To assess growth outcomes of VLBW infants using different growth references and to validate the practice of age adjustment for prematurity in the growth assessment for VLBW infants.
Longitudinal growth data of 514 VLBW infants from 4 to 36 months of adjusted age were analyzed separately based on chronological and adjusted age and by comparison with three growth references.
More infants were labelled as having "subnormal growth" assessed on chronological age than on adjusted age throughout the first three years of life. The proportions of subnormal growth determined using a Canadian and the WHO reference for breastfed infants were similar; they were different from those obtained using the NCHS/WHO reference.
Our findings suggested that the interpretations of growth in VLBW infants vary substantially depending on which reference is used. The age adjustment for prematurity makes substantial difference in identifying subnormal growth in VLBW infants. The adjustment should be carried out throughout the first three years of life.
The smaller size of breast fed children in infancy and thereafter in malnourished and well-nourished populations has resulted in rushes to judgement that have been shown to be ill-advised. The reasons for the smaller size in malnourished populations is due to retaining the small and sickly child at the breast (reverse causality) and the consequent continuing sickliness of this breast fed child (negative confounding). Once the reverse causality and negative confounding have been taken into account breast feeding improves growth, at least through the second year of life. Thus prolonged breastfeeding should always be fostered, especially in malnourished populations. An exception remains when breast milk may transmit disease to the suckling child. In well-nourished populations the magnitude of the difference between breast fed and weaned children is much less than in malnourished populations, is observed to increase over the first year of life, but to have disappeared by the end of the second year. One may never-the-less be concerned that complimentary feeding practices are not adequate for these children.
We evaluated clinical characteristics and growth in 51 (24 males) long-term survivors of childhood cancer (median follow up 12.7 years). Patients were shorter, had a higher proportion of body fat and higher systolic blood pressure than their controls. The change in relative height during treatment was -0.83 standard deviation score (S.D.S.) in patients with cranial irradiation and -0.32 S.D.S. in patients without cranial irradiation; the figures after treatment were -0.56 and 0.20 S.D.S., respectively. Half (r2 = 0.50) of the variation in growth retardation during therapy could be explained by the cumulative doses of 6-mercaptopurine (6-MP) and vincristine and relative height at diagnosis. Cranial irradiation, increased relative height at diagnosis and young age at diagnosis were significant predictors of growth failure over the total observation period, explaining 43% of the variation. We conclude that long-term survivors of childhood cancer have impaired linear growth, increased body fat mass and elevated systolic blood pressure. Young children who are tall for their age at diagnosis and treated with cranial irradiation have the highest risk of impaired growth after the diagnosis. High doses of 6-MP seem to contribute significantly to growth retardation during therapy.
To assess the coexistence of maternal adiposity and child stunting (CS) in Mexico, estimate its national prevalence and identify the associated socio-demographic factors.
A secondary analysis from the Mexican Nutrition Survey 1999, a nationally representative survey, was conducted. Mother and children subsamples were matched and a total of 6225 mother/child pairs were obtained. Stunting was defined as height-for-age z-scores or =0.85) while controlling for biological and socio-demographic factors.
A total of 5974 pairs had complete information. MCA coexisted with CS in 6.2% of the mother/child pairs. The phenomenon was more prevalent in rural locations, in the south region and among indigenous families (14.5, 12.5 and 23.9%). After controlling for child age and maternal BMI, a 78% increase in the likelihood of CS was related to maternal WHR > or =0.85 (odds ratio (OR)=1.78, 95% confidence interval (CI)=1.53, 2.10). After controlling for maternal height, the magnitude of the OR decreased (OR=1.33, 95%CI=1.13, 1.57), but remained significant. Therefore, it is suggested that women with a WHR approximately 1 have had twice the probability of having a stunted child as those with a WHR of 0.65.
Although MCA and CS are two conditions frequently regarded as result of opposite determinants, our observation suggests that this is not necessarily the case, particularly in populations undergoing the nutrition transition. MCA was associated not only to chronic diseases, but also to child stunting.
Human health status in Russia has declined sharply over the last decade. The massive social changes that have taken place since the fall of the Soviet Union have resulted in increasing morbidity and mortality rates. However, relatively little information is available on the changes in health and disease patterns of Russia's many indigenous populations. The present study examines anthropometric indices of growth status of young children (
As a result of the examination of 14500 children, living in the Rostov Region, data have been obtained, characterizing the level and nature of endocrine disturbance in rural children, being evaluated from such aspects as the individual physical and sexual development. Endocrine disease in the rural children (116.2 +/- 3.2%) does not exceed these abnormalities observed among the town children. The prevalence of endocrine diseases increases from 90.3 +/- 5.1% in the children, ranging in age from birth to 7 years old, to 143.2 +/- 5.3% in the schoolchildren. Girls are more often developing obesity (t = 4.2) and endocrine abnormalities (t = 4.6), whereas boys are suffering from delay of the growth (t = 3.5) and sexual maturation. The standard glucose tolerance test, performed in the children at a high risk of diabetes mellitus (with aggravated heredity in regard to diabetes mellitus and obesity of the II, III and IV stages) has revealed intolerance in 59% of the children, of whom 2.2% had diabetic type curves. Based on the data on endocrine abnormalities, a mode of the organization structure for the children's endocrinological service was developed.
Current best evidence-based practice for children with chronic kidney disease (CKD) attempts to achieve good clinical outcomes through careful management of comorbidities and is likely best achieved with a multidisciplinary care (MDC) CKD clinic.
In this retrospective study of children with CKD in British Columbia, Canada, we analyzed clinical outcomes in a cohort of 73 CKD patients from 2003 under a standard care model and a second cohort of 125 CKD patients from 2009 under a MDC clinic model.
Patient demographics were similar, but there was a decrease in the percentage of patients with CKD stage 3-5 in 2009 (59 vs. 75 %; p = 0.002), although the absolute number increased. After adjustment for severity of CKD, hemoglobin was significantly higher (13.0 g/dl vs. 12.2 g/dl, p
OBJECTIVE: To present epidemiologic data on the relatively rare malformation choanal atresia, based on a large collection of material and with special stress on the significance of the so-called CHARGE (coloboma, heart defect, choanal atresia, retarded growth and development, genital anomaly, and ear defect with deafness) association. METHODS: Data from three large registries of congenital malformations were used. Based on more than 5 million births, 444 infants with choanal atresia were identified. RESULTS: The average rate of choanal atresia is 0.82 per 10,000 and varies among programs. There is no statistically significant difference between races in rates, even though white infants have a higher rate than those of other races. The higher rate found in the California program is mainly attributable to unilateral, isolated cases. Unilateral atresia occurs equally often on the right and left. Among all cases of choanal atresia, the sex distribution is normal, a slightly increased risk at twinning exists, and no effect of maternal age or parity is seen. Chromosome anomalies are found in 6% of infants with choanal atresia, and 21 infants (5%) have monogenic syndromes or conditions. An analysis of associated malformations (present in 47% of the infants without chromosome anomalies) indicated that although a weak nonrandom association can be demonstrated between the malformations entering the so-called CHARGE complex, only a small proportion of infants with choanal atresia and other components of that condition probably represent this entity. The term CHARGE association seems to be overused in clinical practice. CONCLUSION: To be meaningful, the term CHARGE should be restricted to infants with multiple malformations and choanal atresia and/or coloboma combined with other cardinal malformations (heart, ear, and genital) and with a total of at least three cardinal malformations. Growth retardation should not be used in the definition.