Human milk POPs and neonatal risk trend from 1982 to 2009 in the same geographic region in Serbia.

Three groups of POPs - DDT, HCH and PCBs were monitored in early human milk for 27 years (1982-2009), as a measure of environmental pollution in the same geographic region (South Backa, Voyvodina, Serbia). Measurements were performed using ECD GC Varian 3400. Concetrations of DDT and HCH had general decreasing trend from 1982 to 2009. However, the concentrations of both groups of compounds showed small rises in 1994. Concentrations of PCBs had general decreasing trend from 1982 to 2009 - smooth and steep only till 1994 and with two small peaks in 2003 and 2009. The latest estimated daily intake of DDT and HCH was well below the EU upper limit for pesticides in food intended for infants and small children. Although the estimated daily intake of PCBs was far below the upper limit for daily milk products in Serbia, its increase in 2003 and 2009 is a clear indication of environmental influx of these compounds after the 1994 measurements. The likely explanation for such POP profiles in South Backa could have been a series of negative environmental impacts escalating in 1999, after which four hot spots were identified in Serbia (Novi Sad, Pancevo, Bor and Kragujevac) by UNEP. The results of this monitoring showed that although a long standing environmental presence of POPs has a decreasing trend, their occasional output in the environment may cause bioaccumulation and biomagnification in human organisms which already start in the neonatal age through mother-child transfer via human milk.

Routine jejunal endoscopic biopsy in children.

UNLABELLED: The aim of the study was to evaluate and compare two methods of jejunal biopsy-endoscopic (EB) and suction (SB). Jejunal EB was performed using an Olympus GIF P20 endoscope in 119, and SB with a modified Crosby capsule in 254 patients. A light microscope with micrometer was used for the analysis and measurement of biopsy specimens. Calculated per patient, the total average number of all adequate specimens was: jejunal or duodenal mucosa -2.97 in EB and 0.93 in SB; jejunal mucosa only -2.82 in EB and 0.89 in SB group. Duodenal mucosa was unintentionally biopsied in 17.1% of EB and in 3.7% of SB. Jejunal mucosal specimens were selected for measurement at random -82 from the EB and 24 from the SB group. The difference in height between EB and SB specimens was not significant (EB: 0.72 +/- 0.13 mm; vs SB: 0.77 +/- 0.14 mm). The difference in length was significant (EB: 2.57 +/- 1.24 mm; vs SB: 3.22 +/- 1.38 mm; P = 0.03). The advantages of the EB over the SB technique included elimination of fluoroscopy, no failures in obtaining biopsies and a 97% success rate in obtaining specimens adequate for histological analysis. It also enabled the biopsy site to be chosen and several specimens to be taken, providing additional tissue for various analyses. CONCLUSION: Jejunal endoscopic biopsy is suggested as a good alternative to the suction biopsy, wherever paediatric upper gastrointestinal endoscopy is available.

Local immunodeficiency of the intestinal mucosa--a contribution to etiopathogenesis of recurrent urticaria and diarrhoea.

The case of a 10 month-old girl with a history of recurrent urticaria and diarrhoea is presented. Immunological study was carried out and secretory component in sputum, duodenal juice and stool was not found, while IgA was detected. Peroral biopsy of intestinum was also carried out and histology revealed partial villous atrophy. Immunofluorescent staining showed only a few IgA and IgG producing cells scattered within the villous stroma, while the IgM producing cells were increased in number. Serum concentration of IgA, IgM and particularly IgG was increased. Both parents had measurable IgA in the serum, however, the secretory component was not detectable neither in mother nor in father. The deficiency of secretory component and deficiency of IgA producing cells in the jejunal villous stroma led to local immunodeficiency of the intestinal mucosa and that caused recurrent urticaria and diarrhoea in the girl presented.

Timing of the gut closure.

This study was designed to establish whether the starting time of breast-feeding (BF) may have affected gut closure for macromolecules during the earliest postnatal period. An increase of serum IgA concentrations was taken as the index of gut permeability to macromolecules. In 14 neonates, BF started 1-6 h after birth and continued every 3 h during the next 38-48 h; in 19 neonates, it started 12-15 h after birth, continuing in the following 34-46 h; and in 20 neonates, BF started at the age of 24-29 h and continued during the next 18-36 h. Serum IgA concentrations were measured before and after the period of BF using the method of single radial immunodiffusion on commercial plates. In neonates in which BF started earlier, serum IgA concentrations fell significantly (p less than 0.001) until the 3rd day of life. This suggested an early gut closure, caused either by some colostral factor(s) or, perhaps, by some other mechanism which prevented further macromolecular absorption. In 11 of 20 neonates in which BF started after 24 h of life, even though in this group of babies, it was of the shortest duration, serum IgA concentrations increased significantly (p less than 0.001), suggesting that if BF is postponed, a spontaneous gut closure may not take place within the first 30 h of life.

Intestinal absorption of IgA in the newborn.

The aim of this study was to establish whether or not the newborn can absorb IgA from colostrum, using two feeding regimens. Single radial immunodiffusion on commercial Behring plates was used for IgA quantitation. In group A, 30 mature newborn infants born by vaginal delivery and fully breast fed, cord serum IgA concentration was 0.0990 +/- 0.0294 mg/ml (means +/- SEM). IgA was detectable in 9 of 30 infants. On the 3rd day of life, IgA concentration in serum was 0.3610 +/- 0.0194 mg/ml (means +/- SEM). It was detectable in all 30 infants; on the 5th day of life, its concentration was 0.4293 +/- 0.0365 mg/ml (means +/- SEM). In group B, 39 newborn infants born by cesarean section and fed boiled human milk exclusively, IgA was not detected either in cord, or in venous blood on the 3rd and 5th day of life. The rise of serum IgA in breast-fed newborn infants, highly significant from the 1st to the 3rd day of life (p less than 0.0001), and its increase between the 3rd and 5th day, although not significant, was in distinct contrast to the undetectable serum IgA in newborn infants fed boiled human milk. These data strongly suggest that IgA absorption from colostrum occurs at least until the 3rd day of life.