ABSTRACT
BACKGROUND: Very low birth weight (VLBW) children have higher risk of neurologic disabilities and growth factors are essential for brain maturation. AIM: To assess whether there are differences in neurologic findings, psychometric parameters and microstructural brain morphology in 1-year-old VLBW infants versus term healthy controls and whether these differences are related to hormonal/growth changes. METHODS: Prospective anthropometry, prefeed venous blood sample [insulin, insulin-like growth factor-I (IGF-I), insulin-like growth factor-II (IGF-II), leptin, glucose], neurologic and imaging assessment, at age 1 year in 34 VLBW infants (12 SGA; 10 M) and 10 healthy term controls (5 M). RESULTS: IGF-I concentrations at 1 month of corrected age were 20% lower in SGA versus appropriate for gestational age VLBW (p < 0.02). Gray and white matter volume and fractional anisotropy in 15/27 regions were decreased (p < 0.001). Abnormal spectroscopy was observed in 4 zones in VLBW versus term controls (p < 0.001). Some of these changes were associated with different periods of first-year growth and IGF-I/IGF-II, leptin and HOMA-IR. CONCLUSIONS: VLBW infants show differences in brain volumes and microstructural brain morphology as compared to term controls, changes related to circulating growth factor and anthropometry changes in the first year. This apparent reorganization of the developing brain offers a unique opportunity to investigate the relationship between changes in cortical anatomy, cognitive and social impairments and periods of early growth.
Subject(s)
Brain/growth & development , Infant, Very Low Birth Weight/growth & development , Insulin-Like Growth Factor I/metabolism , Body Height , Body Weight , Female , Humans , Infant , Infant, Small for Gestational Age/blood , Insulin/blood , Insulin-Like Growth Factor II/metabolism , Leptin/blood , Magnetic Resonance Imaging , Male , Prospective StudiesABSTRACT
Background: A decline in the age of menarche was observed from early 1900s to the 1970s. However, it is not known if a further decline ocurred thereafter. Aim: To evaluate the age of menarche in girls from Santiago, Chile and its relationship with body mass index (BMI) and socioeconomic status. Material and Methods: We studied 1302 healthy girls aged 7 to 19 years. Age of menarche was evaluated through a questionnaire to the patient and her parents. Kaplan-Meier curves were used to determine age of menarche and Cox regression analysis was employed to evaluate the effect of the type of school and BMI on the age of menarche. Results: The mean age at menarche was 12.7±0.04 years. Girls from public and private schools had their period at 12.5±0.1 and 13.05±0.05 years respectively. A negative correlation between z scores for BMIand age of menarche was observed (r-0.3: p =0.001). Girls whose menarche occurred before 11.5 years had higher z scores for BMI and a larger proportion were overweight, compared to girls who had menarche later. Cox regression analysis showed that after adjusment for BMI, age of menarche was similar in both types of schools. Conclusions: Age of menarche is ocurring three months earlier in girls from public schools, which is associated with higher z scores for BMI. Type of school, a marker of socio-economic status in Chile, affects timing of menarche due to differences in body mass index.
Subject(s)
Adolescent , Child , Female , Humans , Body Mass Index , Menarche/physiology , Obesity/physiopathology , Social Class , Kaplan-Meier Estimate , Age of Onset , Chile , Proportional Hazards Models , Surveys and QuestionnairesABSTRACT
BACKGROUND: A decline in the age of menarche was observed from early 1900s to the 1970s. However, it is not known if a further decline occurred thereafter. AIM: To evaluate the age of menarche in girls from Santiago, Chile and its relationship with body mass index (BMI) and socioeconomic status. MATERIAL AND METHODS: We studied 1302 healthy girls aged 7 to 19 years. Age of menarche was evaluated through a questionnaire to the patient and her parents. Kaplan-Meier curves were used to determine age of menarche and Cox regression analysis was employed to evaluate the effect of the type of school and BMI on the age of menarche. RESULTS: The mean age at menarche was 12.7+/-0.04 years. Girls from public and private schools had their period at 12.5+/-0.1 and 13.05+/-0.05 years respectively. A negative correlation between z scores for BMI and age of menarche was observed (r-0.3: p =0.001). Girls whose menarche occurred before 11.5 years had higher z scores for BMI and a larger proportion were overweight, compared to girls who had menarche later. Cox regression analysis showed that after adjustment for BMI, age of menarche was similar in both types of schools. CONCLUSIONS: Age of menarche is occurring three months earlier in girls from public schools, which is associated with higher z scores for BMI. Type of school, a marker of socio-economic status in Chile, affects timing of menarche due to differences in body mass index.
Subject(s)
Body Mass Index , Menarche/physiology , Obesity/physiopathology , Social Class , Adolescent , Age of Onset , Child , Chile , Female , Humans , Kaplan-Meier Estimate , Proportional Hazards Models , Surveys and QuestionnairesABSTRACT
Persistent neonatal hyperinsulinism is the most common cause of refractory hypoglycemia during the first year of life. Inadequate insulin secretion is associated to mutations of four different genes, that can be diagnosed to orient patient management. We report two patients: a female newborn that presented a hypoglycemia of 16 mg/dl two hours after birth, was subjected to a subtotal pancreatectomy that did not correct hypoglycemia, requiring a total pancreatectomy. Pathological study of the pancreas showed a focal adenomatous hyperplasia. At the present time, she is three years of age and maintains euglycemia with fractionated feeding. A male newborn that had seizures at 28 hours of life and a hypoglycemia of 15 mg/dl was detected. He was also subjected to a subtotal pancreatectomy, that did not correct hypoglycemia and bad to be extended to a total pancreatectomy. At the present time, he is 3 years and 11 months of age and has a normal psychomotor development.
Subject(s)
Congenital Hyperinsulinism/diagnosis , Congenital Hyperinsulinism/surgery , Diagnosis, Differential , Female , Humans , Hyperplasia/diagnosis , Infant, Newborn , Male , Pancreas/pathology , PancreatectomyABSTRACT
Acute suppurative thyroiditis (AST) is an uncommon condition because thyroid gland is remarkably resistant to infections. In children, anatomic defects such as a left pyriform sinus fistula or a thyroglossal duct remnant predispose to this infection. Once the diagnosis is confirmed by ultrasound or computed tomography, antimicrobial therapy based on the culture and Gram staining must be started. After two or three weeks of treatment, predisposing anatomic defects must be sought cautiously. We report a 13 year old girl presenting with cervical pain and fever. A cervical ultrasound showed an enlarged thyroid lobule with hypoecogenic zones that suggested a supurative collection. Cefotaxime and cloxacillin were started. A needle aspiration of the collection obtained a purulent material. The culture of this material yielded a Streptococcus Pneumoniae. The clinical condition of the patient improved and she was discharged in good conditions. Two months later a contrast esophagus X ray did not show predisposing anatomic defects.