Growth Velocity Research Articles

Twenty-year trend in the prevalence of increased cardiometabolic risk, measured by abdominal obesity, among Spanish children and adolescents across body mass index categories.

Identifying children and adolescents with cardiometabolic risk at an early stage is crucial for effective treatment and prevention. From a practical perspective, this could be accomplished by assessing the presence of abdominal obesity, which serves as a surrogate indicator of increased cardiometabolic risk and is easy to measure. However, the assessment of abdominal obesity via waist circumference has not yet become a standard procedure in pediatric healthcare. The present study aimed to analyze the secular trends in increased cardiometabolic risk, as indicated by waist circumference among Spanish children and adolescents. This study included 4861 children and adolescents aged 8 to 16years from two nationwide representative cross-sectional surveys, the EnKid study and the PASOS study, conducted in 1998-2000 and 2019-2020, respectively. Anthropometric variables were measured in both surveys by trained personnel. Three different waist-to-height (WHtR) cutoffs were used to define abdominal obesity as criteria for cardiometabolic risk. BMI categories were defined according to the IOTF and WHO growth charts. Abdominal obesity [waist to height ratio (cm/cm) > 0.49] significantly increased from 40.7 to 56.1% and 93.8 to 97.2% in participants with overweight and obesity, respectively, between 1998-2000 and 2019-2020 (p < 0.05). Logistic regression analysis, adjusted for sex and age, revealed that the odds of being at increased cardiometabolic risk in 2019-2020 was 1.99 (95% CI 1.48-2.67) in participants with overweight in comparison with 1998-2000. The effect size was comparable among the three WHtR criteria for abdominal obesity or the BMI categories according to IOTF and WHO boundaries. The prevalence of Spanish children with increased cardiometabolic risk, identified by abdominal obesity, significantly increased among those with overweight during the last two decades. This finding underlines the need of including the measurement of waist circumference as a standard procedure in pediatric practice.

Development and validation of an ultrasound-based estimated fetal weight reference for Chinese twin pregnancy: a retrospective cohort study

BackgroundFetal growth monitoring is important for twin pregnancies. However, there has been no clinically validated tool for monitoring fetal growth of twin pregnancies in China. This study aims to develop and validate a chorionicity-specific growth chart of ultrasound estimated fetal weight (EFW) for Chinese twin pregnancies.MethodsThis retrospective cohort study included all twin pregnancies who delivered two live fetuses with gestational age ≥ 34 weeks without severe obstetric complications at a tertiary hospital from January 2007 to March 2021. The participants were divided into a development set (delivered in or before December 2017) and a validation set (delivered in or after January 2018). Chorionicity-specific growth charts were created using the generalized additive models for location, scale, and shape (GAMLSS) based on the development set. The fetuses from the validation set were classified into three groups based on the last EFW: small-for-gestational-age (SGA) indicated by both the newly established twin charts and the Hadlock singleton chart currently used for twin pregnancies in China, suspected SGA indicated by only the singleton chart, and no SGA indicated by either chart. The incidence of neonatal outcomes among the three groups was then compared accordingly, including intensive care unit (NICU) stay length, respiratory diseases, and neurological disorders.ResultsThe development set included 883 twin pregnancies and a total of 6374 EFW measurements between 16 and 38 weeks of gestation, and the validation set included 801 twin pregnancies and 7630 EFW measurements. In the development set, monochorionic diamniotic (MCDA) twins had a significantly lower EFW compared to dichorionic diamniotic (DCDA) twins beginning at 26 weeks, with the difference gradually increasing thereafter, supporting the establishment of chorionicity-specific growth charts. Of the 1,602 twin neonates in the validation set, 103 (6.4%) were classified into the SGA group, 164 (10.2%) into the suspected SGA group, and 1335 (83.3%) into the no SGA group. The incidence of respiratory diseases and neurological disorders was comparable between the suspected SGA group and the no SGA group, but apparently higher in the SGA group. Meanwhile, NICU stay lengths were consistently longer for twins in the SGA group compared to the no SGA group (difference: 0.57, 95% CI: 0.31–0.83), with no significant differences observed between the suspected SGA and no SGA groups.ConclusionsThe fetal growth trajectories differed by chorionicity, with a lower EFW for MCDA twins beginning at 26 weeks. The establishment of chorionicity-specific growth chart could reduce overdiagnosis of SGA and improve fetal growth monitoring of twin pregnancies.

Growth velocity of fetal sacrococcygeal teratoma as predictor of perinatal morbidity and mortality: multicenter study.

To identify prenatal predictors of poor perinatal outcome in fetuses with isolated sacrococcygeal teratoma (SCT). This was a retrospective study of fetuses with isolated (non-syndromic) SCT managed at one of five pediatric surgery and/or fetal medicine centers between January 2007 and December 2017. The primary outcome was the occurrence of poor perinatal outcome, defined as prenatal death (including termination), or neonatal death or severe compromise (hemorrhagic shock). Data regarding prenatal diagnosis (sonographic features both at referral and at the last ultrasound examination before pregnancy outcome, assessment of SCT growth velocity), perinatal complications and outcome, and neonatal course were analyzed to determine prenatal SCT characteristics associated with adverse perinatal outcome. Fifty-five fetuses were included, diagnosed with isolated SCT at a median gestational age of 22 (interquartile range, 18-23) weeks. There was a poor perinatal outcome in 31% (n = 17) of these cases, including intrauterine fetal demise (4%, n = 2), pregnancy termination (13%, n = 7) and neonatal severe compromise (15%, n = 8), leading to neonatal death in five cases. The overall survival rate after prenatal diagnosis of isolated SCT was 75% (n = 41 of 55). Earlier gestational age at diagnosis (P = 0.02), large tumor volume at referral (P < 0.001), presence of one or more hemodynamic complications (P = 0.02), fast tumor growth velocity (P < 0.001) and high tumor grade (highest tumor grade ≥ 3) (P = 0.049) were associated with poor perinatal outcome on univariate analysis. On stepwise logistic regression analysis, tumor growth velocity was the only remaining independent factor associated with poor perinatal outcome (odds ratio (OR) (per 1-mm/week increase), 1.48 (95%CI, 1.22-1.97), P = 0.001). The best predictive cut-off of tumor growth velocity for poor perinatal outcome was 7 mm/week (OR, 25.7 (95%CI, 5.6-191.3), P < 0.001), yielding a sensitivity of 88% and a specificity of 77%. Approximately 30% of fetuses with a diagnosis of isolated SCT have poor perinatal outcome. Tumor growth velocity ≥ 7 mm/week appears to be an appropriate discriminative cut-off for poor perinatal outcome. These results could help to inform prenatal management and counseling of parents with an affected pregnancy. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A comparative study of the growth indicators of infants born before and during the Covid-19 pandemic

IntroductionGrowth disorders pose significant mental and physical health challenges with long-term complications for children. As monitoring children's growth is of paramount importance, in the present study attempts are made to compare growth indicators of infants from birth to 12 months before and during the outbreak of COVID-19 pandemic. Material and methodThe present descriptive-analytical study was conducted using cluster sampling method in 10 comprehensive healthcare centers and on 200 infants in southwest of Iran during 2023. The infants’ health records and growth chart before and during the outbreak of COVID-19 pandemic served as data collection instruments. The collected data were analyzed using SPSS 21 software and descriptive and analytical statistics. ResultEconomic hardship, job loss, maternal disease and neonatal acquired disease were found to be significantly higher during the pandemic outbreak compared to the pre-pandemic time. the average weight and BMI of the infants in both groups showed no significant difference from birth to two months old, but the difference was found to be significantly higher from 4 months to 1-year-old among infants born during the pandemic (P-value<0.05). Result this study showed that during the pandemic trend of The age of word articulation by infants was increasing (P-value=0.022) and at this time 6 cases of missed vaccination were observed. ConclusionThe results indicate that the COVID-19 pandemic can affect the growth and development of infants, and may, in some cases, disrupt the growth and routine vaccination schedule during infancy and breastfeeding, which should be prevented by proper parental training.

Deciphering Growth Patterns in Korean Children With Sotos Syndrome Through the Development of a Disease-Specific Growth Chart.

Sotos syndrome (SS) is a rare disorder characterized by overgrowth, distinctive facial features, and intellectual disability that is primarily caused by NSD1 pathogenic variants or 5q35 microdeletions. We retrospectively analyzed the clinical characteristics and 339 anthropometric measurements over an average of 4.3 years of follow-up in 57 Korean children with SS. Sex-specific percentile curves for height, weight, and head circumference were developed using a generalized additive model that included factors such as location, scale, and shape. Males with SS demonstrated higher height before the age of 12.0, greater weight before 10.0, and larger head circumference before 15.5 compared to age- and sex-matched controls. Females with SS displayed higher height before 17.0, greater weight before 10.5, and larger head circumference before 12.0 compared to controls. Bone age was advanced compared to chronological age in 40% of males and 8% of females at their last visit. The predicted and target adult heights were not significantly different between groups. In subgroup analysis, the intragenic variant group (n = 48) showed a higher mean standard deviation score of height and weight in males, and head circumference in females compared to the microdeletion group (n = 9). Korean children with genetically confirmed SS exhibited overgrowth in height, weight, and head circumference. Overgrowth phenotypes were more prominent in patients with NSD1 intragenic variants than in those with microdeletions. This is the first study to provide reference data on the growth of Korean children with SS.

Comparative analysis of INTERGROWTH-21st and Fenton growth charts for birthweight classification in a multiethnic Asian cohort: a cross-sectional study.

The objective of this study is to evaluate the impact of using International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) (IG-21) growth standards compared with Fenton growth charts on birthweight classification in a multiethnic newborn cohort in Singapore. Cross-sectional study. KK Women's and Children's Hospital, Singapore. Study population included 2541 babies born between 16 December 2019 and 16 March 2020. None. Birthweight classifications of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) were assessed using IG-21 and Fenton growth charts. The level of agreement between the two charts was measured using Cohen's kappa coefficient (K). Of 2541 neonates, 171 (6.7%) had discordant birthweight classifications. The kappa coefficient indicated moderate overall agreement (K=0.79) between the charts, with decreasing agreement from preterm (K=0.88) to full-term categories (K=0.71). The largest discordance was observed in 98 (60.5%) neonates classified as LGA by IG-21 but AGA by Fenton. In comparison, 60 (2.9%) neonates classified as AGA by IG-21 were SGA by Fenton, while 13 (4.6%) were SGA by IG-21 but AGA by Fenton. The study found discrepancies in birthweight classification between IG-21 and Fenton growth charts, with Fenton charts overclassifying SGA and underclassifying LGA in our study population. These findings suggest the potential need to integrate IG-21 growth standards into local practice to improve accuracy in neonatal growth assessment. Further research is necessary to evaluate the clinical implications of these discordant classifications on neonatal outcomes.

Response of children with Turner syndrome with different types of karyotype abnormalities to growth hormone treatment.

Short stature is the main characteristic of Turner syndrome (TS) patients and growth hormone (GH) therapy has been essential for achieving the final adult height (Ht). In the present study, the response of TS patients with different types of karyotype abnormalities to GH therapy was analyzed. The clinical parameters of 194 TS patients registered in the LG Growth Study were retrospectively reviewed. Data for 4 groups of subjects were obtained as follows: monosomy X (n=56); X structural abnormality (n=26); X mosaicism without structural abnormality (n=41); X mosaicism with structural abnormality (n=71). Clinical characteristics and growth response parameters were compared over 3 years of GH treatment. The baseline Ht standard deviation score (SDS) of all patients was -2.85±0.86. The baseline Ht SDS, body mass index SDS, and chronological age (years)-bone age (years) were significantly different based on chromosomal abnormalities. The growth velocity (GV; cm/yr) in the first year was the highest and significantly different among the groups. The GV in the second year also showed an increase in the X mosaicism without structural abnormality group compared with the monosomy X group. The change in Ht SDS (ΔHt SDS) over 3 years was not statistically different between karyotypes. The response to 3 years of GH therapy did not differ based on the karyotype of TS patients although the initial Ht SDS was the lowest in the monosomy X group.

Comparison of growth hormone stimulation tests in prepubertal children with short stature according to response to growth hormone replacement.

Growth hormone (GH) stimulation tests are essential tools for diagnosing GH deficiency (GHD). We aimed to compare L-dopa, insulin, and arginine-induced stimulation tests based on response to GH replacement. We retrospectively collected data from a review of patients who underwent the GH stimulation test. A total of 138 patients diagnosed with idiopathic short stature were categorized into group I. The remaining 135 patients, who were diagnosed with GHD and treated for 1 year, were classified into 2 subgroups: group IIa, consisting of patients with an increase of at least 0.5 in height standard deviation score (SDS), and group IIb, patients with an increase of less than 0.5 in height SDS. At the initial visit, group IIa exhibited significantly lower insulin-like growth factor binding protein-3 (IGF-BP3) and higher body mass index (BMI) SDS compared to the other groups. Following 1 year of treatment, group IIb showed significantly lower height SDS, height SDS gain, growth velocity, predicted adult height SDS, weight SDS, and a higher insulin-like growth factor-1 SDS than group IIa. Bone age and IGF-BP3 were inversely associated, and BMI SDS and IGF-BP3 were positively associated with height SDS gain in GHD patients. The specificity and accuracy rates were 50.3% and 70.3% for the L-dopa-induced stimulation test, 72.3% and 86.6% for the insulin tolerance test (ITT), and 64.7% and 87.2% for the arginine-induced stimulation test (ArST). The ArST demonstrated lower specificity compared to the ITT. However, patients undergoing ArST experienced fewer side effects, suggesting that a careful selection of stimulation tests is crucial in diagnosing GHD.

Relationship Between Gross Motor Function and Nutritional Status of Children with Cerebral Palsy-A cross-sectional study in a Tertiary Care Hospital of Bangladesh

Background: Cerebral Palsy (CP) is one of the most common causes of chronic disability in children. Childhood malnutrition is a major public health issue in low- and middle-income countries. The gross motor function of children with CP can easily be assessed by the tool Gross Motor Function Classification System- Expanded &amp;Revised (GMFCS-E&amp;R). This study aimed to determine the relationship between GMFCS and nutritional status in children with cerebral palsy. Method: This cross-sectional observational study was conducted in the Department of Pediatric Neurology, IPNA, BSMMU from October 2019 to August 2020. All the patients aged 2-12 years were diagnosed as CP by clinical criteria and classified by GMFCS. Nutritional status (weight for age, height for age, weight for height, BMI) is assessed and classified according to the World Health Organization growth charts. Then linear and multinomial logistic regression methods to determine the associations between GMFCS and nutritional status. The correlation between motor function and nutritional status was assessed. Results: Among the 50 children 68% were male and 32% were female. The mean age of the CP children was 4.90±3.05 years. Most patients (66.0%) came from poor families followed by 24% from the middle class. Functionally majority of patients were in GMFCS level IV (28.0% ) and level V (20.0%). Maximum patients in spastic quadriplegia 42%, spastic hemiplegia 16%. The level of GMFCS was associated with nutritional status, as determined by anthropometry. Moderate and severe underweight significantly related with GMFC level IV and V. Moderate and severe stunted was significantly related with IV and V GMFC level. Moderate wasted was significantly related to GMFC levels III and IV. Mild malnutrition was significantly with GMFC level II and III. Severe malnutrition is significantly related to GMFC level IV and V. Conclusion: This study showed majority of cerebral palsy cases had severe functional gross motor disability and also severe grade of malnutrition. A significant association between severe grade of malnutrition and severe grade of motor disability was found. J Bangladesh Coll Phys Surg 2024; 42: 342-349

Growth Status of Bangladeshi Children in Functional Constipation: Experience From A Tertiary Care Hospital

Background: Constipation is one of the common complaints of children with long-term hazardous consequences. It is a frequent cause of hospital visit in both primary and specialized care which needs proper evaluation and management. Recently in few studies, impairment of growth status has been reported as a result of functional constipation. But the relation is not well evaluated, especially in the pediatric population of our country. Aim: To assess the growth status of Bangladeshi children in functional constipation. Methods: This analytical study was conducted at the department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka. A total 150 children aged 2-18 years were enrolled in this study. Children were divided into two groups, 75 having functional constipation (FC) and 75 healthy children with no constipation. Samples were collected randomly from pediatric out-patient department of BSMMU with consent of parents and child’s approval. Diagnosis of functional constipation was made by Rome IV criteria. Children with any red flag sign, chronic disease and on treatment of constipation were excluded from the study. Growth status (weight, height &amp; BMI) was evaluated by using growth charts. Data collected in semi-structured questionnaire and analyzed by SPSS 23.0. Results: We evaluated 75 constipated children with the mean age of 7.61±3.50 years and 75 healthy children with the mean age of 7.40±3.88 years. The mean weight of children with functional constipation was 22.8±10.01 kg, mean height 117.7 ±18.4 cm and BMI 15.6±2.3 kg/m2. The mean weight of children with no constipation was 28.6± 13.72 kg, mean height 124.49±23.3 cm and BMI 18.11±2.9 kg/m2,demonstrated significant difference between two sets. In functional constipation group, on weight for age and height for age chart, 28% and 24% children were below the 3rd centile respectively and 18.6% children had BMI below 5th centile. All these parameters (weight, height, BMI) were statistically significant in compare to children without constipation and p value is &lt;.05. Presenting features of functional constipation were anorexia (64%), abdominal pain (73.3%), hard stool (84%), blood mixed hard stool (13.3%) and nausea (34%). Conclusion: Growth impairment occurs in children with functional constipation in comparison to children without constipation. Children aged 2 to 18 years with functional constipation may have decelerated weight, height and BMI growth. And this observation needs further large-scale multicenter study for ensuring optimal growth of children with constipation. J Shaheed Suhrawardy Med Coll 2023; 15(1): 73-77

Kidney volume and function of low-birth-weight children at 5years: impact of singleton and twin birth.

Many studies have demonstrated the association between low birth weight (LBW) and chronic kidney disease, estimated glomerular filtration rate (eGFR) and kidney volume (KV). However, studies on twins and those investigating numerous perinatal factors beyond LBW, and their associations with various kidney parameters are scarce. A two-center cross-sectional study on five-year-old LBW children was conducted between 2021 and 2023. 110 children were enrolled (8 LBW, 58 very LBW (VLBW), 44 extremely LBW (ELBW)); 56 were twins. We examined associations between birth weight (BW), various prenatal, perinatal and postnatal factors, and eGFR, KV, tubular abnormalities and kidney ultrasound abnormalities, both in singletons and twins. In children with ELBW, eGFR correlated with BW (r = 0.55, P = 0.0018), while in those with BW ≥ 1000g, eGFR remained constant. Other factors associated with decreased eGFR were hypertensive disorder of pregnancy (93.86 vs. 87.26ml/min/1.73m2, P = 0.0285) in singletons, decreased growth velocity (β = 0.83, P = 0.0277) in twins, and lower total KV (tKV) and relative KV (rKV) in both singletons (r = 0.60, P < 0.0001 for tKV and r = 0.45, P = 0.0010 for rKV) and twins (β = 0.34, P < 0.0001 for tKV and β = 0.23, P = 0.0002 for rKV). Based on the multivariable models excluding KV, BW and gestational age were associated with eGFR in singletons, while male gender, BW, growth velocity, and coffee drinking during pregnancy were associated with eGFR in twins. However, in models that included KV, BW, gestational age and growth velocity were no longer significant. Total KV was associated with BW (r = 0.39, P = 0.0050 for singletons; β = 2.85, P < 0.0001 for twins), body mass index (r = 0.34, P = 0.0145 for singletons; β = 8.44, P < 0.0001 for twins), and growth velocity (β = 1.43, P = 0.0078). Twins born small for gestational age had lower tKV (70.88 vs 89.20ml, P < 0.0001). Relative KV showed similar associations. Relative kidney volumes were significantly lower for both kidneys compared to the reference population (55.02 vs 65.42ml/m2, P < 0.0001 for right kidney and 61.12 vs 66.25ml/m2, P = 0.0015 for left kidney); however, only 8.6% of children had rKV below 10th percentile. Many factors affect eGFR and KV, some of them differ between twins and singletons. Based on multivariable models, eGFR seems to be better predicted by KV than by BW and gestational age in LBW children. Relative kidney volumes were significantly lower in our cohort compared to the reference population, but only 8.6% of rKV were below 10th percentile.

Association of age to nutritional status and muscle mass in children with transfusion-dependent β-thalassemia: a cross-sectional study

BackgroundTransfusion-dependent β-thalassemia (TDT) is a hereditary blood disorder that often leads to complications affecting growth, nutritional status, and muscle mass in children. This study aims to investigate the associations between age, nutritional status, and muscle mass in children with TDT, providing insights into the progressive impact of age on these parameters.MethodsOne hundred twenty-two children with TDT from March 2023 to March 2024 were enrolled in this cross-sectional study. Their nutritional status was assessed using the 2006–2007 World Health Organization (WHO) Growth Charts, and their muscle mass was measured using bioelectrical impedance analysis (BIA). Data related to age, gender, weight, height, fat-free mass (FFM), skeletal muscle mass (SMM), and soft lean mass (SLM) of children were collected for comparative analysis from the hospital record room. Furthermore, Spearman’s rank correlation coefficients and regression analyses were utilized to investigate the associations between age and both nutritional status and muscle mass.ResultsThe results of this study revealed negative correlations between age and wasting (r = −0.26, p &amp;lt; 0.001), stunting (r = −0.28, p &amp;lt; 0.001), FFM (r = −0.3, p &amp;lt; 0.001), SMM (r = −0.23, p &amp;lt; 0.01), and SLM (r = −0.36, p &amp;lt; 0.001). The regression analysis indicated that age was an independent predictor of wasting, stunting, and reduced muscle mass in these children (all p &amp;lt; 0.001).ConclusionOur study observed a trend of worsening stunting, wasting, and muscle loss in children with TDT as they age. These findings highlight the importance of monitoring both nutritional and muscular health in TDT patients. Early detection and comprehensive nutritional management may improve outcomes in this population.

Placental volume at gestational week 27 and subsequent fetal growth: An observational study

ObjectivesTo study if placental volume and placental to fetal ratio at gestational week (GW) 27 correlate with subsequent fetal growth. We also investigated whether the 1/3 smallest and 1/3 largest fetuses have different growth potential depending on placental volume. MethodsPlacental and fetal volume was measured by magnetic resonance imaging (MRI) at GW 27 and 37 in 86 singleton pregnancies. Placental to fetal ratio was calculated as placental volume/fetal volume. Growth was calculated as [(fetal volume at GW 37 – fetal volume at GW 27)/number of days between the MRI examinations]. To explore whether a higher placental volume affected growth of small and large fetuses differently, we performed separate analyses of the 1/3 smallest and 1/3 largest fetuses with placental volume under and above the median at GW 27. ResultsWe found a positive correlation of both placental volume and placental to fetal ratio at GW 27 with average growth velocity, r = 0.51 (p < 0.001) and r = 0.33 (p = 0.002) respectively. The correlation between fetal volume at GW 27 and average growth velocity was r = 0.48 (p < 0.001). The small fetuses had significantly lower average growth velocity if the placental volume was low compared to if the placental volume was high, 22 (SD 3) cm3/day versus 25 (SD 3) cm3/day, p = 0.02. Among the large fetuses, placental volume did not significantly affect growth. ConclusionsPlacental volume and placental to fetal ratio at GW 27 were positively correlated with subsequent fetal growth. Possibly, placental size is an indicator of fetal growth potential, especially among small fetuses.

Assessment of the Scholastic Performance and Cognitive Functions in Malnourished Children of Primary and Secondary Class Students

Abstract Background: Malnutrition is the consequence of a combination of deficiencies in protein, carbohydrates, and micronutrients. It includes undernutrition, overnutrition, and micronutrient deficiencies. Malnutrition is associated with both structural and functional pathology of the brain and reflects in poor scholastic performance and less cognitive functions in children. Aim: The aim of the study was to assess the scholastic performance and cognitive functions in malnourished children of primary and secondary classes studying in a school. Methodology: The study was conducted on 375 school children of primary and secondary classes. The nutritional status was assessed using the World Health Organization growth charts and classified based on their weight, height, and body mass index with malnutrition considered with values &lt;−2 standard deviation for the age group. The scholastic performance was assessed using the school annual examination records and classified as good or poor scholastic performance with cutoff mark criteria of 50%. The cognitive function was assessed using the child mini–mental state examination (MMSE) test with the mean score for the age group. The scholastic performance and cognitive function were compared between the normal and malnourished groups. The variables were compared with respect to age, gender, standard, and P value obtained to see its significance. The variables were compared between the two groups in each class and test results were obtained. The correlation between each of the variables was also done. Results: Malnourished children were more in the primary classes (30%) than the secondary classes (13.2%). The scholastic performance in the normal group was increased than the malnourished group in both primary and secondary classes. The cognitive function based on the child MMSE score was also more in the normal group than in the malnourished group in both primary and secondary classes. There was a positive correlation between scholastic performance and cognitive function. Conclusion: The study results showed that the scholastic performance and cognitive function were decreased in the malnourished group than the normal group in both primary and secondary classes, implying that malnutrition affects the functionality of the brain and can cause long-term effects like poor cognition.

Head circumference values among Inuit children in Nunavut, Canada: a retrospective cohort study.

Inuit children from Nunavut have been observed to have high rates of macrocephaly, which sometimes leads to burdensome travel for medical evaluation, often with no pathology identified upon assessment. Given reports that World Health Organization (WHO) growth charts may not reflect all populations, we sought to compare head circumference measurements in a cohort of Inuit children with the WHO charts. We extracted head circumference data from a previous retrospective cohort study where, with Inuit partnership, we reviewed medical records of Inuit children (from birth to age 5 yr) born between Jan. 1, 2010, and Dec. 31, 2013, and residing in Nunavut. To create a cohort of Inuit children similar to the cohorts used in the development of the WHO growth charts, we excluded children with preterm birth, documented neurologic or genetic disease, and most congenital anomalies. We compared head circumference values with the 2007 WHO charts using centiles estimated with a generalized additive model. We analyzed records of 1960 Inuit children (8866 data points), of whom 993 (50.8%) were female. Most data were from ages 0 to 36 months. At all age points, we found that the study cohort had statistically significantly larger head circumferences than WHO medians, with most z scores for head circumference measurements among Inuit children falling 0.5-1 standard deviations above the WHO reference (p < 0.001). At age 12 months, median head circumferences were 1.3 cm and 1.5 cm larger for male and female Inuit children, respectively. Using WHO growth curves, macrocephaly was significantly overdiagnosed and microcephaly was underdiagnosed (p < 0.001). Our results support the observation that Inuit children from Nunavut have larger head circumferences than other populations, and use of the WHO charts may thus lead to overdiagnosis of macrocephaly and underdiagnosis of microcephaly. Population-specific growth curves for Inuit children should be considered to provide timely and appropriate diagnoses of microcephaly and avoid overinvestigation of macrocephaly.

Growth kinetics and microstructure transition of undercooled Fe7(CoNi)75B18 eutectic muti-principal element alloy

The mechanism of rapid solidification behavior of eutectic muti-principal element alloys (EMPEAs) is an eye-catching field. In this study, the novel Fe7(CoNi)75B18 EMPEA was undercooled via rapid solidification and B2O3 glass purification method and the maximum undercooling up to 190 K was achieved. A clear microstructure evolution path was identified with the undercooling: fully regular eutectic → primary dendrite and regular eutectic → primary dendrite and divorced eutectic. The orientation relationship (OR) between the primary (Fe, Co, Ni) phase and secondary B-rich phase was revealed both at low and medium undercoolings by electron backscatter diffraction (EBSD) analysis. The results show that the OR disappears at high undercooling (190 K) owing to the microstructure fragment and rotation during the post-recalescence. Furthermore, the growth velocity exponentially raised with the increase of undercooling. The maximum growth velocity of the primary phase was 1.152×10−1 m/s, which is significantly lower than binary alloys due to the sluggish kinetics effect of EMPEAs. This study helps to understand the solidification kinetics and microstructure transition of the novel EMPEA and has important implications for controlling the solidification process of more complex alloys.

Three Therapy Regimens and Their Cost-effectiveness for Girls With Central Precocious Puberty: A Real-World Clinical Study.

The objective of this study was to evaluate the effectiveness and cost-effectiveness of different therapy regimens for girls with central precocious puberty (CPP). This study retrospectively analyzed CPP girls from 2013 to 2021 and grouped them into GnRHa, Mixed, and GnRHa+GH based on therapy regimen. While comparing the differences among these groups, initial age and bone age of GnRHa group girls were significantly lower than Mixed and GnRHa+GH groups, but their growth level was significantly higher (P < .05). In the Mixed group, starting with GnRHa alone, the predicted adult height improvement (ΔPAH) decreased to -1.0 cm in the second year, prompting addition of growth hormone (GH) therapy in the third year, resulting in a ΔPAH increase to 3.0 cm. At therapy completion, final predicted adult heights (PAHs) were similar among the groups at 155.6 to 156.7 cm, with ΔPAH between 5.8 and 6.5 cm and no significant intergroup differences (P > .05). Younger CPP girls with greater height can begin therapy with GnRHa alone. Consideration of combining GH therapy depends on growth velocity and PAH during treatment.

Phase 2 Trial of Vosoritide Use in Patients with Hypochondroplasia: A Pharmacokinetic/ Pharmacodynamic Analysis.

Vosoritide is a C-type natriuretic peptide (CNP) analog that binds its receptor on chondrocytes, promoting growth by inhibiting the ERK1/2-MAPK pathway. We previously reported the results of a Phase II study in children with hypochondroplasia. Vosoritide led to an average increase in annualized growth velocity (AGV) of 1.81 cm/year and gain of 0.36 in height SD over 12 months. We present here the pharmacokinetic/ pharmacodynamic (PK/PD) data from this study and examine the correlations between these parameters and growth outcomes. We conducted a Phase II trial of daily subcutaneous vosoritide (15 mcg/kg/day) in 24 prepubertal subjects with hypochondroplasia (12 females, mean age 5.9+/-2.3 years, mean height -3.29+0.68 SD). Plasma vosoritide levels were assayed using an electrochemiluminescence assay. Pharmacodynamic markers including serum collagen X biomarker (CXM) and urine cGMP production were measured at Day 1, Month 6 and Month 12 visits. Pearson correlations and regression analyses were performed between PK and PD parameters and growth outcomes. Vosoritide PK parameters were similar to those previously reported in patients with achondroplasia. CXM levels increased from a baseline mean of 22.5±6.5 to 41.6±15.9 ng/ml after 12 months of treatment (p &lt; 0.0001). Urine cGMP increased within 1 hour and peaked at 2 hours after injection. The mean AUC for cGMP production was not significantly different at each study visit. The maximum change in cGMP AUC correlated with PK AUC ((r=0.46, p=0.0001). However, drug exposure, as measured by average PK AUC, did not correlate with any growth outcome. CXM levels correlated with the prior 6-month interval height velocity (partial correlation coefficient=0.40, p=0.0048). However, change in CXM did not correlate with change in height velocity or change in height SD during treatment. Vosoritide treatment showed improvement in AGV and height SD in children with hypochondroplasia. PK analysis indicates that drug exposure was correlated to global CNP activity as measured by urine cGMP but did not correlate with growth outcomes. More studies are needed to identify specific patient characteristics that can predict response to therapy and clinical outcomes.

A Phase3, Open-Label, Single-Arm Trial of the Efficacy and Safety of Triptorelin 6-Month Formulation in Chinese Children with Central Precocious Puberty.

This phase3 study assessed the efficacy, safety, and pharmacokinetics of the 6-month prolonged release (PR) formulation in Chinese children with central precocious puberty (CPP). In this open-label study (NCT05029622), Chinese children (girls < 9years, boys < 10years) received two doses of triptorelin pamoate 22.5mg (day1 and month6). Primary endpoint was the proportion at month6 with luteinizing hormone (LH) suppression (stimulated peak LH ≤ 5IU/L after gonadotropin-releasing hormone stimulation). Secondary endpoints included safety assessments, hormone level changes, and clinical parameters from baseline. Overall, 66 children completed the study (93.9% girls; median age 8.0 [range 5-9] years). At month6, all patients had LH suppression; this was maintained at month12 in 98.5% of patients. Mean basal and peak LH and follicle-stimulating hormone levels were suppressed throughout follow-up. All patients at months3 to 12had sex hormone suppression to prepubertal levels. Stable or reduced breast development was seen for 98.4% and 93.5% of girls at month6 and 12, respectively; all boys had regression or stable genital development until month12. Compared with baseline (9.82cm/year), mean growth velocity was 5.88cm/year at month6 and 5.17cm/year at month12. Mean bone age/chronological age ratio decreased from 1.27 at baseline to 1.23 and 1.21 at month6 and 12, respectively. In girls, 64.5% showed decreased uterine length at month6 and 12 versus baseline, while 75.0% of boys showed stable testicular volume versus baseline. Thirteen patients (19.7%) had 22 drug-related treatment emergent adverse events (TEAEs); no grade ≥ 3 TEAEs were reported. The efficacy and safety profile of triptorelin 6-month PR in Chinese children with CPP was consistent with data previously reported in non-Chinese children with CPP, supporting this as a viable treatment option for Chinese children with CPP. Trial registration:ClinicalTrials.gov identifier, NCT05029622.

Efficacy of vedolizumab and ustekinumab in pediatric-onset inflammatory bowel disease: A real-world multicenter study.

Vedolizumab and ustekinumab are effective in inducing and maintaining corticosteroid-free clinical remission (CFR) in adult patients with inflammatory bowel disease (IBD). This study describes the efficacy and safety of vedolizumab and ustekinumab in pediatric IBD. All patients ≤18 years of age with Crohn's disease (CD) or ulcerative colitis (UC) treated with vedolizumab or ustekinumab in three centers in Northern France were followed retrospectively. The primary outcome was CFR at Week 14 (W14). Twenty-five patients (9 CD, 16 UC) and 33 patients (28 CD, 5 UC) were started on vedolizumab and ustekinumab respectively between 2016 and 2021. All were previously treated with antitumor necrosis factor (TNF). The median time from diagnosis to treatment initiation was 21.0 (12.0-44.0) and 42.0 (22.0-73.5) months for vedolizumab and ustekinumab respectively. Among vedolizumab-treated patients, 36% were in CFR at W14, including 22% in CD and 44% in UC. At W52, 56% were in CFR, including 33% in CD and 69% in UC. Among ustekinumab-treated patients, 49% were in CFR at W14, including 54% in CD and 20% in UC. At W52, 55% were in CFR, including 57% in CD and 40% in UC. There was a significant increase in median growth velocity between W0 and W52 of +2 SD in vedolizumab-treated patients (p = 0.0002). Four adverse events were reported during vedolizumab treatment, none for ustekinumab-treated patients. Vedolizumab and ustekinumab appear to be effective in inducing and maintaining CFR in pediatric-onset IBD. Randomized controlled trials are needed to confirm these results.