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1.
Eur J Endocrinol ; 183(5): 481-488, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107436

RESUMO

Objective: To describe the etiology of severe short stature in the Helsinki University Hospital district covering a population of 1.2 million that is subject to frequent growth monitoring and screening rules during childhood. Design: Retrospective cohort study. Methods: We identified all subjects born 1990 or later with a height SD score <-3, after the age of 3 years, from the Helsinki University Hospital district growth database. A total of 785 subjects (376 females and 409 males) fulfilled our inclusion criteria; we reviewed their medical records and growth data and report their underlying diagnoses. Results: A pathological cause for short stature was diagnosed in 76% of the girls and 71% of the boys (P = NS). Syndromes were the most numerous pathological cause (n = 160; 20%), followed by organ disorders (n = 127; 16%), growth hormone deficiency (GHD, n = 94; 12%), SGA without catch-up growth (n = 73; 9%), and skeletal dysplasias (n = 57; 7%). Idiopathic short stature (ISS) was diagnosed in 210 (27%) subjects. The probability of growth-related pathology, particularly of a syndrome or skeletal dysplasia, increased with the shorter height SD score and the greater deviation from the target height. Sitting height to height SDS was increased in subjects with ISS, GHD, and SGA (all P < 0.01). Conclusions: Height <-3 SDS after 3 years of age usually results from a pathological cause and should be thoroughly investigated in specialized health care. The chance of finding a specific etiology increased with the severity of short stature, and the mismatch with target height.


Assuntos
Nanismo/etiologia , Transtornos do Crescimento/etiologia , Adolescente , Estatura , Criança , Pré-Escolar , Bases de Dados Factuais , Nanismo/epidemiologia , Feminino , Finlândia/epidemiologia , Gráficos de Crescimento , Transtornos do Crescimento/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Síndrome
2.
Arch. argent. pediatr ; 118(5): s142-s152, oct 2020. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1122562

RESUMO

Es innegable la necesidad de contar con curvas estándar de tamaño al nacer y crecimiento para evaluar y contribuir a orientar las acciones en la atención del neonato. Durante muchos años, se utilizaron las referencias de Lejarraga y Fustiñana, que fueron progresivamente reemplazadas por las de Fenton y Kim.Recientemente, el proyecto INTERGROWTH-21st construyó estándares de crecimiento prescriptivo para evaluar el tamaño al nacer desde las 33 semanas de edad gestacional, referencias para evaluar el tamaño al nacer desde las 24 a las 32,6 semanas de edad gestacional y curvas para el seguimiento longitudinal del crecimiento de recién nacidos pretérmino desde las 27 semanas de edad gestacional. Los Comités de Crecimiento y Desarrollo y de Estudios Feto-neonatales de la Sociedad Argentina de Pediatría, en conjunto con la Secretaría de Gobierno de Salud de la Nación, acordaron recomendar el reemplazo de las curvas de Fenton y Kim por las de INTERGROWTH-21st


It is unquestionable the need to have standards of size at birth and growth to evaluate and contribute to guide the actions in the care of the newborn. For many years the references of Lejarraga and Fustiñana were used, progressively replaced by those of Fenton and Kim. However, recently, the INTERGROWTH-21st project has developed prescriptive growth standards to evaluate the size at birth from 33 weeks of gestational age, references from 24 to 32.6 weeks of gestational age, and curves for postnatal growth from 27 weeks of gestational age onward. The Growth and Development and Neonatal Fetal Studies Committees of the Argentine Society of Pediatrics in conjunction with the Secretary of National Government of Health agreed to recommend the replacement of the Fenton and Kim curves with those of INTERGROWTH-21st.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Peso ao Nascer , Tamanho Corporal , Crescimento e Desenvolvimento , Gráficos de Crescimento , Padrões de Referência , Recém-Nascido Prematuro/crescimento & desenvolvimento , Antropometria , Idade Gestacional
3.
Zhonghua Er Ke Za Zhi ; 58(6): 461-467, 2020 Jun 02.
Artigo em Chinês | MEDLINE | ID: mdl-32521957

RESUMO

Objective: To summarize the clinical manifestation and genetic characteristics of Chinese patients with achondroplasia (ACH) which is caused by pathogenic variants fibroblast growth factor receptor 3 (FGFR3) gene and establish the reference value of height centiles and height for age growth curve of patients for a more practical, simple and useful growth evaluation tool in China. Methods: Through a nationwide cross-sectional survey in China from July 2019 to January 2020 designed by Department of Pediatric Endocrinology and Genetics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 210 subjects (110 boys, 100 girls), who harbored the pathogenic variant of FGFR3 gene and were diagnosed with achondroplasia, were recruited. The clinical and genetic data of enrolled subjects were collected and analyzed to explore the clinical genetic characteristics of Chinese ACH patients. Furthermore, according to the data of height (body length under 2 years old) of boy and girl subjects aged 0-12 years, centiles and height for age growth curve of achondroplasia were calculated and established by LMS method respectively. Results: The characteristic clinical manifestations of 210 Chinese patients (0-14 years old) were disproportionate short stature (206/210, 98.1%), macrocephaly and characteristic facial features (205/210, 97.6%), trident configuration of the hands (191/210, 90.9%), limbs deformity (156/210, 74.3%), together with normal intelligence. Up to 81.9% (172/210) of patients have different complications, and the kyphosis (121/210, 57.6%) and narrow thoracic (79/210, 37.6%) are common complications. Besides, up to 98.6% (207/210) of patients harbored hotspot variants of FGFR3 gene which cause G380R amino acid substitutions. It is notable that the growth pattern of boy and girl patients (0-12 years old) is obviously different from the normal children (t=9.849, 9.596, P<0.01) respectively. The height different between ACH patients and normal children gradually widened with age. The average height of the boy (49.2 cm) and girl patients(48.4 cm) of achondroplasia at birth was -1.22 s and -2 s, however, at the age of twelve, the average height of the boy(113.7 cm) and girl patients(112.4 cm) of achondroplasia was -5.23 s and -6.15 s compared to currently standard reference height for age growth curve of normal children in China, respectively. Conclusions: The results of our study demonstrated that in China disproportionate short stature, macrocephaly and characteristic facial features were typical manifestations of ACH patients, and that up to 98.6% of patients harbored hotspot variants of FGFR3 gene. In addition, the reference value of height centiles and height for age growth curve of ACH patients we establish will be a valuable tool for evaluating the growth pattern, monitoring factors affecting growth, estimating ultimate height, and assessing the curative effect of growth-promoting treatments in Chinese patients with achondroplasia.


Assuntos
Acondroplasia/genética , Adolescente , Estatura , Criança , Pré-Escolar , China , Estudos Transversais , Feminino , Gráficos de Crescimento , Humanos , Lactente , Recém-Nascido , Masculino , Valores de Referência
4.
Anthropol Anz ; 77(5): 423-429, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32462171

RESUMO

Background: Since the 19th century, sexual dimorphism has been known to be sensitive to adverse environmental conditions. Migrants are sensitive to economic and political affluence, and tend to adjust in height towards height of their hosts. We aim to study growth, sexual dimorphism, and height of native and migrant children in three primary schools in Nabire, Papua, Indonesia. Material and Methods 1: Cross-sectional data on height were obtained from 186 children (59 and 56 native Papuan girls and boys, respectively; 38 and 33 trans-migrant girls and boys respectively; who are aged 7.0-7.7 (mean 7.45) years from three primary schools in Nabire, Papua, Indonesia. The Indonesian National Growth Charts were used as references for height. Results 1: With 118.4 cm (SD 6.7) cm, trans-migrant 7-year old boys were almost 3 cm taller compared to their native-age-matched-peers (115.7 cm (5.0 SD) cm, p < 0.05). The case was different among the girls. Trans-migrant girls were not significantly taller than native girls. Material and Method 2: We re-analyzed the height data from over 300,000 infants, children and adolescents, age 0-18 year, from 34 Indonesian provinces. The data were obtained from the latest Indonesian 2013 National Basic Health Survey (NHBS), and have previously been used to construct National Indonesian Growth Charts. St. Nicolas House Analysis was used to translate correlation matrices into network graphs and visualizing chains of associations between parameters that were multiply correlated. Results 2: St. Nicolas House Analysis suggested that the growth of male sex were more sensitive to population crowding, and that crowding contributes to the greater height dimorphism in taller populations. Conclusion: Economic prosperity and increased population density stimulate male adult height to a greater extent than female adult height, and increase the sexual dimorphism in height among the tall populations of densely populated wealthy countries.


Assuntos
Estatura , Gráficos de Crescimento , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Caracteres Sexuais
5.
Arch Dis Child Fetal Neonatal Ed ; 105(6): 646-651, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32451355

RESUMO

OBJECTIVE: To use repeated measurements of weight, length and head circumference to generate growth centile charts reflecting real-world growth of a population of very preterm infants with a well-described nutritional intake close to current recommendations. DESIGN: Infants born before 30 weeks gestational age (GA) were recruited. Infants received nutrition according to an integrated care pathway, with nutrient intake recorded daily, weight recorded twice-weekly and length and head circumference weekly. The LMS method was used to construct growth centile charts between 24 and 36 weeks corrected GA for each parameter. SETTING: A single tertiary neonatal unit in England. PATIENTS: 212 infants (124 male) (median GA at birth: 27.3 weeks, median birth weight: 900 g). RESULTS: Median daily energy, protein, carbohydrate and fat intake were within 3% of published recommendations. The total number of measurements recorded was 5944 (3431 for weight, 1227 for length and 1286 for head circumference). Centile charts were formed for each parameter. Data for male and female infants demonstrated similar patterns of growth and were pooled for LMS analysis. A web application was created and published (bit.ly/sotongrowth) to allow infants to be plotted on these charts with changes in SD score of measurements reported and graphically illustrated. CONCLUSIONS: These charts reflect growth in a real-world cohort of preterm infants whose nutrient intakes are close to current recommendations. This work demonstrates the feasibility of forming growth charts from serial measurements of growing preterm infants fed according to current recommendations which will aid clinicians in setting a benchmark for achievable early growth.


Assuntos
Ingestão de Energia , Gráficos de Crescimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Política Nutricional , Estatura , Peso Corporal , Cefalometria , Estudos de Viabilidade , Feminino , Idade Gestacional , Humanos , Fórmulas Infantis , Recém-Nascido , Estudos Longitudinais , Masculino , Software
6.
Arch. argent. pediatr ; 118(2): 117-: I-124, IV, abr. 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1100161

RESUMO

Introducción. La evaluación del crecimiento durante la infancia y la adolescencia es un componente fundamental de la atención de salud en todos sus niveles, pues es parte del diagnóstico nutricional y permite la detección oportuna de patologías relacionadas. Ecuador, al no disponer de referencias nacionales de crecimiento, ha adoptado los estándares internacionales de la Organización Mundial de la Salud. El objetivo de este estudio fue construir referencias nacionales de peso, estatura e índice de masa corporal para niños, niñas y adolescentes.Métodos. Se investigaron escolares y adolescentes ecuatorianos entre 5 y 19 años de edad durante 1999 y 2012. Los centilos 3, 10, 25, 50, 75, 90 y 97 de peso, talla e índice de masa corporal fueron estimados por el método LMS para datos transversales, que utiliza la transformación Box-Cox para normalizar la distribución de los datos a cada edad.Resultados. Participaron 5934 sujetos sanos (2788 niños y 3146 niñas). Los niños pesaban más y eran más altos que las niñas. En todos los casos, los valores mostraron un aumento creciente conforme la edad avanzaba. A los 18 años, las diferencias entre sexos promediaron 8 kg y 12,5 cm.Conclusión. Las tablas y curvas producto de este estudio constituyen la primera referencia descriptiva del crecimiento de niños ecuatorianos de 5-19 años. Son un importante instrumento de evaluación nutricional. Su implementación en la atención primaria de salud permitirá complementar el diagnóstico nutricional que, tradicionalmente, se realiza sobre la base de los estándares internacionales de la Organización Mundial de la Salud.


Introduction. The assessment of growth during childhood and adolescence is a critical component of health care at all levels, but it is also part of nutritional status diagnosis and the timely detection of related conditions. Ecuador lacks national growth references, so it has decided to adopt the international standards proposed by the World Health Organization. The objective of this study was to develop national references for weight, height, and body mass index for children and adolescents.Methods. Ecuadorian schoolchildren and adolescents aged 5-19 years were studied between 1999 and 2012. The LMS method for cross-sectional data, which uses the Box-Cox transformation to normalize data distribution at each age, was applied to estimate the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th centiles for weight, height, and body mass index.Results. A total of 5934 healthy subjects (2788 boys and 3146 girls) participated. Boys were heavier and taller than girls. In all cases, values increased with age. At 18 years old, the differences between sexes averaged 8 kg and 12.5 cm.Conclusion. The tables and curves obtained with this study are the first descriptive growth references for Ecuadorian children and adolescents aged 5-19 years. They are relevant for nutritional assessment. Their use at the primary level of care will aid in nutritional status diagnosis, which has traditionally been done based on the World Health Organization's international standards.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Estatura , Peso Corporal , Índice de Massa Corporal , Crescimento , Epidemiologia Descritiva , Estudos Transversais , Equador , Gráficos de Crescimento
7.
Gac Med Mex ; 156(2): 117-123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32285859

RESUMO

Introduction: Children and adolescents weight and height are a reflection of the health status and socioeconomic development of a population. Objective: To evaluate height and weight progression patterns of Mexican children and compare them with Dr. Ramos-Galván growth charts 40 years later. Method: Cross-sectional survey conducted on the population of the National Physical Activation Program "Ponte al 100", which includes boys and girls aged six to 12 years. Results: 43,670 boys and 44,103 girls were assessed, stratified by gender and age. The height progression pattern between six and 12 years was 21 cm in males and 22 cm in females, whereas the weight progression pattern was 9.86 and 10.05 kg, respectively, for males and females. The proportion of six- and 12-year-old boys who were overweight was 11.2 and 9 %, while 14.7 and 15 % were obese. The proportion of six- and 12-year-old girls who were overweight was 8.2 and 9.1 %, whereas 21.7 and 13.3 %, respectively, were obese. When the obtained values were compared with those of Dr. Ramos Galván growth charts for boys and girls, the average difference was 2 cm. Conclusions: No secular height or weight increase within the last 40 years was documented.


Assuntos
Estatura , Peso Corporal , Criança , Estudos Transversais , Feminino , Gráficos de Crescimento , Humanos , Masculino , México , Pessoa de Meia-Idade , Fatores de Tempo
8.
PLoS One ; 15(4): e0230502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271790

RESUMO

Early identification of children <5 years with severe acute malnutrition (SAM) is a high priority to reduce child mortality and improved health outcomes. Current WHO guidelines for community screening for SAM recommend a Mid-Upper-Arm Circumference (MUAC) of less than 115 mm to identify children with SAM, but this cut-off does not identify a significant number of children with a weight-for-height Z-score <-3. To establish new specific MUAC cut-offs, pooled data was obtained for 25,755 children from 49 SMART recent surveys in Ethiopia (2016-2019). Sensitivity, proportion of false positive, and areas under receiver-operator characteristic curves (AUC) were calculated. MUAC below 115mm alone identified 55% of children with SAM identified with both methodologies. MUAC was worse in identifying older children (21%), those from a pastoral region (42%) and boys (41%). Using current WHO cut-offs, the sensitivity (Se) of MUAC below 115mm to identify the children severly malnourished screened through Weight-for-height below-3 was 16%. Analysing the ROC curve and Youden Index, Se and Specificity (Sp) were maximal at a MUAC < 133 mm cut-off to identify SAM (respectively Se 61.1%, Sp 81.4%). However, given the high proportion of false-positive children, according to gender, region and age groups, a cut-off around 125 mm to screen SAM could be the optimal one. In Ethiopia, implementation of a MUAC-only screening program for the identification of severe acute malnutrition with the actual cut-off of 115 mm would be unethical as it will lead to many children remaining undiagnosed and untreated. In addition, future study on implementation challenge on screening children with a higher cut-off or gender/age sensitive ones should be assessed with the collection of mortality and morbidity data to ensure that the most in need are being taking care of.


Assuntos
Braço/anatomia & histologia , Pesos e Medidas Corporais/métodos , Desenvolvimento Infantil/fisiologia , Desnutrição Aguda Grave/diagnóstico , Fatores Etários , Viés , Estatura/fisiologia , Peso Corporal/fisiologia , Pré-Escolar , Testes Diagnósticos de Rotina/métodos , Etiópia/epidemiologia , Feminino , Gráficos de Crescimento , Indicadores Básicos de Saúde , Humanos , Lactente , Masculino , Programas de Rastreamento/métodos , Curva ROC , Sensibilidade e Especificidade , Desnutrição Aguda Grave/epidemiologia , Fatores Sexuais
9.
BMC Pregnancy Childbirth ; 20(1): 139, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131758

RESUMO

BACKGROUND: Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to assess for fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers. METHODS: This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. The nutritional status of newborns was assessed using the ponderal index. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios. RESULTS: Two hundred thirty-one pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWTH21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st. (RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%). CONCLUSIONS: In pregnant women with DMG, the ability of customized fetal growth curves to identify newborns with alterations in nutritional status appears to exceed that of INTERGROWTH21st.


Assuntos
Antropometria/métodos , Diabetes Gestacional , Desenvolvimento Fetal , Transtornos da Nutrição Fetal/epidemiologia , Estado Nutricional , Adulto , Peso ao Nascer , Estudos de Coortes , Feminino , Peso Fetal , Idade Gestacional , Gráficos de Crescimento , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade , Espanha
10.
Sci Rep ; 10(1): 4032, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32132590

RESUMO

We aimed to model longitudinal data to create predictive growth charts for weight in preterm infants from birth till discharge, that took into account the differing growth rates post-birth when compared to in-utero growth and therefore was more representative of the data than the UK1990 reference charts. Data from birth until discharge (or death), was collected and rigorously cleaned for all infants born at <32 weeks of gestation over a 4-year period. Means and standard deviations from the UK1990 reference charts were used to compute standard deviation scores (SDS) for our cohort. 2/3rd of the data was randomly selected and used to create gestation and gender-specific predictive weight centile lines through novel application of mixed modelling methods. The remaining 1/3rd of the data was used to test model fit by comparing expected vs actual weights for the new model with those predicted by the UK1990 model. Data from 1,510 preterm infants was analysed. 1067 of these were used to produce the predictive model. Weekly SDS were significantly lower than predicted throughout hospital stay for all gestation groups when compared with UK1990 data. The test data (n = 539) fitted the new centile lines substantially better than those modelled by the UK1990 centile lines. Mixed modelling of longitudinal data produced new predictive references for weight centiles of preterm infants. A large population-based prospective study is needed to produce representative longitudinal reference growth charts using these methods.


Assuntos
Peso ao Nascer , Desenvolvimento Infantil , Idade Gestacional , Recém-Nascido Prematuro , Modelos Biológicos , Feminino , Gráficos de Crescimento , Humanos , Recém-Nascido , Masculino
11.
PLoS One ; 15(3): e0230291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160245

RESUMO

PURPOSE: Percentile curves of refractive development for German children were generated. We hypothesize that refraction in children in central Europe might differ from data in central Asia. METHODS: Non-cycloplegic refraction was measured using the ZEISS i.Profiler plus (Carl Zeiss Vision GmbH, Germany) in 1999 children, of which were 1046 male and 953 female, aged 3 to 18 years. Reference curves were calculated with the R-package GAMLSS as continuous function of age. RESULTS: There were only little differences for all centiles between the genders at 3 years and a general trend towards more myopia with increasing age. For the 97th centile and the 3rd centile, girls showed higher myopia/ less hyperopia than boys. Between the age of 3 and 18, the median refraction became -0.68 D and -0.74 D more myopic for boys and girls, respectively. At the same time, the 97th centile for boys changed +0.29 D towards hyperopia and in girls -0.52 D towards myopia. A general myopic trend was seen in the 3rd centile, which was -2.46 D for boys and -2.98 D for girls. For both genders, the median became less than zero at the age of 10 years but did not become myopic (less than -0.5 D) up to the age of 18. CONCLUSION: Our analysis presents the first reference curve for refraction in central Europe. In comparison to data from China and Korea, there is only little difference at the age of 5 years in all centiles which then increases continuously. For all ethnicities, a trend towards myopia with increasing age could be observed, but myopia progression is much higher in China and Korea than in Germany. The most marked differences can be seen in the lower centiles. Further investigations should clarify whether commencement of preschool activities with prolonged near-work initiates the divergence in refractive development.


Assuntos
Gráficos de Crescimento , Refração Ocular , Erros de Refração/epidemiologia , Adolescente , Fatores Etários , Criança , Feminino , Alemanha , Humanos , Masculino , Fatores Sexuais
14.
J Med Internet Res ; 22(1): e16204, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32012066

RESUMO

BACKGROUND: Parameterization of pediatric growth charts allows precise quantitation of growth metrics that would be difficult or impossible with traditional paper charts. However, limited availability of growth chart calculators for use by clinicians and clinical researchers currently restricts broader application. OBJECTIVE: The aim of this study was to assess the deployment of electronic calculators for growth charts using the lambda-mu-sigma (LMS) parameterization method, with examples of their utilization for patient care delivery, clinical research, and quality improvement projects. METHODS: The publicly accessible PediTools website of clinical calculators was developed to allow LMS-based calculations on anthropometric measurements of individual patients. Similar calculations were applied in a retrospective study of a population of patients from 7 Massachusetts neonatal intensive care units (NICUs) to compare interhospital growth outcomes (change in weight Z-score from birth to discharge [∆Z weight]) and their association with gestational age at birth. At 1 hospital, a bundle of quality improvement interventions targeting improved growth was implemented, and the outcomes were assessed prospectively via monitoring of ∆Z weight pre- and postintervention. RESULTS: The PediTools website was launched in January 2012, and as of June 2019, it received over 500,000 page views per month, with users from over 21 countries. A retrospective analysis of 7975 patients at 7 Massachusetts NICUs, born between 2006 and 2011, at 23 to 34 completed weeks gestation identified an overall ∆Z weight from birth to discharge of -0.81 (P<.001). However, the degree of ∆Z weight differed significantly by hospital, ranging from -0.56 to -1.05 (P<.001). Also identified was the association between inferior growth outcomes and lower gestational age at birth, as well as that the degree of association between ∆Z weight and gestation at birth also differed by hospital. At 1 hospital, implementing a bundle of interventions targeting growth resulted in a significant and sustained reduction in loss of weight Z-score from birth to discharge. CONCLUSIONS: LMS-based anthropometric measurement calculation tools on a public website have been widely utilized. Application in a retrospective clinical study on a large dataset demonstrated inferior growth at lower gestational age and interhospital variation in growth outcomes. Change in weight Z-score has potential utility as an outcome measure for monitoring clinical quality improvement. We also announce the release of open-source computer code written in R to allow other clinicians and clinical researchers to easily perform similar analyses.


Assuntos
Gráficos de Crescimento , Telemedicina/métodos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Projetos de Pesquisa , Estudos Retrospectivos
15.
An. pediatr. (2003. Ed. impr.) ; 92(1): 28-36, ene. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186815

RESUMO

Introducción: La talla baja es motivo de preocupación familiar y constituye una consulta frecuente en pediatría. Para su diagnóstico las gráficas de crecimiento son una herramienta imprescindible. El objetivo de este estudio es evaluar el impacto del cambio de gráficas de referencia en el diagnóstico de talla baja en nuestra área de salud. Sujetos y métodos: Estudio descriptivo transversal de base poblacional. Los valores de la talla de los niños y niñas de 4, 6, 10 y 13 años se compararon con las tablas de la Fundación Orbegozo 2004 Longitudinal y 2011. Se calcularon las prevalencias de talla baja y el percentil 3 de la muestra del estudio para realizar las comparaciones. Resultados: Se obtuvieron 12.256 registros válidos (89% de la población). La prevalencia de talla baja aumentó en todas las edades con el cambio de las gráficas: diferencia de prevalencias del 3,6% (IC95%: 2,8 a 4,5) a los 4 años; 1,8% (IC95%: 1,3 a 2,3) a los 6 años; 2,8% (IC95%: 2,2 a 3,4) a los 10 años y 1,4% (IC95%: 0,8 a 1,9) a los 13 años. En números absolutos, se pasó de 58 diagnósticos de talla baja con las gráficas 2004 (34 niños y 24 niñas) a 352 con las 2011 (155 niños y 197 niñas). Conclusiones: El cambio de referencia ha multiplicado por 6 el número de diagnósticos de talla baja. La patología hallada en los casos diagnosticados con las gráficas 2011 que no se hubieran diagnosticado con las gráficas anteriores nos permitirá evaluar la idoneidad del cambio realizado


Introduction: Short stature is a family concern, and is a common reason for consultations in paediatrics. Growth charts are an essential diagnostic tool. The objective of this study is to evaluate the impact of changing reference charts in the diagnosis of short stature in a health area. Subjects and methods: A population-based-cross-sectional-descriptive-study was performed in which the height of children of 4, 6, 10 and 13 years-old were compared with the growth charts of the Fundación Orbegozo 2004 Longitudinal and 2011. The prevalence of short stature and the 3 rd percentile of the study sample were calculated. Results: There were 12,256 valid records (89% of the population). The prevalence of short stature increased at all ages with the change in the growth charts, with differences of prevalence of 3.6% (95% CI: 2.8 to 4.5) at 4 years; 1.8% (95% CI: 1.3 to 2.3) at 6 years; 2.8% (95% CI: 2.2 to 3.4) at 10 years, and 1.4% (95% CI: 0.8 to 1.9) at 13 years. In absolute numbers, it went from 58 diagnoses of short stature with the 2004 Longitudinal charts (34 boys and 24 girls) to 352 with the 2011 (155 boys and 197 girls). Conclusions: The change in reference growth charts has increased by 6-fold the number of diagnoses of short stature. The pathological condition found in the cases diagnosed with the 2011 growth charts that had not been diagnosed with the previous charts will allow us to evaluate the suitability of the change


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Peso-Estatura , Desenvolvimento Infantil , Gráficos de Crescimento , Prevalência , Epidemiologia Descritiva , Estudos Transversais , Estatura , Estatura-Idade , Antropometria , Análise Estatística
16.
Diabetes Care ; 43(3): 556-562, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31896601

RESUMO

OBJECTIVE: This study investigates two-phase growth patterns in early life and their association with development of islet autoimmunity (IA) and type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: The Environmental Determinants of Diabetes in the Young (TEDDY) study followed 7,522 genetically high-risk children in Sweden, Finland, Germany, and the U.S. from birth for a median of 9.0 years (interquartile range 5.7-10.6) with available growth data. Of these, 761 (10.1%) children developed IA and 290 (3.9%) children were diagnosed with T1D. Bayesian two-phase piecewise linear mixed models with a random change point were used to estimate children's individual growth trajectories. Cox proportional hazards models were used to assess the effects of associated growth parameters on the risks of IA and progression to T1D. RESULTS: A higher rate of weight gain in infancy was associated with increased IA risk (hazard ratio [HR] 1.09 [95% CI 1.02, 1.17] per 1 kg/year). A height growth pattern with a lower rate in infancy (HR 0.79 [95% CI 0.70, 0.90] per 1 cm/year), higher rate in early childhood (HR 1.48 [95% CI 1.22, 1.79] per 1 cm/year), and younger age at the phase transition (HR 0.76 [95% CI 0.58, 0.99] per 1 month) was associated with increased risk of progression from IA to T1D. A higher rate of weight gain in early childhood was associated with increased risk of progression from IA to T1D (HR 2.57 [95% CI 1.34, 4.91] per 1 kg/year) in children with first-appearing GAD autoantibody only. CONCLUSIONS: Growth patterns in early life better clarify how specific growth phases are associated with the development of T1D.


Assuntos
Trajetória do Peso do Corpo , Desenvolvimento Infantil/fisiologia , Diabetes Mellitus Tipo 1/etiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/patologia , Progressão da Doença , Feminino , Finlândia/epidemiologia , Predisposição Genética para Doença , Alemanha/epidemiologia , Gráficos de Crescimento , Humanos , Lactente , Masculino , Estudos Prospectivos , Fatores de Risco , Suécia/epidemiologia , Estados Unidos/epidemiologia
17.
J Pediatr ; 219: 259-262, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31932017

RESUMO

A web-based survey of pediatric care providers revealed differences in their preference for clinical charts that monitor growth in children with obesity. These findings are attributed to pediatric specialty training. Very few providers believe the currently available Centers for Disease Control and Prevention 2000 body mass index-for-age charts adequately track growth in children with obesity.


Assuntos
Gráficos de Crescimento , Obesidade Pediátrica/diagnóstico , Pediatria , Padrões de Prática Médica , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino
18.
J Matern Fetal Neonatal Med ; 33(6): 961-966, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30372647

RESUMO

Background: INTERGROWTH-21st charts provide standards for infants born under optimal pregnancy conditions. However, their validity in a general obstetric population is unclear. We aimed to identify whether INTERGROWTH-21st charts, compared with gestation related optimal weight (GROW) charts customized on maternal height, weight, and parity, better identified the at-risk infant.Methods: We performed a retrospective cohort analysis of all term women who gave birth at a single tertiary obstetric center during the period 1994-2016. Routinely collected maternity data was used for analysis. The primary outcome was an Apgar score <7 at 5 min. Secondary outcomes included Apgar score <5 at 5 min, stillbirth or admission to the neonatal intensive care unit (NICU). Populations of newborns were identified as SGA by: (a) INTERGROWTH-21st <10th centile (SGAIG10th); (b) INTERGROWTH-21st z-score < -1 (SGAIGzscore); and (c) GROW customized charts <10th (SGAcust). The subgroups identified by only one chart were also specifically examined. Each SGA group was compared to infants appropriate for gestational age (AGA) on all charts (non-SGA).Results: Data for 71,487 births were available for analysis after exclusion of women with missing height or weight data. Only 3280 (4.6%) newborns were considered SGAIG10th, with 5878 (8.2%) SGAIGzscore and 7599 (10.6%) SGAcust. INTERGROWTH-21st identified only 110 additional infants (0.15%) that were not identified by customized charts; none of these experienced any adverse outcomes. Customized centiles identified a further 4429 (6.2%) SGA infants (SGAcust-only) that were not identified as SGAIG10th, and who did demonstrate an increased risk of Apgar score <7 (OR 1.33, 95%CI 1.08-3.28) and stillbirth (OR 2.47, 95%CI 1.41-4.44) compared to the non-SGA infant. Significantly more obese women had infants considered SGAcust (19.3%) than SGAIG10th (10.0%) or SGAIGzscore (9.9%).Conclusions: Amongst our general obstetric study population, the 10th centile of INTERGROWTH-21st identified only 4.6% of infants as SGA and was less likely to identify infants of obese women as SGA. Customized centiles identified almost all SGA-IG infants, including an additional group (SGAcust-only) at higher risk of stillbirth and adverse outcomes compared with non-SGA infants.


Assuntos
Índice de Apgar , Peso ao Nascer , Gráficos de Crescimento , Recém-Nascido Pequeno para a Idade Gestacional , Adulto , Estatura , Feminino , Humanos , Recém-Nascido , Masculino , Paridade , Gravidez , Valores de Referência , Estudos Retrospectivos , Medição de Risco
19.
An Pediatr (Barc) ; 92(1): 28-36, 2020 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-31104894

RESUMO

INTRODUCTION: Short stature is a family concern, and is a common reason for consultations in paediatrics. Growth charts are an essential diagnostic tool. The objective of this study is to evaluate the impact of changing reference charts in the diagnosis of short stature in a health area. SUBJECTS AND METHODS: A population-based-cross-sectional-descriptive-study was performed in which the height of children of 4, 6, 10 and 13 years-old were compared with the growth charts of the Fundación Orbegozo 2004 Longitudinal and 2011. The prevalence of short stature and the 3rd percentile of the study sample were calculated. RESULTS: There were 12,256 valid records (89% of the population). The prevalence of short stature increased at all ages with the change in the growth charts, with differences of prevalence of 3.6% (95% CI: 2.8 to 4.5) at 4 years; 1.8% (95% CI: 1.3 to 2.3) at 6 years; 2.8% (95% CI: 2.2 to 3.4) at 10 years, and 1.4% (95% CI: 0.8 to 1.9) at 13 years. In absolute numbers, it went from 58 diagnoses of short stature with the 2004 Longitudinal charts (34 boys and 24 girls) to 352 with the 2011 (155 boys and 197 girls). CONCLUSIONS: The change in reference growth charts has increased by 6-fold the number of diagnoses of short stature. The pathological condition found in the cases diagnosed with the 2011 growth charts that had not been diagnosed with the previous charts will allow us to evaluate the suitability of the change.


Assuntos
Estatura , Gráficos de Crescimento , Transtornos do Crescimento/diagnóstico , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Masculino , Prevalência , Valores de Referência , Espanha/epidemiologia
20.
Arch Pediatr ; 27(2): 95-103, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31791829

RESUMO

BACKGROUND AND AIMS: Malnutrition is common in neurologically impaired (NI) children. It is, however, ill-defined and under-diagnosed. If not recognized and treated, it increases the burden of comorbidities and affects the quality of life of these children. The aim of this study was to characterize the nutritional status of a cohort of children followed up at a reference center for cerebral palsy (CP) in Brussels, Belgium, and to investigate possible links with the occurrence of comorbidities. MATERIAL AND METHODS: We conducted a single-center retrospective study including all the children followed up at the Inter-university Reference Center for Cerebral Palsy ULB-VUB-ULg. The data were obtained by reviewing medical files. Anthropometric measurements as well as the etiology of neurological impairment, comorbidities, feeding patterns, and laboratory test results were collected. The children were assigned a nutritional diagnosis according to the World Health Organization and Waterlow definitions. RESULTS: A total of 260 children with cerebral palsy were included, 148 males and 112 females. Their mean age was 10.9±4.3 years. The gross motor function classification system (GMFCS) level was I for 79 children, II for 63 children, III for 35 children, IV for 33 children, and V for 50 children. Of the children, 54% had a normal nutritional status, 34% showed malnutrition, and 8% were obese; 38% had oropharyngeal dysphagia. The sensitivity of mean upper arm circumference of

Assuntos
Paralisia Cerebral/complicações , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/diagnóstico , Transtornos de Deglutição/complicações , Obesidade Pediátrica/complicações , Adolescente , Bélgica , Criança , Pré-Escolar , Feminino , Fraturas Espontâneas/complicações , Gráficos de Crescimento , Humanos , Lactente , Masculino , Estado Nutricional , Obesidade Pediátrica/diagnóstico , Pneumonia/complicações , Lesão por Pressão/complicações , Estudos Retrospectivos , Extremidade Superior/anatomia & histologia
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