Biomedical subjects
Publications and source records attributed to J P Chouraqui.
This paper presents practical guidelines for nutrition and feeding of infants and toddlers including vitamin D, vitamin K and fluoride supplementations and preventive measures at risk for food allergy based on family history.
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This paper written by the Comité de nutrition de la Société française de pédiatrie is specially devoted to the nutritional treatment of infant and child acute diarrhea, i.e. oral rehydration with salts solution and feeding. It complements an article on drug therapy of child acute diarrhea written by the Groupe francophone d'hépatologie, gastroentérologie et nutrition pédiatriques, and published in this same issue of the Archives de pédiatrie.
In this paper written by the Groupe francophone d'hépatologie, gastroentérologie et nutrition pédiatriques, recommendations are given on the indications of drugs in infant and child infectious acute diarrhea, based upon the current scientific knowledge on their effectiveness and tolerance. This paper complements an article on nutritional treatment of acute diarrhea written by the Comité de nutrition de la Société française de pédiatrie, and published in the same issue of the Archives de Pédiatrie.
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Gastroenteritis continue to be a major cause of mortality and morbidity worldwide. The main objectives in the approach to a child with acute gastroenteritis are to assess the degree of dehydration and provide fluid and electrolyte replacement. The general agreement among paediatric gastroenterologists is to consider that the optimal management of acute gastroenteritis in mild to moderately dehydrated children in Europe should consist of the following practical guidelines: use of oral fast rehydration solution (ORS) to correct estimated dehydration over 3-4 hours using an hypo-osmolar solution; continuation of breast feeding throughout; early refeeding i.e. resumption of normal diet (without restriction of lactose intake) after 4 hours rehydration in most children, while maintaining supplementing fluids with ORS in order to prevent further dehydration; no unnecessary medication.
For many years soy bean-based formulas (SBBF) were the only dietary product used for infants with cow's milk intolerance. At the present time, their place in infant nutrition is reduced as a result of the availability of new dietary products without lactose and/or cow's milk proteins and the recognition of soy bean protein allergy. There is no evidence that SBBF have any efficiency in infant colic. SBBF have no indication in the prevention of allergy, nor in premature infants' nutrition. Their main indication is the feeding of infants of vegetarian parents who do not want to use cow's milk products. Studies have shown that SBBF contain large quantities of phytoestrogens, particularly isoflavone. Because of experimental data suggesting a possible deleterious effect of phytoestrogens on the neuroendocrine maturation, the reduction of their content in SBBF must be considered.
Sodium alginate (Gaviscon) is used in the management of gastro-oesophageal reflux in infants. No digestive disadvantages have as yet been reported with the use of the Gaviscon formula available in France, which contains neither aluminium hydroxide nor thickener. Twenty-two healthy neonates were prospectively studied before and after Gaviscon treatment in order to characterize their whole gut transit time with the use of a carmine index. The head of the marker appeared within the same time in both experiments but the appearance of the tail was earlier in the treated infants (P < 0.05), without any subsequent clinical consequences. The slight increase shown in the rate of the clearance of the marker from the gut, is likely to be related to a less proximal to distal dispersion of the marker, subsequently to physical changes occurring in the viscous alginate. Frequency and consistency of the stools were unmodified by treatment and accordingly Gaviscon can be regarded as having no deleterious effect on transit time in neonates.
Forty cases of irritable bowel syndrome with complete dietary histories were examined retrospectively. Included were infants and children aged 6 to 42 months, who had diarrhoea at least 4 weeks duration, a normal pattern of growth and no evidence of malabsorption or enteric infections. The majority (92.5%) of these patients had been on high carbohydrate, high protein and low fat diets prior to referral. Ten percent of the patients lost weight as a result of marginal caloric intake subsequent to restrictive dietary advice. In 19 of the 25 patients compliant to dietary recommendations, this modification was associated with the resolution of symptoms. Based on this study and previous others we suggest to carefully gather dietary intake information for all patients fulfilling the usual criteria for irritable bowel syndrome and recommend a therapeutic trial of increased dietary fat and diminished carbohydrates and even proteins intake.
Knowledge concerning the absorptive phase of fat remains relatively scanty as compared to the wealth of information available on the digestive phase. However, the past years have seen important developments in our understanding of chylomicron formation and secretion. This has come about thanks to clinical studies of rare congenital disorders of chylomicron synthesis and exocytosis and to the creation of experimental models.
The authors report a case of massive pneumoperitoneum in a newborn who underwent assisted-ventilation for a severe aspiration of meconial amniotic fluid. Clinical and roentgengraphic findings that are helpful in differentiating a pneumoperitoneum of gastrointestinal origin from an extrathoracic air leak are reviewed. In such a situation, laparotomy should be avoided.
The use of somatostatin in the treatment of a newborn infant with hyperinsulinism is reported. When administered alone, somatostatin was only able to prevent hypoglycemia for a short period of time, whereas the addition of a constant infusion of glucagon allowed successful control of the patient's hypoglycemia. As hyperinsulinism relapsed after a subtotal pancreatectomy, a trial was carried out with a somatostatin analog, which has an expected longer duration of action. It led to a significant rise in the blood glucose level but failed to prevent safely hypoglycemia even when 4 injections were performed daily.
The detection of group B streptococcal soluble antigens was performed in 139 newborn infants suspected of infection. A qualitative agglutination test of sensitized latex particles (Wellcogen Strep B) was performed in the urine. The diagnosis of group B streptococcal infection was assessed by retrospective analysis of patient files using previously defined criteria. The correlation between the agglutination test result and the presence or absence of streptococcal infection was statistically significant; the test had a sensitivity of 81%, specificity of 97%, positive predictive value of 76% and negative predictive value of 98%. This study confirms the interest of such a test in the early diagnosis of group B streptococcal infection in infants.
Two children with type I glycogen-storage disease were treated at home with continuous nocturnal intragastric feeding, using a high glucose formula. The children were 6.5 years and 32 months old respectively when initiating treatment, and they have now been treated for 24 and 18 months. A high carbohydrate meal was given soon after stopping the nocturnal infusion, and this was followed by frequent daytime feeding. In this way, the children were rapidly discharged from hospital and soon returned to school. This regimen stabilized blood glucose levels, avoiding hypoglycemic complications, and improved tolerance to fasting and exercise. Moreover it decreased serum triglyceride, cholesterol, uric acid and lactate levels as well as liver size. The increase in linear growth rate was remarkable and was associated with an increase in insulin-glucagon ratio. No complications resulted from the gastric tube. The method proved to be effective, simple, practical and acceptable by children and their parents. In addition, it is relatively inexpensive and represents a reliable long-term alternative therapy to portocaval shunting for patients with type I glycogen-storage disease. The nocturnal infusions should be continued until after adolescence.
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93 children and adolescents with Crohn's disease have been studied. Terminal ileum (25.8%) and ileum and colon (61.3%) were the most common sites of involvement as determined by X-ray examination. The mean age at the time of diagnosis was 13.2 years. A familial incidence of chronic inflammatory bowel disease was found in 12 patients (12.9%). The most common symptoms were: abdominal pain, anorexia, lassitude, diarrhea, loss of weight. Weight below the third percentile, pain on abdominal palpation, anal lesions, mouth ulcers and clubbing of the fingers were the most common clinical signs at the time of diagnosis. Growth retardation (below the third percentile) was present in 22 of 79 children (27.8%) with a mean follow-up of 40 months. 16 patients out of 75 had initial rectal biopsies with histologic changes characteristic of Crohn's disease. 27 patients had surgical treatment; six of them experienced a relapse within a mean period of 26.7 months. Lastly, the authors show that continuous elemental enteral alimentation (CEEA) during 3 weeks induces a remission. CEEA on a longer period is specially targetted to the treatment of growth retardation.