Cows' milk protein-sensitive enteropathy: an important contributing cause of secondary sugar intolerance in young infants with acute infective enteritis.

The effect of cows'' milk protein (CMP) on the mucosal disaccharidases was investigated in 23 infants with acute infective enteritis. Jejunal biopsies performed before and after cows'' milk provocation were subjected to histological examination and to mucosal disaccharidase enzyme (lactase, sucrase, and maltase) analyses. After milk challenge, changes in mucosal histology were observed in 18 infants, in 17 of them the levels of all 3 mucosal disaccharidases were much reduced. 10 of these infants developed diarrhoea and, in 6, the stools were positive for reducing sugar. It is concluded that CMP has a deleterious effect on the jejunal mucosa of young infants recovering from infective enteritis, so that in the management of young infants with sugar intolerance secondary to infective enteritis, CMP and lactose should be excluded from the diet.     

Cows' milk protein-sensitive enteropathy. Combined clinical and histological criteria for diagnosis.

Cows'' milk protein enteropathy is recognised as a significant cause of persistent diarrhoea and malabsorption in young infants, but there are as yet no generally accepted diagnostic criteria. A combined clinical and histological approach to the diagnosis of cows'' milk protein-sensitive enteropathy has been used in 15 patients, and the following set of criteria are proposed. (1) Clinical disease (diarrhoea with or without vomiting) while receiving cows'' milk protein. (2) Clinical improvement on a diet free of cows'' milk protein. (3) Normal or mildly abnormal histology of jejunal mucosa when taken 6-8 weeks after symptoms subside. (4) Histological relapse, with or without clinical relapse, after re-exposure to cows'' milk protein.     

Cows' milk sensitive enteropathy in cystic fibrosis.

Proximal small intestinal mucosal biopsies were carried out in children with cystic fibrosis who had diarrhoea and failed to thrive in spite of adequate treatment, including pancreatic supplements. Histological examination of eight of the 17 biopsies taken over a period of 12 years showed evidence of enteropathy, and accounted for one in 13 (8%) children with cystic fibrosis under 3 years of age attending our clinic. Seven responded to a cows'' milk free diet; the diarrhoea stopped and weight gain increased. One of these responded only when gluten was also excluded from his diet. The eighth child remained on a normal diet and his symptoms did not improve. The enteropathy had resolved in all five patients who had further biopsies taken while receiving treatment, and from 15 months to 3 years of age all the children tolerated a normal diet and continued to thrive. Cows'' milk sensitive enteropathy is an important cause of failure to thrive in children with cystic fibrosis. Small intestinal biopsy is an important investigation in younger children who fail to thrive and have diarrhoea despite adequate treatment.     

Cow's milk protein-sensitive enteropathy. Clinical and histological results of the cow's milk provocation test

Nineteen infants suspected of having cow's milk protein-sensitive enteropathy were studied. They all showed failure to thrive, diarrhoea and/or vomiting when fed a diet of cow's milk, and improved when their diet was changed to casein hydrolysate. Jejunal biopsy was done before and 18--23 hours after a milk challenge. Of the 19 infants, 12 presented histological evidence of cow's milk protein intolerance. Eight suffered from vomiting and diarrhoea within 9 days of the milk challenge, but in 4 cases the histological abnormalities were not accompanied by clinical symptoms. In one case a chicken meat intolerance was documented. The histological appearance of the intestinal mucosa after chicken challenge was identical to that observed after milk challenge. In our opinion, repeated intestinal biopsies before and after an acute challenge is the best method to establish the diagnosis not only of cow's milk protein intolerance but also of intolerance to other alimentary proteins.     

Intractable diarrhoea associated with continuation of cytotoxic chemotherapy during acute infective enteritis

Severe intractable diarrhoea which required prolonged parenteral nutrition is reported in a child with acute leukaemia. The enteropathy is likely to have been the consequence of continuing cytotoxic therapy during an episode of acute infective diarrhoea. It is postulated that the inhibition of crypt mitotic activity prevented the rapid recovery of small intestinal mucosa normally seen after viral infection and resulted in persisting small intestinal dysfunction. The inter-relationship between viral and cytoxic-induced enterocyte damage is discussed and the risks of continuing therapy under such conditions is considered.     

Severity and extent of upper small bowel mucosal damage in cow's milk protein-sensitive enteropathy

A series of 31 infants, 28 with cow's milk protein sensitive enteropathy (CMPSE) and 3 controls, was studied for severity and extent of mucosal damage of the upper small bowel in relation to the development of clinical symptoms. Following challenge with the offending cow's milk, 18 infants (Group 1) developed severe mucosal changes at both the proximal and distal small bowel mucosa and all of these infants presented with clinical symptoms. The other 10 infants (Group 2) who did not develop clinical symptoms following the challenge had less severe damage to the distal small bowel mucosa as compared to the proximal region. The histological score of both the proximal and distal postchallenge biopsies were significantly lower in Group 2 as compared to Group 1 infants. The mucosal disaccharidase and alkaline phosphatase levels were depleted in both the proximal and distal biopsies following challenge but the depletion was greater in the proximal than the distal biopsies. It is suggested that the extent and severity of mucosal damage to the proximal duodenum and jejunum have a critical bearing on the development of clinical symptoms.     

Cows' milk allergy in the syndrome of thrombocytopenia with absent radius.

A girl with the syndrome of thrombocytopenia with absent radius had severe diarrhoea and dehydration relieved by withdrawal of cows'' milk and aggravated by its reintroduction on three occasions. Deterioration in gastrointestinal symptoms was associated with haematological relapse with thrombocytopenia, leucocytosis, anaemia, and eosinophilia. There appeared to be a correlation between milk exposure and the haematological and gastrointestinal disturbances. Supporting evidence from published reports for such a correlation is reviewed. Cows'' milk protein intolerance may be a factor in precipitating haematological relapse in susceptible infants with radius aplasia. Early withdrawal of cow''s milk protein should be tried in thrombocytopenia with absent radius, especially in cases with prominent gastrointestinal upset.     

The steatocrit test as a guide in the prevention of cow's-milk enteropathy following acute infectious enteritis

This study was designed to evaluate the following in infants with acute enteritis (AE): the influence of different types of milk on the evolution of the acute phase of the diarrhea and whether the degree of steatorrhea during the acute phase might be a risk factor for developing cow's milk enteropathy (CME). We studied 90 infants with AE, divided into three groups and refed differently after the acute episode: group A was refed using a semielemental formula; group B was refed using a milk containing soy proteins and vegetable oils; and group C was refed using a common cow's-milk formula. Patients with pathological steatocrit values on hospitalization were randomly assigned to groups A and B; patients with normal steatocrit values were placed in group C. After 4 weeks, the patients included in groups A and B were challenged with cow's milk and their reactions were recorded. During the acute phase of the disease, we noticed a longer persistence of diarrhea in group A than in groups B (p less than 0.01) and C (p less than 0.0025). In addition, the number of evacuations per day and steatocrit values were higher in group A than in groups B or C, but these differences were not statistically significant. After 4 weeks, the patients in groups A and B were challenged with cow's milk, and eight of 60 patients had positive reactions; intestinal biopsy confirmed the diagnosis of CME. The mean age of these eight patients was 40.3 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Aetiology of acute gastroenteritis in infancy and early childhood in southern India.

The aetiology of acute gastroenteritis was studied in 50 infants and young children. Bacterial pathogens were isolated in 33, enteropathogenic E. coli (EPEC), Salmonella, and Shigella being the commonest isolates. Rotaviruses were detected in the stools of 13 of the cases. All children with gastroenteritis in whom rotavirus was detected were seen during the months July to December. In 30 children who served as controls, EPEC were isolated in 6, but rotavirus was detected in none. It is concluded that infection with rotaviruses is a significant cause of morbidity in children with gastroenteritis in southern India.     

Long hospitalization is the most important risk factor for early weaning from breast milk in premature babies

Aim: To identify certain variables related to the infants' course that might have an impact on the mothers' decision to breastfeed.
Patients and Method: Retrospective survey including all patients <1500 g birth weight (BW) treated between January 1, 2000 and December 31, 2005 at the Neonatal Intensive Care Unit of the Medical University of Vienna who were not transferred to another hospital. Multiple regression analysis of the following variables was carried out: gestational age (GA), BW, length of stay (LOS), parity, singleton or multiple gestation, sex and severe morbidity.
Results: Of the 239 patients included, 142 (60%) were fed breast milk at the time of final discharge, 97 (40%) were fed formula. LOS was significantly correlated with the probability of being breastfed: the shorter it was, the higher was the probability of being breastfed at the time of final discharge (p = 0.0064 for singletons, p = 0.001 for multiples). Lower GA also increased the probability of being breastfed, but this was only statistically significant for multiples (p = 0.001).
Conclusion: This study shows clearly that the most important influencing factor on the mothers' decision to continue breastfeeding is the LOS. Thus more emphasis should be put on encouraging mothers to continue lactation throughout their babies' hospital stay.     

An unusual case of craniofacial fibrous dysplasia presenting in early infancy

Fibrous dysplasia (FD) of bone is one of the most frequently encountered anomalies of skeletal development [1]. It may involve one or more bones and, particularly when polyostotic, in sometimes associated with abnormal skin pigmentation and endocrine abnormalities. FD occurs mainly in large limb bones, ribs, and craniofacial bones in older children and young adults. Usually craniofacial involvement is detected because of local swelling or asymmetry of the face or head. Neurological symptoms, primarily due to involvement of the foramina, have been reported but are not common. Infantile fibrous dysplasia of the craniofacial region has rarely been reported.