Association of adipokines with cardiovascular risk factors in low birth weight children: a case–control study

Our aim was to investigate plasma levels of adiponectin, monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) in low birth weight (LBW) children and to determine correlations among these adipokines and birth weight and cardiovascular disease risk factors. In a case–control study, the concentrations of adiponectin, MCP-1 and PAI-1 were measured in 180 schoolchildren (ages 6–11 years). MCP-1 and PAI-1 levels were significantly elevated in LBW children. Conversely, adiponectin concentration was significantly reduced in these children. Similar findings were observed after adjustment for current age, gender and abdominal circumference. Because the children with LBW had altered adipokine levels, as well as higher abdominal circumference, HOMA-IR and systolic blood pressure (SBP), we evaluated the correlation among these variables. These analyses showed that adiponectin levels were inversely correlated with systolic blood pressure (SBP) (r?=??0.501; P?<?0.001), HOMA-IR (r?=??0.293; P?=?0.023) and waist circumference (r?=??0.317; P?=?0.014). The proinflammatory markers were positively correlated with HOMA-IR (PAI-1: r?=?0.358; P?=?0.005) and waist circumference (PAI-1: r?=?0.571; P?<?0.001 and MCP-1: r?=?0.267; P?=?0.039). Conclusion: Adipokines levels were correlated with cardiovascular risk factors in LBW children, and these compounds could be involved in the mechanism that links birth weight to the development of cardiovascular diseases in adulthood.     

Prolonged toilet training in children with Down syndrome: a case–control study

Objectives

Children with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to estimate the age toilet training starts and completes in children with DS compared to children with normal psychomotor development and to evaluate the method and type of toilet training most frequently used, as well as its association with lower urinary tract symptoms and functional constipation.

Type 1 diabetes in offspring of parents with type 1 diabetes: the tip of an autoimmune iceberg?

The objective of the present study was to examine the prevalence of self-reported autoimmune diseases among offspring of type 1 fathers, type 1 diabetic mothers, and non-diabetic parents. Type 1 diabetic probands (n=265; mean age=42 yr), who were ascertained from the Children's Hospital of Pittsburgh Registry for 1950–1964, recently participated in the Familial Autoimmune and Diabetes Study. Non-diabetic probands (n=96), identified from voter registration lists and matched by age, race, median income, and duration of residence in the Pittsburgh area, were also enrolled. Offspring of type 1 diabetic probands were more likely to have a reported autoimmune disease (5.8% vs. 2.4%; p=0.067) than offspring of non-diabetic probands. Half the cases in the diabetic families were disorders other than type 1 diabetes, (e.g., rheumatoid arthritis, Crohn's disease, etc.). Stratification by parental gender revealed a marginally higher risk for type 1 diabetes among offspring of type 1 diabetic fathers compared to mothers (4.9% vs. 3.4%; p=0.38, respectively, through age 20 yr). However, the risk for other autoimmune disorders was statistically significantly increased among offspring of type 1 diabetic mothers (0% vs. 6.2%; p=0.02, respectively, through age 20 yr). These data suggest that offspring of type 1 diabetic parents may be at high risk of developing other autoimmune disorders during childhood, with pediatric diabetes representing the 'tip of an autoimmune iceberg'. The observed risk differences by parental gender, which have also been reported for other autoimmune disorders, warrant further investigation.     

Severe hypoglycaemia,metabolic control and diabetes management in children with type 1 diabetes in the decade after the Diabetes Control and Complications Trial – a large-scale multicentre study

Hypoglycaemia is frequently the limiting factor in achieving optimal glycaemic control. Therefore, insulin therapy, the incidence of hypoglycaemia, and glycaemic control were investigated in 6309 unselected children with type 1 diabetes in a large-scale multicentre study. Using standardised computer-based documentation, the incidence of severe hypoglycaemia, HbA1 _c levels, insulin regimen, diabetes duration, and the number of patients attending a treatment centre were investigated for the age groups 0-<5 years ( n =782), 5-<7 years ( n =1053), and 7-<9 years ( n =4474). The average HbA1 _c level was 7.6% (no significant difference between age groups). Young children had more severe hypoglycaemic events (31.2/100 patient years) as compared to older children (19.7; 21.7/100 patient years, P <0.05) independent of the treatment regimen. Our data suggest that diabetes centres treating less than 50 patients per year have a higher incidence of hypoglycaemia in 0-<5-year-old children (43.0/100 patient years) as compared to larger centres (24.1/100 patient years; P <0.0001). Significant predictors of hypoglycaemia were younger age ( P <0.0001), longer diabetes duration ( P <0.0001), higher insulin dose/kg per day ( P <0.0001), injection regimen ( P <0.0005), and centre experience ( P <0.05). Conclusion:Despite modern treatment, young children have an elevated risk for developing severe hypoglycaemia compared to older children, especially when treated at smaller diabetes centres. The therapeutic goal of carefully regulating metabolic control without developing hypoglycaemia has still not been achieved. Further advances in diabetic treatment may result from giving more attention to hypoglycaemia in young children.On behalf of the German Initiative on Quality Control in Paediatric Diabetology.     

Surgical correction of tracheo-oesophageal fistula and oesophageal atresia in infants with VACTERL association: a retrospective case–control study

Introduction

VACTERL is a rare, non-random association comprising at least three major component features defined by the acronym, and including Vertebral anomalies, Anorectal malformations, Cardiac defects, Tracheo-oEsophageal fistula with or without oesophageal atresia (TOF/OA), Renal abnormalities and Limb anomalies. The aim of this study was to compare the post-operative outcomes following surgical correction of TOF/OA in infants with VACTERL and isolated TOF/OA.

Methods

A retrospective case–control study comparing infants with VACTERL (case group) versus infants with isolated TOF/OA (control group) that underwent surgical correction of TOF/OA at our centre between January 2006 and December 2011. Patient demographics, types of anomalies, operative techniques and post-operative outcomes were collected using inpatient and outpatient records.

Results

We identified 30 consecutive infants with TOF/OA. Five infants had VACTERL (17?%) and 15 infants had isolated TOF/OA (50?%). There was no significant difference in the gestational age (P?=?0.79), birth weight (P?=?0.69) or operative repair (P?=?0.14) between groups. Overall, surgical correction of TOF/OA led to satisfactory morbidity. Infants with VACTERL were not at higher risk of post-operative complications, such as oesophageal stricture (P?=?0.17) or gastro-oesophageal reflux (P?=?1.0), compared to infants with isolated TOF/OA.

Conclusions

VACTERL association does not increase the risk of post-operative complications following TOF/OA repair.     

Dietary total antioxidant capacity and current asthma in Spanish schoolchildren: a case control–control study

The aim of this work was to study the relationship between dietary total antioxidant capacity (TAC) and current asthma in a group of Spanish schoolchildren. A total of 78 Spanish schoolchildren (26 asthmatic and 52 healthy controls) were randomly selected from a cohort of 564 children (9–12 years of age). The weight and height of all subjects were recorded. A questionnaire, completed by the subjects' parents, was used to obtain personal and health information. Current asthma was established when children had ever had asthma, they had been diagnosed with asthma by a physician, and they had been treated with medications at some time in the previous 12 months. Food intake was monitored using a 3-day food record. All consumed foods were converted into energy and nutrients. Dietary TAC was evaluated using the ferric reducing antioxidant power (FRAP), radical-trapping antioxidant parameter (TRAP), and Trolox equivalent antioxidant capacity (TEAC) assays. The TAC measured using all the assays was significantly lower in children with asthma than in children without this condition (2.95 (2.10–3.75)?mmol Fe(II)/day vs. 3.70 (3.08–4.49)?mmol Fe(II)/day, p?<?0.01; 1.50 (1.06–2.05)?mmol Trolox equivalents/day vs. 2.10 (1.40–2.65)?mmol Trolox equivalents/day, p?<?0.05; and 1.60 (1.08–2.00)?mmol Trolox equivalents/day vs. 1.85 (1.50–2.68)?mmol Trolox equivalents/day, p?<?0.05 for FRAP, TEAC, and TRAP, respectively). After adjusting for energy intake, children with FRAP values higher than 3.5 mmol Fe(II)/day (p50) and TEAC values higher than 1.9 mmol Trolox equivalents/day (p50) had 22.6 and 35.0 %, respectively, lower likelihood of suffering asthma episodes than children with lower values. When logistic regression analysis was performed separately for children with nonsmoker and smoker (at least one) parents, the association between dietary TAC and asthma was only observed in the nonsmoker group (OR?=?0.257, 95 % CI?=?0.107–0.618, p?=?0.002 for FRAP; OR?=?0.212, 95 % CI?=?0.069–0.639, p?=?0.006 for TEAC; and OR?=?0.264, 95 % CI?=?0.091–0.769, p?=?0.015 for TRAP assay). Conclusion: Dietary TAC may have a favorable role in asthma in children and, specially, in those with nonsmoker parents.     

Vitamin D status in diabetic Egyptian children and adolescents: a case–control study

Background

Recently, studies suggesting that vitamin D deficiency correlates with the severity and frequency of Type 1 (insulin-dependent) diabetes mellitus (T1DM) and that vitamin D supplementation reduces the risk of developing T1DM have been reported.

Objective

In this study, we aimed to assess vitamin D status in Egyptian children and adolescents with T1DM.

Methods

This was a case–control study including 80 T1DM diagnosed cases aged 6 to 16 years and 40 healthy children with comparable age and gender as the control group. For all subjects, serum 25 (OH) D levels were measured by ELISA, Serum parathyroid hormone (PTH) and serum insulin were measured by an electrochemiluminesce immunoassay. Serum glucose, Glycosylated hemoglobin (HbA1c) levels and homeostasis model assessment of insulin resistance (HOMA-IR) were also assessed.

Results

Compared to the control group, serum vitamin D levels were not significantly lower in diabetic subjects (24.7?±?5.6 vs 26.5?±?4.8 ng/ml; P?>?0.05). Among diabetic cases 44(55%) were vitamin D deficient; meanwhile 36(45%) cases had normal vitamin D level (P?<?0.01). In addition, 26(32.5%) diabetic cases had 2ry hyperparathyroidism and 54(67.5%) cases had normal parathyroid hormone level; meanwhile, none of the control group had 2ry hyperparathyroidism (P?<?0.01). Furthermore, we found a significant difference between vitamin D deficient diabetic cases and those with normal vitamin D level as regards HOMA-IR and diabetes duration (P?<?0.01).

Conclusion

Public health message on the importance of vitamin D status; especially in diabetic children and adolescents, should be disseminated to the public.

     

Description of 101 cases of nipple cracks and risk factors via case–control study in eight units of a perinatal network

Nipple crack are a frequent complication of breastfeeding, causing pain for the mother and feeding difficulties for the baby with the risk of early cessation of breastfeeding. The characteristics of nipple cracks have rarely been described. Treatment varies according to the period of breasfeeding and the maternity ward. Eight maternity wards in a perinatal health network in western France followed up maternal nipple cracks. The cracks were described and their treatment was noted. The variables regarding the mothers, delivery conditions, health of newborns, and their ability to breastfeed were analyzed. Each case patient was matched with a control patient who was in a room adjacent to the case patient. Case–control analysis was univariate, followed by multivariate analysis via logistic regression (SPSS 20.0) with adjusted odds ratios (aOR). In all, 101 cases of women with nipple cracks were studied. The cracks were predominantly located in the upper external quadrants as well as in the central part of the nipple. There were no lateralization effects (right or left). The most frequent treatments after breastfeeding were oils, hydrophilic gel, and maternal milk. Compared with the 101 controls without cracks, the features associated with cracks in multivariate analysis were fair skin (aOR = 1.92 [1.01–3.60]; P = 0.04), history of nipple cracks (aOR = 11.38 [3.69–35.13]; P = 0.0001), first breastfeeding (aOR = 4.21 [1.27–13.86]; P = 0.018), and normal weight or no obesity (aOR = 0.33 [0.14–0.75]; P = 0.008). Two more specific analyses were performed in primiparous and multiparous women. In conclusion, the practitioners learned to describe nipple cracks and analyze their treatments. Knowledge of the risk factors should enable practitioners to propose active prevention to mothers with fair skin, a history of cracks, or a lack of experience in breastfeeding by helping them to breastfeed during the first days of their infant's life, especially for primiparous and overweight or obese women.     

Polymorphism of 3′ UTR of MAMLD1 gene is also associated with increased risk of isolated hypospadias in Indian children: a preliminary report

Objective

To study MAMLD1 gene polymorphisms, serum LH and testosterone levels amongst Indian children with isolated hypospadias (IH) and controls.

Materials and methods

Screening of the MAMLD1 gene was performed by PCR sequencing method in 100 Indian children aged 0–12 years presenting with IH and 100 controls. LH and testosterone hormone levels were also assessed (categorized in four age-wise groups).

Results

IH subjects had significantly higher incidence of MAMLD1 polymorphism as compared to controls (33 vs 15 %, p = 0.01). Of various genomic variants identified in this study, the noteworthy novel ones were missense mutation P299A and single nucleotide polymorphism c.2960C>T in 3′ UTR of Exon 7. While p 299A was found to cause protein structural instability consequent to amino acid change, eighty percent subjects with c.2960C>T in 3′ UTR of Exon 7 (corresponding to newly discovered currently non-validated exon 11) were found to have lower testosterone levels when compared with their age group mean. IH showed statistically higher incidence of c.2960C>T in comparison to controls (22 vs 10 %, p value 0.046) and about 2.5-folds higher risk of this anomaly.

Conclusion

Occurrence of MAMDL1 gene polymorphisms, specially of c.2960C>T in 3′ UTR of its exon 7 is associated with a higher risk of IH in Indian children, probably by lowering androgenic levels.

     

Do children and adolescents with type 1 diabetes suffer from a lack of resources in France? Results from a benchmark study in the New Aquitaine region

BackgroundA benchmark study was conducted in the southwest of France, in the New Aquitaine region, to investigate metabolic outcomes and availability of resources in pediatric diabetes units. We assessed whether the level of care was in accordance with the International Society for Pediatric and Adolescent Diabetes recommendations.MethodsDemographic and clinical data were collected, as were all HbA1c tests for the 2017 calendar year. Pediatricians specialized in diabetes care were invited to complete an online survey concerning means allocated to the management of type 1 diabetes in their centers.ResultsSixteen centers provided data for 1277 patients and 3873 clinical visits. A total of 1115 children suffering from diabetes for more than 1 year were studied. Median HbA1c was 8% (7.4–8.6) for the whole region. Only 29.2% of children had good metabolic control in accordance with the < 7.5% target. We identified slight but significant variation in glycemic control among centers (P = 0.029). The use of an insulin pump varied greatly among centers but did not explain HbA1c differences. We did not identify a correlation between medical or paramedical time dedicated to the follow-up of diabetic patients and the mean HbA1c of each center. For 100 diabetic patients, follow-up was provided by 0.42 physicians (0.23–1.50), 0.15 nurses (0–0.56), 0.12 dietitians (0–0.48), and 0.07 psychologists (0–0.30).ConclusionThis study demonstrates a lack of human resources allocated to the management of type 1 diabetes in the region that is far below international recommendations. The proportion of children achieving the international glycemic target is low. There is a clear need to improve glycemic control in children, which will only be possible with improved professional practices, encouraged by benchmark studies, and by increasing the size of our multidisciplinary teams.     

The Scylla and Charybdis of glucose control in childhood type 1 diabetes?

Glucose control in childhood type 1 diabetes is difficult and often characterized by significant glucose variability, including periods of prolonged hyperglycemia and intermittent episodes of hypoglycemia that can be severe. The brain of the developing child is thought to be more susceptible to metabolic insults because of its relatively high demand for glucose to fuel neuronal growth and differentiation. In this review we consider the impact of glucose variability, especially when associated with recurrent hypoglycemia, on long‐term cognitive function in childhood type 1 diabetes. At present, this indicates a subtle effect of type 1 diabetes per se on a number of cognitive modalities. Within the population of children with type 1 diabetes, a history of severe hypoglycemia also appears to have an additional negative effect on cognitive function. However, interpretation of the literature is difficult in that the human studies draw largely from cross‐sectional observational epidemiology while more basic work has used models that do not translate well into human disease. Moreover, it is likely to be many years before we will be able to clearly document the effects of recurrent hypoglycemia or chronic hyperglycemia on cognitive function. In the meantime, it seems appropriate to advocate that minimizing glucose variability when achieving glycemic targets should be the therapeutic goal of clinicians involved in the management of childhood type 1 diabetes.     

Pediatric patients receiving naloxone within 48 h of anesthesia: a case–control study

Purpose

Excessive narcotization in pediatric surgical patients has not been well characterized. This report describes the use of postoperative naloxone in pediatric patients.

Methods

Pediatric surgical patients from January 1, 2010, through June 30, 2016, who underwent general anesthesia and received naloxone within 48 h postoperatively were identified and matched 1:1 with controls by age, sex, and procedure. Cases and controls underwent retrospective chart review.

Results

Forty-seven patients received naloxone, with a rate of 2.0 (95% CI 1.5–2.7) per 1000 anesthetics. Indications were respiratory depression (n?=?19), facilitating extubation (n?=?15), and reversing sedation (n?=?13), and 44 cases received naloxone in a monitored environment. The median (interquartile range) naloxone dose was 4.0 (2.0–23.5) mcg/kg, and five patients (11%) later required subsequent naloxone treatments. Their characteristics were similar to controls, including opioid medications, except cases that had signs of respiratory depression before naloxone administration. The outcomes were similar, although more cases were admitted to the intensive care unit before naloxone administration. One patient died 13 days postoperatively of unrelated causes.

Conclusion

Postoperative naloxone administration in pediatric patients is rare. The observation that most administrations occurred in a monitored setting implies that at-risk patients had been appropriately identified and kept under closer surveillance.