Failure to Thrive

未能茁壮成长
  • 文章类型: Journal Article
    背景:体重过轻是儿童普遍存在的健康问题。这项研究旨在确定与哈马丹市1-2岁儿童体重不足相关的因素。与在这一领域进行的研究不同,它们是横截面的,没有提供年龄变化对体重不足的影响的信息,我们的纵向方法提供了对体重随时间变化的见解。另一方面,这项研究的重点是1至2岁的高危年龄组,仅在一些研究中得到了解决。
    方法:在这项纵向研究中,414名1至2岁儿童的母亲前往哈马丹市的卫生中心,其信息在SIB系统中,一个全面的电子系统,进行了检查,以确定与体重不足相关的因素。反应变量是按年龄划分的体重标准,分为三类:体重不足,正常体重,超重。使用两级纵向序数模型来确定与体重不足相关的因素。
    结果:在研究的儿童中,201(48.6%)为女孩,213(51.4%)为男孩。体重过轻的重要危险因素包括母亲受教育程度低(AOR=3.56,95%CI:1.10-11.47),孕产妇失业率(AOR=3.38,95%CI:1.05-10.91),产妇身高(AOR=0.85,95%CI:0.79-0.92),缺乏医疗保险(AOR=2.85,95%CI:1.04-7.84),胎龄小于24岁(AOR=3.17,95%CI:16.28-0.97),儿童年龄12-15个月(AOR=2.27,95%CI:1.37-3.74),和儿童出生体重(AOR=0.63,95%CI:0.70-0.58)。
    结论:根据本研究的结果,儿童体重不足的可能性似乎与母亲的特征更相关;因此,照顾妈妈可以控制一些孩子的体重下降。
    BACKGROUND: Underweight is a prevalent health issue in children. This study aimed to identify factors associated with underweight in children aged 1-2 years in Hamadan city. Unlike the studies conducted in this field, which are cross-sectional and do not provide information on the effect of age changes on underweight, our longitudinal approach provides insights into weight changes over time. On the other hand, this study focuses on the high-risk age group of 1 to 2 years, which has only been addressed in a few studies.
    METHODS: In this longitudinal study, 414 mothers with 1 to 2 year-old children referred to the health centers of Hamadan city, whose information is in the SIB system, a comprehensive electronic system, were examined to identify factors related to underweight. The response variable was weight-for-age criteria classified into three categories: underweight, normal weight, and overweight. A two-level longitudinal ordinal model was used to determine the factors associated with underweight.
    RESULTS: Of the children studied, 201 (48.6%) were girls and 213 (51.4%) were boys. Significant risk factors for underweight included low maternal education (AOR = 3.56, 95% CI: 1.10-11.47), maternal unemployment (AOR = 3.38, 95% CI: 1.05-10.91), maternal height (AOR = 0.85, 95% CI: 0.79-0.92), lack of health insurance (AOR = 2.85, 95% CI: 1.04-7.84), gestational age less than 24 years (AOR = 3.17, 95% CI: 16.28-0.97), child age 12-15 months (AOR = 2.27, 95% CI: 1.37-3.74), and child\'s birth weight (AOR = 0.63, 95% CI: 0.70-0.58).
    CONCLUSIONS: Based on the results of the present study, it seems that the possibility of being underweight among children is more related to the characteristics of mothers; therefore, taking care of mothers can control some of the weight loss of children.
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  • 文章类型: Journal Article
    背景:早产(PT)和足月低出生体重(FT-LBW)儿童生长不良的风险很高。
    目的:调查PT和FT-LBW儿童从出生到学龄前的生长轨迹。
    方法:本研究包括1,150,508名婴儿(PT,41,454;FT-LBW,38,250),他们接受了国家婴幼儿健康筛查计划(NHSPIC)的前三轮(4-6、9-12和18-24个月)。从NHSPIC数据库获得生长测量值并将其转换成Z分数。测量2、4和6岁时的生长数据作为结果变量。使用广义估计方程和Cox比例风险回归分析研究了出生小对不良增长结果的影响。
    结果:PT的中位出生体重,FT-LBW,足月(FT)组分别为2.3、2.4和3.2kg,分别。在FT-LBW组中,身材矮小(身高Z评分<-2标准差评分[SDS])和茁壮成长失败(FTT)(体重指数(BMI)Z评分<-2SDS)的发生率最高,其次是PT和FT组。4岁时,发病率为6.0%vs.5.2%与身材矮小的1.9%和4.6%与3.9%与FTT为1.7%。在PT(-0.326SDS)和FT-LBW(-0.456SDS)组中,身高结果的β估计值均较低。
    结论:在整个学龄前期间,FT-LBW组比PT组始终更短和更轻,强调了高危人群生长监测的重要性。
    BACKGROUND: Preterm (PT) and full term with low birth weight (FT-LBW) children are at a high-risk of poor growth outcomes.
    OBJECTIVE: To investigate the growth trajectories of PT and FT-LBW children from birth to preschool ages.
    METHODS: This study included 1,150,508 infants (PT, 41,454; FT-LBW, 38,250) who underwent the first three rounds (4-6, 9-12, and 18-24 months) of the National Health Screening Program for Infants and Children (NHSPIC). Growth measurements were obtained from the NHSPIC database and converted into Z-scores. Growth data at 2, 4, and 6 years old were measured as outcome variables. The impact of being born small on poor growth outcomes was investigated using a generalized estimating equation and Cox proportional-hazards regression analysis.
    RESULTS: The median birth weights of the PT, FT-LBW, and full term (FT) groups were 2.3, 2.4, and 3.2 kg, respectively. The incidence of short stature (height Z-score < -2 standard deviation score [SDS]) and failure to thrive (FTT) (body mass index (BMI) Z-score < -2 SDS) was the highest in the FT-LBW group, followed by the PT and FT groups. At 4 years old, the incidence rates were 6.0% vs. 5.2% vs. 1.9% for short stature and 4.6% vs. 3.9% vs. 1.7% for FTT. The β estimate of height outcome was lower in both the PT (-0.326 SDS) and FT-LBW (-0.456 SDS) groups.
    CONCLUSIONS: The FT-LBW group was consistently shorter and lighter throughout the preschool period than the PT group, highlighting the significance of growth monitoring in high-risk populations.
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  • 文章类型: Journal Article
    小儿先天性心脏病(CHD)患者无法茁壮成长(FTT)的患病率和危险因素仍然不明确。我们的目的是调查患病率,增长概况,危险因素,儿科CHD患者中与FTT相关的易损CHD亚型。
    这是一项基于中国先天性心脏手术数据库的横断面研究。FTT定义为发育迟缓或体重不足(身高或体重标准差评分<-2),它们通过正常中国人群的参考进行了标准化。采用logistic回归模型确定危险因素,并在每个亚组中描绘生长概况。
    本研究共纳入13,256例CHD患者,3994名轻度冠心病患者,7195例中度冠心病患者和2067例庞杂性冠心病患者。发育迟缓的患病率,体重不足,FTT为24%,29.3%和36.9%,分别。术前贫血,左心室收缩功能障碍,年龄较小,更复杂的CHD类型,研究发现,低出生体重和遗传综合征是CHD患者发生FTT的危险因素.发现主动脉弓中断是与FTT相关的最严重的组。
    FTT在冠心病患者中普遍存在,在高危亚组中加重。我们的发现暗示了在儿科日常实践中对冠心病患者进行早期识别和干预的必要性,因为它有可能改善结果并提高他们的生活质量。此外,我们主张启动具有纵向数据的前瞻性研究,以全面调查FTT和CHD在整个生命周期内的相关性.
    这项研究得到了国家高级医院研究资助(2022-GSP-GG-19)的支持,首都健康研究与发展专项资金(2022-1-4032)和国家重点研发计划(2022YFC3600202和2022YFC3600203)。
    UNASSIGNED: The prevalence and risk factors for failure to thrive (FTT) in pediatric patients with congenital heart disease (CHD) remain ambiguous. We aimed to investigate the prevalence, growth profiles, risk factors, and vulnerable subtypes of CHD associated with FTT in pediatric patients with CHD.
    UNASSIGNED: This was a cross-sectional study based on Chinese Database for Congenital Heart Surgery. FTT was defined as either stunting or underweight (height or weight standard deviation score <-2), and they were standardized by references of normal Chinese population. Risk factors was determined with logistic regression model, and growth profiles were delineated in each subgroup.
    UNASSIGNED: A total of 13,256 CHD patients were included in this study, with 3994 patients of mild CHD, 7195 patients of moderate CHD and 2067 patients of complex CHD. The prevalence of stunting, underweight and FTT was 24%, 29.3% and 36.9%, respectively. Preoperative anaemia, left ventricle systolic dysfunction, younger age, more complex CHD types, lower birth weight and genetic syndrome were found to be the risk factors for FTT in CHD patients. Interrupted aortic arch was revealed to be the most severe group associated with FTT.
    UNASSIGNED: FTT is ubiquitous in patients with CHD and exacerbated in high-risk subgroups. Our findings hinted the necessity of early identification and intervention for FTT in patients with CHD during daily practice of pediatrics, as it has the potential to improve outcomes and enhance their quality of life. Furthermore, we advocate for the initiation of prospective research with longitudinal data to comprehensively investigate the association between FTT and CHD across the lifespan.
    UNASSIGNED: This study was supported by National High Level Hospital Research Funding (2022-GSP-GG-19), Capital Health Research and Development of Special Fund (2022-1-4032) and National Key R&D Program of China (2022YFC3600202 and 2022YFC3600203).
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  • 文章类型: Journal Article
    目的:描述先天性膈疝(CDH)患儿第一年的生长轨迹,评估1年生长失败(GF)的危险因素,并确定出院时早期最佳生长所需的营养摄入量。
    方法:基于结构化随访计划数据的单中心回顾性队列研究。
    方法:所有患有CDH(2013-2019)的新生儿在出院时存活,随访至1岁。
    方法:无。
    方法:出生时年龄体重z评分(WAZ),3、6和12月龄;1岁时GF的危险因素;实现早期最佳生长的婴儿的能量和蛋白质摄入量。
    结果:纳入65例出院时存活的新生儿中的63例。7名(11%)在1年时患有GF,3名(4.8%)患有胃造瘘管。平均WAZ在追赶1年之前的前3个月下降(-0.6±0.78)。患有严重形式或早产的儿童经历了更深的损失(从-1.5到-2z分数),并且追赶较晚和有限。根据CDH严重程度,实现正或零体重生长速度所需的能量摄入中位数显着不同,范围从100kcal/kg/天(产后形式)到139kcal/kg/天(严重的产前形式)(p=0.009)。
    结论:CDH婴儿的生长模式提示营养风险分层和喂养方式可能影响生长结局。我们的结果支持基于CDH严重程度的个性化和主动营养管理,健康足月婴儿的能量需求高达推荐摄入量的140%。
    OBJECTIVE: To describe the growth trajectory of children with congenital diaphragmatic hernia (CDH) during the first year, to assess the risk factors for growth failure (GF) at 1 year and to determine nutritional intakes at discharge required for early optimal growth.
    METHODS: Single-centre retrospective cohort study based on data from a structured follow-up programme.
    METHODS: All neonates with CDH (2013-2019) alive at discharge and followed up to age 1.
    METHODS: None.
    METHODS: Weight-for-age z-score (WAZ) at birth, 3, 6 and 12 months of age; risk factors for GF at age 1; energy and protein intake of infants achieving early optimal growth.
    RESULTS: Sixty-three of 65 neonates who were alive at discharge were included. Seven (11%) had GF at 1 year and 3 (4.8%) had a gastrostomy tube. The mean WAZ decreased in the first 3 months before catching up at 1 year (-0.6±0.78). Children with a severe form or born preterm experienced a deeper loss (from -1.5 to -2 z-scores) with late and limited catch-up. The median energy intake required to achieve positive or null weight growth velocity differed significantly according to CDH severity, ranging from 100 kcal/kg/day (postnatal forms) to 139 kcal/kg/day (severe prenatal forms) (p=0.009).
    CONCLUSIONS: Growth patterns of CDH infants suggest that nutritional risk stratification and feeding practices may influence growth outcomes. Our results support individualised and active nutritional management based on CDH severity, with energy requirements as high as 140% of recommended intakes for healthy term infants.
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  • 文章类型: Case Reports
    Angelman综合征(AS)是一种罕见的儿科神经系统疾病,患者最常出现不适当的笑声,小头畸形,言语困难,癫痫发作,和运动障碍。AS可以在临床上诊断,并通过基因检测确认。在这个案例报告中,患者在2日龄时出现9.3%的体重减轻.尽管在泌乳咨询和营养指导方面有多次尝试,病人因未能茁壮成长而入院。由于持续的全球发育迟缓和9个月大的上下肢张力减退,患者被转诊至神经科医师。脑部MRI阴性,基因检测显示15q11.2q13.1缺失,这与AS一致。通过不同的治疗和干预,患者症状改善缓慢。此病例说明了早期识别AS非特异性临床表现的重要性。所有AS患者的一般管理包括物理治疗,言语治疗,移动性支持设备,教育,以及他们在生活中进步的行为疗法。建立早期诊断具有改善患者生活质量和结果的潜在长期益处,通过早期干预措施,例如从6个月大开始的物理治疗,以改善粗大运动功能。当婴儿出现非特异性临床表现,如未能茁壮成长和张力减退时,临床医生应该保持较低的怀疑遗传条件的阈值,这将有助于AS的早期诊断。
    Angelman syndrome (AS) is a rare pediatric neurological condition in which patients most commonly present with inappropriate laughter, microcephaly, speech difficulties, seizures, and movement disorders. AS can be diagnosed clinically and confirmed with genetic testing. In this case report, the patient presented with 9.3% weight loss at two days of age. Although there were multiple attempts at lactational counseling and nutritional guidance, the patient was admitted to the hospital due to failure to thrive. Due to continued global developmental delay and upper and lower extremities hypotonia by the age of nine months, the patient was referred to a neurologist. Brain MRI was negative, and genetic testing revealed 15q11.2q13.1 deletion, which is consistent with AS. Through different therapies and intervention, the patient showed slow improvements in symptoms. This case illustrates the importance of early recognition of nonspecific clinical manifestations of AS. The general management for all AS patients includes physical therapy, speech therapy, mobility support devices, education, and behavioral therapy as they progress through life. Establishing an early diagnosis has potential long-term benefits of improved quality of life and outcomes for patients via early interventions such as physical therapy starting at the age of six months to improve gross motor function. When infants present with nonspecific clinical presentations such as failure to thrive and hypotonia, clinicians should maintain a lower threshold for suspecting genetic conditions, which will facilitate early diagnosis of AS.
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  • 文章类型: Published Erratum
    [这更正了文章DOI:10.3389/fmed.2023.1099840。].
    [This corrects the article DOI: 10.3389/fmed.2023.1099840.].
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  • 文章类型: Journal Article
    目的:这项研究的目的是确定寻求庇护的儿童未能茁壮成长。
    方法:本研究为描述性研究。
    方法:研究样本包括187名在阿富汗协会注册的儿童。在0.5%(中等)效应大小和95%置信水平下,研究的功效为97%。
    方法:数据是在2021年11月8日至2022年1月10日之间收集的,使用社会人口统计学形式和儿童的人体测量学测量。
    结果:57.2%的儿童为男性,44.9%的儿童为6-12岁。确定小于1岁的女性和男性婴儿体重不足(z评分=-2),男性婴儿发育迟缓(z评分≤-1)。
    结论:儿童成长和发育问题是寻求庇护家庭中的重要问题。公共卫生护士需要在为弱势群体和代表性不足的群体组织医疗服务中发挥自己的作用。
    The aim of the study was to determine failure to thrive among asylum-seeking children.
    The study was a descriptive study.
    The sample of the study comprised of 187 children who were registered in an Afghan Association. The power of the study was found to be 97% at 0.5% (moderate) effect size and 95% confidence level.
    The data was collected between November 8, 2021 and January 10, 2022 using a sociodemographic form and the children\'s anthropometric measurement.
    57.2% of children were male and 44.9% were 6-12 years old. It was determined that female and male infants less than 1 year of age were underweight (z-score = -2) and male infants were stunting (z-score ≤-1).
    Childhood growth and development problems are significant issues among asylum-seeking families. Public health nurses need to develop their roles in organizing the healthcare service for vulnerable and underrepresented groups.
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  • 文章类型: Journal Article
    Bartter综合征(BS)是一种罕见的盐消耗性肾小管病,由编码钠的基因突变引起,钾,或Henle环的粗上升肢和/或肾远曲小管的氯化物转运蛋白。BS的特点是多尿,未能茁壮成长,低钾血症,代谢性碱中毒,高肾素血症,和醛固酮增多症。钾和/或钠补充剂,保钾利尿剂,非甾体抗炎药可用于治疗BS。虽然它的症状和初始管理相对众所周知,长期结果和治疗很少.
    我们回顾性分析了来自韩国7个中心的54例临床或基因诊断为BS的韩国患者。
    本研究中包括的所有患者均在中位年龄5岁时被临床或遗传诊断为BS(范围,0-271)个月,他们的中位随访时间为8(范围,0.5-27)年。在39例患者中证实了BS的基因诊断:4例具有SLC12A1基因突变,1有KCNJ1基因突变,33有CLCNKB基因突变,1例发生BSND突变。94%和68%的患者服用氯化钾补充剂和保钾利尿剂,分别。对于年龄小于18岁的患者,氯化钾补充剂的平均剂量为5.0和2.1mEq/day/kg,分别。肾钙化沉着症是BS的常见发现,而且在一些患者中也随着年龄的增长而改善。在最初诊断后8年的最后一次随访中,41%的人身材矮小(身高低于第3百分位数),在6例患者中观察到肾功能受损[慢性肾脏疾病(CKD)G3,n=4;CKDG5,n=2]。
    BS患者一生都需要大量补充钾和保钾药物,但随着年龄的增长往往会提高。尽管有管理,很大一部分人口表现出增长障碍,而11%的患者发展为CKDG3-G5。
    UNASSIGNED: Bartter syndrome (BS) is a rare salt-wasting tubulopathy caused by mutations in genes encoding sodium, potassium, or chloride transporters of the thick ascending limb of the loop of Henle and/or the distal convoluted tubule of the kidney. BS is characterized by polyuria, failure to thrive, hypokalemia, metabolic alkalosis, hyperreninemia, and hyperaldosteronism. Potassium and/or sodium supplements, potassium-sparing diuretics, and nonsteroidal anti-inflammatory drugs can be used to treat BS. While its symptoms and initial management are relatively well known, long-term outcomes and treatments are scarce.
    UNASSIGNED: We retrospectively reviewed 54 Korean patients who were clinically or genetically diagnosed with BS from seven centers in Korea.
    UNASSIGNED: All patients included in this study were clinically or genetically diagnosed with BS at a median age of 5 (range, 0-271) months, and their median follow-up was 8 (range, 0.5-27) years. Genetic diagnosis of BS was confirmed in 39 patients: 4 had SLC12A1 gene mutations, 1 had KCNJ1 gene mutations, 33 had CLCNKB gene mutations, and 1 had BSND mutation. Potassium chloride supplements and potassium-sparing diuretics were administered in 94% and 68% of patients, respectively. The mean dosage of potassium chloride supplements was 5.0 and 2.1 mEq/day/kg for patients younger and older than 18 years, respectively. Nephrocalcinosis was a common finding of BS, and it also improved with age in some patients. At the last follow-up of 8 years after the initial diagnosis, 41% had short stature (height less than 3rd percentile) and impaired kidney function was observed in six patients [chronic kidney disease (CKD) G3, n = 4; CKD G5, n = 2].
    UNASSIGNED: BS patients require a large amount of potassium supplementation along with potassium-sparing agents throughout their lives, but tend to improve with age. Despite management, a significant portion of this population exhibited growth impairment, while 11% developed CKD G3-G5.
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  • 文章类型: Journal Article
    目的:评估整个沙特阿拉伯的父母对生长失败的认识水平,并研究协变量(社会和人口统计学)作为父母知识水平决定因素的潜在影响,母亲和父亲,年龄在18至60岁之间,在国家一级。
    方法:一项涉及4,404名父母的横断面研究,年龄在18至60岁之间,从2022年3月到2022年5月,沙特阿拉伯境内的所有行政区都进行了这项工作。
    结果:大多数参与者对FTT的认识一般,和地区差异,以及教育和专业水平,对这种意识产生了影响,来自西部地区拥有学士学位的参与者和员工比其他人有更好的意识水平。
    结论:为了提高认识,整个公众,尤其是父母,必须不断了解儿童未能茁壮成长,以及如何通过教育计划和提高认识运动来应对这一问题。
    OBJECTIVE: To assess the level of parental Awareness about growth failure across all of Saudi Arabia and look into the potential influence of covariates (social and demographic) as determinants of the level of knowledge of parents, both mother and father, aged between 18 and 60, and on the national level.
    METHODS: A cross-sectional study involving a survey of 4,404 parents, aged between 18 and 60 years, in all administrative regions within Saudi Arabia was undertaken From March 2022 to May 2022.
    RESULTS: The majority of participants had average awareness of FTT, and differences in region, as well as in educational and professional levels, had an impact on this awareness, with participants from the western region who hold bachelor\'s degree and employees have a better level of awareness than others.
    CONCLUSIONS: To raise awareness, the whole public, especially parents, has to be continuously informed on failure to thrive in children and how to deal with it through educational programs and awareness campaigns.
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  • 文章类型: Journal Article
    RAS或其主要效应途径的失调是RAS的分子机制,一组多系统先天性疾病。神经系统并发症在罕见的先天性心脏病(CFC)综合征的治疗中尤其具有挑战性。这项研究评估了临床神经系统和神经发育特征及其与CFC综合征基因变异的关联。
    招募了一个由138名CFC综合征患者组成的跨国队列(BRAF=90,MAP2K1=36,MAP2K2=10,KRAS=2)。通过临床医生对病历的审查和护理人员完成的电子调查来捕获神经系统表现。已验证的癫痫发作严重程度的措施,自适应函数,并获得粗大运动功能。
    智力残疾和癫痫发作的总体频率为82%和55%,分别。BRAF或MAP2K1变异个体的癫痫发作频率和严重程度高于MAP2K2变异个体。不成比例的严重发病率,在BRAF催化蛋白激酶结构域和MAP2K1共同p.Y130位点变异的患者中观察到治疗抗性癫痫发作.神经发育结果与基因型以及癫痫发作严重程度相关。
    分子遗传学检测有助于预测CFC综合征中的癫痫和神经发育表型。研究结果在相关动物模型的开发中发现了潜在的CFC综合征相关变异,神经认知,和运动功能障碍。
    Dysregulation of RAS or its major effector pathway is the molecular mechanism of RASopathies, a group of multisystemic congenital disorders. Neurologic complications are especially challenging in the management of the rare RASopathy cardiofaciocutaneous (CFC) syndrome. This study evaluated clinical neurologic and neurodevelopmental features and their associations with CFC syndrome gene variants.
    A multinational cohort of 138 individuals with CFC syndrome (BRAF = 90, MAP2K1 = 36, MAP2K2 = 10, KRAS = 2) was recruited. Neurologic presentation was captured via clinician review of medical records and caregiver-completed electronic surveys. Validated measures of seizure severity, adaptive function, and gross motor function were obtained.
    The overall frequency of intellectual disability and seizures was 82% and 55%, respectively. The frequency and severity of seizures was higher among individuals with BRAF or MAP2K1 variants than in those with MAP2K2 variants. A disproportionate incidence of severe, treatment-resistant seizures was observed in patients with variants in the catalytic protein kinase domain of BRAF and at the common p.Y130 site of MAP2K1. Neurodevelopmental outcomes were associated with genotype as well as seizure severity.
    Molecular genetic testing can aid in prediction of epilepsy and neurodevelopmental phenotypes in CFC syndrome. Study results identified potential CFC syndrome-associated variants in the development of relevant animal models for neurologic, neurocognitive, and motor function impairment.
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