Acta paediatrica Scandinavica. Supplement最新文献

The growth patterns of 158 infants with significant intrauterine growth retardation (IUGR) were studied for the first 2 years of life. Eighty-four infants were born after 36 completed weeks. All these full-term infants survived; complete follow-up data were obtained for 78. Acceleration of growth in weight began soon after birth and continued for an average of 6 months. Acceleration of linear growth began somewhat later, but was limited to the first 9 months. Twenty-three infants (29%) were still below the 5th centile for both weight and height by 2 years of age. There was a negative correlation between the neonatal ponderal index and length at 18 months for females only. Seventy-four infants were born prematurely, before 37 weeks' gestation. Mortality in this group was 18% and complete follow-up data were obtained for 49 of the 61 survivors. Birth weight was regained on average at 11 days; accelerated weight velocity began 4-6 weeks before the expected date of delivery (term date). The potential for catch-up growth lasted up to 9 months after the term date. By 18 months, however, 44% of these pre-term infants were still below the 5th centile for weight. Size at 18 months post-term was correlated with weight at the term date and length at 3 months post-term, but not with the degree of IUGR or with the ponderal index.

Growth hormone (GH) deficiencies have rarely been reported in intrauterine growth retardation (IUGR). This study has investigated GH secretion using GH provocation tests, 24-hour GH secretory profiles, and insulin-like growth factor I (IGF-I) measurements in 24 children with intrauterine growth retardation. The criteria for diagnosis were a birth length and weight below the 10th percentile for gestational age. The average age at investigation was 5.5 years, and the average growth retardation was -3.3 SD. Twenty children had shown catch-up growth between the ages of 6 months and 3 years, followed by varying decreases in growth velocity. Studies of GH secretion demonstrated GH deficiency in 16 patients, with neurosecretory dysfunction in six. Treatment with pituitary GH in nine children increased mean growth velocity from 3.5 cm/year to 7 cm/year. GH therapy should thus be effective in improving the height prognosis of children with intrauterine growth retardation.

Patients with cystic fibrosis (CF) do not reveal a primary immune defect and respond with high numbers of functional polymorphonuclear leukocytes (PMN) and specific antibodies to lung infection with Pseudomonas aeruginosa. The mucoid character of P. aeruginosa, an altered epithelial cell surface, and high concentrations of PMN-derived lysosomal enzymes contribute to impaired bacterial lung clearance and result in chronic infection. Released PMN-elastase inactivates exotoxin A, the major toxin of P. aeruginosa, thus reducing its virulence. The imbalance between PMN-proteinases and their inhibitors leads to lung tissue damage, impaired opsonophagocytosis, and T-cell and B-cell imbalance. New therapeutical concepts in CF therefore combine anti-inflammatory drugs with effective antibiotics.

The Wessex Growth Study is a community-based longitudinal survey of short children recruited from two Health Districts in Wessex during 1985-86 (cohort I) and 1986-87 (cohort II). Screening of new school entrants during 1985-86 identified only 1.3% who were at or below the 3rd centile for height as defined by Tanner and Whitehouse, suggesting a strong secular trend and an urgent need for updated height charts. After exclusion of the small number of children with underlying organic pathology and those from ethnic minorities, there were 84 children in cohort I on whom this report is based. These apparently normal, short children were sex- and age-matched with normal controls (10th-90th centile) from the same school class. Forty-two per cent of cohort I had a delayed bone age, and 34% lay above the 3rd centile after correction for parental height. Forty-four per cent were of low birth weight. The correlation between two successive height velocities measured at 6 and 12 months was only -0.14 for cohort I and -0.15 for their controls. Twelve-month mean height velocity SD scores (SDS) were -0.45 and +0.25, respectively, corresponding to the 33rd and 60th centiles, and rather higher than the 25th and 50th centiles expected in view of the heights of these children. Thirty-eight per cent of cohort I had a 12-month height velocity below the 25th centile, and in 16% height velocity was below the 10th centile. As a group, the children in cohort I grew more slowly than their controls, but the height velocity in 88% of cases lay within the control range.(ABSTRACT TRUNCATED AT 250 WORDS)

This report presents the results of a preliminary epidemiological study of growth in Akita prefecture. Data were collected from 5672 pupils from nine elementary schools in the region. Previous epidemiological investigations of growth have set the screening standard for growth retardation at -2.58 SD below the mean. On the basis of this figure it was estimated that 22 out of the 5672 pupils screened in this preliminary study (0.39%) would suffer from growth retardation. When this standard is applied to all 102,193 elementary school students in Akita prefecture, 396 children in the region are estimated to be growth retarded. An epidemiological investigation in Niigata prefecture in 1985 found that 10.5% of growth-retarded patients suffered from growth hormone deficiency. While this percentage is known to vary between different studies and with different methods of statistical analysis, application of this rate to the estimated number of 396 growth-retarded patients in Akita prefecture suggests that there may be 41 or 42 patients with growth hormone deficiency.