Pelvic and breast ultrasound abnormalities and associated metabolic disturbances in girls with premature pubarche due to adrenarche.

OBJECTIVE: Premature adrenarche (PA) has been suggested as a risk factor for future health problems, such as metabolic syndrome and early menarche. However, not all girls with PA have these features and it is not certain who will develop them. We propose that these abnormalities might be identified earlier, even before they are visible. DESIGN: Case-control study. SETTING: Tertiary care hospital. PARTICIPANTS: Forty-eight girls with premature pubarche due to PA and age (mean age 7.6 ± 1.0 years), weight, body mass index (BMI), birth weight and gestational age-matched 49 girls with no palpable breast tissue. MEASUREMENTS: Early pubertal pelvic and breast ultrasonographic changes and their associations with obesity and metabolic parameters were evaluated. Blood samples were collected, breast and pelvic ultrasound examinations were performed and bone ages were assessed. RESULTS: Girls with PA were taller and their bone ages were higher (p = .049 and p = .005). Fasting blood glucose, insulin, triglycerides, high-density lipoprotein and low-density lipoprotein cholesterol were not different between the groups. Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol were not different either. Ultrasonography revealed breast gland tissue in 30% of girls with PA and 5% of controls (p = .006). Uterine volume and endometrial thickness were higher in girls with PA (p = .03 and p = .04). Endometrial thickness was positively associated with serum insulin levels in the whole study group and after adjusting for age, diagnosis, BMI, mean ovarian volume and LH, FSH, estradiol levels, this association remained with a borderline p-value (R2 = 0.486, p = .050). CONCLUSIONS: We found early changes in uterus and breast glands of girls with PA and endometrial thickness was positively associated with insulin levels.

Prevalence of allergic disorders and risk factors associated with food allergy in Turkish preschoolers.

BACKGROUND: The prevalence of allergic disorders is on the rise, affecting about 10% of the population. In this retrospective cohort, we investigated prevalence of allergic disorders, associated risk factors, and the outcome of food allergies. MATERIAL AND METHODS: We analyzed data from birth cohorts of two university hospitals' well-child outpatient clinics. Factors related to onset and type of allergic diseases were assessed from demographic, socioeconomic, and clinical data. RESULTS: Analyses were performed on 949 (431F/518M) infants at a mean current age of 28±6 months. Any allergic disease was established among 177 cases (22%); atopic dermatitis in 123 (12.8%), respiratory allergies in 55 (5.7%), and food allergy in 41 (4.3%). The risk for allergic disorders was found to be significantly increased for male gender (OR: 2.31, 95% CI; 1.54-3.46), and positive parental atopy (OR: 1.94, 95% CI; 1.31-2.86). The risk of food allergies was significantly higher in the male gender (OR: 2.47, 95% CI; 1.21-5.02), who consumed egg-white between 6 and 12 months (OR: 2.34, 95% CI; 1.22-4.48), and who were formula-fed before 6 months (OR: 2.16, 95% CI; 1.14-4.10). We found no significant association between the rate of food allergy outgrowth or food induced-anaphylaxis with regards to the timing of introducing egg-white into the diet. CONCLUSIONS: Although the introduction of egg-white into infant diet at 6-12 months of life appeared as an independent risk for any food allergy, none of the patients developed anaphylaxis. Age at symptom onset and outgrowing food allergy were similar compared to those introduced egg-white after 12 months. We recommend promoting exclusive breastfeeding during the first 6 months of life, and avoidance of prolonged restrictive diets for children with food allergy.

Prevalence of allergic disorders and risk factors associated with food allergy in Turkish preschoolers

BACKGROUND: The prevalence of allergic disorders is on the rise, affecting about 10% of the population. In this retrospective cohort, we investigated prevalence of allergic disorders, associated risk factors, and the outcome of food allergies. MATERIAL AND METHODS: We analyzed data from birth cohorts of two university hospitals' well-child outpatient clinics. Factors related to onset and type of allergic diseases were assessed from demographic, socioeconomic, and clinical data. RESULTS: Analyses were performed on 949 (431F/518M) infants at a mean current age of 28 ± 6 months. Any allergic disease was established among 177 cases (22%); atopic dermatitis in 123 (12.8%), respiratory allergies in 55 (5.7%), and food allergy in 41 (4.3%). The risk for allergic disorders was found to be significantly increased for male gender (OR: 2.31, 95% CI; 1.54-3.46), and positive parental atopy (OR: 1.94, 95% CI; 1.31-2.86). The risk of food allergies was significantly higher in the male gender (OR: 2.47, 95% CI; 1.21-5.02), who consumed egg-white between 6 and 12 months (OR: 2.34, 95% CI; 1.22-4.48), and who were formula-fed before 6 months (OR: 2.16, 95% CI; 1.14-4.10). We found no significant association between the rate of food allergy outgrowth or food induced-anaphylaxis with regards to the timing of introducing egg-white into the diet. CONCLUSIONS: Although the introduction of egg-white into infant diet at 6-12 months of life appeared as an independent risk for any food allergy, none of the patients developed anaphylaxis. Age at symptom onset and outgrowing food allergy were similar compared to those introduced egg-white after 12 months. We recommend promoting exclusive breastfeeding during the first 6 months of life, and avoidance of prolonged restrictive diets for children with food allergy

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[Prevalence of maternal measles, rubella, mumps and varicella antibodies in the first six months of life]. / Ilk alti ayda maternal kizamik, kizamikçik, kabakulak ve suçiçegi antikorlarinin durumu.

The protection of infants against infections during the first few months of life is provided mainly by maternal antibodies. The presence of maternal antibodies can decrease vaccine efficacy. The waning time of maternal antibodies shows variations therefore seroepidemiological studies are important for the development of vaccination schedules. Some recent studies showed that the maternal measles antibodies may disappear around 3 months of age especially in infants born from mothers who were vaccinated. There are few cross-sectional studies from Turkey evaluating the maternal antibody levels of infants against measles in recent years. The aim of this prospective, multicentre study is to evaluate the seropositivity of measles, rubella, mumps, and varicella in mothers and their infants at 1 and 6 months after birth. The study was carried out at the Social Pediatrics Units of two university hospitals, a private hospital and a state hospital. The exclusion criteria were known impaired immune system or immune deficiency disorder in mother or child, preterm delivery (< 37 gestational week), administration of immunoglobulins or any blood products before admission or during the follow-up period, and history of vaccination or exposure to one of these diseases during the study period. The final analysis encompassed 209 mother-infant pairs. Blood samples were collected 1 month after birth from mothers and 1 and 6 months after birth from their babies. Antibody levels were determined by ELISA (Enzyme-Linked ImmunoSorbent Assay) method. Information on the socio-economic and demographic characteristics of the families were collected by a face-to-face questionnaire. Seropositivity was found as 95.7%, 92.8%, 92.8% and 96.7% for measles, mumps, rubella and varicella (MMRV) respectively. Majority of infants lost maternal antibodies at 6 months of age. Of all 6 month-old infants 25% were seropositive for measles,14.6% for mumps, 23.2% for rubella and 17.1% for varicella. The proportion of seropositive infants born from seropositive mothers was higher than those born from seronegative mothers for all four diseases. This difference was statistically significant only at 1 month of age (p= 0.001). Our study showed that maternal antibodies against MMRV decreased rapidly by 6 months of age therefore necessary measures should be taken to close this gap between the loss of maternal protection and the vaccination of infants for MMRV. As the epidemiology of the diseases changes in time, it is important to carry out such studies with large series in different countries and settings. Important results were determined in our study within this respect.

The relationship between infancy growth rate and the onset of puberty in both genders.

BackgroundIn this study, we examined the hypothesis that weight gain and linear growth during the first years of life influence the onset of puberty both in girls and in boys.MethodsA cohort of 157 healthy children, aged 6-9 years, was evaluated and their growth patterns were analyzed retrospectively. Repeated measures mixed model was used to examine the longitudinal anthropometric data.ResultsGirls with pubertal signs were heavier than their peers starting at 9 months of age (P=0.02), and the difference became more evident over time (P<0.001). Accelerated weight gain between 6 and 15 months of age was found to increase the odds of having a pubertal sign at the study visit (odds ratio (OR)=34.5) after adjusting for birth weight, gestational age and current age, height, weight, and BMI (P=0.004). Anthropometric indices of boys with or without pubertal signs were not significantly different at the study visit, but boys with accelerated height gain between 9 and 15 months of age were more likely to have pubertal signs (OR=15.8) after adjusting for birth weight, gestational age and current age, height, weight, and BMI (P=0.016).ConclusionEarly growth acceleration might be important for the timing of puberty in both genders.

An evaluation of stillbirths in Istanbul by examining death certificates.

AIM: Despite the fact that the frequency of stillbirth is estimated to be about the same as that of early neonatal deaths, stillbirth records and statistics are not kept on a regular basis worldwide and their causes cannot be determined. The aim of our study was to examine the causes and characteristics of stillbirths in Istanbul. MATERIAL AND METHODS: All death certificates of 2011 archived in 8 District Cemetery Directorships, which manage 322 cemeteries within the boundaries of Istanbul Metropolitan Municipality, were examined. Based on the burial licences, weight, gestational weeks, the main cause and causes of death related to stillbirth were analyzed. Cervical insufficieny, placenta abnormalities, preeclampsia, complications of multiple pregnancy, chronic diseases of mothers, conditions including malignancy in mothers were evaluated under the title of "maternal and gestational causes." Intrapartum infections, meconium aspiration, and asphyxia were evaluated under the title of "perinatal causes." RESULTS: A total of 2078 stillbirths and 128 abortus records were found among the death certificates. Nineteen of the abortus records and 109 stillbirths were misidentified. A total of 1988 stillbirth records were examined, of which 68.4% were low-birth-weight babies (<2 500 g). Approximately three quarters of the stillbirths were mild preterm and extremely preterm babies, whereas 10% were at or more than 37 gestastional weeks. The cause of death was not known in 30% of the stillbirths. CONCLUSIONS: The cause of death was not known in a significant portion of stillbirths in Istanbul. Recordings should be made more meticulosuly directed to the cause of death. The cause of stillbirth in term babies is another research subject. Regional and global epidemiologic studies are needed to understand the causes of stillbirths and thus to take necessary precautions.

Effect of maternal and infant vitamin D supplementation on vitamin D levels of breastfed infants.

The aim of our study was to investigate the effect of maternal vitamin D3 (400 U/day) supplementation on breastfed infants at 6 months of age. Mothers (n=96) were enrolled within 1 month after birth and assigned to the 400 IU/day regimen or no vitamin D3 supplementation for 6 months. All infants received 400 IU/day of vitamin D3 and were exclusively breastfed until 4 months of age. Of all mothers, 22.2% had vitamin D levels above 20 ng/ml initially. At the end of the study, vitamin D levels of mothers and their infants were similar in both groups. Thirteen percent of the infants in the intervention group and 20.5% in the control group had vitamin D levels below 12 ng/ml. Serum 25-hydroxyvitamin D (25(OH)D) concentrations at 6 months had increased significantly in mothers in the intervention group. Lactating mothers and their children need vitamin D supplementation but further studies are required with higher doses.

Pediatric acute lymphoblastic leukemia complicated by secondary hemophagocytic lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis (HLH) may be familial or secondary to infections, malignancies, metabolic disorders. Infectious causes are mostly viral and EBV is the mostly frequently seen etiologic agent. In this case, we report a child with acute lymphoblastic leukemia (ALL), who had three episodes of secondary HLH, possibly due to two different viral etiologies, namely CMV and RSV together with her malignancy, during her induction-consolidation treatment.