RESUMO
OBJECTIVES: To compare the growth of preterm neonates with fetal growth restriction (FGR) and preterm neonates born appropriate-for-gestational-age (AGA) from birth to 12-18 mo of corrected age (CA). METHODS: In this prospective cohort study, 85 preterm neonates with FGR and 85 gestation- and gender-matched AGA neonates were followed up from birth till 12-18 mo corrected age. Anthropometric indices were compared at specific time points and the risk factors for underweight status were analyzed. RESULTS: Mean gestational age of the cohort was 32.8 ± 2.1 wk. Mean birth weight was 1414 ± 248 g in the FGR and 1806 ± 416 g in AGA neonates. At 12-18 mo of corrected age, a significantly greater proportion of FGR infants were wasted (24.3% vs. 7.2%, P = 0.005). A greater proportion of FGR infants were underweight (27% vs. 17.4%, P = 0.11), stunted (41.9% vs. 36.2%, P = 0.30), and microcephalic (27% vs. 23.1%, P = 0.36), although the differences were not statistically significant. Significant catch-up growth from 40 wk postmenstrual age (PMA) to 12-18 mo corrected age in weight (52.8% vs. 13.1%, P <0.001) and length (37.9% vs. 8.7%, P <0.001) was observed in the FGR neonates. The z-score of weight for age at 3 mo (adjusted OR 0.65, 95% CI: 0.52-0.8; P <0.001), the median time to full feeds (aOR: 1.10, 95% CI: 1.04-1.15; P = 0.001), and hypothyroidism (aOR 2.44, 95% CI: 1.46-4.08; P = 0.001), were independent predictors of underweight status at 12-18 mo. CONCLUSIONS: At 12-18 mo of corrected age, a significantly greater proportion of preterm FGR neonates were wasted compared to AGA ones. The former also exhibited significantly greater catch-up growth than the latter.
RESUMO
We hereby report a 17-year-old adolescent who presented with heart failure with an underlying diagnosis of Takayasu arteritis. Her clinical complaints were intermittent fever, claudication pain in the left upper limb, New York Heart Association (NYHA) grade III dyspnea, and episodes of dizziness for the past two years. On examination, she was unconscious, had absent peripheral pulses, and had severe hypotension. Diagnostic investigations revealed anemia, deranged renal and liver functions, cardiomegaly on chest X-rays, and severe coarctation of the aorta on echocardiography. Further imaging with CT aortography highlighted extensive arterial wall thickening. Laboratory findings included elevated inflammatory markers and negative autoimmune and infectious markers, confirming the diagnosis of large vessel vasculitis (Takayasu arteritis) with heart failure with reduced ejection fraction (LVEF 20-25%) in NYHA class III. The patient was managed with a combination of antihypertensive medications, diuretics, and immunosuppressive therapy. Subsequent follow-up demonstrated improvement in heart failure symptoms and inflammatory markers. This case emphasizes the challenging diagnostic and therapeutic considerations in managing Takayasu arteritis with concurrent cardiovascular complications in the adolescent population.
