Pediatric Reports

1038 KiB

Open AccessArticle

Sensitivity Analysis of Weight Reduction Results of an Observational Cohort Study in Overweight and Obese Children and Adolescents in Germany: the EvAKuJ Study

by Thomas Böhler, Cornelia Goldapp, Reinhard Mann, Thomas Reinehr, Monika Bullinger, Reinhard Holl, Ulrike Hoffmeister, Andreas van Egmond-Fröhlich, Ulrike Ravens-Sieberer, Nora Wille, Joachim Westenhöfer and Jürgen Bengel

Pediatr. Rep. 2013, 5(3), e16; https://doi.org/10.4081/pr.2013.e16 - 07 Oct 2013

Cited by 4 | Viewed by 1

Abstract

In the German EvAKuJ observational cohort study, changes in the body mass index standard deviation score (BMI-SDS) of overweight and obese children and adolescents as primary outcome of multimodal (short, inpatient or long, outpatient) weight-loss interventions are difficult to interpret. Published intention-to-treat (ITT) and per protocol data obtained at the end of the intervention (T1), one year (T2), and two years (T3) after its end were used for sensitivity analysis of treatment success rates. The odds ratio and the number needed to treat (NNT) for BMI-SDS reduction of at least −0.2 (successful treatment) and at least −0.5 (good treatment success) were related to spontaneous BMI-SDS reduction rates in a hypothetical control group (control event rate, CER). At T1, treatment seems to be effective up to a CER of 10% in inpatients and of 5% in outpatients. ITT analysis, compromised by a loss to follow-up of 81 to 90% (inpatients) and 57 to 66% (outpatients), indicated that treatment may become less effective at a CER above 1% in inpatients (e.g., successful treatment at T2: NNT=106, at T3: NNT=51), and above 5% in outpatients (successful treatment at T2: NNT=7, at T3: NNT=8; good treatment success at T2 and T3: NNT=25). Positive short-term effects of inpatient treatment of overweight and obese children and adolescents may not be maintained in the long term. Long-term effectiveness of outpatient treatment may depend on age and the degree of overweight. Full article

684 KiB

Open AccessReview

Pectus Excavatum and Heritable Disorders of the Connective Tissue

by Francesca Tocchioni, Marco Ghionzoli, Antonio Messineo and Paolo Romagnoli

Pediatr. Rep. 2013, 5(3), e15; https://doi.org/10.4081/pr.2013.e15 - 24 Sep 2013

Cited by 40 | Viewed by 1

Abstract

Pectus excavatum, the most frequent congenital chest wall deformity, may be rarely observed as a sole deformity or as a sign of an underlying connective tissue disorder. To date, only few studies have described correlations between this deformity and heritable connective tissue disorders such as Marfan, Ehlers-Danlos, Poland, MASS (Mitral valve prolapse, not progressive Aortic enlargement, Skeletal and Skin alterations) phenotype among others. When concurring with connective tissue disorder, cardiopulmonary and vascular involvement may be associated to the thoracic defect. Ruling out the concomitance of pectus excavatum and connective tissue disorders, therefore, may have a direct implication both on surgical outcome and long term prognosis. In this review we focused on biological bases of connective tissue disorders which may be relevant to the pathogenesis of pectus excavatum, portraying surgical and clinical implication of their concurrence. Full article

592 KiB

Open AccessArticle

Does Intravenous Immunoglobulin Therapy Prolong Immunodeficiency in Transient Hypogammaglobulinemia of Infancy?

by Lale Memmedova, Elif Azarsiz, Neslihan Edeer Karaca, Guzide Aksu and Necil Kutukculer

Pediatr. Rep. 2013, 5(3), e14; https://doi.org/10.4081/pr.2013.e14 - 17 Sep 2013

Cited by 11 | Viewed by 1

Abstract

Transient hypogammaglobulinemia of infancy (THI) is characterized by recurrent infections and one or more reduced serum immunoglobulin levels. Typically, THI patients recover spontaneously, mostly within 30-40 months of age, but sometimes recovery may be delayed until 5-6 years of age. The use of intravenous immunoglobulin (IVIg) as an alternative to antibiotic prophylaxis remains contraversial also in symptomatic THI patients. In fact, some authors believe that IVIg therapy may cause a delay in the maturation of the humoral immune system because of the interference from passively transfered antibodies. The aim of this study was to investigate the effect of IVIg replacement on recovery from immunodeficiency in THI patients and determine new parameters in order to include these patients in IVIg therapy groups. In this retrospective study, 43 patients (65%) received IVIg replacement therapy while 23 patients (34.8%) showed spontaneous normalization without IVIg. The percentages of patients who had more than six times the number of febrile infections in a year decreased from 91% to 21% in the group receiving IVIg treatment. At admission, before being recruited to IVIg therapy, serum immunoglobulin G (IgG) levels and anti-hemophilus B (Hib) antibody titers were found to be significantly low in cases who were selected for IVIg replacement. The percentages of patients who did not have protective levels of anti-Hib, anti-rubella or anti-rubeola-IgG were also significantly high in IVIg cases. There was no statistically significant difference in the age at which IgG levels normalized between the IVIg and the non-IVIg group. Patients in the IVIg group and non-IVIg group reached normal IgG levels at the age of 42.9±22.0 and 40.7±19.8 months, respectively. In conclusion, IVIg infusions do not cause a delay in the maturation of the immune system in THI patients. Besides the well-established criteria, very low and non-protective specific antibody responses against previously applied vaccines are important factors to consider when selecting patients for IVIg therapy. Full article

637 KiB

Open AccessCase Report

Central Precocious Puberty and Granulosa Cell Ovarian Tumor in an 8-Year Old Female

by Valeria Calcaterra, Ghassan Nakib, Gloria Pelizzo, Barbara Rundo, Gaetana Anna Rispoli, Stella Boghen, Federico Bonetti, Barbara Del Monte, Chiara Gertosio and Daniela Larizza

Pediatr. Rep. 2013, 5(3), e13; https://doi.org/10.4081/pr.2013.e13 - 29 Jul 2013

Cited by 8 | Viewed by 1

Abstract

Ovarian tumors associated with hormonal changes of the peripheral iso-sexual precocious puberty are of common presentation. We describe here a rare case of juvenile granulosa cell tumor in a female with central precocious puberty (CPP). An 8-year old girl with CPP presented with vaginal bleeding four months after the diagnosis and before starting treatment with gonadotropin-releasing hormone (GnRH)-analogs. Suppression of basal follicle-stimulating hormone (FSH) level, elevation of serum estradiol, progesterone and Cancer Antigen-125 were documented. Abdominal ultrasound examination (US) and magnetic resonance imaging showed a pelvic mass affecting the left ovary. A left salpingo-oophorectomy was performed and the mass was totally resected. Juvenile granulosa cell ovarian tumor was diagnosed. One month post surgery, estradiol and progesterone decreased to values of the first evaluation and FSH increased; Cancer Antigen-125 resulted normal while ultrasound pelvic examination showed absence of pelvic masses. In our patient, the tumor had grown very quickly since hormonal data demonstrated a CPP without any evidence of ovarian mass on US only four months before diagnosis. The overstimulation of the FSH or aberrant activation of FSH receptors may have contributed to the development of the mass. Full article

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Pediatr. Rep., Volume 5, Issue 3 (July 2013) – 4 articles

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