Idiopathic Inflammatory Bowel Disease Crohns Disease

Crohn's disease is a chronic inflammatory disorder that can affect any part of the gastrointestinal tract involvement of the small bowel may be referred to as Crohn's enteritis. Crohn's disease is comparatively more common in North America and Europe which have the highest incidence the disease is relatively rare elsewhere, particularly in developing countries. To put it in context of all causes of enteropathy, recent data suggests the incidence of all childhood and adolescent Crohn's disease...

Rationale for and against Early Aggressive Nutrition

Despite numerous advances in nutrition of preterm infants over the past decade, the increasing survival at lower birth weights is resulting in a new frontier of extrauterine nutritional support of these vulnerable infants. Extremely low birth weight infants (ELBW, i.e. < 1,000 g in weight) have unique metabolic substrate requirements, predicted by high protein turnover rates, high metabolic rates, and high glucose utilization rates. The ELBW infant has endogenous energy reserves of only about...

Classification of Food Allergy Disorders

Food allergy disorders may be classified based on the role of IgE antibody as IgE-mediated, non-IgE-mediated (cell-mediated) and mixed-IgE- and cellmediated (table 4). Table 3. IgE epitope recognition patterns in subjects with allergy to cow's milk, egg white and peanut Allergen Patient population and methods Cow's 10 patients with persistent CMA and milk 10 patients who subsequently outgrew their milk allergy 25 decapeptides of a(s1)-casein, a(s2)-casein, K-casein, a-lactalbumin, and...

Weaning from Parenteral Nutrition

Parenteral nutrition is a potentially life-threatening form of nutritional support the overriding priority is to wean the child off parenteral nutrition as soon as is possible. Infants and children who have an acute episode of severe intestinal failure with a previously normal gut, e.g. after surgery or during a course of chemotherapy, may when gut function has recovered tolerate the rapid reintroduction of a normal diet. On the other hand, children with primary gut disease will often need the...

Growth Standards for Preterm Infants

In order to measure growth in preterm infants one needs a standard to which to make comparisons. There are three main choices of such a standard (1) normal fetal growth, (2) growth of a peer group of (preterm) infants and (3) growth of term infants. A variety of fetal growth standards exist, but there are many problems with them 7, 17 . Growth of the fetus can be assessed indirectly using ultrasound measurements, but these are prone to both ultrasound operator errors as well as errors in the...

Biological Aspects of Nutrition for Cholestatic Children

CLD is characterized by decreased or absent hepatic secretion of bile into the intestine. The most common cause of CLD in children requiring liver transplantation is biliary atresia. Biliary atresia is a progressive disorder characterized by an inflammatory reaction towards the extrahepatic and intra-hepatic bile ducts, leading to their destruction and subsequent replacement by fibrotic scar tissue. The etiology of biliary atresia remains unknown, although an inflammatory reaction to a...

Infectious Enteropathy

Postinfectious persistent diarrhea occurs in infants and young children associated with a variety of enteric viral and bacterial pathogens that cause acute infectious diarrheal disease including rotavirus, enteric adenovirus, astrovirus, Shigella, and Salmonella, among others. Postinfectious diarrhea may follow a single severe episode of acute diarrhea or more commonly repeated distinct episodes of acute diarrhea by different pathogens, persisting well after the inciting infectious agent is no...

Immunological Inflammatory Diarrheal Disorders

Regulator Cell Activation

The neonatal course is completely normal. Onset of intestinal symptoms is within the first months of life and it is rarely isolated, in contrast to congenital early onset enterocyte disorders. Diarrhea is often bloody and most often systemic inflammatory symptoms exist, i.e. fever, elevated inflammatory markers in blood and stools. Changes in the mode of alimentation, such as withdrawal of breastfeeding, the introduction of cow's milk proteins, but sometimes even a simple viral infection or a...

Abnormal Immune Response

CD is complex autoimmune enteropathy caused by a permanent sensitivity to gluten in genetically predisposed individuals. European and US studies indicate the prevalence of CD in children between 2.5 and 15 years is approximately 3-13 per 1,000 children 13 . Previously considered rare in children in developing countries, more recent evidence challenges this view 14 . In some ways, CD also represents an important form of food-allergic enteropathy. Small bowel damage occurs following mucosal...

Requirements Determined by the Factorial Method

The factorial approach derives nutrient requirements as the sum of two (in the case of parenteral requirements) or three components (in the case of enteral requirements). The largest component, and the component that changes most with body size, is the growth component, i.e., nutrient accretion. The other components are inevitable losses and, in the case of enteral nutrient requirements, efficiency of nutrient absorption. Determination of the growth component requires knowledge of nutrient...

Syndromic Persistent Diarrhea

Syndromic persistent diarrhea in context of the current discussion refers to a condition of chronic enteropathy and diarrhea in infants and young children in developing countries, typically associated with malnutrition often in a vicious cycle, downward spiral relationship (fig. 3). While persistent diarrhea constitutes less than 10 of all diarrheal episodes in developing countries, it Fig. 3. Conceptual framework of the pathogenesis of syndromic persistent diarrhea. CHO Carbohydrate. Fig. 3....

Infant eHF and pHF in Clinical Studies

EHF fulfill the criteria to be classified as a formula for therapy, but they are also recommended by the American and the European Pediatric Societies for allergy prevention 4, 5 . The most intensively tested eHF is based on 100 casein (eHF-C). Its allergy-preventive effect has been investigated in several birth cohorts of high-risk infants and compared with breast milk, cow's milk formula and pHF 10, 27-34 , and in two of these studies also with eHF-W 10, 27 . Most of the pHFs available today...

Immune Dysregulation

Different immune deficiencies have been related to an (often patchy) enteropathy, caused by the primary immune disorder and or by the increased occurrence of (common and opportunistic) infections. In a-7- and hypo-7-globulinemia, the plasma cells in the lamina propria are absent or reduced, respectively, with an increased rate of intestinal infections and malabsorption. In isolated IgA deficiency, enteropathy may be primary or secondary to (increased coexistence of) CD, food allergy and...

Congenital Constitutive Diarrheal Disorders

The typical clinical picture is abundant watery, sometimes mucous diarrhea starting within the first hours or days of life 2, 3 . Diarrhea can be so important that within a few hours a rapidly life-threatening situation develops due to massive dehydration and metabolic acidosis. The neonatal course (presence or absence of polyhydramnios) presents essential information contributing towards the differential diagnosis of a secretory (chloride or sodium) diarrheal disorder if polyhydramnios is...

Early Parenteral Nutrition Studies in ELBW Neonates

The first comprehensive, prospective, randomized, controlled trial of 'aggressive' versus 'conservative' nutrition in 125 relatively sick neonates weighing < 1,500 g at birth was conducted in the 1990s by Wilson et al. 18 . Infants in the aggressive intake group were sicker, were started on earlier enteral nutrition (day 2 vs. day 5 in the control group), parenteral amino acids (day 1 vs. 3), and parenteral lipid (day 2 vs. 5). Nutrients were advanced more quickly and to higher maximal...

Primary Enterocyte Abnormalities

Intestinal Epithelial Dysplasia (Tufting Enteropathy) Intestinal epithelial dysplasia presents at neonatal age with chronic watery diarrhea, impaired growth and possible facial dysmorphisms. Small bowel biopsies reveal variable villous atrophy, crypt hyperplasia and slightly increased inflammatory activation in the lamina propria without a marked increase of intraepithelial lymphocytes. The characteristic feature of tufting enteropathy is the presence of focal epithelial 'tufts' composed of...