Subclinical atherosclerosis after heart and heart-lung transplantation in childhood

Abstract:  Children after heart transplantation are considered as at-risk patients for extracardiac atherosclerotic complications. Noninvasive ultrasound measurement of the common carotid artery (IMT) provides valid information about the endothelial structure of the vascular system. Twenty-two patients (17 male, mean age 12.4 ± 4.5 yr) after heart and (5.7 ± 4.5 yr) heart–lung transplantation were enrolled. The mean IMT was measured and compared with a control group (18 children, 10 male, mean age 11.8 ± 1.8 yr) and to normative data. Transplanted children had a higher IMT than controls (0.453 ± 0.003 vs. 0.424 ± 0.002 mm, p < 0.001). IMT-SDS was increased as well (1.6 ± 0.1 vs. 0.8 ± 0, p < 0.001). Transplanted children had a higher LDL/HDL-ratio (2.2 ± 0.2 vs. 1.2 ± 0.1, p < 0.001). Time after transplantation, age at the time of transplantation, or medical therapy did not influence the findings. We found evidence for subclinical atherosclerosis in children after heart and heart–lung transplantation. Even if single atherosclerotic risk factors could not be identified, transplanted children seem to be at risk for atherosclerosis. Our findings support the recently published statement of the AHA-Expert panel: after heart transplantation atherosclerotic complications may occur with increased incidence. We propose the IMT-measurement in these patients as an easy method to assess the vascular status and to guide preventive measures.     

Cholesterol and carotid artery wall in children and adolescents with familial hypercholesterolaemia: a controlled study by ultrasound

The carotid artery wall was studied with ultrasound in 23 children and adolescents with familial hypercholesterolaemia and in 23 age-matched healthy controls. The study revealed changes in the carotid artery wall related both to familial hypercholesterolaemia and to age. In the control subjects, the carotid artery wall became stiffer with age. In the patients with hypercholesterolaemia, no clear age-dependence was found, but wall stiffness correlated with total and low-density lipoprotein cholesterol. The intimal-medial wall thickness was associated with serum total cholesterol, low-density lipoprotein and triglyceride concentrations, and correlated inversely with the ratio of high-density lipoprotein to total cholesterol. Carotid artery wall properties seem to be associated with the degree of hypercholesterolaemia and the high-density lipoprotein-to-total cholesterol ratio even in children. In childhood and adolescence it is already possible, with ultrasound, to detect changes in the arterial wall related both to familial hypercholesterolaemia and to age.     

Cognitive abilities in reading-disabled children: a longitudinal study

Longitudinal psychometric test data collected at two different ages (9.4 +/- 1.3 and 14.8 +/- 1.2 years) were utilized to compare the developmental rates of 69 pairs of reading-disabled and matched control children. Results of a two-factor (GROUP X TIME), mixed-model, multivariate analysis of variance indicated that reading-disabled children manifested deficits on measures of academic achievement, symbolic processing speed and spatial reasoning abilities at both ages. Although both reading-disabled and control children were found to improve significantly between the two testing sessions, the lack of a significant GROUP X TIME interaction on measures of academic achievement and spatial reasoning abilities indicated that the rate of development was similar for the two groups. For measures of symbolic processing speed, however, differences between reading-disabled and control children were somewhat greater at the later age.     

Growth in very preterm children: a longitudinal study

The knowledge about the long-term growth of very preterm children in relation to gestational age at birth is incomplete. Therefore, a retrospective study of longitudinal growth from birth to 7 y of age in 52 of 56 surviving children who were born at a gestational age of <29 wk between 1988 and 1991 to mothers resident in the city of G?teborg, Sweden, was performed. A majority of the children had an initial decrease in weight during the first months of life, followed by an increase, with a maximum weight gain occurring at 36-40 wk postmenstrual age. After a period of decreased weight and length velocity, a second increase in weight velocity was demonstrated from 6 mo to 2 y of corrected age. A corresponding increase in length velocity was found from 2 to 12 mo of corrected age. A later catch-up growth period was found at 4-5 y of age. At 7 y of age, all but two had reached the normal height range of the population. This long-term catch-up in height was established later in those who were born at an earlier gestational age. We conclude that all preterm infants had an initial period of poor growth, which rendered them growth retarded during the first years of life. It took approximately 4-7 y to overcome what the very preterm child lost in growth during the first months of life. However, as a group, they did reach normal height, weight, and weight for height before puberty.     

Maternal employment and breastfeeding: results from the longitudinal study of Australian children

AIM: To investigate the effect of maternal postnatal employment on breastfeeding duration in Australia in the first 6 months after birth. METHOD: Secondary data analysis of the infant data (2004) from the Longitudinal Study of Australian Children (LSAC). Complete maternal and breastfeeding data were available for 3,697 infants. Multivariable logistic regression was used to investigate the effect of timing of resumption of maternal employment and maternal employment status on breastfeeding at 6 months postpartum after adjustment for maternal education, maternal age, maternal smoking during pregnancy and socioeconomic status of the child's area of residence. RESULTS: Fewer women employed full-time were breastfeeding their infants at 6 months (39%) than nonemployed women (56%). Participation in full-time employment before 6 months had a strong, negative effect on the likelihood of continuing breastfeeding for 6 months, adjusted OR = 0.35 (95%CI: 0.22-0.55). Compared to nonemployed women, fewer women in part-time employment were breastfeeding at 6 months (44%), adjusted OR = 0.49 (95% CI: 0.37-0.64). CONCLUSIONS: Results from this large representative cohort of Australian infants confirm that maternal employment in the first 6 months of life contributes to premature cessation of breastfeeding even when known risk factors for breastfeeding cessation are controlled for.     

Heritability of attention problems in children: longitudinal results from a study of twins, age 3 to 12

BACKGROUND: Twin studies of childhood behavior problems support the conclusion that individual differences in impulsivity, hyperactivity, and inattention are largely due to genetic influences. Non-genetic variation is due to environmental influences that are unique to the individual, and possibly to rater contrast effects. In the present longitudinal twin study, we report on the size of genetic and environmental effects on individual differences in attention problems at ages 3, 7, 10 and 12 years. METHODS: Mothers were asked to complete the CBCL for their twin offspring when the children were 3 (n = 11,938), 7 (n = 10,657), 10 (n = 6,192), and 12 years old (n = 3,124). We focus on the Overactivity (OA) scale in the Child Behavior Checklist (CBCL/2-3), and on the Attention Problem (AP) scale of the CBCL/4-18. The data were analyzed using longitudinal structural equation modeling. RESULTS: Broad heritability of OA and AP is estimated at nearly 75%, at each age. A contrast effect was observed at age 3 only. The results revealed less stability of OA at age 3 to AP at age 7 (r = .40), compared to the stability from AP at age 7 and beyond (r = .70). Genetic effects explained between 76% and 92% of the covariance between OA and AP. CONCLUSIONS: OA and AP are highly heritable at all ages in both genders. The same set of genes appears to be expressed in boys and girls. The size of genetic and environmental contributions remains the same across the ages studied. Stability in OA and AP is accounted for by genetic influences. Children who do not display OA or AP at a given age are unlikely to develop these problems at a subsequent age.     

Diagnosis of a trend towards obesity in preschool children: a longitudinal study

The study was planned to determine identifiable starting points of a trend towards obesity and the influence of variables in preschool children aged 0 to 6 years. In this longitudinal follow-up study, 102 children were enrolled. Anthropometric measurements such as weight–height centiles (specific for gender and age group), weight–height growth velocities, and body mass indices were taken annually and compared within each group from birth to 6 years. Family history and lifestyle variables were also recorded and compared. Our study has shown that gender does not affect the trend towards obesity. In obese children, the earliest sign of a trend was the rapid increase of weight and weight gain velocity after 6 months. There were upward trends in the BMI values indicating obesity at 1 year of age in boys and at 6 months of age in girls. The height was higher in obese children than in non-obese ones after 4 years of age. Paternal obesity and having an obese sibling were significant risk factors for obesity. In conclusion, 6 months are considered to be the most critical periods for evaluating the development of obesity in childhood. The efforts for preventing obesity should be initiated at 6 months of age.     

亚临床甲状腺功能减退症对患儿骨龄和身高的影响

目的 观察亚临床甲状腺功能减退症(甲减)对儿童骨龄(BA)、身高及甲状腺激素水平的影响.方法 选取30例亚临床甲减患儿为亚临床甲减组,30例体检健康儿童为健康对照组.对每位研究对象采用同一磅秤标准,测量其身高、体质量.采用Greulich-Pyle图谱法对各组儿童左手腕指关节正位片进行BA水平的评定;采用罗氏化学发光免疫分析仪E170检测各组儿童促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)水平.采用SPSS 17.0软件比较2组儿童BA、身高、TSH、FT3及FT4的差异;BA与身高、TSH、FT3及FT4间进行Pearson相关分析.结果 亚临床甲减组儿童的BA[(8.17±2.29)岁]、身高[(131.47±13.41) cm]水平均落后于健康对照组[(10.08±2.75)岁、(141.05±15.12) cm](t=2.92、2.60,Pa<0.05);TSH水平[(5.93±1.77) mIU·L-1]显著高于健康对照组[(2.66±1.28) mIU·L-1](t=8.17,P<0.001).亚临床甲减组儿童的BA与身高呈显著正相关(r=0.940,P<0.01);BA与TSH呈显著负相关(r=-0.450,P<0.05).亚临床甲减组FT3[(5.43±1.37) pmol·L-1]、FT4[(17.29±2.03) pmol·L-1]与健康对照组[(5.83±1.11) pmol·L-1、(17.22±1.96) pmol·L-1 ]比较差异均无统计学意义(t=1.24、0.14,Pa>0.05).结论 儿童亚临床甲减可引起BA、身高的落后,需要用药物进行干预治疗.     

Overweight and hypertension: longitudinal study in school-aged children

AIM: A continuous increase in overweight has been documented in the paediatric population. The increase occurred in many developed and also developing countries. In the United States prevalence of overweight is 21.5% among African-Americans, 21.8% among Hispanics, and 12.3% among non-Hispanic whites; in Europe, from 10% to 20% in Northern Europe and 20% to as high as 36% in parts of Southern Italy (International Obesity Task Force data). The association between overweight and hypertension in children has been reported. This longitudinal study assessed the prevalence of hypertension and the relationships between gender, overweight, and blood pressure. METHODS: School-based screening was performed in 1.563 children (3-16 years). Age, gender, height, weight and blood pressure were registered every year for 3 subsequent years, in the period 1997-2000. Body mass index (BMI, kg/m2) was calculated and overweight was defined as centile corresponding to BMI = or >25 at 18 years. Blood pressure > 95th centile defined hypertension. RESULTS: The prevalence of elevated blood pressure at first, second and third screenings was 35.1%, 33.8% and 23.9% in males, and 41%, 40.2% and 31.2% in females. The relative risk was significant for overweight subjects. CONCLUSIONS: These results confirm an increasing epidemic of cardiovascular risk in children, as evidenced by an increase in the prevalence of overweight and hypertension. This increase in association with other cardiovascular risk factors that include dyslipidemia, insulin resistance, glucose intolerance, type II diabetes mellitus, suggest the necessity of accurate prevention strategies.     

免疫性血管炎致动脉粥样硬化的实验研究

目的　探讨免疫性血管炎与动脉粥样硬化 (AS)发生的关系。方法　 4周龄日本大耳幼年家兔 6 1只及 4月龄成兔 10只分为 6组。用 10 %牛血清清蛋白重复静脉注射诱发免疫性血管炎 ,并喂饲胆固醇饲料。A组 :血管炎幼兔冠脉造影组 2 7只 ;B组 :正常成年兔冠脉造影对照组 10只 ;C组 :正常幼兔冠脉造影对照组 10只 ;D组 :血管炎加胆固醇喂饲组 8只 ;E组 :单纯胆固醇喂饲对照组 8只 ;F组 :基础喂饲对照组 8只。实验满 4周后A、B、C三组行冠状动脉造影 ;满 12周后D、E、F三组分别取心脏做主动脉冠状动脉组织病理学检查。结果　A组中 6只出现明显冠状动脉扩张 ,B组和C组冠脉无扩张。D组出现严重AS ,表现为脂质斑块厚 ,隆起于内膜表面。E组仅出现轻度AS ,表现为脂质斑块薄 ,且主要集中于主动脉根部。D组与E组比较 ,其脂质斑块面积百分比 (PA)、冠状小动脉粥样硬化发生率 (IA)和冠状动脉管腔狭窄程度 (DS)均有显著性差异 (P <0 .0 1)。F组无AS改变。结论　血清性免疫血管炎急性期可致部分幼兔冠状动脉扩张 ,并可显著加重胆固醇喂饲家兔AS形成。免疫性血管炎是AS和缺血性心脏病发生新的危险因素     

Cocaine, anemia, and neurodevelopmental outcomes in children: a longitudinal study

This longitudinal study investigated the rates of iron-deficiency (ID) and iron-deficiency anemia (IDA) among prenatally cocaine-exposed and nonexposed two- and four-year-old children and assessed their relationships to neurodevelopmental outcomes. The sample consisted of 143 two-year-old (70 exposed and 73 nonexposed) and 274 four-year-old (139 exposed and 135 nonexposed) low socioeconomic status children recruited from an ongoing longitudinal study. Hematological assessments included hemoglobin, serum ferritin, mean corpuscular volume, transferrin saturation, and blood lead levels. The neurodevelopmental outcomes consisted of the Bayley Mental (MDI) and Motor (PDI) Development indices at two years, and the Wechsler Preschool and Primary Scales of Intelligence (WPPSI) and the Peabody Developmental Motor Scales (PDMS) at four years. The rate of IDA in four-year-old children was significantly greater among the cocaine-exposed compared to the nonexposed group (p =.026), while the rates at two years were not significant. Exposure to IDA at two years was associated with a significant decrease in concurrent motor scores (p =.011) after adjustment for relevant covariates. Peak exposure to IDA, defined as being anemic at 2 and/or 4 years of age, was associated with a significant (p <.05) decrease in Full Scale IQ after adjustment. Cocaine exposure was not a significant predictor of Full Scale IQ with the inclusion of peak IDA and lead in the model. These findings indicate the need for greater pediatric surveillance of IDA and lead in cocaine-exposed infants, in order to reduce long-term neuropsychological deficits.     

Theory of mind in children with 'lesser variants' of autism: a longitudinal study

BACKGROUND: The study investigated the development of theory-of-mind (ToM) knowledge in children with lesser variants' of autism (PDD-NOS) over a period thought to be critical for ToM development (i.e., 3 to 5 years of age). METHOD: The sample included 11 children with PDD-NOS; 23 normally developing children were included for cross-sectional comparison and 13 normally developing children for longitudinal comparison. The groups were comparable in verbal and non-verbal mental age. Two storybooks were used for repeated assessment of various aspects of the children's theory of mind: emotion recognition, the distinction between physical and mental entities, prediction of behaviour and emotions on the basis of desires and prediction of behaviour and emotions on the basis of beliefs. RESULTS: The results showed that the children with PDD-NOS had specific difficulties in understanding and predicting other people's emotions on the basis of situational cues, desires and beliefs. However, their ability to predict actions from beliefs and desires were relatively intact. Compared to the normally developing children, these children achieved lower levels of theory-of-mind knowledge, both at time of initial assessment and approximately 6 months later. CONCLUSIONS: The data suggest that the theory-of-mind development of children with PDD-NOS is both delayed and deviant. The growth pattem of theory-of-mind skills in children with PDD-NOS seemed to be qualitatively different from the growth pattern found in the group of normally developing children.     

Perceptions of stressful life events in Northern Irish school children: a longitudinal study

BACKGROUND: Adults' perceptions of stressful life events have been acknowledged as important moderators of the stress adjustment relationship. Until recently, however, there has been a lack of research on children's perceptions of negative life events. This study assesses children's own perceptions of the stressfulness of negative familial, academic and social events as well as events related to the political conflict in Northern Ireland. METHOD: Developmental changes in children's perceptions of events are traced over time. One hundred and sixty 8-year-old children completed a self-report measure of the perceived stressfulness of a range of negative life events. The sample was drawn from schools in the Greater Belfast area to include children of both genders, primary religious affiliations in Northern Ireland (i.e., Protestant and Roman Catholic) and of varying socio-economic status. Three years later, 113 of these children, then aged 11, were traced through the school system and completed the same measure. RESULTS: Children's perceptions of stressful events are related to a host of social factors. Girls viewed many negative events as more stressful than their male counterparts. Roman Catholic and Protestant children differed in their perceptions of conflict-related events. Perceptions of various types of negative experiences were differentially related to socio-economic status and age. CONCLUSION: Personal, social and situational factors differentially determine children's perceptions of negative life experiences.