Faecal chymotrypsin concentrations in neonates with cystic fibrosis and healthy controls.

Brown, Gregory A.; Halliday, R. B.; Turner, Paul J.; Smalley, C A

doi:10.1136/adc.63.10.1229

Cited by 9 publications

(3 citation statements)

References 8 publications

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“…Appetite was measured, when possible, on the basis of calorie intake and defined "excessive" when measured intakes were 25% more than expected. Of the tests carried out during admission for diagnosis, specific measures of nutritional status and pancreatic function included levels of albumin (abnormal if %3Og/l) (17,18,19,20,21), and faecal chymotrypsin (abnormal 5 6 U/g) (22)(23)(24)(25), respectively. Stools were considered abnormal if frequent, bulky, foul-smelling and greasy.…”

Section: Methodsmentioning

confidence: 99%

Failure to thrive: the earliest feature of cystic fibrosis in infants diagnosed by neonatal screening

et al. 1997

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The benefits of early treatment of nutritional and respiratory problems in the CF infant and of genetic counselling for the parents are widely recognized. However, clinical diagnosis of CF is often delayed despite early onset of symptoms and the usefulness of neonatal population screening as a preventive measure is still under debate. This study analyses the clinical history of CF patients diagnosed exclusively on the basis of positive neonatal screening tests with the aim of identifying the earliest markers of the disease. We studied 103 CF infants born in north-east Italy, diagnosed following neonatal screening: assay of immunoreactive trypsin (IRT) from a heel-prick blood sample followed by a measurement of meconium lactase in cases with raised IRT. Diagnosis was confirmed by sweat test at an average age of 39 days. Eighty-one patients (79%) had symptoms strongly suggestive of CF at diagnosis, and signs and/or symptoms of pancreatic insufficiency were present in 16 of the remaining 22 cases. The most frequent symptom was growth failure (69% of infants) and of these, 44% weighed the same as at birth or less. Pancreatic insufficiency was confirmed by the low level of faecal chymotrypsin found in 85% of cases. IRT was elevated in all cases. CF had not been suspected in any symptomatic infant, although most of the infants had been monitored by a paediatrician. In conclusion, most infants with CF diagnosed by neonatal screening are already symptomatic in the first six weeks of life and the most frequent symptom is failure to thrive; pancreatic insufficiency was already present in most cases. In areas without CF neonatal screening programs, the disease should be excluded by differential diagnosis in all cases with growth failure notwithstanding adequate caloric intake in the first months of life. The high sensitivity, low cost and simple execution of IRT and fecal chymotrypsin tests make them an ideal first step in suspect cases before proceeding to the sweat test, often performed late because of limited availability.

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Section: Methodsmentioning

confidence: 99%

Failure to thrive: the earliest feature of cystic fibrosis in infants diagnosed by neonatal screening

et al. 1997

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“…In 46 children with cystic fibrosis and clinical evidence of malabsorption, chymotrypsin measured in a single stool was unequivocally subnormal in each case, and in five children with undetectable or only traces of chymotrypsin in the duodenum after stimulation, the mean faecal chymotrypsin concentrations were only 3-10% of the lower reference range. 27 In infants with meconium ileus, faecal chymotrypsin was below the reference range in all 22 who were subsequently shown to have cystic fibrosis and within the normal range in all eight who later had negative sweat tests.27 This test is therefore useful for identifying pancreatic insufficiency in the surgical newborn too young for sweat testing, and in this clinical situation is both sensitive and specific. Concentrations in preterm infants are similar to those at term, and lower in growth retarded compared with appropriately grown infants,28 a finding consistent with the effects on the pancreas of antenatal malnutrition in animal models and starvation in childhood.…”

Section: Puntis Assessment Ofpancreatic Exocrinefunctionmentioning

confidence: 96%

Assessment of pancreatic exocrine function.

Puntis¹

1993

Archives of Disease in Childhood

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“…Fasting levels of a variety of gut peptides and their postprandial surges are lower in breast-fed than in formula-fed infants (3). Surges in jejunal disaccharidase activity (4) and in pancreatic exocrine function (5) also take place over the first few days. axis were qualitativel y similar but substantially smaller.…”

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confidence: 99%

Doppler Assessment of Human Neonatal Gut Blood Flow Velocities

Coombs,

Morgan,

Durbin

et al. 1992

J. pediatr. gastroenterol. nutr.

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SummaryDuplex pulsed Doppler ultrasound was used to study changes in gut blood flow velocities during the first week of life in a group of 14 term babies. There was a significant increase in fasting peak systolic velocity in the superior mesenteric artery between days 1 and 2 with a further upward trend until day 5; no such changes were seen in the coeliac axis. Fasting velocities were 20% lower in breast‐fed babies than bottle‐fed babies. Following feeds, there was a significant increase in velocity in the superior mesenteric artery that was 35% greater in the bottle‐fed than breast‐fed babies. Changes in the coeliac axis were qualitatively similar but substantially smaller. The peak velocity in both vessels occurred 50 min after a feed. We conclude that Doppler ultrasound can be readily used to measure gut blood flow velocities in the human newborn. It provides a noninvasive technique for investigating adaptive postnatal changes in the splanchnic circulation, and, in particular, the response to feeds.

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Faecal chymotrypsin concentrations in neonates with cystic fibrosis and healthy controls.

Cited by 9 publications

References 8 publications

Failure to thrive: the earliest feature of cystic fibrosis in infants diagnosed by neonatal screening

Failure to thrive: the earliest feature of cystic fibrosis in infants diagnosed by neonatal screening

Assessment of pancreatic exocrine function.

Doppler Assessment of Human Neonatal Gut Blood Flow Velocities

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