Blood spot follicle-stimulating hormone during early postnatal life in normal girls and Turner's syndrome.

Although FSH has previously been found to be elevated during infancy in agonadal subjects, it is not known whether perinatal FSH levels are also increased. Neonatal blood spot FSH levels were studied retrospectively in nine full term girls born with Turner's syndrome and compared with presumably normal full term girls born the same week. FSH was measured using a highly specific immunoradiometric assay adapted to blood spots collected at the time of systematic neonatal screening. On day 5-6 after birth, FSH was undetectable (< 1 IU/L) or low (1-4.4 IU/L) in normal girls. Among the nine patients with Turner's syndrome, five had FSH levels below 3 IU/L, and four showed slightly elevated levels, ranging from 4.3-10.9 IU/L. These differences in FSH secretion were not related to differences in karyotype. Among five patients studied longitudinally during the first 6 weeks of life, three showed increases in FSH levels to 14.9-15.9 IU/L during the second week of life. However, this increase was comparable to that seen in some normal girls sampled on a second occasion during the first weeks after birth. One patient with Turner's syndrome still had low FSH (2.5 IU/L) on day 23, but showed some increase to 8.5 IU/L on day 30. We conclude that 1) in Turner patients, perinatal changes in FSH secretion are similar to those in normal girls, although there is already a lack of feedback control by gonadal hormones on the hypothalamo-pituitary axis; and 2) the FSH assay cannot be used for neonatal screening of Turner's syndrome.

Atopic dermatitis: role of food and house dust mite allergens.

OBJECTIVE: The aim of this study was to evaluate the humoral immune response to cow milk (CM) protein, soya protein, and house dust mites in a group of 64 CM-fed infants, who had atopic dermatitis as the sole atopic manifestation, by measuring not only IgE but also specific IgG antibodies (Ab) against bovine beta-lactoglobulin, soya flour aqueous extracts, and Der P1 antigens. METHODS: A CM-free diet (Nan HA, Nestle) was given to these 64 CM-fed infants and the sensitivity to CM proteins was established by a positive challenge test with the offending food in improved infants. The serum was obtained just before the start of the CM-free diet, at the first consultation. The patients were classified into two groups according to their clinical response to the hypoallergenic formula. RESULTS: Thirty-one infants (group 1) improved dramatically (positive challenge test), and 33 (group 2) did not improve with the exclusion diet but did improve after eviction of dust-producing items in the environment. The two groups were different in terms of their total IgE immunoglobulin concentration (higher in group 1, P < .05) and concentration of specific IgE Ab against CM protein (more frequent in group 1, P < .01). The IgG Ab concentrations against beta-lactoglobulin, the major CM antigen (P < 10-4), and against soya protein (P < .01) were significantly more elevated in the group improved by the diet, with a threshold above which the response to the exclusion diet could be predicted as positive. On the contrary, the level of specific IgG Ab against house dust mites was four times higher in group 2 than in group 1. Twenty-nine of the 33 infants of group 2 improved after eviction of dust-producing items in the environment. CONCLUSIONS: It is proposed that specific IgG Ab concentrations against beta-lactoglobulin, soya protein, and Der P1 antigen be determined in infants and children suffering from atopic dermatitis as a means of predicting the response to an exclusion diet, and a possible role of house dust mites in the pathogenicity of the disease is suggested.

The increase in zincaemia provoked by starvation does not influence the intestinal absorption of zinc.

Serum zinc, measured in obese patients undergoing two weeks of therapeutic starvation (0 kcal, water ad libitum) increased significantly during the starvation period (+48% at day 10) and returned to prestarvation values after refeeding with a 500 kcal diet. Intestinal absorption of zinc was investigated by an oral zinc tolerance test (with 75 mg of zinc acetate) on the second and the tenth day of starvation. No significant differences were observed between the first and the second test. In our experimental conditions 10 days of starvation failed to induce a loss of zinc exceeding 0.75% of the total body stores. It is concluded that the concentration of zinc in blood per se does not regulate intestinal absorption in the absence of a significant change in zinc requirements.

Altered phospholipid composition and changed fatty acid pattern of the various phospholipid fractions of red cell membranes of cystic fibrosis children with pancreatic insufficiency.

After two-dimensional thin-layer chromatography, it appears that the phospholipid composition of the erythrocyte membranes of cystic fibrosis children, compared with healthy ones, is changed by an increase of the phosphatidyl inositol content. The plasmalogen concentration of the membrane phospholipids is the same for both groups. The fatty acid pattern of the various red cell membrane phospholipid fractions was determined by gas chromatography (Tables II, III and IV), and significant changes were observed in the cystic fibrosis patients (Table V). Phosphatidyl choline and ethanolamine (non-plasmalogen forms) especially show strikingly abnormal fatty acid patterns similar to those in the various plasma lipid fractions.

Evaluation of clinical and biological parameters in marastic Kwashiorkor children treated by parenteral nutrition.

Reduction of hospital stay and mortality rate due to dehydration and electrolyte imbalance in children suffering from severe marasmic Kwashiorkor was attempted. A program of parenteral nutrition providing 70 to 100 milliliters water, 30 to 40 kilocalories, and 3 to 4 grams amino acids per kilogram daily was given. Seventy-seven African children suffering from protein deficiency and calorie deficiency were given an intravenous perfusion of casein hydrolysate or cristalloid amino acids for a mean period of 6 days. An oral supplement of tea and sugar, boiled rice, and palm oil was also given. The total mortality has not been modified in comparison with that in children given an oral diet (semi-liquid) consisting of low fat milk and locally available proteins. In more than half of the cases, the parenteral nutrition has favored water and salt retention and the development of cardiac failure possibly due to adynamic circulatory state. Weight curve, serum albumins, serum and urine amino acids were followed closely for 1 month. In eleven patients, nitrogen balance studies were done. All were positive independently of the coexisting infectious pathology. Correlating the increase in serum proteins with the cumulative nitrogen balance allowed us to consider casein hydrolysate as particularly useful for hepatic protein synthesis while cristalloid amino acids seem to favor muscular protein synthesis. The introduction of parenteral nutrition as a therapeutic regimen for standard use in the malnourished child seems less favorable than oral realimentation programs and does not seem desirable in developing countries.

Change in bile salt dependent lipase in human breast milk during extended lactation.

Two hundred eighty-one milk samples collected from Zaïrian nonprivileged, undernourished mothers, in series of nine groups from 1 month to 18 months after parturition, and 66 milk samples collected from French privileged mothers in series of four groups from 2 days to 16 months postpartum, were analyzed for their lactose, lipid and protein contents. In addition, the activity of bile salt-dependent lipase (esterase), which may play an important role in the newborn infant's lipids digestion, was measured. After the first month postpartum, independent of the nutritional state of the mother, sugar and protein concentrations were identical. Lipid content of French mothers' milk was lower in transitional milk, but appeared constant in mature milk with an average value of 29.1 +/- 5.8 mg/mL of milk. In Zaïrian mothers' milk, the lipid content of mature milk plateaued at around 50-55 mg/mL independent of the stage of lactation. Bile salt-dependent lipase showed constant esterase activity within the lactation stage in privileged mothers' milk, but decreased by almost 80-90% during the first four months of lactation in undernourished mothers. The data suggest that milk from nonprivileged mothers may lose some of its ability to hydrolyze milk lipid esters, which could also be of consequence to the infant's normal growth in view of its effect on the esters of the lipid-soluble vitamins A, E and D.

Breast-feeding and the growth and development of the infant.

PIP: Milk production and infant growth were compared in 2 regions of Zaire: the highlands of Central Africa and the city of Bukavu. There were no statistical differences between the 2 groups in breastfeeding patterns or maternal prolactin levels. There were significant differences, however, in anthropometric characteristics and serum albumin levels. Urban women produced almost twice as much milk as women in rural areas. In terms of infant growth, a faltering in weight gain occurs at 3 months of age in rural areas as opposed to 6-7 months in the urban area. In addition, the 1st episode of diarrhea and of intestinal parasitosis occurred earlier in rural children than in their urban counterparts, most likely due to the earlier introduction of supplementary food in rural areas. Height remained well below the reference curve level from birth in the rural sample and from the 3rd month of life in the city. Finally, the serum albumin level remained strikingly low throughout infancy among rural children surveyed. Exclusive breastfeeding for the 1st 5-6 months of life is recommended to combat the exposure the infections and parasitosis conferred by early supplemental feeding.^ieng

Minor and trace elements in human milk from Guatemala, Hungary, Nigeria, Philippines, Sweden, and Zaire. Results from a WHO/IAEA joint project.

Concentrations of As, Ca, Cd, Cl, Co, Cr, Cu, F, Fe, Hg, I, K, Mg, Mn, Mo, Na, Ni, P, Pb, Sb, Se, Sn, V, and Zn were determined in human whole milk samples from Guatemala, Hungary, Nigeria, Philippines, Sweden, and Zaire; in most of these countries, three groups of subjects representing different socioeconomic conditions were studied. Analytical quality control was a primary consideration throughout. The analytical techniques used were atomic absorption spectrophotometry, atomic emission spectrometry with an inductively coupled plasma, colorimetry, electrochemistry, using an ion-selective electrode and neutron activation analysis. The differences between median concentrations of Ca, Cl, Mg, K, Na, and P (minor elements) were lower than 20% among the six countries. Among trace elements, concentrations observed in Filipino milk for As, Cd, Co, Cr, Cu, F, Fe, Mn, Mo, Ni, Pb, Sb, Se, and V were higher than for milk samples from other countries. The remaining five countries showed a mixed picture of high and low values. In the case of at least some elements, such as, F, I, Hg, Mn, Pb, and Se, the environment appears to play a major role in determining their concentrations in human milk. The nutritional status of the mother, as reflected by her socioeconomic status, does not appear to influence significantly the breast milk concentrations of minor and trace elements. Significant differences exist between the actual daily intakes observed in this study and current dietary recommendations made by, for example, WHO and the US National Academy of Sciences. These differences are particularly large (an order of magnitude or more!) for Cr, F, Fe, Mn, and Mo; for other elements, such as, Ca, Cu, Mg, P, and Zn, they amount to at least a factor 2. In the opinion of the present authors, these findings point to the need for a possible reassessment of the dietary requirements of young infants with respect to minor and trace elements, particularly for the elements Ca, Cr, Cu, F, Fe, Mg, Mn, Mo, P, and Zn.