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1.
Objectives
To measure the Peak expiratory flow rate (PEFR) of healthy school children and to find out the correlation between PEFR values and anthropometric parameters, to create a nomogram of PEFR for children and formulate a regression formula for PEFR.Methods
A cross-sectional study was conducted on healthy school children between the age group of 10 and 16 y, at three higher secondary schools selected in urban area of Jabalpur, Madhya Pradesh. After collecting baseline data, PEFR was measured using mini Wright peak flow meter. The highest of three measurements were recorded for analysis.Results
Of the 2607 students screened, 2156 were included in the study. Out of which 757 were boys and 1399 were girls. Significant linear correlation was seen in PEFR with height, weight and BMI (r = 0.847, r = 0.750 & r = 0.466 respectively, p < 0.001). Nomograms were plotted based on the observed values of PEFR in the study population. Prediction equations were derived for PEFR with height and weight in boys and girls. Prediction equations for PEFR are -464 + 1.408 × Weight (kg) + 439.192 × Height (m) in boys and ?486.544 + 1.064 × Weight (kg) + 462.282 × Height (m) in girls.Conclusions
Significant correlation was noted between PEFR and anthropometric parameters like height, weight and BMI. Hence, nomogram and formula created can be used in the study area.2.
Kushagra Taneja Virendra Kumar Rama Anand Harish K Pemde 《Indian journal of pediatrics》2018,85(2):108-112
Objective
To determine the normative data for inferior vena cava (IVC) diameter in children and its correlation with various somatic parameters like height, weight and body surface area in Indian children. Readily available baseline data of IVC diameter in normal children shall be of great help in rapid assessment of variations in sick children.Methods
Total 475 healthy children aged one month to 12 y visiting out patient clinics (OPD’s) were enrolled in this study. Weight, height and body surface area were calculated at the time of examination. The maximum and minimum diameters of IVC were measured during the expiratory and inspiratory phase of the respiratory cycle respectively using M mode ultrasonography. Collapsibility Index was also calculated for each subject by measuring difference between the maximum (expiratory) and minimum (inspiratory) IVC diameters divided by the maximum diameter.Results
The mean age of study subjects was 4.72 ± 3.72 y. Out of 475 subjects, 285 (60%) were boys and 190 (40%) were girls. Mean weight for age (%) of subjects was 89.18 ± 13.26%. Correlation was studied between physical parameters and IVC diameter which revealed a positive correlation of age, height and weight with both maximum and minimum IVC diameter. Regression analysis was also performed to derive the equations for maximum and minimum diameters of children from 1 y to 12 y.Conclusions
This study provides reference values of IVC diameters for Indian children of different age groups.3.
Lavanya Parthasarathy Vaman Khadilkar Shashi Chiplonkar Anuradha Khadilkar 《Indian pediatrics》2016,53(11):990-992
Objective
To study longitudinal growth in children with type 1 diabetes mellitus.Methods
Anthropometry, disease duration, insulin regimens and HbA1C recorded from patients with diabetes enrolled in a specialty clinic.Results
160 children (75 boys; mean (SD) age 9.4 (3.3) y) were enrolled. 35% children had low (<25th centile) height velocity. Disease duration and HbA1C affected height velocity (adjusted for puberty). Children on basal-bolus had higher height velocity Z scores than those on a split mix regimen [(0.5(1.6) vs. -0.3(1.4), P<0.05)]. Children diagnosed before 5 years of age had lowest height velocity. Of the children who reached final height, 53% remained below target height.Conclusion
Children with type 1 diabetes mellitus have lower height velocity compared to healthy children; those diagnosed at younger age were at higher risk for growth failure.4.
V. Hesse O. Schnabel E. Judis H. Cammann J. Hinkel J. Weissenborn 《Monatsschrift für Kinderheilkunde》2016,164(6):478-496
Background
In Germany, the longitudinal growth data of children aged 0 to 6 years, which are currently still in use, are 35–50 years old.Objectives
What are the current age-dependent values for the length/height, weight, body mass index (BMI; kg/m2), ponderal index (kg/m3), and growth rates in German children aged 0 to 6 years? Have there been changes in the secular trend?Methods
A longitudinal clinical trial with 212 children (112 boys, 100 girls, living in Berlin), within the framework of the German Language Development Study, determining 13 different body measurements, calculating four indices and five secondary ratios.Results
Body height did not change considerably within the first year of life, but increased during the period 2 to 6 years of age compared with previous studies. Also, body weight increased in relation to current values from age 2 to 6. BMI values indicate no further upward trend. It appears that the 97th percentiles of BMI values are lower than the currently used “standard values” from cross-sectional studies and only slightly higher than those from longitudinal studies conducted before the “obesity epidemic”.Conclusions
There is still a slight toward the secular acceleration of growth in preschool children. BMI values show no further increase. Newly obtained age-related growth data and the growth rate values for height, weight, BMI, the ponderal index and the new somatogram can be used as the current relevant growth standards in children aged 0 to 6?years for clinical practice and for screening purposes.5.
Sikha Sinha Abha Rani Aggarwal Clive Osmond Caroline H. D. Fall Santosh K. Bhargava Harshpal Singh Sachdev 《Indian pediatrics》2017,54(3):185-192
Objective
To evaluate intergenerational change in anthropometric indices of children and their predictors.Design
Prospective cohort.Participants
New Delhi Birth Cohort participants (F1), born between 1969 and 1972, were followed-up for anthropometry at birth and 6-monthly intervals until 21 years. Their children (F2) below 10 years were evaluated anthropometrically.Outcome measure
Intergenerational change (F2-F1) in height, weight and body mass index (BMI) of children in comparison to their parents at corresponding ages.Results
432 F2-F1 pairs were analyzed in age-groups of 0-5 (26.9%) and 5-10 (73.1%) years. Children were considerably taller (0-5 years 0.99 SD; 5-10 years 1.17 SD) and heavier (0-5 years 0.77 SD; 5-10 years 1.52 SD) while only those aged 5-10 years were broader (had a higher BMI; 1.03 SD), than their parents. These increases for 0-5 and 5-10 years, respectively corresponded to 3.9 and 6.4 cm for height, 1.3 and 5.4 kg for weight and 0.2 and 1.9 kg/m2 for BMI. Lower parents’ anthropometric indices and poor water supply and sanitation facilities; higher age of parents at child birth and of children when measured (for height and weight); and more parental education (for weight and BMI), were associated with greater intergenerational gains in children.Conclusion
Over one generation in an urban middle-class population, whose general living conditions had improved, underfive children have become considerably taller and heavier, and 5- 10 year old children have additionally become broader, than their parents at corresponding ages. Child populations probably ‘grow up’ before ‘growing out’.6.
Sudha Chaudhari Madhumati Otiv Bharati Khairnar Anand Pandit Mahendra Hoge Mehmood Sayyad 《Indian pediatrics》2012,49(9):727-732
Objective
To assess the growth, adiposity and blood pressure of non-handicapped low birthweight children at 18 years.Design
Prospective cohort study.Setting
Infants born between 1987-1989 with birthweight less than 2000g, discharged from a neonatal special care unit of a referral hospital and followed up till the age of 18 years.Methods
The height, weight, and head circumference were measured. Measurements for adiposity, blood pressure, parental height and weight were recorded.Results
The cohort of 161 low birth weight (LBW) infants was divided into three groups according to their gestation — preterm SGA (n=61), full term SGA (n=30) and preterm AGA (n=70). 71 full term AGA infants served as controls. Preterm SGA males had height of 164.5 cms (162–166.9, 95% CI) which was significantly less (mean deficit = 5.7 cms) than that of controls (P=0.02). However, PTSGA children were short inspite of normal midparental height. Preterm SGA and AGA children had smaller head circumference. There was no evidence of adiposity and no child had hypertension. Mid-parental height was an important determinant of height in LBW children. Both parentss’ weight and BMI were important determinants of weight and BMI, respectively in all LBW children.Conclusion
Preterm SGA males were short, but there was no difference in the weight of the LBW group and controls. Preterms had smaller head circumference. There was no evidence of adiposity or hypertension.7.
Objective
Correlation of catch-up growth and Insulin-like Growth Factor -1 levels (IGF-I) in SGA babies.Methods
50 Full-term Small for Gestational Age children aged 12–18 months were analyzed for Catch-up growth (gain in weight and/or length, Standard Deviation Score/SDS >0.67). IGF-1 was measured after post-glucose load using ELISA method and correlated with catch-up growth.Results
Mean (SD) birthweight and length were 2.1 (0.3) Kg and 44.4 (3.1) cm, respectively. At enrollment, mean (SD) age, weight and length were 15.0 (2.1) months, 7.7 (1.3) Kg, and 72.9 (5.6) cm, respectively. Catch-up growth was noted in 60% children. IGF-1 levels were significantly higher in children showing catch-up growth (56.6 (63.2) ng/mL) compared to those not having catch up growth (8.7 (8.3) ng/mL). IGF-1 was positively correlated with both weight and length catch-up.Conclusion
Majority of Small for Gestational Age showed catch-up growth by 18 months, which had good correlation with IGF-1 levels.8.
Background
Acute hemorrhages in neonates and young children can be compensated for a long period of time until a decrease in blood pressure and manifest shock occur.Objective
To determine the characteristics of the pathophysiology of the circulation in children and to recognize critical signs and symptoms of hemorrhage.Material and methods
Pathophysiology and discussion of the literatureResults
Shock in neonates and children can be present long before a decrease in blood pressure occurs. It is characterized by tachycardia, tachy(dys)pnea, prolonged capillary refilling time, disorders of consciousness (apathy), disturbance of temperature regulation and reduced urine output. Laboratory markers are metabolic acidosis and elevated lactate and a normocytic anemia earlier than in adults.Conclusion
In contrast to adults a decrease in blood pressure in neonates and young children is a late sign of shock, whereas normocytic anemia occurs earlier than in adults.9.
Background
Association of distal renal tubular acidosis (RTA) with autoimmune diseases is extremely rare in children.Case Characteristics
12-year-old girl with distal RTA. Despite resolution of acidosis on bicarbonate, she continued to have poor growth and delayed puberty. Investigations revealed autoimmune thyroiditis and celiac disease.Outcome
Levothyroxine and gluten-free diet were initiated. Child gained height and weight and had onset of puberty after gluten withdrawal.Messages
Distal RTA in children may rarely be of autoimmune etiology.10.
Background
An increased but unpredictable risk of malnutrition is associated with hospitalization, especially in children with chronic diseases. We investigated the applicability of Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), an instrument proposed to estimate the risk of malnutrition in hospitalized children. We also evaluated the role of age and co-morbidities as risk for malnutrition.Methods
The STRONGkids consists of 4 items providing a score that classifies a patient in low, moderate, high risk for malnutrition. A prospective observational multi-centre study was performed in 12 Italian hospitals. Children 1–18 years consecutively admitted and otherwise unselected were enrolled. Their STRONGkids score was obtained and compared with the actual nutritional status expressed as BMI and Height for Age SD-score.Results
Of 144 children (75 males, mean age 6.5?±?4.5 years), 52 (36%) had an underlying chronic disease. According to STRONGkids, 46 (32%) children were at low risk, 76 (53%) at moderate risk and 22 (15%) at high risk for malnutrition. The latter had significantly lower Height for Age values (mean SD value -1.07?±?2.08; p?=?0.008) and BMI values (mean SD-values -0.79?±?2.09; p?=?0.0021) in comparison to other groups. However, only 29 children were actually malnourished.Conclusions
The STRONGkids is easy to administer. It is highly sensitive but not specific. It may be used as a very preliminary screening tool to be integrated with other clinical data in order to reliably predict the risk of malnutrition.11.
Background
Erythropoiesis stimulating agents (ESAs) are neuroprotective in cell and animal models of preterm birth. Prematurity has been shown to alter neurometabolite levels in children in studies using proton magnetic resonance spectroscopy (1H-MRS).Objective
We hypothesized that ESA treatment in premature infants would tend to normalize neurometabolites by 4–6 years of age.Materials and methods
Children in a longitudinal study of neurodevelopment underwent MRI and 1H-MRS at approximately 4 years and 6 years of age. Prematurely born children (500–1,250 g birth weight) received ESAs (erythropoietin or darbepoetin) or placebo during their neonatal hospitalization, and these groups were compared to healthy term controls. 1H-MRS spectra were obtained from the anterior cingulate (gray matter) and frontal lobe white matter, assessing combined N-acetylaspartate and N-acetylaspartylglutamate (tNAA), myo-inositol, choline compounds (Cho), combined creatine and phosphocreatine, and combined glutamate and glutamine.Results
No significant (P≤0.5) group differences were observed for any metabolite level. Significant age-related increases in white-matter tNAA and Cho were observed, as well as a trend for increased gray-matter tNAA.Conclusion
Neither prematurity nor neonatal ESA treatment was associated with differences in brain metabolite levels in the children of this study at a significance level of 0.05. These findings suggest that earlier differences that might have existed had normalized by 4–6 years of age or were too small to be statistically significant in the current sample.12.
13.
Background
Childhood overweight is a growing problem in industrialized countries. Parents play a major role in the development and the treatment of overweight in their children. A key factor here is the perception of their child’s weight status. As we know of other studies, parental perception of children’s weight status is very poor. This study aimed to determine factors associated with childhood overweight and parental misperception of weight status. The height and weight of children, as reported by parents were compared with measured data.Methods
The study was conducted at a general pediatric outpatient clinic in Vienna, Austria. A total of 600 children (aged 0–14 years) participated in the study. Collection of data was performed by means of a questionnaire comprising items relating to parental weight and social demographics. The parents were also asked to indicate their children’s weight and height, as well as the estimated weight status. Children were weighed and measured and BMI was calculated, allowing a comparison of estimated values and weight categories with the measured data.Results
Parental BMI, parental weight and a higher birth weight were identified as factors associated with childhood overweight. No association with the parents’ educational status or citizenship could be proven. We compared parents’ estimations of weight and height of their children with measured data. Here we found, that parental estimated values often differ from measured data. Using only parental estimated data to define weight status leads to misclassifications. It could be seen that parents of overweight children tend to underestimate the weight status of their children, compared to parents of children with normal weight.Conclusions
Pediatricians should bear in mind that parental assessment often differs from the measured weight of their children. Hence children should be weighed and measured regularly to prevent them from becoming overweight. This is of particular importance in children with higher birth weight and children of overweight parents.Trial registration
Study was not registered. The study was approved by the Ethic committee of the city of Vienna. (EK 13–146-VK).14.
Background
De novo low-profile gastrojejunostomy tubes in pediatric patients offer less external catheter bulk and decreased propensity for dislodgement as children become more mobile. While small cohort studies have evaluated de novo placement of coaxial, adjustable-length, percutaneous gastrojejunostomy (GJ) tubes in children, placement of de novo low-profile GJ tubes in pediatric patients has not been analyzed.Objective
This study evaluates technical feasibility, safety and clinical efficacy of percutaneous, retrograde placement of de novo low-profile GJ tubes in infants and children.Materials and methods
Following institutional review board approval, all de novo low-profile GJ tube placements in patients were retrospectively reviewed between May 2014 and May 2017. Technical parameters of fluoroscopy time, tube size, T-fasteners and complications were recorded. Clinical data, including age, indication, weight gain and complications, were analyzed.Results
Thirty-four de novo low-profile GJ tubes were placed in 34 patients (median age: 9.4 months, range: 2 months-11.8 years; median pre-procedural weight: 7.5 kg, range: 2.9-31.6 kg). Twenty-one 14-Fr and 13 16-Fr GJ tubes were placed with technical success rate of 100%. Average weight gain 3 months’ post procedure was 1.1 kg (range: 0.3-4.8 kg) and average weight percentile for age increase was 9.6% (range: -48.9% to 53.5%). One major complication occurred following balloon inflation within the tract causing pain requiring urgent replacement of the GJ tube. Minor complications occurred in 11 patients (32%): accidental dislodgement (n=9), skin irritation (n=4), tube dysfunction (n=2), leakage (n=2) and tube migration into the esophagus (n=1).Conclusion
Percutaneous, antegrade, image-guided placement of de novo low-profile GJ tubes is technically feasible, safe and clinically efficacious in appropriately selected pediatric patients.15.
Background
Contrast enemas with barium or water-soluble contrast agents are sometimes performed in children with severe intractable constipation to identify anatomical abnormalities. However there are no clear definitions for normal colonic size or abnormalities such as colonic dilation or sigmoid redundancy in children.Objective
To describe characteristics of colonic anatomy on air contrast enemas in children without constipation to provide normal values for colonic size ratios in children.Materials and methods
We performed a retrospective chart review of children aged 0–5 years who had undergone air contrast enemas for intussusception. The primary outcome measures were the ratios of the diameters and lengths of predetermined colonic segments (lengths of rectosigmoid and descending colon; diameters of rectum, sigmoid, descending colon, transverse colon and ascending colon) in relation to the L2 vertebral body width.Results
We included 119 children (median age 2.0 years, range 0–5 years, 68% boys). Colonic segment length ratios did not change significantly with age, although the differences for the rectosigmoid/L2 ratio were borderline significant (P?=?0.05). The ratios that involved the rectal and ascending colon diameters increased significantly with age, while diameter ratios involving the other colonic segments did not. Differences by gender and race were not significant.Conclusion
These data can be used for reference purposes in young children undergoing contrast studies of the colon.16.
Background
Confirmation of appendicitis in children often requires CT. A focused CT scan that is limited to the lower abdomen/pelvis might help to reduce radiation exposure.Objective
To determine the position of the appendix relative to the umbilicus and derive a height-adjusted threshold for a focused CT that would identify most appendices.Materials and methods
We conducted a retrospective study of children younger than 18 years who underwent a CT scan for suspected appendicitis. A pediatric radiologist determined the distance from the most cephalad portion of the appendix to the center of the umbilicus. This distance was divided by the child’s height to create a ratio for each child. We then assessed the largest of these distance/height ratios (“height constants”) as potential height-adjusted thresholds that, when multiplied by any patient’s height, would yield the superior threshold for the focused CT scan. Radiation reduction was calculated as percentage decrease in scan length compared to a complete abdominopelvic CT.Results
Of 270 patients whose entire appendix was identified on CT, all were identified within 10.5 cm above the umbilicus. A focused CT using a height constant of 0.07 identified 100% of the appendices visualized on the complete CT scan and resulted in an estimated mean percentage radiation reduction of 27% (standard deviation [SD] +/-4.7). If a height constant of 0.03 was used, 97% of appendices were identified and the estimated radiation reduction was 43% (SD +/-4.3).Conclusion
A height-adjusted focused abdominopelvic CT scan might reduce radiation exposure without sacrificing the diagnostic accuracy of the complete CT scan.17.
Background
Adenotonsillectomy (AT) has been an effective treatment for sleep-disordered breathing (SDB) in children, and several studies described the risk of postoperative weight gain and obesity in children treated with AT. The present study aimed to evaluate behavioral improvements in children with SDB one year after adenotonsillectomy and to investigate an influence of postoperative weight gain on behaviors.Methods
The study included 170 children aged 5–11 years who underwent adenotonsillectomy for SDB and 150 controls. Body mass index percentile was obtained for age and gender, and parental sleep-related breathing disorder (SRBD) questionnaire was used to assess the severity of SDB. Psychological assessment was performed pre- and post-adenotonsillectomy using standardized questionnaires including strength and difficulties questionnaire, children’s depression inventory and screen for child anxiety-related emotional disorder.Results
The mean age of 170 patients was 7.7 ± 1.5 years with 73 (42.9%) girls and 97 (57.1%) boys. The mean follow-up period were 15.4 ± 2.7 months. The patients had shown significant improvements in SDB scores as well as in questionnaire-based behavioral problems after adenotonsillectomy. The odds of a child being overweight were significantly increased after adenotonsillectomy. Less improvements in hyperactivity and conduct problems were observed in the patients with older ages, higher SRBD scores, and overweight/obesity at 1-year follow-up after adenotonsillectomy.Conclusion
These data suggest that abnormal behavioral outcomes should be evaluated postoperatively, which potentially could be reduced with the early adenotonsillectomy and adequate postoperative weight control.18.
Valentina Rossi Cinzia Mazzola Lorenzo Leonelli Paolo Gandullia Serena Arrigo Marina Pedemonte Maria Cristina Schiaffino Margherita Mancardi Oliviero Sacco Nicola Massimo Disma Clelia Zanaboni Giovanni Montobbio Arrigo Barabino Girolamo Mattioli 《Pediatric surgery international》2016,32(3):277-283
Background
Fundoplication is considered a mainstay in the treatment of gastro-esophageal reflux. However, the literature reports significant recurrences and limited data on long-term outcome.Aims
To evaluate our long-term outcomes of antireflux surgery in children and to assess the results of redo surgery.Methods
We retrospectively analyzed all patients who underwent Nissen fundoplication in 8 consecutive years. Reiterative surgery was indicated only in case of symptoms and anatomical alterations. A follow-up study was carried out to analyzed outcome and patients’ Visick score assessed parents’ perspective.Results
Overall 162 children were included for 179 procedures in total. Median age at first intervention was 43 months. Comorbidities were 119 (73 %), particularly neurological impairments (73 %). Redo surgery is equal to 14 % (25/179). Comorbidities were risk factors to Nissen failure (p = 0.04), especially children suffering neurological impairment with seizures (p = 0.034). Follow-up datasets were obtained for 111/162 = 69 % (median time: 51 months). Parents’ perspectives were excellent or good in 85 %.Conclusions
A significant positive impact of redo Nissen intervention on the patient’s outcome was highlighted; antireflux surgery is useful and advantageous in children and their caregivers. Children with neurological impairment affected by seizures represent significant risk factors.19.
Priyanka Minocha Sadasivan Sitaraman Anita Choudhary Rajiv Yadav 《Indian journal of pediatrics》2018,85(1):15-19
Objective
To determine the prevalence of undernutrition in children with cerebral palsy and to compare subjective and objective methods of nutritional assessment.Methods
This was a hospital based analytical observational study in which 180 children of cerebral palsy, aged 1–12 y, attending tertiary level hospital, Jaipur from March, 2012 through March, 2013 were included. Subjective assessment was done by questionnaire (Subjective Global Nutritional Assessment; SGNA) in which questions related to nutrition history and physical examination, signs of fat, muscle wasting and edema was done while objective assessment was done by weight, height and triceps skinfold thickness (TSFT) measurements.Results
In this study prevalence of undernutrition by subjective method (SGNA) was 76.67% while by objective measurement (weight, height, TSFT) was 48.89%, 77.78% 35.18% respectively. There was fair to moderate agreement between the SGNA and objective assessments including weight and height (k = 0.341, p = 0.000; k = 0.337, p = 0.000 respectively) while for TSFT agreement between both methods was poor (k = 0.092, p = 0.190). In the index study, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SGNA was for weight was 95%, 37%, 56%, 90%; for height 84%, 50%, 85%, 47%; for TSFT 81%, 30%, 38%, 75% respectively.Conclusions
The prevalence of undernutrition is high in cerebral palsy children. SGNA can be a reliable tool for assessing nutritional status in children with cerebral palsy and is a simple, comprehensive, noninvasive, and cost-effective tool for screening undernutrition in children of cerebral palsy.20.