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Pregnant and lactating women are continuously and ubiquitously exposed to numerous environmental pollutants from various sources including air, food, water, and occupational and household environments. The available evidence shows that pollutants are present in human milk and one of the emerging questions is what happens when the nursing infant is involuntarily exposed to contaminants through breastfeeding.The available literature does not currently provide a conclusive evidence of any consistent or clinically relevant health consequences in infants exposed to environment chemicals through breast milk. The available data strongly suggest that the benefits of breastfeeding outweigh the potential harmful effects of pollutants contained in human milk. The committee of nutrition of the French Pediatric Society strongly supports breastfeeding but also calls for public health actions to reduce the overall contamination level in the environment, to continue promoting breastfeeding, and to support research in this area.

Amino acid-based formulas (AAFs) are recommended for children with cow's-milk allergy (CMA) failing to respond to extensively hydrolysed formulas (eHFs). We evaluated the effects of a new thickened AAF (TAAF, Novalac), containing a pectin-based thickener, and a reference AAF (RAAF, Neocate) on allergy symptoms and safety, through blood biochemistry analysis and growth.Infants (ages18 months) with CMA symptoms failing to respond to eHFs were randomised in a double-blind manner to receive TAAF or RAAF for 3 months. All of the infants were then fed TAAF for 3 additional months. Paediatric visits occurred at 1, 3, and 6 months. Blood samples were collected at inclusion and 3 months.Results at 1 month were previously described. The 75 infants with proven CMA and eHF intolerance tolerated their allocated formula. At 3 months, the dominant allergic symptom had disappeared in 76.2% of the infants with TAAF and in 51.5% of the infants with RAAF (P = 0.026). The Scoring Atopic Dermatitis Index significantly improved more with TAAF than with RAAF (-27.3 ± 2.3 vs -20.8 ± 2.2, P = 0.048). Of the infants, 92.9% had normal stools (soft or formed consistency) with TAAF vs 75.8% with RAAF (P = 0.051). More infants in TAAF group had better quality of nighttime sleep (P = 0.036) and low frequency of irritability signs (P 0.001). With both formulas, all of the biochemical parameters were within normal ranges. There were no differences between the 2 groups in any of the anthropometric z scores.The new TAAF was tolerated by all of the infants with CMA and intolerance to eHFs. Anthropometric and clinical data showed that both formulas were safe.

The aim of the study was to assess the usefulness of gastric biopsy-based quantitative real-time polymerase chain reaction (qPCR) for the detection of Helicobacter pylori infection and the identification of clarithromycin-resistant strains in children.A gastric biopsy-based qPCR for the detection of H pylori infection and the identification of clarithromycin-resistant strains in children was evaluated in 62 children with infection and 341 children without infection. H pylori infection was considered by the "reference method" when culture was positive for both histology and rapid urease test (RUT). Results were compared with those obtained using the qPCR.The reference method versus H pylori qPCR positivity showed 95% confidence interval sensitivity 100% versus 100%, specificity 93.2% (86.9-99.4) versus 100%, positive predictive value 59.7% (47.4-71.9) versus 100%, negative predictive value 100% versus 100%, and, finally, test accuracy of 59.6% (47.3-71.8) versus 100%. Sixty-two children were found to be H pylori positive, based on the qPCR results. Among those, 31 children had both positive qPCR and culture with concordant antimicrobial susceptibility testing results, whereas 31 children had negative culture and positive qPCR. The qPCR showed a bacterial load ≥10 copies per milliliter when culture, histology, and RUT were all positive (29/31 children) versus10 copies per milliliter when culture, histology, and RUT were all negative (25/31 children). Grades 2 and 3 histological gastritis were associated with a bacterial load ≥10 copies per milliliter for 28/35 of children versus 27/27 of grade 0 to 110 copies per milliliter.H pylori qPCR positivity is a more precise test than the routine culture, histology, RUT alone and allows detecting low bacterial loads.

Background: The purpose of this multicenter case-control study was to search for causes and risk factors related to the severe upper digestive tract lesions often seen in neonates. Methods: Case patients were full-term neonates with endoscopically confirmed severe bleeding or ulcerative lesions of the esophagus and/or stomach. Matched control subjects were the next infant born in the same maternity unit who met the same criteria and had no clinical abnormality (and, for ethical reasons, no endoscopy). The analysis was based on 137 case-control pairs and considered data showing the mothers' medical and obstetric background, the infants' clinical status and laboratory results, feeding details, and the State and Trait Anxiety Inventory (STAI) questionnaire, which was used to assess the anxiety of the mothers. Results: Cases and controls did not differ in any demographic or social factors. Antacid and anti-ulcer drugs were used significantly more frequently during the last month of pregnancy by case mothers than by control mothers (28% and 10%, respectively; P < 0.001). Mode of delivery was similar. Case infants more frequently experienced cardiac deceleration during labor and delivery (28% and 12.9%; P = 0.003). Breast-feeding at birth was less frequent for case infants (36% and 49%; P = 0.05). The mean trait anxiety scores did not differ between the two groups, but the mean state anxiety score was higher in case mothers. Multivariate logistic regression found that three factors were independently and significantly associated with esophageal and gastric lesions: use of antacid and antiulcer treatments (odds ratio [OR], 3.9; P < 0.001), cardiac deceleration (OR, 2.2; P = 0.03), and breast-feeding (OR, 0.5; P = 0.02). Conclusions: Antacid drug use by mothers during the last month of pregnancy was associated with esophageal and gastric lesions. Breast-feeding may play a protective role against severe lesions in neonates.

Background. The easiest way to identify the presence of current or past Helicobacter pylori infection is to test for antibodies. The aim of this study was to compare an enzyme-linked immunosorbent assay (ELISA) technique based on the detection of IgG antibodies directed against a global antigenic preparation with immunoblotting based on the analysis of IgG antibody reactivity to separate proteins. Methods. Sera were collected from 80 children (mean age, 9.9 ± 4.3 years). The reference tests were microbiologic and histologic examination of gastric biopsies obtained at upper endoscopy. Results. The immunoblotting was more sensitive (100%) and specific (88%) than ELISA (96 and 79%, respectively) in the evaluation of H. pylori infection in children. Its positive predictive value was 92%, and its negative predictive value was 100%. The best performance index of immunoreactive bands to detect antibodies was obtained with the 26-kDa (88.7%), 30-kDa (77.5%) and 19.5-kDa (70%) antigens. Antibodies by immunoblot technique against the CagA antigen were present in 43.1% of children. Conclusion. Immunoblotting is highly sensitive and more specific than ELISA in children and provides additional information about the full serologic profile. Immunoblotting may therefore be a useful complement to serology, particularly in cases with doubtful ELISA results.

Background: Cisapride is a gastrointestinal prokinetic agent that is used worldwide in the treatment of gastrointestinal motility-related disorders in premature infants, full-term infants, and children. Efficacy data suggest that it is the most effective commercially available prokinetic drug. Methods: Because of recent concerns about safety, a critical and in-depth analysis of all reported adverse events was performed and resulted in the conclusions and recommendations that follow. Results: Cisapride should only be administered to patients in whom the use of prokinetics is justified according to current medical knowledge. If cisapride is given to pediatric patients who can be considered healthy except for their gastrointestinal motility disorder, and the maximum dose does not exceed 0.8 mg/kg per day in 3 to 4 administrations of 0.2 mg/kg (not exceeding 40 mg/d), no special safety procedures regarding potential cardiac adverse events are recommended. However, if cisapride is prescribed for patients who are known to be or are suspected of being at increased risk for drug-associated increases in QTc interval, certain precautions are advisable. Such patients include those:(1) with a previous history of cardiac dysrhythmias, (2) receiving drugs known to inhibit the metabolism of cisapride and/or adversely affect ventricular repolarisation, (3) with immaturity and/or disease causing reduced cytochrome P450 3A4 activity, or (4) with electrolyte disturbances. In such patients, ECG monitoring to quantitate the QTc interval should be used before initiation of therapy and after 3 days of treatment to ascertain whether a cisapride-induced cardiac adverse effect is present. Conclusions: With rare exceptions, the total daily dose of cisapride should not exceed 0.8 mg/kg divided into 3 or 4 approximately equally spaced doses. If higher doses than this are given, the precautions above are advisable. In any patient in whom a prolonged QTc interval is found, the dose of cisapride should be reduced or the drug discontinued until the ECG normalizes. If the QTc interval returns to normal after withdrawal of cisapride, and the administration of cisapride is considered to be justified because of its efficacy and absence of alternative treatment options, cisapride can be restarted at half dose with control of the QTc interval. Unfortunately, at present, normal ranges of QTc interval in children are unknown. However, a critical analysis of the literature suggests that a duration of less than 450 milliseconds can be considered to be within the normal range and greater than 470 milliseconds as outside it.

Background: The purpose of the study was to determine the accuracy of the labelled 13 carbon urea breath test for the diagnosis of Helicobacter pylori in children and to simplify the 13 carbon urea breath test in identifying the most discriminating sampling time. Methods: H. pylori was searched for in 100 children aged 10.5 ± 4.5 years by histology, bacteriological counts, and culture on antral biopsies together with serology and 13 carbon urea breath test. Breath samples were obtained before ingestion (T0) of 75 mg urea- 13 C and every 10 minutes after until T60. 13 CO 2 excess ratio was measured by isotope ratio mass spectrometry, and values expressed as delta per mil over baseline enrichment (δ 13 CO 2 ). The arithmetic mean (Mδ 13 CO 2 ) of T20 to T60 values was calculated and the test considered positive with Mδ 13 CO 2 higher than Mδ 13 CO 2 + 3 SD as determined in noninfected children. Results: Mδ 13 CO 2 of noninfected children as assessed by culture was 1.4 ± 0.6 per mil, determining a positive cut-off value of 3.44 per mil. Mδ 13 CO 2 was correlated in 11 children with biopsy bacteriological counts. Both culture and 13 carbon urea breath test were positive in 38 of 100 children, without any discordance. Plotting 13 carbon urea breath test results at each sampling time versus Mδ 13 CO 2 showed weaker correlations at T20, T30, T50, and T60, than at T40. The two-sample method at T0 and T30, T40, T50, had high sensitivity and specificity. Single-sample analysis obtained at T40 gave a comparable sensitivity and a slightly reduced specificity. Conclusion: 13 carbon urea breath test is sensitive and specific in children. Two samples collected at T0 and T40 provide the most discriminating procedure.

The impact of human recombinant growth hormone (GH) after massive small bowel resection was studied in 38 weaning female Wistar rats (65 +/- 5 days old; 193 +/- 26 g). Animals underwent a 80% small bowel resection, leaving in place similar lengths of jejunum and ileum. Animals were assigned to four groups: group A (n = 9), small bowel resection only; group B (n = 10), resection and treatment with 0.2 GH units (GHU) s.c. every other day; group C (n = 9), resection and 0.4 GHU; and group D (n = 10), laparotomy without intestinal resection. Twenty-eight days later, weight gain (percentage of initial weight) was 1 +/- 3 in group A, 12 +/- 8 in group B, 12 +/- 9 in group C, and 16 +/- 7 in group D; p0.001, groups B-D. Time to recover initial weight was 26.2 +/- 3.3 days in group A; 11.7 +/- 5.4 days in group B (p0.001); and 16 +/- 6.1 days in group C (p0.001 vs. A). The size of the intestinal remnant after the rats were killed was 1.3 +/- 0.6 cm (13 +/- 10% of initial length) in A; 5.15 +/- 2.4 cm (37 +/- 18%) in B (p0.01); 4.2 +/- 2.3 cm (33 +/- 20%) in C (p0.01 vs. A); and 4.4 +/- 3.5 cm (5.8 +/- 4.9%) in D (p0.001 vs A). Villus height and diameter, average number of mitosis per field, and muscular layer and wall thickness were greater in groups A, B, and C than in group D (p0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

An intestinal permeability test analyzing the differential urinary elimination of lactulose and mannitol orally ingested at the same dosage was carried out first in fasting condition, then combined with specific food ingestion, in 17 children with clinical symptoms of irritable bowel syndrome (IBS). Foods were selected based on a suggestive clinical history or on a positive radioallergosorbent or prick test. Comparison of the results with those of a control population reported in a previous study showed that in nine IBS patients, specific food ingestion was associated with a modification of intestinal permeability. The nine children all had a personal and/or familial history of allergy and/or raised total IgE. The symptoms disappeared in the nine patients after food exclusion either alone (seven patients) or together with further treatment by cromolyn (two patients). We conclude that, at least in some children, symptoms of IBS may be related to food hypersensitivity.

The 12-h urinary elimination of orally ingested mannitol and lactulose was studied in 29 infants aged 3 days-20 months admitted in an intensive care unit of gastrointestinal surgery, and in 24 age-matched healthy controls. In patients with short bowel syndrome, there was a significant fourfold reduction in urinary mannitol elimination compared with controls. The lactulose/mannitol urinary ratio was significantly increased in patients with necrotizing enterocolitis (p less than 0.01) and in patients with disorders of intestinal propulsion during episodes of diarrhea with a monomorphic fecal flora (p less than 0.01). The urinary recovery of mannitol and lactulose after oral loads is a good marker of intestinal mucosal damage in infants with surgical disorders of the digestive tract.

Atopy patch test may help early diagnosis of cow-milk allergy in preterm infants. In the retrospective analysis of 5 girls and 9 boys, born at 31 +/- 2 (mean +/- SD) weeks of gestation and presenting digestive symptoms at age 42 +/- 18 days, 10 had a complete recovery following the shift to an exclusive feeding with an amino acid-based formula. Cow-milk-skin prick tests and specific immunoglobulin E were always negative, whereas the atopy patch test was positive in 7 of the 10 infants with complete recovery.