bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gas Production by Feces of Infants
Authors: Jiang Tianan , Suarez Fabrizis L. , Levitt Michael D. , Nelson Steven E. , Ziegler Ekhard E. 
Published: January 2024

ABSTRACTBackgroundIntestinal gas is thought to be the cause abdominal discomfort in infants. Little is known about the type and amount of gas produced by the infant's colonic microflora and whether diet influences gas formation.MethodsFresh stool specimens were collected from 10 breast‐fed infants, 5 infants fed a soy‐based formula, and 3 infants fed a milk‐based formula at approximately 1, 2, and 3 months of age. Feces were incubated anaerobically for 4 hours at 37°C followed by quantitation of hydrogen (H 2 ), methane (CH 4 ), carbon dioxide (CO 2 ), hydrogen sulfide (H 2 S), methanethiol (CH 3 SH), and dimethyl sulfide (CH 3 SCH 3 ) in the head‐space.ResultsH 2 was produced in greater amounts by breast‐fed infants than by infants in either formula group, presumably the consequence of incomplete absorption of breast milk oligosaccharides. CH 4 was produced in greater amounts by infants fed soy formula than by infants on other diets. CO 2 was produced in similar amounts by infants in all feeding groups. Production of CH 3 SH was conspicuously low by feces of breast‐fed infants and production of H 2 S was high by soy‐formula–fed infants. CH 3 SCH 3 was not detected. Only modest changes with age were observed and there was no relation between gas production and stool consistency, although stools were more likely to be malodorous when concentrations of H 2 S and/or CH 3 SH were high.ConclusionsGas release by infant feces is strongly influenced by an infant's diet. Of particular interest are differences in production of the highly toxic sulfur gases, H 2 S and CH 3 SH, because of the role that these gases may play in certain intestinal disorders of infants.
Intestinal and Systemic Infection, HIV, and Mortality in Zambian Children With Persistent Diarrhea and Malnutrition
Authors: Amadi Beatrice , Kelly Paul , Mwiya Mwiya , Mulwazi Elvin , Sianongo Sandie , Changwe Francis , Thomson Michael , Hachungula Justina , Watuka Angela , Walker‐Smith John , Chintu Chifumbe 
Published: January 2024

ABSTRACTBackgroundPersistent diarrhea–malnutrition syndrome is a complex of infection and immune failure that involves protein, calorie and micronutrient depletion, and metabolic disturbances. We report an analysis of the impact of HIV infection on infectious disease, clinical presentation, and mortality in Zambian children with persistent diarrhea and malnutrition.MethodsTwo hundred children (94 boys and 106 girls, 6–24 months old) were examined on admission to the malnutrition ward of University Teaching Hospital in Lusaka, Zambia. There was then 1 month of follow‐up.ResultsAntibodies to HIV were found in 108 of the children (54%). The common intestinal infections (Cryptosporidium parvum [26%] and nontyphoid Salmonella spp [18%]), septicemia (17%), and pulmonary tuberculosis confirmed by gastric lavage (13.5%) were not significantly more common in HIV‐seropositive than in HIV‐seronegative children. HIV‐seropositive children were more likely to have marasmus whereas HIV‐seronegative children were more likely to have kwashiorkor. Weight‐for‐age z scores at nadir (postedema) were lower in HIV‐seropositive children (median, ‐4.4; interquartile range [IQR], −5.0 to −3.8) than in HIV‐seronegative children (median, −3.7; IQR, ‐4.2 to ‐3.1;P < 0.0001). Height‐for‐age and weight‐for‐height z scores and mid‐upper arm circumference showed a similar difference. Of the 200 children, 39 (19.5%) died within 28 days; cryptosporidiosis and marasmus were the only independent predictors of death.ConclusionsAlthough intestinal and systemic infections did not differ for HIV‐seropositive and HIV‐seronegative children, HIV influenced nutritional states of all children. Cryptosporidiosis and marasmus were associated with higher mortality.
Extent of Intestinal Damage in the Developing Chick Embryo After Repetitive Hypoxia Under Normoxic or Hyperoxic Conditions
Authors: Van Golde Jolanda , Tibboel Dick , Okazaki Tadaharu , Blanco Carlos E. 
Published: January 2024

ABSTRACTBackgroundEpisodes of hypoxia and reperfusion play an important role in the development of intestinal damage during perinatal development. The aim of this study was to investigate the histopathology of the intestine in the developing chick embryo after exposure to repetitive hypoxia and recovery under two different conditions: normoxic and hyperoxic (60% O 2 ).MethodsChick embryos were exposed to 5 minutes of hypoxia. This was repeated six times with a recovery period of 15 minutes under normoxic conditions (21% O 2 ) for chick embryos in test group 1 (TG1) and under hyperoxic conditions (100% O 2 ) for chick embryos in test group 2 (TG2), from day 11 until day 20. Chick embryos that recovered under hyperoxic conditions (100% O 2 ) were previously incubated under hyperoxic conditions (60% O 2 for 24 hours). Histologic evaluation of the ileum was performed at different times after the interventions (2, 4, 8, 16, and 24 hours).ResultsIn both test groups, only chick embryos older than 19 days showed intestinal damage. Intestinal histology on day 19 showed vasodilation of villus capillaries (10% in TG1 and 15% in TG2), necrosis in the top of the villi (29% in TG1 and 30% in TG2), and necrosis with preservation of base of the crypts (2% in TG1) and transmucosal necrosis (2% in TG2).ConclusionsSignificant histologic changes, compared with the control group, were only found in chick embryos that were studied 2 hours after the interventions. Furthermore, recovery under hyperoxic conditions did not cause more intestinal damage compared with recovery under normoxic conditions.
13 C Mixed Triglyceride Breath Test: A Noninvasive Method to Assess Lipase Activity in Children
Authors: van Dijk‐van Aalst Kristal , Van Den Driessche Mieke , van der Schoor Sophie , Schiffelers Sandra , van't Westeinde Tanneke , Ghoos Yvo , Veereman‐Wauters Gigi 
Published: January 2024

ABSTRACTBackgroundResults from the 13 C mixed triglyceride (MTG) breath test correlate with duodenal lipase activity in adults. This noninvasive test is a potential screening and diagnostic tool for children with fat malabsorption. The aim of this study was to adapt the methodology of the MTG breath test to study test meals and sampling methods and to define normal values for healthy children of all age groups; premature and full‐term infants have similar pancreatic lipase deficiencies.MethodsAfter parental consent was obtained, 12 premature infants (< 37 weeks gestation and with body weights > 2 kg), 12 full‐term infants (1–6 months old), 20 children (3–10 years old), and 20 teenagers (11–17 years old) were tested. All children were thriving well, had no gastrointestinal or respiratory problems, and had not received any medication that contained natural 13 C. For the premature and full‐term infants, a formula was prepared that had a low and stable natural 13 C content mixed with 100 mg 13 C‐labeled MTG (1,3‐distearyl, 2‐[ 13 C‐carboxyl] octanoyl glycerol) and 1 g polyethylene‐glycol 3350. The best accepted test meal for children over 3 years old was a slice of white bread with 5 g butter and 15 g chocolate paste, mixed with 250 mg 13 C‐labeled MTG, and a glass of 100 mL whole‐fat milk. Children over 3 years old were able to blow through a straw in a vacutainer for collecting the breath samples. In children under 3 years old, expired air was collected by aspirating breath via a nasal prong. Carbon dioxide production was calculated according to weight, age, and sex.ResultsFor healthy pediatric control participants, the mean values for cumulative excretion of 13 CO 2 as a percentage of the administered dose after 6 hours were 23.9 ± 5.2% in premature infants, 31.9 ± 7.7% in full‐term infants, 32.5 ± 5.3% in children, and 28.0 ± 5.4% in teenagers. The mean value for healthy adults is 35.6% with a lower reference limit of 22.8%.ConclusionsAge‐specific test meals and breath‐sampling techniques for the MTG breath test were defined. The mean values for different age groups may serve as guidelines for normal values in the pediatric population. The cumulative values for expired 13 CO 2 were above the lower limit for adults, which suggests that preduodenal lipases compensates for pancreatic lipase deficiency in premature and full‐term infants.
Cisapride Plasma Levels and Corrected QT Interval in Infants Undergoing Routine Polysomnography
Authors: Benatar A. , Feenstra A. , Decraene T. , Vandenplas Y. 
Published: January 2024

ABSTRACTBackgroundReported QTc prolongation associated with cardiac arrhythmia in a small number of children undergoing cisapride therapy and lack of pharmacokinetic correlation provided the impetus for this prospective study. The authors evaluated the relation between cisapride plasma concentrations, the electrocardiographic QT interval, and cardiac rhythm in infants undergoing routine 8‐hour polysomnography.MethodsA total of 211 infants were enrolled: 84 (17 born prematurely) undergoing cisapride therapy for at least 4 days for suspected gastroesophageal reflux and 127 controls (10 born prematurely), aged between 1 week and 13.5 months. Infants underwent continuous bipolar limb lead I recording during routine 8‐hour polysomnography. QT intervals and heart rate were measured at hourly intervals. The morning after polysomnography, 12‐lead electrocardiography was performed (1 hour after cisapride administration). Cisapride plasma concentrations were determined immediately before and 1 to 2 hours after administration. Serum electrolyte concentrations were measured.ResultsThe administered cisapride dose ranged from 0.35 to 1.55 (mean, 0.81, median 0.79) mg · kg −1 · d −1 . Cisapride plasma concentrations were significantly higher in infants younger than 3 months of age. Cisapride‐treated infants younger than 3 months of age had longer QTc intervals compared with age‐matched controls. Heart rate was similar for cisapride‐treated and control infants. No arrhythmia or atrioventricular conduction abnormalities were observed.ConclusionsAt comparable doses of cisapride and comparable plasma concentrations, the QTc was significantly higher in infants younger than 3 months of age. This confirms age‐dependent cisapride pharmacokinetics in the first 10 to 12 weeks strongly correlated with changes in body weight and may also suggest an altered ability of infants younger than 3 months of age to metabolize cisapride. The clinical significance and risk of the increased QTc interval is unclear. Cisapride should be judiciously prescribed in infants younger than the age of 3 months and electrocardiography should be performed before and during therapy.
Autonomic Abnormalities in Children With Functional Abdominal Pain: Coincidence or Etiology?
Authors: Chelimsky Gisela , Boyle John T. , Tusing Lora , Chelimsky Thomas C. 
Published: January 2024

ABSTRACTBackgroundThere is increasing evidence that autonomic neuropathies may adversely affect gastrointestinal motility by involving the extrinsic nerves of the gut. The authors' hypothesize that functional abdominal pain in children is associated with generalized autonomic dysfunction.MethodsThe authors performed detailed autonomic testing in eight patients with functional abdominal pain, including deep breathing, Valsalva, tilting (to assess parasympathetic and sympathetic adrenergic function), and axon‐reflex function and thermoregulatory sweat testing to assess sympathetic cholinergic function. Patients also completed a questionnaire regarding other autonomic symptoms.ResultsResults of autonomic testing were abnormal in seven patients. Parasympathetic function was normal in all, and the abnormalities were restricted to sympathetic cardiac, vasomotor, and sudomotor function. Abnormal results of axon‐reflex testing in six were consistent with peripheral nervous system dysfunction. Five had decreased sweating over the abdomen, determined by thermoregulatory sweat testing. Five eight had nongastrointestinal autonomic symptoms, primarily palpitations and flushing.ConclusionsFunctional abdominal pain in the current patients is associated with generalized dysfunction of the autonomic nervous system. This dysfunction can be peripheral or central in different individuals but seems to be restricted to the sympathetic branch. The known function of the sympathetic nervous system as the motility “brake” suggests that pain could be a manifestation of unmodulated peristalsis, resulting in abdominal cramps.
Screening for Celiac Disease in Children With Recurrent Abdominal Pain
Authors: Fitzpatrick Kelly P. , Sherman Philip M. , Ipp Moshe , Saunders Norman , Macarthur Colin 
Published: January 2024

ABSTRACTBackgroundThe clinical presentation of celiac disease—a life‐long gluten intolerance—may be characterized by chronic abdominal pain. The objective of this study was to determine if children with recurrent abdominal pain had a higher prevalence of antiendomysial antibodies (a serologic marker of celiac disease) compared with healthy children.MethodsChildren with recurrent abdominal pain and healthy control participants were recruited from the offices of community pediatricians. Serum samples were drawn and antiendomysial antibodies were measured in both groups. Demographic data included age, gender, height, and weight.ResultsA total of 200 children were recruited, of whom 173 (87%) had serum samples drawn. Of these, 92 were children with recurrent abdominal pain and 81 were control participants. Only 2 of the 173 samples (1.2%) were positive for antiendomysial antibody. The frequency of antiendomysial antibody positivity in children with recurrent abdominal pain was 1 in 92 (1%; 95% confidence interval, 0–6%) compared with 1 in 81 (1%; 95% confidence interval, 0–7%) in control participants.ConclusionsThis community‐based case‐control study found no association between recurrent abdominal pain and the prevalence of antiendomysial antibody. Therefore, these data do not support screening for celiac disease in the child with classic recurrent abdominal pain in the primary care setting.
Effects of Therapy With Lansoprazole on Intestinal Permeability and Inflammation in Young Cystic Fibrosis Patients
Authors: Hendriks Han J. E. , van Kreel Bernard , Forget Philippe P. 
Published: January 2024

ABSTRACTBackgroundDefective pancreatic bicarbonate secretion with low intestinal pH or intestinal inflammation of any origin increase intestinal permeability in cystic fibrosis (CF).MethodsIn this open study, the authors evaluated the effect of a proton‐pump inhibitor on intestinal permeability and inflammation in 14 young, pancreatic‐insufficient CF patients. Permeability was measured by a three‐sugar permeability test before and after 1 year of lansoprazole use, and urinary nitric oxide (NO) oxidation products were assessed before and during that year as a marker of inflammation.ResultsAfter 1 year of lansoprazole use, median urinary recovery percentages changed from 2.5% to 1.7% (P = 0.064), from 24.9% to 24.5% (no significance), and from 10.5% to 11.1% (no significance) for lactulose, mannitol, and l ‐rhamnose, respectively. Despite the fact that the median urinary excretion ratios decreased from 0.108 to 0.083 (P = 0.03) and from 0.246 to 0.176 (P = 0.016) for lactulose and mannitol and for lactulose and rhamnose, respectively, they both remained increased. Median urinary NO products‐to‐creatinine ratios were 0.287 for CF patients before lansoprazole and 0.130 for healthy control participants (P = 0.002). Although there was a tendency toward a decrease in the NO products‐to‐creatinine ratio during treatment, this was not significant at the end point.ConclusionsIntestinal permeability is considerably increased in CF patients and is partly corrected after the use of a proton‐pump inhibitor for 1 year, which may point to a harmful effect of the acid luminal contents on the tight junctional related paracellular permeability pathway. The start and end values for the NO products‐to‐creatinine ratio in CF patients were not significantly different, but were considerably increased when compared with control participants (P = 0.002).
Contamination of Gastrostomy Feeding Systems in Children in a Home‐Based Enteral Nutrition Program
Authors: Bott L. , Husson M. O. , Guimber D. , Michaud L. , Arnaud‐Battandier F. , Turck D. , Gottrand F. 
Published: January 2024

ABSTRACTBackgroundThere are few data concerning the risk of contamination of enteral feeding systems via gastrostomy in children, and none for conditions that pertain to home‐based care.MethodsTo investigate the risk of contamination of enteral feeding systems during the home‐based care of 20 children receiving gastrostomy tube feeding, five samples were taken for analysis: two samples before the enteral feeding period (gastrostomy, enteral feeding system) and three after this period (gastrostomy, distal giving set, liquid remained in container). Microorganisms were identified and counted. Different factors were studied to elucidate their role in bacterial colonization: acid suppressive therapy, gastrostomy tube or button, hanging feeding time, rate of enteral feeding, gastric pullulation and retrograde contamination, manipulation error, and use of open or closed enteral feeding systems.ResultsOvergrowth was defined as a microorganismal load exceeding 10 4 colony‐forming units (cfu)/mL. Overgrowth was present in 85% of gastrostomy samples before enteral nutrition started. Most microorganisms belonged to gastric flora. Some bacteria had an environmental origin or derived from cutaneous flora. Forty‐five percent of the lines showed overgrowth at the end of enteral nutrition period, mainly with the same microorganism found in the gastrostomy. Closed enteral bags remained sterile, even if manipulation error occurred. Duration, rate of enteral feeding, and acid suppression treatment were not risk factors for overgrowth.ConclusionsRetrograde contamination of gastrostomy feeding systems occurs frequently. The preferential use of closed enteral feeding systems is recommended for home‐based enteral nutrition programs.
Gastric Electrical Activity and Gastric Emptying in Preterm Newborns Fed Standard and Hydrolysate Formulas
Authors: Riezzo G. , Indrio F. , Montagna O. , Tripaldi C. , Laforgia N. , Chiloiro M. , Mautone A. 
Published: January 2024

ABSTRACTBackgroundBecause infant formulas containing hydrolyzed cow milk protein are used to reduce feeding intolerance and to improve gastric emptying, the effect on gastrointestinal motility of a hydrolysate formula was compared with that of a standard preterm formula.MethodsThirty‐six preterm newborns with a gestational age of 32.2 ± 2.3 weeks were assigned randomly to standard formula or hydrolyzed formula. Cutaneous electrogastrography and ultrasound examination of gastric emptying were performed simultaneously to evaluate gastrointestinal motility before and after the test meal. All recording sessions were performed 1 week after infants had reached full enteral feeding.ResultsNo significant difference in gastrointestinal symptoms was noted in the newborns fed the different formulas. In particular, regurgitation and vomiting were observed in 78% versus 64% of preterm newborns after standard and hydrolyzed formula, respectively (Fisher exact test, not significant). No differences were found in terms of gastric electrical activity and gastric emptying time between the two groups.ConclusionsIt seems unnecessary to use hydrolysate formulas to improve motility in preterm infants.
Effect of Feeding Yogurt Versus Milk in Children With Acute Diarrhea and Carbohydrate Malabsorption
Authors: Boudraa Ghazalia , Benbouabdellah Malika , Hachelaf Wahiba , Boisset Michel , Desjeux Jehan‐François , Touhami Mahmoud 
Published: January 2024

ABSTRACTBackgroundThe aim of this study was to compare the effect of infant formula and the same formula subjected to microbial fermentation (yogurt) on the duration of diarrhea in young children with acute watery diarrhea, with or without reducing substances in stools.MethodsOne hundred twelve well‐nourished children, aged 3 to 24 months, who were admitted to the hospital with acute watery diarrhea were included in a randomized trial. After appropriate rehydration, they were fed either an infant formula (group M, n = 56) or the same formula fermented with Lactobacillus bulgaricus and Streptococcus thermophilus (group Y, n = 56). The two feedings were comparable in lactose concentration (40 to 42 g/L), pH 4.5, flavor, and texture. The groups were subdivided into those with or without reducing sugars in stools at presentation. The presence of reducing sugars in stool was used as a marker of carbohydrate malabsorption.ResultsGroup M and group Y had comparable clinical characteristics at admission, including the number of patients with reducing sugars in stools (n = 31 in group M and 27 in group Y). The success rate (cessation of diarrhea and appropriate weight gain 7 days after enrollment into the study) was similar in both groups (82% in group M vs. 84% group Y). Clinical failure was 3.6% in both groups. The percentage of patients withdrawn from the study for medical reasons (5.4% in group M vs. 7.1% in group Y) or withdrawn at the parents’ request (8.9% in group M vs. 5.4% in group Y) was similar. Duration of diarrhea and number of stools were significantly less in group Y compared with group M. Forty‐eight hours after inclusion, diarrhea was still present in 62% of group M versus in 35% of group Y (P < 0.002). In children with reducing sugars in stools, the rate of success (82%) was similar in groups M and Y, but the duration of diarrhea and number of stools per day were significantly decreased in group Y. Forty‐height hours after inclusion, diarrhea was still present in 75% of group M patients and in 20% of group Y patients who had reducing substances in the stool.ConclusionYoung children with acute watery diarrhea, without malnutrition or associated disease, can be equally well treated with feeding of either infant formula or yogurt. Yogurt feeding is associated with a clinically relevant decrease in stool frequency and duration of diarrhea in children who have reducing sugars in stools.
Are Children with Cystic Fibrosis Who Are Treated With a Proton‐Pump Inhibitor at Risk for Vitamin B 12 Deficiency?
Authors: ter Heide Henriëtte , Hendriks Han J. E. , Heijmans Hiltje , Menheere Paul P. C. A. , Spaapen Leo J. M. , Bakker Jaap A. , Forget Pierre‐Philippe 
Published: January 2024

ABSTRACTBackgroundIn a recent study, the authors demonstrated the beneficial effect of proton‐pump inhibitors (PPI) on fat malabsorption and bone mineral content in children with cystic fibrosis (CF). Prolonged use of PPI could result in vitamin B 12 deficiency as a consequence of impaired release of vitamin B 12 from food in a nonacid environment. The aim of this study was to evaluate the vitamin B 12 status of CF patients either treated with a PPI or not by measuring vitamin B 12 and homocysteine blood levels, the latter being a sensitive indicator of vitamin B 12 deficiency.MethodsThe study population consisted of 20 CF patients, 11 patients treated with a PPI for at least 2 years and 9 patients not treated with a PPI, and 10 healthy, age‐matched control participants. Homocysteine blood levels were measured by high‐performance liquid chromatography, and vitamin B 12 levels were measured by a competitive protein‐binding assay.ResultsVitamin B 12 levels were significantly higher in both CF groups compared with the control participants (PPI+, P = 0.02; PPI−, P = 0.009). There was no significant difference in vitamin B 12 levels between both CF groups. Homocysteine levels were normal and similar in all groups.ConclusionsCystic fibrosis patients treated with a PPI for at least 2 years show no signs of vitamin B 12 deficiency.