The role of nutrition in brain development.

Common sense always links good nutrition with optimal development of infants and, particularly, of brain development. Fortunately, brain development is rather resistant to nutritional deficiencies, provided that the psychomotor stimulation of the baby is adequate, as shown by many authors in the case of global protein energy malnutrition. For two types of micronutrient deficiency, those of iron and long-chain polyunsaturated fatty acids, it is easier to isolate the role of micronutrient deficiency from the role of psychosocial deprivation, although not entirely. Term babies seem to be perfectly able to synthesize both docosahexaenoic acid (DHA) of the n-3 series and arachidonic acid (AA) of the n-6 series in sufficient quantities for their normal brain development, provided that their diet contains the precursors of the two series in adequate proportions. For low-birth-weight infants, AA does not seems to be necessary, and the discussion is still open regarding the essentiality of DHA. For iron, it seems that the level of education of the mother affects both the iron status of the child and its psychomotor development. The additional role of iron deficiency on infection sensitivity and muscular strength could also have an effect on the overall nutritional status and on the ability to communicate with the environment and learn.

Milk formulae in the prevention of food allergy.

Because food allergy is frequent and severe, all possible means should be used to try to prevent its manifestations or at least to delay them until the child is older and stronger and therefore better able to follow an exclusion diet. The capacity of breast-feeding for preventing food allergy has been challenged in the past, but a consensus seems to be emerging now that breast-feeding can indeed prevent food allergy if it is started at birth and is exclusive for at least 4, and preferably 6, months. In the most "at-risk" babies the breast-feeding mother should try to eliminate the most potent allergens (eggs, fish, soya, nuts, and cow's milk) from her diet. If a substitute or a complement to breast milk is necessary, neither goat's milk nor soy milk formula are adequate. Heat treatment alone will not be sufficient to make cow's milk hypoallergenic. Only a combination of protein hydrolysis and managed heat treatment can make cow's milk hypoallergenic and retain its nutritional value. This nutritional value should be assessed by animal studies and also by studying infant growth. The hypoallergenicity of a formula can be studied in vitro and with animal tests, but only clinical trials on human infants will prove its efficacy.

Tannin-rich carob pod for the treatment of acute-onset diarrhea.

Infants aged 3-21 months with acute diarrhea of bacterial and viral origin were treated as inpatients with oral rehydration fluid and randomly received for up to 6 days either a tannin-rich carob pod powder (40% tannins or 21.2% polyphenols and 26.4% dietary fiber), 1.5 g/kg/day (n = 21) to a maximum of 15 g, or an equivalent placebo (n = 20). The duration of the diarrhea from admission was 2.0 +/- 0.27 days in the test group and 3.75 +/- 0.30 days in the placebo group (p less than 0.001). Normalized defecation, body temperature, and weight and cessation of vomiting were reached more quickly by the patients who received the test substance. The test substance was well accepted and tolerated.

Effect of an acidified milk on diarrhoea and the carrier state in infants of low socio-economic stratum.

The effect on diarrhoeal disease of an acidified, modified powdered cow's milk infant formula (Pelargon) was evaluated in 82 infants (Group I) for six months; 104 infants who received the same formula but non acidified, served as controls (Group II). Nutritional status remained satisfactory in both groups throughout the observation period. Some children rejected the taste of the acidified milk. The incidence of diarrhoea was lower in Group I (p less than 0.001). The proportion of days in which the children suffered from acute diarrhoea, and the duration of the episodes were also lower in the children given the acidified milk (p less than 0.001). The rate of detection of enteropathogens and the species identified were comparable in both groups. Carrier rates for bacterial enteropathogens fell over time in Group I while they rose in Group II (p less than 0.001). Carrier rates for enteric parasites were comparable to those expected in our setting for this age group. These results suggest that acidified milk exerts a protective effect against diarrhoeal disease.

Protection by milk immunoglobulin concentrate against oral challenge with enterotoxigenic Escherichia coli.

Enterotoxigenic Escherichia coli is a common cause of traveler's diarrhea. Prophylaxis against traveler's diarrhea has been associated with side effects from bismuth subsalicylate and the development of resistance to antimicrobial agents. We undertook a double-blind controlled trial in which a bovine milk immunoglobulin concentrate with high titers of antibodies against enterotoxigenic E. coli was used as prophylaxis against E. coli challenge in volunteers. Lyophilized milk immunoglobulins were prepared from the colostrum of cows immunized with several enterotoxigenic E. coli serotypes and fimbria types, E. coli heat-labile enterotoxin, and cholera toxin. As a control, an immunoglobulin concentrate with no anti-E. coli activity was prepared. Ten volunteers received buffered immunoglobulin concentrate against enterotoxigenic E. coli, and 10 received the control immunoglobulin concentrate, dissolved in water, three times a day. No side effects were observed. On the third day of immunoglobulin prophylaxis, the volunteers were given 10(9) colony-forming units of enterotoxigenic E. coli H10407 (O78:H11). This strain produces colonization factor antigen I and heat-labile and heat-stable enterotoxins. None of the 10 volunteers receiving the immunoglobulin concentrate against E. coli had diarrhea, but 9 of the 10 controls did (P less than 0.0001). All volunteers excreted E. coli H10407. We conclude from these preliminary results that milk immunoglobulin concentrate may be an effective prophylaxis against traveler's diarrhea.

[New aspects in the nutrition of newborn infants with low birth weight]. / Neue Aspekte der Ernährung von Neugeborenen mit niedrigem Geburtsgewicht.

Optimalize the feeding of low birth weight infants is a very important problem in industrial as well as in developing countries where such infants are very numerous. Water need is very important but gastric and vascular capacity is limited in LBW infants. Energy has to be absorbed at a rate of 120 to 130 Kcal/kgBW/day without raising the osmolarity of the food. Protein intake has to be higher than in term babies but due to enzyme and kidney immaturity the amino acid pattern of the protein has to be carefully adapted to the pattern of the proteins to be synthesized. Calcium, phosphorus, iron, zinc and other trace minerals as well as vitamins have to be provided in relatively large quantities but their bioavailability has also to be checked. The utilisation of breast milk and particularly of own mothers milk having delivered prematurely is also discussed.

Randomised placebo-controlled trial of hepatitis B surface antigen vaccine in french haemodialysis units: II, Haemodialysis patients.

A vaccine against hepatitis B surface antigen (Institut Pasteur Production) was assessed in 138 haemodialysis patients in a placebo-controlled randomised double-blind trial. In an interim analysis, hepatitis B infections were observed in 21% of the vaccine group and 45% of the placebo group (p less than 0.02). 2 of the infections in the vaccine group and 12 of the infections in the placebo group occurred after the third injection. 60% of the vaccine recipients had an immune response. 4 months after the first injection the mean titre of anti-HBs was 120 mlU/ml.

Randomised placebo-controlled trial of hepatitis B surface antigen vaccine in French haemodialysis units: I, Medical staff.

A vaccine against hepatitis B surface antigen (Institut Pasteur Production) was assessed in staff members from forty-eight French haemodialysis units where the risk of hepatitis B was high. Of 318 subjects who completed the protocol, 164 received three monthly injections of vaccine and 154 received corresponding injections of placebo. Hepatitis B infection was observed in 3.6% of the vaccine group and 12.3% of the placebo group (p less than 0.005). The 6 infections in the vaccine group all arose within 63 days from the first injections, whereas the 19 in the placebo group arose throughout the 12 months of follow-up. The rate of side-effects after injection did not differ in the two groups. 94% of the vaccine recipients had an immune response ( greater than 10 mIU/ml in at least 5 successive specimens). 4 months after the first injection the mean + or - 2 SE peak level of anti-HBs was 2433 + or - 1077 mIU/ml.

A controlled field trial of liver oral typhoid vaccine Ty21a.

A controlled field trial of a live oral typhoid vaccine was carried out in Alexandria, Egypt, in 1978-79. A total of 32 388 children were included in the study. They were divided in two comparable groups, one given 3 doses of the vaccine and the other 3 doses of the placebo. Each active dose contained 1 x 10(9)-8 x 10(9) live Ty21a bacteria. From March 1978 to March 1979, the population studied was followed up and suspected typhoid cases were investigated bacteriologically and serologically. The effectiveness of the vaccine was assessed by analysis of the incidence of typhoid fever in the two groups. The results of the follow-up indicate that, in the dosage schedule used, the Ty21a mutant strain, found previously to be stable and safe, is protective against typhoid fever for at least one year.

[Arterial hypertension caused by anomaly of the renal artery or its branches in children]. / Hypertension artérielle par anomalie de l'artère rénale ou de ses branches chez l'enfant.

38 cases of severe hypertension due to a vascular abnormality of the renal pedicle were studied in children under 16 years of age, 18 boys and 20 girls. The most common presentation was at routine clinical examination. The diagnosis of an abnormality of the renal artery was suggested by the appearances of intravenous urography. There were many causes; 4 aneurysms of the renal artery or its branches, 4 fibromuscular dysplasias with one case of bilateral fibromuscular dysplasia, 4 idiopathic stenoses, 2 endarteritis, and 6 thromboses revascularised to variable degrees (2 after umbilical vein catheterisation and one due to DLE). In three cases the hypertension was related to compression of the pedicle by a tumour of haematome, and 14 cases had multiple arterial lesion. In the latter group, 6 cases of neurofibromatosis, 2 cases of William and Beuren's disease, 1 case of generalised Elastorhexia, 2 cases of aortic medio stenosis, probably Takayashu's disease, and 3 unidentified conditions. Surgery was performed on 29 patients, 21 of whom had unilateral lesions and were definitively cured of hypertension. Of the 8 cases with multiple lesions, only 2 were completely corrected with cure of their hypertension.

Immunologically mediated tubulo-interstitial nephritis in children.

14 children with proven or presumably immunologically mediated tubulo-interstitial nephritis are presented. In 2 patients anti-tubular basement membrane antibodies were detected. In 6 immunofluorescence microscopy showed granular deposits of immunoglobulin and/or complement likely representing interstitial location of immune complexes. The findings by immunofluorescence were not significant in the remaining 6 patients. However, the association of renal disease to extra-renal disorders, namely chronic active hepatitis and ulcerative colitis, or uveitis or the presence of an epithelioid granuloma with multinucleated giant cells suggests that in such patients an immunologic disorder might be responsible for the tubulo-interstitial nephritis.