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Newborns who do not reach a weight appropriate for their gestational age and sex can be classified in different ways. This article defines the concepts of small for gestational age (SGA) and intrauterine growth restriction, as well as the underlying causes of these conditions, with the goal of establishing consensus definitions for these patients, in whom treatment with growth hormone throughout childhood may be indicated and who may be at risk of developing endocrine or metabolic disorders in puberty and adulthood. Most SGA children experience spontaneous catch-up growth that is usually completed by age 2 years. In SGA children who remain short, treatment with recombinant human growth hormone is effective, increasing adult height. Small for gestational age infants with rapid catch-up growth and marked weight gain are at increased risk of premature adrenarche, early puberty, polycystic ovary syndrome (girls), insulin resistance and obesity, all of which are risk factors for type 2 diabetes and metabolic syndrome in adulthood. The SGA status can affect different areas of neurodevelopment and manifest at different stages in life; neurodevelopmental outcomes are better in SGA infants with spontaneous catch-up growth. Due to the potential risks associated with SGA, adequate characterization of these patients at birth is imperative, as it allows initiation of appropriate follow-up and early detection of abnormalities., (Copyright © 2024 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: It is recommended to periodically evaluate the health-related quality of life (HRQoL) in children and adolescents with type 1 diabetes mellitus (DM1). Despite this, no specific paediatric HRQoL instrument for DM1 has been validated in Spanish., Objectives: Multicentre, prospective descriptive study in children and adolescents with DM1 with the aim of carrying out cross-cultural adaptation to Spanish and evaluating the reliability and validity of the DISABKIDS chronic disease and diabetes-specific HRQoL questionnaires, using reverse translation., Material and Methods: Sociodemographic variables were compiled together with the most recent capillary glycated haemoglobin (HbA1c) value and HRQoL questionnaires were handed out to 200 Spanish children and adolescents with DM1 aged between 8 and 18 years of age under evaluation in 12 different hospitals., Results: The mean score on the HRQoL questionnaire (patient version) for chronic disease was 80.32 (13.66), being significantly lower (P = .04) in patients with a shorter duration of the disease (≤5 years): 78.34 (13.70) vs. 82.60 (13.36). The mean score of the DM1-specific modules was: 60.81 (16.23) for disease impact and 65.59 (26.19) for treatment impact. The mean HbA1c value was 7.08 (0.79), with no differences (P > .05) noted in the mean score of the HRQoL instruments in patients with HbA1c ≤7% vs. HbA1c >7%. The Cronbach α value varied between 0.72 and 0.90., Conclusions: The Spanish versions of the DISABKIDS HRQoL instruments meet the proposed objectives of semantic equivalence and internal consistency, making it possible to periodically assess HRQoL in these patients. The good average glycaemic control presented by the patients may explain why no difference was found in the HRQoL instruments based on the HbA1c value., (Copyright © 2022 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The use of certain Complementary and Alternative Medicines (CAM) in children has been documented in Spain. The main aim of this study is to estimate the knowledge, recommendations, and use of CAM by Spanish paediatricians., Material and Methods: A national study was conducted from June to July 2020 using an online questionnaire. Two e-mails were sent to paediatricians who were members of the Spanish Association of Paediatrics (AEP)., Results: Out of 1414 responses received, acupuncture was considered as a science by 31.8%. Homeopathy was recommended to parents by 28.1%. CAM was used by 21.3% of physicians, at least once, to improve their own health. Only 3.8% had ever replaced a conventional treatment with CAM. The following variables were associated with a greater disposition to prescribe homeopathy: female, age over 45 years old, paediatricians working in Primary Care, and paediatricians working in private healthcare., Conclusions: This AEP Committee on Medicines questionnaire provides new data that should be considered alarming and should ask for a serious thinking on the use of CAM in Spain. Some paediatricians are recommending parents to give treatments not supported by scientific evidence to their children. This practice could be potentially harmful, especially when conventional treatment is being replaced., (Copyright © 2021. Published by Elsevier España, S.L.U.)

Infants born small for gestational age (SGA) are known to have increased risk of developing several pathologies, including the metabolic syndrome, when they grow up. It has been described that both the growth pattern of these children as well as the risk of their presenting future metabolic disorders can be influenced by the expression of adipokines. Among them, chemerin has demonstrated to be implicated in lipid and glucose metabolism, presenting higher circulating concentration in diabetic and obese subjects. Thus, the aim of this study was to analyze the association of anthropometric parameters and plasmatic biochemical parameters with circulating chemerin concentration in SGA children. This prospective, longitudinal study was carried out in plasma samples of Caucasian children born SGA at Hospital Universitario de Álava-Txagorritxu. Significant positive correlations were observed between chemerin concentrations at 3 months and insulin values at 3 months and also with triglyceride levels at 24 months. These associations were maintained after adjustment by anthropometric parameters. Therefore, we suggest that circulating chemerin concentration, measured at an early age, might be an indicator of future metabolic alterations in SGA children.

Introduction: Several studies conclude that small for gestational age (SGA) children have a higher number of comorbidities, as well as a different hormonal profile compared to those with appropriate weight for gestational age (AGA). Thyroid hormones play an important role in growth and neurocognitive development. Thyroid function in SGA children is still not completely known., Objectives: To compare the thyroid function of SGA children during the first 2 years of life with that in publications on thyroid function in other groups of infants, such as AGA and premature children, using the same methodology., Methods: A cohort of 38 SGA children was obtained, in which the TSH values in blood were measured at different points in the development of the SGA child. The results were compared with a population of AGA children from Zaragoza and a population of premature children from Barcelona by comparing the means using a 2-tailed test., Results: A statistically significant difference (P<.05) was observed between the SGA children in our study and the AGA children older than 6 months, but not between the SGA children of the study and the population of premature infants., Conclusions: SGA children have higher TSH values compared to AGA children older than 6 months. Therefore, it seems reasonable to establish a screening and a follow-up protocol in those SGA with high risk to develop thyroid dysfunction., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Introduction: The use of certain Complementary and Alternative Medicines (CAM) in children has been documented in Spain. The main aim of this study is to estimate the knowledge, recommendations, and use of CAM by Spanish paediatricians., Material and Methods: A national study was conducted from June to July 2020 using an online questionnaire. Two e-mails were sent to paediatricians who were members of the Spanish Association of Paediatrics (AEP)., Results: Out of 1,414 responses received, acupuncture was considered as a science by 31.8%. Homeopathy was recommended to parents by 28.1%. CAM was used by 21.3% of physicians, at least once, to improve their own health. Only 3.8% had ever replaced a conventional treatment with CAM. The following variables were associated with a greater disposition to prescribe homeopathy: female, age over 45 years old, paediatricians working in Primary Care, and paediatricians working in private healthcare., Conclusions: This AEP Committee on Medicines questionnaire provides new data that should be considered alarming and should ask for a serious thinking on the use of CAM in Spain. Some paediatricians are recommending parents to give treatments not supported by scientific evidence to their children. This practice could be potentially harmful, especially when conventional treatment is being replaced., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Background: Non-adherence to r-hGH treatments occurs in a variable percentage of subjects. One problem found when evaluating adherence is the great variability in methods of detection and definitions utilized in studies. This study assessed the level of adherence in subjects receiving r-hGH with the easypod™ electronic device., Methods: National, multicenter, prospective and observational study involving 238 subjects (144 with GH deficiency (GHD), and 86 with small for gestational age (SGA), 8 with Turner Syndrome), who received r-hGH with easypod™ for at least 3 months before inclusion. The follow-up period was 4 years., Results: Overall adherence was 94.5%; 97.5% after 6 months, 95.3% after 1 year, 93.7% after 2, 94.4% after 3 and 95.5% after 4 years of treatment. No differences in adherence were observed between prepubertal and pubertal groups and GHD and SGA groups. Change in height after 1 and 2 years, change in height SDS after 1 and 2 years, HV after 1 year, HV SDS after at 1 and 4 years, change in BMI after 1 year and change in BMI SDS at 1 and 2 years showed significant correlation with adherence. No significant differences in adherence according to IGF-I levels were found in follow-up visits or between groups., Conclusions: The easypod™ electronic device, apart from being a precise and objective measure of adherence to r-hGH treatment, allows high compliance rates to be achieved over long periods of time. Adherence significantly impacts growth outcomes associated with r-hGH treatment.

Introduction: Since its approval by the European Medicines Agency, a great number of patients born small for gestational date have received recombinant growth hormone treatment in Spain. The aim of this study is to analyse its outcome in the setting of ordinary clinical practice., Methods: Information was gathered from the registers of the assessment boards that authorise all growth hormone treatments prescribed in public hospitals in six autonomic communities (regions)., Results: Valid data from 974 patients was obtained. All of them complied with criteria established by the European Medicines Agency. Patients in the sample were smaller in length than weight at birth, with their median target height being below 1 standard deviation (SD), and 23% of them had been delivered prematurely. Treatment was started at 7.2±2.8 years (mean±SD). The mean patient height at start was -3.1±0.8 SD. They gained 0.7±0.2 SD in the first year, and 1.2±0.8 SD after two years. Final height was attained by 8% of the sample, reaching -1.4±0.7 SD., Conclusions: These results are similar to other Spanish and international published studies, and are representative of the current practice in Spain. Despite treatment being started at a late age, adequate growth is observed in the short term and in the final height. Up to a 24% of patients show a poor response in the first year., (Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

The classical form of congenital adrenal hyperplasia is the result of mutations in the 21-hydroxylase gene (CYP21A2). Most deficient alleles carry pre-existing mutations in the CYP21PA homologue pseudogene, located in tandem. Mutant alleles are inherited from carrier parents, and de novo mutations during gametogenesis or foetal development are exceptional. The present paper describes a de novo mutation occurring at the maternal allele (I172N) of a patient with a classical form of 21-hydroxylase deficiency, whose father was heterozygous for R356W. The mother did not carry the mutation. Microsatellite analyses confirmed a correct allelic segregation. The I172N mutation (in compound heterozygosity with a null mutation) gives rise to a virilizing phenotype not associated with salt-wasting., (Copyright (c) 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Objective: To determine the possible association between the decrease in emergency episodes and the strike in day care centers in Vitoria (Spain) in the autumn of 2004, which affected 86 % of children attending these centers., Patients and Method: We performed a retrospective observational study. In Vitoria, there were 27404 children under the age of 14 in 2004; of these, 5890 were under the age of 3 years. The day care centers on strike affected 25.4 % of the latter. We compared emergency episodes and hospital admissions during the strike (September to November, 2004) with those occurring in the previous 5 years. To contrast the hypothesis, a comparison of proportions was used with statistical significance set at p < 0.005., Results: A significant decrease (rate x 1000 inhabitants) was observed in the number of emergency episodes in children under 3 years old in two of the three months of the strike (October and November, p < 0.01). No significant differences were observed in emergency rates in children aged more than 3 years old, or in hospital admissions in all ages., Conclusions: These data suggest that children attending day care centers have a higher risk of catching banal diseases (which do not require hospital admission and are probably infectocontagious illnesses) than children not attending these centers, thus increasing demand for pediatric emergency services. Since the solution does not lie in closing day care centers, hygienic and sanitary measures should be maximized in these centers.

Background: Some ethnic groups are thought to have greater resistance to disease. However, scientific studies of this phenomenon are lacking in our environment., Objective: To study hospitalization rates and type of disease among infants according to ethnic group., Material and Methods: In 2000, 496 infants aged between 1 and 24 months were admitted to our hospital. Using ethnic group as a variable, 403 infants (81.25 %) were classified as non-gypsy and 93 (18.75 %) as gypsy. Demographic data were used to compare the variables of ethnicity and the main diagnostic group. Descriptive statistical analysis of the variables was performed. Differences were considered significant when p < 0.05., Results: The gypsy group represented 6.51 % of the infant population but accounted for 18.75 % of infant admissions (p < 0.05). The gypsy group accounted for 54.83 % of readmissions compared with 20.80 % in the non-gypsy group (p < 0.001). Respiratory disease was more prevalent in the gypsy group (35.48 %) than in the non-gypsy group (22.58 %) (p < 0.05). However, digestive problems were more frequent in the non-gypsy group (34.73 %) than in the gypsy group (19.35 %) (p < 0.05). No statistically significant differences were found in other diagnostic groups., Conclusion: The differences observed between demographic distribution and admission rate contradict the belief that members of the gypsy ethnic group show greater disease resistance. The differences in admission rate and diagnostic group may be due to socioeconomic, hygienic, health and educational differences between both groups. Differences in the prevalence of respiratory disease were probably due to overcrowding. Gypsy lifestyle in our population does not confer greater disease resistance.