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Background: Postnatal growth failure (PGF), a multifactorial condition is common in preterm infants and infants born weighing <1500 g and is associated with impaired neurodevelopmental and growth outcomes. In low-resource settings, like Uganda, parenteral nutrition and breastmilk fortifier are often unavailable, and preterm infants rely solely on their mother’s expressed breastmilk, which can be inadequate. This retrospective cohort study, conducted in a level II neonatal unit in eastern Uganda, aimed to evaluate the incidence of and risk factors for postnatal growth failure among infants <1500 g. Methods: The study included infants with birthweight <1500 g, admitted within 24 h of birth, and who spent 7 or more days in the neonatal unit. Major congenital malformations or a diagnosis of hypoxic ischemic encephalopathy were exclusion criteria. PGF was defined as a decrease in weight Z score between birth and discharge of more than − 1.28. Data on feeding, anthropometry, co-morbidities, and clinical measures were extracted from medical records. Statistical analyses were performed using Stata 17.0 with crude and adjusted relative risks (RR) were reported. Results: One hundred and four infants were recruited, including 47 (45.2%) male and 57 (54.8%) female, with a mean birth weight of 1182 g (SD 18 g, 95% CI: 1140, 1210). Almost half were small for gestational age, most were singletons (66.3%), and most were born by spontaneous vaginal delivery (82.7%). PGF was observed at discharge in 75.9% (N = 79). Clinical risk factors for PGF included: small for gestational age (cRR 1.25, 95% CI: 1.01, 1.53), respiratory distress syndrome (aRR 1.30 95% CI: 1.01, 1.67), duration of bubble continuous positive airway pressure use (aRR 1.35, 95% CI: 1.10, 1.66), sepsis requiring second line (aRR 1.58, 95% CI: 1.22, 2.04) and third line treatment (aRR 1.46, 95% CI: 1.20, 1.77), prolonged time to achieve full feeds (aRR 1.30, 95% CI: 1.01, 1.66) and prolonged hospitalisation (aRR 1.85, 95% CI: 1.31, 2.61). Conclusion: PGF was common among infants <1500 g in this hospitalised cohort who were primarily fed on their mother’s own milk. Urgent action is needed to enhance postnatal growth in this vulnerable patient group. Future research should focus on exploring multidisciplinary interventions that can improve growth outcomes in this population and understanding the long-term implications and need for care for these infants. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure. Summary Background Data: Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited. Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight < -2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ² test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables. Results: Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P= 0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2). Conclusions: This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months. [ABSTRACT FROM AUTHOR]

Abstract Background Postnatal growth failure (PGF), a multifactorial condition is common in preterm infants and infants born weighing

Mauriac syndrome (MS) is an exceptionally rare disorder occurring in poorly controlled Type-1 diabetic patients. The consequences include dwarfism, obesity, hepatomegaly, delayed puberty, growth failure and higher levels of transaminase enzyme. We report a case of an adolescent female with classical features of Mauriac syndrome.

Introduction: Thalassemia, a hereditary autosomal recessive blood disorder, arises from genetic abnormalities leading to a diminished synthesis rate of one of the globin chains constituting hemoglobin. The integration of transfusion and chelation therapies has significantly elongated the lifespan of individuals diagnosed with thalassemia. This study aims to understand growth failure among individuals with beta-thalassemia major when compared to typically developing children of similar age groups. Additionally, the research explores the potential hormone treatment requirement in this situation. Methods: Between November 1, 2019, and June 7, 2020, case-control research was carried out at the Thalassemia Centre of the Maternity and Children Hospital in Diwaniyah. The dataset included data from 100 thalassemic patients receiving blood transfusions and normal follow-up visits at the hospital. The patients ranged in age from 5 to 15 years. In addition, data were collected from 100 individuals without thalassemia, also within the same age range. Collected data encompassed age, gender, height, and weight, evaluated using the clinical growth chart from CDC. Further details recorded included the frequency of blood transfusions, the chelating agent used, serum ferritin levels, and hormone levels. Results: We discovered that, with a P value less than 0.0001, there is a significant difference in normal weight between healthy children and beta thalassemic patients. Additionally, the healthy children were found to be taller than the beta thalassemic patients. Conclusion: The study has revealed that the growth failure rate is directly linked to recurrent blood transfusion, and iron overload & resulting endocrine dysfunction.

Background: The composite index of anthropometric failure (CIAF) provides a comprehensive measure of growth failure through various child anthropometric indicators. In regions with a high prevalence of stunting, several factors may contribute to the occurrence of growth failure in children under five years. Objectives: This study aims to analyze the factors influencing the incidence of child growth failure based on the CIAF in a province with high stunting prevalence in Indonesia. Methods: The cross-sectional study used the 2022 Indonesian Nutrition Status Survey (SSGI) data. The sample comprised children aged 0-23 months from West Sulawesi Province, totaling 1,573 children. The number of samples analyzed was 1,327 children, excluding incomplete data and outliers that were values outside a certain range and treated as missing values based on the World Health Organization (WHO). Multivariate analysis was conducted using logistic regression with a complex sample facility. Results: This study found that 24.9% of children experienced growth failure based on the CIAF. Factors associated with the incidence of growth failure based on the CIAF were older age between 12-23 months (OR=4.5; CI=2.36-8.43; p=0.000), birth weight less than 2,500 g (OR=6.85; CI=3.85-12.21; p=0.000), boys (OR=1.56; CI=1.13-2.15; p=0.000), incomplete immunization status (OR=1.8; CI=1.31-2.77; p=0.001), and poor economic status in quintile 1 (OR=2.1; CI=1.08-3.99; p=0.028). Conclusions: The risk factors for child growth failure based on the CIAF included older age, male sex, low birth weight, incomplete immunization status, and low economic status.

Abstract Background Colostrum is the first milk for a newborn. Its high content in microbiota shaping compounds and its intake at the time of gut microbiota seeding suggests colostrum may be critical in the establishment of a healthy microbiota. There is also accumulating evidence on the importance of the gut microbiota for healthy growth. Here, we aimed to investigate the contribution of colostrum, and colostrum-induced microbiota to growth promotion. Addressing this question is highly significant because (1) globally, less than half of the newborns are fully colostrum fed (2) the evidence for the importance of the microbiota for the prevention of undernutrition has only been demonstrated in juvenile or adult pre-clinical models while stunting already starts before weaning. Results To address the importance of diet at birth in growth failure, we developed a unique mouse model in which neonates are breastfed by mothers at an advanced stage of lactation who no longer provide colostrum. Feeding newborn mice with mature milk instead of colostrum resulted in significant growth retardation associated with the biological features of chronic undernutrition, such as low leptin levels, dyslipidemia, systemic inflammation, and growth hormone resistance. We next investigated the role of colostrum in microbiota shaping. At the end of the lactation period, we found a major difference in gut microbiota alpha diversity, beta diversity, and taxa distribution in control and colostrum-deprived mice. To determine the causal relationship between changes in microbiota and growth trajectories, we repeated our experiment in germ-free mice. The beneficial effect of colostrum on growth remained in the absence of microbiota. Conclusion Our data suggest that colostrum may play an important role in the prevention of growth failure. They highlight that the interplay between neonatal gut microbiome assembly and diet may not be as crucial for growth control in the developing newborn as described in young adults. This opens a paradigm shift that will foster research for colostrum’s bioactives that may exert a similar effect to microbiota-derived ligands in promoting growth and lead to new avenues of translational research for newborn-tailored prevention of stunting. Video Abstract

Background: Colostrum is the first milk for a newborn. Its high content in microbiota shaping compounds and its intake at the time of gut microbiota seeding suggests colostrum may be critical in the establishment of a healthy microbiota. There is also accumulating evidence on the importance of the gut microbiota for healthy growth. Here, we aimed to investigate the contribution of colostrum, and colostrum-induced microbiota to growth promotion. Addressing this question is highly significant because (1) globally, less than half of the newborns are fully colostrum fed (2) the evidence for the importance of the microbiota for the prevention of undernutrition has only been demonstrated in juvenile or adult pre-clinical models while stunting already starts before weaning. Results: To address the importance of diet at birth in growth failure, we developed a unique mouse model in which neonates are breastfed by mothers at an advanced stage of lactation who no longer provide colostrum. Feeding newborn mice with mature milk instead of colostrum resulted in significant growth retardation associated with the biological features of chronic undernutrition, such as low leptin levels, dyslipidemia, systemic inflammation, and growth hormone resistance. We next investigated the role of colostrum in microbiota shaping. At the end of the lactation period, we found a major difference in gut microbiota alpha diversity, beta diversity, and taxa distribution in control and colostrum-deprived mice. To determine the causal relationship between changes in microbiota and growth trajectories, we repeated our experiment in germ-free mice. The beneficial effect of colostrum on growth remained in the absence of microbiota. Conclusion: Our data suggest that colostrum may play an important role in the prevention of growth failure. They highlight that the interplay between neonatal gut microbiome assembly and diet may not be as crucial for growth control in the developing newborn as described in young adults. This opens a paradigm shift that will foster research for colostrum's bioactives that may exert a similar effect to microbiota-derived ligands in promoting growth and lead to new avenues of translational research for newborn-tailored prevention of stunting. 98mWSFedBqCALfgBr5hPfA Video Abstract [ABSTRACT FROM AUTHOR]

Introduction: Thalassemia, a hereditary autosomal recessive blood disorder, arises from genetic abnormalities leading to a diminished synthesis rate of one of the globin chains constituting hemoglobin. The integration of transfusion and chelation therapies has significantly elongated the lifespan of individuals diagnosed with thalassemia. This study aims to understand growth failure among individuals with beta-thalassemia major when compared to typically developing children of similar age groups. Additionally, the research explores the potential hormone treatment requirement in this situation. Methods: Between November 1, 2019, and June 7, 2020, case-control research was carried out at the Thalassemia Centre of the Maternity and Children Hospital in Diwaniyah. The dataset included data from 100 thalassemic patients receiving blood transfusions and normal follow-up visits at the hospital. The patients ranged in age from 5 to 15 years. In addition, data were collected from 100 individuals without thalassemia, also within the same age range. Collected data encompassed age, gender, height, and weight, evaluated using the clinical growth chart from CDC. Further details recorded included the frequency of blood transfusions, the chelating agent used, serum ferritin levels, and hormone levels. Results: We discovered that, with a P value less than 0.0001, there is a significant difference in normal weight between healthy children and beta thalassemic patients. Additionally, the healthy children were found to be taller than the beta thalassemic patients. Conclusion: The study has revealed that the growth failure rate is directly linked to recurrent blood transfusion, and iron overload & resulting endocrine dysfunction. [ABSTRACT FROM AUTHOR]

There is an emerging body of evidence showing that young patients, post haematopoietic stem cell transplantation (HSCT), can develop skeletal changes that mimic an osteochondrodysplasia process. The key discriminator is that these children have had otherwise normal growth and skeletal development before the therapeutic intervention (HSCT), typically for a haematological malignancy. Herein we present that case of a boy who underwent HSCT for Haemophagocytic Lymphohistiocytosis (HLH) aged 2 years. Following Intervention with HSCT this boy's growth has severely decelerated (stature less than 1st centile matched for age) and he has developed a spondyloepiphyseal dysplasia. [ABSTRACT FROM AUTHOR]

Hypopituitarism, or the failure to secrete hormones produced by the anterior pituitary (adenohypophysis) and/or to release hormones from the posterior pituitary (neurohypophysis), can be congenital or acquired. When more than one pituitary hormone axis is impaired, the condition is known as combined pituitary hormone deficiency (CPHD). The deficiency may be primarily due to a hypothalamic or to a pituitary disorder, or concomitantly both, and has a negative impact on target organ function. This review focuses on the pathophysiology, diagnosis and management of anterior pituitary hormone deficiency in the pediatric age. Congenital hypopituitarism is generally due to genetic disorders and requires early medical attention. Exposure to toxicants or intrauterine infections should also be considered as potential etiologies. The molecular mechanisms underlying the fetal development of the hypothalamus and the pituitary are well characterized, and variants in the genes involved therein may explain the pathophysiology of congenital hypopituitarism: mutations in the genes expressed in the earliest stages are usually associated with syndromic forms whereas variants in genes involved in later stages of pituitary development result in non-syndromic forms with more specific hormone deficiencies. Tumors or lesions of the (peri)sellar region, cranial radiation therapy, traumatic brain injury and, more rarely, other inflammatory or infectious lesions represent the etiologies of acquired hypopituitarism. Hormone replacement is the general strategy, with critical periods of postnatal life requiring specific attention. [ABSTRACT FROM AUTHOR]

Abstract Background Extremely preterm infants, defined as those born before 28 weeks’ gestational age, are a very vulnerable patient group at high risk for adverse outcomes, such as necrotizing enterocolitis and death. Necrotizing enterocolitis is an inflammatory gastrointestinal disease with high incidence in this cohort and has severe implications on morbidity and mortality. Previous randomized controlled trials have shown reduced incidence of necrotizing enterocolitis among older preterm infants following probiotic supplementation. However, these trials were underpowered for extremely preterm infants, rendering evidence for probiotic supplementation in this population insufficient to date. Methods The Probiotics in Extreme Prematurity in Scandinavia (PEPS) trial is a multicenter, double-blinded, placebo-controlled and registry-based randomized controlled trial conducted among extremely preterm infants (n = 1620) born at six tertiary neonatal units in Sweden and four units in Denmark. Enrolled infants will be allocated to receive either probiotic supplementation with ProPrems® (Bifidobacterium infantis, Bifidobacterium lactis, and Streptococcus thermophilus) diluted in 3 mL breastmilk or placebo (0.5 g maltodextrin powder) diluted in 3 mL breastmilk per day until gestational week 34. The primary composite outcome is incidence of necrotizing enterocolitis and/or mortality. Secondary outcomes include incidence of late-onset sepsis, length of hospitalization, use of antibiotics, feeding tolerance, growth, and body composition at age of full-term and 3 months corrected age after hospital discharge. Discussion Current recommendations for probiotic supplementation in Sweden and Denmark do not include extremely preterm infants due to lack of evidence in this population. However, this young subgroup is notably the most at risk for experiencing adverse outcomes. This trial aims to investigate the effects of probiotic supplementation on necrotizing enterocolitis, death, and other relevant outcomes to provide sufficiently powered, high-quality evidence to inform probiotic supplementation guidelines in this population. The results could have implications for clinical practice both in Sweden and Denmark and worldwide. Trial registration ( Clinicaltrials.gov ): NCT05604846

Abstract Background Despite the rising incidence of pediatric inflammatory bowel disease (PIBD) globally, multicenter collaborative studies of PIBD children among developing countries remain sparse. We therefore aimed to define the initial presentation and short-term outcomes of Thai children with PIBD from a multicenter registry. Methods Four teaching hospitals participated in this study. A diagnosis of PIBD requires gastrointestinal endoscopy and histopathology in children aged

Background. We report four pediatric subjects with Cushing's disease (CD) diagnosed in the Czech Republic. We focus on initial symptoms of Cushing's syndrome (CS) which can lead to early diagnosis, on typical symptoms of CS in children, their age and sex distribution, the mean length of symptoms prior to diagnosis, indication for examination, post-cure growth, sexual development and pituitary function in our four CD patients after transsphenoidal pituitary surgery (TSS). We describe the diagnostic process leading to confirmation of CD and we emphasize the biochemical and radiological diagnostic difficulties. Conclusions. Pediatric CD has a number of features distinct from adult CD. Our retrospective analysis confirmed the presence of growth retardation and change in facial appearance with development of moon face as the first symptoms of CS. According to our observation, growth retardation is prior to development of moon face. The other typical symptoms frequently seen in pediatric patients are pseudo-precocious puberty in both sexes, hirsutism in pubertal girls due to excessive adrenal androgen secretion and pubertal delay. A corticotropin-releasing hormone (CRH) test and especially bilateral inferior petrosal sinus sampling for ACTH (BIPSS) contribute to confirming the diagnosis of CD and excluding ectopic ACTH syndrome in children with unvisible adenoma on pituitary magnetic resonance imaging (MRI).

BACKGROUND: Growth failure (GF) is a multifactorial problem in preterm infants. The intestinal microbiome and inflammation may contribute to GF. OBJECTIVES: This studys objective was to compare the gut microbiome and plasma cytokines in preterm infants with and without GF. METHODS: This was a prospective cohort study of infants with birth weights of

Background: Despite the rising incidence of pediatric inflammatory bowel disease (PIBD) globally, multicenter collaborative studies of PIBD children among developing countries remain sparse. We therefore aimed to define the initial presentation and short-term outcomes of Thai children with PIBD from a multicenter registry. Methods: Four teaching hospitals participated in this study. A diagnosis of PIBD requires gastrointestinal endoscopy and histopathology in children aged < 19 years. Besides demographics, we collected clinical information and treatment with the data at 1-year follow up. Results: We included 35 Crohn's disease (CD), one IBD-unclassified, and 36 ulcerative colitis (UC) children (total n = 72 with 60.6% males). The mean age at diagnosis was 7.9 years (SD 4.1) with 38% being very early onset IBD (VEO-IBD). When compared with UC, the CD children were more likely to exhibit fever (42.3 vs. 13.9%), weight loss/failure to thrive (68.6 vs. 33.3%), and hypoalbuminemia (62.9 vs. 36.1%) but less likely to have bloody stools (51.4 vs. 91.7%) (all P < 0.05). No significant differences in demographics, clinical data and medications used with regards to VEO-IBD status. At 1 year after diagnosis (n = 62), 30.7% failed to enter clinical remission and 43.7% remained on systemic corticosteroids. Diarrhea (OR 9.32) and weight issues (OR 4.92) at presentation were independent predictors of failure to enter clinical remission; and females (OR 3.08) and CD (vs. UC) (OR 3.03) were predictors of corticosteroids use at 1-year follow-up. Conclusions: A high proportion of VEOIBD is noted, and CD was more likely to present with significant inflammatory burden. Diarrhea and weight issues at presentation were independent predictors of failure to enter clinical remission; and females and CD (vs. UC) were predictors of corticosteroids use at 1-year follow-up. [ABSTRACT FROM AUTHOR]

The care of infants at risk of poor growth and development is a global priority. To inform new WHO guidelines update on prevention and management of growth faltering among infants under six months, we examined the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants between 0 and 6 months. We searched nine electronic databases from January 2000 to August 2021, included interventional studies, evaluated the quality of evidence for seven outcome domains (anthropometric recovery, child development, anthropometric outcomes, mortality, readmission, relapse, and non-response) and followed the GRADE approach for certainty of evidence. We identified thirteen studies with preterm and/or low birth weight infants assessing effects of breastfeeding counselling or education (n = 8), maternal nutrition supplementation (n = 2), mental health (n = 1), relaxation therapy (n = 1), and cash transfer (n = 1) interventions. The evidence from these studies had serious indirectness and high risk of bias. Evidence suggests breastfeeding counselling or education compared to standard care may increase infant weight at one month, weight at two months and length at one month; however, the evidence is very uncertain (very low quality). Maternal nutrition supplementation compared to standard care may not increase infant weight at 36 weeks postmenstrual age and may not reduce infant mortality by 36 weeks post-menstrual age (low quality). Evidence on the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering is limited and of 'low' to 'very low' quality. This emphasizes the urgent need for future research. The protocol was registered with PROSPERO (CRD42022309001). [ABSTRACT FROM AUTHOR]

Background. We report four pediatric subjects with Cushing's disease (CD) diagnosed in the Czech Republic. We focus on initial symptoms of Cushing's syndrome (CS) which can lead to early diagnosis, on typical symptoms of CS in children, their age and sex distribution, the mean length of symptoms prior to diagnosis, indication for examination, post-cure growth, sexual development and pituitary function in our four CD patients after transsphenoidal pituitary surgery (TSS). We describe the diagnostic process leading to confirmation of CD and we emphasize the biochemical and radiological diagnostic difficulties. Conclusions. Pediatric CD has a number of features distinct from adult CD. Our retrospective analysis confirmed the presence of growth retardation and change in facial appearance with development of moon face as the first symptoms of CS. According to our observation, growth retardation is prior to development of moon face. The other typical symptoms frequently seen in pediatric patients are pseudo-precocious puberty in both sexes, hirsutism in pubertal girls due to excessive adrenal androgen secretion and pubertal delay. A corticotropin-releasing hormone (CRH) test and especially bilateral inferior petrosal sinus sampling for ACTH (BIPSS) contribute to confirming the diagnosis of CD and excluding ectopic ACTH syndrome in children with unvisible adenoma on pituitary magnetic resonance imaging (MRI). [ABSTRACT FROM AUTHOR]

Introduction: Chronic glucocorticoid therapy by systemic and inhaled forms is the most common cause of adrenal insufficiency. There is no administrative form, dosing, duration or underlying disease for which it is more common, although higher dose and prolonged use have highest risk. Clinical case characteristics: A 11-year-old girl was brought with cough and cold for a week, fever, vomiting and headache for one day. She had been diagnosed to have asthma and allergic rhinitis 7 years ago. She was started on Mometasone 120mcg nasal spray OD, used for 4 years and Budesonide 64mcg nasal spray BD for 1 year. She was also put on Formoterol 6mcg + Mometasone 200mcg MDI, used for 4 years, and Formoterol 6mcg + Budesonide 200mcg MDI, used for 1 year. No significant birth or family history. On examination, child was severely stunted and wasted, with height and weight below - 3 standard deviations on IAP growth chart. She was hemodynamically stable, head to toe and systemic examination was normal. Outcome: She was found to have severe hyponatremia, which was corrected. Due to significant past history of chronic usage of intranasal and inhaled corticosteroids, adrenal insufficiency was suspected and serum cortisol levels done, which were low. ACTH stimulation test was administered and serum cortisol levels tested at 30 minutes and 60 minutes, remained below the reference range after the test. Hence the child was diagnosed to have adrenal insufficiency. Pediatric endocrinology reference taken and steroids tapered over several weeks. Serum cortisol levels monitored during follow up were normal. Conclusion: Clinicians must have a high index of suspicion, especially in patients with nonspecific symptoms after cessation of high-dose or long-term steroids and consider testing for cortisol levels. Patient education, monitoring and regular follow up is a key feature of management of this condition. [ABSTRACT FROM AUTHOR]

Abstract Background Preterm and term small for gestational age (SGA) babies are at high risk of experiencing malnutrition and impaired neurodevelopment. Standalone interventions have modest and sometimes inconsistent effects on growth and neurodevelopment in these babies. For greater impact, intervention may be needed in multiple domains—health, nutrition, and psychosocial care and support. Therefore, the combined effects of an integrated intervention package for preterm and term SGA on growth and neurodevelopment are worth investigating. Methods An individually randomized controlled trial is being conducted in urban and peri-urban low to middle-socioeconomic neighborhoods in South Delhi, India. Infants are randomized (1:1) into two strata of 1300 preterm and 1300 term SGA infants each to receive the intervention package or routine care. Infants will be followed until 12 months of age. Outcome data will be collected by an independent outcome ascertainment team at infant ages 1, 3, 6, 9, and 12 months and at 2, 6, and 12 months after delivery for mothers. Discussion The findings of this study will indicate whether providing an intervention that addresses factors known to limit growth and neurodevelopment can offer substantial benefits to preterm or term SGA infants. The results from this study will increase our understanding of growth and development and guide the design of public health programs in low- and middle-income settings for vulnerable infants. Trial registration The trial has been registered prospectively in Clinical Trial Registry – India # CTRI/2021/11/037881, Registered on 08 November 2021.

Abstract Background The incidence of inflammatory bowel disease (IBD) in children is on the increase worldwide. Growth disorders are common in pediatric patients with inflammatory bowel disease. The aim of this paper is to investigate anthropometric indicators, including height and weight in children with inflammatory bowel disease in Saxony, one of the German federal states, and to evaluate growth trends in patients by comparing their height and weight with that of healthy children in Germany. Methods In Saxony, all children and adolescents with IBD were registered in the Saxon Pediatric IBD Registry from 2000 to 2014. The data used are therefore based on a total area-wide survey over 15 years. For this study, 421 datasets of children and adolescents aged 0–14 years with Crohn’s disease (CD) (n = 291) or ulcerative colitis (UC) (n = 130) were analyzed. Z-score and percentile calculations were used to compare differences between IBD patients and the general population. Results The children with CD or UC (both sexes) had a significant lower weight at diagnosis (the mean weight z-score had negative values) versus the general population. The weight values lay mostly below P50 (the 50th percentile, median), more precisely, mostly between P10 and P50 of the body weight child growth curve for corresponding sexes (KiGGS 2003–2006). The height values of both sexes at diagnosis lay also mostly below P50 (the 50th percentile, median) of the child body growth curve for corresponding sexes (KiGGS 2003–2006), i.e. the mean height z-score was negative. But only the children with CD had a significant lower height, more precisely, mostly between P25 and P50 versus the general population (KIGGS). For children with UC the difference was not significant. Conclusion In pediatric patients with IBD the possibility of growth disturbance, mainly in the form of weight retardation, is very probable.

Background: Preterm and term small for gestational age (SGA) babies are at high risk of experiencing malnutrition and impaired neurodevelopment. Standalone interventions have modest and sometimes inconsistent effects on growth and neurodevelopment in these babies. For greater impact, intervention may be needed in multiple domains—health, nutrition, and psychosocial care and support. Therefore, the combined effects of an integrated intervention package for preterm and term SGA on growth and neurodevelopment are worth investigating. Methods: An individually randomized controlled trial is being conducted in urban and peri-urban low to middle-socioeconomic neighborhoods in South Delhi, India. Infants are randomized (1:1) into two strata of 1300 preterm and 1300 term SGA infants each to receive the intervention package or routine care. Infants will be followed until 12 months of age. Outcome data will be collected by an independent outcome ascertainment team at infant ages 1, 3, 6, 9, and 12 months and at 2, 6, and 12 months after delivery for mothers. Discussion: The findings of this study will indicate whether providing an intervention that addresses factors known to limit growth and neurodevelopment can offer substantial benefits to preterm or term SGA infants. The results from this study will increase our understanding of growth and development and guide the design of public health programs in low- and middle-income settings for vulnerable infants. Trial registration: The trial has been registered prospectively in Clinical Trial Registry – India # CTRI/2021/11/037881, Registered on 08 November 2021. [ABSTRACT FROM AUTHOR]

Introduction: Patients with homozygous recessive mutations in STAT5B have severe progressive postnatal growth failure and insulin-like growth factor-I (IGF-I) deficiency associated with immunodeficiency and increased risk of autoimmune and pulmonary conditions. This report describes the efficacy and safety of recombinant human IGF-1 (rhIGF-1) in treating severe growth failure due to STAT5B deficiency. Case Presentation: Three siblings (P1, 4.4 year-old female; P2, 2.3 year-old male; and P3, 7 month-old female) with severe short stature (height SDS [HtSDS] −6.5, −4.9, −5.3, respectively) were referred to the Center for Growth Disorders at Cincinnati Children's Hospital Medical Center. All three had a homozygous mutation (p.Trp631*) in STAT5B. Baseline IGF-I was 14.7, 14.1, and 10.8 ng/mL, respectively (all < −2.5 SDS for age and sex), and IGFBP-3 was 796, 603, and 475 ng/mL, respectively (all < −3 SDS for age and sex). The siblings were started on rhIGF-1 at 40 μg/kg/dose twice daily subcutaneously (SQ), gradually increased to 110–120 μg/kg/dose SQ twice daily as tolerated. HtSDS and height velocity (HV) were monitored over time. Results: Six years of growth data was utilized to quantify growth response in the two older siblings and 5 years of data in the youngest. Pre-treatment HVs were, respectively, 3.0 (P1), 3.0 (P2), and 5.2 (P3) cm/year. With rhIGF-1 therapy, HVs increased to 5.2–6.0, 4.8–7.1, and 5.5–7.4 cm/year, respectively, in the first 3 years of treatment, before they decreased to 4.7, 3.8, and 4.3 cm/year, respectively, at a COVID-19 pandemic delayed follow-up visit and with decreased treatment adherence. ΔHtSDS for P1 and P2 was +2.21 and +0.93, respectively, over 6 years, but −0.62 for P3 after 5 years and in the setting of severe local lipohypertrophy and suboptimal weight gain. P3 also experienced hypoglycemia that limited our ability to maintain target rhIGF-1 dosing. Conclusion: The response to rhIGF-1 therapy is less than observed with rhIGF-1 therapy for patients previously described with severe primary IGF-I deficiency, including patients with documented defects in the growth hormone receptor, but may still provide patients with STAT5B deficiency with an opportunity to prevent worsening growth failure. [ABSTRACT FROM AUTHOR]

Neonatal enterostomy is a known risk for growth failure. We hypothesized that episodes of inflammation may drive a catabolic state, exploring this by assessing serum biochemistry alongside growth trajectory in enterostomy patients. A retrospective analysis of infants with histologically confirmed NEC from 01/2012–07/2021 in a tertiary neonatal surgical centre was performed. Change in weight-for-age Z-score (Δ Z) between stoma formation and closure was calculated. Serum CRP (C-reactive protein), urea, and creatinine levels were recorded and duration of elevated levels calculated as Area Under Curve (AUC). We examined for trends of serum levels rising together using intersecting moving averages. Spearman's correlation analysis was performed, while multivariable linear regression examined factors associated with Δ Z. 79 neonates were included. At stoma formation, median Z-score was −1.42 [range −4.73, +1.3]. Sixty-two patients (78 %) had a fall in Z-score during their time with a stoma, 16 (20 %) had a Δ Z less than −2. Urea AUC was significantly univariably correlated with Δ Z and remained statistically significant in a multivariable model (Exp(B) x 100 = −0.57[−1, −0.09]; p = 0.022). The number of biomarker peaks correlated significantly with Δ Z for urea (r = −0.25; p = 0.025) and CRP (r = −0.35; p = 0.0017) but not Creatinine (r = −0.21; p = 0.066). Analysing the number of peaks of any combination of variables coinciding was consistently significantly correlated negatively with Δ Z (r = −0.29 to −0.27; p ≤ 0.016 for all). Our data shows that infants who were more severely affected by growth failure had more frequent and severe uremia while they had a stoma (suggesting a catabolic state). Disturbances in urea were commonly associated with CRP, suggesting that inflammation is a significant factor in growth failure in these infants. These findings promote aggressive management of sepsis in these infants, as well as suggesting an earlier closure of stoma to minimise their "at-risk"' period. • Growth failure is common in infants with an enterostomy, factors associated with this have not been explored. • Serum biochemical markers (urea and CRP) were shown to associate with growth failure. • Raised urea suggests a catabolic state, while raised CRP suggests periods of sepsis or inflammation may drive this faltering growth. • Reducing time with a stoma and aggressive sepsis management may improve outcomes in a future prospective cohort study. [ABSTRACT FROM AUTHOR]

Background: Pediatric inflammatory bowel disease (IBD) has been known to be a disease predominant in the west. There is scarcity of data on pediatric IBD (P-IBD) from northern India. The objective of our study was to analyze the clinical spectrum of P-IBD in northern India. Methods: A retrospective analysis of 126 children (<18-year old) diagnosed with IBD from January 1999 to December 2019 was done on a pre-designed proforma. It was systematically entered in a MS Excel spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. The descriptive phenotypes of Ulcerative colitis (UC) and Crohn's disease (CD) were revised according to the Paris classification. Results: Of 126 children, UC was diagnosed in 76 (60.3%), CD in 44 (34.9%) and IBD-unclassified (IBD-U) in six (4.76%) patients. The mean age at diagnosis was 11.3 years; 38.8% were < 10 years with the male: female ratio of 1.6:1. Sixteen children (12.7%) had very early onset IBD (VEOBD). Overall, the median time to diagnosis in IBD was 12 months (interquartile range [IQR]: 3.25–24), which was as high as 52.5 months (IQR: 11–98) in CD. Pancolitis with bleeding per rectum and ileocolonic involvement with pain in abdomen were the commonest presentations in UC and CD, respectively. Stricturing disease was seen in 27% of CD cases. Relapses were seen in 46% (35/76) of U.C and 23% (10/44) of CD kids. Step-up treatment protocol was employed in them with the use of biologicals in 12% of cases. There was a 2.75-fold rise in the IBD cases in the last 10 years (2010-20). There was reduction in time to diagnosis (21 months vs. 90 months; p – 0.012) and empirical anti-tubercular therapy use (90% vs. 5.8%) in CD over two decades. Conclusion: From our experience in a tertiary care centre in northern India, P-IBD is on the rise. UC is more common than CD. Pancolitis and ileocolonic disease are the commonest disease sites in UC and CD, respectively There is a significant delay in the time to diagnosis in CD. Stricturing disease was seen in a quarter of children with CD. [ABSTRACT FROM AUTHOR]

Background: The incidence of inflammatory bowel disease (IBD) in children is on the increase worldwide. Growth disorders are common in pediatric patients with inflammatory bowel disease. The aim of this paper is to investigate anthropometric indicators, including height and weight in children with inflammatory bowel disease in Saxony, one of the German federal states, and to evaluate growth trends in patients by comparing their height and weight with that of healthy children in Germany. Methods: In Saxony, all children and adolescents with IBD were registered in the Saxon Pediatric IBD Registry from 2000 to 2014. The data used are therefore based on a total area-wide survey over 15 years. For this study, 421 datasets of children and adolescents aged 0–14 years with Crohn's disease (CD) (n = 291) or ulcerative colitis (UC) (n = 130) were analyzed. Z-score and percentile calculations were used to compare differences between IBD patients and the general population. Results: The children with CD or UC (both sexes) had a significant lower weight at diagnosis (the mean weight z-score had negative values) versus the general population. The weight values lay mostly below P50 (the 50th percentile, median), more precisely, mostly between P10 and P50 of the body weight child growth curve for corresponding sexes (KiGGS 2003–2006). The height values of both sexes at diagnosis lay also mostly below P50 (the 50th percentile, median) of the child body growth curve for corresponding sexes (KiGGS 2003–2006), i.e. the mean height z-score was negative. But only the children with CD had a significant lower height, more precisely, mostly between P25 and P50 versus the general population (KIGGS). For children with UC the difference was not significant. Conclusion: In pediatric patients with IBD the possibility of growth disturbance, mainly in the form of weight retardation, is very probable. [ABSTRACT FROM AUTHOR]

Chronic inflammatory conditions, such as juvenile idiopathic arthritis, are associated with growth failure. Growth failure appears to be correlated with both the effects of inflammation and negative effects of glucocorticoids (used as therapeutic option) on the growth hormone axis and locally on the growth plate and bone metabolism. In the last decade, the introduction of biologics has changed the disease course regarding consequences and outcomes. Anyway in some cases, treatment with biologics has failed in restoring normal growth in patients with juvenile idiopathic arthritis; in contrast, several studies have reported improved height velocity and growth rate in patients with juvenile idiopathic arthritis treated with growth hormone. This study aimed to evaluate the impact of growth hormone treatment on the growth and pubertal development in juvenile idiopathic arthritis patients through a narrative review of the literature over the last four decades. [ABSTRACT FROM AUTHOR]

Mauriac syndrome (MS) is a rare complication, seen in pediatric patients with uncontrolled type 1 diabetes mellitus (DM) characterized by growth failure and hepatomegaly and is associated with microvascular complications. We describe the case report of a 13-year-old girl with type 1 DM with MS due to inadequate insulin treatment with only short-acting insulin. She had growth failure, hepatomegaly with raised liver enzymes, neuropathy, very high HbA1c, and was in Tanner's stage 1 sexual maturity. Her condition improved after switching to premixed insulin twice daily with additional short acting insulin before the lunch. Her enzymes normalized after 2 weeks of insulin intensification. Glycogen deposition in the liver due to uncontrolled DM is the cause of liver injury in MS. Thorough monitoring of growth and microvascular complications during each encounter with health-care personnel, along with tackling of social, mental, and emotional problems of children with type 1 DM is needed to prevent MS in resource-limited settings. [ABSTRACT FROM AUTHOR]

Background Growth failure due to infection in children is a major health problem throughout the world. It provokes a systemic immune response, with increased interleukin (IL)-6 and reduced IL-10. Lactoferrin (Lf) is a multifunctional iron-binding protein that can be found in whey protein inside formula milk such as oral nutrition supplement (ONS), which is able to upregulate anti-inflammatory cytokines (IL-10) and modulate pro-inflammatory cytokines. We conducted this study to investigate the effect of Lf supplementation in ONS on IL-6 and IL-10 levels in children with failure to thrive and infection. Methods We performed a quasi-experimental pre- and post-study in children aged 12–60 months old with failure to thrive due to infectious illness. The subjects received 400 ml of oral nutritional supplements (ONS, 1 ml equivalent to 1 kcal) each day for 90 days, and their parents received dietary advice and medication based on the underlying illness. Blood was drawn to measure IL-6 and IL-10 before and after the intervention. Results There were 75 subjects recruited and divided into group-1 and group-2 based on age. The incidence of undernutrition was 37.33%. Lf in ONS intervention improved body weight and body length. Lf also reduced IL-6, although there was not a significant difference before and after the intervention. However, the IL-6 reduction was significantly higher in subjects with undernutrition compared with subjects with weight faltering. Pre-intervention IL-6 levels were higher in children with stunting than in children with normal stature. There was a greater change in IL-6 in children with severe stunting than in children with normal stature or stunting. IL-10 was significantly reduced after the intervention. Conclusions In addition to improving body weight and length, Lf supplementation in ONS improved immune response homeostasis by balancing IL-6 and IL-10 levels and by improving the IL-6/IL-10 ratio. ClinicalTrials.gov number ID: NCT05289674, dated May 3 rd 2022.

Background Growth failure due to infection in children is a major health problem throughout the world. It provokes a systemic immune response, with increased interleukin (IL)-6 and reduced IL-10. Lactoferrin (Lf) is a multifunctional iron-binding protein that can be found in whey protein inside formula milk such as oral nutrition supplement (ONS), which is able to upregulate anti-inflammatory cytokines (IL-10) and modulate pro-inflammatory cytokines. We conducted this study to investigate the effect of Lf supplementation in ONS on IL-6 and IL-10 levels in children with failure to thrive and infection. Methods We performed a quasi-experimental pre- and post-study in children aged 12–60 months old with failure to thrive due to infectious illness. The subjects received 400 ml of oral nutritional supplements (ONS, 1 ml equivalent to 1 kcal) each day for 90 days, and their parents received dietary advice and medication based on the underlying illness. Blood was drawn to measure IL-6 and IL-10 before and after the intervention. Results There were 75 subjects recruited and divided into group-1 and group-2 based on age. The incidence of undernutrition was 37.33%. Lf in ONS intervention improved body weight and body length. Lf also reduced IL-6, although there was not a significant difference before and after the intervention. However, the IL-6 reduction was significantly higher in subjects with undernutrition compared with subjects with weight faltering. Pre-intervention IL-6 levels were higher in children with stunting than in children with normal stature. There was a greater change in IL-6 in children with severe stunting than in children with normal stature or stunting. IL-10 was significantly reduced after the intervention. Conclusions In addition to improving body weight and length, Lf supplementation in ONS improved immune response homeostasis by balancing IL-6 and IL-10 levels and by improving the IL-6/IL-10 ratio. ClinicalTrials.gov number ID: NCT05289674, dated May 3rd 2022.

ABSTRACTGrowth failure is among the most prevalent and devastating consequences of prematurity. Up to half of all extremely preterm neonates struggle to grow despite modern nutrition practices. Although elegant preclinical models suggest causal roles for the gut microbiome, these insights have not yet translated into biomarkers that identify at-risk neonates or therapies that prevent or treat growth failure. This systematic review aims to identify features of the neonatal gut microbiota that are positively or negatively associated with early postnatal growth. We identified 860 articles, of which 14 were eligible for inclusion. No two studies used the same definitions of growth, ages at stool collection, and statistical methods linking microbiota to metadata. In all, 58 different taxa were associated with growth, with little consensus among studies. Two or more studies reported positive associations with Enterobacteriaceae, Bacteroides, Bifidobacterium, Enterococcus, and Veillonella, and negative associations with Citrobacter, Klebsiella, and Staphylococcus. Streptococcus was positively associated with growth in five studies and negatively associated with growth in three studies. To gain insight into how the various definitions of growth could impact results, we performed an exploratory secondary analysis of 245 longitudinally sampled preterm infant stools, linking microbiota composition to multiple clinically relevant definitions of neonatal growth. Within this cohort, every definition of growth was associated with a different combination of microbiota features. Together, these results suggest that the lack of consensus in defining neonatal growth may limit our capacity to detect consistent, meaningful clinical associations that could be leveraged into improved care for preterm neonates.

Objective: To determine the treatment outcomes on growth of children diagnosed with glycogen storage disease (GSD) presenting to National Institute of Child Health (NICH), Karachi, Pakistan. Study Design: Descriptive Longitudinal study. Setting: Department of Hepatology and Gastroenterology, NICH, Karachi, Pakistan. Period: March 2021 to September 2022. Material & Methods: Children of either gender aged above 1 year diagnosed with GSD were enrolled. Demographic details and disease details of all children were included and necessary biochemical and laboratory investigations were assessed. Children were treated with uncooked corn starch (corn flour) and dietary restrictions were also advised. Growth outcomes in terms of height, weight and liver size were measured for the period of 6-months and compared with the baseline data. Results: In a total of 36 children with GSD, 20 (55.6%) were male. The mean age was 2.81±1.80 years (ranging between 1 to 6 years). At the time of presentation, abdominal distension and hepatomegaly were observed in 36 (100%) children each. Significant improvements were found in terms of height gain among children aged 1-3 years (p<0.0001) and 4-6 years (p=0.0039) after 6-months of treatment. Although, children between 1-3 years and 4-6 years gained weight after 6 months of treatment but the difference was insignificant (p>0.05). Reduction in liver size was observed among children between 1-3 years (p=0.0073) and 4-6 years (p=0.0376) after 6-months of treatment. Conclusion: Treatment with uncooked corn starch (corn flour) and dietary restriction resulted in significant improvement on the growth of children diagnosed with GSD presenting to National Institute of Child Health, Karachi, Pakistan. [ABSTRACT FROM AUTHOR]

Introduction: The metalloproteinase pregnancy-associated plasma protein A2 (PAPP-A2) cleaves insulin-like growth factor (IGF)-binding proteins 3 and 5 to release bioactive IGF-I from its ternary complex. Patients with mutations in PAPP-A2 have growth failure and low free IGF-I despite elevated total IGF-I. We describe 5-year treatment response to recombinant human IGF-1 (rhIGF-1) in a patient with PAPP-A2 deficiency, and the phenotype of PAPP-A2 deficiency in three siblings. Methods: Two siblings (P2, P3) with PAPP-A2 deficiency were recruited for rhIGF-1 therapy at 120 μg/kg subcutaneous twice daily, along with a third sibling (P1) for phenotyping. We evaluated efficacy and safety of rhIGF-1 therapy, including effect on metabolic measures and bone mineral density (BMD). Results: Treatment with rhIGF-1 was started in 10.4-year- (P3) and 14.5-year (P2)-old brothers. P2 discontinued therapy due to pseudotumor cerebri. P3 continued rhIGF-1 for 5 years; height velocity increased (3.0 cm/year at baseline; 5.0–7.6 cm/year thereafter) as did height SDS (+0.6). P3's pubertal onset was at 12.4 year. BMD height-adjusted Z-score modestly improved for lumbar spine (+0.4), and decreased in forearm (−0.2) and hip (−0.3). All siblings had hyperinsulinemia. Impaired glucose tolerance (IGT) resolved in P1. P2 showed worsening glucose tolerance (2-h glucose: 225 mg/dL). Impaired fasting glucose and hyperinsulinemia initially resolved for P3, but IGT (2-h glucose: 152 mg/dL) developed during puberty. Conclusion: Therapy with rhIGF-1 modestly improved linear growth in one patient with PAPP-A2 deficiency, but without true catch-up. Therapy was associated with pseudotumor cerebri in a sibling. Initial improvement in BMD and glycemic pattern on rhIGF-1 was not sustained during puberty. [ABSTRACT FROM AUTHOR]

Background: Growth failure due to infection in children is a major health problem throughout the world. It provokes a systemic immune response, with increased interleukin (IL)-6 and reduced IL-10. Lactoferrin (Lf) is a multifunctional iron-binding protein that can be found in whey protein inside formula milk such as oral nutrition supplement (ONS), which can upregulate anti-inflammatory cytokines (IL-10) and modulate pro-inflammatory cytokines. This study investigates the effect of Lf supplementation in ONS on IL-6 and IL-10 levels in children with failure to thrive and infection. Methods: We performed a quasi-experimental pre- and post-study in children aged 12–60 months old with failure to thrive due to infectious illness. The subjects received 400 ml of oral nutritional supplements (ONS, 1 ml equivalent to 1 kcal) each day for 90 days, and their parents received dietary advice and medication based on the underlying illness. Blood was drawn to measure IL-6 and IL-10 before and after the intervention. Results: There were 75 subjects recruited and divided into group-1 and group-2 based on age. The incidence of undernutrition was 37.33%. Lf in ONS intervention improved body weight and body length. Lf also reduced IL-6, although there was not a significant difference before and after the intervention. However, the IL-6 reduction was significantly higher in subjects with undernutrition compared with subjects with weight faltering. Pre-intervention IL-6 levels were higher in children with stunting than in children with normal stature. There was a greater change in IL-6 in children with severe stunting than in children with normal stature or stunting. IL-10 was significantly reduced after the intervention. Conclusions: In addition to improving body weight and length, Lf supplementation in ONS improved immune response homeostasis by balancing IL-6 and IL-10 levels and by improving the IL-6/IL-10 ratio. ClinicalTrials.gov number ID: NCT05289674, dated May 3 rd 2022.

The care of infants at risk of poor growth and development is a global priority. To inform new WHO guidelines update on prevention and management of growth faltering among infants under six months, we examined the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants between 0 and 6 months. We searched nine electronic databases from January 2000 to August 2021, included interventional studies, evaluated the quality of evidence for seven outcome domains (anthropometric recovery, child development, anthropometric outcomes, mortality, readmission, relapse, and non-response) and followed the GRADE approach for certainty of evidence. We identified thirteen studies with preterm and/or low birth weight infants assessing effects of breastfeeding counselling or education (n = 8), maternal nutrition supplementation (n = 2), mental health (n = 1), relaxation therapy (n = 1), and cash transfer (n = 1) interventions. The evidence from these studies had serious indirectness and high risk of bias. Evidence suggests breastfeeding counselling or education compared to standard care may increase infant weight at one month, weight at two months and length at one month; however, the evidence is very uncertain (very low quality). Maternal nutrition supplementation compared to standard care may not increase infant weight at 36 weeks postmenstrual age and may not reduce infant mortality by 36 weeks post-menstrual age (low quality). Evidence on the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering is limited and of ‘low’ to ‘very low’ quality. This emphasizes the urgent need for future research. The protocol was registered with PROSPERO (CRD42022309001).

Objective: Kidney transplantation can improve linear growth in pediatric recipients but may not ensure attainment of the target adult height. The aim of this study is to determine the prevalence of growth failure in pediatric kidney transplantation recipients and to investigate the factors that influence growth. Methods: This single-center retrospective study included 62 kidney transplantation recipients (37 males) transplanted before 18 years of age. Patients’ medical records were retrospectively reviewed for annual posttransplant anthropometric measurements. Target height was calculated based on midparental height. The standard deviation score of height was calculated for baseline (at transplantation), final (at study time), and target heights. Results: The median age at transplantation was 11.9 (8.8-14.8) years, and the median follow-up time after transplantation was 5.9 (3.2-7.2) years. Forty-seven children (76%) had growth failure (standard deviation score of height < –1.88) at baseline. After transplantation, a significant increase in the standard deviation score of height was observed between baseline and final (P < .001); however, the final standard deviation score of height was significantly lower than the target standard deviation score of height (P < .001), and 38 patients (61%) still had growth failure at final examination. Twenty-seven patients (43.5%) achieved their target SD score of height. Children transplanted over 12 years had lower growth velocity (cm/year) than those transplanted at 2-5 years and 5-12 years (P < .05). A high final standard deviation score of height was independently associated with lower transplant age, higher baseline standard deviation score of height, and lower cumulative steroid dose (P < .05 for all). Conclusion: Kidney transplantation improves linear growth in pediatric recipients, but growth failure is still common after transplantation, and most patients are unfortunately far from their target height. [ABSTRACT FROM AUTHOR]

Background: Growth failure due to infection in children is a major health problem throughout the world. It provokes a systemic immune response, with increased interleukin (IL)-6 and reduced IL-10. Lactoferrin (Lf) is a multifunctional iron-binding protein that can be found in whey protein inside formula milk such as oral nutrition supplement (ONS), which can upregulate anti-inflammatory cytokines (IL-10) and modulate pro-inflammatory cytokines. This study investigates the effect of Lf supplementation in ONS on IL-6 and IL-10 levels in children with failure to thrive and infection. Methods: We performed a quasi-experimental pre- and post-study in children aged 12–60 months old with failure to thrive due to infectious illness. The subjects received 400 ml of oral nutritional supplements (ONS, 1 ml equivalent to 1 kcal) each day for 90 days, and their parents received dietary advice and medication based on the underlying illness. Blood was drawn to measure IL-6 and IL-10 before and after the intervention. Results: There were 75 subjects recruited and divided into group-1 and group-2 based on age. The incidence of undernutrition was 37.33%. Lf in ONS intervention improved body weight and body length. Lf also reduced IL-6, although there was not a significant difference before and after the intervention. However, the IL-6 reduction was significantly higher in subjects with undernutrition compared with subjects with weight faltering. Pre-intervention IL-6 levels were higher in children with stunting than in children with normal stature. There was a greater change in IL-6 in children with severe stunting than in children with normal stature or stunting. IL-10 was significantly reduced after the intervention . Conclusions: In addition to improving body weight and length, Lf supplementation in ONS improved immune response homeostasis by balancing IL-6 and IL-10 levels and by improving the IL-6/IL-10 ratio. ClinicalTrials.gov number ID: NCT05289674, dated May 3 rd 2022.

Adolescent motherhood has been linked with poor health outcomes at birth for children, including high neonatal mortality, low birthweight, and small‐for‐gestational‐age rates. However, longer‐term growth outcomes in the children of adolescent mothers in low‐resource settings remain inadequately studied. We used longitudinal data from the India Human Development Surveys, 2004–2005 and 2011–2012 (n = 12,182) and employed regression and propensity score matching analysis to compare the following growth indicators of children born to adolescent mothers (ages 19 years or below) with those born to older mothers. Growth indicators included height and weight during ages 0–5 years and 6–12 years and change in height and weight between the two periods. In regression‐based estimates, children born to adolescent mothers were 0.01 m shorter and weighed 0.2 kg less than children of older mothers at ages 0–5 years. At ages 6–12 years, those born to adolescent mothers were 0.02 m shorter and weighed 0.97 kg less. The height difference between the two groups increased by 0.01 m and the weight difference grew by 0.77 kg over time. Height and weight difference between the two groups worsened among boys over time, while for girls, only the weight gap worsened. The results were similar when using propensity score matching methods. Public policies for reducing child marriage, combined with targeted health, nutrition, and well‐being programs for adolescent mothers, are essential for both preventing adolescent childbearing and reducing its impact on growth failure among children in India. [ABSTRACT FROM AUTHOR]

Background: Hemoglobin H disease (HbH), a hemoglobinopathy resulting from abnormal alpha globin genes, is classified into two categories: deletional HbH (DHbH) and non-deletional HbH (NDHbH). The alpha-mutation genotypes exhibit a range of clinical anemias, which differentially impact patient growth. Objectives: This retrospective study assessed the growth of HbH patients at Siriraj Hospital, Mahidol University. Methods: Patients diagnosed with HbH between January 2005 and April 2021 were analyzed using growth standard scores of the Thai Society for Pediatric Endocrinology (2022 version) and BMI-for-age Z scores of the World Health Organization. Growth failure was defined as a patient’s height for age exceeding two standard deviations below the mean. Results: Of the 145 HbH patients, 75 (51.7%) had NDHbH, with --SEA/αCSα being the most common genotype (70 patients; 93.3%). The mean baseline hemoglobin level was significantly lower in NDHbH patients than in DHbH patients (8.16 ± 0.93 g/dL vs. 9.51 ± 0.68 g/dL; P < 0.001). Splenomegaly and growth failure prevalences were higher in NDHbH patients (37.3% vs. 0%, with P < 0.001, and 22.7% vs. 8.6%, with P = 0.020, respectively). Multivariable analysis revealed that splenomegaly > 3 cm was associated with growth failure (OR = 4.28; 95% CI, 1.19–15.39; P = 0.026). Conclusions: NDHbH patients exhibited lower hemoglobin levels and more pronounced splenomegaly than DHbH patients. Growth failure can occur in both HbH types but appears more prevalent in NDHbH. Close monitoring of growth velocity is essential, and early treatment interventions may be required to prevent growth failure.

Abstract Background Childhood stunting, wasting and underweight are significant public health challenges. There is a gap in knowledge of the coexistence of stunting, wasting, and underweight among children under five years (under-5) in Bangladesh. This study aims to (i) describe the prevalence of the coexistence of stunting, wasting, and underweight and ii) examine the risk factors for the coexistence of stunting, wasting, and underweight among children under-5 in Bangladesh. Methods This study included 6,610 and 7,357 under-5 children from Bangladesh Demographic Health Surveys (BDHS) 2014 and 2017/18, respectively. The associations between the coexistence of stunting, wasting, and underweight and independent variables were assessed using the Chi-square test of independence. The effects of associated independent variables were examined using negative binomial regression. Results The prevalence of coexistence of stunting, wasting, and underweight gradually declined from 5.2% in 2014 to 2.7% in 2017/18. Children born with low birth weight ((adjusted incidence rate ratios, aIRR) 2.31, 95% CI 1.64, 3.24)); children of age group 36–47 months (aIRR 2.26, 95% CI 1.67, 3.08); children from socio-economically poorest families (aIRR 2.02, 95% CI 1.36, 2.98); children of mothers with no formal education (aIRR 1.98, 95% CI 1.25, 3.15); and children of underweight mothers (aIRR 1.73, 95% CI 1.44, 2.08) were the most important risk factors. Further, lower incidence among children with the coexistence of stunting, wasting, and underweight was observed in the 2017–18 survey (aIRR 0.59, 95% CI 0.49, 0.70) compared to children in the 2014 survey. Conclusions One out of thirty-five under-5 children was identified to have coexistence of stunting, wasting, and underweight in Bangladesh. The burden of coexistence of stunting, wasting, and underweight was disproportionate among children born with low birth weight, socio-economically poorest, a mother with no formal education, and underweight mothers, indicating the need for individual, household, and societal-level interventions to reduce the consequences of coexistence of stunting, wasting, and underweight.

Children with congenital heart disease (CHD) are at increased risk for undernutrition. The aim of our study was to describe the growth parameters of Italian children with CHD compared to healthy children. We performed a cross-sectional study collecting the anthropometric data of pediatric patients with CHD and healthy controls. WHO and Italian z-scores for weight for age (WZ), length/height for age (HZ), weight for height (WHZ) and body mass index (BMIZ) were collected. A total of 657 patients (566 with CHD and 91 healthy controls) were enrolled: 255 had mild CHD, 223 had moderate CHD and 88 had severe CHD. Compared to CHD patients, healthy children were younger (age: 7.5 ± 5.4 vs. 5.6 ± 4.3 years, p = 0.0009), taller/longer (HZ: 0.14 ± 1.41 vs. 0.62 ± 1.20, p < 0.002) and heavier (WZ: −0,07 ± 1.32 vs. 0.31 ± 1.13, p = 0.009) with no significant differences in BMIZ (−0,14 ± 1.24 vs. –0.07 ± 1.13, p = 0.64) and WHZ (0.05 ± 1.47 vs. 0.43 ± 1.07, p = 0.1187). Moderate and severe CHD patients presented lower z-scores at any age, with a more remarkable difference in children younger than 2 years (WZ) and older than 5 years (HZ, WZ and BMIZ). Stunting and underweight were significantly more present in children affected by CHD (p < 0.01). In conclusion, CHD negatively affects the growth of children based on the severity of the disease, even in a high-income country, resulting in a significant percentage of undernutrition in this population. [ABSTRACT FROM AUTHOR]

On a global basis, 144 million people are stunted, and in Ethiopia, it remains a major public health problem. A limited number of studies have been conducted at the national level and in the study area to generate information on stunting at birth. The present study investigated the magnitude and predictors of stunting among newborns delivered at the Public Hospitals of Hawassa City, Ethiopia. A facility-based cross-sectional study was conducted between August and September 2021 among mothers and newborns (N 371). Data were collected through face-to-face interviews with the mother in a waiting room after the delivery of the child at the hospital. Newborn length and weight were measured and converted to length-for-age Z-score using WHO standards. The prevalence of stunting at birth (35⋅6 %) and low birth weight (24⋅6 %) were high. In the adjusted model, factors significantly associated with stunting were birth interval <2 years, low birth weight, inadequate dietary diversity and food insecurity (P < 0⋅01) mid-upper arm circumference (MUAC) of mother <23 cm (P < 0⋅05). The high magnitude of stunting and low birth weight calls all stakeholders and nutrition actors to work on preventing maternal undernutrition and improving their dietary practice through nutrition education. It is also recommended to mitigate food insecurity with evidence-based interventions using a combination of measures. Additionally improving maternal health services including family spacing was recommended to reduce stunting and low birth weight among newborns in the study area. [ABSTRACT FROM AUTHOR]