Centile Charts Research Articles

Obesity Affects Health-Related Quality of Life in Schools Functioning Among Adolescents in Southwest of Nigeria.

The relationship between body mass index (BMI) and health-related quality of life (HRQoL) in adolescence is important but there is a dearth of this information among developing countries such as Nigeria. To assess the relationship between BMI and HRQoL among healthy schooling adolescents in Southwestern Nigeria. We assessed the relationship between BMI and HRQoL among healthy schooling adolescents in southwestern Nigeria. In a cross-sectional study design, 650 adolescents were selected and interviewed about their quality of life in the preceding 1 month using a validated instrument with contents adapted from the Pediatric Quality of Life Inventory (PedsQLTM) questionnaire. The BMI was calculated and plotted on the Center for Disease Control and Prevention percentile chart to categorize as underweight, normal, overweight, or obese. Comparisons were made using Student's t-test, ANOVA, and linear regression model at P = 0.05. Participants mean BMI and overall HRQoL score was 19.0 ± 3.0 kg/m2 and 73.7 ± 11.7, respectively. The prevalence of underweight, overweight, and obesity was 6.9%, 2.3%, and 0.6%, respectively. Females (72.3 ± 12.2) had a significantly lower overall mean HRQoL score than males (75.0 ± 11.1), P = 0.048. Post-hoc ANOVA showed that obese adolescents had significantly lower mean HRQoL in school functioning domain (55.0 ± 20.8) than underweight (83.5 ± 14.), and normal BMI (81.3 ± 16.3) participants (P < 0.05). Obesity reduces HRQoL in the school functioning domain among adolescents in Ibadan, Nigeria. Our finding buttresses the need to monitor body mass and size in high schools for enhancing quality of life.

Longitudinal Reference Values for Cerebral Ventricular Size in Preterm Infants Born at 23-27 Weeks of Gestation

To establish longitudinal reference values for cerebral ventricular size in the most vulnerable patients at risk for intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilatation (PHVD). This retrospective study included neurologically healthy preterm neonates born at 230/7-266/7weeks of gestational age between September 2011 and April 2019. Patients were treated at 2 Austrian tertiary centers, Medical University of Vienna and Medical University of Innsbruck. All available cerebral ultrasound scans until 30weeks corrected age were analyzed. Ventricular measurements included ventricular index, anterior horn width (AHW), and thalamo-occipital distance (TOD) and longitudinal percentiles were created. The study cohort consisted of 244 preterm neonates, with a median gestational age of 253/7weeks (IQR, 244/7-260/7weeks) and a median birth weight of 735g (IQR, 644-849g). A total of 993 ultrasound scans were available for analysis, resulting in >1800 measurements of ventricular index, AHW, and TOD. Special attention was given to the 97th percentile as well as 2mm and 4mm above the 97th percentile, which are used internationally as cutoffs for intervention in the presence of PHVD. We present percentile charts based on a cohort of extremely premature infants including neonates born at the border of viability suited to follow-up the most vulnerable patients at risk for IVH and PHVD. Furthermore, we provide an extensive literature research and comparison of all available reference values, focusing on ventricular index, AHW, and TOD.

Blood pressure percentiles and systemic hypertension-associated factors among children aged between 6 and 15 years in Southern Vietnam

Background: The present study determined blood pressure percentiles in children aged between 6 and 15 years in Southern Vietnam. Material and methods: Blood pressure was measured in a random sample of 1080 students aged 6–15 years who was studying at primary and secondary high schools in My Tho city, Vietnam. A descriptive cross-sectional study was conducted from November 2019 to June 2020. To diagnose children systemic hypertension, the blood pressure must be above the 95 th percentile. Data were analyzed by IBM SPSS statistics software version 20.0. The Chi-squared test was employed to evaluate the relationship between systemic hypertension and child demographic characteristics including gender and obesity. Results: The results showed that the 95 th percentiles of systolic and diastolic blood pressure of the children was 110/70 mm Hg in the 6-year-old group, 120/75 mm Hg in the 7 to12-year-old group and 125/80 mm Hg in the 13 to 15-year-old group, respectively. The rate of systemic hypertension in the children was 10% whereas boys had a 1.2 time higher risk of systemic hypertension than girls (p &gt; 0.05). Obese children had an 8.6 time higher risk of systemic hypertension than non-obese ones (p &lt; 0.001). Conclusion: The blood pressure percentile chart of school children aged 6–15 years were reported here for the first time in Vietnam. The results provided useful information in early diagnosis and timely treatment of systemic hypertension in children.

Ambivalence in distinguishing double burden of malnutrition among school children in three districts of south India

ObjectivesTo assess the nutritional status of school-going children in the age group 6–17 years and to compare BMI growth percentile charts of WHO and IAP (Indian Academy of Paediatrics). MethodsA cross-sectional study was conducted among school children aged 6–17 years studying in 44 schools of three districts in South India, between 2018 and 2019. A total of 8688 students were assessed for their height and weight. Anthropometric data were plotted on both WHO and IAP BMI charts. ResultsThere were 50.1% boys and 49.9% girls; 32.1% were urban and 67.9% from rural localities. According to the WHO BMI chart, 14.7% of the school students were severely thin, 15.8% were thin, 6.9% were overweight and 2.2% were obese. Under-nutrition among boys was 9.7% more prevalent than girls. Overweight prevalence was higher in girls (9.6%); 4.1% higher prevalence among urban than rural girls. The difference between the two BMI chart measurements for <3rd percentile possessed a variation of 24.2% for boys and 12.3% for girls. Significant undernutrition (53.6%) was among 6–8yrs and overnutrition (11%) among adolescents. ConclusionThe study reveals a double burden of malnutrition with gender, age, and geographic disparity. Boys were severely thin than girls while girls were overweight than boys. Rural students were underweight whereas urban students were overweight and obese. Thinness was inversely proportional to age. The sensitivity to determine under-nutrition was with the WHO chart whilst the IAP chart was for over-nutrition.

"Aggressive" Feeding of Very Preterm Neonates and Body Mass Index at School Age.

Introduction: The effects of “aggressive” neonatal feeding policies of very preterm neonates (VPN) and the risk of metabolic syndrome later in life remain questionable. We aimed to evaluate the effect of our “aggressive” nutrition policies of VPN during hospitalisation on body mass index (BMI) at ages 2 and 8 years. Materials and Methods: Eighty four VPN, who received “aggressive” nutrition during hospitalisation in an effort to minimise postnatal growth restriction (PGR) (group A), and 62 term neonates, as controls (group B), were enrolled in the study. Group A was further divided in four subgroups depending on the type (A1: fortified expressed breast milk and preterm formula; A2: exclusively preterm formula) and quantity of milk received (A3: maximum feeds 180–210 mL/kg/day; A4: maximum feeds 210 and up to 260 mL/kg/day). BMI was calculated at ages 2 and 8 years and plotted on the centile charts. Results: There was no significant difference in BMI between groups A and B at 2 and 8 years, respectively, in both absolute BMI values and their centile chart distribution. There was no significant difference in BMI at 2 and 8 years either between subgroups A1 and A2 or between subgroups A3 and A4. Conclusions: “Aggressive” and individualised feeding policy for VPN did not affect the BMI and obesity rates at ages of 2 and 8 years in our study population. The type and quantity of milk feeds had no impact on their BMI at school age. Further larger studies are needed to confirm our results.

MO1021HYPERTENSION IN CHILDHOOD MINIMAL CHANGE DISEASE: IGNORED, MISSED OR UNDER-DIAGNOSED?

Abstract Background and Aims Minimal change disease (MCD) is most common form of primary nephrotic syndrome (76.6% as per ISKDC) in children aged 1 to 10 years. As per current literature, blood pressure (BP) is usually normal in childhood MCD while in adults, 50% MCD cases are hypertensive. We hypothesized that hypertension is prevalent in childhood MCD also and most of cases are missed or under-diagnosed due to lack of BP monitoring, inappropriate BP cuff size (larger cuff will inaccurately show lower BP; cuff should cover 75% to 80% of arm circumference between antecubital fossa and axilla) or lack of knowledge about childhood hypertension criteria (systolic or diastolic BP&amp;gt; 95th percentile for age on ≥2 clinical visits at least 1 week apart). Method This cross-sectional study was performed from March 2018 to December 2020 at a tertiary care centre in India. Newly diagnosed and relapses of primary nephrotic syndrome (presumed MCD) in children aged 1 to 10 years were included in the study. All cases were subjected to careful BP monitoring and charting using appropriate BP cuff, while child is calm and relaxed, in quiet room with comfortable temperature and empty bladder. Three measurements were taken at 1 minute interals and taking average of last 2 measurements. Percentile charts for age and height were followed. Results fifty four cases of childhood MCD were studied. Thirty six cases (66.67%) were male. Mean age was 5.48 years (SD ±2.31). Thirty two cases (59.26%) were found to be hypertensive. Fourteen cases (43.75%) were relapses. Seven cases (21.87%) were steroid resistant nephrotic syndrome while three cases were steroid dependent. Five cases were already on calcineurin inhibitors when diagnosed of hypertension. There was family history of hypertension in 9 cases diagnosed of hypertension (p value 0.77). There was no correlation between occurrence of hypertension and degree of proteinuria, hypoalbuminemia or body mass index. All hypertensives were managed with angiotensin receptor blockers and regularly followed-up. Conclusion Results of our study are contrary to traditional belief that hypertension is not common in childhood MCD. Significant number of cases are hypertensive. Correct BP measurement and interpretation is necessary in each childhood MCD case. Its occurrence is not correlated with family history or degree of proteinuria, hypoalbuminemia or body mass index.

Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study.

BackgroundAntidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. This study examines trends and variation in antidepressant prescribing across English primary care.AimTo examine trends and variation in antidepressant prescribing in England, with a focus on: monoamine oxidase inhibitors (MAOIs); paroxetine; and dosulepin and trimipramine.Design & setting Retrospective longitudinal study using national and practice-level data on antidepressant items prescribed per year (1998–2018) and per month (2010–2019).MethodClass- and drug-specific proportions were calculated at national and practice levels. Descriptive statistics were generated, percentile charts and maps were plotted, and logistic regression analysis was conducted.ResultsAntidepressant prescriptions more than tripled between 1998 and 2018, from 377 items per 1000 population to 1266 per 1000. MAOI prescribing fell substantially, from 0.7% of all antidepressant items in 1998 to 0.1% in 2018. There was marked variation between practices in past year prescribing of paroxetine (median practice proportion [MPP] = 1.7%, interdecile range [IDR] = 2.6%) and dosulepin (MPP = 0.7%, IDR = 1.8%), but less for trimipramine (MPP = 0%, IDR = 0.2%).ConclusionRapid growth and substantial variation in antidepressant prescribing behaviour was found between practices. The causes could be explored using mixed-methods research. Interventions to reduce prescribing of specific antidepressants, such as dosulepin, could include review prompts, alerts at the time of prescribing, and clinician feedback through tools like OpenPrescribing.net.

Normative reference values of handgrip strength for Brazilian older people aged 65 to 90 years: Evidence from the multicenter Fibra‑BR study.

Handgrip strength (HGS) is an indicator of muscle strength, suited for evaluating the aging process. Its use depends on the availability of reliable normative reference values (NRV). The main objective of this study is to provide NRV of HGS for Brazilians aged 65 to 90 years. Participants were from the Frailty in Brazilian Older People research. 2,999 successful aging (SA) participants comprised the development sample. HGS was measured using a hydraulic dynamometer. Obtaining NRV involved regressing HGS on age per sex-height strata, fitting separate fractional polynomial (FP) models for the mean and coefficient of variation. Model fit was assessed via standardized residuals, probability/quantile plots, and comparing observed to normal expected percentages of participants falling within specified centile intervals. For validation, the latter procedure was applied to 2,369 unsuccessfully aging (UA) participants. Across strata, the best-fitting models for the means were FP of power 1. FP models for the CV indicated age invariance, entailing steady heteroscedastic age decline in SD since coefficients for the means were negative and SD = CV×mean. All models adjusted well. Centiles distributions for the SA and UA populations showed anticipated patterns, respectively falling on and below the normative expected centile references. Results (NRV) are presented in tables and centile charts. Equations are also provided. NRV/charts may be endorsed for routine use, while still tested further. They would aid professionals caring for older people, not only to identify those at risk and eligible for immediate provisions, but also in planning prevention and rehabilitation measures.

Physical fitness percentiles of Polish children aged 4\u20137 years

The purpose of this study was to report sex- and age-specific physical fitness level in Polish children aged 4 to 7. 11.709 children participated in the study, including 5.684 girls and 6.025 boys aged 4 to 7 who attended kindergarten institutions throughout Poland. Physical fitness was assessed using four tests developed by Sekita including shuttle run 4 × 5 m with moving the block, standing long jump, throwing 1 kg medicine ball with two hands above the head and 20 m run. Percentile charts were developed separately for males and females using the LMS method. Boys showed higher physical fitness values than girls. In addition, an increase in the level of physical fitness was observed along with the age of the subjects. The developed reference values by age and sex in the field of physical fitness can be used for diagnostic purposes and assessing the level of physical fitness of preschool children. In addition, they can be helpful for healthcare professionals, parents and teachers to develop children’s motor activation programs and monitor their physical fitness.

REFERENCE CENTILE CHARTS OF PAPP-AAND FREE β-HCG IN INDIAN PREGNANT WOMEN.

The combined rst-trimester screening (CFTS) for fetal aneuploidy involves a combination of maternal age, fetal nuchal translucency (NT), maternal serum pregnancy-associated plasma protein-A(PAPP-A) and free β-human chorionic gonadotropin (β-hCG) from 11+0 to 13+6 weeks of gestation [1]. International prescriptive standards for early fetal linear size and ultrasound dating of pregnancy in the rst trimester are available and used throughout the world. Ethnicity has an effect on the biochemical parameters of rst trimester screening. As there is a lack of reference chart for the women of Indian ethnicity, we aimed to nd out the level of PAPP-Aand free β-hCG for fetal crown rump length (CRL) of 40-84 mm in the rst trimester of pregnancy and construct the centile charts for both the parameters. Asignicant but weak correlation between the individual models of PAPP-A and β-hCG and CRL (P&lt;0.001). In conclusion, the normal range of PAPP-A and free β-hCG depending on the gestation (CRL) was derived in this cohort study. This would act as a reference for our population and would be helpful in calculating the risk of an adverse maternal and fetal outcome.

Dynamic Change of Thyroid Hormones With Postmenstrual Age in Very Preterm Infants Born With Gestational Age

BackgroundAt present, the relationship between thyrotropin (TSH) and free thyroxine (FT4) in relation to postmenstrual age (PMA) in preterm infants is still unclear, and there is no reliable standard thyroid hormone reference ranges, resulting in different diagnostic criteria for congenital hypothyroidism been used by different newborn screening programs and different countries.ObjectivesTo investigate the relationship between TSH/FT4 and PMA in very preterm infants (VPIs) born with gestational age (GA) <32 weeks and to derive thyroid function reference charts based on PMA.MethodsA prospective cohort study was performed on VPIs born with GA<32 weeks and born in or transferred to the 27 neonatal intensive care units from January 1, 2019 to December 31, 2019. Serial TSH and FT4 values were measured at the end of each week during the first month after birth and also at PMA36 weeks, PMA40 weeks and at discharge, respectively. The 2.5th, 5th, 50th, 95th, and 97.5th percentiles of TSH and FT4 of different PMA groups were calculated to draw the percentile charts based on PMA.Results1,093 preterm infants were included in this study. The percentile charts of TSH and FT4 levels based on PMA were drawn respectively, and the result indicated that the percentile charts of TSH values were gradually increased initially and then decreased with increasing PMA. The 97.5th percentile chart reached the peak at PMA30 weeks (17.38μIU/ml), and then decreased gradually, reaching the same level as full-term infants (9.07μIU/ml) at PMA38–40 weeks. The 2.5th percentile chart of FT4 was at its lowest point at PMA26–27 weeks (5.23pmol/L), then increased slowly with PMA and reached the same level as full-term infants at PMA38–40 weeks (10.87pmol/L). At PMA36 weeks, the reference intervals of the 2.5th to 97.5th percentiles of TSH and FT4 were 1.18–12.3μIU/ml and 8.59–25.98pmol/L, respectively.ConclusionThe percentile charts of TSH and FT4 in VPIs showed characteristic change with PMA. The results prompt that age-related cutoffs, instead of a single reference range, might be more useful to explain the thyroid function of VPIs. And repeated screening is necessary for preterm infants.

Feokromasitomanın İlk Bulgusu Olarak Paroksismal Baş Ağrısı, Olgu Sunumu

Pheochromocytoma is a rare tumor that develops from the chromaffin cells of the sympathetic nervous system. Although hypertension is the most common manifestation of pheochromocytoma, it is less common in children than in adults. This condition may be overlooked like in our patient who had an undiagnosed headache for several years. Our patient was admitted to our emergency department due to the increase in headache, which lasted for about 6 years, and a neurological evaluation was performed. Due to the high blood pressure in her follow-up, she was examined further. Abdominal USG revealed a 36x26x27 mm solid lesion in the right adrenal gland with a mild hyperechogenic appearance with a cystic component. With supporting findings in magnetic resonance imaging and high catecholamine levels in blood, she was diagnosed with pheochromocytoma. Our aim in sharing this case is to emphasize the importance of measuring blood pressure in patients accurately and at each examination, evaluating them with percentile charts, and monitoring them closely.

The Relation between Gestational Age and Anthropometric Measurements among Newborns

Background: Growth monitoring and assessing its parameters have an important role because accurate gestational age and growth measurements are important which reflects standard growth and morbidity, and mortality in newborns is directly, linked with gestational age and anthropometric measurements. This study aimed to investigate the relationship between gestational age and anthropometric measurements among newborns. Design: A cross-sectional study was conducted in the Obstetrics and Gynecology ward at Sohag University Hospital, from Dar El – Salam Abed- Allah Maternal and Child Health Center at Sohag City and Maternal and Child Health Center at Talkha City belonging to Dakhahlia Governorate within six months, including 280 newborns. Tools: A structured questionnaire, anthropometric measurement, and percentile charts from the 10th, 50th, and 90th percentiles were utilized for collecting the data. A positive correlation was found between gestational age and anthropometric variables. Conclusion: A positive correlation between gestational age and anthropometric measurements among newborns, and anthropometric variables can be used as simple tools for predicting gestational age

Fat mass prediction equations and reference ranges for Saudi Arabian Children aged 8-12 years using machine technique method.

BackgroundThe number of children with obesity has increased in Saudi Arabia, which is a significant public health concern. Early diagnosis of childhood obesity and screening of the prevalence is needed using a simple in situ method. This study aims to generate statistical equations to predict body fat percentage (BF%) for Saudi children by employing machine learning technology and to establish gender and age-specific body fat reference range.MethodsData was combined from two cross-sectional studies conducted in Saudi Arabia for 1,292 boys and girls aged 8–12 years. Body fat was measured in both studies using bio-electrical impedance analysis devices. Height and weight were measured and body mass index was calculated and classified according to CDC 2,000 charts. A total of 603 girls and 374 boys were randomly selected for the learning phase, and 153 girls and 93 boys were employed in the validation set. Analyses of different machine learning methods showed that an accurate, sensitive model could be created. Two regression models were trained and fitted with the construction samples and validated. Gradient boosting algorithm was employed to achieve a better estimation and produce the equations, then the root means squared error (RMSE) equation was performed to decrease the error. Body fat reference ranges were derived for children aged 8–12 years.ResultsFor the gradient boosting models, the predicted fat percentage values were more aligned with the true value than those in regression models. Gradient boosting achieved better performance than the regression equation as it combined multiple simple models into a single composite model to take advantage of that weak classifier. The developed predictive model archived RMSE of 3.12 for girls and 2.48 boys. BF% and Fat mass index charts were presented in which cut-offs for 5th, 75th and 95th centiles are used to define ‘under-fat’, ‘normal’, ‘overfat’ and ‘subject with obesity’.ConclusionMachine learning models could represent a significant advancement for investigators studying adiposity-related issues in children. These models and newly developed centile charts could be useful tools for the estimation and classification of BF%.

High-resolution pediatric reference intervals for 15 biochemical analytes described using fractional polynomials.

Assessment of children's laboratory test results requires consideration of the extensive changes that occur during physiological development and result in pronounced sex- and age-specific dynamics in many biochemical analytes. Pediatric reference intervals have to account for these dynamics, but ethical and practical challenges limit the availability of appropriate pediatric reference intervals that cover children from birth to adulthood. We have thereforeinitiated the multi-center data-driven PEDREF project (Next-Generation Pediatric Reference Intervals) to create pediatric reference intervals using data from laboratory information systems. We analyzed laboratory test results from 638,683 patients (217,883-982,548 samples per analyte, a median of 603,745 test results per analyte, and 10,298,067 test results in total) performed during patient care in 13 German centers. Test results from children with repeat measurements were discarded, and we estimated the distribution of physiological test results using a validated statistical approach (kosmic). We report continuous pediatric reference intervals and percentile charts for alanine transaminase, aspartatetransaminase, lactate dehydrogenase, alkaline phosphatase, γ-glutamyl-transferase, total protein, albumin, creatinine, urea, sodium, potassium, calcium, chloride, anorganic phosphate, and magnesium. Reference intervals are provided as tables and fractional polynomial functions (i.e.,mathematical equations) that can be integrated into laboratory information systems. Additionally, Z-scores and percentiles enable the normalization of test results by age and sex to facilitate their interpretation across age groups. The provided reference intervals and percentile charts enable precise assessment of laboratory test results in children from birth to adulthood. Our findings highlight the pronounced dynamics in many biochemical analytes in neonates, which require particular consideration in reference intervals to support clinical decision making most effectively.

Cardiovascular magnetic resonance normal values for pulmonary arteries and ventricular volumes in paediatric patients with transposition of the great arteries after arterial switch operation

Abstract Funding Acknowledgements Type of funding sources: None. Background The anatomy of the pulmonary arteries (PA) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) with Lecompte manoeuvre is different compared to healthy subjects and stenoses of the PA are known to occur. Cardiovascular magnetic resonance (CMR) imaging is an excellent imaging modality to assess PA anatomy in TGA patients. However, disease specific normal values for PA size do not exist. Furthermore, the impact of pulmonary artery size, age and gender on ventricular volumes and function is unknown. Therefore, we sought to establish disease specific normative ranges for PA dimensions as well as biventricular volumes and function. Methods 70 CMR scans of paediatric patients with TGA after ASO with Lecompte manoeuvre (mean age 12.3 ± 3.6 years; range 5-18 years; 57 males) were included. Cine CMR sequences as well as contrast-enhanced magnetic resonance angiography (CE-MRA) data were used to measure pulmonary artery dimensions. Right and left PA were each measured at three locations during its course around the aorta. Ventricular volumes, mass and ejection fraction were measured from a stack of short axis cine images. Results Mean systolic and diastolic diameters of the MPA were 15.0 ± 2.3 mm (10.5 ± 2.7 mm/m²) / 13.2 ± 2.9 mm (9.2 ± 2.9 mm/m²) and mean cross-sectional MPA area was 286.7 ± 81.7 mm². Mean systolic and diastolic diameters for the RPA and LPA at the narrowest point were: RPA 10.5 ± 2.8 mm (7.8 ± 2.4 mm/m²) / 8.1 ± 2.2 mm (6.0 ± 1.9 mm/m²); LPA 8.4 ± 2.8 mm (6.2 ± 2.1 mm/m²) / 7.4 ± 2.3 mm (5.4 ± 1.6 mm/m²). Mean values for biventricular volumes, ejection fraction and mass were as follows: 1) left ventricular (LV) end-diastolic volume (EDV) 89.0 ± 20.3 ml/m² and end-systolic volume (ESV) 35.1 ± 11.7 ml/m², 2) right ventricular (RV) EDV 76.4 ± 15.4 ml/m² and ESV 32.4 ± 9.1 ml/m², 3) LV and RV ejection fraction 61.1 ± 6.5 % / 58.9 ± 6.1 % and 4) LV and RV mass 59.6 ± 15.2 g/m² / 23.3 ± 7.4 g/m². Separate centile charts for boys and girls for PA dimensions as well as biventricular volumes, mass and ejection fraction were created. Conclusion We established disease specific CMR normal values for the PA dimensions as well as for ventricular volumes, mass and ejection fraction in paediatric patients with TGA after ASO. Our data will improve CMR image interpretation and may serve as a reference in future studies.

Cardiovascular magnetic resonance (CMR) normal values for pulmonary arteries in healthy children and adolescents

Abstract Funding Acknowledgements Type of funding sources: None. Background Changes in the right ventricular outflow tract (RVOT) and pulmonary arteries (PAs) are often seen in paediatric patients with congenital heart disease (CHD), pulmonary hypertension or genetic disorders (e.g. Marfan syndrome, Loeys-Dietz syndrome, Williams syndrome, DiGeorge syndrome). Cardiovascular magnetic resonance (CMR) imaging is an excellent method to visualize the RVOT and PAs without the use of ionizing radiation and contrast media but for the interpretation of CMR data in the paediatric population the knowledge of normal values is crucial. However, normal values for pulmonary arteries from contrast-free cine CMR images are lacking. Purpose The aim of this retrospective multicentre study was to establish reference ranges for the diameters of the mean PA (MPA), right PA (RPA) and left PA (LPA). Methods 163 CMR scans of healthy children and adolescents (mean age 13.8 ± 2.9 years; range 5-18 years) from two centres in the UK and Germany were included. The diameter of the MPA was measured in sagittal-oblique RVOT cine images and transaxial cine stacks, whereas the diameter of the RPA and LPA were measured from transaxial stacks and specific pulmonary artery branch cine images. Results Mean systolic and diastolic diameters for the MPA were 22.1 ± 2.8 mm (14.4 ± 2.2 mm/m²)/ 17.2 ± 2.3 mm (11.3 ± 1.9 mm/m²) measured in RVOT cine stacks. Mean systolic and diastolic diameters for the RPA and LPA were: 1) RPA, 12.4 ± 1.7 mm (7,9 ± 1,6 mm/m²)/ 9.8 ± 1.6 mm (5.9 ± 1.8 mm/m²) and 2) LPA, 13.3 ± 1.5 mm (8.3 ± 2.1 mm/m²)/ 10.8 ± 1.5 mm (6.8 ± 1.8 mm/m²). Separate centile charts for boys and girls for the MPA were created. Conclusions We established CMR normal values for the MPA, RPA and LPA for children and adolescents. Our data might be useful for the detection of PA stenosis and dilatation and may serve as a reference in future studies.

Cardiovascular magnetic resonance normal values in children for biventricular wall thickness and mass

BackgroundPediatric patients are becoming increasingly referred for cardiovascular magnetic resonance (CMR). Measurement of ventricular wall thickness is typically part of the assessment and can be of diagnostic importance, e.g. in arterial hypertension. However, normal values for left ventricular (LV) and right ventricular (RV) wall thickness in pediatric patients are lacking. The aim of this study was to establish pediatric centile charts for segmental LV and RV myocardial thickness in a retrospective multicenter CMR study.MethodsCMR was performed in 161 healthy children and adolescents with an age range between 6 and 18 years from two centers in the UK and Germany as well as from a previously published CMR project of the German Competence Network for Congenital Heart Defects. LV myocardial thickness of 16 segments was measured on the short axis stack using the American Heart Association segmentation model. In addition, the thickness of the RV inferior and anterior free wall as well as biventricular mass was measured.ResultsThe mean age (standard deviation) of the subjects was 13.6 (2.9) years, 64 (39.7%) were female. Myocardial thickness of the basal septum (basal antero- and inferoseptal wall) was 5.2 (1.1) mm, and the basal lateral wall (basal antero- and inferolateral) measured 5.1 (1.2) mm. Mid-ventricular septum (antero- and inferoseptal wall) measured 5.5 (1.2) mm, and mid-ventricular lateral wall (antero- and inferolateral wall) was 4.7 (1.2) mm. Separate centile charts for boys and girls for all myocardial segments and myocardial mass were created because gender was significantly correlated with LV myocardial thickness (p < 0.001 at basal level, p = 0.001 at midventricular level and p = 0.005 at the apex) and biventricular mass (LV, p < 0.001; RV, p < 0.001).ConclusionWe established CMR normal values of segmental myocardial thickness and biventricular mass in children and adolescents. Our data are of use for the detection of abnormal myocardial properties and can serve as a reference in future studies and clinical practice.

Reference charts of birth weight and birth length by gestational age in south east Serbian newborns: Preliminary results

Background/Aim. To date, there has been no population-based neonatal anthropometric chart published in Serbia. Charts based on infants born in a single hospital (hospital-based) in the 1 990s are still widely used in our country, as well as the Alexander chart. The aim of this study was to construct population-based centile, gender-specific charts for birth weight and length for singleton infants born in Southeast Serbia from 24 t o 42 weeks of gestation and to compare them with other previously published charts. Methods. Data on 39,842 singleton live infants, delivered from 2006 to 2015 in three maternity wards in Southeast Serbia (Nis, Prokuplje, and Aleksinac), were analyzed. Results. The inclusion criteria met 37,169 newborns. Preterm births were relatively uncommon (5.25%). Estimated centile charts for male and female birth weights and lengths were constructed showing the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th centiles. Conclusion. Our birth weight percentiles provide a population norm for singleton infants adjusted for gender, born in Southeast Serbia. These references are both of epidemiological and clinical use. There is a need for large-scale research that will include a larger number of pre-term newborns which were represented in limited numbers in our study. There is also a need for setting up the gold standard method for the precise determination of the gestational age, i.e. the use of the early fetal ultrasound.

Age-Specific Distribution of Serum Anti-Mullerian Hormone and Antral Follicle Count in Indian Infertile Women.

Background:Ovarian reserve declines with age. However, there are considerable ethnic differences in the decline of ovarian reserve between individuals.Aim:This study aimed to make age-specific percentile charts of anti-Mullerian hormone (AMH) and antral follicle count (AFC) in Indian infertile women and to find the proportion of young women with low ovarian reserve.Setting and Design:This was a retrospective data analysis of AMH and AFC of 5525 infertile women from August 2015 to December 2018.Materials and Methods:Infertile women aged 20– 44 years, with body mass index 18–32 kg/m2 and having both ovaries were included in the study. Women with pituitary/adrenal disorders, malignancy, total AFC >40, tuberculosis, endometriosis, autoimmune disorders, smoking, chemotherapy, radiotherapy and recent ovarian surgery were excluded from the study.Statistical Analysis:Comparison between groups was done by Chi-square test.Results:About 14.5% of women <35 years and 50.5% of women >35 years had low AMH values (<1.1 ng/ml). In addition, 5.6% of women <35 years and 23.6% of women >35 years had a low AFC of ≤5. In this study, 55.7% of women who had low AMH and 50.7% who had low AFC were <35 years of age. The median AMH values were 4.23 ng/mL in 20–25 years’ age group, 3.48 ng/mL in women aged 26–30 years, 2.43 ng/mL in women aged 31–35 years, 1.28 ng/mL in women aged 36–40 years and0.52 ng/mL in 40–44 years’ age group. The median AFCs were 20, 18, 14, 10 and 6 for each of the age groups, respectively.Conclusion:This study suggests that approximately more than half of the infertile women who were tested to have low ovarian reserve were <35 years of age.