Barness E. F. , Rao B. , Odell G. B. 
Published: February 2024

Summary:The case report describes the clinical features, imaging findings, and pathology of a lymphangioendothelioma that almost entirely replaced the liver parenchyma in a neonate. No other organs were involved.
Metabolic Etiologies of Cyclic or Recurrent Vomiting
Authors: Korson Mark 
Published: February 2024

Summary:Treatable metabolic diseases are infrequently considered in the differential diagnosis of a child with cyclic or recurrent vomiting. Helpful clues in a complete medical history can heighten a clinician's suspicion about a metabolic etiology, as can the presence of certain symptom complexes or biochemical features. A rational approach to investigation is discussed using routine laboratory tests as a first‐line screen. More definitive testing is indicated when screening results are abnormal or when the patient's history is particularly suggestive. Until test results become available, patients in whom a metabolic etiology cannot be ruled out should be treated as if they have an inborn error, in parallel with other conventional therapies, to avoid complications that are often preventable.
Psychophysiologic Treatment of Cyclic Vomiting
Authors: Magagna Jeanne 
Published: February 2024

Summary:Cyclic vomiting (CV) presents a crisis not only to the identified patient but also to the entire family, who often feel like helpless victims of the effects of the vomiting cycles. This often creates despair, depression, and anger about the vomiting continuing indefinitely. If the child can be given effective medication and the family can be helped with the emotional burden surrounding the illness, the frequency and severity of CV tends to diminish. This article explores ways of lessening the psychologic and social effects of the cyclical vomiting through a multidisciplinary treatment plan for the family that involves the pediatrician, school, psychotherapist, and family as effective therapeutic agents. The child needs to be helped to express feelings which he or she cannot put into words. The article describes dramatic play involving symbolization of the illness, creation of metaphors in stories and drawings for the dilemmas surrounding CV and family therapy in which unnamed stresses are given consideration. Through this treatment, health and hope are promoted within each family member.
T Cells of the Colonic Mucosa in Patients With Infantile Colitis
Authors: Örmälä Timo , Rintala Risto , Savilahti Erkki 
Published: February 2024

ABSTRACTBackgroundInfantile colitis is a heterogeneous group of disorders, including enterocolitis complicating Hirschsprung disease, allergic colitis, inflammatory bowel disease, and Behçet syndrome. There are limited data concerning the immune responses induced by the inflammation of the intestine in young infants.MethodsTwenty‐four colonic biopsy specimens from 12 infantile colitis patients and 12 age‐matched control patients were studied by immunohistologic methods. The authors compared the T cells, their subsets expressing the surface antigens CD8 and CD4, and T‐cell receptors αβ and δγ, and densities of mononuclear and epithelial cells expressing human leukocyte antigen class II antigens.ResultsThe density of CD3+ intraepithelial lymphocytes (IELs) in the large intestinal specimens was significantly higher (P = 0.036) in colitis patients than in the control group. The majority of the CD3+ IELs were CD8+‐expressing cells, and only a minority were CD4+ cells in both groups. T‐cell receptors αβ+ (P = 0.023) and δγ+ (P = 0.027) IELs were observed significantly more frequently in colitis patients than in the control group. In surface epithelium, δ non–disulphide‐linked type T‐cell receptor (δTCS1) IELs were found strikingly more frequently (P = 0.001) in the specimens taken from the colitis patients. Also, the density of the δTCS1+ cells in crypts of the large intestine was significantly higher in colitis patients than in the control patients (P = 0.047).ConclusionsA significant increase of CD3+ lymphocytes in the colonic epithelium of the patients with infantile colitis was noted. This increase involved both T‐cell receptor αβ‐positive and δγ‐positive IELs. The finding of this study supports the proposal that intraluminal antigens, either microbial or food derived, are important in the pathogenesis of colitis in young infants.
Intravenous Omeprazole in Children: Pharmacokinetics and Effect on 24‐Hour Intragastric pH
Authors: Faure C. , Michaud L. , Shaghaghi E. Khan , Popon M. , Turck D. , Navarro J. , Jacqz‐Aigrain E. 
Published: February 2024

ABSTRACTBackgroundOmeprazole is a proton pump inhibitor, acting selectively on the gastric parietal cell H+K+‐adenosine triphosphatase. Data on the intravenous route are limited in children and not available in infants.ObjectiveThis study was designed to determine the pharmacokinetics and the optimal dosage of intravenous omeprazole in patients younger than 30 months of age.MethodsNine children (three girls), aged 4.5 to 27 months, with normal liver and renal functions requiring intravenous omeprazole were studied. After enrollment in the study and randomization, omeprazole was administered once daily, at 8 am, as a 1‐hour infusion. Group 1, consisting of the first four patients, received 20 mg/1.73 m2, and group 2, consisting of the following five patients, received 40 mg/1.73 m2. At day 3, a 24‐hour intragastric pH and a pharmacokinetic study of omeprazole were performed. Plasma concentrations were measured by high‐performance liquid chromatography.ResultsPatients in group 2 had a significantly higher median pH (6.99 vs. 3.35;P = 0.01) and percent of monitored time with gastric pH >4 than children given 20 mg/1.73 m2 (90.6% vs. 44.8%;P < 0.01). Four had a pH more than 4 during more than 90% of the time versus none of the patients of group 1. The plasma concentration versus time curves showed rapid elimination of the drug. The median area under the curve of omeprazole was 0.78 μg · mL−1 · h−1 (range, 0.55–1.64 μg · mL−1 · h−1) and 3.95 μg · mL−1 · h−1 (range, 1.9–4.9 μg · mL−1 · h−1), respectively, in groups 1 and 2 (P < 0.05). Systemic clearance was not different between the two groups: median values were 0.68 and 0.42 L · kg−1 · h−1 (P = 0.22).ConclusionsIn critical situations, intravenous administration of omeprazole may be required in infants. The authors demonstrate that the dose of 20 mg/1.73 m2 is not effective in maintaining 24‐hour gastric pH of more than 4 and that a dose of 40 mg/1.73 m2 is required.
Safety of Lansoprazole in the Treatment of Gastroesophageal Reflux Disease in Children
Authors: Tolia Vasundhara , Fitzgerald Joseph , Hassall Eric , Huang Bidan , Pilmer Betsy , Kane Robert 
Published: February 2024

ABSTRACTObjectives:To evaluate the safety of lansoprazole in children between 1 and 11 years of age.Methods:In a phase I/II, open‐label, multicenter (11 sites) study, children with symptomatic gastroesophageal reflux disease (GERD), erosive esophagitis (≥grade 2), and/or esophageal pH < 4 for > 4.2% of the 24‐hour period were assigned, on the basis of body weight, to lansoprazole 15 mg (≤30 kg) or 30 mg (>30 kg) once daily for 8 to 12 weeks. At the discretion of the investigator, the dosage of lansoprazole was increased up to 60 mg daily in children who continued to be symptomatic after 2 weeks of treatment. Safety for all study participants was monitored by adverse event reports and laboratory evaluations.Results:Sixty‐six children were enrolled in the study and were included in the safety analysis. Throughout the treatment period, no child discontinued therapy because of an adverse event and no. clinically significant changes in laboratory values were observed. Three of the 32 children (9%) who received lansoprazole 15 mg once daily (mean exposure 50.3 days) and 6 of the 34 children (18%) who received the 30 mg once‐daily dose (mean exposure 49.4 days) experienced one or more treatment‐related adverse events before any dose increase. The three children in the lansoprazole 15 mg treatment group were treated with doses of 0.6 mg to 1.2 mg/kg/day; those in the lansoprazole 30 mg treatment group were treated with doses of 0.7 mg to 0.9 mg/kg/day. Only one child experienced a new treatment‐related adverse event after an increase in lansoprazole dose to 1.3 mg/kg/day. Treatment‐related events experienced by two or more children were: constipation (lansoprazole 15 mg QD, two children; lansoprazole 30 mg QD, one child), and headache (lansoprazole 30 mg QD, two children). Mean fasting serum gastrin levels were significantly increased from 58.0 pg/mL at baseline to 112.4 pg/mL at week 2 and 121.9 pg/mL at the final visit (P ≤ 0.001 for each comparison). However, the median fasting serum gastrin levels at the week 2 and the final visit were within the normal range (25‐111 pg/mL).Conclusion:Lansoprazole, when administered on the basis of body weight in children between 1 and 11 years of age, is safe and well‐tolerated.
Comparison of Longstanding Pediatric‐Onset and Adult‐Onset Crohn's Disease
Authors: Freeman Hugh J. 
Published: February 2024

ABSTRACTIntroduction:Limited information is available on the characteristics of longstanding Crohn's disease with onset in childhood or adolescence.Materials and Methods:In this retrospective study, 224 patients with pediatric‐onset Crohn's disease were compared to a group of patients with disease diagnosed as adults.Results:More than 50% of the patients in the pediatric‐onset group were followed for more than a decade, with a mean follow‐up of 12.2 years. There were 96 male (42.9%) and 128 female (57.1%) patients. Most had disease diagnosed in adolescence. The female predominance, similar to adult‐onset disease, was noted only among patients with disease diagnosed in adolescence (13–19 years), not in childhood. Disease most often involved both ileum and colon (128 of 224; 57.1%). Isolated ileal or colonic disease was less common. Upper gastrointestinal tract disease was present in 42 of 224 (18.8%) patients. The incidence of strictures (28.6%) and penetrating complications (46.4%) was similar to that of adults followed for the same period of time.Conclusion:In pediatric‐onset Crohn's disease, female‐predominance emerges during adolescence. Pediatric‐onset disease is more extensive than adult‐onset disease. When followed for an extended period of time, it has high rates of disease complexity, with strictures and penetrating complications similar to adult‐onset disease.
Variations in Incidence of Necrotizing Enterocolitis in Canadian Neonatal Intensive Care Units
Authors: Sankaran Koravangattu , Puckett Barbara , Lee David S.C. , Seshia Mary , Boulton Jill , Qiu Zhenguo , Lee Shoo K. ,   The Canadian Neonatal Network
Published: February 2024

ABSTRACTObjectives:Necrotizing enterocolitis (NEC) is the most common acquired intestinal disease of neonates. Previous reports on incidence have generally examined small cohorts of extremely low–birth‐weight infants and have not examined risk‐adjusted variations among neonatal intensive care units (NICUs). The authors examined risk‐adjusted variations in the incidence of NEC in a large group of Canadian NICUs and explored possible therapy‐related risks.Methods:The authors obtained data on 18,234 infants admitted to 17 tertiary level Canadian NICUs from January 1996 to October 1997. They used multivariate logistic regression analysis to examine the inter‐NICU variation in incidence of NEC, with adjustment for population risk factors and admission illness severity, and explored therapy‐related variables.Results:The incidence of NEC was 6.6% (n = 238) among 3,628 infants with birth weight ≤1,500 g (VLBW), and 0.7% (n = 98) among 14,606 infants with birth weight >1,500 g (HBW). Multivariate logistic regression analysis showed that for VLBW infants, NEC was associated with lower gestational age and treatment for hypotension and patent ductus arteriosus. Among HBW infants, NEC was associated with lower gestational age, presence of congenital anomalies (cardiovascular, digestive, musculoskeletal, multiple systems) and need for assisted ventilation. There was no significant variation in the risk‐adjusted incidence of NEC among NICUs, with the exception of one NICU reporting no cases of NEC.Conclusions:Risk factors for NEC were different in VLBW and HBW infants. There was no significant variation in the risk‐adjusted incidence of NEC among Canadian NICUs, with one possible exception.
Gastric Emptying and Small Intestinal Transit Time in Preterm Infants: a Scintigraphic Method
Authors: Bodé Susan , Dreyer Marianne , Greisen Gorm 
Published: February 2024

ABSTRACTObjectives:Practical methods to determine gastric emptying (GE) and small intestinal transit time in preterm infants are required. The aim of this study was to develop a scintigraphic method to determine GE and small intestinal transit time in preterm infants which produce minimal radiation exposure and physical disturbance in these infants.Methods:Ten premature infants were studied. Median (and range) for gestational age was 28.9 (26–33) weeks, postnatal age was 19 (6–37) days, birth weight was 1194 (687–2300) grams and feeding volume was 173 (6–205) mL/kg/day. Nine of the patients were on nasal continuous positive airway pressure; one patient was on mechanical ventilation. A dose (0.2–0.4 MBq) of 99mTc‐DTPA (0.5 mL) was given at the end of a meal administered by naso‐gastric tube. Static images were obtained with a mobile gamma camera during the next 9 to 12 hours. The radiation dose was at most 0.30 mSv. Regions of interest (ROIs) were drawn around the stomach and the cecum. Time‐activity curves were generated. Gastric emptying half‐time (T½GE) was calculated. Residual gastric activity after 1 hour (R (1h)) and after 2 hours (R (2h)) was determined. Orocecal transit time was defined as the time until significant increase in activity was detected in the cecal ROI.Results:Images showed gastric emptying in all cases. Median (range) half time was 1.0 (0.5–3.0) h. R (1h) was 37.5% (19% to 100%), R (2h) was 23% (6% to 61%). In one patient the tracer did not reach the cecum within 12 hours. In the remaining nine patients orocecal transit time was 3.1 (1.3–6.1) h.Conclusions:We present a new scintigraphic method to determine GE and orocecal transit time. It appears safe and practicable as a research tool in preterm infants.
Polyethylene Glycol 3350 Without Electrolytes for the Treatment of Functional Constipation in Infants and Toddlers
Authors: Loening‐Baucke Vera , Krishna Rachana , Pashankar Dinesh S. 
Published: February 2024

ABSTRACTObjectives:We have recently reported the safety and efficacy of polyethylene glycol 3350 without electrolytes (PEG) for the daily treatment of constipation in older children. Because there are very few data available on the use of PEG in infants and toddlers, we evaluated the efficacy and safety of PEG for the treatment of constipation in children <2 years of age.Methods:This is a retrospective chart review of 75 constipated children <2 years of age at start of PEG therapy. PEG was started at an average dose of 1 g/kg body weight/d and parents were asked to adjust the dose to yield 1 to 2 soft painless stools/d. Data from the history and physical examination were collected initially and at short‐term (≤4 months) and long‐term (≥6 months) follow‐up.Results:75 otherwise healthy children received PEG for functional constipation. The mean age was 17 months (range, 1 to 24 months) and the mean duration of constipation was 10 months (range, 0.5 to 23 months). The mean duration of short‐term follow‐up was 2 months and mean duration of long‐term follow‐up was 11 months. The mean effective short‐term PEG dose was 1.1 g/kg body weight/d and the mean long‐term dose was 0.8 g/kg body weight/d. Constipation was relieved in 85% with short‐term and in 91% with long‐term PEG therapy. Adverse effects were mild and included diarrhea, which disappeared with lowering the dose. No subjects stopped PEG because of adverse effects.Conclusion:PEG is effective, well tolerated and appeared safe for the treatment of functional constipation in children <2 years of age.
Colon Microflora in Infants Fed Formula with Galacto‐ and Fructo‐Oligosaccharides: More Like Breast‐Fed Infants
Authors: Knol Jan , Scholtens Petra , Kafka Corinna , Steenbakkers Jochem , Groß Sabine , Helm Klaus , Klarczyk Malte , Schöpfer Helmut , Böckler Heinz‐Michael , Wells John 
Published: February 2024

ABSTRACTObjectives:The intestinal flora of breast‐fed infants is generally dominated by Bifidobacteria. We aimed to investigate whether an infant formula supplemented with galacto‐oligosaccharides and fructo‐oligosaccharides (GOS/FOS) is able to establish a bifido‐dominant microflora, not only in numbers but also with respect to the metabolic activity in the colon.Methods:Two groups of infants fed infant formula with 0.8 g/100 ml GOS/FOS in a ratio of 9:1 (OSF group), or control formula (SF group) were evaluated in a randomised, double blind, placebo controlled intervention study. A breast‐fed group was studied in parallel. At study onset and after 4 and 6 weeks, faecal samples were examined for the number of bifidobacteria, pH, short chain fatty acids and lactate.Results:After 6 weeks, the mean proportion of bifidobacteria was significantly higher in the OSF group (59.6% versus 49.5% in the SF group; P < 0.05). Compared with controls, infants in the OSF group had a lower stool mean pH and an increased proportion of acetate and a decreased proportion of propionate. The mean pH in the OSF and SF groups were 5.7 and 6.3, respectively (P < 0.001).Conclusions:The addition of the prebiotic GOS/FOS mixture to an infant formula has a stimulating effect on the growth of bifidobacteria and on the metabolic activity of the total intestinal flora. The changes in short chain fatty acids, lactate and pH in the prebiotic group represent a fermentation profile that is closer to that observed in breast‐fed infants compared to infants fed control formula.