Correlative study of hydrochloric acid, pepsin, and intrinsic factor secretion in newborns and infants

Agunod, Mona; Yamaguchi, Nobuo; Lopez, Rafael; Luhby, A. Leonard; Glass, George B. Jerzy

doi:10.1007/bf02239360

Cited by 274 publications

(115 citation statements)

References 21 publications

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“…[126][127][128] This maturational difference was confirmed by Gharpure et al, 124 who reported that pepsin levels of 20 μg/mL or less as well as trypsin levels of 50 μg/mL or greater were associated with aspirates from intestinal tubes. Westhus 129 reported that pepsin levels greater than 20 μg/mL and trypsin levels less than 50 μg/mL are good predictors of gastric placements of feeding tubes; however, negative results were not good predictors of intestinal placement.…”

Section: Implications For Practice: Predicting Insertion Lengthmentioning

confidence: 87%

“…The nurse should feel confident with the result of the verification methods that the tip of the tube is in the stomach. Numerous case reports of tubes verified as being in correct place by auscultation, later found to be malpositioned 97,100,101,115 Cutoff values for capnography not established Colorimetric device may detect respiratory placement 120 but does not allow distinction between esophageal, gastric, and intestinal placement Conflicting evidence that the cutoff of 5 mg/dL allows distinction between gastric and intestinal placement 89,124,125 No bedside test Values highly variable during first year of life [126][127][128] Conflicting evidence regarding predictive value 124,129 No bedside test Values <50 μg/mL may be associated with gastric placement, but values ≥50 μg/mL may not be associated with intestinal placement 129 No bedside test pH values ≤5 good predictor of gastric placement 89,124 ; however, values >5.0 are not as helpful at identifying tubes that are not in the stomach 89 Does not allow distinction between respiratory and intestinal placement Most useful if used in conjunction with aspirate color 102,105,129,130 Subjective May not allow distinction between respiratory, esophageal, and gastric placement Most useful if used in conjunction with pH 102,105,129,130 limitations associated with various methods of verifying tube placement. Radiography remains the only single method by which feeding tube placement can be reliably determined.…”

Section: Methods Of Verifying Placementmentioning

confidence: 99%

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Examining the Evidence to Guide Practice: Challenging Practice Habits

Makic

Rauen

Watson

et al. 2014

Critical Care Nurse

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I n 2001, the Institute of Medicine challenged all health care professionals to decrease variation in practice through adoption of practice interventions based on best evidence to improve patients' outcomes.1 Current reviews of clinical practice suggest that only 10% to 15% of clinicians consistently implement evidence-based care 2 and indicate that it may take up to 2 decades for original research to be put into routine clinical practice.3 It is well established that evidence-based practice (EBP) is associated with higher quality care and better outcomes for patients than care that is steeped in tradition. 4 Yet at times, clinicians continue to practice on the basis of tradition.

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Section: Implications For Practice: Predicting Insertion Lengthmentioning

confidence: 87%

Section: Methods Of Verifying Placementmentioning

confidence: 99%

Examining the Evidence to Guide Practice: Challenging Practice Habits

Makic

Rauen

Watson

et al. 2014

Critical Care Nurse

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“…Our data provide a causal explanation for the concept established by multiple epidemiological studies that the risk of Helicobacter infection appears to be low for adults, since their gastric environment consists of large amounts of pepsin activated by low pH values. In young infants, however, neutral pH values persist for up to an hour after breast feeding (17), and pepsin secretion increases in the first months from low values until it reaches the adult values (1,21). The decreased pepsin activity during this period of time might give H. pylori the opportunity to colonize.…”

Section: Discussionmentioning

confidence: 99%

Rapid Loss of Motility of Helicobacter pylori in the Gastric Lumen In Vivo

Schreiber¹,

Bücker²,

Groll³

et al. 2005

Infect Immun

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The human pathogen Helicobacter pylori has infected more than half of the world's population. Nevertheless, the first step of infection, the acute colonization of the gastric mucus, is poorly understood. For successful colonization, H. pylori must retain active motility in the gastric lumen until it reaches the safety of the mucus layer. To identify the factors determining the acute colonization, we inserted bacteria into the stomach of anesthetized Mongolian gerbils. We adjusted the gastric juice to defined pH values of between 2.0 and 6.0 by using an autotitrator. Despite the fact that Helicobacter spp. are known to survive low pH values for a certain time in vitro, the length of time that H. pylori persisted under the assay conditions within the gastric juice in vivo was remarkably shorter. In the anesthetized animal we found H. pylori to be irreversibly immotile in less than 1 min at lumen pH values of 2 and 3. At pH 4 motility was lost after 2 min. However, the period of motility increased to more than 15 min at pH 6. Blocking pepsins in the gastric lumen in vivo by using pepstatin significantly increased the period of motility. It was possible to simulate the rapid in vivo immotilization in vitro by adding pepsins. We conclude that pepsin limits the persistence of H. pylori in the gastric chymus to only a few minutes by rapidly inhibiting active motility. It is therefore likely that this short period of resistance in the gastric lumen is one of the most critical phases of Helicobacter infection.

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“…22 The slow passage of food and decreased ability to digest may cause flocculation of casein by gastric acid to form curd casein, a mass that can obstruct the intestinal tract leading to intestinal obstruction. 23 Neonates have some limitations i.e., the inability to swallow solid food, 24 slow regeneration of intestinal mucosa, 25 undeveloped pancreatic alpha amylase, 26 small quantity of gastric acid secretion, 27 and immature immune system. 28 Those limitations cause disturbances of peristalsis and flow of intestinal content, which further can easily cause SIO.…”

Section: Resultsmentioning

confidence: 99%

Association between the absence of colostrum feeding and symptoms of intestinal obstruction or neonatal necrotizing enterocolitis

Wiryo¹,

Hakimi²,

Wahab³

et al. 2016

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Objective To assess the relationship between withholding colostrum and symptoms of intestinal obstruction (SIO) or neonatal necrotizing enterocolitis (NNEC).Methods This was a longitudinal cohort study in four subdistricts in West Lombok involving mothers and live newborns. Mothers were interviewed about prenatal care, delivery process, and practice of colostrum feedings. Neonates were followed everyday for 28 days by field assistants for signs of intestinal obstruction or NNEC. We used X 2 test to analyze the association between the absence of colostrum feeding and the occurence of SIO and student t test to compare the average of colostrum feeding between the SIO and the non-SIO group.Results 3420 live newborns between 1993-1994 were observed. 1900 mothers gave colostrum while 1520 did not. The incidence of SIO was 1.8%. There was a significant association between the absence of colostrum feeding and the occurence of the SIO (RR 1.816; p=0.028). No infants with NNEC were given colostrum. Conclusion

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Correlative study of hydrochloric acid, pepsin, and intrinsic factor secretion in newborns and infants

Cited by 274 publications

References 21 publications

Examining the Evidence to Guide Practice: Challenging Practice Habits

Examining the Evidence to Guide Practice: Challenging Practice Habits

Rapid Loss of Motility of Helicobacter pylori in the Gastric Lumen In Vivo

Association between the absence of colostrum feeding and symptoms of intestinal obstruction or neonatal necrotizing enterocolitis

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