Growth Impairment In Children Research Articles

Prenatal arsenic exposure is associated with increased plasma IGFBP3 concentrations in 9-year-old children partly via changes in DNA methylation

Exposure to inorganic arsenic (As), a carcinogen and epigenetic toxicant, has been associated with lower circulating levels of insulin-like growth factor 1 (IGF1) and impaired growth in children of pre-school age. The aim of this study was to assess the potential impact of exposure to As on IGF1 and insulin-like growth factor-binding protein 3 (IGFBP3) as well as DNA methylation changes in 9-year-old children. To this end, we studied 9-year-old children from a longitudinal mother–child cohort in rural Bangladesh (n = 551). Prenatal and concurrent exposure to As was assessed via concentrations in maternal urine at gestational week 8 and in child urine at 9 years, measured by HPLC-HG-ICPMS. Plasma IGF1 and IGFBP3 concentrations were quantified with immunoassays. DNA methylation was measured in blood mononuclear cells at 9 years in a sub-sample (n = 113) using the Infinium HumanMethylation450K BeadChip. In multivariable-adjusted linear regression models, prenatal As (natural log-transformed), but not children’s concurrent urinary As, was positively associated with IGFBP3 concentrations (β = 76, 95% CI 19, 133). As concentrations were not associated with IGF1. DNA methylation analysis revealed CpGs associated with both prenatal As and IGFBP3. Mediation analysis suggested that methylation of 12 CpG sites for all children was mediator of effect for the association between prenatal As and IGFBP3. We also found differentially methylated regions, generally hypermethylated, that were associated with both prenatal As and IGFBP3. In all, our study revealed that prenatal exposure to As was positively associated with IGFBP3 concentrations in children at 9 years, independent of IGF1, and this association may, at least in part, be epigenetically mediated.

The effects of water-pipe smoking on birth weight: a population-based prospective cohort study in southern Iran.

OBJECTIVESConsecutive community health assessments revealed that water-pipe smoking in women and impaired growth in children were among the main health concerns in suburban communities in southern Iran. The aim of the present study was to identify the effects of water-pipe smoking during pregnancy on birth weight.METHODSData from a population-based prospective cohort study of 714 singleton live pregnancies in the suburbs of Bandar Abbas in southern Iran in 2016-2018 were used in this study. Data about water-pipe smoking patterns and birth weight were collected by questionnaires during and after the pregnancy. Low birth weight (LBW) was defined as a birth weight below 2,500 g. Statistical analyses were performed using generalized linear models, and the results were presented in terms of relative risk (RR) and 95% confidence intervals (CI).RESULTSFifty (8.2%) of the study subjects smoked water-pipe. The adjusted risk of LBW increased 2-fold in water-pipe smokers (adjusted RR [aRR], 2.09; 95% CI, 1.18 to 3.71), and by 2.0% for each 1-year increase in the duration of water-pipe smoking (aRR, 1.02; 95% CI, 0.99 to 1.05).CONCLUSIONSOur results showed that water-pipe smoking during pregnancy was an important risk factor for LBW in this population sample from southern Iran. The introduction of regulations onto prevent water-pipe smoking and the implementation of community health action plans aiming at empowering women and increasing women’s knowledge and awareness regarding the health consequences of water-pipe smoking are proposed.

Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study.

We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth. Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed-up twice weekly for the first 6 months of life. Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight-for-length (P < 0.05) and weight-for-age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight-for-length and weight-for-age. The most frequent EAEC coinfections included Campylobacter spp, heat-labile toxin-producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no-pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast-feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05). These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.

Growth Impairment in Acute Central Infectious Diseases

AbstractAcute meningitis is an inflammation of the meninges affecting the pia, arachnoid, and subarachnoid space that still causes morbidity and mortality. Among the sequelae of meningitis, endocrine complications have been reported in patients recovering from acute central infectious diseases. Although the results of the studies are conflicting, the most common pituitary hormone deficiency during the acute phase or at 1-year follow-up evaluation is growth hormone deficiency, which results in growth impairment in children and a dysregulation of body composition and lipid metabolism throughout life. The mechanisms involved in growth failure secondary to meningitis are unknown. Therefore, endocrinological evaluation, including clinical, auxological, and hormonal assessments, should be performed during the acute phase of the infection and during recovery.

Enteric Infections in Young Children are Associated with Environmental Enteropathy and Impaired Growth.

To investigate the relationship between faecal contamination in child play spaces, enteric infections, environmental enteropathy (EE) and impaired growth among young children. A prospective cohort study was conducted of 203 children 6-30months of age in rural Bangladesh. Stool samples were analysed by quantitative PCR for Shigella, Enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, Giardia intestinalis and Cryptosporidium spp. Four faecal markers of intestinal inflammation were also measured: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. Child growth was measured at baseline and 9months after enrolment. E.coli was measured in soil in child play spaces. Forty-seven percent of study children had three or more enteric pathogens in their stool. Thirty five percent (71/203) of children had Shigella, 30% (61/203) had ETEC, 73% (148/203) had C.jejuni, 79% (160/203) had Giardia intestinalis and none had Cryptosporidium. Children with ETEC had significantly higher calprotectin concentrations (Coefficient: 1.35, 95% Confidence Interval [CI]: 1.005, 1.82). Children with Shigella had a significantly higher odds of being stunted at our 9-month follow-up (OR: 2.01, 95% CI: 1.02, 3.93). Children with Giardia intestinalis had significantly higher E.coli counts in the soil collected from their play spaces (OR: 1.23, 95% CI: 1.02, 1.48). Enteric infections were significantly associated with EE and impaired growth in rural Bangladesh. These findings provide further evidence to support the hypothesis that contaminated soil in child play spaces can lead to enteric infections, many of which are likely subclinical, resulting in EE and impaired growth in young children.

Impact of elimination diets on nutrition and growth in children with multiple food allergies.

Growth and nutritional intake of children with cows' milk allergy and other food allergens has been thoroughly investigated in recent years across many different countries and age groups. An impaired growth in atopic children should not be attributed only to a high number of allergens and foods to be avoided, but to a general condition of 'sub-inflammation', which unfavorably affects the absorption and utilization of fuel and substrates. Atopic study participants may represent a good target for personalized nutrition and in this review we sought to outline many of the issues that should be taken into account when dietitians advise patients regarding food avoidance and expected effects on growth. The dietary management of food allergy requires appropriate dietary choices to maintain adequate growth, starting with special formulas in infancy. An emerging area of research is the fussy eating related to the exclusion of cow's milk and other foods during infancy and the long-term effects on eating habits and food preferences. Study participants with either mono or polyallergic diseases should ideally undergo the definition of their allergic and metabolic characteristics, to precisely adjust dietary interventions on an individual basis to support the genetic potential of growth and prevent unfavorable outcomes.

A Review on the Safety and Efficacy of Inhaled Corticosteroids in the Management of Asthma

Asthma is a chronic inflammatory disease characterized by symptoms of cough, dyspnea, chest tightness, and wheeze. Inhaled corticosteroids (ICS) have been recommended as initial therapy in the treatment of persistent asthma in all guidelines, as they have been shown to reduce morbidity and mortality. However, high-dose regimens and long-term use of ICS may be associated with a variety of side effects, similar to those observed with systemic corticosteroid therapy. These side effects include impaired growth in children, osteoporosis, fractures, glaucoma, cataracts, and skin thinning. The current recommendations on ICS use in asthma management will be reviewed in this article with a view to highlight treatment strategies that strike an optimal balance between safety and efficacy.

Infant nutritional status and markers of environmental enteric dysfunction are associated with mid‐childhood anthropometry and blood pressure in Tanzania

BackgroundIn industrialized countries, risk factors for chronic diseases are linked with infant nutritional status; however, limited data exist from resource‐poor settings, where rates of undernutrition, infectious disease, environmental enteric dysfunction (EED), and impaired child growth in infancy and childhood are high.ObjectiveTo assess the extent to which growth and biomarkers of EED in infancy are related to health outcomes in mid‐childhood in Dar es Salaam, Tanzania.MethodsChildren who participated in one of two randomized controlled trials of micronutrient supplements in infancy were followed‐up in mid‐childhood (4.6–9.8 years). Anthropometry was measured at age 6 and 52 weeks in both trials, while blood samples were available from all children at 6 weeks and 6 months from one of the two trials. Linear regression models were used to assess whether length‐for‐age, weight‐for‐age and weight‐for‐length z‐scores (LAZ, WAZ and WLZ) at age 6 weeks, and change from 6 to 52 weeks, as well as flagellin IgG and IgA and LPS IgG and IgG predicted height‐for‐age, body‐mass‐index and weight for age z‐scores (HAZ, BMIZ and WAZ) as well as systolic and diastolic blood pressure in mid‐childhood.Results113 children were re‐enrolled in the follow‐up study in mid‐childhood. LAZ at 6 weeks and change in LAZ from 6 to 52 weeks were independent, positive predictors of HAZ in mid‐childhood in multivariate models (p&lt;0.001 for both), while change in WAZ and WLZ from 6 to 52 weeks were also positively correlated with mid‐childhood HAZ in multivariate models. 6‐week WLZ and change in WLZ from 6 to 52 weeks were independently, positively associated with BMIZ in mid‐childhood in multivariate models as were WAZ at 6 weeks and change in WAZ during infancy. BMIZ in mid‐childhood was in turn positively associated with systolic blood pressure at follow‐up. Among the 66 children from the second trial who had blood samples analyzed for EED biomarkers, serum anti‐flagellin IgA concentration at 6 weeks was significantly associated with systolic and diastolic blood pressure in mid‐childhood in multivariate models (p=0.001 for both).ConclusionsLength at 6 weeks and gains in length in the first year of life are independently, positively associated with attained height in childhood, while weight at 6 weeks and weight gain throughout infancy are independently associated with an increased BMIZ in mid‐childhood. EED in infancy may also have long‐term consequences for cardio‐metabolic risk. Interventions in early life should focus on optimizing linear growth while minimizing excess weight gain and EED risk.Support or Funding InformationNational Institutes of Health (R01 HD043688‐01, R01 HD048969‐01, K24HD058795 and K24 DK104676), Bill and Melinda Gates Foundation (OPP1066203) and the Feed the Future Food Innovation Lab for Nutrition which is funded by the United States Agency for International Development (USAID).

Complex agricultural livelihoods and aflatoxin exposure in rural Uganda

Aflatoxins are secondary metabolites produced by Aspergillus flavus and A. parasiticus species of fungi. They are highly toxic and have been designated by the International Agency for Research on Cancer (IARC) as human carcinogens (Class 1: definitely carcinogenic to humans). High levels of exposure can cause acute hepatic necrosis and death while chronic exposure can cause carcinoma of the liver and possibly also growth impairment in children and compromised immunity. Contamination of crops most often occurs during harvest and storage, when damp, warm conditions allow the fungi to proliferate. Possible barriers to effective local interventions to reduce exposure were explored, by examining agricultural livelihoods and patterns of household food consumption within a population cohort in rural south west Uganda. Previous work in this cohort and elsewhere in Uganda showed that aflatoxin exposure was ubiquitous and that there are multiple sources of exposure. Data on agricultural practices were collected through a survey of 200 households; 22 of those were randomly selected for in-depth interviews. While crops such as maize, cassava, beans and groundnuts - all potential sources of aflatoxin - are grown, stored and consumed locally, the sale of home-grown foods, unfavourable climate, pests and diseases and limited labour, all facilitate food scarcities and subsequent insecurities leading to purchase of poorly stored foods which may also contain aflatoxins. Processed foods are easily accessible by many households, from the numerous trading centres established within villages. This paper gives background information on heterogeneity of household diets and seasonal trends in food consumption in rural Uganda and by so doing, identifies potential risk factors for aflatoxin contamination in the study area. Risks of aflatoxin contamination are multifaceted and this complexity makes it challenging to design and implement risk control measures and advocacy strategies. The argument of the paper is that the complexity of agricultural livelihoods and patterns of household food consumption in rural Uganda may mitigate the impact of simple, local interventions to reduce aflatoxin exposure. Therefore, intervention approaches need to take into account this complexity in order to minimize risk factors, especially amongst poor populations in rural areas.

Aflatoxin exposure during the first 36 months of life was not associated with impaired growth in Nepalese children: An extension of the MAL-ED study.

Exposure to aflatoxin, a mycotoxin common in many foods, has been associated with child growth impairment in sub-Saharan Africa. To improve our understanding of growth impairment in relation to aflatoxin and other risk factors, we assessed biospecimens collected in Nepalese children at 15, 24, and 36 months of age for aflatoxin exposure. Children (N = 85) enrolled in the Bhaktapur, Nepal MAL-ED study encompassed the cohort analysed in this study. Exposure was assessed through a plasma biomarker of aflatoxin exposure: the AFB1-lysine adduct. The aflatoxin exposures in the study participants were compared to anthropometrics at each time period (length-for-age [LAZ], weight-for-age [WAZ], and weight-for-length [WLZ] z-scores), growth trajectories over time, age, and breastfeeding status. Results demonstrated chronic aflatoxin exposure in this cohort of children, with a geometric mean of 3.62 pg AFB1-lysine/mg albumin. However, the chronic aflatoxin exposure in this cohort was not significantly associated with anthropometric z-scores, growth trajectories, age, or feeding status, based on the available time points to assess aflatoxin exposure. Low mean levels of aflatoxin exposure and infrequent occurrence of stunting, wasting, or underweight z-score values in this cohort are possible contributing factors to a lack of evidence for an association. Further research is needed to examine whether a threshold dose of aflatoxin exists that could induce child growth impairment.

Protein Malnutrition Impairs Intestinal Epithelial Cell Turnover, a Potential Mechanism of Increased Cryptosporidiosis in a Murine Model.

Malnutrition and cryptosporidiosis form a vicious cycle and lead to acute and long-term growth impairment in children from developing countries. Insights into mechanisms underlying the vicious cycle will help to design rational therapies to mitigate this infection. We tested the effect of short-term protein malnutrition on Cryptosporidium parvum infection in a murine model by examining stool shedding, tissue burden, and histologic change and explored the mechanism underlying the interaction between malnutrition and cryptosporidiosis through immunostaining and immunoblotting. Protein malnutrition increased stool shedding and the number of intestine-associated C. parvum organisms, accompanied by significant suppression of C. parvum-induced caspase 3 activity and expression of PCNA and Ki67, but activation of the Akt survival pathway in intestinal epithelial cells. We find that even very brief periods of protein malnutrition may enhance (or intensify) cryptosporidiosis by suppressing C. parvum-induced cell turnover and caspase-dependent apoptosis of intestinal epithelial cells. This implicates a potential strategy to attenuate C. parvum's effects by modulating apoptosis and promoting regeneration in the intestinal epithelium.

Biomarkers of Environmental Enteropathy, Inflammation, Stunting, and Impaired Growth in Children in Northeast Brazil

Critical to the design and assessment of interventions for enteropathy and its developmental consequences in children living in impoverished conditions are non-invasive biomarkers that can detect intestinal damage and predict its effects on growth and development. We therefore assessed fecal, urinary and systemic biomarkers of enteropathy and growth predictors in 375 6–26 month-old children with varying degrees of malnutrition (stunting or wasting) in Northeast Brazil. 301 of these children returned for followup anthropometry after 2-6m. Biomarkers that correlated with stunting included plasma IgA anti-LPS and anti-FliC, zonulin (if >12m old), and intestinal FABP (I-FABP, suggesting prior barrier disruption); and with citrulline, tryptophan and with lower serum amyloid A (SAA) (suggesting impaired defenses). In contrast, subsequent growth was predicted in those with higher fecal MPO or A1AT and also by higher L/M, plasma LPS, I-FABP and SAA (showing intestinal barrier disruption and inflammation). Better growth was predicted in girls with higher plasma citrulline and in boys with higher plasma tryptophan. Interactions were also seen with fecal MPO and neopterin in predicting subsequent growth impairment.Biomarkers clustered into markers of 1) functional intestinal barrier disruption and translocation, 2) structural intestinal barrier disruption and inflammation and 3) systemic inflammation. Principle components pathway analyses also showed that L/M with %L, I-FABP and MPO associate with impaired growth, while also (like MPO) associating with a systemic inflammation cluster of kynurenine, LBP, sCD14, SAA and K/T. Systemic evidence of LPS translocation associated with stunting, while markers of barrier disruption or repair (A1AT and Reg1 with low zonulin) associated with fecal MPO and neopterin.We conclude that key noninvasive biomarkers of intestinal barrier disruption, LPS translocation and of intestinal and systemic inflammation can help elucidate how we recognize, understand, and assess effective interventions for enteropathy and its growth and developmental consequences in children in impoverished settings.

Epidemiology and Impact of Campylobacter Infection in Children in 8 Low-Resource Settings: Results From the MAL-ED Study.

Enteropathogen infections have been associated with enteric dysfunction and impaired growth in children in low-resource settings. In a multisite birth cohort study (MAL-ED), we describe the epidemiology and impact of Campylobacter infection in the first 2 years of life. Children were actively followed up until 24 months of age. Diarrheal and nondiarrheal stool samples were collected and tested by enzyme immunoassay for Campylobacter Stool and blood samples were assayed for markers of intestinal permeability and inflammation. A total of 1892 children had 7601 diarrheal and 26 267 nondiarrheal stool samples tested for Campylobacter We describe a high prevalence of infection, with most children (n = 1606; 84.9%) having a Campylobacter-positive stool sample by 1 year of age. Factors associated with a reduced risk of Campylobacter detection included exclusive breastfeeding (risk ratio, 0.57; 95% confidence interval, .47-.67), treatment of drinking water (0.76; 0.70-0.83), access to an improved latrine (0.89; 0.82-0.97), and recent macrolide antibiotic use (0.68; 0.63-0.74). A high Campylobacter burden was associated with a lower length-for-age Z score at 24 months (-1.82; 95% confidence interval, -1.94 to -1.70) compared with a low burden (-1.49; -1.60 to -1.38). This association was robust to confounders and consistent across sites. Campylobacter infection was also associated with increased intestinal permeability and intestinal and systemic inflammation. Campylobacter was prevalent across diverse settings and associated with growth shortfalls. Promotion of exclusive breastfeeding, drinking water treatment, improved latrines, and targeted antibiotic treatment may reduce the burden of Campylobacter infection and improve growth in children in these settings.

Aflatoxin exposure among young children in urban low-income areas of Nairobi and association with child growth

Populations in tropical and subtropical developing countries are exposed to largely uncontrolled levels of aflatoxins through food. These countries (especially in Africa and Asia) also present a high prevalence of stunting. Studies have reported an association between aflatoxin exposure and growth impairment in children but there is not yet conclusive evidence that aflatoxins are a significant cause of stunting in children, thus further research is warranted. In this cross-sectional study, 204 low-income households were randomly selected in two low-income areas of Nairobi, Kenya. Korogocho is a higher population density area and Dagoretti a lower population density area. We asked questions about household demographics and a 24-hour dietary recall was conducted in children aged 1–3 years. Child anthropometric measurements were also conducted. Height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ) and weight-for-height Z-scores (WHZ) were calculated for each child using World Health Organization (WHO) growth standards reference data. Samples of foods were taken from the household or from the retailer for analysis using competitive enzyme-linked immunosorbent assay (ELISA). Laboratory results for aflatoxin levels in the food samples collected were used to calculate the daily aflatoxin intake, according to the results from the dietary assessment. The study found 41% of children sampled had stunted growth. Boys were more stunted than girls (p=0.057) and Korogocho had more stunted children than Dagoretti (p=0.041). In all, 98% of food samples collected tested positive for aflatoxin and there was an average exposure to aflatoxins of 21.3 ng/kg bodyweight per day. Exposure to aflatoxin M1 (AFM1), location and sex were significantly associated with HAZ, with boys and children from Korogocho having lower HAZ, and AFM1 was negatively associated with HAZ (p=0.047), indicating that AFM1 was associated with stunting. There was no association between total aflatoxins (aflatoxin B [AFB] and aflatoxin G [AFG]) and HAZ, WAZ and WHZ. The study showed a high prevalence of malnutrition, especially stunting, in two low-income urban sites, and this was most pronounced in the high-density area. The reported association between AFM1 and stunted children indicates that more research is needed on the health impacts of this aflatoxin in growing children. Keywords: stunting, aflatoxin M1, contamination, exposure, mycotoxin, ELISA, aflatoxins, mycotoxins, aflatoxin B1

Pengetahuan Berhubungan dengan Sikap Ibu dalam Kemampuan Menstimulasi Pertumbuhan dan Perkembangan Anak Balita dengan Gizi Kurang

&lt;p&gt;Nutrition is an important factor in determining the level of health. The state of malnutrition in children results in impaired growth and development of children. Knowledge or cognitive domain is very important for the formation of maternal attitudes and actions in stimulating the growth and development of children.&lt;br /&gt;Children who are directed stimulation will grow faster than children who did not receive stimulation. The purpose of study is to know the relationship of knowledge with mother attitude in the ability to stimulating growth and development of young children with less nutrition in Banaran village work area Galur II Health Centers Kulon Progo Yogyakarta. This type of research is an analytic survey, with the cross sectional approach. The sampling technique is purposive sampling, with 43 respondents. Bivariate analysis used Spearman Rank correlation. The results showed the knowledge of mothers with 25.6% in good category category, 67.4% in enough category, and 7,0% in less category. While the mother’s attitude showed 18.6% in good categories, and 81.4% in enough category. The results of the statistical test showed r=0.467 with a significance level of correlation coefficient 0.002. Conclusion, the research indicated that significant relationship between knowledge with mother attitude in the ability to stimulating growth and development of young children with less nutrition in Banaran village work area Galur II Health Centers Kulon Progo Yogyakarta.&lt;/p&gt;

Growth impairment in children with pulmonary hypertension

Growth impairment in children with pulmonary hypertension

Stunted at 10 Years. Linear Growth Trajectories and Stunting from Birth to Pre-Adolescence in a Rural Bangladeshi Cohort.

BackgroundFew studies in low-income settings analyse linear growth trajectories from foetal life to pre-adolescence. The aim of this study is to describe linear growth and stunting from birth to 10 years in rural Bangladesh and to analyse whether maternal and environmental determinants at conception are associated with linear growth throughout childhood and stunting at 10 years.Methods and FindingsPregnant women participating in the MINIMat trial were identified in early pregnancy and a birth cohort (n = 1054) was followed with 19 growth measurements from birth to 10 years. Analyses of baseline predictors and mean height-for-age Z-scores (HAZ) over time were modelled using GLMM. Logistic regression analysis was used to investigate the associations between baseline predictors and stunting (HAZ<-2) at 10 years. HAZ decreased to 2 years, followed by an increase up to 10 years, while the average height-for-age difference in cm (HAD) to the WHO reference median continued to increase up to 10 years. Prevalence of stunting was highest at 2 years (50%) decreasing to 29% at 10 years. Maternal height, maternal educational level and season of conception were all independent predictors of HAZ from birth to pre-adolescence (p<0.001) and stunting at 10 years. The highest probability to be stunted at 10 years was for children born by short mothers (<147.5 cm) (ORadj 2.93, 95% CI: 2.06–4.20), mothers with no education (ORadj 1.74, 95% CI 1.17–2.81) or those conceived in the pre-monsoon season (ORadj 1.94, 95% CI 1.37–2.77).ConclusionsHeight growth trajectories and prevalence of stunting in pre-adolescence showed strong intergenerational associations, social differentials, and environmental influence from foetal life. Targeting women before and during pregnancy is needed for the prevention of impaired child growth.

Steroid Administration and Growth Impairment in Children with Crohn's Disease.

Growth impairment remains a major concern in children with Crohn's disease, but evidence remains unclear, in particular, whether steroid use is implicated. We aimed to (1) determine the frequency of temporary (TGI) and permanent (PGI) growth impairment in children administered steroids and (2) examine whether cumulative steroid administration was associated with TGI and/or PGI. A retrospective cohort study was performed in patients with Crohn's disease (<18 yr) administered steroids at the gastroenterology clinics of Sainte-Justine Hospital, Montreal. Steroid dosage, height during follow-up, adult height (after age 20), and parental heights were ascertained. Patients with height z score <-1.64 on more than 1 occasion before age 18 were considered as patients with TGI. Patients with adult heights <8.5 cm below the expected target heights were considered as patients with PGI. Association between steroid dosage and TGI/PGI was studied using logistic regression analyses. Data from the Swiss IBD Cohort Study were analyzed for comparison. A total of 221 children were studied. Approximately 19% (42/221) children were deemed as TGI, and 8/137 patients (5.8%) had PGI. TGI was associated with diagnosis at younger age (P value 0.002) and steroid administration at younger age (P value 0.001), but not with steroid dosage. Final adult height was associated with target height, but not with cumulative steroid dosage. Rates of PGI in the Swiss cohort were ∼ 9.1% in steroid users and 2.7% in nonusers. Most children with TGI attain normal adult heights. Cumulative steroid use does not seem to be associated with either TGI or PGI in children with Crohn's disease.

Anthropometric Effect of Mucoperiosteal Nostril Floor Reconstruction in Complete Cleft Lip.

The primary objective of this study was to investigate whether growth impairment in children with cleft lip is caused by reconstructing the nostril floor using lateral nasal and premaxillary mucoperiosteal flaps. The effects on growth and symmetry of tip rhinoplasty at the time of initial repair, as well as cleft sidedness are similarly investigated. An Institutional Review Board approved, retrospective, single-center study at an academic children's hospital from July 2005 to 2010 was designed. Seventy-four patients with unilateral cleft lip ± palate were followed postsurgical repair of the cleft lip deformity. Serial digital photographs from clinical encounters were analyzed. Anthropometric measurements of 10 soft tissue landmarks were extracted from anteroposterior and submental vertex views at serial visits; growth velocities, defined as c = Δd/Δt, were generated using linear mixed models on selected measurements to study time-related changes on growth. The effects on growth and symmetry of primary tip rhinoplasty on perinasal landmarks and nostril floor reconstruction with medial and lateral nasal mucoperiosteal flaps on perioral and perinasal landmarks were analyzed. Proxies for midfacial height (en-al) and maxillary height (al-ch) were used to evaluate the effect of mucoperiosteal dissection, whereas nostril width, height, and angle were used as proxies to evaluate the effects of tip rhinoplasty. Seventy-four patients met the inclusion criteria. Midface height (En-Al) growth velocity was 0.014 mm/month and maxillary height (Al-Ch) was relatively stable at -0.0059 mm/month with no difference between the subgroups. Nostril height growth was -0.0046 mm/month, nostril width was 0.03 mm/mo, and nostril angle -0.09 °/mo showed no difference between patient with or without primary tip rhinoplasty. Patients with complete cleft showed more asymmetry than those with incomplete clefts in lip and maxillary landmarks at T0 (P < 0.001). Mucoperiosteal reconstruction of the nostril floor at the time of lip repair does not affect anthropometric growth velocities over a 5-year follow-up. Within the limitations of the selected landmarks, primary tip rhinoplasty did not significantly improve symmetry at 5 years, but also did not affect the growth of the nose. Patients with complete clefts display more postoperative asymmetry than those with incomplete clefts.

Impaired cardiac growth and function in children and adolescents after heart transplantation assessed by cardiac magnetic resonance

Impaired cardiac growth and function in children and adolescents after heart transplantation assessed by cardiac magnetic resonance