Small for gestational age as an independent risk factor for long-term pediatric gastrointestinal morbidity of the offspring*

Objective: The concept of neonatal programming has begun to emerge as an important component of adult health. Scarce data exist regarding perinatal risk factors for long-term gastrointestinal (GI) morbidity of the offspring. We aimed to evaluate the association between birthweight (BW) at term and long-term pediatric GI morbidity.

Study design: A population-based cohort analysis was performed, comparing the risk of long-term GI morbidity (up to the age of 18 years) in children delivered at term according to their BW. The study included all term deliveries occurring between 1991 and 2014 at a single regional tertiary medical center. Multiple gestations and fetuses with congenital malformations were excluded. BW was subdivided into: small for gestational age (small for gestational age (SGA) – BW?≤?5th centile), appropriate for gestational age (AGA ?5th centile?Results: During the study period, 225,600 term singleton deliveries met the inclusion criteria. Of them, 4.6% (n?=?10,415) were SGA and 4.3% (n?=?9796) were LGA. During the 18-years follow-up period, 11,791 (5.2%) children were hospitalized with GI morbidity. Hospitalizations were significantly more common in the SGA group, as compared with the AGA and LGA groups (6.6 versus 5.2 versus 4.5%, respectively, p?p?p?Conclusions: SGA offspring are at an increased and independent risk for long-term pediatric GI morbidity.     

Mechanisms of vascular dysfunction in the interleukin-10–deficient murine model of preeclampsia indicate nitric oxide dysregulation

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Family history of diabetes mellitus and long-term endocrine morbidity of the offspring

Abstract

Background: Little is known regarding the long-term outcomes of offsprings to non-diabetic mothers with family history of diabetes mellitus (FHDM).

Objective: The aim of the study was to determine whether being born to a non-diabetic mother with FHDM increases the risk for long-term endocrine morbidity.

Methods: This is a population-based cohort study, comparing long-term endocrine morbidity between offspring born to non-diabetic mothers with and without FHDM. The Kaplan–Meier survival curve was used to compare cumulative morbidity incidence. Cox proportional hazards model was performed to control for confounders.

Results: During the study period, 208,728 children met the inclusion criteria. Using a Kaplan–Meier survival curve, offspring born to non-diabetic mothers with a FHDM had higher cumulative incidence of endocrine morbidity compared to their counterparts without FHDM (Log rank test p?=?.014). Using a Cox model, controlling for confounders, being born to a non-diabetic mother with FHDM was an independent risk factor for long-term endocrine morbidity of the offspring (adjusted HR = 1.24, 95%CI 1.001–1.54; p?=?.043).

Conclusion: Being born to a non-diabetic mother with a FHDM is independently associated with higher risk for long-term endocrine morbidity of the offspring.     

Does the Cerebellum Implement or Select Geometries? A Speculative Note

The Cerebellum - During evolution, living systems, actively interacting with their environment, developed the ability, through sensorimotor contingencies, to construct functional spaces shaping...     

Maternal obesity and long-term neuropsychiatric morbidity of the offspring

Archives of Gynecology and Obstetrics - To evaluate the long-term pediatric neuropsychiatric morbidity of children born to obese patients. A population-based cohort analysis was performed comparing...     

Low‐dose fludarabine and cyclophosphamide combined with standard dose rituximab (LD‐FCR) is an effective and safe regimen for elderly untreated patients with chronic lymphocytic leukemia: The Israeli CLL study group experience

Chronic lymphocytic leukemia (CLL) is a disease of elderly patients. The fludarabine, cyclophosphamide, and rituximab (FCR) regimen is considered the treatment of choice for young fit patients with CLL; however, this combination is toxic for older patients. At the time this study was first planned and initiated, there was no standard chemo‐immunotherapy regimen regarded as standard therapy for the less fit elderly patient with CLL. Here, we conducted a single‐arm, phase II trial to examine the efficacy and safety of lower‐dose fludarabine and cyclophosphamide combined with a standard dose of rituximab (LD‐FCR) in elderly patients with previously untreated CLL. Forty patients received LD‐FCR and were included in the efficacy analysis. Two patients treated with FC alone were only included in the safety analysis. The median age was 72.7 years (range, 65.0 to 85.0). The overall response and complete response rates were 67.5% and 42.5%, respectively. Median progression‐free survival (PFS) was 35.5 months (95% CI, 29.27‐41.67). Two patients (4.8%) died during the study period. Hematological toxicities and infections were the most common complications encountered; grade 3 to 4 treatment‐related neutropenia occurred in 20 (47.6%) patients. During the entire study follow‐up, 26 patients (61.9%) had all grades of infection including six (14.3%) with neutropenic fever and eight (19%) with grade 3 to 4 non‐neutropenic infections. In conclusion, LD‐FCR is an effective and relatively safe regimen for previously untreated patients with CLL. It has the advantage of being both “time and cost limited” and, even in the era of novel agents, can still be considered when planning treatment for elderly patients without high‐risk biomarkers. However, recent results in fit elderly patients using the combination of bendamustine and rituximab which have achieved longer PFS with good safety profile must be taken into consideration in this regard.