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Late and very late onset group B Streptococcus sepsis:one and the same?
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Joseph B Cantey, Courtney Baldridge, Rachel Jamison, Leticia A Shanley |
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Late and very late onset group B Streptococcus sepsis:one and the same?
Joseph B Cantey, Courtney Baldridge, Rachel Jamison, Leticia A Shanley
Dallas, TX, USA
Author Affiliations: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA (Cantey JB, Baldridge C, Jamison R, Shanley LA)
Corresponding Author: Joseph B Cantey, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA (Tel: 214-648-2520; Fax: 214-648-2961; Email: joseph.cantey @utsouthwestern.edu)
doi: 10.1007/s12519-014-0450-8
Background: This study aimed to describe the clinical characteristics of group B Streptococcus (GBS) sepsis in infants aged 4-90 days [late onset (LO)] compared to infants >90 days of age [very late onset (VLO)].
Methods: Microbiology records at Children's Medical Center Dallas were screened. Demographic, clinical, and outcome data were collected for infants with GBS recovered from blood or cerebrospinal fluid culture from January 1, 2006 to July 1, 2012.
Results: Totally 48 infants were identified (42 LO, 6 VLO). Infants with VLO sepsis had lower median gestational age (28.5 vs. 39 weeks gestation, P<0.001) and longer median nursery admissions (8.8 vs. 0.5 weeks, P=0.004). When gestational age was controlled for, there were no differences in clinical presentation, intensive care unit admission, length of stay, neurodevelopmental outcome, and mortality. Infants with VLO sepsis were more likely to receive vancomycin (83% vs. 33%, P=0.02) or third-generation cephalosporins (83% vs. 24%, P=0.009), and more likely to continue on those agents even after GBS was identified.
Conclusions: Infants with VLO sepsis had lower gestational ages and longer nursery stays than infants with LO sepsis. Beyond age at presentation, there were no significant differences in clinical presentations, hospital course, frequency of neurodevelopmental sequelae, and mortality in infants presenting with LO vs. VLO GBS sepsis. Infants with VLO sepsis were more likely to receive empiric broad spectrum antimicrobials and more likely to continue receiving broad therapy even following GBS identification.
Key words: group B Streptococcus; infant; meningitis; sepsis
World J Pediatr 2014;10(1):24-28 |
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[Abstract] [Full Text] [PDF]
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Surveillance of childhood blood lead levels in 11 cities of China
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Tao Li, Yao-Hua Dai, Xiao-Hua Xie, Zang-Wen Tan, Shuai-Ming Zhang, Zong-Han Zhu |
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Surveillance of childhood blood lead levels in 11 cities of China
Tao Li, Yao-Hua Dai, Xiao-Hua Xie, Zang-Wen Tan, Shuai-Ming Zhang, Zong-Han Zhu
Beijing, China
Author Affiliations: Department of Integrated Early Childhood Development Capital Institute of Pediatrics, Beijing, China (Li T, Dai YH, Xie XH, Tan ZW, Zhang SM); Chinese Pediatrician Association, Beijing, China (Zhu ZH)
Corresponding Author: Yao-Hua Dai, Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, 2 Ya Bao Road, Chaoyang District, Beijing 100020, China (Tel: 8610 85636169; Fax: 8610 85622025; Email: yh.dai@263.net)
doi: 10.1007/s12519-014-0452-6
Background: Exposure to lead can be deleterious to children's health. Surveillance for blood lead levels (BLLs) is reported every year in the USA and some other countries. However, such reports are lacking in China which has the world's largest population of children. In this study, we provided the latest nationally representative data on BLLs among Chinese children living in cities, described the change in BLLs since 2004, and explored the risk factors for elevated BLLs (EBLLs) among children.
Methods: We studied 12 693 children aged 0-6 years in 2004 and 11 255 children aged 0-6 years in 2010. We evaluated the average BLLs and the prevalence of EBLLs, and a multivariate logistic regression model was used to estimate predictors of EBLLs.
Results: The geometric mean BLLs of children aged 0-6 years dropped by 16% (from 46.38±2.10 μg/L in 2004 to 38.95±1.83 μg/L in 2010), while the prevalence of EBLLs dropped by 87% (from 9.78% in 2004 to 1.32% in 2010). In a multivariate analysis, the following factors were associated with EBLLs: (1) children being cared for at home or at a boarding nursery (compared to children being cared for in a day nursery), (2) children having fathers with a lower education level, and (3) children often eating popcorn and chewing fingernails or sucking fingers were associated with EBLLs.
Conclusions: The results of this study demonstrated a substantial decline in BLLs from 2004 to 2010 among Chinese children 0-6 years living in cities. However, these levels were higher than levels in countries, such as the USA, Canada, Japan and Sweden. These data demonstrate that Chinese children's lead exposure remains a public health problem that requires additional effort and resources.
Key words: child; gasoline; lead; surveillance
World J Pediatr 2014;10(1):29-37 |
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[Abstract] [Full Text] [PDF]
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Effects of a long-term physical exercise program with and without diet on obese boys after six-month detraining
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Antonio García-Hermoso, Jose M Saavedra, Yolanda Escalante, Ana M Domínguez |
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Effects of a long-term physical exercise program with and without diet on obese boys after six-month detraining
Antonio García-Hermoso, Jose M Saavedra, Yolanda Escalante, Ana M Domínguez
Cáceres, Spain
Author Affiliations: Faculty of Sport Sciences, AFIDES Research Group, University of Extremadura, Spain (García-Hermoso A, Saavedra JM, Escalante Y, Domínguez AM)
Corresponding Author: Jose M Saavedra, Faculty of Sport Sciences, University of Extremadura, Avda, Universidad s/n, 10071 Cáceres, Spain (Tel: + 34 927257450; Fax: + 34 927257451; Email: jsaavdra@unex.es)
doi: 10.1007/s12519-014-0451-7
Background: Most studies on physical fitness and detraining have been conducted on normal-weight children. Their results indicate that any gains regress to the untrained control values during the detraining period. It, therefore, seems necessary to determine how detraining affects the different fitness parameters in obese children. The aim of the present study was to evaluate the effects of detraining (6 months) on kinanthropometry and the components of physical fitness after an intervention (31 months) consisting of a program of exercise and/or diet for obese boys.
Methods: The participants were 18 boys, aged between 8 and 11 years, divided into E and E+D groups according to the program they followed. The E group followed a physical exercise program (three 90-minute sessions/week), and the E+D group the same physical exercise program plus a low calorie diet. Physical fitness was assessed by the European physical fitness test battery including flamingo balance, plate tapping, sit-and-reach, standing broad jump, hand-grip strength, sit-ups, bent-arm hang, 10×5-metre shuttle run, and 20-metre endurance shuttle run. The Kruskal-Wallis test was applied to reveal overall intergroup differences (E and E+D groups), and measurements showing significant differences were further analysed for differences between individual groups by the Mann-Whitney U test.
Results: In both groups, changes were observed in various physical fitness parameters, especially limb speed (E group, P=0.001; E+D group, P=0.002), agility (E group, P<0.001; E+D group, P<0.001), and aerobic fitness (E group, P=0.009; E+D group, P=0.002).
Conclusion: Detraining after a long-term intervention based on the combination of exercise program and exercise program plus diet in obese boys does not affect the changes attained during the intervention.
Key words: aerobic fitness; agility; balance; body mass index; strength
World J Pediatr 2014;10(1):38-45 |
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[Abstract] [Full Text] [PDF]
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Pulmonary hypertension in extremely low birth weight infants: characteristics and outcomes
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Wambui Waruingi, Maroun Jean Mhanna |
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Pulmonary hypertension in extremely low birth weight infants: characteristics and outcomes
Wambui Waruingi, Maroun Jean Mhanna
Cleveland, OH, USA
Author Affiliations: Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA (Waruingi W, Mhanna MJ)
Corresponding Author: Maroun Jean Mhanna, MD, MPH, Department of Pediatrics, Metro Health Medical Center, 2500 Metro Health Drive, Cleveland, OH 44109, USA (Tel: 216-778-1346; Fax: 216-778-4223; Email: mmhanna@metrohealth.org)
doi: 10.1007/s12519-014-0464-2
Background: To determine the characteristics and outcomes of pulmonary arterial hypertension (PAH) in extremely low birth weight (ELBW) infants.
Methods: A retrospective case-control study of all ELBW infants admitted to a level III neonatal intensive care unit (NICU) between January 1, 2003 and December 31, 2010.
Results: During the study period, 450 ELBW infants were admitted. 6.4% (29/450) were diagnosed with PAH and were matched to 26 controls. The mean gestational age of infants with PAH and their controls were similar [24.5±1.3 vs. 24.9±1.8 weeks (P=0.26)]; however the cases were smaller at birth than were controls [640.7±119.5 vs. 727.0±184.5 g (P=0.04)]. The diagnosis of PAH was made at a mean postnatal age of 131.8± 53.7 days. Infants with PAH had a higher rate of intrauterine exposure to illicit maternal drug use [12/29 (41%) vs. 1/25 (4%); P=0.001], a longer duration of initial mechanical ventilation [74.9±28.3 vs. 59.1±27.8 days; P=0.04)], a higher incidence of severe BPD [23/29 (79%) vs. 13/26 (50%); P=0.02], and a greater NICU mortality rate [12/29 (41%) vs. 4/26 (15%); P=0.04].
Conclusion: PAH in ELBW infants is associated with maternal illicit drug use in pregnancy, longer exposure to mechanical ventilation, severe bronchopulmonary dysplasia and a significant increase in early mortality.
Key words: bronchopulmonary dysplasia; echocardiography; illicit drug use; mechanical ventilation; prenatal exposure
World J Pediatr 2014;10(1):46-52 |
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[Abstract] [Full Text] [PDF]
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Neonatal outcomes of very preterm infants from a neonatal intensive care center
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Wei-Qin Zhou, Ya-Bo Mei, Xiao-Ying Zhang, Qiu-Ping Li, Xiang-Yong Kong, Zhi-Chun Feng |
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Neonatal outcomes of very preterm infants from a neonatal intensive care center
Wei-Qin Zhou, Ya-Bo Mei, Xiao-Ying Zhang, Qiu-Ping Li, Xiang-Yong Kong, Zhi-Chun Feng
Beijing, China
Author Affiliations: Department of Pediatrics, BaYi Children's Hospital Affiliated to the Clinical Medical College of the General Hospital of Beijing Military Region, Southern Medical University, Beijing, China (Zhou WQ, Mei YB, Zhang XY, Li QP, Kong XY, Feng ZC)
Corresponding Author: Zhi-Chun Feng, Department of Pediatrics, BaYi Children's Hospital Affiliated to the Clinical Medical College of the General Hospital of Beijing Military Region, Southern Medical University, 5 Nanmencang Road, Dongcheng District, Beijing 100700, China (Tel: 86-10-66721786; Fax: 86-10-64063099; Email: fengzhichun81@sina.com)
doi: 10.1007/s12519-013-0445-x
Background: Information about clinical outcomes of very preterm (VPT) infants in tertiary neonatal intensive care unit (NICU) setting is scant in China. This study aimed to investigate the mortality and morbidity of VPT infants admitted to BaYi Children's Hospital, which serves as a NICU referral center for the city of Beijing, China.
Methods: Retrospectively collected perinatal/neonatal data on all admissions of infants born at <32 weeks of gestational age and subsequently admitted to the VPT-NICU from clinical records between October 2010 and September 2011.
Results: Totally 729 infants were identified. 90% of VPT infants were outborn. The overall survival of the infants to discharge was 92%, which increased with increasing gestational age (range from 69% at <28 weeks to 99% at 31 weeks). The incidence of bronchopulmonary dysplasia was 4%, retinopathy of prematurity requiring treatment 2%, intraventricular hemorrhage III-IV 6%, and periventricular leukomalacia 2%. 10% of the VPT infants had a major morbidity at discharge.
Conclusions: The outcomes of the VTP infants at this referral NICU were comparable to those in tertiary centers in developed countries. The most common complications were lower than those in other cohorts. Accordingly, high-volume NICU may minimize the adverse effects of VPT infants' transport.
Key words: morbidity; mortality; transport; very preterm
World J Pediatr 2014;10(1):53-58 |
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[Abstract] [Full Text] [PDF]
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Efficacy of rituximab therapy in children with refractory nephrotic syndrome: a prospective observational study in Shanghai
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Li Sun, Hong Xu, Qian Shen, Qi Cao, Jia Rao, Hai-Mei Liu, Xiao-Yan Fang, Li-Jun Zhou |
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Efficacy of rituximab therapy in children with refractory nephrotic syndrome: a prospective observational study in Shanghai
Li Sun, Hong Xu, Qian Shen, Qi Cao, Jia Rao, Hai-Mei Liu, Xiao-Yan Fang, Li-Jun Zhou
Shanghai, China
Author Affiliations: Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai 201102, China (Sun L, Xu H, Shen Q, Cao Q, Rao J, Liu HM, Fang XY, Zhou LJ)
Corresponding Author: Hong Xu, MD, PhD, Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai 201102, China (Tel: 86-21-64931001; Fax: 86-21-64931901; Email: hxu@shmu.edu.cn)
doi: 10.1007/s12519-014-0453-5
Background: Idiopathic nephrotic syndrome is the most common glomerular disease in children. This study was undertaken to observe the efficacy and side-effects of rituximab (RTX) in treating children with different types of refractory primary nephrotic syndrome.
Methods: Twelve patients with steroid dependent nephrotic syndrome (SDNS), frequently relapsing nephritic syndrome (FRNS), and steroid resistant nephrotic syndrome (SRNS) were enrolled in our study. There were obvious drug side-effects, and proteinuria remained difficult to control. RTX was administered at a dose of 375 mg/m2 body surface area, once or twice weekly.
Results: The male to female ratio was 3:1, and the onset age was 1.6-8.9 years. There were 9 patients with steroid sensitive nephrotic syndrome (SDNS or FRNS), and 3 patients with SRNS. There were 7 patients with minimal change disease (MCD), 3 patients with focal segmental glomerular sclerosis (FSGS), 1 with focal proliferative glomerulonephritis, and 1 without renal biopsy. The total effective treatment rate of RTX was 91.67%, and for 77.78% of the patients, steroid dosage could be reduced. Six months before and after RTX infusion, the mean steroid dosage was significantly decreased (P=0.014) and the recurrence number was significantly reduced (P<0.001). The results were better in MCD patients than in FSGS patients (P=0.045). There was no significant difference between FRNS/SDNS and SRNS patients (P=0.175). During RTX administration, 3 patients developed skin rashes, 1 developed hypotension, and 1 developed a fever. One patient experienced a persistent decrease in serum immunoglobulin level but without serious infection.
Conclusion: RTX was effective in the treatment of refractory nephrotic syndrome, and it could significantly reduce the use of steroid and immunosuppressants.
Key words: refractory nephritic syndrome; rituximab
World J Pediatr 2014;10(1):59-63 |
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[Abstract] [Full Text] [PDF]
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Clinical characteristics and mutation analysis of propionic acidemia in Thailand
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Nithiwat Vatanavicharn, Somporn Liammongkolkul, Osamu Sakamoto, Mahattana Kamolsilp, Achara Sathienkijkanchai, Pornswan Wasant |
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Clinical characteristics and mutation analysis of propionic acidemia in Thailand
Nithiwat Vatanavicharn, Somporn Liammongkolkul, Osamu Sakamoto, Mahattana Kamolsilp, Achara Sathienkijkanchai, Pornswan Wasant
Bangkok, Thailand
Author Affiliations: Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (Vatanavicharn N, Liammongkolkul S, Sathienkijkanchai A, Wasant P); Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan (Sakamoto O); Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand (Kamolsilp M)
Corresponding Author: Nithiwat Vatanavicharn, MD, Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 2 Prannok Road, Bangkok 10700, Thailand (Tel: 66 2 419 5675; Fax: 66 2 419 5675; Email: nithiwat_v@hotmail.com)
doi: 10.1007/s12519-014-0454-4
Background: Propionic acidemia (PA) is caused by a deficiency of propionyl CoA carboxylase. A characteristic urine organic acid profile includes 3-hydroxypropionate, methylcitrate, tiglylglycine, and propionylglycine. The diagnosis of PA is confirmed by detection of mutations in the PCCA or PCCB genes. We herein report the clinical and molecular findings of four Thai patients with PA.
Methods: Clinical findings of four Thai patients with PA were retrospectively reviewed. Urine organic acids were analyzed by gas chromatography-mass spectrometry. PCR-sequencing analyses of encoding exons and intron/exon boundaries of the PCCA and PCCB genes were performed.
Results: All patients had neonatal onset of PA. One patient died of cardiomyopathy, and another one of pneumonia and metabolic decompensation. The remainder experienced significant neurocognitive impairment. Mutation analysis of the PCCA gene identified homozygous c.1284+1G>A in patient 1, c.230G>A (p.R77Q) and c.1855C>T (p.R619X) in patient 2, homozygous c.2125T>C (p.S709P) in patient 3, and only one mutant allele, c.231+1G>T in patient 4. No PCCB mutation was identified. Four mutations including c.230G>A, c.231+1G>T, c.1855C>T, and c.2125T>C have not been reported previously.
Conclusions: The clinical and molecular study of these Thai patients provided additional knowledge of the genotype and phenotype characteristics of PA. The results of the study suggested that PCCA mutations in Asian populations were distinct from those of other populations.
Key words: mutations; propionic acidemia; Thailand
World J Pediatr 2014;10(1):64-68 |
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[Abstract] [Full Text] [PDF]
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Delivery room surgery: an applicable therapeutic strategy for gastroschisis in developing countries
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Lei Du, Wei-Hua Pan, Wei Cai, Jun Wang, Ye-Ming Wu, Cheng-Ren Shi |
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Delivery room surgery: an applicable therapeutic strategy for gastroschisis in developing countries
Lei Du, Wei-Hua Pan, Wei Cai, Jun Wang, Ye-Ming Wu, Cheng-Ren Shi
Shanghai, China
Author Affiliations: Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665, Kongjiang Road, Shanghai 200092, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China (Du L, Pan WH, Cai W, Wang J, Wu YM, Shi CR)
Corresponding Author: Wei Cai, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China (Tel: 021-65790000; Fax: 021-65125173; Email: caiw1978@163.com)
doi: 10.1007/s12519-014-0455-3
Background: The survival rate of infants with gas-troschisis has improved significantly. It is over 90% in developed countries, but 50% in developing countries. This study aimed to investigate the factors improving the survival rate of infants with gastroschisis in developing countries.
Methods: Neonates meeting the inclusion criteria, who presented to our center since the establishment of delivery room surgery, were enrolled into this retrospective study. Data were evaluated specifically to determine the role of delivery room surgery in reducing the mortality and morbidity of infants with gastroschisis and to identify factors optimizing the conditions of outborn infants.
Results: A total of 64 infants were identified. The overall survival rate of the infants was 60.9%. The survival rate of infants in inborns was 76.5%, and the survival rate of infants in outborns was 43.3%. Infants of the outborn group took more time to reach full enteral feeding, and were more likely to require a prolonged stay in hospital when compared with those of the inborn group. Logistic analysis identified that the surgical technique, the presence of sepsis and intestinal necrosis could be expected to influence the outcome of gastroschisis.
Conclusions: The strategy of delivery of patients in a center prepared to perform delivery room closure of gastroschisis appears to improve the survival of patients with gastroschisis. Further reduction in mortality rates will depend on improved conditions of outborn infants.
Key words: gastroschisis; neonatal surgery; outcomes analysis
World J Pediatr 2014;10(1):69-73 |
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[Abstract] [Full Text] [PDF]
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Timing and secular trend of pubertal development in Beijing girls
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Fang-Fang Chen, You-Fa Wang, Jie Mi |
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Timing and secular trend of pubertal development in Beijing girls
Fang-Fang Chen, You-Fa Wang, Jie Mi
Beijing, China
Author Affiliations: Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China (Chen FF, Mi J); Johns Hopkins, Global Center for Childhood Obesity, Department of International Health, Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA (Wang YF)
Corresponding Author: Jie Mi, Department of Epidemiology, Capital Institute of Pediatrics, Yabao Road 2, Chaoyang District, Beijing, China (Tel: 86-10-8569-5591; Fax: 86-10-8563-2799; Email: jiemi@vip.163.com)
doi: 10.1007/s12519-014-0456-2
Background: Historical research is limited in changes in pubertal development in Chinese girls. We aimed to identify the timing of pubertal characteristics and the secular trend of menarche age among Beijing girls from the 1980s through the 2000s.
Methods: Six data sets were analyzed, including the Beijing Child and Adolescent Metabolic Syndrome study in 2004, where 9778 Bejing girls aged 6-18 years were studied. The Fetal Origins of Adult Disease study provided retrospective menarche age from 1940 through 1960. Other four studies were conducted in Beijing to obtain supplementary information to assess secular trend in menarche age. Linear regression method was used to analyze the data.
Results: Among Beijing girls in 2004, the median age at menarche was 12.1 years, which was 0.6 years earlier in urban than in rural areas. The median age at Breast Tanner Stage 2 was 9.5±1.2 years, representing 9.4±1.1 years and 9.6±1.2 years for urban and rural girls, respectively. In contrast, the median age at Pubic Hair Tanner Stage 2 was 11.1±1.1 years, representing 10.8±1.1 and 11.4±1.1 years for urban and rural girls, respectively. The menarche age of urban girls decreased by 4.2 months per decade, and that of rural girls by 9.6 months per decade from 1980 to 2004.
Conclusions: Urban girls mature earlier than rural girls in Beijing. A secular trend towards earlier menarche was observed between the 1980s and the 2000s.
Key words: breast; menarche; puberty; pubic hair
World J Pediatr 2014;10(1):74-79 |
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[Abstract] [Full Text] [PDF]
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