Weight Z-score Research Articles

Abstract 17043: Role of Child Opportunity Index on Neonatal Mortality and 1-Year Mortality in Infant Congenital Heart Disease: A Contemporary Population-Based Report

Introduction: Although mortality has declined among infants with congenital heart disease (CHD), racial/ethnic and sociodemographic disparities persist. The child opportunity index (COI) is a census-based metric of neighborhood conditions based on education, health/environment, and social/economic domains. We sought to determine the impact of COI on neonatal and 1-year mortality of infants with CHD. Hypothesis: We hypothesized that neighborhood sociodemographic factors as measured by COI would have a greater impact on longer-term outcomes. Methods: This is a retrospective population-based cohort in California (2011-2017) of infants with CHD who underwent a cardiac intervention in the first year of life. COI was categorized into high, moderate, and low. Each COI domain was evaluated. The primary outcomes included 1-year mortality, neonatal mortality prior to 30 days of life, and days alive out of hospital in the first year of life (DAOOH). Uni- and multivariable logistic and linear regression were used. Results: The sample included 9,729 infants with an overall 1-year mortality rate of 8.2% and neonatal mortality rate of 3.5%. After adjusting for race/ethnicity, maternal age, sex, CHD severity (RACHS-1 category), birth weight z-score, and gestational age at birth, the odds of 1-year mortality were significantly higher among infants from low compared to high COI (1.37, 95%CI: 1.13, 1.67). In contrast, the adjusted odds of neonatal mortality were not different in low compared to high COI (1.20, 95%CI:0.89,1.61). Low and moderate COI groups had significantly lower DAOOH compared to high COI (low: -10.30, 95%CI: -15.2, -5.4; moderate: -7.43, 95%CI: -12.96, -1.89). Results were similar for each COI domain ( Figure 1). Conclusion: Neighborhood factors reflecting the home environment influence outcomes beyond the neonatal period. Future studies are needed to determine whether targeting domains of the COI will mitigate ongoing risks of poor CHD outcomes.

Clinical factors associated with need for neurosurgical care in young children with imaging for macrocephaly: a case control study

BackgroundMacrocephaly is present in 2.3% of children with important neurosurgical conditions in the differential diagnosis. The objective of this study was to identify clinical associations with actionable imaging findings among children with head imaging for macrocephaly.MethodsWe conducted a case-control study of head imaging studies ordered for macrocephaly among children 24 months and younger in a multistate children’s health system. Four neurosurgeons reviewed the images, determining cases to be a ‘concern’ if neurosurgical follow-up or intervention was indicated. Electronic health records were reviewed to collect patient-level data and to determine if surgery was performed. Controls were matched 3:1 to cases of ‘concern’ in a multivariate model using conditional logistic regression.ResultsIn the study sample (n = 1293), 46 (4%) were concern cases, with 15 (1%) requiring surgery. Significant clinical factors associated with neurosurgical concern were bulging fontanel [aOR 7.47, (95% CI: 2.28–24.44), P < 0.001], prematurity [aOR 21.26, (95% CI: 3.76–120.21), P < 0.001], any delay [aOR 2.67, (95% CI: 1.13–6.27), P = 0.03], and head-weight Z-score difference (W_diff, defined as the difference between the Z-scores of head circumference and weight) [aOR 1.70, (95% CI: 1.22–2.37), P = 0.002].ConclusionsHead imaging for macrocephaly identified few patients with findings of concern and fewer requiring surgery. A greater head-weight Z-score difference appears to represent a novel risk factor for neurosurgical follow-up or intervention.

Developing a nutrition screening tool for children with cystic fibrosis ages 0 to 2 years: Children with cystic fibrosis nutrition screening tool

BackgroundFor children with cystic fibrosis (CF), achieving and maintaining optimal growth by the age of 2 years is critical for future health outcomes. A standardized nutrition screening is needed to identify growth problems, enable timely interventions, and improve nutritional outcomes for children (0 to 2 years) with CF. The purpose of this study was to develop a nutrition screening tool for children (0 to 2 years) with CF to identify nutrition risk at every clinical encounter. MethodsA retrospective cross-sectional study was used to develop a nutrition screening tool to determine if nutrition interventions needed to change (at-risk) or continue (not at-risk). Retrospective data for pertinent nutrition factors were collected for 99 children attending an accredited CF clinic. The nutrition factors were compared to a dietitian assessment. A stepwise discriminant analysis determined weight-for-age (WFA) and weight-for-length (WFL) z-scores were significant. Then anthropometric data and corresponding dietitian assessment results were collected for children with CF attending two other accredited CF clinics (n = 29, n = 30). Discriminant analysis was used to determine sensitivity and specificity of the nutrition factors and to create a nutrition screening tool equation. ResultsThe nutrition screening model that included WFA z-score, LFA z-score, WFL z-score, and weight change velocity adequacy determined nutrition risk the best. The sensitivity was 89.7 %, specificity 83.2 %, NPV 93.3 %, and PPV 75.4 % for this model. ConclusionThe nutrition screening tool equation developed in this study standardizes the process to identify children (0 to 2 years) with CF at nutrition risk. Further validation is needed.

Empowered mothers and co-resident grandmothers: Two fundamental roles of women impacting child health outcomes in Punjab, Pakistan.

We show that i) empowered mothers and ii) coresident grandmothers each benefit children's nutritional health measured by height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for age groups 5 years and less. First, using cross-sectional data from the Pakistan Demographic and Health Survey (PDHS) for the year 2017-18, we estimate the impact of empowered mothers on child health outcomes using an instrumental variable approach to correct for endogeneity. Empowerment is measured by two indices: as a sum of the questions that gauge both attitudinal and behavioral dimensions of female agency and also and using multiple correspondence analysis (MCA) for these same questions. Second, we use a fuzzy regression discontinuity design (FRDD) to measure the causal impact of coresident grandmothers on the health outcomes of the children using multiple rounds of the Multiple Indicator Cluster Survey (MICS) from the years 2008, 2011, 2014 and 2018. The difference between the actual ages of the grandmother from the Potential Retirement Eligibility Criteria (PREC) has been used to correct for potential endogeneity. The results show that on average, the weight for age z-scores (WFA) for children under five increases by 0.28 SD with a one-index point increase in mother's empowerment. Similarly, on average, WFA increases by 0.098 SD when grandmothers are present in a household. Finally, we explore heterogeneity in the average effects stated above based upon the gender of the child as well as the wealth and geographic location of the household. The benefits of mothers' empowerment are largely driven by improvements in girls' nutrition as well as children living in rural areas while the presence of grandmothers primarily improves the nutrition of boys, children in rural areas, and children belonging to poor families.

A Quality Improvement Initiative to Reduce Necrotizing Enterocolitis in Very Preterm Infants.

To reduce the incidence of necrotizing enterocolitis (NEC) among very preterm infants in the Calgary Health Region to ≤2% within 2 years. A multidisciplinary team developed key drivers for NEC. Targeted interventions included strategies to increase mothers' own milk (MOM), improve compliance with feeding regimens, standardize management of feeding intolerance, prevent intestinal microbial aberrations, and feed conservatively during blood transfusion and the treatment of patent ductus arteriosus. The outcome measure was NEC (≥ stage 2). Changes in NEC rates were examined among racial and ethnic groups. Process measures included MOM feeding at discharge, the difference between actual and expected time to reach full feeds, lowest hemoglobin, and the duration of empirical antibiotics. Growth, the rate of blood transfusion, and the duration of parenteral nutrition were balancing measures. The preintervention, intervention, and sustainment periods were January 2013 to June 2016, July 2016 to December 2018, and December 2018 to December 2021, respectively. We included 2787 infants born at ≤326/7 weeks' gestation (1105 preintervention, 763 during intervention, and 919 in sustainment). NEC decreased from 5.6% to 1.9%. Process measures indicated increased MOM feeding at discharge, improved compliance with feeding regimens, increased lowest hemoglobin levels, and shorter durations of empirical antibiotics. Balancing measures revealed improved weight Z-scores, shorter durations on parenteral nutrition, and increased rates of blood transfusion. Quality improvement initiatives to increase MOM, improve compliance with feeding regimens, feed conservatively during blood transfusion and treatment of patent ductus arteriosus, and prevent intestinal microbial aberrations were associated with reduced NEC.

Anthropometric Differences in Community- Versus Clinic-Recruited Infants Participating in a Trial of Azithromycin for Prevention of Childhood Mortality in Burkina Faso.

Clinic-based recruitment for preventative interventions for child health may select for healthier populations compared with community-based outreach. Nutritional status during infancy as measured by anthropometry is predictive of mortality, growth faltering later in life, and poor cognitive development outcomes. We evaluated baseline differences in infant nutritional status among children recruited directly in their community versus clinic recruitment among infants participating in a trial of azithromycin compared with placebo for prevention of mortality in three districts of Burkina Faso. Infants between 5 and 12 weeks of age were recruited in their community of residence via vaccine outreach teams or in primary health-care clinics during vaccine clinics. Weight, height, and mid upper arm circumference were measured. We used linear and logistic regression models to compare anthropometric outcomes among community and clinic recruited infants, adjusting for age at enrollment, gender, and season. Among 32,877 infants enrolled in the trial, 21,273 (64.7%) were recruited via community outreach. Mean weight-for-age z-score (WAZ) was -0.60 ± 1.2 (SD), weight-for-length z-score (WLZ) was -0.16 ± 1.5, and length-for-age z-score was-0.53 ± 1.3. Infants enrolled in the community had lower WAZ (mean difference, -0.12; 95% CI, -0.20 to -0.04) and WLZ (mean difference, -0.21; 95% CI, -0.32 to -0.09). Community-recruited infants were more often underweight (WAZ < -2; odds ratio [OR], 1.25; 95% CI, 1.09-1.43) and wasted (WLZ < -2; OR, 1.54; 95% CI, 1.31-1.79). There was no evidence of a difference in height-based measures. Community and clinic recruitment likely reach different populations of children.

Association Between Birth Weight Z-Score and Blood Pressure in Young Adults

Association Between Birth Weight Z-Score and Blood Pressure in Young Adults

Association Between Birth Weight Z-Score and Blood Pressure in 9- to 10-Year-Old Icelandic Children

Association Between Birth Weight Z-Score and Blood Pressure in 9- to 10-Year-Old Icelandic Children

Childhood interstitial lung disease in Turkey: first data from the national registry.

The childhood interstitial lung diseases (chILD) Turkey registry (chILD-TR) was established in November 2021 to increase awareness of disease, and in collaboration with the centers to improve the diagnostic and treatment standards. Here, the first results of the chILD registry system were presented.In this prospective cohort study, data were collected using a data-entry software system. The demographic characteristics, clinical, laboratory, radiologic findings, diagnoses, and treatment characteristics of the patients were evaluated. Clinical characteristics were compared between two main chILD groups ((A) diffuse parenchymal lung diseases (DPLD) disorders manifesting primarily in infancy [group1] and (B) DPLD disorders occurring at all ages [group 2]).There were 416 patients registered from 19 centers. Forty-six patients were excluded due to missing information. The median age of diagnosis of the patients was 6.05 (1.3-11.6) years. Across the study population (n = 370), 81 (21.8%) were in group 1, and 289 (78.1%) were in group 2. The median weight z-score was significantly lower in group 1 (- 2.0 [- 3.36 to - 0.81]) than in group 2 (- 0.80 [- 1.7 to 0.20]) (p < 0.001). When we compared the groups according to chest CT findings, ground-glass opacities were significantly more common in group 1, and nodular opacities, bronchiectasis, mosaic perfusion, and mediastinal lymphadenopathy were significantly more common in group 2. Out of the overall study population, 67.8% were undergoing some form of treatment. The use of oral steroids was significantly higher in group 2 than in group 1 (40.6% vs. 23.3%, respectively; p = 0.040). Conclusion: This study showed that national registry allowed to obtain information about the frequency, types, and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. What is Known: • Childhood interstitial lung diseases comprise many diverse entities which are challenging to diagnose and manage. What is New: • This study showed that national registry allowed to obtain information about the frequency, types and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. Also, our findings reveal that nutrition should be considered in all patients with chILD, especially in A-DPLD disorders manifesting primarily in infancy.

Nutritional status of young children born with low birthweight in a low resource setting: an observational study

ObjectiveEvery year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda.MethodsWe conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14.ResultsOf the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively.ConclusionSix of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.

Development of weight and height age z-score after total cavopulmonary connection.

We aimed to analyze somatic growth of patients after total cavopulmonary connection (TCPC) as well as to identify factors influencing postoperative catch-up growth. A total of 309 patients undergoing TCPC at 4 years old or less between 1994 and 2021 were included. Weight-for-age z-score (WAZ) and height-for-age-z-score (HAZ) at TCPC and at postoperative time between 1 to 3 years were calculated. Factors influencing somatic growth were analyzed. Most frequent diagnosis and initial palliation were hypoplastic left heart syndrome (HLHS) (34%) and the Norwood procedure (51%), respectively. Median age and weight at TCPC was 2.0 (IQR: 1.7-2.5) years and 11.3 (10.5-12.7) kg, respectively. Median 519 days after TCPC, significant increase in WAZ (-0.4 to -0.2, p<0.001) was observed, but not in HAZ (-0.6 to -0.6, p=0.38). Older age at TCPC (p<0.001, OR: 2.6) and HLHS (p=0.007, OR: 2.2) were risks for low WAZ after TCPC. Older age at TCPC (p=0.009. OR: 1.9) and previous Norwood procedure (p=0.021, OR: 2.0) were risks for low HAZ after TCPC. Previous bidirectional cavopulmonary shunt (BCPS) was a protective factor for both WAZ (p=0.012, OR: 0.06) and HAZ (p=0.028, OR: 0.30) at TCPC. In patients undergoing TCPC at the age of 4 years or less, a significant catch-up growth was observed in weight-for-age z-score after TCPC, but not in height-for-age-z-score. Previous BCPS resulted to be a protective factor for a better somatic development at TCPC. HLHS undergoing Norwood were considered as risks for somatic development after TCPC.

Maternal capital predicts investment in infant growth and development through lactation.

Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes. The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed. Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital. Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.

Longitudinal growth of children born with gastroschisis or omphalocele

Normal childhood growth is an indicator of good health, but data addressing the growth of children born with abdominal wall defects (AWDs) are limited. The detailed growth phenotypes of children born with gastroschisis or omphalocele are described and compared to peers without AWDs from birth to adolescence. Data from 183 gastroschisis and 144 omphalocele patients born between 1993 and 2017 were gathered from Finnish nationwide registers and electronic health records. Weight (n = 3033), length/height (n = 2034), weight-for-length (0–24 months, n = 909), and body mass index measures (2–15 years, n = 423) were converted into sex- and age-specific Z-scores. Linear mixed models were used for comparisons. Intrauterine growth failure was common in infants with gastroschisis. Birth weight Z-scores in girls and boys were − 1.2 (0.2) and − 1.3 (0.2) and length Z-scores − 0.7 (0.2) and − 1.0 (0.2), respectively (p < 0.001 for all comparisons to infants without AWDs). During early infancy, growth failure increased in infants with gastroschisis, and thereafter, catch-up growth was prominent and faster in girls than in boys. Gastroschisis children gained weight and reached their peers’ weights permanently at 5 to 10 years. By 15 years or older, 30% of gastroschisis patients were overweight. Infants with omphalocele were born with a normal birth size but grew shorter and weighing less than the reference population until the teen-age years.Conclusion: Children with gastroschisis and omphalocele have distinct growth patterns from fetal life onwards. These growth trajectories may also provide some opportunities to modulate adult health.What is Known:• Intrauterine and postnatal growth failure can be seen frequently in gastroschisis and they often show significant catch-up growth later in infancy. It is assumed that part of the children with gastroschisis will become overweight during later childhood.What is New: • The longitudinal growth of girls and boys with gastroschisis or omphalocele is described separately until the teenage years. The risk of gaining excessive weight in puberty was confirmed in girls with gastroschisis.

Evaluation of the risk factors for noncommunicable diseases in patients with inborn errors of amino acid metabolism receiving nutrition therapy.

There is growing concern about the low-protein and high-energy diet therapies used in the treatment of inherited amino acid metabolism disorders. We aimed to identify the risk factors for noncommunicable diseases that may arise from nutritional therapies and suggests approaches that may prevent the development of the noncommunicable diseases. The present study evaluates 112 patients, on long-term nutritional therapy for at least the last 2 years with a diagnosis of an inborn error of the amino acid metabolism, and their 28 healthy siblings. The participants are assessed for the development of overweight and metabolic syndrome based on an analysis of anthropometric parameters, body composition and the results of biochemical tests. Anthropometric measurements including BMI, weight Z-score, waist circumference and fat mass were not significantly different between patients and controls. Height Z-scores were similar in phenylketonuria patients compared to controls, but lower in urea cycle disorders, organic acidemia and maple syrup urine disease groups. No increased risk of development of overweight or metabolic syndrome was detected in the patient group, while there were findings suggesting malnutrition in patients diagnosed with urea cycle disorders. There was a correlation between patients' BMI and C3-carnitine levels in organic acidemia patients and leucine levels in maple syrup urine disease patients. All forms of malnutrition can be prevented in patient groups receiving limited nutrients under a dietary management protocol, based on the findings of anthropometric and biochemical evaluations and analyses of body composition.

Growth hormone use in pediatric inflammatory bowel disease.

Impaired linear growth is a known complication of pediatric inflammatory bowel disease (IBD), but theuse of growth hormone (GH) in this population is not well-described. The primary aim of this study is to determine whether growth hormone use in pediatric IBD leads to improved height outcomes. This was a retrospective chart review of patients with IBD aged 0-21 years followed at a single center between 2018 and 2021 treated with at least 1 year of GH. Records collected included demographics, IBD phenotype, IBD disease activity scores, medications, weight z-score, height z-score, bone age, and details of GH therapy including testing for GH deficiency. The primary outcome measure was change in height z-score after 1 year of GH treatment. Forty-six patients were identified and 18 were excluded. Of the 28 patients included (7 female; 25.0 %), 26 (92.9 %) had a diagnosis of Crohn's disease (CD) and 2 (7.1 %) had ulcerative colitis (UC). The mean (SD) age at GH initiation was 9.6 (3.4) years. Among all participants, there was a significant mean difference in height z-score from baseline to 1 year on therapy (-2.25 vs.-1.50, respectively; difference, 0.75; 95 % CI, 0.56 to 0.94; p<0.001). Among the 19 subjects thatcompleted GH therapy there was a significant mean difference between baseline and final height z-scores (-2.41vs.-0.77, respectively; difference, 1.64; 95 % CI, 1.30 to 1.98; p<0.001). GH use was associated with improved height outcomes. The pediatric IBD patients in this cohort had significant improvements in height z-scores both after one year on therapy and at completion of GH therapy.

SAT581 Parathyroid Hormone Related Protein-induced Hypercalcemia In Medullary Thyroid Carcinoma In Pediatric Patient With MEN2A

Abstract Disclosure: S.A. Ackah: None. L.A. DiMeglio: None. J.C. Sanchez: None. G.C. Geddes: None. Background: PTHrp is a well-known cause of hypercalcemia of malignancy. Although PTHrp can often be detected in papillary, follicular and anaplastic thyroid cancers it does not always lead to hypercalcemia. Okotur 2007 described PTHrp in an adult medullary thyroid carcinoma (MTC). No pediatric cases have been described. Case: 8 year old female presented on transfer from hospital in Kenya where she had been admitted for three months with diarrhea and malnourishment (weight Z-score -6.5). She had been initially treated for aspiration pneumonia with negative testing for HIV, tuberculosis, stool cultures and parasites. At our facility, chest, abdomen and pelvis imaging were interpreted as an abscess from perforated appendicitis, bilateral hydroureteronephrosis, bilateral multifocal pneumonia and coronary artery ectasia. She experienced respiratory status decline requiring intubation. Further work up included consults and testing by infectious disease, genetics, immunology, cardiology, gastroenterology, pulmonology, and urology. In Kenya, the patient was initially normocalcemic and the calcium then slowly increased, so that on admission to our facility was found to have calcium 18.3 mg/dL (8.5-10.5), phosphorous 3.3 mg/dL (3.4-5.5), Creatinine 0.3 mg/dL (0.3-0.8), albumin 3.5 g/dL (3.5-4.7), PTH 5 pg/mL(10-65), TSH 1.9 mIU/ml (0.4-4.2), Free T4 0.8 ng/dL(0.6-1.5). IV hydration and pamidronate 0.5 mg/kg x 3 days administration resolved the hypercalemia. Rapid whole genome testing revealed a de novo pathogenic variant in RET (RET NM_020975.6 c.2753T&amp;gt;C; p.M918T) previously reported in individuals with MEN type 2A and 2B phenotypes. Thyroid ultrasound showed 2 nodules. FNA of both showed MTC; MTC was also present on lung biopsy. Screening labs obtained then showed PTHrp 301 pmol/L(adult range 0.0-3.4), Calcitonin 1433 pg/mL(0.0-5.1), VIP &amp;lt;13 pg/mL(0-60), Gastrin 45 pg/mL(0-100), Chromogranin A 4049 ng/mL(0-103), CEA123.7 ng/mL(0.0-2.5), metanephrine 0.91 nmol/L(0.00-0.49), normetanephrine 0.48 nmol/L(0.00-0.89). Bone scan showed diffusely diminished physiological uptake in the growth plates and diffuse bilateral lung uptake. Due to concern about ability to tolerate thyroidectomy, the patient was begun on selpercatinib, an oral chemotherapeutic agent specifically for tumors with disruption of RET gene. On day 11 of treatment, she was extubated to noninvasive respiratory support. Now, 3 months out from pamidronate and her hypercalcemia has not recurred. Conclusions: Hypercalcemia in pediatric patients with low PTH should prompt further workup including PTHrP measurement. In this case, we report a case of a child with MEN 2A and metastasized MTC with hypercalcemia attributable to PTHrp secretion.

OR15-04 Accelerated Longitudinal Weight Gain Among Infants With In Utero COVID-19 Exposure

Abstract Disclosure: M.W. Ockene: None. S.C. Russo: None. H. Lee: None. C. Monthé-Drèze: None. T.L. Stanley: Consulting Fee; Self; RosVivo Therapeutics. Grant Recipient; Self; Pfizer, Inc. I.L. Ma: None. M. Toribio: None. L.L. Shook: None. S.K. Grinspoon: Consulting Fee; Self; Theratechnologies. A.G. Edlow: Consulting Fee; Self; Mirvie, Inc. Grant Recipient; Self; Merck. L.T. Fourman: Consulting Fee; Self; Amryt Pharmaceuticals. Grant Recipient; Self; Amryt Pharmaceuticals. Background: Since its initial outbreak in 2019, coronavirus disease 2019 (COVID-19) has led to unprecedented morbidity and mortality worldwide. Due to a high burden of infection among pregnant women, a novel population of children with in utero exposure to maternal COVID-19 has emerged for which health outcomes are largely unknown. Given the role of the intrauterine environment in shaping chronic disease risk over the life course through effects on fetal programming, there is a pressing need to delineate longitudinal growth patterns among infants born to mothers with COVID-19 during pregnancy. Methods: We conducted a longitudinal cohort study leveraging a prospectively-enrolled perinatal biorepository among 149 infants with in utero exposure to maternal COVID-19 and 127 unexposed controls. Weight, length, and BMI were abstracted from health records at 0, 2 (±0.5), 6 (±1), and 12 (±1) months and standardized using World Health Organization (WHO) growth charts. Linear mixed effect and linear regression models were used to examine differences in anthropometric z-score trajectories over the first year of life between groups. Analyses were adjusted for maternal age, ethnicity, parity, insurance type, and BMI as well as infant sex, birthdate, and breastfeeding. Our pre-specified primary endpoint was change in BMI z-score from birth to 12 months. Results: Infants with in utero COVID-19 exposure versus controls exhibited differential trajectories of weight and BMI, but not length, z-scores over the first year of life (study group x time interaction, P &amp;lt; 0.0001 for weight and BMI z-scores). Infants born to mothers with prenatal COVID-19 had lower BMI z-score at birth (effect size: -0.35, 95% CI, -0.66 to -0.03) and greater increase in BMI z-score from birth to 12 months (effect size: 0.53, 95% CI, 0.06 to 0.99). Change in BMI z-score was greater than the WHO population average of 0 within the exposed (P &amp;lt; 0.0001) but not the unexposed group. Birth weight z-score was found to mediate a significant proportion of the relationship between COVID-19 exposure and postnatal growth (estimate ± standard error, 32 ± 14%, P = 0.02). Conclusions: Infants with in utero exposure to maternal COVID-19 were found to exhibit lower birth weight and accelerated weight gain over the first year of life compared to their unexposed peers. The exaggerated growth trajectory observed in these children may be a catch-up response to a prenatal growth deficit. Lower birth weight and accelerated postnatal weight gain are established risk factors for obesity, abdominal adiposity, and cardiovascular disease later in life. Thus, children born to mothers with prenatal COVID-19 may be at heightened risk of long-term cardiometabolic complications and require close monitoring over the life course. Further studies are now needed to delineate cardiometabolic sequelae of in utero COVID-19 exposure among this emerging global population. Presentation: Friday, June 16, 2023

THU150 The Association Between Glycated Albumin And HbA1c In Pediatric Acute Leukemia Patients

Abstract Disclosure: S. Sim: None. M. Ahn: None. B. Suh: None. Introduction: Traditionally, HbA1c has been used as a preferred glycemic index in diabetes patients. However, as many acute leukemia patients often present with anemia and/or pancytopenia, HbA1c may not accurately represent blood glucose level in this group. Glycated albumin represents the average level of blood glucose in recent 2-3 weeks, independent of red blood cell life. In this study, we aim to evaluate the usefulness of glycated albumin as glycemic monitoring index in pediatric patients diagnosed with acute leukemia. Methods: We performed retrospective analysis of a total of 206 pediatric patients from The Seoul St. Mary’s hospital, Catholic university of Korea. Medical records of 25 patients diagnosed with type 2 DM and 66 patients with acute leukemia were investigated for serum glycated albumin, HbA1c, fasting blood glucose level, and demographic data such as sex, age, height, weight and BMI z-scores. 115 children and adolescents who visited our outpatient center for routine child health examination were enrolled as the control group. Results: The median serum glycated albumin levels were 12.4%, 19.1% for acute leukemia and T2DM patients. HbA1c and fasting blood glucose levels, 5.3% and 7.6%, 92mg/dl and 129mg/dl respectively, also differed in the two groups. All glycated albumin, HbA1c and fasting blood glucose level did not appear different in between the control and acute leukemia group. In type 2 DM patients, glycated albumin and HbA1c showed positive correlations (r=0.926, p&amp;lt;0.01). Fasting blood glucose level was also positively correlated to glycated albumin (r=0.821, p&amp;lt;0.001) and HbA1c (r=0.773, p&amp;lt;0.001). While glycated albumin did not appear related to HbA1c in the normal control group (r=-0.02, p=0.824), patients with acute leukemia also revealed a positive correlation between glycated albumin and HbA1c (r=0.253, p=0.04). Glycated albumin was negatively related to BMI z-scores in the control group (r=0.554, p&amp;lt;0.001); however, the level showed no correlation to BMI z-scores in acute leukemia group and in T2DM patients (r=-0.133, p=0.286 and r=-0.292, p=0.156). HbA1c level was positively related to BMI z-scores in the control group (r=0.241, p=0.01) and showed no relations in the other two groups. Regression analysis found glycated albumin to be positively correlated to HbA1c both in acute leukemia pediatric patients and T2DM patients even when adjusted for age, sex and BMI z-score (p=0.039, p=0.007). Conclusion: In acute leukemia patients, glycated albumin may be a complementary parameter of glycemic status as in diabetic patients. Presentation: Thursday, June 15, 2023

THU161 The Characteristics Of DNA Methylation Pattern In Children Born Small For Gestational Age Who Failed To Catch-up Growth

Abstract Disclosure: M. Kang: None. E. Kwon: None. I. Hwang: None. Introduction: DNA methylation is one of major mechanisms of epigenetic mutation. Differentially methylated regions (DMRs) are found in various imprinting disorders. In this pilot study, we aimed to analyze DNA methylation pattern of short stature children born small for gestational age (SGA-SS). Method: SGA-SS subjects were included when all the following criteria were met: birth weight ≤ 3 percentile; height z-score after age 4 ≤ -1.881 (3 percentile); both parental heights &amp;gt; -1.881 (3 percentile). When the age of subjects were 4.0-7.5 years, they were sorted into SGA-SS group 1 (n=17). Normal control (NC) was age- and sex-matched to SGA-SS group 1 (n=11). NC subjects were normal birth weight (&amp;gt;10 percentile) and normal stature (&amp;gt; 10 percentile). When the height z-score after age 4&amp;lt;-2.5, they were sorted into SGA-SS group 2. DNA methylation patterns of IGF2, H19, PLAG1, MEG3, MEST, SGCE-PEG10, KvDMR genes were performed by pyrosequencing. Result: Mean birth weight and height z-score of NC was 3.3 kg and 0.60, respectively. Mean birth weight SDS and height z-score of SGA-SS group 1 was -2.37 and -2.08, respectively. Mean birth weight SDS and height z-score of SGA-SS group 2 was -2.60 and -2.98, respectively and birth weight was not significantly different compared to that of SGA-SS group 1. Mean DNA methylation levels of IGF2/H19/PLAG1/MEG3/MEST/SGCE-PEG10/KvDMR gene were 58.0/46.8/44.4/55.0/53.2/45.4/48.7%, 55.1/38.2/45.6/53.1/50.6/42.8/47.1%, and 54.4/42.7/45.0/53.6/51.8/44.7/46.3 % in NC, SGA-SS group 1, and SGA-SS group 2, respectively. DNA methylation levels of SGA-SS group 1 were decreased in IGF2 (P=0.027), MEST (P&amp;lt;0.001) compared to those of NC. There was difference of DNA methylation levels of MEST between SGA-SS group 1 and SGA-SS group 2 (P=0.013). Conclusion: DNA methylation levels of SGA-SS groups were different in several candidate genes related to fetal growth compared to those of NC. Although the mechanism of epigenetic mutation is diverse, DNA methylation pattern may have the role in pathophysiology and heterogeneity in SGA children. Presentation: Thursday, June 15, 2023

Children of a syndemic: co-occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV-affected mother-infant dyads in Cape Town, South Africa.

Several HIV-related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding. A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013-2017). All WLHIV initiated antenatal efavirenz-based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2-week recall) and neurodevelopment (BSID-III, measured at ∼12 months' age) were compared across bio-social strata using generalised linear regression models, with interaction terms; maternal data included interview-based measures for HD (AUDIT-C), IPV (WHO VAW) and HFIS. Among 872 breastfeeding mother-infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p >0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight-for-age Z-score (WAZ) was 0.06 (-0.14; 0.25) for food insecure CHU; -0.26 (-0.42; -0.10) for food secure CHEU; and -0.43 (-0.61; -0.25), for food insecure CHEU. Results were similar for underweight (WAZ < -2), infectious-cause hospitalisation, cognitive and motor delay. HIV-IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV-HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD-unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD-exposed CHU; 3.57 (0.84; 15.13) for HD-unexposed CHEU and 6.01 (2.22; 16.22) for HD-exposed CHEU. These data suggest that maternal HIV-related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.