BACKGROUND Hydrolysates are used in the treatment and prevention of cows milk protein allergy. Hydrolysis might alter the plasma level of amino acids. METHODS Forty-five infants were included in a double-blind prospective study and were randomized in two groups: one receiving a whey predominant formula (n = 20) and the second group receiving a whey hydrolysate formula (n = 25). Weight and length gain was evaluated up to the age of 13 weeks, when blood was sampled for determination of fasting plasma amino acids. RESULTS Four infants of the hydrolysate group dropped out because refusal to ingest the formula. Weight and length gain at 13 weeks of age were extremely comparable. Significant differences in plasma concentrations were observed for a number of nonessential and essential amino acids (p = .035 to .0001). Threonine and lysine were both higher in the hydrolysate group, and aspartic acid, cystine, methionine, tyrosine, phenylalanine, histidine, and arginine were lower in the hydrolysate group. CONCLUSIONS These differences in plasma amino acid levels have to be regarded with care because all concentrations were within normal ranges, with the exception of threonine. Weight and length gain of the hydrolysate and the whey predominant formula were identical.

Intestinal manifestations are the predominant symptoms of food allergy. Nevertheless, it is generally accepted that dietary proteins can also induce intestinal manifestations such as systemic reactions or symptoms related to the skin, the respiratory tract, the central nervous system, the urinary tract, the vascular system, the joints. The cause-effect relationship between the contact with the dietary protein (e.g. it is unclear if direct skin contact is more relevant in patients with cutaneous manifestations than ingestion) and the symptoms if often difficult to prove. As a consequence, the number of ''extra-intestinal'' manifestions that are suggested to be related to food proteins is probably greater than the number of manifestions that are generally accepted as such.

Intestinal manifestations are the predominant symptoms of food allergy Nevertheless, it is generally accepted that dietary proteins can also induce intestinal manifestations such as systemic reactions or symptoms related to the skin, the respiratory tract, the central nervous system, the urinary tract, the vascular system, the joints. The cause-effect relationships between the contact with the dietary protein (e.g. it is unclear if direct skin contact is more relevant in patients with cutaneous manifestations than ingestion) and the symptoms if often difficult to prove. As a consequence, the number of “extra-intestinal” manifestations that are suggested to be related to food proteins is probably greater than the number of manifestations that are generally accepted as such.

Intestinal manifestations are the predominant symptoms of food allergy. Nevertheless, it is generally accepted that dietary proteins can also induce intestinal manifestations such as systemic reactions or symptoms related to the skin, the respiratory tract, the central nervous system, the urinary tract, the vascular system, the joints. The cause-effect relationships between the contact with the dietary protein (e.g. it is unclear if direct skin contact is more relevant in patients with cutaneous manifestations than ingestion) and the symptoms if often difficult to prove. As a consequence, the number of "extra-intestinal" manifestations that are suggested to be related to food proteins is probably greater than the number of manifestations that are generally accepted as such.

Forty-five healthy infants were included in a double-blind randomized prospective study comparing the nutritional value of two formulas. One group received a whey-predominant formula (n = 20); the other group received a whey hydrolysate formula (n = 25). Four infants of the whey hydrolysate group were dropped because they refused the formula. Although the mean daily volume intake was smaller with the whey hydrolysate formula compared with the whey-predominant formula (p < 0.001), the weight gain in the two groups after 13 weeks was identical (27.2 g/day in both groups; the mean difference in weight gain between the groups after 13 weeks was only 8 g). Length gain at 13 weeks was 10.4 cm in the whey-predominant formula group and 10.8 cm in the whey hydrolysate formula group (p = NS). After 13 weeks, blood was sampled for hemoglobin, hematocrit, red blood cell count, white blood cell count, lymphocytes, glycemia, proteins, albumin, prealbumin, calcium, phosphorus, urea, creatinine, iron, iron-binding capacity, zinc, and vitamins A and E. Except for the iron-binding capacity, zinc, urea (in plasma as well as in urine) (all three were higher in the whey hydrolysate group), no significant differences were found. According to these results, exclusive feeding of the whey hydrolysate formula from birth to 3 months of age to healthy infants appears to result in an adequate nutritional status, as assessed at 3 months of age.

Whey hydrolysate formulas are a recent and important innovation in infant feeding. This study compared clinical tolerance and acceptability of a whey hydrolysate formula (WH) with those of a whey-predominant formula (WF) in 45 infants. Four infants (16%) who refused to drink WH formula were eliminated from the study. Mean volume intake was significantly lower for WH (120 mL/kg/day) than for WF (147 mL/kg/day; P <.001). Consequently, mean caloric intake was also significantly different: 80 kcal/kg/day (WF) vs 97 kcal/kg/day (WF; P <.001). Nevertheless, weight gain from birth to 13 weeks of age was nearly identical in both groups (171% for WH vs 178% for WF). No significant differences were noted in duration of feeding, number of pauses during feeding, number of stools per day, or number of regurgitations per day. The lower rate of caloric intake and the dropout rate of 16% for WH raise questions about the use of WH formula in normal infants, as has become the case in some Western European regions.

Journal of Pediatric Gastroenterology and NutritionVolume 17, Issue 4 p. 461-461 ORIGINAL ARTICLE: PDF Only 14. HELICOBACTER PYLORI (HP) SEROPOSITIVITY IN ASYMPTOMATIC INFANTS AND CHILDREN Y. Vandenplas, Y. Vandenplas Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this authorS. Pcclers, S. Pcclers Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this authorT. Devreker, T. Devreker Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this authorU. Blecker, U. Blecker Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this authorH. Loeb, H. Loeb Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this author Y. Vandenplas, Y. Vandenplas Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this authorS. Pcclers, S. Pcclers Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this authorT. Devreker, T. Devreker Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this authorU. Blecker, U. Blecker Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this authorH. Loeb, H. Loeb Academisch Ziekenhuis Kinderen, Free University of Brussels, Brussels, BelgiumSearch for more papers by this author First published: 01 November 1993 https://doi.org/10.1002/j.1536-4801.1993.tb11030.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume17, Issue4November 1993Pages 461-461 RelatedInformation

Alkaline gastroesophageal reflux is a rare disorder, although it has been suggested as a cause of esophagitis. However, up to now, there exists no unequivocally accepted diagnostic method for alkaline reflux that can be routinely applied. "Normal ranges" of episodes of pH greater than 7.0-7.5 in asymptomatic as well as in symptomatic infants are proposed. In the asymptomatic infants (n = 83), the mean percentage of time the pH was greater than 7.0 was 1.3 +/- 2.6, and the number of episodes in 24 h with a pH greater than 7.0 was 10.4 +/- 16.4. In the symptomatic group (n = 60), including infants with chronic vomiting, the mean percentage of time the pH was greater than 7.0 was 0.15 +/- 0.5, and the number of episodes with a pH greater than 7.0 was 2.8 +/- 5.5. In all but six infants the percentage of time the pH was greater than 7.5 was less than 0.1. In three of four of these infants (endoscopy was refused by two parents) whose conditions exceeded the cut-off limits, there was a histologically proven esophagitis. To evaluate the proposed "normal" ranges for episodes of pH greater than 7.0 and 7.5, 200 symptomatic children were included in a prospective study. Symptoms were repetitive vomiting (n = 110), excessive crying (n = 53), and chronic respiratory disease (n = 37). Esophagoscopy was performed in 18 babies (9%) because pH monitoring data exceeded the proposed limits for the percentage of time the pH was greater than 7.0.(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous monitoring of oesophageal pH is regarded as the gold standard for all reflux investigations. However, since gastro-oesophageal reflux is considered a normal phenomenon which occurs to a certain extent in each individual, the distinction between "normal" and "abnormal" is not always obvious and is not possible to achieve with a single test. Moreover, data depend on technical hardware such as recording devices and electrodes together with such patient characteristics as age, position, activity, and medication. Although much literature on pH monitoring has appeared recently, many investigations have failed to take into account the basic principles that are of major importance for any biomedical test such as reproducibility, sample reliability, and indications. There is a need to standardize the technique in order to compare studies performed in different centres, provided the technique is reproducible.

Eosinophilic gastroenteropathy in children is a rare, idiopathic disease characterized by eosinophilic infiltration of the gastrointestinal tract. We describe a 10-day-old boy with aspecific clinical manifestations (unconsolable crying). Treatment with a semi-elemental diet was successful, suggesting a “milk-sensitive enteropathy”, although he had been exclusively breast fed. Recent literature is reviewed.

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.

Long-term oesophageal pH monitoring has become the preferred technique for detection and quantification of gastro-oesophageal reflux (GOR). The most obvious advantages of pH monitoring are the duration of the investigation, the possibility of being able to relate "events" (emesis, heartburn, apnoea) to pH changes (and to study "occult GOR"), the physiological conditions in which the data are recorded (sleep, work), and the possibility of repeating the investigation in treatment conditions. However, it has been reported that the accuracy of pH monitoring is no higher than 90%, because the intermittent presence of acid in the oesophagus is only one of the various abnormalities in the syndrome of GOR. A tremendous number of technique- (pH monitoring system, type of electrode, location of the electrode) and patient-related factors influence pH data. Age, position (both for adults and for infants), duration of the investigation (day/night), feeding and drugs are patient-related factors. Finally, the question arises (which is still unanswered) whether the indication for pH monitoring should be considered in the interpretation of the data: are the same criteria valid for GOR in children presenting with emesis and oesophagitis as for children with GOR resulting in chronic respiratory disease or "near-miss sudden infant death syndrome".

Gastro-oesophageal reflux (GOR) occurs mainly during postcibal (PC) periods. The duration of PC gastric acidity and the incidence of GOR were analysed in 11 asymptomatic premature infants. GOR was studied during PC periods of 120 min and also during the following 120 min defined as fasting (FT) periods. These infants were subjected to simultaneous continuous gastric and oesophageal pH monitoring using a double-blind crossover technique. Two formulae with different fat contents (2.6 vs 3.6 g/100 ml) and different carbohydrate concentrations (8.1 vs 7.3 g/100 ml; malto-dextrin 2.8 vs 1.9 g/100 ml) were given. Gastric acidity (pH<4) in the PC periods lasted significantly (P<0.001) longer (68 min±10) with the low fat/high malto-dextrin formula versus 43 min±11 with the high fat/low malto-dextrin formula. Oesophageal pH monitoring data were within normal limits for the total investigation time in all infants. During PC periods acid GOR was detected more frequently in the group with a low fat formula. More PC GOR was recorded when the gastric acidity time was longer.

The incidence of atopic manifestations due to cow's milk proteins was analysed in five groups of 15 newborns considered to be at risk for atopy because of a positive family history. All infants were studied over a 4-month period. The infants received either an adapted formula (AdFo), breast milk or a new hypo-allergic formula (HAF). Atopic manifestations appeared in 1 out of 15 breast-fed infants compared with 18 out of 45 infants fed with an AdFo. None of the infants receiving the HAF (exclusively from birth for 2–4 months) developed symptoms of atopy. Symptoms in each infant receiving an AdFo (n=18) disappeared with the HAF. Although the results of this study are promising, data on a larger population and double-blind investigations are needed before firm conclusions can be drawn.

International Journal of Clinical PracticeVolume 42, Issue 6 p. 245-247 Clinical Study A single-blind parallel group study investigating the antipyretic properties of ibuprofen syrup versus acetylsalicylic acid syrup in febrile children G Heremans MD, G Heremans MD Paediatrician H Hart Kliniek, Lier, BelgiumSearch for more papers by this authorF Dehaen MD, F Dehaen MD Paediatrician Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this authorN Rom MD, N Rom MD Paediatrician Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this authorJ Ramet MD, J Ramet MD Paediatrician Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this authorM Verboven MD, M Verboven MD Paediatrician Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this authorH Loeb MD, H Loeb MD Professor and Head of the Department of Paediatrics Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this author G Heremans MD, G Heremans MD Paediatrician H Hart Kliniek, Lier, BelgiumSearch for more papers by this authorF Dehaen MD, F Dehaen MD Paediatrician Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this authorN Rom MD, N Rom MD Paediatrician Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this authorJ Ramet MD, J Ramet MD Paediatrician Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this authorM Verboven MD, M Verboven MD Paediatrician Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this authorH Loeb MD, H Loeb MD Professor and Head of the Department of Paediatrics Children's University Hospital, V.U.B., Brussels, BelgiumSearch for more papers by this author First published: 01 June 1988 https://doi.org/10.1111/j.1742-1241.1988.tb08570.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume42, Issue6June 1988Pages 245-247 RelatedInformation

whereas milk- (or formula-)feeding neutralizes the gastric content(pH>4), gastric pH monitoring can be used studying the gastric anacidity, and subsequently the gastric emptying, time (Sutphen, AJDC 1986;140:1062-1064). Using a new technique, extended simultaneous esophageal and gastric pH monitoring, we measured the postcibal time gastric pH was > 4 in 11 asymptomatic infants according to a double-blind cross-over technique. Two isocaloric formulae with a different fat concentration were studied. The composition of both formulae (Fo1/ Fo2) is as follows (g/100ml): protein 2.2/2.2; Fat 2.6/3.6; Carbohydrates 8.2/7.6; Lactose 5.3/5.4. The results of the esophageal pH monitoring were in all infants within normal ranges, but GER occured more in the postcibal period of infants receiving Fo2. The duration gastric pH was > 4, was significantly (P<0.001; Student's t-test) shorter in the infants receiving Fo1 (52 +/- 10 min) {mean +/- 1 SD) than in the infants receiving Fo2 (79 +/- 11 min). Whereas a delayed gastric emptying time has been reported as one of the causes of GERpathology (Hillemeier, J Pediatr 1981;98:190-193), the administration of a low-fat formula (milk) could possibly decrease the incidence of reflux by shortening the gastric emptying time.