Mean Height Percentile Research Articles

Physical growth and endocrinal disorders during pubertal maturation in girls with epilepsy.

This study investigated the effect of epilepsy and/or antiepileptic drugs (AEDs) on the physical growth, pubertal development, and androgenic status of girls with epilepsy between ages 8 and 18 years. Sixty-six female patients with epilepsy, their mean ages 13.47 +/- 3.5 years, were included. Anthropometric measurements, staging of pubertal maturation, and clinical manifestations of hyperandrogenism were assessed, as well as measurement of serum levels of testosterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), and free androgen index (FAI). Of the included patients, 44 had transabdominal ultrasonic examination of the ovaries and fasting serum insulin levels were measured. Forty healthy age-matched females served as a control group. Patients showed reduced mean height percentile compared with controls (z = 2.07; p = 0.04), which was negatively correlated with the duration of their epilepsy. Patients showed increased frequency of obesity, especially postpubertal girls taking valproate (VPA; 67%), who also showed higher insulin levels (t = 8.01; p = 0.0003). Patients showed increased frequency of clinical hyperandrogenemia in the different stages of puberty. High levels of testosterone and DHEAS were found in female patients with epilepsy, especially pubertal and postpubertal girls. Hyperandrogenism (clinical and/or laboratory) was most affected by the types of AEDs, with higher incidence in patients taking VPA compared with those taking enzyme-inducing AEDs (chi2= 9.16; p = 0.01). Eighteen percent of the patients were diagnosed as having polycystic ovary syndrome (PCOS). No difference was found in the types of seizures, degree of seizure control, type of AEDs, or insulin levels between patients with and those without PCOS. Longer duration of the disease has a negative impact on the stature of female patients with epilepsy. Postpubertal girls taking VPA are more liable to obesity, which is associated with increased incidence of hyperinsulinemia. Clinical and/or laboratory evidence of hyperandrogenism is seen at a high frequency in patients, especially with the use of VPA. Furthermore, female patients with epilepsy especially in the postpubertal stage of sexual maturation, have a high prevalence of PCOS, independent of the type of AED or the characteristics of the epilepsy disorder.

Growth in steroid-responsive nephrotic syndrome: a study of 85 pediatric patients.

The statural growth of 85 patients with steroid-responsive idiopathic nephrotic syndrome, attending the Pediatric Nephrology Unit, Children's Institute, Hospital das Clínicas School of Medicine, University of São Paulo, with a minimum follow-up of 3 years, was evaluated. Analysis of the patient population as a group did not show any significant alterations in the height Z score and the mean height percentile between the first (-0.59 and 33.9, respectively) and last consultation (-0.57 and 34.8, respectively). Analysis of each individual patient allowed the definition of two subgroups. Subgroup A, which achieved growth improvement, was composed of 47 children-initial Z score and mean initial height percentile of -0.91 and 24.0, respectively; final Z score and mean height percentile of -0.30 and 40.7, respectively ( P=0.00). Subgroup B, which showed growth retardation, was composed of 38 children-initial Z score and mean initial height percentile of -0.19 and 46.2, respectively; final Z score and mean height percentile of -0,9 and 27.5, respectively ( P=0.00). The following factors were significantly different when both subgroups were compared: (1) total duration of prednisone therapy and total prednisone dose were greater in subgroup B; (2) the final chronological age of patients using prednisone was higher in subgroup B; (3) the pubertal growth spurt in subgroup B showed attenuation and retardation.

Influence Of Enterocystoplasty on Linear Growth in Children With Exstrophy

Many children with bladder exstrophy undergo reconstruction incorporating bowel into the lower urinary tract, which may result in metabolic changes affecting height. Linear growth in children with exstrophy who underwent enterocystoplasty was studied. We retrospectively reviewed the charts of children with classic bladder exstrophy who underwent bladder augmentation with small or large bowel, or creation of a bowel neobladder before age 11 years. Mean followup plus or minus standard error was 9.4 +/- 0.9 years. Most patients were assessed yearly with measurement of height and serum electrolytes. Metabolic acidosis was treated with oral bicarbonate. Preoperative height percentiles at enterocystoplasty were compared to height percentiles at the most recent visit. In addition, height percentiles in a control group of individuals with exstrophy who did not undergo enterocystoplasty were compared to postoperative height percentiles in the enterocystoplasty group. The t test was used for statistical analysis. Data on 18 children who underwent bladder reconstruction with bowel were compared with those on a control group of 18 with exstrophy. The mean preoperative height percentile at a mean age of 5.2 years was 35.6 +/- 4.5 and the postoperative height percentile at a mean age of 14.6 years was 20.3 +/- 5.7 (p <0.01). The mean height percentile in the control group at a mean age of 15.2 years was 30.6 +/- 7.8 (p <0.01 versus the postoperative height percentile in the study group. In the enterocystoplasty group 2 patients were receiving oral bicarbonate for metabolic acidosis. Five patients who underwent enterocystoplasty and 6 controls were below the third percentile for height. In children with bladder exstrophy bladder augmentation or neobladder creation may have an adverse effect on linear growth. The height of children with bladder exstrophy is less than average compared with standard growth charts.

Prevalence and clinical characteristics of celiac disease in Downs syndrome in a U.S. study

Celiac disease is an autoimmune gastrointestinal disorder characterized by mucosal atrophy of the jejunum on exposure to gluten, a protein found in grains. The purpose of our study was to determine the prevalence of celiac disease in children with Downs syndrome in a U.S.-based Caucasian population. The 97 Downs syndrome children were screened for celiac disease using serum IgA-anti-endomysial antibody testing, which is highly specific and sensitive for the disorder. Children with titers greater than 1:5 (using the IgA endomysial antibody [EMA] test; EMA+) were considered affected. Ten children (10.3%) were EMA+. We examined their HLA DQA1 DQB1 genotype, karyotype, clinical characteristics, and the prevalence of celiac disease in their first-degree relatives. The nine available karyotypes were trisomy 21. Downs syndrome-specific mean height percentile was 64% ± 26% (range <5–99%) and weight percentile was 43% ± 28% (range 5–95%). Presence of diarrhea, constipation, vomiting, and abdominal pain was similar for children with and without celiac disease. Only bloating symptoms were significantly more frequent in those with celiac disease (EMA+). Seven of eight (88%) genotyped EMA+ children had the celiac disease-associated high-risk HLA DQA1*0501 DQB1*0201 genotype as compared with 13/80 (16%) of EMA− children. Five of 48 (10%) first-degree relatives of the celiac disease (EMA+) children were EMA+. In conclusion, celiac disease, as diagnosed by positive endomysial antibody tests, has an increased prevalence in children with Downs syndrome in the U.S. as compared with the general population (1/250). Clinical and growth characteristics do not distinguish between children with and without celiac disease. Based on these observations, it is recommended that children with Downs syndrome be screened for celiac disease. © 2001 Wiley-Liss, Inc.

Prevalence and clinical characteristics of celiac disease in Downs syndrome in a U.S. study

Celiac disease is an autoimmune gastrointestinal disorder characterized by mucosal atrophy of the jejunum on exposure to gluten, a protein found in grains. The purpose of our study was to determine the prevalence of celiac disease in children with Downs syndrome in a U.S.-based Caucasian population. The 97 Downs syndrome children were screened for celiac disease using serum IgA-anti-endomysial antibody testing, which is highly specific and sensitive for the disorder. Children with titers greater than 1:5 (using the IgA endomysial antibody [EMA] test; EMA+) were considered affected. Ten children (10.3%) were EMA+. We examined their HLA DQA1 DQB1 genotype, karyotype, clinical characteristics, and the prevalence of celiac disease in their first-degree relatives. The nine available karyotypes were trisomy 21. Downs syndrome-specific mean height percentile was 64%+/-26% (range <5-99%) and weight percentile was 43%+/-28% (range 5-95%). Presence of diarrhea, constipation, vomiting, and abdominal pain was similar for children with and without celiac disease. Only bloating symptoms were significantly more frequent in those with celiac disease (EMA+). Seven of eight (88%) genotyped EMA+ children had the celiac disease-associated high-risk HLA DQA1*0501 DQB1*0201 genotype as compared with 13/ 80 (16%) of EMA- children. Five of 48 (10%) first-degree relatives of the celiac disease (EMA+) children were EMA+. In conclusion, celiac disease, as diagnosed by positive endomysial antibody tests, has an increased prevalence in children with Downs syndrome in the U.S. as compared with the general population (1/250). Clinical and growth characteristics do not distinguish between children with and without celiac disease. Based on these observations, it is recommended that children with Downs syndrome be screened for celiac disease.

Growth Failure and Bony Changes Induced by Deferoxamine

We reviewed the linear growth and growth plate morphology in all children with homozygous beta thalassemia followed in Toronto, for whom monthly height percentiles were available before, and for a 36-month period after, the initiation of nightly subcutaneous deferoxamine therapy. All patients were less than 7 years of age when begun on deferoxamine, and had received nightly deferoxamine for a minimum of 36 months. Marked abnormalities of the metaphyseal growth plate were readily observed in the distal ulnar, radial, and tibial metaphyses in 11 of 37 patients in whom a significant decline in mean height percentile was also noted. (In 10 of these 11 patients, height was less than the 15th percentile after 36 months.) These 11 patients had received a significantly greater (p less than 0.025) initial and average daily dose of deferoxamine, and had maintained a significantly lower (p less than 0.025) mean serum ferritin concentration over the 36 months, than the remainder of the cohort. To determine whether deferoxamine played a causative role in growth failure, growth in patients who began deferoxamine before the age 2 years was compared to that of patients who began after age 5 years, for the period between 2 and 5 years of age. Only patients begun on deferoxamine prior to age 2 years demonstrated a significant (p less than 0.01) decline in height percentile by the third year, implicating deferoxamine therapy as the cause of growth failure. We conclude that both the decline in height percentile and the bony changes observed in well-chelated patients are directly related to deferoxamine therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Management and outcome of children with congenital hypothyroidism detected on neonatal screening in South Australia

Thirty-eight congenitally hypothyroid children who were detected in a neonatal screening programme have been treated for a mean period of 3.8 years (range, 0.5-8.5 years) by the maintenance of the free thyroxine index in the upper normal range as the main determinant of the dose of thyroxine. Only excessive elevation of, or serial rises in, thyroid stimulating hormone (TSH) level influenced the dose of thyroxine. This treatment strategy, which aims to avoid the potentially adverse effects of thyroxine overdosage, has often resulted in delayed return of TSH levels to normal, especially in athyrotic children (mean TSH +/- SD at one year of age in athyrotic children, 72 +/- 90 mU/L; in children with ectopic thyroid glands, 24 +/- 16 mU/L; normal range, 0-7 mU/L). The mean thyroxine dose of about 100 micrograms/m2 did not change significantly with age, and is lower than the doses that are sometimes quoted in the literature; athyrotic children require significantly more thyroxine (P less than 0.05) than those with ectopic thyroid glands. Symptoms and signs of congenital hypothyroidism, although subtle, were significantly more common (P less than 0.05 for symptoms and P less than 0.001 for signs) in athyrotic children compared with those with ectopic glands. No physical or developmental abnormality related to congenital hypothyroidism has been demonstrated on follow-up; mean height and weight percentiles approximate the 50th percentile at ages one to six years and mean developmental scores +/- SD at about two years of age by the Griffiths Mental Development Scale and at 4.5-6.5 years by the Wechsler Preschool and Primary Scale are 102.4 +/- 10.4 and 111.2 +/- 12.2, respectively. Long-term follow-up studies are necessary to exclude more subtle developmental and neurological abnormalities.