J Paediatr Child Health

Malnutrition, gastroenteritis and trypsinogen concentration in hospitalised Aboriginal children.

Year 1998
Briars GL. Thornton SJ. Forrest Y. Ehrlich J. Shepherd RW. Cleghorn GJ.
Children's Nutrition Research Centre, Royal Children's Hospital, Brisbane, Queensland, Australia.
OBJECTIVE: To explore relationships between malnutrition and pancreatic damage in hospitalised aboriginal children. METHODS: Immunoreactive trypsinogen (IRT) concentrations were measured in two populations of hospitalised aboriginal children in Australia: 472 children aged 0-3 years, in Alice Springs (Northern Territory); and 187 children aged 0-16 years in Mount Isa (Queensland). Correlation of whole blood IRT with height and weight z-scores, four-site skinfold thickness and upper arm circumference was sought. RESULTS: In Mount Isa, the geometric mean IRT concentration rose with decreasing weight z-score. The IRT concentration was otherwise unrelated to nutritional indices. Sixty percent of the 39 Mount Isa patients with gastroenteritis and 24.5% of the 358 Alice Springs patients with gastroenteritis had an IRT concentration in the upper quartile for their population, compared with 16% for patients with other diagnoses in both populations. CONCLUSIONS: A high IRT concentration in patients with low weight z-scores is a confounding effect of gastroenteritis, and may result from subclinical pancreatic disease in gastroenteritis.

Bowel dysfunction in cystic fibrosis: importance of breath testing.

Year 1998
Lewindon PJ. Robb TA. Moore DJ. Davidson GP. Martin AJ.
Gastroenterology Unit, Women's and Children's Hospital, North Adelaide, South Australia.
OBJECTIVE: To investigate the prevalence of carbohydrate malabsorption and bacterial overgrowth in children with cystic fibrosis (CF) and abnormal stool pattern referred for breath hydrogen testing. METHODS: Results from 89 tests using lactose, sucrose and lactulose in 54 children with CF were compared with 5430 tests on children with non-CF-related stool abnormalities. RESULTS: Children with CF were more frequently unable to ferment lactulose to hydrogen (39% vs. 20%, P

Understanding tracheomalacia.

Year 1998
Beasley SW. Qi BQ.
Department of Paediatric Surgery, Christchurch Hospital, New Zealand.
Tracheomalacia is an abnormality of the trachea that probably is present to some degree in all infants and children with oesophageal atresia. It causes the trachea to collapse during breathing, leading to obstruction of the upper airway. Our knowledge of the structural abnormalities underlying tracheomalacia is limited, mainly because patients with oesophageal atresia usually survive. Recently, the Adriamycin-induced rat model of oesophageal atresia and tracheomalacia has clarified some aspects of its pathology and the factors which may influence its development. The rat model suggests that the same detrimental factors that cause oesophageal atresia might also affect the development of the trachea, and that anomalous great vessels may exacerbate the severity of tracheomalacia locally.

Humoral immune and clinical responses to food antigens following acute diarrhoea in children.

Year 1998
Ahmed T. Sumazaki R. Shin K. Nagai Y. Shibasaki M. Fuchs GJ. Takita H.
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
OBJECTIVE: To investigate the effect of acute watery diarrhoea in children upon humoral immune responses to food antigens and the subsequent development of food allergy. METHODOLOGY: Serum antibodies to cows' milk, beta-lactoglobulin, alpha-lactalbumin, bovine serum albumin and ovalbumin were measured in 30 children with acute diarrhoea in the acute phase and 1 month after recovery. The children were followed for 1 year to assess the development of food allergy. RESULTS: IgG antibeta-lactoglobulin titres for the study group increased 1 month after recovery compared to the titres during the acute phase (P = 0.02). Antibody concentration for the other antigens studied did not rise. Four children developed positive IgE antibodies to one or more of the allergens after the diarrhoeal episode, although the titres were very low. None showed evidence of allergy to cows' milk or egg during the year-long follow-up. CONCLUSIONS: Acute diarrhoea in children resulted in increased production of IgG antibody to beta-lactoglobulin and had a priming effect for development of positive IgE antibody to cows' milk. Clinical food allergy was not observed in any of the children during the year-long follow-up.

The sleep patterns of infants and young children with gastro-oesophageal reflux.

Year 1998
Ghaem M. Armstrong KL. Trocki O. Cleghorn GJ. Patrick MK. Shepherd RW.
Department of Gastroenterology, Royal Children's Hospital and District Health Service, Herston, Queensland, Australia.
OBJECTIVE: Sleep disturbance in gastro-oesophageal reflux disease (GORD) in infants and young children has not been systematically studied nor has this manifestation been compared with population norms. METHODS: Sleep patterns of 102 infants and children aged 1 to 36 months with and without GORD, defined by pH monitoring, were analysed using the same questionnaire as in recent studies of normal sleep behaviour in this age range. Main outcome measures included time taken to settle at night, the number of night time wakenings requiring parental intervention, day time sleep patterns and parents problems with their childs' sleep behaviour. RESULTS: Compared with the population norms (n=3102), those with GORD (n=76) had greater prevalence of night time waking >3/night (50% vs 13% aged 3-12 months; 60% vs 10% aged 12-24 months, P

Current approaches to the nutritional management of cystic fibrosis in Australia.

Year 1998
Anthony H. Catto-Smith A. Phelan P. Paxton S.
Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.
OBJECTIVE: The aim of this study was to determine current Australian practice for the nutritional management of cystic fibrosis (CF) and compare it to USA and UK guidelines. METHODOLOGY: A structured questionnaire was completed by dietitians from 15 major CF centres. It was estimated that these centres manage or co-manage 84% of Australians with CF. RESULTS: There was close agreement between UK and USA guidelines and Australian practice for dietary intervention strategies, nutritional monitoring and surveillance, and electrolyte replacement. Infant feeding practices were more closely aligned with the UK. There were some differences in the areas of pancreatic enzyme replacement therapy, vitamin requirements in CF and dietary management of CF-related diabetes. CONCLUSIONS: Despite the lack of formal agreement, nutritional management practices of most Australian centres are closely aligned with current published international recommendations. However, there is need for consensus in the area of enzyme replacement therapy, management of CF-related diabetes and vitamin supplementation based on optimal clinical outcomes.