Low bone mineral density in small for gestational age infants: correlation with cord blood zinc concentrations.

Twenty eight term small for gestational age (SGA) infants and 18 term appropriate for gestational age (AGA) infants were studied prospectively to assess bone mineral density and cord serum zinc concentrations. Growth and nutritional status were evaluated, and bone mineral density was measured by dual energy x ray densitometry of the lumbar spine. Cord serum zinc, parathyroid hormone, osteocalcin, vitamin D metabolite and mineral concentrations were measured. Growth, nutritional status, and bone mineral density (mean (SD) 0.223 (0.032) vs 0.277 (0.032) g hydroxyapatite/cm2) were significantly low in SGA infants. Bone mineral density was linearly related to growth and nutritional measures. Cord serum zinc concentrations were in the normal range and similar in both groups (mean (SD) 13.86 (3.0) vs 13.43 (2.1) mumol/l). It is suggested that SGA infants may not be zinc deficient. Low bone mineral density could be caused by growth and nutritional status deficiencies, the mechanisms for which could be those that reduce nutrient substrate supply to the fetus.     

哮喘患儿持续吸入激素治疗对骨代谢指标和骨密度影响

目的　观察持续小剂量吸入糖皮质激素对哮喘患儿骨代谢指标和骨密度的影响。方法　随机将 4 5例 5～ 8岁哮喘缓解期患儿分 3个开放治疗组 ,吸入糖皮质激素 (布地奈德 )分别为 10 0、2 0 0、30 0 μg/d ,持续 12个月。于治疗开始 ,6、12个月行临床评估和肺功能FEV1测定 ;检测血骨钙素 (OST)、胰岛素样生长因子 1(IGF 1)、骨碱性磷酸酶 (BALP)和尿脱氧吡啶 (DPD) /尿肌酐 (Cr)水平。用双能X线骨密度仪监测骨密度 (BMD)。结果　哮喘患儿治疗后临床评分和肺功能FEV1明显改善 ;血OST稍高于正常儿童对照组 ,但无显著差异 ;血BALP显著高于正常对照组 ;血IGF 1水平与同龄正常儿童比较显著增高 ;尿DPD/Cr水平显著低于正常对照组 ;治疗前后患儿股骨近端 (股骨颈 ,大转子 ,Ward′s三角 )、脊柱区域 (2～ 4 )和前臂 (前臂远端和近侧端 )的BMD无显著降低。结论　持续小剂量吸入糖皮质激素对哮喘患儿的骨代谢指标和BMD无明显抑制影响。     

Pubertal development in children born small for gestational age

Reduced fetal growth appears to be associated with precocious adrenarche, early puberty and polycystic ovary syndrome with subsequent fertility problems. We investigated pubertal development and DHEAS levels in children born small for gestational age (SGA) and children born appropriate for gestational age (AGA). Physical examination was carried out twice. Mean age (+/-SD) at the first visit: SGA group, 9.1+/-1.1 yr; AGA group, 9.0+/-1.1 yr. AT FOLLOW-UP: SGA group, 11.6+/-1.0 yr; AGA group, 11.6 +/-1.1 yr. Pubertal stages of the children were assessed. Pubic hair was recorded as a measure of androgenization. Chronological age (CA) was expressed as a percentage of the age corresponding to the pubertal stage (CA/pubertal age [PA] x 100%). Estradiol, testosterone and dehydroepiandrosterone sulfate (DHEAS) were measured in all children. FIRST VISIT: All children were prepubertal without signs of pubarche. DHEAS concentrations were higher in SGA children than in AGA children (p = 0.004). FOLLOW UP: Twenty SGA children and 15 AGA children were pubertal. CA/PA x 100% was lower in SGA girls than in AGA girls (p = 0.004). Since 2.5 years earlier all girls had been prepubertal, this means a more rapid progression in the SGA girls. CA/PA x 100% was similar in SGA and AGA boys (p = 0.1). DHEAS levels tended to be higher in SGA children than in AGA children (p = 0.06). These data support that a low birth weight may have long-lasting effects on pubertal development, as observed in a more rapid progression in SGA girls. In prepubertal SGA children, an exaggerated adrenarche is observed compared to AGA children, which tended to persist through puberty.     

小于胎龄儿血生化营养指标研究

为提高小于胎龄儿今后的生活质量,探讨其出生后即刻血生化指标的变化,以正确评价小于胎龄儿出生时营养状况,对我科2000年1月～2005年5月出生的早产小于胎龄儿、足月小于胎龄儿、足月适于胎龄儿的血生化营养指标进行比较,现将结果总结如下。1资料与方法1.1临床资料早产小于胎龄儿(A组)27例,胎龄30～36(33.04±1.51)周,体重1020～1565(1235.67±145.57)g;足月小于胎龄儿(B组)35例,胎龄37～41(38.33±1.06)周,体重1500～2000(1801.67±123.99)g;足月适于胎龄儿(C组)30例,胎龄37～41(38.87±1.31)周,体重2595～3885(3331.94±363.20)g。出生时…     

Dietary intakes in children born small for gestational age and appropriate for gestational age: A longitudinal study

Children born small for gestational age (SGA) have an increased risk of cardiovascular disease (CVD) and associated risk factors in later life; however, little is known about their dietary intakes. The objective of this study was to assess dietary intakes in SGA and appropriate for gestational age (AGA) at 3.5, 7, and 11 years. The Auckland Birthweight Collaborative Study is a longitudinal case–control study of children born at term (n = 871). Children were assessed at 3.5 (n = 550), 7 (n = 591), and 11 (n = 620) years of age. Diet was assessed using a 24‐hr record‐assisted recall. Reported dietary intakes were analyzed and compared with the Australian and New Zealand Nutrient Reference Values. Compared with AGA, median energy intakes were significantly lower in SGA at 3.5 years (4.2 MJ [IQR, 3.0 to 5.8] vs. 5.4 MJ [IQR, 3.9 to 6.5]; p < .0001) but not at 7 and 11 years. Inadequate dietary intakes of micronutrients were more prevalent among SGA at 3.5 years and 11 years of age. A large proportion of SGA and AGA children consumed more than the recommended amounts of saturated fats, sugars, and sodium. There was no association of dietary intake and socio‐demographic factors. This study reveals that dietary intake in 3.5‐year‐old children born SGA is lower in energy and a variety of micronutrients compared with dietary intake in AGA. These intakes may however be appropriate given their BMI z‐scores. High intakes of sodium, saturated fat, and sugars are a concern for all children in this cohort.     

Growth and growth hormone in children born small for gestational age

Although most children born small for gestational age catch up in growth by age 2 y, up to 14% remain more than 2 standard deviations below the mean for height. Recombinant growth hormone is approved by the US Food and Drug Administration and by the European Agency for Evaluation of Medicinal Products for the treatment of children born small for gestational age who fail to manifest catch-up growth by 2 y or 4 y, respectively.

Conclusion: We conclude from clinical studies that growth hormone therapy can induce catch-up growth in these children.     

Bone mineral density and bone metabolism in children treated for bone sarcomas

In adolescent bone sarcoma patients, bone mass acquisition is potentially compromised at a time in which it should be at a maximum. To evaluate the problem we measured bone mineral density (BMD) and serum markers of bone formation and resorption in a series of pediatric patients with bone tumors. BMD was measured by dual-energy x-ray absorptiometry, at clinical remission, for lumbar spine and the neck of the femur in 38 osteosarcoma and 25 Ewing's sarcoma patients. Mean age was 20.65 and 19.13 y respectively. Serum markers of bone metabolism were: OC, PICP, ICTP, 25-OH vit D and 1,25-(OH)(2) vit D, IGF-I, IGFBP-3 and intact PTH. Serum was sampled throughout anti-tumoral treatments and follow-up. We analyzed 85 samples from 59 osteosarcoma patients and 54 samples from 36 Ewing's sarcoma patients. Patients had decreased lumbar and femoral BMD. The decrease was more pronounced in pubertal patients compared with those who had completed pubertal development at the time of disease diagnosis. Multivariate analysis indicated that sex, age, weight and BMI were significant in lumbar BMD depletion. Weight and BMI were significant in femoral BMD depletion. Serum markers of bone formation (PICP and OC) and resorption (ICTP) were, throughout, lower than reference values. Significant alterations in other markers were also observed. Up to a third of osteosarcoma and Ewing's sarcoma patients in clinical remission had some degree of BMD deficit. The corresponding increased risk of pathologic bone fractures constitutes a reduction in future quality of life.     

Evaluation of bone mineral density in children with diabetes mellitus

Multiple studies have documented reduction in peripheral bone mass in children with insulin dependent diabetes mellitus (IDDM). In this study, the bone mineral density (BMD) of the lumbar vertebrae (L₂–L₄) was measured by dual photon absorptiometry in 14 female and 16 male diabetic patients of age 11 to 16 years with varying clinical duration. Twenty three children between 11 to 16 years with normal anthropometric measurements between 10th and 97th percentile and no known history of metabolic bone disease served as a control group. BMD values, weight, height, body mass index, metabolic, biochemical and growth parameters of the study group were compared with those of the control group. BMD (L₂ AP 0.732±0.15 gm/cm², L₂ lateral 0.534 ±0.09 gm/cm²in the study group and 0.812±0.63 gm/cm² and 0.619±0.20 gm/cm² in the control group) and osteoccalcin (10.10±3.40 ng/ml and 23.12±2.74 ng/ml in diabetes and control respectively) levels were significantly lower in diabetic patients (p<0.05, p<0.01 respectively). Within the study group BMD correlated positively with age but not with the duration of the disease nor with the level of metabolic control.     

Determinants of low bone mineral density in children with epilepsy

Introduction

Children with epilepsy on long-term antiepileptic drugs (AEDs) are at risk of low bone mineral density (BMD). The aims of our study were to evaluate the prevalence and determinants of low BMD among Malaysian children with epilepsy.

Evaluation of bone mineral density in children with cerebral palsy

In the present study, bone mineral density of 40 children with cerebral palsy (study group) and the effects of various risk factors on bone mineralization in these children were investigated by comparing with 40 age-matched healthy children (control group). Weight, height, skinfold thickness, body-mass index measurements, and serum levels of calcium, phosphorus, alkaline phosphatase and 25 OH vitamin D were not significantly different between the study and control groups (p>0.05). The mean bone mineral density value of the study group measured by dual-energy X-ray absorptiometry method at L2-L4 levels of lumbar vertebrae was significantly lower than that of the control group (p<0.05). When the patients in the study group were assessed with respect to ambulation status, pattern of involvement, calcium and energy intakes, and whether or not they had taken and/or were taking a regular physical therapy program, there was a significant difference only between the hemiplegic and tetraplegic patients (p<0.05), while there were no significant differences among the patients who were ambulant versus non-ambulant, who had sufficient versus insufficient calcium and energy intakes, and who did and did not take a regular physical therapy (p>0.05). Although the ambulatory status, quantity of calcium and energy intakes, and the presence or absence of a physical therapy program had no effects on bone mineral density values of the children with cerebral palsy in this study, the exact factors and mechanisms responsible for the reduced bone mineral density in children with cerebral palsy should be investigated in further large-scale studies considering the increased risk of pathological fractures in these patients.     

Longitudinal follow-up of growth in children born small for gestational age

Postnatal growth was followed in a population-based group of 123 small-for-gestational-age (SGA, birth weight < -2 SD) children (66 boys and 57 girls) to four years of age in order to determine the incidence and time of catch-up growth. Gestational age was determined by ultrasound in gestational weeks 16–17 in all pregnancies, thus eliminating the problem of distinguishing between SGA and preterm infants. Infants with well-defined causes for slow growth rate, i.e. those infants with chromosomal disorders, severe malformations, intrauterine viral infections or cerebral palsy, were excluded. The boys showed an extremely fast weight catch-up, 85% of them reaching weights greater than -2 SD at the age of three months and remaining above this level to the end of the study period. Such a fast catch-up growth was observed in only two-thirds of the girls, but at four years of age 85?4 of the girls were also above -2SD. Length catch-up was more gradual than weight catch-up. Of the boys, 54% had lengths below -2 SD at birth, 26% at 1 year of age, 22% at 2 years of age, 17% at 2.5 years of age and 11% (n= 8) at 4 years of age. Corresponding figures for girls were: 69% at birth, 28%) at 1 year, 15% at 2 years, 12% at 2.5 years and 5%) (n = 3) at 4 years. At 4 years of age, only six boys and three girls remained below -2 SD for both weight and height. We conclude that in Sweden the prognosis for catch-up growth for an SGA child, when children with well-defined causes of growth disturbances are excluded, is very good and it is extremely rare for the child still to have a height below -2 SD by the age of 4 years.     

Assessment of bone density in children with cerebral palsy by areal bone mineral density measurement

The aim of this cross-sectional study was to investigate the frequency of decreased areal bone mineral density (aBMD) among patients with cerebral palsy (CP), as estimated by using various aBMD Z-score adjustment methods. In addition, this study examined factors related to decreased aBMD scores. One hundred and two children between the ages of 3.2 and 17.8 years were examined. In patients with severe CP, the incidences of decreased aBMD according to various adjusting methods based on decimal age, bone age, height age, and height-for-age Z-score (HAZ) were 79.5%, 69.5%, 51.9%, and 38.3%, respectively. Abnormal levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, or anticonvulsant were not predictive for a decreased aBMD. Mean aBMD Z-scores were significantly lower in all aBMD Z-score adjustment methods in patients with severe CP compared to patients with mild-to-moderate CP, except for the adjustment method based on HAZ.     

Natural growth in children born small for gestational age with and without catch-up growth

This first report from a population-based postnatal growth study of 3650 healthy Swedish subjects born at full term provides new reference values for height and weight and shows that over the last 20 years there has been a small secular trend in height (0.2–0.4 SDS over the whole age range) in Sweden in both boys and girls. Within this cohort, 111 (3.1%) were of low birth weight (below –2 SDS) and 141 (3.5%) were of low birth length (below –2 SDS); 54 (1.5%) were both light and short at birth. Of the children born small for gestational age, 87% showed full catch-up growth within 2 years of life. They attained puberty at a normal or early age and reached a mean final height of –0.7 SDS. The remaining subgroup of 13% born small for gestational age remained below –2 SDS throughout childhood and reached puberty somewhat early. Their mean final height was –1.7 SDS. The current data set is too small to identify possible background factors, but it is being expanded with this objective in mind.     

218例无追赶生长的小于胎龄儿儿童期糖代谢分析

目的 探索无追赶生长的小于胎龄儿在儿童期的胰岛素敏感性.方法 收集2008年8月至2016年8月于北京大学第三医院儿科门诊就诊的身材矮小患儿439例,分为小于胎龄儿组(small for gestational age,SGA)218例和特发性矮小组(idiopathic short stature,ISS)221例.比较两组之间的空腹胰岛素、空腹血糖、空腹血糖与胰岛素比值、胰岛β细胞功能(HOMA%)和胰岛素抵抗指数(HOMA-IR)特点.结果 两组患儿均根据青春期分期及性别分组,SGA组与ISS组,青春期前男性患儿的空腹血糖分别为(4.7±0.6)mmol/L和(4.8±0.6)mmol/L,P=0.678,空腹胰岛素(5.1±4.0)mU/L和(4.3±4.7)mU/L,P=0.345,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期前女性患儿的空腹血糖分别为(4.5±0.5)mmol/L和(4.6±0.5)mmol/L,P=0.828,空腹胰岛素分别为(4.7±3.5)mU/L和(4.5±3.3)mU/L,P=0.603,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期男性患儿的空腹血糖分别为(5.0±0.8)mmol/L和(4.9±0.5)mmol/L,P=0.176,空腹胰岛素分别为(5.9±4.3)mU/L和(6.0±4.5)mU/L,P=0.958,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期女性患儿的空腹血糖分别为(4.9±0.6)mmol/L和(4.8±0.4)mmol/L,P=0.141,空腹胰岛素分别为(7.5±6.4)mU/L和(7.4±8.6)mU/L,P=0.448,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义.     

Low bone mineral density in children with Crohn's disease]

Recent studies have reported low bone mineral density in children with Crohn's disease. The aims of this retrospective study were to quantify its frequency and to search for risk factors. POPULATION AND METHODS: Bone mineral density of 29 children with Crohn's disease was measured by dual-energy X-ray absorptiometry. All the children were taking calcium and vitamin D, during all the follow-up. RESULTS: Osteoporosis (Z-score < or = -2.5 S.D.) was found in 38% of the children, and osteopenia in 38% (Z-score between -1 and -2.5 S.D.). Low bone mineral density was correlated with age, suggesting it begins with puberty. Daily corticosteroid exposure was significantly higher for patients with osteoporosis. Disease severity measured with Harvey-Bradshaw index and exposure to immunosuppressive drugs were almost statistically significant. Sex, height, duration and site of disease, nutritional assistance exposure were not associated with low bone mineral density. CONCLUSION: This study confirms the high frequency of low bone mineral density in children with Crohn's disease, mainly during puberty. Corticosteroid exposure is a risk factor, and the disease severity, a probable one (non significant). New treatment strategy has to be defined to prevent and to treat this complication.     

Growth hormone therapy in short children born small for gestational age

Being born small for gestational age (SGA) is one of the most common causes of childhood short stature, and recombinant GH therapy has been recently licensed to promote growth in short SGA children from the age of 4 years old. Studies are now reporting very encouraging effects on adult height gains, especially in those children who started GH therapy early, at least 2 years prior to the onset of puberty. Compared to the age at starting treatment, the GH dose has a less significant impact on final height, and more attention needs to be paid now to identify earlier those SGA children who fail to catch-up spontaneously. The benefits are not just in terms of height, but also in body composition and possibly blood pressure and lipid levels. However the risk of side effects and long-term complications, particularly related to the expected metabolic effects of GH in inducing insulin resistance and hyperinsulinaemia, need to be carefully monitored especially in SGA children with a family history of type 2 diabetes. Recently, GH therapy was found to amplify the adrenarche of short SGA children and to induce a pro-inflammatory shift, as judged by a rise of neutrophil count and circulating interleukin-6 (IL-6), and a fall in adiponectin levels. Further progress is anticipated to assess the addition of insulin-sensitizing therapy to attenuate the GH-induced hyperinsulinemia, in order to alter the pro-inflammatory course, to avoid excessive release of adrenal androgens, and to slow down the potential rapid tempo of pubertal progression in SGA children. In the meantime, post-SGA short stature is rapidly becoming one of the prime indications for GH therapy in childhood.     

Growth hormone secretion and sensitivity in children born small for gestational age

This short communication discusses aspects of growth hormone (GH) secretion and GH insensitivity in short children born short for gestational age (SGA).