Angiogenesefaktoren versus Doppler follow-up in der Prädiktion von schlechtem Outcome bei small-for-gestational-age Feten im dritten Trimenon

Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus ≥2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84–2.35], P =0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50–2.68, P <0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery ( P interaction =0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms.

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Genetic Screening for Growth Hormone Therapy in Children Small for Gestational Age: So Much to Consider, Still Much to Discover

Frontiers in Endocrinology ◽

10.3389/fendo.2021.671361 ◽

2021 ◽

Vol 12 ◽

Author(s):

Claudio Giacomozzi

Keyword(s):

Growth Hormone ◽

Gestational Age ◽

Small For Gestational Age ◽

Genetic Screening ◽

Adult Height ◽

Recombinant Human Growth Hormone ◽

Early Years ◽

Current Evidence

Children born small for gestational age (SGA), and failing to catch-up growth in their early years, are a heterogeneous group, comprising both known and undefined congenital disorders. Care for these children must encompass specific approaches to ensure optimal growth. The use of recombinant human growth hormone (rhGH) is an established therapy, which improves adult height in a proportion of these children, but not with uniform magnitude and not in all of them. This situation is complicated as the underlying cause of growth failure is often diagnosed during or even after rhGH treatment discontinuation with unknown consequences on adult height and long-term safety. This review focuses on the current evidence supporting potential benefits from early genetic screening in short SGA children. The pivotal role that a Next Generation Sequencing panel might play in helping diagnosis and discriminating good responders to rhGH from poor responders is discussed. Information stemming from genetic screening might allow the tailoring of therapy, as well as improving specific follow-up and management of family expectations, especially for those children with increased long-term risks. Finally, the role of national registries in collecting data from the genetic screening and clinical follow-up is considered.

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Longitudinal follow-up of growth in children born small for gestational age

Acta Paediatrica ◽

10.1111/j.1651-2227.1993.tb12718.x ◽

1993 ◽

Vol 82 (5) ◽

pp. 438-443 ◽

Cited By ~ 86

Author(s):

K Albertsson-Wikland ◽

G Wennergren ◽

M Wennergren ◽

G Vilbergsson ◽

S Rosberg

Keyword(s):

Gestational Age ◽

Small For Gestational Age

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Long-term follow up of carbohydrate metabolism and adverse events after termination of Omnitrope® treatment in children born small for gestational age

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/20420188211013121 ◽

2021 ◽

Vol 12 ◽

pp. 204201882110131

Author(s):

Mieczyslaw Walczak ◽

Mieczyslaw Szalecki ◽

Gerd Horneff ◽

Jan Lebl ◽

Barbara Kalina-Faska ◽

...

Keyword(s):

Adverse Events ◽

Carbohydrate Metabolism ◽

Gestational Age ◽

Small For Gestational Age ◽

Follow Up Study ◽

Short Children ◽

Rhgh Treatment ◽

Phase Iv

Background: Recombinant human growth hormone (rhGH) therapy can affect carbohydrate metabolism and lead to impaired glucose tolerance during treatment. In addition, short children born small for gestational age (SGA) are predisposed to metabolic abnormalities. This study assessed the long-term safety of rhGH (Omnitrope®) use in short children born SGA. Methods: This was a follow-up observational study of patients from a phase IV study. The baseline visit was the final visit of the phase IV study. Further visits were planned after 6 months (F1), 1 year (F2), 5 years (F3), and 10 years (F4). The primary objective was to evaluate the long-term effect of rhGH treatment on the development of diabetes mellitus; secondary objectives included incidence/severity of adverse events (AEs). Results: In total, 130 subjects were enrolled in the follow-up study; 99 completed F1, 88 completed F2, and 13 completed F3 (no subject reached F4). The full analysis set for evaluation comprised 118 patients (64 female). Mean (standard deviation) duration of follow up was 39.6 (24.4) months. No subject was newly diagnosed with diabetes. The results for carbohydrate metabolism parameters were consistent with this finding. A total of 144 AEs were reported in 54 subjects; these were mostly of mild-to-moderate intensity (96.5%) and not suspected to be related to previous rhGH treatment (94.4%). Serious AEs ( n = 18) were reported in eight patients; three (in one patient) were suspected as possibly related to previous rhGH treatment (anemia, menorrhagia, oligomenorrhoea). One fatal event occurred (sepsis), which was judged as not related to previous rhGH treatment. Conclusions: None of the participating subjects, who had all been previously treated with Omnitrope® in a phase IV study, developed diabetes during this follow-up study. In addition, no other unexpected or concerning safety signals were observed.

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Kangaroo Mother Care –Differences and Quantitative Benefits in Different Subgroups of Low Birth Weight Babies

Journal of Pediatrics & Neonatal Biology ◽

10.33140/jpnb.05.01.02 ◽

2020 ◽

Vol 5 (1) ◽

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Head Circumference ◽

Cost Effective ◽

Kangaroo Mother Care ◽

Daily Weight Gain ◽

At Home

Objectives: To determine the effectiveness of Kangaroo Mother Care in subgroups of LBW babies-Preterm AGA, Preterm SGA and Term SGA, To assess any differences in benefits of KMC in relation to duration in the subgroups, To assess weight gain difference in NICU and at home at first follow up visit and up to 40 weeks of follow up to Preterm AGA, Preterm SGA and till gain of 2500g in Term SGA babies. Study design: Prospective observational study. Setting: NICU in a large teaching institute, department of pediatrics, Mahatma Gandhi Memorial Hospital, North Telangana. Subjects and Methods: 240 neonates with birth weight <2500g, hemodynamically stable. Intervention: The subjects are classified into three subgroups-based on gestational age (by new Ballard’s score) and by weight (Lubchenco’ s charts) into Preterm Appropriate for gestational age (PT AGA) (102), Preterm Small for Gestational Age (PT SGA) (88) and Term Small for Gestational age (T SGA) (50). Further categorized into <=32 wks,33-34wks,35- 36wks,>=37wks.KMC was given to all subgroups at hospital and home with mean duration of 9+2hrs at hospital and 5+2hrs at home. Outcome Measures: Growth measured by average daily weight gain, mean weight gain, (weight was measured by electronic weighing scale (seca), head circumference (measured by non-stretchable and non-metallic tape) and total length (measured by infant meter) in follow up to 40 weeks of corrected gestational age in Preterm and up to gain of 2500g in Term SGA were assessed with KMC. Results: Better weight gain was noticed in all the 3 subgroups of LBW neonates with KMC at hospital and home. In spite of lower duration of KMC at home PT AGA (33-34 weeks) subgroup has the highest weight gain (24.5+5.5g/day, p=0.003), highest head circumference gain (0.70+0.5cm/week, p=0.002), highest length gain (0.90+0.6cm/week, p <0.008). The time taken to reach full feeds and the time to reach initiation of direct breastfeeds were comparable in all subgroups but attained much earlier in PT AGA (33-34wks) and PT AGA (35-36wks). Duration of hospital stay is least in PT AGA with mean of 12.68 ± 6.37 days.KMC significantly reduced the incidence of apnea in all subgroups of LBW babies. All babies were on exclusive breastfeeds at the end of the study (98%). Conclusion: We conclude by this present study that KMC improves growth in all sub groups of LBW infants. KMC has significantly reduced the incidence of co mortifies like apnea, hypothermia, hypoglycemia in all the subgroups of LBW babies. KMC is cost effective, easily accessible and acceptable not only to mothers but also by majority of the family members

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