North American Children Research Articles

Prevalence of carotid ultrasound screening in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

Many childhood cancer survivors are at risk for cardiovascular disease and stroke. The North American Children's Oncology Group long-term follow-up guidelines recommend carotid ultrasound in cancer survivors 10 years after neck radiation therapy (RT) ≥40 Gy. The use of carotid ultrasound in this population has not been described. Survivors of childhood cancer diagnosed 1970-1999 (N=8693) and siblings (N=1989) enrolled in the Childhood Cancer Survivor Study were asked if they had ever had a carotid ultrasound. Prevalence of carotid ultrasound was evaluated. Prevalence ratios (PR) and 95% confidence intervals (CIs) were evaluated in multivariate Poisson regression models. Among participants with no reported cardiovascular condition, prevalence of carotid ultrasound among survivors with RT≥40 Gy to the neck (N=172) was 29.7% (95% CI, 22.5-36.8), significantly higher than those with <40 Gy (prevalence 10.7%; 95% CI, 9.9%-11.4%). Siblings without a cardiovascular condition (N=1621) had the lowest prevalence of carotid ultrasound (4.7%; 95% CI, 3.6%-5.7%). In a multivariable models among survivors with no reported cardiovascular condition and RT≥40 Gy to the neck, those who were over age 50 (vs. 18-49) at follow-up (PR=1.82; 95% CI, 1.09-3.05), with a history of seeing a cancer specialist in the last 2 years (PR=2.58; 95% CI, 1.53-4.33), or having a colonoscopy (PR=2.02; 95% CI, 1.17-3.48) or echocardiogram (PR=6.42; 95% CI, 1.54-26.85) were more likely to have had a carotid ultrasound. Many survivors do not undergo carotid ultrasound despite meeting existing guidelines. Health care delivery features such as having seen a cancer specialist or having other testing are relevant.

Multiplexed immunohistochemical evaluation of small bowel inflammatory and epithelial parameters in environmental enteric dysfunction

BackgroundEnvironmental enteric dysfunction (EED) is characterized by reduced absorptive capacity and barrier function of the small intestine, leading to poor ponderal and linear childhood growth. ObjectivesTo further define gene expression patterns that are associated with EED to uncover new pathophysiology of this disorder. MethodsDuodenal biopsies from cohorts of children with EED from Bangladesh, Pakistan and Zambia were analyzed by immunohistochemistry (IHC) to interrogate gene products that distinguished differentiation and various biochemical pathways in immune and epithelial cells, some identified by prior bulk RNA sequence analyses. Immunohistochemical staining was digitally quantified from scanned images and compared to cohorts of North American children with celiac disease (gluten-sensitive enteropathy) or with no known enteric disease and no pathologic abnormality (NPA) detected in their clinical biopsies. ResultsAfter multivariable statistical analysis, we identified statistically significant (P < 0.05, 2-tailed t-test) elevated signals representing cluster of differentiation 45 (80%; 95% confidence interval [CI]: 24%, 127%), lipocalin 2 (659%; 95% CI: 198%, 1838%), and regenerating family 1 beta (221%; 95% CI: 47%, 600%) and lower signals corresponding to granzyme B (−74%; 95% CI: −82%, −62%), and sucrase isomaltase (−58%; 95% CI: −75%, −29%) in EED biopsies compared with NPA biopsies. Computerized algorithms also detected statistically significant elevation in intraepithelial lymphocytes (49%; 95% CI: 9%, 105%) and proliferation of leukocytes (267%; 95% CI: 92%, 601%) in EED biopsies compared with NPA biopsies. ConclusionsOur results support a model of chronic epithelial stress that decreases epithelial differentiation and absorptive function. The close association of several IHC parameters with manual histologic scoring suggests that automated digital quantification of IHC panels complements traditional histomorphologic assessment in EED.

Duodenal transcriptomics demonstrates signatures of tissue inflammation and immune cell infiltration in children with environmental enteric dysfunction across global centers

BackgroundEnvironmental enteric dysfunction (EED) is an inflammatory condition of the small intestine that is prevalent in children residing in low- and middle-income countries. EED is accompanied by profound histopathologic changes in the small bowel, loss of absorptive capacity, increased intestinal permeability, increased microbial translocation, and nutrient loss. ObjectivesWe sought to identify dysregulated genes and pathways that might underlie pediatric EED. MethodsRNA-sequencing libraries were generated from endoscopically obtained duodenal tissue from undernourished children with EED from 3 prospective cohorts of children with EED. The EED transcriptome was defined in comparison to North American children without EED. Weighted gene coexpression network analysis (WGCNA) was tested for gene modules associated with EED and its histologic features. ResultsThe 1784 upregulated genes in EED were highly enriched for immune and inflammatory processes, including IL-17 and JAK-STAT signaling, and cytokine–cytokine receptor interactions. The 1388 downregulated genes included genes corresponding to xenobiotic metabolism, detoxification, and antioxidant capacities. A gene coexpression module enriched for antimicrobial responses and chemokine activity was significantly associated with villous blunting, goblet cell depletion, and overall histologic severity of EED. ConclusionsThe transcriptome signatures of EED include specific innate and adaptive immune responses that are consistently elevated across study centers, coupled with reduced detoxification and antioxidant capacities. These data may have implications for targeted interventions to improve EED outcomes.

Prevalence, pain trajectories, and presurgical predictors for chronic postsurgical pain in a pediatric sample in Spain with a 24-month follow-up.

Pediatric chronic pain, particularly chronic postsurgical pain (CPSP), poses a significant public health challenge, impacting 20% of pediatric populations. While several presurgical predictors have been identified, there is a scarcity of data on long-term outcomes, especially beyond 1 to 2 years postsurgery. Previous research primarily focuses on North American children, creating gaps in understanding CPSP outcomes in diverse health systems, such as in Spain. This study, registered as NCT04735211, investigates CPSP in 159 children and adolescents (mean age = 12.4 years, 37.1% girls, retention rate = 65%) undergoing various surgeries in Spain. The objectives include examining CPSP prevalence (Numerical Rating Scale ≥ 4) at 3, 6, 12, and 24 months, exploring postsurgical pain trajectories through group-based trajectory modeling, and identifying potential presurgical predictors for CPSP (pain intensity, pain catastrophizing, pain anxiety, fear of pain, kinesiophobia, health-related quality of life, pain interference, and physical activity), using multiple logistic regressions. Results show a CPSP prevalence of 41% at 3 months, decreasing to 14% at 24 months. Presurgical factors including pain intensity (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.02-1.53), pain catastrophizing (aOR = 1.06, 95% CI = 1.00-1.13), and pain anxiety (aOR = 1.06, 95% CI = 1.02-1.11) were associated with CPSP at 3 months. Group-based trajectory modeling revealed 3 postsurgical pain trajectories: Low Pain with Rapid Recovery Group (30.2%), Moderate Pain with Recovery Group (53.5%), and High Pain with Slow Recovery Group (16.3%), with group differences in presurgical predictors, excluding physical activity. This study contributes valuable insights into CPSP, emphasizing the need for long-term follow-up. The findings could inform the implementation of preventive programs for CPSP into diverse health systems.

A Multi-Sample Comparison and Rasch Analysis of the Evaluation of Children's Listening and Processing Skills Questionnaire.

Assessing listening difficulties and associated complaints can be challenging. Often, measures of peripheral auditory functions are within normal ranges, making clinicians feel unsure about proper management strategies. The range and nature of observed or experienced difficulties might be better captured using a qualitative measure. The Evaluation of Children's Listening and Processing Skills (ECLiPS) questionnaire was designed to broadly profile the auditory and cognitive problems often present in children with listening difficulties. This 38-item questionnaire was initially standardized in British children aged 6 to 11 years, was subsequently modified for use with North-American children, and was recently translated into Flemish-Dutch. This study aimed to compare typical scores of the Flemish version with the UK and US versions, and to evaluate and compare its psychometric quality based on Rasch analysis. We selected 112 Flemish children aged 6 to 11 years with verified normal hearing and typical development, and asked two caregivers of every child to fill out the ECLiPS. Data from two comparator samples were analyzed, including responses for 71 North-American children and 650 British children. Typical values for ECLiPS factors and aggregates were determined as a function of age and gender, and meaningful differences across samples were analyzed. Rasch analyses were performed to evaluate whether ECLiPS response categories work as intended, and whether item scores fit a linear equal interval measurement scale that works the same way for everyone. Item and person metrics were derived, including separation and reliability indices. We investigated whether items function similarly across linguistically and culturally different samples. ECLiPS scores were relatively invariant to age. Girls obtained higher scores compared with boys, mainly for items related to memory and attention, and pragmatic and social skills. Across ECLiPS versions, the most pronounced differences were found for items probing social skills. With respect to its psychometric quality, ECLiPS response categories work as intended, and ECLiPS items were found to fit the Rasch measurement scale. Cultural differences in responses were noted for some items, belonging to different factors. Item separation and reliability indices generally pointed toward sufficient variation in item difficulty. In general, person separation (and reliability) metrics, quantifying the instrument's ability to distinguish between poor and strong performers (in a reproducible manner), were low. This is expected from samples of typically developing children with homogeneous and high levels of listening ability. Across the languages assessed here, the ECLiPS caregiver questionnaire was verified to be a psychometrically valid qualitative measure to assess listening and processing skills, which can be used to support the assessment and management of elementary school children referred with LiD.

She made it with her friend: How social object history influences children's thinking about the value of digital objects.

Two studies examine how social object histories from collaborative experiences influenced North American children (N = 160, 5-10 years) thinking about the value of digital objects (48% male/51% female; 51% White/24% Black/11% Asian). With forced-choice judgments, Study 1 found (moderate-large effects) that children viewed digital and physical objects with social histories as more special than objects without such histories. On a 10-point scale, Study 2 found (large effects) that children rated digital objects with positive social histories as more special than objects with negative ones. Overall, the studies found that children's tendencies to use object history to understand object value extends into digital contexts. They also reveal how an unexplored kind of history-social history-affects judgments.

Supervisory neglect: Critical questions regarding child supervision and protection system responses

Concerns about child supervision are present in a large proportion of the circumstances responded to by North American child protection systems. This paper examines different perspectives on low-supervision, from parental-deficit to critical-ecological formulations, to address two questions that are central to assessing reports: why low-supervision is deemed to be harmful, and why low-supervision events occur The implications of this knowledge for child protection system responses is explored, and the conceptualization and application of supervisory neglect as a maltreatment category is critically questioned in order to tease apart what this label may represent in practice. The paper considers how thinking could be reframed to make supervisory neglect a more discrete classification which informs subsequent action, including centering the environmental hazard in supervisory neglect formulations and giving primacy to the impact on the child rather than to parent behavior. The role of normative thinking in decision-making and the risk of perpetuating social inequalities and oppressive power is also considered. More research is required to examine responses and outcomes under current systems of practice, and how child protection workers and systems reflexively analyze reports. In addition, more societal dialogue is needed to prevent widespread risk-averse thinking about how children should be supervised, which can reinforce restrictive child protection policy.

Epidemiology of mental health comorbidity in patients with atopic dermatitis: An analysis of global trends from 1998 to 2022.

The prevalence rates of attention deficit hyperactivity disorder (ADHD), depression, anxiety and suicide are increasing in patients with atopic dermatitis (AD), although no research has systematically examined these trends yet. Here, we explore the prevalence of the occurrence of comorbidities, such as ADHD, depression, anxiety and suicide with AD. We searched seven electronic databases from inception to October 2022 to identify relevant studies, and the Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Scale (NOS) tools were used to assess the quality of observational studies. Statistical analysis was performed using R software. Publication bias was evaluated using Egger's and Begg's linear tests. The global prevalence rates of ADHD, depression, anxiety and suicidal ideation in patients with AD were 7%, 17%, 21% and 13%, respectively, between 1998 and October 2022. Among children (aged <18 years), North American children with AD had the highest prevalence rates of ADHD (10%), depression (13%) and anxiety (20%). Among the adult (aged ≥18 years) population, patients with AD in Africa had the highest prevalence rates of depression (36%) and anxiety (44%), while Asian adults with AD had the highest prevalence rates of ADHD (7%) and suicidal ideation (20%). These results highlight the high prevalence and comorbidity rates of mental illnesses with AD, which should be brought to the attention of patients with AD and their physicians.

The development of rhythmic categories as revealed through an iterative production task

Both humans and non-humans (e.g. birds and primates) preferentially produce and perceive auditory rhythms with simple integer ratios. In addition, these preferences (biases) tend to reflect specific integer-ratio rhythms that are common to one's cultural listening experience. To better understand the developmental trajectory of these biases, we estimated children's rhythm biases across the entire rhythm production space of simple (e.g., ratios of 1, 2, and 3) three-interval rhythms. North American children aged 6–11 years completed an iterative rhythm production task, in which they attempted to tap in synchrony with repeating three-interval rhythms chosen randomly from the space. For each rhythm, the child's produced rhythm was presented back to them as the stimulus, and over the course of 5 such iterations we used their final reproductions to estimate their rhythmic biases or priors. Results suggest that regardless of the initial rhythm, after 5 iterations, children's tapping converged on rhythms with (nearly) simple integer ratios, indicating that, like adults, their rhythmic priors consist of rhythms with simple-integer ratios. Furthermore, the relative weights (or prominence of different rhythmic priors) observed in children were highly correlated with those of adults. However, we also observed some age-related changes, especially for the ratio types that vary most across cultures. In an additional rhythm perception task, children were better at detecting rhythmic disruptions to a culturally familiar rhythm (in 4/4 m with 2:1:1 ratio pattern) than to a culturally unfamiliar rhythm (7/8 m with 3:2:2 ratios), and performance in this task was correlated with tapping variability in the iterative task. Taken together, our findings provide evidence that children as young as 6-years-old exhibit simple integer-ratio categorical rhythm priors in their rhythm production that closely resemble those of adults in the same culture.

Parental Cooking Confidence is Associated with Children's Intake of Fish and Seafood.

Purpose: Fish and seafood consumption by North American children is low. This is concerning, given the critical role of n-3 polyunsaturated fatty acids (eicosapentaenoic acid and docosahexaenoic acid), found in fish and seafood, in early development. This study aimed to determine whether parental factors related to fish and seafood consumption are associated with frequency of fish and seafood consumption in Canadian children.Methods: A subgroup of parents (n = 28) participating in the Guelph Family Health Study Pilot reported their perceptions and history of fish and seafood consumption, confidence in preparing fish and seafood dishes, and the frequency of intake for their children (n = 40).Results: This study found that 20% of children consumed one serving of saltwater fish, freshwater fish, or shellfish weekly and 63% consumed at least one type of fish or seafood monthly. Parental cooking confidence preparing fish and seafood was positively associated with at least monthly fish and seafood intake in children.Conclusions: These findings suggest that some children may have low intakes of fish and seafood due to a lack of parental cooking confidence when preparing fish and seafood dishes. Therefore, future research and interventions focused on addressing this barrier may aid in improving fish and seafood intake.

Culture, executive functions, and academic achievement.

Although it is well known that children of East Asian immigrants show higher academic achievement than native-born North American children, the social-cognitive determinants of this difference remain poorly understood. Given the importance of executive functions (EF) for academic achievement, and evidence that EF develops more quickly in East Asian compared to North American cultures, it is conceivable that differences in academic achievement might be rooted in EF differences between these groups. We examine this possibility by reviewing evidence of cross-cultural differences in EF development but find core concepts and findings limited in several key respects. To address these limitations, we propose a framework for relating EF, culture, and academic achievement that draws on new theoretical ideas about the nature of EF and its relation to social context. We conclude by discussing avenues for future research on the relations between culture, executive functions, and academic achievement.

Deletions in DNAL1 Cause Primary Ciliary Dyskinesia Across North American Indigenous Populations

We report 4 cases of primary ciliary dyskinesia in unrelated indigenous North American children caused by identical, homozygous, likely pathogenic deletions in the DNAL1 gene. These shared DNAL1 deletions among dispersed indigenous populations suggest that primary ciliary dyskinesia accounts for more lung disease with bronchiectasis than previously recognized in indigenous North Americans.

Abdominal Circumference Contributes to Absence of Wasting in Brazilian Children

A number of population groups in Latin America show high prevalences of stunting (low height-for-age) despite very low rates of wasting (weight-for-height deficits). One possible explanation for this phenomenon is an increase in abdominal circumference, which would affect children's weights but not their heights. This study was designed to describe the abdominal circumferences of a group of poor children from Northeast Brazil, and to relate these to their weight-for-weight z-score. Children (n = 252) participating in a government growth monitoring program were studied. The prevalence of stunting (below -2 SD) was 26.2%, but only 1.2% were wasted. Abdominal circumferences increased with age up to 36 mo, followed by a slight decline after 48 mo. Abdominal circumference was the anthropometric measurement most closely associated with weight-for-height, with a coefficient of determination of 41%. Even after adjusting for arm circumference, abdominal circumference continued to explain 16% of the variation in weight-for-height. Despite slight differences in measurement techniques, the study children had consistently larger abdominal girths than a sample of North American children. These findings must be verified by replication but highlight a possible contribution of abdominal circumference in the determination of levels of wasting.

How do childhood ADHD symptoms affect labour market outcomes?

Inattention, hyperactivity and impulsivity are the main symptoms of ADHD, which affects up to one in ten European and North American children. Existing research shows these symptoms are associated with school exclusion and poor academic performance during childhood and adolescence. Using the British Cohort Study (n = 17,196 people born in April 1970), this is the first study of relationships between ADHD symptoms measured during childhood (age 10) and labour market outcomes measured beyond early adulthood (ages 26–46); and the first to explore the role of childhood circumstances (at birth) and academic performance (ages 10 and 26) in explaining those relationships. A one standard deviation increase in childhood symptoms reduced employment by up to two percentage points and pay by up to four percentage points. Differences in academic performance at age 10 accounted for almost half the observed variation in employment outcomes, indicating a possible role for educational interventions in schools.

Elevated Plasma Soluble ST2 Levels are Associated With Neuronal Injury and Neurocognitive Impairment in Children With Cerebral Malaria.

Background:Murine experimental cerebral malaria studies suggest both protective and deleterious central nervous system effects from alterations in the interleukin-33 (IL-33)/ST2 pathway.Methods:We assessed whether soluble ST2 (sST2) was associated with neuronal injury or cognitive impairment in a cohort of Ugandan children with cerebral malaria (CM, n=224) or severe malarial anemia (SMA, n=193).Results:Plasma concentrations of sST2 were higher in children with CM than in children with SMA or in asymptomatic community children. Cerebrospinal fluid (CSF) sST2 levels were elevated in children with CM compared with North American children. Elevated plasma and CSF ST2 levels in children with CM correlated with increased endothelial activation and increased plasma and CSF levels of tau, a marker of neuronal injury. In children with CM who were ≥5 years of age at the time of their malaria episode, but not in children <5 years of age, elevated risk factor-adjusted plasma levels of sST2 were associated with worse scores for overall cognitive ability and attention over a 2-year follow-up.Conclusions:The study findings suggest that sST2 may contribute to neuronal injury and long-term neurocognitive impairment in older children with CM.

GCT-02. Imaging response assessment for Central Nervous System Germ Cell Tumours: consensus recommendations from the European Society for Paediatric Oncology Brain Tumour Group (SIOPE-BTG) and North American Children’s Oncology Group (COG)

Abstract BACKGROUND: Central nervous system (CNS) germ cell tumours (GCT) comprise a heterogeneous and relatively rare group of neoplasms. Improving the ability to conduct international clinical trials for CNS GCT requires use of homogeneous, common objective disease assessments and standardised response criteria. Currently, different criteria are employed between European and North American protocols for assessing radiological disease response. METHODS: An international working group of the European Society for Paediatric Oncology (SIOPE) Brain Tumour Group (BTG) and North American Children’s Oncology Group (COG) was therefore established to develop consensus recommendations for imaging response assessment for CNS GCT. The working group first reviewed existing literature and current practices and identified major challenges regarding imaging assessment. RESULTS: New clinical imaging standards were defined for the most common sites of intracranial GCT disease (suprasellar/pineal/bifocal), as well as for definition of loco-regional extension. In particular, clear standards were highlighted for definition of partial response (PR) and complete response (CR) to induction chemotherapy at different sites. Furthermore, growing teratoma syndrome (GTS) was clearly defined [apparent radiological increase in non-germinomatous GCT (NGGCT) size during induction chemotherapy despite normalising/normalised AFP/HCG markers – requiring surgery], to avoid such potential cases being classified as progressive disease (PD). CONCLUSION: This consensus will allow more consistent prospective neuroradiological evaluation of response to therapy for patients with CNS GCT and facilitate direct comparison of treatment outcomes across international studies. Ultimately, it may allow international trials to be developed and undertaken across a larger group of collaborating nations, which will be essential to answer many of the remaining questions for this rare but diverse group of tumours.

Imaging response assessment for CNS germ cell tumours: consensus recommendations from the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group.

Homogeneous and common objective disease assessments and standardised response criteria are important for better international clinical trials for CNS germ cell tumours. Currently, European protocols differ from those of North America (the USA and Canada) in terms of criteria to assess radiological disease response. An international working group of the European Society for Paediatric Oncology Brain Tumour Group and North American Children's Oncology Group was therefore established to review existing literature and current practices, identify major challenges regarding imaging assessment, and develop consensus recommendations for imaging response assessment for patients with CNS germ cell tumours. New clinical imaging standards were defined for the most common sites of CNS germ cell tumour and for the definition of locoregional extension. These new standards will allow the evaluation of response to therapy in patients with CNS germ cell tumours to be more consistent, and facilitate direct comparison of treatment outcomes across international studies.

Abnormal-Becoming-Normal: Conceptualizations of Childhood Disability in Children’s Rehabilitation Textbooks

Despite advancements to theory and practice, children’s rehabilitation is dominated by taken-for-granted assumptions about disability and childhood. In order to address a pressing need for scholarship in this area, this paper draws on post-structuralism, critical disability studies, and disabled children’s childhood studies to interrogate the underlying logics and central assumptions of eight North American children’s rehabilitation textbooks. Using discourse analysis, we highlight how the discourse of normal/abnormal is pervasive and underpins the understandings and logics deployed throughout the texts. We argue that the texts construct disabled children as abnormal-becoming-normal, and thus reinforce a moral imperative whereby disabled children are understood as requiring motivation and self-efficacy to lead a ‘good’/normal life. In drawing on these reductive understandings, children’s rehabilitation relies on a disempowering conception of disabled children as lacking, and thus fails to acknowledge and appreciate the many ways in which disabled children can be and become.

Determination of Bone Age and its Correlation to the Chronological Age Based on the Greulich and Pyle Method in Saudi Arabia

Introduction: Many clinical indications need the measurement of bone age, including growth and development abnormalities, the timing of corrective procedures in pediatric patients, and the assessment and treatment of specific endocrine conditions. These evaluations are also useful in forensic science.&#x0D; Aim: This study aims to compare the bone age of children aged 4 to 18 years old with their chronological age in order to determine whether the Greulich-Pyle (GP) method is trustworthy for Saudi youngsters.&#x0D; Materials &amp; Methods: Multiple approaches for determining bone age have been published, but Greulich and Pyle's methodology is the most extensively utilized. This method is based on an inspectional evaluation that compares the radiograph to the pattern described in a 1950 atlas using a sample of North American children aged birth to 18 years for the female sex and up to 19 years for the male sex. It is one of the most commonly utilized procedures for assessing the skeletal age of children and adolescents since it is rapid and quick to perform. It is based on the fact that ossification centers in the hand and wrist bones emerge in a predetermined order. For male and female youngsters, the degree of ossification in various hand and wrist bones is compared to the nearest matching plate on the Greulich &amp; Pyle Atlas. This cross-sectional study was performed during April 2021 to September 2021.&#x0D; Results: Total 216 patients were included or selected in this study among age group 4-18 years, the sex distribution among them were 148 (68.5%) and 68 (31.5%) were male and female respectively. Chronological age and bone age assessment by GP methodamong doctors when chronological age was 135.2 ± 45.0 (range, 45-216 months). Chronological age in male and female were 143.5 ± 44.0 and 116.9 ± 41.8 respectively with p value &lt;0.001 which was statistically significant. The bone age were observed in two reading, first reading and second reading after 15 days by two doctors separately and all the finding were recorded almost similar and significant with p value &lt;0.001. Correlation between Chronological age and Bone age by GP method in both sex observed significant p value &lt;0.001. Linear regression analysis showed that the bone ageand its correlation to the chronological age assessment in first reading in male(r=0.761 and p&lt;0.001) and female(r=0.889 and p&lt;0.001), in reading after 15 days in male(r=0.760 and p&lt;0.001) and female(r=0.868 and p&lt;0.001).&#x0D; Conclusion: In order to evaluate whether the Greulich-Pyle (GP) technique is accurate for Saudi children, the bone age of children aged 4 to 18 years old should be evaluated to their chronological age, according to this research.

Intravenous cyclophosphamide induces remission in children with difficult to treat steroid resistant nephrotic syndrome from minimal change disease

BackgroundSteroid resistant nephrotic syndrome (SRNS), while uncommon in children, is associated with significant morbidity. Calcineurin inhibitors (CNIs) remain the first line recommended therapy for children with non-genetic forms of SRNS, but some children fail to respond to them. Intravenous (IV) cyclophosphamide (CTX) has been shown to be effective in Asian-Indian children with difficult to treat SRNS (SRNS-DTT). Our study evaluated the outcome of IV CTX treatment in North American children with SRNS-DTT.MethodsRetrospective review of the medical records of children with SRNS-DTT treated with IV CTX from January 2000 to July 2019 at our center. Data abstracted included demographics, histopathology on renal biopsy, prior and concomitant use of other immunosuppressive agents and serial clinical/laboratory data. Primary outcome measure was attainment of complete remission (CR).ResultsEight children with SRNS-DTT received monthly doses (median 6; range 4–6) of IV CTX. Four (50%) went into CR, 1 achieved partial remission and 3 did not respond. Three of the 4 responders had minimal change disease (MCD). Excluding the 1 child who responded after the 4th infusion, the median time to CR was 6.5 (range 0.5–8) months after completion of IV CTX infusions. Three remain in CR at a median of 8.5 years (range: 3.7–10.5 years) after completion of CTX; one child relapsed and became steroid-dependent. No infections or life-threatening complications related to IV CTX were observed.ConclusionsIV CXT can induce long term remission in North-American children with MCD who have SRNS-DTT.