RESUMEN
OBJECTIVES: To evaluate anorectal motor function in healthy premature and term infants with the use of micromanometric techniques. STUDY DESIGN: Anorectal manometry was performed in 22 healthy neonates (9 female) with a mean postmenstrual age of 32 weeks (range, 30 to 38 weeks) with a micromanometric anorectal assembly (od 2.0 mm). The assembly incorporated a 2-cm-long sleeve sensor for measurement of resting anal sphincter pressures and relaxation, and 4 sideholes recorded anal and rectal pressures. Rectal distension was performed with a latex balloon or direct air insufflation to elicit the anorectal inhibitory reflex (AR). RESULTS: The mean anal sphincter pressure, rectal pressure, and rhythmic wave frequency were 40 mm Hg (range, 7 to 65 mm Hg), 11 mm Hg (range, 1 to 27 mm Hg), and 10/min (range, 8 to 14/min), respectively. A normal AR could be elicited in 21 of the 22 infants studied. CONCLUSION: An anorectal micromanometric sleeve catheter is suitable for use in evaluating anorectal pressures in preterm and term neonates. Insufflation of air without the use of a balloon to elicit the AR is reliable and suitable for use in infants <34 weeks. Premature infants older than 30 weeks' postmenstrual age have normal anorectal pressures and a normal AR.
Asunto(s)
Canal Anal/fisiología , Recien Nacido Prematuro , Manometría/métodos , Reflejo , Análisis de Varianza , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Manometría/instrumentación , PresiónRESUMEN
OBJECTIVES: To characterize esophageal body and lower esophageal sphincter (LES) motor function in very premature infants. STUDY DESIGN: Esophageal manometry was performed in 12 very premature infants of 26 to 33 weeks' postmenstrual age (PMA) (body weights of 610-1360 g). Esophageal motor patterns were recorded for 30 minutes with a perfused micromanometric sleeve assembly (outer diameter, 2.0 mm). RESULTS: Esophageal pressure waves triggered by dry swallows were predominantly (84%) peristaltic in propagation sequence. All infants showed tonic LES contraction; the mean resting LES pressure (LESP) for individual infants ranged from 5.0 +/- 4.1 mm Hg to 20.0 +/- 4.8 mm Hg. In all infants the LES relaxed (duration, 5.8 +/- 3.0 seconds; nadir pressure, 1.8 +/- 2.6 mm Hg) in response to pharyngeal swallows. Transient LES relaxations (TLESRs) (duration, 21.7 +/- 8.7 seconds; nadir pressure, 0.1 +/- 1.8 mm Hg) occurred on average 2.6 +/- 1.6 times per study; 86% of these relaxations triggered esophageal body common cavity events known to be associated with gastroesophageal reflux. CONCLUSIONS: Esophageal motor function is well developed in very premature infants. Our data also suggest that TLESR is the predominant mechanism of reflux in these babies.
Asunto(s)
Esófago/fisiología , Recien Nacido Prematuro/fisiología , Unión Esofagogástrica/fisiología , Humanos , Recién Nacido , Recién Nacido de muy Bajo Peso , Manometría , Contracción Muscular , Peristaltismo , PresiónRESUMEN
OBJECTIVES: Strobel's formula (Esophageal length = 5 + 0.252 x Height) is frequently used as a guide for determining the distance from the nares to the lower esophageal sphincter (LES) in term infants. The aim of this study was to examine this relationship in premature infants. STUDY DESIGN: The distance from nares to LES was manometrically determined in 156 premature infants (26-40 weeks' postmenstrual age; body weights of 610-3050 g). The ability of body weight, height (body length), head circumference, and postmenstrual age to predict the manometrically determined LES position was evaluated with linear and non-linear regression analyses. RESULTS: Body weight and body length were the most predictive of distance from nares to LES (r(2) = 0.848 and 0.802, respectively). These relationships were non-linear and, in the case of body length, deviated substantially from Strobel's model. CONCLUSIONS: In premature neonates, a different formula is needed for prediction of the distance between nares and LES than that applied to term infants and children.
Asunto(s)
Unión Esofagogástrica/anatomía & histología , Recien Nacido Prematuro , Antropometría , Estatura , Peso Corporal , Cefalometría , Femenino , Humanos , Recién Nacido , Masculino , Nariz/anatomía & histologíaRESUMEN
OBJECTIVE: To evaluate the efficacy of cisapride in the treatment of uncomplicated gastroesophageal reflux in children younger than 36 months of age. STUDY DESIGN: A total of 95 patients satisfied the entry criteria and were randomly assigned to double-blind treatment with either cisapride (n = 50), 0.2 mg/kg 4 times daily, or placebo (n = 45) for 2 weeks. At the end of the 2-week treatment period, symptom diary and parental evaluation with repeat 24-hour pH study were performed. RESULTS: Sixty-eight patients completed the trial (38 in the cisapride group and 30 in the placebo group). There were no significant differences in the symptoms of crying, vomiting, or gagging; the overall symptom intensity score; or parental global evaluations. There was a significant difference (P <.03) in the percent time pH <4, the number of reflux episodes lasting more than 5 minutes, and the duration of the longest episode. No significant difference was demonstrated for the number of episodes with pH <4 or the reflux score. CONCLUSIONS: Cisapride was no better than placebo for relief of symptoms in children with uncomplicated gastroesophageal reflux. A beneficial effect was demonstrated in the cisapride group in relation to the measured parameters for esophageal acid exposure time.
Asunto(s)
Cisaprida/uso terapéutico , Reflujo Gastroesofágico/tratamiento farmacológico , Fármacos Gastrointestinales/uso terapéutico , Administración Oral , Australia , Distribución de Chi-Cuadrado , Cisaprida/efectos adversos , Método Doble Ciego , Esófago/fisiopatología , Femenino , Reflujo Gastroesofágico/diagnóstico , Fármacos Gastrointestinales/efectos adversos , Humanos , Concentración de Iones de Hidrógeno , Lactante , Masculino , Placebos , Estadísticas no Paramétricas , Insuficiencia del TratamientoRESUMEN
OBJECTIVES: To investigate the relationship of intestinal permeability in children and adolescents with inflammatory bowel disease (IBD) to disease activity, disease extent, and response to therapy. STUDY DESIGN: Patients with new and established diagnoses of IBD (12 Crohn's disease [CD] and 18 ulcerative colitis [UC]) were studied. Intestinal permeability was evaluated by measuring with high-performance liquid chromatography 5-hour urinary excretion ratio of lactulose/L-rhamnose (L/Rh). RESULTS: In 8 of 9 patients with active CD, the L/Rh ratio was higher than the reference range (0.006 to 0.074, n = 36). In inactive CD (n = 3) the L/Rh ratio was within the reference range. In 6 of 7 patients with active extensive UC, the L/Rh ratio was elevated. In inactive extensive UC (n = 6) the normal permeability ratio was shown. In both active CD and active extensive UC, the frequency of elevated intestinal permeability was significantly greater than values in both inactive forms. The permeability ratio was normal in 4 of 5 patients with active left-sided colitis. In 5 of 7 patients (3 CD, 4 UC), repeat permeability values entered the reference range after acute phase therapy. Two patients with persistently elevated intestinal permeability (1 CD, 1 UC) had a disease flare-up within 6 months. CONCLUSIONS: Intestinal permeability is a marker of disease activity in CD and extensive UC. Serial permeability test may be useful in monitoring disease activity.
Asunto(s)
Colitis Ulcerosa/diagnóstico , Enfermedad de Crohn/diagnóstico , Mucosa Intestinal/metabolismo , Adolescente , Permeabilidad de la Membrana Celular , Niño , Cromatografía Líquida de Alta Presión , Colitis Ulcerosa/metabolismo , Enfermedad de Crohn/metabolismo , Femenino , Humanos , Lactulosa/orina , Masculino , Valores de Referencia , Ramnosa/orinaRESUMEN
OBJECTIVES: The aim of this study was to characterize the motor events responsible for gastroesophageal reflux (GER) and esophageal acid clearance in a cohort of healthy preterm infants. STUDY DESIGN: Esophageal motility was recorded for 2 to 3 hours after a feeding in 24 preterm infants, 31 to 38 weeks' postmenstrual age, by using a sleeveside hole micromanometric assembly incorporating a pH probe. RESULTS: Sixty acid GER episodes were recorded by pH probe, and 133 non-acid GER episodes were recorded manometrically by the presence of esophageal common cavities. Of the 193 GER episodes, 159 (82%) were associated with transient lower esophageal sphincter relaxation (TLESR). TLESRs were significantly longer in duration than single swallows (15.1 seconds vs 5.6 seconds, P < .001) and had lower nadir pressures (0.8 mm Hg vs 2.3 mm Hg, P < .001). A total of 3216 esophageal body pressure waves were analyzed; 70% of swallow-induced pressure waves were peristaltic in sequence compared with 5% of swallow-unrelated pressure waves. During periods of esophageal acidification (pH below 4), peristaltic esophageal body pressure wave sequences cleared acid refluxate more effectively than nonperistaltic pressure wave sequences. CONCLUSIONS: In healthy preterm infants, TLESRs are the predominant mechanism underlying GER, and esophageal clearance mechanisms are well developed by at least 31 weeks' postmenstrual age.
Asunto(s)
Reflujo Gastroesofágico/fisiopatología , Enfermedades del Prematuro/fisiopatología , Estudios de Cohortes , Unión Esofagogástrica/fisiopatología , Esófago/fisiología , Femenino , Ácido Gástrico/fisiología , Determinación de la Acidez Gástrica , Reflujo Gastroesofágico/diagnóstico , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Masculino , Manometría , Peristaltismo/fisiologíaRESUMEN
To assess the possible relationship between maternal drug use during pregnancy and subsequent sudden infant death syndrome (SIDS), we identified 1760 cases of SIDS from a population of more than 1.2 million infants (1.45/1000) born in New York City between 1979 and 1989. The SIDS rate in drug-exposed infants was 5.83 per 1000 infants, compared with 1.39 per 1000 infants who were not drug exposed. With control for known associated high-risk variables, the risk ratio for SIDS in each individual drug group (methadone, 3.6; heroin, 2.3; methadone and heroin, 3.2; cocaine, 1.6; cocaine and methadone or heroin, 1.1) was higher than in the non-drug-exposed group. Higher rates of SIDS were found in infants exposed to opiates alone than in cocaine-exposed infants, but increasing rates of SIDS in cocaine-exposed infants toward the end of the decade suggested that "crack" cocaine may be linked to these increasing rates. Declines in the overall rate of SIDS during the decade were observed for both the drug-exposed (11.28 to 4.09 per 1000) and the nonexposed groups (1.70 to 1.05 per 1000). Differences in rates of SIDS between major racial-ethnic groups in nonexposed infants were not apparent if the mothers used drugs during pregnancy. Seasonal variation and distribution of ages at time of SIDS death did not differ between the drug-exposed group and the nonexposed group, suggesting that drug-associated SIDS may provide clues as to the cause or causes of SIDS.
Asunto(s)
Cocaína , Heroína , Metadona , Efectos Tardíos de la Exposición Prenatal , Trastornos Relacionados con Sustancias/complicaciones , Muerte Súbita del Lactante/etiología , Adulto , Factores de Edad , Distribución de Chi-Cuadrado , Intervalos de Confianza , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Ciudad de Nueva York/epidemiología , Embarazo , Riesgo , Factores Sexuales , Trastornos Relacionados con Sustancias/epidemiología , Muerte Súbita del Lactante/epidemiología , Población Urbana/estadística & datos numéricosRESUMEN
An infant with epidermolysis bullosa simplex had diarrhea at 3 weeks of age; severe ulcerative colitis was subsequently diagnosed. Epidermolysis bullosa simplex has not been associated with gastrointestinal disease except for buccal ulceration.
Asunto(s)
Colitis Ulcerosa/complicaciones , Epidermólisis Ampollosa Simple/complicaciones , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/patología , Colon/patología , Epidermólisis Ampollosa Simple/epidemiología , Epidermólisis Ampollosa Simple/patología , Humanos , Recién Nacido , Masculino , Piel/patologíaRESUMEN
In 122 healthy newborn infants, we studied the relationship between breath hydrogen (H2) production after feedings containing lactose (human milk or commercial formula) in colicky and noncolicky infants at 6 weeks and 3 months. Eighty-three infants (68%) developed colic (mild, moderate, or severe) by 2.6 +/- 1.8 weeks of age (mean +/- SD). Zero time (baseline) breath H2 values were significantly higher in colicky compared with noncolicky infants at both 6 weeks (40.6 +/- 41.4 vs 14.8 +/- 32.9 ppm) and 3 months (27.7 +/- 38.1 vs 8.5 +/- 18.2 ppm). There were significantly more positive breath H2 tests in colicky compared with noncolicky infants at 6 weeks (78% vs 36%) and 3 months (89% vs 45%). Failure to produce H2 throughout the breath H2 test was significantly more frequent in noncolicky compared with colicky infants at 6 weeks (50% vs 18%) and 3 months (43% vs 4%). These findings remained significant even when infants with mild colic (at 6 weeks and 3 months) were included in the noncolicky group. We conclude that colicky infants produce more breath H2 in the fasting state and in response to feedings containing lactose than noncolicky infants produce. This may represent increased lactose malabsorption, differences in colonic bacterial fermentation conditions, or differences in the handling of colonic gas produced.
Asunto(s)
Pruebas Respiratorias/métodos , Cólico/etiología , Hidrógeno/metabolismo , Enfermedades Intestinales/etiología , Intolerancia a la Lactosa/complicaciones , Prueba de Tolerancia a la Lactosa/métodos , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Intolerancia a la Lactosa/diagnósticoRESUMEN
The effect of taurine supplementation (30 to 40 mg/kg/24 hr) on fat absorption and related measurements was examined in 21 preadolescent children with cystic fibrosis (CF) using a 12-month double-blind crossover technique. The mean coefficient of fat absorption was unchanged by taurine both in the unselected study group (without taurine, mean +/- SD 84.0% +/- 11.9%; with taurine, 84.4% +/- 11.8%, n = 20) and in a subgroup of seven children with moderately severe fat malabsorption (without taurine, 75.6% +/- 15.6%; with taurine, 74.8% +/- 14.6%). The mean fecal split fat/total fat ratio, which generally reflects bile acid-related fat malabsorption, was also unchanged. Linoleic and arachidonic acid deficiencies noted in plasma before supplementation showed no significant improvement with taurine supplementation. Likewise, plasma/serum vitamin A, E, and D levels were unchanged. Standard scores for height and weight were not affected significantly. This study does not support the use of taurine supplementation in the nutritional management of CF.
Asunto(s)
Fibrosis Quística/metabolismo , Grasas de la Dieta/metabolismo , Crecimiento , Taurina/uso terapéutico , Estatura , Peso Corporal , Niño , Preescolar , Ensayos Clínicos como Asunto , Fibrosis Quística/tratamiento farmacológico , Fibrosis Quística/fisiopatología , Método Doble Ciego , Ácidos Grasos Esenciales/metabolismo , Heces/análisis , Femenino , Glicina/metabolismo , Humanos , Absorción Intestinal , Masculino , Taurina/metabolismo , Vitaminas/metabolismoAsunto(s)
Infecciones por Campylobacter/complicaciones , Gastroenteritis/etiología , Polirradiculoneuropatía/etiología , Anticuerpos Antibacterianos/líquido cefalorraquídeo , Campylobacter/inmunología , Preescolar , Femenino , Gastroenteritis/complicaciones , Humanos , Polirradiculoneuropatía/líquido cefalorraquídeoAsunto(s)
Enteritis/complicaciones , Intolerancia a la Lactosa/complicaciones , Síndromes de Malabsorción/complicaciones , Enfermedad Aguda , Pruebas Respiratorias , Niño , Preescolar , Hospitalización , Humanos , Lactante , Recién Nacido , Intolerancia a la Lactosa/diagnóstico , Fenómenos Fisiológicos de la Nutrición , Población UrbanaRESUMEN
Structural abnormalities and disaccharidase deficiency were demonstrated in biopsies of duodenal mucosa from four infants who had symptoms of failure to thrive and chronic diarrhea associated with a megaloblastic anemia. Goat's milk was the main dietary constituent for each infant for six to eight months prior to presentation. The structural abnormalities consisted of villous blunting, crypt hypertrophy, megaloblastic changes in epithelial cells, and nuclear enlargement. All changes reverted to normal with the addition of folic acid to the diet. This study provides evidence that nutritional folic acid deficiency can cause structural and functional alterations of the small intestine in infants.