Effect of infant formula on stool characteristics of young infants.

BACKGROUND: Many infants are switched between multiple formula preparations early in life because of perceived abnormalities in stooling pattern as well as gastrointestinal symptoms. OBJECTIVE: To investigate the relationship between the type of formula consumed and the stooling characteristics and gastrointestinal symptoms of young infants. METHODS: Healthy 1-month-old infants were fed one of four commercial formula preparations (Enfamil, Enfamil with Iron, ProSobee, and Nutramigen) for 12 to 14 days in a prospective double-blinded (parent/physician) fashion. Parents completed a daily diary of stool characteristics as well as severity of spitting, gas, and crying for the last 7 days of the study period. A breast-fed infant group was studied as well. RESULTS: Two hundred eighty five infants were enrolled and 238 completed the study. Infants receiving breast milk or Nutramigen had twice as many stools as other formula groups (P < .001). Infants receiving ProSobee had hard/firm stools more often than breast-fed or other formula-fed groups (P < .00001). Watery stools were more common in infants fed Nutramigen than other formula groups (P < .04). Green stools were more common in 12 mg/L iron preparations (Enfamil with iron, ProSobee, Nutramigen) than in those with 1 mg/L (Enfamil, breast milk) (P < .00001). Spitting, gassiness, and crying were of equal severity in all formula groups. CONCLUSIONS: The interpretation of stool frequency, color, and consistency must take into account the infant's formula type as significant variations in normal infants occur. Parental education on the range of infant stooling characteristics as well as the common occurrence of spitting, gas, and crying may alleviate concern for formula intolerance and underlying gastrointestinal disease.

Percutaneous endoscopic placement of the "button" gastrostomy tube as the initial procedure in infants and children.

Percutaneous endoscopic gastrostomy (PEG) tube placement is routinely performed in children with special nutritional needs. For convenience and cosmetic reasons, many parents prefer a skin-level, nonrefluxing, ("button") gastrostomy tube. After healing of the track, a button gastrostomy tube can replace a PEG but this requires a second procedure. This study assessed the technique and complication rate of placement of a button gastrostomy tube mounted for endoscopic placement as the initial procedure. Seventeen patients (10 males), ages 4 months to 12 years were studied. All patients underwent successful placement of the button under conscious sedation using a standard endoscopic push technique. In the first 10 patients, an 18 French device was used. Four patients developed migration of the device into the track between 9 and 55 days after placement and the button was removed. Migration was preceded or accompanied by a wound infection in 3 of the 4 patients. In the next 7 patients, a larger, 24 French button was used without any wound infections or migration of the device. In thirteen patients with successful placement, a follow-up period of 110-450 days has revealed no further complications. Placement of the button gastrostomy tube in infants and children can be accomplished using standard endoscopic techniques. However, further study of the optimal size of the device and optimal placement procedure to prevent wound infection and migration should be undertaken.

Pediatric liver transplantation: Part I. Choosing and caring for the transplant candidate.

Liver transplantation is now an accepted modality of treatment for acute fulminant hepatic failure, end-stage chronic liver disease and certain hepatic-based inborn errors of metabolism in children. This paper reviews the criteria used in selecting appropriate candidates for transplantation based on a knowledge of the natural history of the underlying disease and the individual patient's condition. Important clinical, laboratory, radiologic and histologic data used to make decisions regarding transplantation are reviewed. Nutritional assessment and management are emphasized as part of the comprehensive evaluation and therapeutic plan to prepare a patient for transplantation.

Pediatric liver transplantation: Part II. Managing the long-term complications.

Increasing numbers of children are receiving liver transplants at major centers and returning to their home hospitals for long-term follow-up. This review summarizes the long-term complications in pediatric liver transplant recipients and their recognition and management. Emphasis is placed on an understanding of the practical aspects of the pharmacokinetics and toxicity of cyclosporine, the major immunosuppressive drug used in these patients. Common infectious problems, particularly serious viral infections, are reviewed with their unique clinical presentations in this immunocompromised population. Therapeutic alternatives for episodes of acute rejection are offered to facilitate communication with the transplant center and familiarize the local pediatric gastroenterologist and his or her staff with the management issues facing those who take care of these complex patients.

Carbohydrate malabsorption following fruit juice ingestion in young children.

We performed breath hydrogen analyses in 13 healthy children (9 to 36 months of age) and seven children (14 to 27 months of age) with chronic nonspecific diarrhea after they had ingested pear, grape, and apple juices and a 2% sorbitol solution. Excess breath H2 excretion was found in virtually all study subjects following the ingestion of either pear juice (with approximately 2% sorbitol content) or the 2% sorbitol solution, in approximately 50% of those ingesting apple juice (0.5% sorbitol), and in 25% of those ingesting grape juice (no sorbitol) (P less than .001, analysis of variance). No differences were noted between the healthy children and those with chronic nonspecific diarrhea. Forty percent of all study subjects in whom excess breath hydrogen excretion occurred also had diarrhea and abdominal cramping. Carbohydrate malabsorption appears to be frequent following the ingestion of common fruit juices and in some children may be associated with nonspecific gastrointestinal symptoms.