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Aashima Dabas
Email:
[email protected]
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Treatment of congenital hyperthyroidism and final
height: a 20-year study (Italian J Pediatr. 2015;41:82)
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Neurodevelopmental outcomes have shown to greatly improve with early
detection and treatment of congenital hypothyroidism (CH). However, the
impact on growth has not yet been elucidated in detail. In this study,
the authors prospectively evaluated linear growth in 215 children with
permanent CH (152 girls, 63 boys) who were diagnosed at mean age of 25.1
(10.5) days and started on thyroxin at 8.8 (2.9) mcg/kg/day. The
follow-up period at attainment of final height was 16.1 (1.7) years. The
pubertal onset occurred at 11.4 (1.2) years in boys and at 10.4 (1.1)
year in girls. The final height was significantly higher than target
height [-0.1 (1.0) SDS vs -0.8 (1.0) SDS; P<0.001]. Final
height showed poor correlation with age at diagnosis or the age of
starting thyroxin, and was chiefly dependent upon target height and
height at puberty onset. These results must be interpreted taking in
account that all these children were timely detected through newborn
screening, and most received treatment within first month of life.
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Do we need to measure autoantibodies in all
new onset pediatric diabetes? (Pediatr Diabetes. 2015
(online first) doi: 10.1111/pedi.12304)
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The estimation of diabetes associated autoantibodies (glutamic acid
decarboxylase, insulin, insulinoma-associated antigen 2) have been
questionable for routine initial diagnosis of Type 1 diabetes mellitus
(T1DM). A retrospective study of 1089 children (45.4% girls, mean age
10.6 y) at Boston’s Children hospital was performed. A scoring system
was developed using weight, age and race to classify and detect type of
diabetes. Out of 1021 patients diagnosed with T1DM, diabetes associated
antibodies were negative in 78 (7.9%). Using the scoring system,
estimation of antibodies was found unnecessary in 85.3% of patients. The
study highlights the importance of clinical evaluation of patients which
cannot replace expensive laboratory testing.
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Consumption of sugar-sweetened beverage and age of menarche
(Hum Reprod. 2015;30:675-83)
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Sugar-sweetened beverage (SSB) consumption is known to be associated
with obesity which may indirectly affect timing of menarche. In this
study, the authors evaluated the impact of consumption of sweetened
beverage on timing of menarche in 5583 girls (age 9–14 y), between 1996
and 2001. During 10,555 person-years of follow-up, 94% of girls reported
their age at menarche. Premenarcheal girls who reported consuming >1.5
servings of SSBs per day had earlier menarche (mean difference -2.7 mo;
95% CI: -4.1, -1.3 mo) as compared to girls consuming d"2 servings of
SSBs weekly. This relation remained significant across all tertiles of
baseline BMI. Non-carbonated fruit drinks and sugar-sweetened soda also
predicted earlier menarche, but not iced tea. Girls consuming more SSB
also reported less milk and less protein intake. Thus, even though the
study didn’t explore other potential confounders affecting menarcheal
age, it would be still advisable to promote healthier drinks than
sweetened beverages since childhood.
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Predicting final height and puberty in SGA
children treated with growth hormone (Clin Pediatr
Endocrinol. 2015;24:15-25)
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Growth hormone (GH) treatment was approved for use in short children
born small for gestation age (SGA) in Japan in 2008. However the long
term safety, effectiveness and impact on puberty were not evaluated.
Data of 22 SGA children out of 61 children who were enrolled in a
baseline study, was used to assess impact of low (0.033 mg/kg/d; n=29)
or high dose (0.067 mg/kg/d; n=32) of GH therapy. The mean birth
weight was similar in two groups and GH therapy was commenced at 5.2 to
5.4 years respectively in both groups till final height. The mean near
adult height achieved was comparable to normal Japanese adults. The
height velocity improved after GH therapy from 5.36 cm/yr to 8.09 cm/yr
in those receiving low dose GH and from 5.45 cm/yr to 9.72 cm/yr in
those receiving higher dose GH, which declined after two years of
treatment in both groups. The mean change in height SDS from baseline to
10 yr of treatment was 1.66 and 2.25 respectively in both groups. Median
age of puberty was 11.4 y in boys and 9.9 y in girls. One girl reported
treatment-related serious side effect (jaw malformation) in the second
group.
However, generalizing GH therapy in SGA children in
Indian settings is still a long way to go, where ensuring adequate
nutrition is a more felt need than providing GH therapy.
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Maternal versus infant vitamin D supplementation during
lactation (Pediatrics. 2015;136:625-34)
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Vitamin D supplementation is routinely advocated in healthy infants due
to low vitamin D content of breast milk. This study aimed to ascertain
the role of maternal vitamin D supplementation instead of infant’s
supplementation. Total 334 exclusively breastfeeding mother-infant pairs
were randomized into three groups to receive either 400, 2400, or 6400
IU vitamin D daily for six months. Infants received 400 IU of vitamin D
in first group and placebo in latter two groups. The mothers were
sampled monthly and infants were sampled at baseline, 4 months and 7
months. The breastfeeding rates dropped to 44.3% at 4 months and 28.4%
at 7 months. The maternal vitamin D levels significantly increased in
6400 IU than 400 IU group. However, infants in all three groups had
similar vitamin D levels at 4 and 7 months. Thus, supplementing vitamin
D to lactating women can be a better and equally effective strategy to
prevent and treat both maternal and infant vitamin D deficiency, than
supplementing infants alone.
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