儿童期开始年龄及其对儿童时期生长影响的纵向研究

目的　应用婴儿 儿童 青春期 (ICP)生长模型研究儿童期开始年龄 (ACO)并探讨其对儿童时期生长的影响。方法　选择自出生纵向随访至 6岁的小儿共 16 2 3名。根据计算机绘制的每个小儿身长及其身长速率曲线对应ICP生长曲线图来判断ACO值。结果　男、女孩的平均ACO值分别为 11 2个月和 10 7个月。女孩显著早于男孩 (P <0 0 5 )。ACO值对儿童后期的生长有显著的作用 ,儿童期开始年龄延迟 1个月 ,到 5岁时其身高男孩降低 0 4cm、女孩降低 0 5 6cm。对ACO值的影响因素进行多元回归分析发现 ,性别、6月龄时身长和父母亲平均身高与ACO值均有显著关系 (P <0 0 5 )。对儿童期开始年龄和父母亲平均身高作线性相关分析发现 ,父母亲平均身高低于均数 2个标准差的男、女孩其儿童期开始年龄要比父母亲平均身高高于均数 2个标准差的男、女孩分别晚 1 5个月和 1 3个月。结论　应用ICP生长模型同样适合我国儿童体格生长的研究 ,儿童期开始年龄对儿童时期的生长起着重要作用     

New reference for the age at childhood onset of growth and secular trend in the timing of puberty in Swedish

The objectives of the present work were to present a new reference for the age at childhood onset of growth and to investigate the secular trend in the timing of puberty in a community‐based normal population in Sweden. A total of 2432 children with longitudinal length/height data from birth to adulthood were used to determine the two measures by visual inspection of the measured attained length/height and the change in growth velocity displayed on a computer‐generated infancy‐childhood‐puberty (ICP) based growth chart. The series represents a sample of normal full‐term children born around 1974 in Göteborg, Sweden. We found about 10% of children were delayed (>12 mo of age) in the childhood onset of growth based on the previous reported normal range, i.e. 14% in boys and 8% in girls. Distribution of the age at childhood onset of growth was skewed. The medians were 10 and 9 mo for boys and girls, respectively. After natural logarithmic transformation, the mean and standard deviation (SD) were 2.29 (anti‐log 9.9 mo) and 0.226 for boys, 2.23 (anti‐log 9.3 mo) and 0.220 for girls, respectively. The 95% normal ranges were 6.3‐15.4 and 6.0‐14.3 for boys and girls, respectively. The distribution of the timing of PHV was close to the normal distribution. The mean values were 13.5 y for boys and 11.6 y for girls with 1 y SD for both sexes. Conclusion: A downward secular trend in the onset of puberty was clearly shown in the population. The age at childhood onset of growth did not correlate with the timing of puberty (r=?0.01 and 0.05, p > 0.7 and 0.1 in boys and girls, respectively). Normal ranges of the age at childhood onset of growth are in need of revise, as this study indicates. The new reference presented here could be a reliable indicator in further studies.     

Longitudinal growth pattern of children during pre-school age and its relationship with different socio-economic classes

Summary This report deals with the study of longitudinal growth of pre-school children from different socio-economic classes in the urban community of Delhi. The role of socio-economic factors which affect the growth standards of weight, height, circumference of head, chest, arm, calf and pelvic width of these children at different ages from birth up to 5 years is discussed. It is observed that in malnutrition resulting from an adverse effect of poor socio-economic status, all measurements of the body are affected, the height and the head being the least and the weight, the circumferences of the chest, arm and calf the most. From the Longitudinal Morbidity and Mortality Survey of Children’s Unit, Indian Council of Medical Research, New Delhi.     

Determinants of linear growth and predictors of severe stunting during infancy in rural Malawi

Stunting is common among children under 5 y of age in sub-Saharan Africa. Several risk factors have been associated with poor growth but few studies have prospectively addressed the development of linear growth faltering and stunting during the first year of life. The present study was designed to analyse typical growth among rural Malawian infants, focusing particularly on the impact of birth size, adherence to feeding guidelines and morbidity in the development of severe stunting during infancy. A community-based cohort of 613 singleton newborns was prospectively followed by monthly home visits. Data were collected on the children's socioeconomic background, maternal size and weight gain during pregnancy, birth events, morbidity, breastfeeding and complementary feeding, growth and mortality. Univariate and multivariate analyses were used to determine associations between predictor variables and poor linear growth. The proportions of stunted infants (Height-for-age Z-score 3 32) at 3, 6 and 9 mo of age were 27%, 51%, and 63%, respectively. At 1 y of age, over two-thirds (71%) of the infants were at least moderately (HAZ 3 32) and 31% severely stunted (HAZ 3 33). Conclusion: The strongest predictor of severe stunting at 12 mo of age was small birth size. Other variables independently associated with this outcome included inappropriate complementary feeding, high morbidity, maternal short stature, male gender, and home delivery. Faltering of linear growth started soon after birth and continued throughout infancy. Interventions increasing birth size could have a significant role in the prevention of early childhood stunting. The ideal strategy should also emphasize the importance of appropriate infant feeding and decreasing the number of illness episodes amongst the infants.     

Hospitalization for vascular complications in childhood onset type 1 diabetes--effects of gender and age at onset.

AIMS: To study the cumulative incidence of hospitalization for severe diabetic vascular complications in childhood onset type 1 diabetes patients with special regards to age at onset and gender. METHODS: The Swedish Childhood Diabetes Register (SCDR) was linked to the Swedish Hospital Discharge Register up to 31 December 2004. The following diagnoses were traced: diabetic kidney disease, myocardial infarction, stroke, lower limb arterial disease and diabetes with multiple complications. Cox proportional hazards survival method was applied with the following covariates: maternal age, birthweight deviation from gestational week standard, age at onset and gender. RESULTS: Until 31 December 9974 children had been followed for at least 10 years corresponding to 141 839 person years at risk and 103 (7.3 per 1000 person years) had been hospitalized at least once at the maximum duration of follow-up of 26 years. Diabetic kidney disease was the most common cause of hospitalization and 63 patients had more than one diabetic complication. Female gender (RR=2.02, 95% CI=1.05-3.89) and age at onset of diabetes (RR=1.37, 95% CI=1.20-1.56) were significant risk factors for severe complication. CONCLUSIONS: Hospitalization for severe diabetic complications at a maximum follow-up of 26 years is rather low in Sweden. There is a higher hospitalization rate among females than among males, and also among patients diagnosed with diabetes after 10 years of age than among patients diagnosed before the age of 10 years.     

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.     

Longitudinal follow-up of children born preterm: cognitive development at age 19

In a long-term prospective study, 39 preterm children born before 35 completed weeks of gestation and 23 full-term children were followed up at 4, 9 and 19 years of age. Psychometric evaluation of the cognitive development at 4 years of age showed that the preterms fell within the normal range, although their performance was inferior to that of the full-terms. This difference between the groups was not found at 9 and 19 years of age. Within the preterm group there was no correlation between the test results and birthweight, gestational age, prenatal or perinatal optimality scores. Full-terms had better scholastic performance at the end of compulsory schooling, while there was no difference at 19 years of age. At 19 years of age, about 1/3 of the children in both groups rated themselves as having had attention deficits during their childhood and adolescence. In this group of moderately immature, low-risk children, preterm birth without major physical or mental disabilities poses a developmental risk that seems to have the greatest impact during the preschool years and then gradually attenuates.     

Psychiatric outcomes at age seven for very preterm children: rates and predictors

Background: Uncertainty remains about the rate of specific psychiatric disorders and associated predictive factors for very preterm (VPT) children. The aims of this study were to document rates of psychiatric disorders in VPT children aged 7 years compared with term born children, and to examine potential predictive factors for psychiatric diagnoses in VPT children. Methods: Participants were 177 VPT and 65 term born children. Perinatal medical data were collected, which included brain abnormalities detected using magnetic resonance imaging. The Infant‐Toddler Social‐Emotional Assessment (ITSEA) and Strengths and Difficulties Questionnaire (SDQ) were administered at 2 and 5 years respectively. At 7 years of age, the Developmental and Well‐being Assessment (DAWBA) was used to indicate psychiatric diagnoses. Results: Compared with term born children, VPT children had three times the odds of meeting criteria for any psychiatric diagnosis at age 7 years (odds ratio 3.03; 95% confidence interval 1.23, 7.47, p = .02). The most common diagnoses were anxiety disorders (11% VPT, 8% term), attention‐deficit/hyperactivity disorder (10% VPT, 3% term) and autism spectrum disorder (4.5% VPT, 0% term). For VPT children, those with severe global brain abnormalities (p = .02), those who displayed social‐emotional problems at age 5 (p = .000) and those with higher social risk at age 7 (p = .001) were more likely to meet criteria for a psychiatric illness at age 7. Conclusions:  Compared with term born children, VPT children have higher rates of psychiatric diagnoses at early school age, predicted by neonatal brain abnormalities, prior social‐emotional problems and social factors.     

Effects of growth during infancy and childhood on bone mineralization and turnover in preterm children aged 8-12 years

To investigate the effect of growth on later bone mass and turnover, bone mineral content (BMC) and density (BMD: dual X-ray absorptiometry (QDR 1000W) and single photon absorptiometry (Lunar SP2)) and bone turnover (plasma osteocalcin, urine deoxypyridinoline) were measured at 8-12 y in 244 preterm children who had weight and height measured at 18 mo and 7.5-8 y corrected age. Weight and length at birth, 18 mo, 7.5-8 y and current follow-up showed increasingly strong, positive correlations with bone area, BMC and BMD. After adjusting for current size, there were significant negative associations between earlier size measurements and later whole body and lumbar spine bone mass which were stronger for length than for weight, and a negative relationship between birthweight for gestation and later radial bone mass; but no relationship with bone turnover. Current calcium intake and activity level had no independent effect on bone mass. Bone mass at 8-12 y is related to current bone and body size, which tracks throughout childhood. However, amongst children of the same current size, those who have shown the greatest increase in size, particularly in height, have the highest bone mass. These findings raise the hypothesis that improving linear growth in vulnerable children may be important in maximizing bone mass.     

Indices of fatness and serum cholesterol at age eight years in relation to feeding and growth during early infancy

During the early months of life, gains in length and weight are more rapid by formula-fed than by breast-fed infants and we and others have speculated that the greater gains of the formula-fed infants are the result of greater food intake. If overfeeding during early infancy resulted in establishment of habits of overeating, or if, for any other reason, diet-induced fatness in infancy persisted into childhood, we might be able to demonstrate differences in fatness in childhood related to mode of feeding (breast or bottle) during infancy. We therefore examined at age 8 years 469 children born in 1966-1971 who had been studied intensely in our unit from 8 to 112 days of age. At age 8 years there were no differences in indices of fatness related to mode of feeding during infancy. Serum concentrations of cholesterol at age 8 years were also of interest because of reports from animal studies that differences in feeding during early life may be responsible for subsequent differences in cholesterol homeostasis. Cholesterol concentrations at age 8 years did not demonstrate significant differences related to mode of feeding during infancy. It is possible, however, that age 8 years is too early for an effect to be demonstrated.     

Hospitalization for vascular complications in childhood onset type 1 diabetes – effects of gender and age at onset

Aims: To study the cumulative incidence of hospitalization for severe diabetic vascular complications in childhood onset type 1 diabetes patients with special regards to age at onset and gender.
Methods: The Swedish Childhood Diabetes Register (SCDR) was linked to the Swedish Hospital Discharge Register up to 31 December 2004. The following diagnoses were traced: diabetic kidney disease, myocardial infarction, stroke, lower limb arterial disease and diabetes with multiple complications. Cox proportional hazards survival method was applied with the following covariates: maternal age, birthweight deviation from gestational week standard, age at onset and gender.
Results: Until 31 December 9974 children had been followed for at least 10 years corresponding to 141 839 person years at risk and 103 (7.3 per 1000 person years) had been hospitalized at least once at the maximum duration of follow-up of 26 years. Diabetic kidney disease was the most common cause of hospitalization and 63 patients had more than one diabetic complication. Female gender (RR = 2.02, 95% CI = 1.05–3.89) and age at onset of diabetes (RR = 1.37, 95% CI = 1.20–1.56) were significant risk factors for severe complication.
Conclusions: Hospitalization for severe diabetic complications at a maximum follow-up of 26 years is rather low in Sweden. There is a higher hospitalization rate among females than among males, and also among patients diagnosed with diabetes after 10 years of age than among patients diagnosed before the age of 10 years.