Linear growth in prepubertal children with atopic dermatitis

OBJECTIVE: To define the evolution of prepubertal growth in atopic dermatitis and the factors influencing that growth pattern. METHODS: Height and height velocity over two years, weight, triceps and subscapular skin fold thickness, and bone age were assessed in 80 prepubertal patients with atopic dermatitis and a control group of 71 healthy prepubertal school children. RESULTS: Height standard deviation scores (SDS) and height velocity SDS did not differ between patients and controls, and were not influenced by body surface area affected by atopic dermatitis, topical glucocorticoid potency, or coexisting asthma. However, height SDS (r = -0.37) and height velocity SDS (r = -0.31) correlated inversely to age in patients but not in controls. A greater proportion (z = 2.84) of patients than controls had year 2 height velocity SDS less than -1.96. Patients had a mean delay in bone age of 0.22 years and 0.41 years at the beginning of year 1 and year 2 of the study, respectively. The delay in bone age correlated positively with age (r = 0.39) and duration of atopic dermatitis (r = 0.39), and negatively with height SDS (r = -0.51) and height velocity SDS (r = -0.38). CONCLUSIONS: Prepubertal children with atopic dermatitis are not short compared with controls. However, as they approach the teenage years their height velocity decreases, the proportion of children with extremely low height velocity increases, and the delay in bone age increases. These features are consistent with the pattern of growth seen in people with constitutional growth delay.     

Overweight does not increase asthma risk but may decrease allergy risk at school age after infantile bronchiolitis

Aim: Increasing evidence suggests that overweight children are at increased risk of asthma. The association between weight gain and allergy is more complex. The aim was to evaluate the association between overweight or obesity and asthma, allergy, bronchial reactivity or atopic sensitization at school age in children with bronchiolitis in infancy. Subjects and methods: Eighty‐one children hospitalized for bronchiolitis at <24 months of age attended control visits at 7.2 and 12.3 years of ages. The visits consisted of medical examinations, weight and height measurements, body mass index (BMI) calculations, skin prick tests and exercise challenge tests. BMI >1.3 SD from age‐ and gender‐specific references meant overweight and BMI >2.0 SD obesity. Results: Current or previous overweight or obesity did not increase the risk of asthma, allergy, bronchial reactivity or atopic sensitization at 7.2 or 12.3 years of age. Previous and current obesity decreased the risk of atopic dermatitis, and current overweight and obesity decreased the risk of sensitization to outdoor allergens at 12.3 years of age. Conclusion: Previous or current overweight does not increase asthma or allergy risk but current obesity may decrease allergy risk at school age after bronchiolitis in infancy.     

Impaired pubertal growth in acute lymphoblastic leukaemia.

The growth of 182 patients who were long term survivors of childhood acute lymphoblastic leukaemia was retrospectively analysed. All remained in first remission and were treated with either 1800 or 2400 cGy of cranial irradiation. None had been treated with either testicular or spinal irradiation. Ninety three (51 boys, 42 girls) were treated with 2400 cGy and 89 (42 boys, 47 girls) were treated with 1800 cGy cranial irradiation. All patients were treated with standard chemotherapy including intrathecal methotrexate in similar dose regimens in either group. Mean age (SD) at diagnosis in the group treated with 2400 cGy was 4.8 (2.6) years and mean age in the group treated with 1800 cGy was 6.5 (3.3) years. Mean height SD score at diagnosis in the 2400 cGy group was +0.29 and final height achieved was -0.63. Mean height SD score at the start of treatment in the group treated with 1800 cGy was +0.40 and mean final height was -0.53. There was a similar reduction in height SD score in both groups during the pubertal growth spurt. The decrement in height SD score was greater when treatment was administered at less than 7 years of age in either dose regimen, both in prepubertal and pubertal growth. However, the decrease in height SD score was found to be greater in girls than boys. There was a trend in both sexes for the onset of puberty to be at a younger age with a lower treatment dose of radiotherapy. However, in girls treated with the lower dose regimen there was a significant reduction in the mean age of onset of puberty which was 9.9 years. Our data suggest that girls treated at less than 7 years of age have a severe impairment of pubertal growth, which is probably a combination of the dual endocrinopathy of premature puberty and growth hormone insufficiency.     

Growth and body proportions in congenital adrenal hyperplasia.

Total height, sitting height, and subischial leg length were measured in 27 patients (19 girls and eight boys aged 4.3-21.1 years) with congenital adrenal hyperplasia to determine the influence of chronic hyperandrogenaemia on body proportions. Proportions were normal in 24 patients with classical congenital adrenal hyperplasia who had received steroid treatment since birth, but one of three patients with non-classical (late onset) congenital adrenal hyperplasia had a disproportionately large trunk. Eleven patients with classical congenital adrenal hyperplasia had completed growth, of whom seven had height standard deviation (SD) scores for chronological age less than zero, and one had extremely short stature (SD score -3.25). In 13 patients who were still growing, nine had height SD scores for chronological age of less than zero despite having mean (SD) advances in bone age over chronological age of 1.64 (1.68) years. Height SD scores for bone age were less than 0 in all 13 patients, indicating a loss of height despite advanced skeletal maturation. Doses of glucocorticoid that permit mild chronic or intermittent hyperandrogenaemia also seem to be associated with mild growth retardation. An adult height below average may be an inevitable consequence for many patients with congenital adrenal hyperplasia receiving conventional glucocorticoid treatment.     

Comparative effect of two doses of growth hormone for growth hormone deficiency. The Dutch Growth Hormone Working Group.

The comparative effect and safety of 2 IU compared with 4 IU/m2/day of recombinant human growth hormone (rhGH) was studied in 38 growth hormone deficient children regarding the impact of several factors on short term (one year) and long term (three year) growth response. In 21 newly diagnosed patients, three years of rhGH treatment resulted in a significant increase of height velocity SD score, height SD score, and predicted adult height SD score, irrespective of rhGH dose. In 17 transfer patients (previously treated with 12 IU rhGH/m2/week) 4 IU/m2/day resulted in a significantly higher height velocity SD score and height SD score for chronological age than 2 IU/m2/day, while more of them reached their target range or showed a substantial height SD score increment. Height SD score for bone age and predicted adult height SD score only increased significantly with 4 IU rhGH. After one year of rhGH treatment, new patients showed significant negative correlation between delta height SD score with age and baseline insulin-like growth factor I (IGF-I) SD score, and positive correlation with rhGH dose. After three years of treatment, delta height SD score for chronological age was significantly, negatively correlated with age and baseline 'corrected' height SD score (height SD score for chronological age minus target height SD score). There was no significant correlation with rhGH dose. Prolonged treatment with either dose had no adverse effect on IGF-I concentrations, carbohydrate or lipid metabolism. As early age and divergence between height SD score and target height SD score seem more important for growth response than rhGH dose, it is recommended that treatment starts early with 2 IU rhGH/m(2)/day and the dose is doubled if growth is insufficient after several years of treatment.     

Growth and Sexual Maturation in Paediatric Patients Treated by Dialysis and Following Kidney Transplantation

Linear growth and sexual maturation were assessed in 48 children during dialysis treatment and in 68 children following renal transplantation. Height at the onset of haemodialysis treatment was more than 2 SD below the mean in 33% of prepubertal children. During dialysis treatment most children showed a progressive deterioration in SD score. The onset of puberty and sexual maturation was delayed but was in accordance with bone age. After transplantation 59% of prepubertal children had a normal height increment. Onset of puberty was recorded at a chronological age of 14.6 ± 1.9 years in boys and 13.3 ± 1.9 years in girls. The peak of the pubertal growth spurt was 6.6 ± 1.6 cm/year in boys and 6.5 ± 2.9 cm/year in girls. The duration of pubertal development in transplanted children was within normal limits. In transplanted girls menarche was achieved at a mean chronological age of 15.9 years and bone age of 12.9 years. Adult height was achieved at a mean age of 20.3 years in men and 18.7 years in women. Overall, one third of the children attained an adult height more than 2 SD below the mean. These data indicate that poor growth is achieved in most children on dialysis treatment; following transplantation normal growth may be restored. However, poor growth before kidney transplantation and the loss of growth potential during pubertal development have a great influence on adult height.     

Growth and sexual maturation in children after kidney transplantation

Linear growth and sexual maturation were assessed in 68 long-term pediatric renal allograft recipients (43 boys) receiving daily or alternate-day prednisone therapy. Growth was analyzed both during the prepubertal period and during puberty. Height at transplantation was greater than 2 SD below the mean in 34.2% of prepubertal children. After the first posttransplant year, 59.2% of the prepubertal children had a normal height increment (greater than 4.8 cm/yr). Onset of puberty was recorded at a chronologic age of 14.6 +/- 1.9 years in boys and 13.3 +/- 1.9 years in girls. Height at onset of puberty related to chronologic age was -2.4 +/- 1.3 SD. Height velocity during puberty was within normal limits in 62.5% of the children. No significant difference in pubertal growth was detected in patients who had received transplants before and after the onset of puberty. Duration of pubertal development was within normal limits. In girls, menarche was achieved at a mean chronologic age of 15.9 years and bone age 12.9 years. Adult height was attained at an average age of 20.3 years in boys and 18.7 years in girls. Overall, one third of the children attained an adult height greater than 2 SD below the mean. Our data indicate that although poor growth before kidney transplantation has a great influence on adult height, the loss of growth potential during pubertal development seems even more important.     

Pubertal growth in response to testosterone replacement therapy for radiation-induced leydig cell failure

The adolescent growth pattern of eight boys, who had puberty induced with androgen replacement therapy following radiation-induced Leydig cell failure, was studied from induction of puberty at a mean age of 13.1 years (range 11.6-14.5) to final height at mean age of 18.8 years (range 17.7-20.3). The mean gains during puberty (SD) for standing height, sitting height, and sub-is-chial leg length were 18.56 cm (3.98), 10.46 cm (2.39), and 8.1 cm (2.01) respectively, which were significantly reduced compared with normal Tanner standards (P <.001). The peak velocity for each parameter occurred in the 1st year of induced puberty in contrast to the pattern in normal adolescence, although the mean peak velocity for each auxological parameter was not significantly different from the normal Tanner standards. The mean adult standing height (SD), 167.5 cm (9.88), and mean adult leg length (SD), 80.8 cm (6.19), were not significantly different from the normal Tanner standards, whereas the mean adult sitting height (SD), 86.7 cm (4.78), was shorter (P < .001). Three of the eight patients had a leg length standard deviation score less sitting height standard deviation score in excess of +2.96 suggesting the presence of significant skeletal disproportion. Seven of the eight boys reached target genetic height, though in six, the final height was below mid-parental height (P < .05). The modest loss in height potential was mainly due to radiation-induced skeletal dysplasia attenuating the growth of the spine. The families of boys with radiation-induced Leydig cell failure requiring androgen replacement therapy can be reasonably optimistic about height prognosis as seven of the eight boys reached target genetic height. © 1994 Wiley-Liss, Inc.     

Disturbed pubertal growth in girls treated for acute lymphoblastic leukemia

Pubertal growth was studied in 10 girls previously treated for acute lymphoblastic leukemia. The average age at menarche was 12.2 years, which is significantly lower (p less than 0.01) than the expected 13.1 years. Compared with normal girls, these girls showed a subnormal (p less than 0.05) peak height velocity during the second year before menarche. The remaining growth before menarche as well as the total postmenarchal growth was close to the normal average. The average final standing height was 1 SD less than what would be expected from their height 1 year after the cessation of therapy. A relative growth hormone deficiency in combination with early onset of puberty could account for this loss in final height.     

Growth prognosis and growth after menarche in primary hypothyroidism.

The long term growth of 20 girls and nine boys with juvenile primary hypothyroidism was studied until they reached final height. At diagnosis the girls had a mean age of 8.8 years (range 3.0-13.0); mean bone age was 5.4 years. The mean age of the boys at diagnosis was 9.5 years (range 3.7-14.2); mean bone age was 6.3 years. The patients were treated with thyroxine 100 micrograms/m2/day and serum thyroxine concentrations were maintained in the normal range. During treatment the rate of skeletal maturation exceeded the change in chronological age. Initial mean height SD score for bone age before treatment in the girls was +0.59 and after 11 years of treatment fell to -0.55 Mean height SD score for bone age in the boys decreased from +1.6 to -0.87 during treatment. In the girls the onset of puberty was 1.2 years later than the normal population but the duration of puberty was reduced. Mean age (SD) of menarche was 13.8 (1.7) years. The pattern of growth in girls with treated hypothyroidism was abnormal as growth continued after menarche, at a time when normal girls have almost stopped growing. During the second year after menarche our patients still had a mean growth velocity of 4.1 cm/year. Our data suggest that juvenile primary hypothyroidism results in a permanent height deficit. In addition, there is a loss of the normal harmony between growth and sexual maturation in girls, despite adequate treatment, in that growth continues for much longer after menarche than in normal girls.     

Height-weight development of uremic children undergoing dialysis and after kidney transplantation

Fifty-nine children with end stage renal disease treated by hemodialysis or renal transplantation have been assessed for linear growth. Mean follow-up duration of study was 6 years (0.25 to 15.5 yr). At the beginning of hemodialysis, the mean growth delay was 2 SD. Every year, prepubertal children were affected by a growth delay of 0.50 SD whereas pubertal children caught up by +0.10 SD. In patients with renal transplantation, the mean growth curve remained at the same standard deviation once the transplant had been performed. An increase in growth was exhibited in about one-third of this group provided the transplant functioned satisfactorily and the patient was under 11 years of age. The characteristic pubertal linear growth spurt was delayed and demonstrated a lower amplitude than in normal children; but if it took place over a prolonged period, a better final height was obtained. The mean final stature was about 2 SD. There was strong variability in the final height according to the age of renal failure onset, renal transplantation and the level of renal function. Bone age allowed adult height to be predicted. Metabolic disorders have to be dealth with as soon as possible in order to limit growth impairment.     

Linear growth and weight gain in diabetic children--a cross-sectional and longitudinal evaluation

OBJECTIVE: To examine linear growth and weight gain in diabetic children and to assess the influence of the age at onset of diabetes on growth. SUBJECTS AND METHODS: A retrospective longitudinal and cross-sectional analysis of the growth data of 61 children attending the diabetic clinic for the whole year of 1998 was completed. RESULTS: The children were of average height and weight at onset with mean (SD) Height SDS = -0.095 (0.96) and mean (SD) body mass index (BMI) SDS = 0.58 (1.15). But amongst the subgroups, boys with onset before five years were found to be significantly taller (Height SDS = 0.39 (0.75), P<0.05) and heavier (BMI SDS = 1.28 (1.05), P<0.05). There was no significant change from onset to time at analysis either within individual subgroups or as a whole. Girls showed a gain in mean (SD) BMI SDS from 0.41 (1.14) to 1.03 (1.25), which however did not reach statistical significance (P=0.08). No similar tendency was observed in boys. There was no significant change in Height SDS for the 12 children who reached final height. Longitudinal follow up of growth data agreed with the observations from cross-sectional data. CONCLUSION: Prepubertal linear growth was not affected even in those children diagnosed early in childhood. The 12 children who reached final height did not show any impairment of growth. Increased growth at onset was observed in the subgroup of boys with onset of diabetes before 5 years. The tendency towards excessive weight gain observed in diabetic girls needs further evaluation.     

Growth in atopic eczema

Growth was studied in 68 children aged 2-12 years with atopic eczema. Height SD scores were significantly correlated with the surface area of skin affected by eczema. The mean height of 41 patients with less than 50% of their skin surface affected (group I) was normal (mean SD score -0.11). The 27 children with more than 50% of their skin affected (group II) were significantly shorter (SD score -0.83) and were also short allowing for their parental target height. The predicted heights were also normal in group I but were lower than expected in group II. Regression analysis suggested that height was most dependent on parental height. The extent of the disease had a significant additional effect, whereas dietary treatment and treatment with topical steroids had only marginal additional effects. The growth of children with eczema affecting less than 50% of the skin surface area appears to be normal, and impaired growth is confined to those with more extensive disease.     

Growth in atopic eczema.

Growth was studied in 68 children aged 2-12 years with atopic eczema. Height SD scores were significantly correlated with the surface area of skin affected by eczema. The mean height of 41 patients with less than 50% of their skin surface affected (group I) was normal (mean SD score -0.11). The 27 children with more than 50% of their skin affected (group II) were significantly shorter (SD score -0.83) and were also short allowing for their parental target height. The predicted heights were also normal in group I but were lower than expected in group II. Regression analysis suggested that height was most dependent on parental height. The extent of the disease had a significant additional effect, whereas dietary treatment and treatment with topical steroids had only marginal additional effects. The growth of children with eczema affecting less than 50% of the skin surface area appears to be normal, and impaired growth is confined to those with more extensive disease.     

Final height in boys with untreated constitutional delay in growth and puberty.

To determine the natural history and psychological impact of the growth pattern in boys with constitutional delay in growth and puberty (CDGP), 43 boys presenting with short stature due to CDGP were followed up to final height. At presentation mean (SD) chronological age was 14.0 (1.9) years, bone age delay 2.7 (1.0) years, standing height standard deviation score (SDS) -3.4 (0.6), and predicted adult height SDS -1.3 (0.7). Final adult height SDS was -1.6 (0.9), measured at 21.2 (2.6) years. There was no significant difference between final height and predicted adult height, but there was a significant difference between final height and measured mid-parental height. Psychological questionnaires showed no significant difference in self esteem, marital, or employment state between the CDGP group and a control group. There was no correlation between self esteem and final height, but 25 felt their growth delay had affected their success either at school, work, or socially and 20 would rather have had treatment to advance their growth spurt. This study supports the more frequent use of active medical treatment to advance growth in boys with CDGP, and shows that although boys with CDGP reach their predicted heights, this is short for their families.     

Natural history of intrauterine growth retardation: pubertal growth and adult height

The evolution of height and bone age up to complete or near complete achievement of growth has been followed in 13 children born at term with a length of 42 to 46 cm, who after age 2 years had still a growth delay of -2.1 to -4.9 SD. Their mean annual growth velocity has been slightly below the average, excepted in the years preceding and following immediately the onset of puberty. The bone age, largely delayed and close to height age up to approximatively 8 years, afterwards has increased more than growth, so that the final height has always been less than the adult height predicted at age 8 years. The main factor in this difference between final and predicted height has been the fact that puberty has not been delayed. Starting at the usual age, in children whose height deficiency was still important, the pubertal growth spurt has not allowed full catch-up. Thus, in spite of delayed bone age during childhood, the mean adult height in the 13 patients of this series has been -3.43 SD versus -3.16 SD at age 2-5 years, these mean values involving different individual growth curves with absolute deterioration in 6 only of the 13 cases. These data will have to be considered when discussing the final results of therapeutic trials in children with severe and persisting intra-uterine growth retardation.     

Growth and childhood asthma.

Height and weight were measured every six months in a long term prospective study of 66 children with chronic perennial asthma for a mean 13.1 years. There was no evidence of growth retardation on entry into the study. Growth developed along normal lines in all 66 children until about 10 years, and in 35 of these children growth continued along normal lines throughout the whole period of follow up. Thirty children showed the physiological decelerating growth velocity pattern seen in children with delay in the onset of puberty, and one child had an early menarche. The tendency for delay in the onset of puberty was significant for both boys and girls and was noted to be independent of severity of asthma. Once puberty finally began in these children, complete catch up growth resulted in the attainment of the predicted adult height. Long term prophylactic inhalation of beclomethasone dipropionate in 26 children in a dosage up to 600 mcg/day before puberty and 400 mcg/day during puberty was shown not to affect growth. It is concluded that asthma had no direct influence on growth in height but was associated with delay in the onset of puberty. The pre-adolescent physiological deceleration of growth velocity that occurs in these children gives the impression of growth retardation.     

Outcome of premature thelarche: relation to puberty and final height

BACKGROUND—There is a debate about the possible progression of idiopathic premature thelarche towards precocious or early puberty.
OBJECTIVE—To evaluate height and age at onset of puberty in a group of girls with a history of idiopathic premature thelarche.
STUDY DESIGN—The height and age at onset of puberty of 42 girls now over 10 years of age who were diagnosed with isolated premature thelarche before the age of 3 years were evaluated.
RESULTS—Menarche was reached before or at 11 years of age in 13.5% of this group of girls. This percentage of early menarche was higher than would be expected from historical controls in the general population, but was consistent with maternal age of menarche. The mean (SD) height of the girls (n = 15) who achieved adult height was 162.9 (6.3) cm, which was slightly higher than the mean (SD) relative midparental height (160.7 (6.7) cm).
CONCLUSIONS—Isolated premature thelarche with onset before 3 years of age progresses towards precocious puberty, although this was consistent with the maternal age of menarche. Furthermore, adult height was normal when compared with population norms in all patients.

     

Does the severity of atopic dermatitis correlate with serum IgE levels?

Recent studies suggest an association between atopic phenotypes and serum IgE levels. In contrast to asthma, this association has not been proven for atopic dermatitis. For 345 children (mean age 2.9 years), we investigated a correlation of the severity of eczema (defined by SCORAD score) and serum IgE levels. Additionally, the data was analyzed for differences between children with high and low SCORAD quartile. Parameters such as genetic background, the prevalence of other atopic phenotypes such as bronchial asthma, allergic rhinoconjunctivitis, and allergic sensitization were recorded. Our results indicate a significant correlation between SCORAD and serum IgE levels (R = 0.31, p < 0.001), but the standard deviation was large. Children with atopic dermatitis showed a high prevalence of sensitization to foods independent of the IgE levels; children with high SCORAD levels showed a sensitization to aeroallergens significantly more often (p < 0.02). No differences were found in prevalences of atopic family background, or a number of additional atopic symptoms such as asthma and allergic rhinoconjunctivitis. These results suggest that serum IgE levels seem to correlate with the degree of eczema. Children with severe atopic dermatitis and high IgE levels are at risk for sensitization to food allergens and aeroallergens.     

Asthma, inhaled corticosteroid treatment, and growth.

To evaluate the effects on growth of inhaled corticosteroid treatment (ICT) and of the quality of control of asthma, height velocity was studied in 58 prepubertal children attending a specialist asthma clinic because of chronic asthma that was difficult to control. The height velocity standard deviation (SD) score was maximal when the asthma was well controlled both before (0.01) and after (-0.07) starting ICT. It was least when the asthma was poorly controlled both before (-1.50) and after (-1.55) starting ICT. The effectiveness of control correlated significantly with the height velocity SD score, both before and after ICT was started. No evidence was found that the administration of ICT has an adverse effect on growth.