Pediatric Problems Research Articles

If things were simple, word would have gotten around. Can complexity science help us improve pediatric research?

Complexity science is a discipline which explores how complex systems behave and how we interact with them. Though it is widely implemented outside medicine, particularly in the sciences involving human behavior, but also in the natural sciences such as physics and biology, there are only a few applications within medical research. We propose that complexity science can provide new and helpful perspectives on complex pediatric medical problems. It can help us better understand complex systems and develop ways to cope with their inherent unpredictabilities. In this article, we provide a brief introduction of complexity science, explore why many medical problems can be considered 'complex', and discuss how we can apply this perspective to pediatric research. IMPACT: Current methods in pediatric research often focus on single mechanisms or interventions instead of systems, and tend to simplify complexity. This may not be appropriate. Complexity science provides a framework and a toolbox to better address complex problems. This review provides a starting point for the application of complexity science in pediatric research.

Aleksander F. Tur — outstanding pediatrician, scientist, teacher (on the 130th anniversary of birth)

In 2024, the medical community will celebrate the 130th anniversary of the birth of the outstanding pediatrician, scientist, creator of scientific and practical schools of pediatrics — Alexander F. Tur. Alexander F. Tur was born on September 3 (15), 1894. In 1911 he was enrolled in the Imperial Military Medical Academy. From April 1915 he worked as a doctor in the active army; in August of the same year, A.F. Tur was captured and worked as a doctor in the infirmary for 3 years. In 1918, A.F. Tur resumed his studies at the Academy. From 1921 to 1930 — he worked part-time in the clinic of childhood diseases of the Military Medical Academy, under the guidance of Professor M.S. Maslov, in 1925 he was enrolled in the staff of the Leningrad Scientific and Practical Institute of Maternity and Infancy Protection named after Clara Zetkin. In 1939, the Department of Hospital Pediatrics was organized at the institute, headed by Alexander F. Tur and worked there until the end of his life. During the war years, A.F. Tur supervised the organization of clinic bomb shelters, advised children, conducted rounds, lectured students, and gave lectures to residents of the besieged city. A.F. Tur worked on a wide range of scientific problems in pediatrics, devoting his work to the most pressing issues of medicine: physiological characteristics and education of healthy children, physiology and pathology of newborns and premature babies, hematology of a healthy and sick child, dietetics of a healthy and sick child, rickets in children and its prevention, organization of children’s healthcare. A.F. Tur laid the foundations of preventive medicine at the outpatient stage, which are still followed today. The legacy of scientist is a fundamental pediatric school, a large number of scientific discoveries and works, thousands of trained do.

Determination of Attitudes and Knowledge Levels of Pediatricians about Pediatric Medicolegal Problems in Turkey

Objective: In recent years, allegations of medical errors in Turkey have been increasing. These allegations are generally concentrated on the issue of consent. Since most children are medically and legally incapable of making their own decisions on consent issues and the decision is made by the legal representative instead, various legal and ethical dilemmas arise. Pediatrics ranks first in lawsuits filed for medical errors. In our study, we aimed to evaluate the awareness of forensic legal issues among pediatricians. Materials and Methods: Our study is prospective and cross-sectional. Participants were asked 25 questions based on 14 possible case examples. They were asked to give a score between 1 and 5 points for each question about their feeling of adequacy regarding the information, consent, documents, and procedures that should be done according to these cases. Mann‒Whitney U and Kruskal‒Wallis tests were used statistically; p<0.05 was considered significant. Results: Two hundred nine pediatricians answered the questions. Sixty-six percent of the participants were working in tertiary care hospitals. Pediatricians were undecided about feeling adequate regarding the necessary information, consent, documents, and procedures to be performed for children (3.19/5) and felt inadequate when facing the refusal of treatment (2.77/5). There was no statistically significant difference between feeling competent in terms of title and professional seniority. Only 2% of the pediatricians stated that children under 12 years of age have the power of discernment, and only 7% stated that children over 15 years of age do not have the power of discernment. Conclusion: The general conclusion we reached in our study is that pediatricians do not feel adequate even concerning basic legal issues such as information, consent, and refusal of treatment. Therefore, they need to gain knowledge of these issues. For this reason, educational activities such as adding legal education to the medical school curriculum, legal training for pediatricians, and regular seminars effectively eliminate the lack of knowledge on this issue and prevent lawsuits.

Difficulties in diagnosing hereditary angioedema (HAE) with normal c1 inhibitor levels in a patient with a pathogenic mutation in the MEFV gene associated with familial Mediterranean fever

Hereditary angioedema (HAE) is an orphan disease that causes potentially life-threatening edema in various locations and remains serious problem in both pediatrics and adult clinical practice often disguised as various diseases. The HAE diagnosis with normal C1 inhibitor activity is particularly difficult. The purpose of this publication is to demonstrate unique clinical case of HAE with normal C1 inhibitor activity in young patient with a pathogenic mutation in the MEFV gene, which is associated with familial Mediterranean fever. Severe abdominal attacks in this patient have been regarded for a long time as a part of therapeutic pathology (gastroenteritis, gastritis, Familial Mediterranean fever), acute surgical and gynecological diseases, which led to late diagnosis verification. The HAE requires timely diagnosis, elimination of factors that provoke exacerbations and an immediate therapy administration, that significantly improves life quality of patients and helps prevent death.

Comorbid conditions in pediatric practice

The comorbidity is an urgent scientific and practical problem of modern pediatrics. The practical significance of combined pathology in children is determined by its widespread occurrence and universal impact on all aspects of a child’s health and treatment options. In patients with congenital heart defects, outcomes are influenced by numerous non-cardiac and genetic factors. In childhood and adolescent bronchial asthma, concomitant diseases are a common cause of adverse outcomes, such as poor disease control, frequent seizures, decreased quality of life and increased healthcare costs. A stable interdependence between the state of the gastrointestinal tract and the development of allergic or autoimmune diseases has been proven. The article describes a clinical case of late diagnosis of concomitant pathology in a child with chronic gastritis with clinical symptoms, diagnostic criteria and drug treatment options. The understanding the etiology and pathogenesis of concomitant conditions in children will help identify risk groups for the formation of chronic noncommunicable diseases and develop a plan for their prevention.

An Analysis of Emergency Surgical Outcomes for Pediatric Traumatic Brain Injury: A Ten-Year Single-Institute Retrospective Study in Taiwan.

Background and Objectives: Pediatric traumatic brain injury (pTBI) remains a major pediatric public health problem, despite well-developed injury prevention programs. The purpose of this study is to analyze the emergency surgical outcomes of pTBI in a single institute ten-year retrospective study to offer a real-world clinical result. Materials and Methods: Our institute presented a clinical retrospective, single-institute research study of 150 pediatric TBI cases that were diagnosed and underwent emergency surgical treatment from 2010 to 2019. Results: The incidence of radiological findings is detailed as follows: brain edema (30%, 45/150), followed by acute subdural hematoma (27.3%, 41/150), epidural hematoma (21.3%, 32/150), chronic subdural hemorrhage (10%, 15/150), skull fracture (6.7%, 10/150), and traumatic subarachnoid hemorrhage (4.7%, 7/150). Surgical intervention data revealed that decompressive craniectomy was still the main effective surgical method. The results showed longer hospital stays and higher morbidity rates in the brain edema, acute subdural hematoma, and chronic subdural hemorrhage groups, which were viewed as poor surgical outcome groups. Epidural hematoma, skull fracture and traumatic subarachnoid hemorrhage were categorized into good surgical outcome groups. Notably, the data revealed gross improvement in Glasgow Coma Scale/Score (GCS) evolution after surgical interventions, and the time to cranioplasty was a significant factor in the development of post-traumatic hydrocephalus (PTH). Conclusions: Our study provided real-world data for the distribution of etiology in pTBI and also categorized it into six groups, indicating disease-orientated treatment. In addition, our data supported that decompressive craniectomy (DC) remains a mainstay surgical treatment in pTBI and early cranioplasty could decrease the incidence of PTH.

Intracerebroventricular Enzyme Replacement Therapy in Patients with Neuropathic Form of Mucopolysaccharidosis Type II: to Help Practicing Physician

Mucopolysaccharidosis type II (Hunter syndrome, MPS II) is a rare hereditary disease from the group of hereditary metabolic diseases. There are neuropathic and non-neuropathic forms of this disease. The neuropathic form is most common and leads to severe cognitive impairment and progressive damage of central nervous system. Nowadays, early diagnosis and timely initiation of pathogenetic therapy in patients with orphan diseases is the crucial problem of modern pediatrics. Intracerebroventricular administration of idursulfase beta is one of the promising treatment options in patients with neuropathic form of MPS II as it prevents severe complications development. The study of new pathogenetic therapy methods for rare hereditary diseases will help doctors of pediatric specialties to route patient correctly in timely manner to receive all the necessary treatment.

Evolution of dizziness-related disability in children following concussion: a group-based trajectory analysis.

This study aimed to identify Dizziness-Related Disability (DRD) recovery trajectories in pediatric concussion and assess clinical predictors of disability groups. In this prospective cohort study, 81 children (8-17 years) diagnosed with an acute concussion took part in 3 evaluation sessions (baseline, 3-month, and 6-month). All sessions included the primary disability outcome, the Dizziness Handicap Inventory (DHI) to create the DRD recovery trajectories using group-based multi-trajectory modeling analysis. Each independent variable included general patients' characteristics, premorbid conditions, function and symptoms questionnaires, and clinical physical measures; and were compared between the trajectories with logistic regression models. Low DRD (LD) trajectory (n = 64, 79%), and a High DRD (HD) trajectory (n = 17, 21%) were identified. The Predicting and Preventing Postconcussive Problems in Pediatrics (5P) total score (Odds Ratio (OR):1.50, 95% Confidence Interval (CI): 1.01-2.22), self-reported neck pain (OR:7.25, 95%CI: 1.24-42.36), and premorbid anxiety (OR:7.25, 95%CI: 1.24-42.36) were the strongest predictors of belonging to HD group. Neck pain, premorbid anxiety, and the 5P score should be considered initially in clinical practice as to predict DRD at 3 and 6-month. Further research is needed to refine predictions and enhance personalized treatment strategies for pediatric concussion.

94 The effect of continuous positive airway pressure (CPAP) on airway problems in pediatrics's subglottic stenosis patients who underwent balloon dilatation

94 The effect of continuous positive airway pressure (CPAP) on airway problems in pediatrics's subglottic stenosis patients who underwent balloon dilatation

Adolescent smoking as risk factor of decrease in adaptation resources of neutrophil metabolism in oral cavity and progressive recurrent bronchitis

High prevalence of smoking among children and its early onset is an urgent problem in modern pediatrics. For proper health risk quantification, it is extremely important to understand and parameterize relationships between effects of adverse factors and physiological processes in the body, including the cellular level. The aim of this study was to analyze how tobacco smoking influences maladaptive changes in the mucosal immunity system of the oral cavity in adolescents and to assess kinetic trends in the clinical course of recurrent bronchitis (RB) in long-term outlook. The study included 92 patients with RB aged 16.8 ± 3.1 years. Two groups were created of them; the observation group was made of 64 patients, who admitted smoking as a habit, and the reference group included 28 people without nicotine addiction. The control group was made of 23 adolescents of the same age without any signs of the analyzed disease. Oral neutrophils (N) were selected as basic research material. N oxygen metabolism was registered by luminol-dependent chemiluminescence (LDCL) in spontaneous (sLDCL) and induced (iLDCL) variants. Functional N probing was performed using opsonized zymosan (Σ) and and peptidoglycan from S. aureus strain Cowan. Concentrations of antibodies (AT) to glycolipid (GLP) (Re-mutant Salmonella Minnesota), Candida albicans and S. аureus were determined by ELISA tests. The analyses made it possible to detect a close relationship between levels of ROS generation by neutrophilic granulocytes and the immune components of anti-endotoxic immunity. Immune changes were not established to be universal in the groups of examined patients and were shown to reflect the specificity of destabilizing effects produced by tobacco smoke. A direct moderate correlation was established in the observation group between sLDCL indicators and the concentration of anti-candidosis antibodies (r = +0.59, p = 0.0382), which reflects the level of bacterial stimulation involving dysbiotic shifts in gut microbiota. A direct correlation was detected between levels of biocidal parameters of neutorphil granulocytes and anti-glycolipid levels (r = +0.64 p = 0.417).

Курение подростков как фактор риска снижения адаптационных ресурсов метаболизма нейтрофилов ротовой полости и прогрессирующего течения рецидивирующего бронхита

High prevalence of smoking among children and its early onset is an urgent problem in modern pediatrics. For proper health risk quantification, it is extremely important to understand and parameterize relationships between effects of adverse factors and physiological processes in the body, including the cellular level. The aim of this study was to analyze how tobacco smoking influences maladaptive changes in the mucosal immunity system of the oral cavity in adolescents and to assess kinetic trends in the clinical course of recurrent bronchitis (RB) in long-term outlook. The study included 92 patients with RB aged 16.8 ± 3.1 years. Two groups were created of them; the observation group was made of 64 patients, who admitted smoking as a habit, and the reference group included 28 people without nicotine addiction. The control group was made of 23 adolescents of the same age without any signs of the analyzed disease. Oral neutrophils (N) were selected as basic research material. N oxygen metabolism was registered by luminol-dependent chemiluminescence (LDCL) in spontaneous (sLDCL) and induced (iLDCL) variants. Functional N probing was performed using opsonized zymosan (Σ) and and peptidoglycan from S. aureus strain Cowan. Concentrations of antibodies (AT) to glycolipid (GLP) (Re-mutant Salmonella Minnesota), Candida albicans and S. аureus were determined by ELISA tests. The analyses made it possible to detect a close relationship between levels of ROS generation by neutrophilic granulocytes and the immune components of anti-endotoxic immunity. Immune changes were not established to be universal in the groups of examined patients and were shown to reflect the specificity of destabilizing effects produced by tobacco smoke. A direct moderate correlation was established in the observation group between sLDCL indicators and the concentration of anti-candidosis antibodies (r = +0.59, p = 0.0382), which reflects the level of bacterial stimulation involving dysbiotic shifts in gut microbiota. A direct correlation was detected between levels of biocidal parameters of neutorphil granulocytes and anti-glycolipid levels (r = +0.64 p = 0.417). Integral assessment of specific humoral immunity to glycolipid and the phagocytic link of the mucosal protection in the oral cavity reflects the degree of endogenous intoxication and kinetic trends in the RB clinical course in adolescents in subsequent years of life. These relationships may provide solid rounds for ‘exposure – response’ stage in the risk assessment procedure for assessing risks of respiratory diseases in smoking adolescents.

Predicting Recovery After Concussion in Pediatric Patients: A Meta-Analysis.

Prognostic prediction models (PPMs) can help clinicians predict outcomes. To critically examine peer-reviewed PPMs predicting delayed recovery among pediatric patients with concussion. Ovid Medline, Embase, Ovid PsycInfo, Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Google Scholar. The study had to report a PPM for pediatric patients to be used within 28 days of injury to estimate risk of delayed recovery at 28 days to 1 year postinjury. Studies had to have at least 30 participants. The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist was completed. Six studies of 13 PPMs were included. These studies primarily reflected male patients in late childhood or early adolescence presenting to an emergency department meeting the Concussion in Sport Group concussion criteria. No study authors used the same outcome definition nor evaluated the clinical utility of a model. All studies demonstrated high risk of bias. Quality of evidence was best for the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score. No formal PPM Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) process exists. The 5P clinical risk score may be considered for clinical use. Rigorous external validations, particularly in other settings, are needed. The remaining PPMs require external validation. Lack of consensus regarding delayed recovery criteria limits these PPMs.

Behavior Problem and Mental Health of Children Affected by Floods-2022 in Pakistan

Objectives The present study aimed to examine the association between socio-demographic characteristics, damage to perceived needs, post-traumatic stress symptoms, general effect of flood and behavior problems among flood-affected children. Method Cross-sectional research design was used. A sample of 76 children (aged 8–16 years, experienced extreme hazard flood event) was collected from two schools in a flood-affected rural community in South Punjab-Pakistan through purposive sampling. Children revised impact of event scale-13 and a pediatric symptom checklist were used to screen for post-traumatic stress disorder (PTSD) and internalizing, externalizing or inattention behavior problems respectively. Results Primary school children who reported financial loss in terms of damage to houses, difficulty faced by parents in building new houses and living in tents were more affected by the flood. Age was a significant positive predictor of the general effect of flood on children. Female children positively predicted arousal PTSD and pediatric behavior problems including inattention problems. Moreover, children who lost their pets had more post-traumatic stress symptoms, as well as externalizing and inattention behavior problems. Number of times previously exposed to floods positively predicted arousal PTSD. Post-traumatic stress symptoms positively predicted behavior problems. Conclusion Primary school children affected by a flood are at greatest risk of developing behavior and mental health problems.

Modern technologies for medical rehabilitation of children with knee joint injuries

Pathology of the knee joint in children is a pressing problem in pediatric traumatology, orthopedics and pediatrics. The frequency of injuries to the knee joint is determined by the complexity of its structure, biomechanical features with a high probability of overload. At the same time, intra-articular injuries in children and adolescents, accounting for up to 7 % in the structure of inpatient pathology, are the cause of pronounced functional disorders of the lower limb and the risk of developing post-traumatic osteoarthritis Currently, physical factors are widely used at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint. The conducted studies have established the effectiveness of using local air cryotherapy in the early postoperative period, characterized by a pronounced anti-edematous, analgesic effect. Early regression of pain and elimination of microcirculatory disorders in the area of injury as a result of a course of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint have been recorded. The beneficial effect of a pulsed low-frequency electrostatic field on indicators of orthopedic status, and thermography indicators in the area of injury in children with knee joint injuries has been established. Data were obtained on more pronounced regression of pain, earlier restoration of range of motion in the damaged joint and relief of signs of post-traumatic synovitis with the complex use of a pulsed low-frequency electrostatic field and robotic mechanotherapy in children with damage to the capsular ligamentous apparatus of the knee joint. The obtained clinical and functional results are of great importance for injuries of the knee joint with the risk of contractures in the postoperative period.

About effectiveness of domestic drug liraglutide: results of clinical cases in pediatrics

Obesity is a global problem in pediatrics. Scientific interest in the study of this disease in childhood and adolescence is due to a number of factors: a steady increase in the number of patients in most countries of the world, unfavorable long-term consequences and complications, its progression into adulthood. These circumstances dictate the need for health professionals to search for new methods of treatment and prevention. The basis of treatment is a comprehensive approach, including normocaloric diet, increased physical activity, behavioral therapy and psychological support. However, these methods are often ineffective. In recent years, medications, particularly glucagon-like peptide-1 agonists (the drug liraglutide), have been approved for effective weight loss. However, there is some clinical stagnation on the part of the medical community regarding its prescription due to the lack of clear criteria determining the validity and increasing the effectiveness of treatment. On the basis of clinical observations, to propose criteria determining the possibility of prescribing a domestic analog of liraglutide (enligria) to improve the effectiveness of treatment of obesity in adolescent children. Four clinical cases demonstrated the high efficacy of liraglutide with respect to leveling cardiometabolic risks regardless of the degree of obesity and increasing adherence to lifestyle modification principles in patients with a metabolically “healthy” obesity phenotype. Also, its use was associated with facilitating the management of different types of eating disorders. Additional criteria determining the validity of liraglutide prescription in the therapy of obesity in adolescent children were proposed. It will contribute to a wider introduction of this drug into practical healthcare.

Parameters of physical development of term newborns with Intrauterine Growth Retardation, born in a 3B Level Perinatal Centre of St. Petersburg State Pediatric Medical University in 2022

BACKGROUND: Intrauterine growth retardation of a newborn child is an current problem in neonatology, obstetrics and pediatrics. Due to intrauterine development disorders, these newborns have increased morbidity and mortality rates. In the presence of Intrauterine growth retardation, the likelihood of developing complications in the early neonatal period increases (birth asphyxia, meconium aspiration, hypoglycemia, polycythemia, etc.), and the risk of developing infections and neurological disorders) is increased. AIM: The aim of this study is to study the parameters of physical development of term newborns born in the Perinatal Centre 3B level of the St. Petersburg State Pediatric Medical University in 2022 year, to determine the frequency and structure of disorders associated with Intrauterine growth retardation and malnutrition depending on the gestational age of term newborns for a differential approach in the management of children with Intrauterine growth retardation by neonatologists and paediatricians. MATERIALS AND METHODS: There were analyzed 1000 hospital neonatal records of newborns children born at the Perinatal Centre of Level 3B of St. Petersburg State Pediatric Medical University in 2022 year. Of these, 55 term babies were born with Intrauterine growth retardation. The study examined the physical development of term newborns, determined the frequency and structure of disorders associated with intrauterine growth retardation and malnutrition, depending on the gestational age of term newborns. RESULTS: Retardation of intrauterine growth and development in newborn children born in level 3B centres are represented by low body weight in relation to gestational age in 63.6% of cases, trophic disorders with normal body weight and reduced weight/length ratio in 34.6% of cases, and low height index with normal body weight in 1.8% of cases. Severe physical developmental disorders were found only in children with low body weight: in 13% of cases of low birth weight for gestational age, and in 55% of cases of small fetal size for gestational age. CONCLUSIONS: the distribution of physical development disorders (ICD code P05.2) in term infants, depending on the degree of maturity has a linear trend and occurs with maximum frequency (50%) in late term newborns, which is associated with the onset of aging of the placenta and the intensification of existing, even compensated, placental insufficiency.

Community experience and awareness regarding foreign body aspiration in Asir region, Kingdom of Saudi Arabia.

Foreign body aspiration (FBA) is a serious preventable pediatric health problem and one of the main causes of accidental death in children. Although unusual in adults, it is often overlooked as a cause of airway obstruction with serious consequences. This study assessed awareness and previous FBA experiences in the Asir community, Kingdom of Saudi Arabia. Using validated questionnaire, an annonymous online survey was conducted among 870 people aged 18 years and above. The questionnaire was used to collect data about the personal and sociodemographic characteristics of the respondents, as well as their experiences with FBA, and participants' knowledge and perceived seriousness of FBA. The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%. The majority of the participants (79.7%) were females, 48.1% were aged 18 to 30 years, 72.9% had university degree, 30.6% were students, 26.9% worked in the educational sector, 43.6% reported monthly income of <5000 Saudi Riyals and 19.8% of them identified themselves as healthcarepractitioners. Although the community experience with FBA was considerably high (70.6%) among the study participants, their awareness levels about FBA were deficient. Only 24.7% of the respondents had good knowledge of FBA. Older age, being a health practitioner, and perceiving FBA as a serious incident were significantly associated with good knowledge (P < .001). The findings of this study indicate an urgent need to raise community awareness of FBA. To reduce FBA morbidity and mortality, health education efforts in community and healthcare settings are required to educate people about the seriousness and importance of early diagnosis and management of the condition.

Common paediatric surgical problems in Bangladesh: experience in tertiary care center, Dhaka, Bangladesh

Common paediatric surgical problems in Bangladesh: experience in tertiary care center, Dhaka, Bangladesh

Reengineering eADVICE for Long Waitlists: A Tale of Two Systems and Conditions

Long outpatient waiting times pose a significant global challenge in healthcare, impacting children and families with implications for health outcomes. This paper presents the eHealth system called eADVICE (electronic Advice and Diagnosis Via the Internet following Computerised Evaluation) that is designed to address waiting list challenges for paediatricians. Initially designed for children’s incontinence, the system’s success in terms of health goals and user experience led to its adaptation for paediatric sleep problems. This paper focuses on user experiences and the development of a working alliance with the virtual doctor, alongside health outcomes based on a randomised controlled trial (N = 239) for incontinence. When reengineering eADVICE to sleep disorders, the promising results regarding the reciprocal relationship between user experience and building a working alliance encouraged a focus on the further development of the embodied conversational agent (ECA) component. This involved tailoring the ECA discussion to patient cognition (i.e., beliefs and goals) to further improve engagement and outcomes. The proposed eADVICE framework facilitates adaptation across paediatric conditions, offering a scalable model to enhance access and self-efficacy during care delays.

Comparison of the clinical picture and hormonal test results in children with growth hormone deficiency and idiopathic short stature – diagnostic difficulties and brief overview

Introduction and objective: Short stature is a common paediatric problem. Some children with short stature present growth hormone (GH) deficiency (GHD), whereas others have no hormonal disturbances (idiopathic short stature, ISS). Distinguishing between these two conditions is the task of the paediatric endocrinology centres. The aim of this study was to compare the clinical picture and hormonal tests results in patients with short stature caused by GHD and ISS. Materials and methods: The study included 100 short stature children. In all the children, medical history was obtained and a physical examination was performed. Next, bone age, insulin-like growth factor type 1 (IGF-1) levels, and GH secretion in two stimulation tests were assessed. With respect to the GH results, the children were divided into two groups: GHD (n = 38) and ISS (n = 62). Results: There were no significant differences between the groups with respect to age, sex, puberty stage, bone age, birth length and birth weight. Growth retardation was observed in both groups with a similar frequency, but in the ISS group it occurred significantly earlier. The mother’s height was lower in the ISS group. Body mass was significantly higher, but IGF-1 significantly lower in the GHD group. In both groups, the maximum GH secretion in the stimulation tests was higher after clonidine than after glucagon, which indicates that this test is more reliable. Conclusions: A similar degree of growth deficiency, growth rate deceleration and bone age delay are observed in ISS and GHD children, though ISS children are thinner and have higher IGF-1 levels. Despite some differences in clinical presentation, all short stature patients with growth rate deceleration should undergo thorough diagnostic testing along with GH stimulation tests.