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Deviation Score (deviation + score)
Kinds of Deviation Score Selected AbstractsIntra-individual variability in infancy: Structure, stability, and nutritional correlatesDEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2008Theodore D. Wachs Abstract Intra-individual variability (IIV) refers to relatively stable differences between individuals in the degree to which they show behavioral fluctuations over relatively short time periods. Using temperament as a conceptual framework the structure, stability, and biological roots of IIV were assessed over the first year of life. Biological roots were defined by maternal and infant nutrition. The sample was 249 Peruvian neonates, followed from the second trimester of pregnancy through the first 12 months of life. Maternal anthropometry, diet, iron status, and fetal growth were assessed prenatally. Neonatal anthropometry and iron status were assessed at birth. Degree of exclusive breastfeeding was assessed at 3 and 6 months, infant anthropometry was assessed at 3, 6, and 12 months, infant dietary intake was assessed at 6 and 12 months and infant iron status was tested at 12 months. Individual differences in IIV at 3, 6, and 12 months were derived from a residual standard deviation score based on infant behaviors measured using the Louisville Temperament Assessment Procedure. Principal components analysis indicated that individual differences in IIV were defined by two components at 3, 6, and 12 months. There was modest stability between IIV components assessed at 3 and 12 months. Reduced levels of IIV at 3 months were predicted by higher maternal weight and higher fetal weight gains in the first and second trimesters of pregnancy. Higher levels of IIV at 3 months were predicted by higher levels of maternal hemoglobin during pregnancy and higher levels of neonatal ferritin. © 2008 Wiley Periodicals, Inc. Dev Psychobiol 50: 217,231, 2008. [source] Childhood growth and age at diagnosis with Type 1 diabetes in Colorado young peopleDIABETIC MEDICINE, Issue 10 2009K. Vehik Abstract Objective, Studies have suggested that the age at diagnosis of Type 1 diabetes (T1D) is decreasing over time. The overload hypothesis postulates that risk factors, such as accelerated growth, may be responsible for this decrease. We assessed changes in age, body mass index (BMI), weight and height at diagnosis with T1D in non-Hispanic white (NHW) and Hispanic (HISP) young people from Colorado, using data from the IDDM Registry and SEARCH Study. Methods, In three time periods, 656 (1978,1983), 562 (1984,1988) and 712 (2002,2004) young people aged 2,17 years were newly diagnosed with T1D. Age, weight, height and presence of diabetic ketoacidosis (DKA) at diagnosis with T1D were obtained from medical records. Trends over the three time periods were assessed with regression analyses. Results, Age at diagnosis decreased by 9.6 months over time (P = 0.0002). Mean BMI standard deviation score (SDS), weight SDS and height SDS increased over time (P < 0.0001), while prevalence of DKA decreased (P < 0.0001). Increasing height over time accounted for 15% (P = 0.04) of the decreasing age at diagnosis with T1D. Conclusions, Our study provides evidence that increased linear growth, but not increased BMI or weight over time, may account, at least in part, for the younger age at diagnosis of T1D in Colorado children. This finding supports the hypothesis that increasing environmental pressure resulting from changes in potentially preventable risk factors may accelerate the onset of T1D in children. [source] Comparison of continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) in paediatric Type 1 diabetes: a multicentre matched-pair cohort analysis over 3 yearsDIABETIC MEDICINE, Issue 1 2008B. I. Jakisch Abstract Aims To conduct a multicentre, matched-pair cohort analysis comparing glycaemic control and adverse events of continuous subcutaneous insulin infusion (CSII) with multiple daily injections (MDI) in paediatric patients. Methods Using standardized computer-based prospective documentation, HbA1c, insulin dose, body mass index,standard deviation score (BMI,SDS), rate of hypoglycaemia, rate of diabetic ketoacidosis (DKA) and intensity of care were analysed in 434 matched pairs during a follow-up period of 3 years after initiation of MDI or CSII. Results HbA1c was significantly lower in the CSII group during the first year of new regimen (CSII 7.5 ± 0.05 vs. MDI 7.7 ± 0.06; P < 0.05), but rose to the same level as in the MDI group during year 3. Insulin requirement remained significantly lower in the CSII group. The BMI,SDS increased in both study groups, with no significant difference. The rate of severe hypoglycaemia decreased significantly after the change of regimen (CSII 17.87 ± 2.85 vs. MDI 25.14 ± 3.79; P < 0.05) and during year 3 of the regimen, particularly when compared with baseline (,21% vs. ,16%). The rate of DKA was lower at baseline in the CSII group and remained significantly lower over all 3 years. Intensity of care was the same in both subsets. Conclusions Employing a large cohort, this matched-pair analysis has demonstrated over a 3-year study period that CSII is a safe form of intensive insulin therapy with similar glycaemic effects, but with significantly reduced rates of hypoglycaemia and DKA and a lower insulin requirement when compared with MDI. [source] Early treatment with l -thyroxine in children and adolescents with type 1 diabetes, positive thyroid antibodies, and thyroid gland enlargementPEDIATRIC DIABETES, Issue 4 2007Olga Kordonouri Aim:, To investigate whether early treatment with l -thyroxine may prevent deterioration of thyromegaly and progression to subclinical or clinical hypothyroidism in pediatric patients with type 1 diabetes, positive thyroid antibodies, and ultrasound abnormalities of the thyroid gland. Methods:, The development of thyroid gland volume and function in patients without l -thyroxine treatment (group A, n = 8) was assessed and compared with that in patients receiving l -thyroxine treatment (group B, n = 7) with median follow-up time of 2.0 yr (range 0.6,3.0 yr). Standard deviation score (SDS) of thyroid gland volume was calculated according to gender- and age-corresponding data. Results:, Median thyroid gland volume SDS at study entry was 4.8 (range 2.0-15.3) in group A and 5.6 (3.6,13.9) in group B. At follow-up, median thyroid volume SDS has increased by 0.8 (,3.9 to 6.0) at 1 yr and by 2.0 (,4.5 to 10.9) at 2 yr in group A but decreased significantly by ,3.4 (,10.0 to 0.4) and ,5.3 (,12.3 to ,1.7) in group B, respectively. The change of thyroid gland volume was significantly different between the two groups (p = .043 and .032, respectively). In group A, three of eight patients without therapy developed subclinical hypothyroidism with thyroid-stimulating hormone elevation. Conclusion:, These data demonstrate that treatment with l -thyroxine in patients with diabetes, positive thyroid antibodies, and elevated gland volume leads to a significant reduction of thyromegaly. Prospective randomized clinical trials are required to prove these preliminary findings. [source] Anthropometric indices as predictors of the metabolic syndrome and its components in adolescentsPEDIATRICS INTERNATIONAL, Issue 3 2010Christian Jung Abstract Background:, Overweight and related health problems are becoming increasingly recognized, especially in children and adolescents. For early screening, different anthropometrical measurements of obesity have been proposed to identify individuals at risk. We compared body mass index (BMI), BMI standard deviation score, waist circumference, waist-to-hip ratio (WHR), and waist/height ratio with respect to their power to predict the metabolic syndrome, its components and low-grade inflammation. Methods:, A total of 79 male Caucasian German adolescents (13,17 years) were studied. All anthropometrical measurements of obesity were recorded and blood samples drawn. Predictive power was estimated using receiver operating characteristic curves, by comparing the area under the curve (AUC). Results:, Except for WHR, all tested anthropometrical measurements of obesity showed comparably good AUC values for correct prediction, with the highest AUC for BMI (P < 0.001, AUC = 0.885 ± 0.039). Superior prediction power was not observed for BMI standard deviation score, waist circumference, WHR or waist/height ratio. Furthermore, BMI was the best predictor of elevated C-reactive protein levels as a marker for low-grade inflammation (P < 0.001, AUC = 0.786 ± 0.064). Conclusions:, In this cross-sectional study the well-established parameter BMI was shown to have the best predictive power to identify metabolic syndrome, its components and markers for low-grade inflammation. Newly developed parameters did not provide superior values. Future longitudinal studies are needed to compare these anthropometrical markers in larger cohorts, incorporating different age groups and ethnic backgrounds. [source] Cognitive effects of hormonal therapy in early stage breast cancer patients: a prospective studyPSYCHO-ONCOLOGY, Issue 8 2009Barbara Collins Abstract Objective: The primary purpose of this study was to evaluate the cognitive effects of adjuvant hormonal therapies in breast cancer patients. Participants and Methods: Post-menopausal breast cancer patients scheduled to receive tamoxifen (n=31) or anastrozole (n=14) completed neuropsychological testing around the time of commencement of treatment (T1), and again 5,6 months later (T2). A sample of healthy female volunteers (n=28) was tested at comparable intervals. A standardized regression-based approach was used to assess cognitive change. This method uses test/retest scores of the healthy control group to generate an equation that predicts T2 scores from T1 scores. The difference between the predicted and obtained T2 scores divided by the standard error of the estimate produces a deviation score that reflects the discrepancy from the T1,T2 difference scores that would be expected on the basis of practice and error alone. Results: Analysis of individual deviation scores revealed that both the patients taking tamoxifen and those taking anastrozole were more likely than healthy controls to show reliable cognitive decline from T1 to T2 (39, 64, and 7%, respectively). Processing speed and verbal memory were the cognitive domains most affected. Conclusion: These data suggest that hormonal therapies exert a subtle negative influence on cognition in breast cancer patients. Further analyses indicated that this effect was not fully accounted for by demographic factors or fatigue. Methodological limitations of the current study are addressed, along with recommendations for future studies in this area. Copyright © 2008 John Wiley & Sons, Ltd. [source] A Randomized Trial to Assess the Impact of Early Steroid Withdrawal on Growth in Pediatric Renal Transplantation: The TWIST StudyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010R. Grenda Minimizing steroid exposure in pediatric renal transplant recipients can improve linear growth and reduce metabolic disorders. This randomized multicenter study investigated the impact of early steroid withdrawal on mean change in height standard deviation score (SDS) and the safety and efficacy of two immunosuppressive regimens during the first 6 months after transplantation. Children received tacrolimus, MMF, two doses of daclizumab and steroids until day 4 (TAC/MMF/DAC, n=98) or tacrolimus, MMF and standard-dose steroids (TAC/MMF/STR, n=98). Mean change in height SDS was 0.16 ± 0.32 with TAC/MMF/DAC and 0.03 ± 0.32 with TAC/MMF/STR. The mean treatment group difference was 0.13 (p < 0.005 [95% CI 0.04,0.22]), 0.21 in prepubertal (p = 0.009 [95% CI 0.05,0.36]) and 0.05 in pubertal children (p = ns). Frequency of biopsy-proven acute rejection was 10.2%, TAC/MMF/DAC, and 7.1%, TAC/MMF/STR. Patient and graft survival and renal function were similar. Significantly greater reductions in total cholesterol and triglycerides but significantly higher incidences of infection and anemia were found with TAC/MMF/DAC (p < 0.05 all comparisons). Early steroid withdrawal significantly aided growth at 6 months more so in prepubertal than pubertal children. This was accompanied by significantly better lipid and glucose metabolism profiles without increases in graft rejection or loss. [source] Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: Results of a national prospective studyARTHRITIS & RHEUMATISM, Issue 11 2009Yaël A. de Man Objective To determine the outcome of pregnancy in women with rheumatoid arthritis (RA) in relation to disease activity and medication use during the pregnancy. Methods In a prospective study, pregnant women with RA were evaluated before conception (when possible), during each trimester of the pregnancy, and postpartum. Clinical characteristics, disease activity, medication use, and pregnancy outcome were analyzed. To examine the independent influence of prednisone use and disease activity on birth weight, regression analyses were performed, with adjustments for gestational age of the child at delivery, the sex of the newborn, and the mother's smoking status, education level, parity, and use of an assisted reproduction technique. Kaplan-Meier curve analyses were performed to examine the association between medication use and gestational age at delivery. Results Data from 152 Caucasian RA patients with singleton pregnancies were available. Both the mean ± SD birth weight (3,379 ± 564 gm) and the mean ± SD birth weight standard deviation score (SDS; +0.1 ± 1.1), which is the birth weight adjusted for the gestational age and sex of the newborn, were comparable with those in the general population. On multiple linear regression analyses of birth weight and birth weight SDS, both of which were adjusted for covariates, only disease activity was associated with lower birth weight (P = 0.025). The gestational age at delivery was significantly lower in women who were taking prednisone (38.8 versus 39.9 weeks; P = 0.001), and their delivery was more often premature (<37 weeks; P = 0.004). Conclusion Pregnancy outcome in women with well-controlled RA is comparable with that in the general population. The effect of prednisone on birth weight is mediated by a lower gestational age at delivery, whereas a higher level of disease activity independently influences birth weight negatively, suggesting an immune-mediated mechanism. [source] Late effects of early growth hormone treatment in Down syndromeACTA PAEDIATRICA, Issue 5 2010Å Myrelid Abstract Objective:, Down syndrome (DS) is associated with short stature and psychomotor delay. We have previously shown that growth hormone (GH) treatment during infancy and childhood normalizes growth velocity and improves fine motor skill performance in DS. The aim of this study was to investigate late effects of early GH treatment on growth and psychomotor development in the DS subjects from the previous trial. Design:, Twelve of 15 adolescents with DS (3 F) from the GH group and 10 of 15 controls (5 F) participated in this follow-up study. Fifteen other subjects with DS (6 F) were included as controls in anthropometric analyses. Cognitive function was assessed with the Leiter International Performance Scale-Revised (Leiter-R) and selected subtests of the Wechsler Intelligence Scale for Children, Third edition (WISC-III). The Bruininks-Oseretsky Test of Motor Proficiency, Second edition (BOT-2), was used to assess general motor ability. Results:, Although early GH treatment had no effect on final height, the treated subjects had a greater head circumference standard deviation score (SDS) than the controls (,1.6 SDS vs. ,2.2 SDS). The adolescents previously treated with GH had scores above those of the controls in all subtests of Leiter-R and WISC-III, but no difference in Brief IQ-score was seen between the groups. The age-adjusted motor performance of all subjects was below ,2 SD, but the GH-treated subjects performed better than the controls in all but one subtest. Conclusion:, The combined finding of a greater head circumference SDS and better psychomotor performance indicates that DS subjects may benefit from early GH treatment. [source] Long-term effects of rapid weight gain in children, adolescents and young adults with appropriate birth weight for gestational age: the kiel obesity prevention studyACTA PAEDIATRICA, Issue 2 2010B Hitze Abstract Aim:, This study investigates the effect of rapid weight gain in term children, adolescents and young adults born appropriate for gestational age. Methods:, In all, 173 girls and 178 boys aged 6.1,19.9 (12.5 ± 3.1)years participated. Rapid weight gain (group 1) was defined as a change in weight-SDS (standard deviation score) from birth till two years >0.67, ,no change' as ,,0.67 and ,0.67 (group 2) vs ,slow weight gain' as <,0.67 (group 3). BMI-SDS, waist circumference (WC) z-score, fat mass (FM)/fat free mass (FFM; Air-Displacement-Plethysmography), resting energy expenditure (REE; ventilated hood system), cardio-metabolic risk factors, serum leptin and adiponectin were assessed. >90th age-/sex-specific BMI-percentile was defined as overweight. Parental BMI, socio-economic status and lifestyle were assessed as confounders. Results:, A total of 22.8% gained weight rapidly, and 15.7% was overweight. Group 1 compared with group 2 and 3 subjects was taller, heavier and had a higher prevalence of overweight (girls/boys: 26.2%/28.9% vs 11.6%/19.0% vs 2.8%/5.0%; p < 0.01/p < 0.05). Concomitantly, a higher WC, %FM and FFM were observed. Rapid weight gain was positively associated with REE (adjusted for FFM) in boys (r = 0.26; p < 0.01), but not with cardio-metabolic risk factors. Conclusion:, Rapid weight gain was related to increases in height, weight, a higher prevalence of overweight and central fat distribution. In addition, rapid weight gain was related to a higher REE in boys, but not to cardio-metabolic risk factors. [source] Nephrocalcinosis in children: a retrospective multi-centre studyACTA PAEDIATRICA, Issue 10 2009Anita Ammenti Abstract Aim:, To review the data of children with NC and to analyse aetiology, clinical manifestations, growth and renal function at presentation; to relate growth and renal function to changes in NC in patients with a follow-up of at least 12 months. Methods:, Data of 41 children from four institutions were gathered retrospectively. Results:, Presenting symptoms were failure to thrive in the first year of life (41%), urinary tract infections, bladder voiding dysfunction or abdominal pain (17%) and psychomotor delay (10%). In 24% of cases NC was detected incidentally. Glomerular function at diagnosis was normal in 83% of children. During a median follow-up of 4 yrs and 5 months in 28 patients, growth standard deviation score improved from a median of ,2.2 to ,1.0 and glomerular function remained stable in 89% of patients, in spite of worsening of the degree of NC in 62% of cases. The most frequent causes of NC were hereditary tubulopathies and vitamin D intoxication. Conclusion:, Our results show that the treatment of the underlying conditions is associated with catch-up growth and stabilization of glomerular function in many children, but not with the reduction in the degree of NC in the majority of cases. We believe that early recognition of conditions leading to NC is clinically useful and suggest a diagnostic flowchart, which may be helpful in the approach to NC. [source] Motor performance in very preterm infants before and after implementation of the newborn individualized developmental care and assessment programme in a neonatal intensive care unitACTA PAEDIATRICA, Issue 6 2009Anna Ullenhag Abstract Aim: To compare motor performance in supine position at the age of 4-months corrected age (CA) in very preterm (VPT) infants cared for in a neonatal intensive care unit (NICU) before and after the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Methods: Assessments of motor performance in supine position according to level of motor development and quality of motor performance were made, using the Structured Observation of Motor Performance in Infants (SOMP-I). Subjects: VPT infants cared for in a NICU at a Swedish university hospital before, Group A (n = 68), and after, Group B (n = 58), the implementation of developmentally supportive care based on NIDCAP. Results: The infants who were treated after the introduction of NIDCAP showed higher level of motor development in the arms/hands and trunk. No significant group differences were noted in total deviation score for the respective limbs, but lower frequency of lateral flexion in head movements, extension,external rotation,abduction, extension,internal rotation,adduction and varus and valgus position in the feet was found in the NIDCAP group, compared with those treated before the introduction. Conclusion: The infants who were treated after NIDCAP care had been implemented showed a higher level of motor development in arms/hand and trunk and fewer deviations in head, legs and feet at 4-months CA than infants treated before NIDCAP implementation. The observed changes may be due to NIDCAP and/or improved perinatal and neonatal care during the studied time period. [source] Parental and perinatal factors affecting childhood anthropometry of very-low-birth-weight premature infants: a population-based surveyACTA PAEDIATRICA, Issue 6 2009Imad R Makhoul Abstract Background: The perinatal,neonatal course of very-low-birth-weight (VLBW) infants might affect their childhood growth. We evaluated the effect of parental anthropometry and perinatal and neonatal morbidity of VLBW neonates on their childhood growth. Methods: We obtained parental anthropometry, height and weight at age 6,10.5 years of 334 children born as VLBW infants. Parental, perinatal and neonatal data of these children were tested for association with childhood anthropometry. Results: (1) Maternal and paternal weight standard deviation score (SDS) and discharge weight (DW) SDS were associated with childhood weight SDS (R2= 0.111, p < 0.00001); (2) Maternal and paternal height SDS, corrected gestational age (GA) at discharge, maternal assisted reproduction and SGA status were associated with childhood height SDS (R2= 0.208, p < 0.00001); (3) paternal weight SDS, DW SDS and surfactant therapy were associated with childhood body mass index (BMI) SDS (R2= 0.096, p < 0.00001). 31.1% of VLBW infants had DW SDS < ,1.88, and are to be considered small for gestational age (,SGA'). One quarter of these infants did not catch up by age 6,10.5 years. Conclusion: Childhood anthropometry of VLBW infants depends on parental anthropometry, postnatal respiratory morbidity and growth parameters at birth and at discharge. Almost one-third of VLBW premature infants had growth restriction at discharge from neonatal intensive care unit (NICU), a quarter of whom did not catch up by age 6,10.5 years. [source] Increased neonatal thyrotropin in Down syndromeACTA PAEDIATRICA, Issue 6 2009Å Myrelid Abstract Aim: Down syndrome (DS) is frequently associated with thyroid dysfunction. The aim of this study was to investigate the blood concentration of thyrotropin (TSH) observed at neonatal screening of infants with DS and its possible association with development of hypothyroidism during childhood. Methods: TSH levels from neonatal screening of 73 children (34 F) with DS born in 1986,1996 were studied retrospectively and compared with those of controls. The DS children were followed up regarding thyroid function to the age of 10 years in this descriptive study. Results: The DS infants had a higher mean TSH level and a higher TSH standard deviation score (SDS) than controls (7.0 ± 7.45 mU/L vs. 3.9 ± 2.43 mU/L and 1.1 ± 2.67 vs. 0, respectively). The differences were mainly attributable to higher values in the male DS children. The TSH level at screening did not predict thyroid dysfunction during childhood. Conclusion: Infants with DS, especially boys, showed elevated levels of TSH at neonatal screening, indicating the occurrence of mild hypothyroidism already in early life. The TSH levels could not predict development of manifest thyroid disease later in childhood. [source] Physical activity to prevent obesity in young children: cluster randomised controlled trialCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 3 2007Richard Reading Physical activity to prevent obesity in young children: cluster randomised controlled trial . Reilly, J. J., Kelly, L., Montgomery, C., Williamson, A., Fisher, A., McColl, J. H., Lo Conte, R., Paton, J. Y. & Grant, S. ( 2006 ) British Medical Journal , 333 , 1041 DOI: 10.1136/bmj.38979.623773.55. Objective To assess whether a physical activity intervention reduces body mass index in young children. Design Cluster randomized controlled single blinded trial over 12 months. Setting Thirty-six nurseries in Glasgow, Scotland. Participants In total, 545 children in their pre-school year, mean age 4.2 years (SD 0.2) at baseline. Intervention Enhanced physical activity programme in nursery (three 30-minute sessions a week over 24 weeks) plus home-based health education aimed at increasing physical activity through play and reducing sedentary behaviour. Main outcome measure Body mass index, expressed as a standard deviation score relative to UK 1990 reference data. Secondary measures were objectively measured physical activity and sedentary behaviour; fundamental movement skills; and evaluation of the process. Results Group allocation had no significant effect on the primary outcome measure at 6 and 12 months or on measures of physical activity and sedentary behaviour by accelerometry. Children in the intervention group had significantly higher performance in movement skills tests than control children at 6-month follow-up (P = 0.0027; 95% CI 0.3,1.3) after adjustment for sex and baseline performance. Conclusions Physical activity can significantly improve motor skills but did not reduce body mass index in young children in this trial. [source] Insulin sensitivity, VO2max and body composition in severely obese Swedish children and adolescentsACTA PAEDIATRICA, Issue 1 2009Gunilla Morinder Abstract Aim: The aim of this study was to identify relationships between insulin sensitivity (SI), cardiorespiratory fitness and body composition in severely obese Swedish children and adolescents. Methods: Two hundred and twenty-eight obese children (119 girls, 8,16 years, body mass index (BMI) 23.2,57.0 kg/m2) performed a frequently sampled intravenous glucose tolerance test (FSIVGTT), a submaximal bicycle ergometry test and a dual-energy X-ray absorptiometry (DEXA). Results: Mean SI (SD) was 0.38 (0.32) (×10,5/min/pM). SI correlated positively with relative body mass (BM) VO2max (r = 0.42) (p < 0.001), relative fat-free mass (FFM) VO2max (r = 0.36) (p < 0.001) and negatively with body mass index standard deviation score (BMI SDS) (r =,0.22) (p = 0.001). SI did not correlate with percent body fat (r =,0.01) and absolute VO2max (r = 0.01). In multiple regression analyses with SI as dependent variable, VO2max and body composition, together with gender, age and Tanner stage, explained 20,26% of the variance. Conclusion: Relative (BM) VO2max and relative (FFM) VO2max were stronger predictors of SI than percent body fat in severely obese children and adolescents. The study confirms that cardiorespiratory fitness is of importance for the metabolic syndrome in the studied population. Efforts to improve SI should include physical activity targeting cardiorespiratory fitness also in severely obese children and adolescents. [source] ORIGINAL ARTICLE: Should short children born small for gestational age with a distance to target height <1 standard deviation score be excluded from growth hormone treatment?CLINICAL ENDOCRINOLOGY, Issue 3 2010Annemieke J. Lem Summary Context, The criteria for starting growth hormone (GH), an approved treatment for short children born small for gestational age (SGA), differ between Europe and the USA. One European requirement for starting GH, a distance to target height (DTH) of ,1 standard deviation score (SDS), is controversial. Objective, To investigate the influence of DTH on growth during GH treatment in short SGA children and to ascertain whether it is correct to exclude children with a DTH <1 SDS from GH. Patients, A large group of short prepubertal SGA children (baseline n = 446; 4 years GH n = 215). Measurements, We analysed the prepubertal growth response during 4 years of GH. We investigated the influence of the continuous variable DTH SDS on growth response and a possible DTH SDS cut-off level below which point the growth response is insufficient. Results, Height gain SDS during 4 years of GH showed a wide variation at every DTH SDS level. Multiple regression analyses demonstrated that, after correction for other significant variables, an additional DTH of 1 SDS resulted in 0·13 SDS more height gain during 4 years of GH. We found no significant differences in height gain below and above certain DTH SDS cut-off levels. Conclusions, DTH SDS had a weak positive effect on height gain during 4 years of GH, while several other determinants had much larger effects. We found no support for using any DTH cut-off level. Based on our data, excluding children with a DTH <1 SDS from GH treatment is not justified. [source] Adiponectin levels in adolescent girls with polycystic ovary syndrome (PCOS)CLINICAL ENDOCRINOLOGY, Issue 6 2009Orit Pinhas-Hamiel Summary Objective, To determine serum adiponectin concentrations in adolescent girls with and without polycystic ovary syndrome (PCOS) and to assess possible correlations of adiponectin levels with insulin and androgen levels. Design, Prospective case,control study. Setting, Endocrine clinics in the community. Patients, Forty-four adolescent girls were grouped as follows: 14 were overweight [body mass index (BMI) standard deviation score >1·645] with PCOS; 16 were lean (BMI SDS <1·036) with PCOS; and 14 were lean (BMI SDS <1·036) without PCOS. Intervention, Blood samples were collected from all girls between 8 and 11 am, after an overnight fast. Main outcome measures, Serum levels of adiponectin, leptin, insulin, Müllerian-inhibiting substance, luteinizing hormone, follicle-stimulating hormone, testosterone, 17-alpha-hydroxyprogesterone, androstendione, dehydroepiandrosterone sulphate (DHEAS) and 17,-oestradiol. Results, Adiponectin concentrations were significantly decreased in obese adolescents with PCOS (10·5 ± 5·5 ,g/ml) compared with that in lean girls with or without PCOS (16·9 ± 8·64 and 18·0 ± 7·4 ,g/ml respectively). Leptin levels were significantly elevated in obese adolescents with PCOS compared with the levels in normal weight adolescents with PCOS, and compared with that in normal weight controls. Insulin levels were markedly higher in obese adolescents with PCOS compared with that in normal weight adolescents (12·3 ± 12·2 vs. 4·5 ± 2·9, P < 0·05), and compared with that in normal weight PCOS adolescents (7·4 ± 4·9); however, this difference was not statistically significant. Insulin levels did not differ between normal weight adolescents with PCOS and normal controls. Adiponectin concentrations correlated inversely with BMI, leptin and insulin. Conclusions, Hypoadiponectinaemia is evident only in obese adolescents with PCOS and therefore does not seem to be involved in the pathogenesis of PCOS in this age group. [source] Kisspeptin serum levels in girls with central precocious pubertyCLINICAL ENDOCRINOLOGY, Issue 4 2009L. De Vries Summary Objective, Central precocious puberty (CPP) causes early epiphyseal maturation, and early initiation of treatment improves final height. Unfortunately, there is no one parameter that can distinguish CPP from premature thelarche (PT), which is self-limited and requires no therapy. In animal models, kisspeptin, the ligand for the G-protein coupled receptor GPR54, was found to induce precocious activation of the gonadotrophic axis. Data on kisspeptin levels in girls with precocious puberty or in healthy prepubertal girls are lacking. We measured blood kisspeptin levels in girls with CPP and evaluated its potential as a clinical marker for CPP. Design, This was a case,control study. Patients, Thirty-one girls clinically diagnosed with CPP and 14 prepubertal age-matched healthy controls. Measurements, Kisspeptin blood levels. Results, Kisspeptin levels were significantly higher in the girls with CPP than in the controls: 14·62 ± 10·2 pmol/l vs. 8·35 ± 2·98 pmol/l, P < 0·05. Within the CPP group, there were no significant differences between the girls with a peak LH >5·0 IU/l and those with a peak LH ,5·0 IU/l regarding kisspeptin or any of the clinical, laboratory or ultrasound parameters, or in Tanner stage. No correlation was found between kisspeptin and body mass index standard deviation score (BMI-SDS) or height-SDS (Ht-SDS) for the entire cohort, or when analysed separately for the CPP group and the control group. Conclusions, Although kisspeptin is significantly higher in girls with true CPP than in age-matched prepubertal controls, the evident overlap limits its use as a single diagnostic tool until further data obtained in larger studies should prove otherwise. [source] Insulin, adiponectin, IGFBP-1 levels and body composition in small for gestational age born non-obese children during prepubertal agesCLINICAL ENDOCRINOLOGY, Issue 1 2008Ozlem Sancakli Summary Background, Being small for gestational age (SGA) at birth and postnatal growth pattern may have an impact on insulin resistance and body composition in later life. Adiponectin is a strong determinant of insulin sensitivity. Objective, The aim of this study was to evaluate insulin resistance and adiponectin levels in SGA born children with catch-up growth (CUG) in the absence of obesity in prepubertal ages and relations with body composition and insulin-like growth factor binding protein (IGFBP)-1. Methods, Twenty-four (15F, 9M) SGA born children with CUG but without obesity were evaluated at age 6·3 ± 0·5 years with respect to glucose, insulin, IGFBP-1, leptin and adiponectin levels, and body composition by dual-energy X-ray absorptiometry (DEXA). Their data were compared to that of 62 (27F, 35M) appropriate for gestational age (AGA) children. Results, SGA and AGA children had similar height standard deviation score (SDS) corrected for parental height and body mass index (BMI) SDS. Homeostasis model for insulin resistance (HOMA-IR) was significantly high in SGA (0·7 ± 0·6) than in AGA children (0·4 ± 0·2) (P = 0·029). There were no significant differences in leptin, IGFBP-1, adiponectin, and total and truncal fat between SGA and AGA children. However, being born SGA and having higher BMI in the upper half for the distribution in the sample, although within normal ranges, was associated with lower adiponectin levels (estimated means of log adiponectin levels 3·8 ± 0·3 vs. 4·4 ± 0·1 µg/ml, P = 0·040). Conclusions, SGA children with CUG and with no obesity have higher insulin levels compared to AGA children. Both SGA birth and recent size seem to have an effect on serum adiponectin levels in childhood. [source] Long-term effects of growth hormone (GH) treatment on body composition and bone mineral density in short children born small-for-gestational-age: six-year follow-up of a randomized controlled GH trialCLINICAL ENDOCRINOLOGY, Issue 4 2007Ruben H. Willemsen Summary Context, Alterations in the GH-IGF-I axis in short small-for-gestational-age (SGA) children might be associated with abnormalities in bone mineral density (BMD) and body composition. In addition, birth weight has been inversely associated with diabetes and cardiovascular disease in adult life. Data on detailed body composition in short SGA children and long-term effects of GH treatment are very scarce. Objective, To investigate effects of long-term GH treatment on body composition and BMD by dual energy X-ray absorptiometry (DXA) in short SGA children. Design, Longitudinal 6-year GH study with a randomized controlled part for 3 years. Results, At baseline, fat percentage standard deviation score (SDS) and lumbar spine BMD SDS corrected for height (BMADLS SDS) were significantly lower than zero. Lean body mass (LBM) SDS adjusted for age was also reduced, but LBM adjusted for height (LBM SDSheight) was not decreased. GH treatment induced a decrease in fat percentage SDS and an increase in BMADLS SDS. LBM SDSheight remained similar in GH-treated children, but deteriorated in untreated controls. When these untreated controls subsequently started GH treatment, their LBM SDSheight rapidly normalized to values comparable with zero. Conclusion, During long-term GH treatment in short SGA children, fat percentage SDS decreased and BMADLS SDS increased. These effects of GH treatment were most prominent in children who started treatment at a younger age and in those with greater height gain during GH treatment. LBM SDSheight remained around 0 SDS in GH-treated children, but declined to low normal values in untreated controls. [source] Factors predicting final height in early treated congenital hypothyroid patientsCLINICAL ENDOCRINOLOGY, Issue 5 2006Maurizio Delvecchio Summary Objective, To evaluate pubertal development and final height (FH) in early treated patients with congenital hypothyroidism (CH) and to identify the main factors predicting FH. Design, Retrospective. Patients, Eighty-five patients with early diagnosed and treated CH. Measurements, Evaluation of length/height at diagnosis (mean age 26·6 days), at onset of puberty, and at the end of linear growth. Results, Mean FH was 161·7 cm in females and 173·8 cm in males, within ± 0·9 cm of the 50th percentile of Italian growth charts, 5 cm higher than the mean target height (TH). Linear growth did not differ according to thyroid imaging findings. In males, height at onset of puberty was 0·16 standard deviation score (SDS), not statistically different from FH (,0·09 SDS). In females, height both at onset of puberty (0·39 SDS) and at menarche (0·57 SDS) was significantly higher (P < 0·001) than FH (,0·10 SDS). Puberty started at a mean chronological age of 10·2 and 11·6 years in females and males, respectively, with a corresponding bone age. FH correlated with TH and height at diagnosis, at onset of puberty, and at menarche. Multiple regression analysis showed that height at onset of puberty and TH are the most important factors explaining FH variability, although height at onset of puberty is slightly more important. Conclusions, Our results, obtained in the largest reported available group of congenital hypothyroid patients, show that final height is higher than target height in both sexes and that height at onset of puberty is the main factor affecting final height. [source] Insulin sensitivity in growth hormone-deficient children: influence of replacement treatmentCLINICAL ENDOCRINOLOGY, Issue 4 2004Giorgio Radetti Summary objective, In adults, excessive GH secretion may lead to secondary diabetes mellitus, while prolonged GH treatment may accelerate the onset of type 2 diabetes mellitus in predisposed children. The aim of the study was to evaluate insulin sensitivity (IS) and glucose tolerance (GT) in a group of GH-deficient children treated with GH for a period of 6 years. patients and design, One hundred and twenty-eight children (40 females, 88 males) were included in the study. At the beginning of treatment chronological age was 8·9 ± 3·2 years, height standard deviation score (SDS) ,2·43 ± 0·90 and body mass index (BMI) SDS 0·18 ± 1·60. At the end of the study chronological age was 13·0 ± 2·9 years, height SDS ,1·24 ± 1·27 and BMI SDS 0·23 ± 1·54. GH was administered at a mean weekly dosage of 0·3 mg/kg, injected subcutaneously over 6,7 days. GT was assessed according to the criteria of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. IS was evaluated with the quantitative insulin sensitivity check index (QUICKI). results, No cases of impaired GT or diabetes were recorded during the follow-up period. IS, already lower than in controls before starting treatment with GH, decreased significantly during the first year of therapy (QUICKI: 0·346 ± 0·033 vs. 0·355 ± 0·044, P < 0·05), with no further decrease in the following years. No correlation was found between QUICKI, BMI, years of treatment and onset of puberty. conclusions, GH treatment in GH-deficient children does not lead to an impaired GT or type 2 diabetes mellitus, although it does significantly decrease IS. [source] Confirmation of severe GH deficiency after final height in patients diagnosed as GH deficient during childhoodCLINICAL ENDOCRINOLOGY, Issue 4 2002Andrea F. Attanasio Summary objective Human GH treatment of patients with childhood-onset (CO) growth hormone deficiency (GHD) ceases when they reach final height; this provides an opportunity to retest GH status in all patients before determining whether GH therapy will be required in adult life. At present, the diagnostic approach to these patients is not fully standardized. This study aimed to characterize a large group of previously GH-treated CO GHD patients and establish their GH status. patients and methods The multinational study included 167 patients diagnosed as GH deficient and treated with hGH to final height during childhood. Mean age was 19·2 years and mean height standard deviation score (SDS) was ,1·08. Peak serum GH concentrations were determined in standard GH stimulation tests. IGF-I and IGFBP-3 concentrations were determined at a central laboratory and converted to SDS values by reference to a normal population. results Using only a peak GH value of less than 3 µg/l (1 mg = 3 U) in stimulation tests as the cut-off, 133 (79·6%) patients would be classed as GH deficient. Using only an IGF-I value less than ,2 SDS as the cut-off, 134 (80·2%) patients would be classed as GH deficient. However, by using both criteria there were 120 (71·9%) patients who were definitely severely GH deficient (group 1) and 20 (12·0%) who were not GH deficient (group 2), leaving 14 (8·4%) classed as GH deficient from IGF-I SDS only (group 3) and 13 (7·8%) classed as GH deficient from stimulation test only (group 4). There was no difference between the groups in height SDS or body mass index (BMI), but the GH-deficient patients tended to have been diagnosed at a younger age (group 1, 8·2 ± 3·9; group 2, 10·0 ± 4·0; P = 0·052). For patients classed as GH deficient compared with those not GH deficient, the percentage of males was lower (group 1, 64·2%; group 2, 90·0%; P = 0·022) and the percentage with multiple pituitary hormone deficiencies was higher (group 1, 81·7%; group 2, 20·0%; P < 0·001), with the other two groups being intermediate in each case. Only the group classed as GH deficient by both criteria had a mean IGFBP-3 less than ,2 SDS and both IGF-I SDS and IGFBP-3 SDS increased steadily across the four groups. conclusions A high percentage (71·9%) of these childhood-onset GH-deficient patients were still GH deficient in adult life and are likely to require further hGH treatment. While 12·0% could be classed as definitely no longer GH deficient, there are some patients who are intermediate (16·2%) and may be classed as GH deficient by one criterion but not the other. When GH stimulation test results and IGF-I concentration are discordant, the IGFBP-3 level does not establish diagnosis and the hGH treatment requirement of such patients remains a dilemma. [source] Foetal size to final heightACTA PAEDIATRICA, Issue 6 2000J Karlberg It is well known that some adult diseases, such as cardiovascular diseases, may be programmed during foetal life. It is not clear, however, whether final height may be predicted from foetal growth. A longitudinal cohort of full-term healthy Swedish babies (n = 3650) was followed up from birth to maturity in a population-based growth study. Length or height and its changes were analysed from birth to 18 y of age; 2807 children, with data available on birth length, final height and parental height, were included in this analysis. The result clearly shows that length at birth relates to final height. In terms of standard deviation scores (SDS), the mean difference in length at birth from the mean was greatly decreased in final height, but retained the same order as was seen at birth. In terms of centimeter difference from the reference mean values, the difference in length at birth remained roughly stable into final height. For instance, babies 5 cm above or below the mean birth length will end up approximately 5 cm above or below the mean in final height. Parental height,a surrogate value of the genetic final height potential of an individual,is shown to influence postnatal growth in height strongly. However, the difference from the mean in length at birth remained into adulthood within the same midparental height group. Conclusion: This study reveals that trends in foetal linear growth continue into maturity. Foetal growth is a significant predictor of postnatal growth. Final height is dependent on both the magnitude of foetal growth and the genetic potential in stature, and appears to some extent to be programmed from foetal growth. [source] Effect of a gluten-free diet on growth and small-bowel histology in children with celiac disease in IndiaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2007Surender K Yachha Abstract Background and Aim:, Follow-up studies on growth and histological recovery of children with celiac disease (CD) while on a gluten-free diet (GFD) are lacking from Asia. We therefore assessed the effects of this diet. Methods:, Forty-two children with CD were enrolled. Weight and height were expressed as weight for height (WfH) and height standard deviation scores (HSDS), respectively. Twenty-five children had repeated duodenal biopsies after 1,2 years and 14 had a third biopsy after 3,7 years of GFD. Compliance was checked by regular interview and IgA antiendomysial antibody estimation (EMA). Results:, At diagnosis (n = 25), mean HSDS was ,3.3 ± 1.6 with 76% having a HSDS of <,2; 60% were undernourished (WfH mean 81.6 ± 5.7). Over a mean follow up of 3.7 years, HSDS improved to ,1.3 ± 1.7 and 84% cases achieved normal nutrition. Mean height velocity was 13.9 cm during first year and 5.6 cm in subsequent years. Small-bowel biopsies at diagnosis showed subtotal villous atrophy (Marsh IIIb) in 18 (72%) and partial villous atrophy (Marsh IIIa) in seven (28%) patients. Repeat biopsy at 1,2 years showed shift from subtotal to partial villous atrophy in 94% (n = 17/18) and normalization in one patient. In patients with Marsh IIIa improvement of partial villous atrophy was observed in all. Immunoglobulin A endomysial antibody was negative in 81%. Repeat biopsies at 5 years of GFD showed improvement to Marsh I,II, but none normalized. Conclusion:, The majority of children with CD show normalization of nutrition and growth after GFD. Small-bowel histology improves markedly but does not normalize even after 5 years of GFD. [source] Audit of feeding practices in babies <1200 g or 30 weeks gestation during the first month of lifeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2006Barbara E Cormack Aim: In 2002, the composition of the breast milk fortifier used in our hospital changed, giving increased protein and energy. We therefore decided to prospectively audit nutritional management in our unit and to compare nutritional intake and growth in our babies with published data. Methods: Data were prospectively collected over a 3-month period on infants <1200 g or 30 weeks gestation. Prescribed and delivered volumes of all parenteral and enteral fluids were recorded. Babies were weighed as per unit protocol. Results: Thirty-four infants met the audit criteria. Data are median (range). After the first week of life, energy and protein intakes were 147 (78,174) kcal/kg/day and 3.9 (2.1,4.8) g/kg/day respectively. Daily weight gain was 17 (,3.2,35.4) g/kg and was significantly associated with both energy and protein intakes (P < 0.001). However, standard deviation scores for weight fell from 0.15 (,1.9,2.0) at birth to ,1.0 (,2.9,0.8) by 36 weeks corrected age. Time to commencing enteral feeds was 1 (1,3) day and to full enteral feeds was 8 (5,28) days. One infant was diagnosed with necrotising enterocolitis and eight with chronic lung disease. Mean protein intake was significantly lower in babies with chronic lung disease (P = 0.005). Conclusion: Overall, nutritional intakes and weight gain in this cohort of babies lie within the recommended ranges, although protein intakes in the smallest babies are at the lower end of the range. Enteral feeds are introduced early and advanced rapidly, but we have a low incidence of necrotising enterocolitis. However, babies still fell across weight centiles, suggesting that actual intakes for these tiny babies may be inadequate. [source] Craniofacial cephalometric morphology in children with CATCH 22 syndromeORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 4 2006A Heliövaara Structured abstract Authors ,, Heliövaara A, Hurmerinta K Objectives ,, To evaluate cephalometrically the craniofacial, pharyngeal and cervical morphology in children with CATCH 22, and to compare and quantify the findings with age- and sex-matched controls. Design ,, A retrospective case,control study. Setting and Sample Population , Forty-one children (20 girls) with CATCH 22 were compared with age- and sex-matched controls from lateral cephalograms taken at the mean age of 8.5 years (range 5.8,12.9). The deletion of 22q11 was verified by fluorescence in situ hybridization techniques. Thirteen of the children with CATCH 22 had palatal clefts. Outcome measure ,, Linear and angular measurements were obtained from lateral cephalograms. A Student's t -test and a paired Student's t -test were used in the statistical analysis. Standard deviation scores (SDS) were calculated to quantify the variation. Results ,, Children with CATCH 22 had obtuse cranial base angles and long anterior cranial bases. Their faces were long with increased facial convexity. The maxillae were long but both jaws were retrognathic and the lower jaws posteriorly diverged. The pharynges were wide in the nasopharyngeal area and narrow in the hypopharyngeal area. The development of the hyoid bones was delayed, and hyoid bone and atlas lengths were reduced. The morphology of the children with CATCH 22 with and without a palatal cleft was similar. Despite several statistically significant differences between the children with CATCH 22 and the controls, the SDS did not exceed ±2 for any of the measurements. Conclusion ,, Children with CATCH 22 have several minor distinctive morphological features in the craniofacial, pharyngeal, and cervical areas. [source] The addition of rosiglitazone to insulin in adolescents with type 1 diabetes and poor glycaemic control: a randomized-controlled trialPEDIATRIC DIABETES, Issue 4pt1 2008Monique L Stone Objective:, To evaluate the effect of rosiglitazone, an insulin sensitizer, on glycaemic control and insulin resistance in adolescents with type 1 diabetes mellitus (T1DM) Research design and methods:, Randomized, double-blind, placebo-controlled crossover trial of rosiglitazone (4 mg twice daily) vs. placebo (24 wk each, with a 4 wk washout period). Entry criteria were diabetes duration >1 yr, age 10,18 yr, puberty (,Tanner breast stage 2 or testicular volume >4 mL), insulin dose ,1.1 units/kg/day, and haemoglobin A1c (HbA1c) >8%. Responses to rosiglitazone were compared with placebo using paired t -tests. Results:, Of 36 adolescents recruited (17 males), 28 completed the trial. At baseline, age was 13.6 ± 1.8 yr, HbA1c 8.9 ± 0.96%, body mass index standard deviation scores (BMI-SDS) 0.94 ± 0.74 and insulin dose 1.5 ± 0.3 units/kg/day. Compared with placebo, rosiglitazone resulted in decreased insulin dose (5.8% decrease vs. 9.4% increase, p = 0.02), increased serum adiponectin (84.8% increase vs. 26.0% decrease, p < 0.01), increased cholesterol (+0.5 mmol/L vs. no change, p = 0.02), but no significant change in HbA1c (,0.3 vs. ,0.1, p = 0.57) or BMI-SDS (0.08 vs. 0.04, p = 0.31). Insulin sensitivity was highly variable in the seven subjects who consented to euglycaemic hyperinsulinaemic clamps. There were no major adverse effects attributable to rosiglitazone. Conclusion:, The addition of rosiglitazone to insulin did not improve HbA1c in this group of normal weight adolescents with T1DM. [source] Head circumference and development in young children after renal transplantationPEDIATRICS INTERNATIONAL, Issue 1 2009Osamu Motoyama Abstract Background:, Growth impairment, microcephaly and developmental delay in young children with chronic renal failure improve after successful renal transplantation. There have been few reports on head circumference (HC) and development after transplantation. Method:, Standard deviation scores (SDS) of height and HC and developmental quotient (DQ) after successful renal transplantation were evaluated in 12 recipients under 5 years of age. At the time of transplantation their mean age was 2.5 years and mean bodyweight was 9.0 kg. Results:, Mean height SDS was ,3.0 at transplantation and increased to ,2.3 at 1 year after transplant (P = 0.002). Mean HC-SDS increased from ,1.4 to ,0.9 at 1 year after transplant (P = 0.02). As for each category of DQ examined 1 year after transplant, mean scores of gross motor function, basic practice, personal relations, speech and recognition increased from 69 to 90 (P = 0.007), from 77 to 102 (P = 0.02), from 87 to 103 (P = 0.04), from 71 to 90 (P = 0.0006), and from 88 to 101 (P = 0.03), respectively. Conclusion:, In young children, physical growth, HC growth and DQ scores increased 1 year after transplantation. Dialysis and transplantation program should be planned in young children with end-stage renal failure in anticipation of growth and development of each patient. [source] | |||||||||||||||||||||||||