Inflammatory Bowel Disease in Children and Adolescents: a Somatic and Psychiatric Investigation

ABSTRACT. Twenty consecutive patients between 9 and 18 years of age with inflammatory bowel disease (IBD) [ulcerative colitis (UC) or Crohn's disease (CD)] were assessed for the presence of psychiatric disorder. The prevalence of psychiatric disorder using the DSM-111-R criteria (Diagnostic and Statistical Manual 3rd ed., revised), was 60% in the IBD group compared to 15% in a matched control group ( p =0.009). The psychiatric disturbances were mainly depressive or anxiety disorders. The IBD children also scored significantly higher ( p =0.0028) on the Child Behaviour Checklist (CBCL) which was completed by the mothers. This indicates more behavioural problems in the IBD group than in the control group. The present study suggests that children and adolescents with IBD comprise a population at high risk for developing a psychiatric disorder that may not be overt but nevertheless plays an important interactive role in the course of the disease.     

Inflammatory bowel disease in mother or father and neonatal outcome

Even a minor decrease in birthweight predisposes to adult disease. Inflammatory bowel disease (IBD) in the mother is a risk factor for low birthweight and preterm infants. This study investigated the effect of IBD in the mother or father, adjusting for confounders, on the newborn infant, with the focus on birthweight and pregnancy duration. A total of 10399 single-birth mother-infant pairs was prospectively enrolled within the ABIS project (All Babies In Southeast Sweden). Outcome measures included birth week, preterm birth (<37 wk), birthweight, low birthweight (<2500 g), birth length, caesarean section and neonatal hospital care. Ulcerative colitis (UC) in the mother was associated with lower birthweight in the infant (adjusted difference: -330 g, adjusted 95% confidence interval: -509 to -150 g, p < 0.001), and with even lower birthweight when the mother was treated with Mesalazine or steroids. No decrease in birthweight was seen in infants whose mother suffered from Crohn's disease (CD) (adjusted difference: -65 g, adjusted 95% confidence interval: -354 to 224 g, p > 0.05). Maternal UC or CD did not affect the pregnancy duration. The neonatal outcome of infants whose father suffered from UC and CD did not differ from the control group. CONCLUSION: UC in the mother affects the birthweight of the infant, which may predispose to future disease in the infant. Most women and men with UC and CD can, however, expect a healthy child with neither preterm birth nor low birthweight.     

Clinical Disease Activity and Inflammatory Activity in the Rectum in Relation to Mucosal Inflammation Assessed by Colonoscopy A Study of Children and Adolescents with Chronic Inflammatory Bowel Disease

ABSTRACT. The relationship between clinical disease activity, rectal inflammatory activity and mucosal inflammation established at total colonoscopy has been studied in 36 young patients with ulcerative colitis (UC) and 24 with Crohn's colitis (CC). Semiformed stools, diarrhea and frequent bowel movements seem to be better indicators of extensive mucosal inflammation of a moderate or severe degree than blood in faeces. There were, however, several patients with a discrepancy between the degree of clinical disease activity and the extent and degree of mucosal inflammation at endoscopic and histologic assessment. In about one-third of the patients with UC and in about half of the patients with CC, who had mucosal inflammatory activity of a moderate or severe degree, the rectal inflammatory activity was of a lower degree. Total colonoscopy seems to be necessary in order to establish the extent and degree of mucosal inflammation.     

Serum Antibodies to Cow's Milk Proteins in Pediatric Inflammatory Bowel Disease

ABSTRACT. Serum antibodies to five cow's milk proteins (α-casein, bovine serum albumin, β-lactoglobu-lin A and B, and α-lactalbumin) were investigated in young patients with inflammatory bowel disease (56 Crohn's disease, 24 ulcerative colitis). IgG antibodies against bovine serum albumin, β-lactoglobulin A and β-lactoglobulin B were higher in Crohn's disease patients than in those with ulcerative colitis or the controls. IgG anti-bovine serum albumin antibodies were higher in those Crohn's disease patients who had higher scores of disease activity. Finally, IgA antibodies to α-casein were higher in patients with Crohn's disease and ulcerative colitis when compared to controls. These findings may be due to increased uptake of dietary antigens or enhanced immunological response occurring in Crohn's disease patients.     

Fusidic Acid Binding to Serum Albumin and Interaction with Binding of Bilirubin

ABSTRACT. Sodium fusidate, an antibiotic used in staphylococcal infections, is strongly bound to human serum albumin, competitively with bilirubin. It is given in molar amounts sufficient to occupy a considerable fraction of circulating albumin. In order to avoid a risk of bilirubin encephalopathy, induced by displacement of bilirubin, fusidate should be given with caution to newborn infants, particularly if patients are prematurely born, icteric or acidotic. Fusidate does not interfere with albumin binding of warfarin or diazepam .     

Current diagnosis, management and morbidity in paediatric inflammatory bowel disease

In the 1970s several reports highlighted the long delay in diagnosis often experienced by children with Crohn's disease. In recent years this disorder has attracted much publicity, and many believe that the incidence has increased substantially. The aim of this investigation was to determine whether heightened awareness had shortened the interval to diagnosis, improved clinical management and reduced morbidity. A retrospective study was therefore carried out on 112 children with inflammatory bowel disease (64 Crohn's disease, 41 ulcerative colitis, 7 indeterminate colitis) referred to a paediatric gastroenterology department in the UK between 1994 and 1998. In Crohn's disease the median interval to diagnosis was 47 wk (maximum 7 y). In those without diarrhoea this was longer (66 vs 28 wk; p = 0.005). In ulcerative colitis the median interval was 20 wk (maximum 3 y). Even in severe colitis the median interval was 5.5 wk (range 3-9 wk) and 4 required urgent colectomy soon after referral. Many with unrecognized Crohn's disease had undergone inappropriate treatments, such as growth hormone or psychiatric therapy. Nineteen (17%) had undergone endoscopic investigations in adult units prior to referral. Malnutrition was equally common in Crohn's disease and ulcerative colitis (11%). Short stature was present in 19% with Crohn's disease, and 5% with ulcerative colitis, and was severe in 8% with Crohn's disease. There was a significant correlation between symptom duration and the degree of growth impairment present (r(s) = -0.4; p = 0.004). Conclusion: This study suggests that late diagnosis and inappropriate investigation and management are still significant problems.     

Serum Antibodies to Cow's Milk Proteins in Pediatric Inflammatory Bowel Disease: Crohn's Disease vs. Ulcerative Colitis

ABSTRACT. Serum antibodies to five cow's milk proteins, α-casein, bovine serum albumin (BSA), β-lac-toglobulin A and B (BLG-a, BLG-b) and α-lactalbumin (ALA) were investigated in young patients with inflammatory bowel disease, 56 with Crohn's disease (CD), 24 with ulcerative colitis (UC). IgG antibodies against BSA and BLG-a and -b were higher in Crohn's disease patients as compared to those with ulcerative colitis and controls. The IgG anti-BSA were higher in the group of CD patients with higher score of disease activity. Additionally, IgA antibodies to a-casein were higher in CD and UC compared to control. These findings may be due to increased uptake of dietary antigens or enhanced immunological response occurring in CD patients.     

Breast-Milk Calcium Concentrations during Prolonged Lactation in British and Rural Gambian Mothers

ABSTRACT. Detailed investigations of breast-milk calcium concentrations during 2 years of lactation have been conducted in Cambridge, UK, and rural Gambia. Mature milk concentrations remained steady for 3 months but declined during months 4-12 by over 25% (p< 0.001). The pattern was identical in both communities despite differences in breast-feeding practices. Calcium concentrations were not related to feed frequency or breast-milk sodium concentrations, suggesting that breast involution is not responsible for the decrease after 3 months. Breast-milk calcium concentrations were characteristic of the individual, varied twofold between mothers and were independent of maternal age, parity and milk output. Gambian breast-milk contained 19% less calcium than Cambridge milk, throughout lactation (p< 0.001). The extent to which this reflected the lower calcium intakes of Gambian mothers is unknown. Further studies are required to determine factors regulating breast-milk calcium secretion.     

Incidence and prevalence of inflammatory bowel disease in children in South-Western Sweden

Hildebrand H, Brydolf M, Holmquist L, Krantz I, Kristiansson B. Incidence and prevalence of inflammatory bowel disease in children in South-Western Sweden Acta PEdiatr 1994;83:640–5. Stockholm. ISSN 0803–5253
The incidence and prevalence of inflammatory bowel disease were estimated in all children less than 16 years of age living in the city of Göteborg and in three counties in South-Western Sweden, from 1983 to 1987. One hundred and thirty-two patients were classified according to set criteria into one of four diagnostic categories: ulcerative colitis, Crohn's disease, probable Crohn's disease and indeterminate colitis. The crude incidence of inflammatory bowel disease was 5.3 per 100 000 children per year and the prevalence 21.5 per 100000 children. This study lends support to the hypothesis that Crohn's disease has increased among Swedish children. Crohn's disease now appears to be at least as common as ulcerative colitis. Thirty-five of 55 patients first classified as indeterminate colitis or probable Crohn's disease later fulfilled the criteria of ulcerative colitis or Crohn's disease during a mean follow-up period of 4.6 years. This study emphasizes the importance, in epidemiological studies of inflammatory bowel disease, of inciuding those cases where a definite diagnosis of ulcerative colitis or Crohn's disease cannot be established initially and of re-evaluating the initial diagnosis regularly.     

Serum Immunoglobulin Levels in Children with Acute Lymphoblastic Leukaemia and Their Mothers and Sibs

Serum immunoglobulins G, A, and M were estimated in 29 children with acute lymphoblastic leukaemia and their first-degree relatives. 6 newborn sibs had high IgM levels in cord blood. IgG and IgM were raised in the mothers'' sera and there was a significant decrease in the serum IgG of sibs aged 2 to 10 years. The findings suggest the presence of some antigenic stimulus, possibly a virus, in the intrauterine life of affected sibships. It is postulated that the immunoglobulin abnormalities may be related pathogenetically to the leukaemic process.     

Selected Trace Elements and Proteins in Serum of Apparently Healthy Newborn Infants of Mothers Who Smoked during Pregnancy

ABSTRACT. The serum concentrations of selected trace elements and proteins in cord blood from 17 new-bom infants whose mothers were habitual smokers were compared with values from 22 infants of non-smoking mothers. All the mothers were healthy with normal pregnancies and deliveries. Cigarette smoke exposure was verified by determinations of nicotine, cotinine and thiocyanate concentrations in cord blood. Infants of smoking mothers had a slightly lower mean birth weight (3490±430 g) than control infants (3780±460 g). Infants of smokers had lower serum iron ( p =0.05) and prealbumin ( p ≤0.05), but higher serum copper ( p ≤0.05) and ceruloplasmin ( p ≤0.01) levels than the controls. Infants of smoking mothers tended to have higher levels of the acute-phase reactants alpha-₂-macroglobulin and orosomucoid, but lower levels of albumin, transferrin and retinol-binding-protein, although differences were not statistically significant.     

儿童溃疡性结肠炎172例

目的分析中国儿童溃疡性结肠炎（UC）患者的临床资料为其诊治提供帮助。方法采用CBM、CNKI及VIP数据库检索1995~2004年国内发表的儿童UC的文献,对符合纳入标准者及同期本院确诊UC患儿172例的临床特征、X线和内镜表现、组织学特点、治疗及预后进行分析。结果172例中男女之比是1.07：1.0;就诊年龄2个月~15岁,≤3岁36.7%;病程3d~4年;阳性家族史1例。儿童UC以慢性腹泻、黏液血便或脓血便、腹痛为主要表现,发热、体质量减低或营养不良、贫血等全身表现常见,肠外表现及并发症少见,病变范围以全结肠为主,病情以中重型居多。以水杨酸偶氮磺胺吡啶（SASP）或5-乙酰水杨酸（5-ASA）为基础,配合糖皮质激素治疗在短期内可获得临床缓解,但长时程随访完全缓解者不足1/3。结论婴幼儿UC患者并不少见,儿童UC临床特征有异于成人,3岁前后亦不尽相同。儿童UC误诊率高,治疗困难。制定一套适合中国儿童UC的诊疗规范十分必要。     

小儿常见风湿性疾病细胞因子变化及干预

目的通过检测白细胞介素(IL)-1β、IL-12、转化生长因子-β1(TGF-β1)在几种小儿常见风湿性疾病治疗前后的血清水平,了解这3种细胞因子与小儿常见风湿病病变的关系。方法对17例急性期川崎病患儿、14例活动期幼年类风湿关节炎患儿及17例急性风湿热患儿在药物治疗前和治疗2-4周及8～12周进行血清IL-1β、IL-12、TGF-β1水平检测,与20例正常小儿的细胞因子进行比较。结果此3种疾病患儿在药物治疗前,其血清IL-1β和IL-12水平皆显著高于对照组,使用药物治疗2-4周及8～12周,这2种细胞因子血清水平显著降低,同时血清TGF-β1水平显著上升和临床表现改善或消失。结论在发病初期,血清IL-1β和IL-12水平升高,对这3种常见小儿风湿性疾病起致炎作用;在疾病恢复期血清TGF-β1水平升高起抗炎作用。     

新生儿炎症性肠病的临床特征及基因诊断研究

目的 分析2例新生儿期起病的炎症性肠病临床特点及基因诊断结果,以提高对该病的认识和临床诊疗水平.方法 2018年至2019年,解放军总医院第七医学中心八一儿童医院共收治2例新生儿期起病的炎症性肠病患儿.对2例诊断为新生儿炎症性肠病的患儿行结肠镜检查,并行病理活检,采用直接测序法对患儿进行白细胞介素-10受体A(inte...     

Endogenous Digoxin-Like Factor in Neonates: Effect of Age and Relation to Serum Bilirubin Levels

ABSTRACT. Endogenous digoxin-like immunoreactive factor(s) (DLIF) have been found in serum and urine of newborn infants, including those born prematurely. We assessed the effect of age on serum levels of DLIF in 73 samples obtained from 66 healthy full term newborn infants at birth and during the first two months of life. DLIF concentrations were highest at birth and fell progressively with age. In cord blood, DLIF levels were 0.73 ± 0.35 ng/ml (mean ± SD). DLIF concentrations were 0.45 ± 0.11 ng/ml on day 1, 0.26 ± 0.08 ng/ml on day 3,0.19 ± 0.07 ng/ml on day 5, 0.17 ± 0.09 ng/ml on day 11, 0.11 ± 0.02 ng/ml on days 15–30, and not detectable after 45 days of life. We also studied the relation between serum levels of DLIF and bilirubin in 23 jaundiced newborns between 3–5 days of life. We found a highly significant positive correlation between serum bilirubin concentrations and DLIF. These findings support the assumption that DLIF plays a role in impeding bilirubin excretion in the neonatal period, perhaps by inhibiting the activity of (Na-K)ATPase.     

Intact Parathyroid Hormone Levels during Pregnancy, in Healthy Term Neonates and in Hypocalcemic Preterm Infants

ABSTRACT. We measured parathyroid hormone levels in pregnant and nonpregnant women and at 1, 2 and 5 days of life in healthy term neonates and in hypocalcemic preterm infants using a new immunoradiometric assay which measures only biologically active intact parathyroid hormone and by a mid-molecule parathyroid hormone radioimmunoassay. During pregnancy intact and mid-molecule parathyroid hormone levels did not show any modification and were not different from parathyroid hormone levels of nonpregnant age-matched controls. Serum calcium and phosphorus levels did not vary during each trimester of pregnancy. In cord serum intact and mid-molecule parathyroid hormone values were low in both term and preterm infants. In term neonates intact and mid-molecule parathyroid hormone levels peaked on day 1; in preterm infants intact parathyroid hormone levels peaked on day 1 while mid-molecule parathyroid hormone values peaked on day 2. Intact parathyroid hormone levels showed a more marked increase in preterm (19-fold) than in term neonates (7.5-fold) on day 1. Our data do not confirm the previously reported "physiologic" hyperparathyroidism in pregnancy. Moreover we found a normal parathyroid gland responsiveness to decreasing serum calcium levels in the first days of life in term and preterm infants. Our results suggest that measurement of intact parathyroid hormone 1-84 by immunoradiometric assay in the first days of life is a more sensitive index of parathyroid gland secretory function than the measurement of middle or carboxyl-terminal parathyroid hormone fragments allowing the detection of the dynamic changes of parathyroid hormone which occur in hypocalcemic preterm infants.     

Iodine intake and status during pregnancy and lactation before and after government initiatives to improve iodine status,in Palmerston North,New Zealand: a pilot study

Iodine deficiency during pregnancy and lactation may adversely affect fetal and infant development. Two initiatives were introduced in New Zealand to prevent deficiency: (1) mandatory fortification of bread with iodised salt; and (2) provision of a subsidised iodine supplement (150 μg) for all pregnant and breastfeeding women. The aim of this study was to assess iodine intake and status among a self‐selecting sample of pregnant and lactating women in Palmerston North, both before and after the two initiatives. Pregnant and breastfeeding women were recruited before (n = 25 and 32; 2009) and after (n = 34 and 36; 2011) the initiatives. Iodine concentration was determined in 24‐h urine and breast milk samples using inductively‐coupled plasma mass spectrometry. Use of supplements and salt, knowledge of iodine deficiency, and awareness of the initiatives were determined by questionnaire. Median urine iodine concentration (UIC) was higher in 2011 compared with 2009 for both pregnant (85 and 47 μg L^?1) and breastfeeding (74 and 34 μg L^?1) participants; median UIC were below the cut‐offs for adequate iodine status. However, in 2011, the estimated daily iodine intake during pregnancy was 217 μg day^?1; 74% of women achieved the Estimated Average Requirement. Knowledge of the initiatives was low, only 28–56% were aware of the need for iodine supplements and only 15–22% were aware of the mandatory addition of iodised salt to bread. Despite initiatives, UIC of these women indicates iodine deficiency, however, dietary intakes appear adequate. Ongoing surveillance of supplement use and iodine status among pregnant and lactating women throughout New Zealand is needed to fully assess the efficacy of the initiatives. Alternative strategies may require evaluation to ensure all women have adequate iodine during pregnancy and breastfeeding.     

Mental Health and Psychological Functioning in Children and Adolescents with Inflammatory Bowel Disease: a Comparison with Children having Other Chronic Illnesses and with Healthy Children

Psychiatric disorders and behaviour problems were found to be commoner in children and adolescents with inflammatory bowel disease (IBD) than in matched comparison groups with tension headache and diabetes as well as in healthy children. Depression, anxiety and low self-esteem were common. Many children denied their problems. This may be due to the type of illness, its social consequences and the embarrassment experienced by the children. Discrepancies were found between the children's and their mothers' replies. These results are discussed in terms of their implication for paediatric practice.