G. Aicardi

Fetal growth velocity: kinetic, clinical, and biological aspects.

With the aim of determining fetal growth kinetics, prenatal data were analysed which had been longitudinally collected in the framework of a perinatal growth survey. The sample comprised 238 singleton normal pregnancies, selected in Genoa and Turin (between 1987 and 1990), and repeatedly assessed by ultrasound scans (five to nine per pregnancy). Five morphometric traits were considered: BPD (biparietal diameter), OFD (occipitofrontal diameter), HC (head circumference), FDL (femur diaphysis length) and AC (abdomen circumference). Growth rate seemed to increase in the early part of the second trimester, and decrease subsequently: velocity peaks were steeper and earlier for head diameters and circumference (about 18 weeks) than for femur length (20 weeks) and abdomen circumference (22 weeks). Velocity standards were traced using a longitudinal two-stage linear model: this ensures unbiased description of the shape of the growth curve, even when growth kinetics are asynchronous, and efficient estimation of the outer centiles--the most useful for diagnostic purposes.

Turner's syndrome in Italy: familial characteristics, neonatal data, standards for birth weight and for height and weight from infancy to adulthood.

In 1990, the Italian Study Group for Turners Syndrome (ISGTS) undertook a nationwide survey, involving the retrospective collection of cross‐sectional data and longitudinal growth profiles of 772 girls with Turners syndrome born between 1950 and 1990. The study was carried out in 29 pediatric endocrinological centers. In this first report, the familial characteristics and neonatal data of Turner girls are described, compared to those of the general population, and related to postnatal somatic development. Furthermore, charts for birth weight and growth standards for height and weight from infancy to adulthood are presented (these are the first charts based on a large sample from the Mediterranean area). The main findings were: (1) incidence of Turner births increases with parental age or parity; (2) most of the neonates are small for dates; (3) girls with normal birth weight tend to be both taller and heavier than girls with low birth weight during the whole growth period; and (4) a 10‐cm difference in midparental height leads to a 6.5‐cm difference in adult stature.

Differences in size at birth are determined by differences in growth velocity during early prenatal life.

Physiologic interindividual differences in neonatal size are traditionally thought of as determined by differences in fetal growth occurring only in the second half of pregnancy. Whether possible differences in early intrauterine growth velocity are the effect of random growth fluctuations or may affect size at birth is still debated. This article aims at evaluating to what extent differences in neonatal size are accounted for by differences in fetal growth velocity. We analyzed the fetal growth of 130 healthy singletons for whom head (HC) and abdomen (AC) circumferences and femur diaphysis length (FDL) longitudinal profiles were available, together with the measures of weight (BW), length (BL), and head circumference (BHC) at birth. Individual profiles were fitted with ad-hoc models. Neonatal traits were transformed into standard deviation scores (SDS). Neonates in the upper third of BW-SDS distribution (3618 ± 43 g, mean ± SEM) had, at 22 wk of gestational age, AC growth velocity higher by 0.55 ± 0.10 mm/wk than those in the lower third (2902 ± 36 g). Neonates in the upper third of BL-SDS distribution (51.7 ± 0.21 cm) had, at 20 wk, FDL growth velocity higher by 0.11 ± 0.05 mm/wk than those in the lower third (48.2 ± 0.18 cm). Neonates in the upper third of BHC-SDS distribution (35.7 ± 0.13 cm) had, at 18 wk, HC growth velocity higher by 0.57 ± 0.20 mm/wk than those in the lower third (33.3 ± 0.11 cm). The differences in growth velocity remain constant throughout the second and third trimester for AC, and tend to vanish in the third trimester for HC and FDL. The differences in fetal growth velocity, which in our study were observed as early as mo 4, suggest that the genetic component plays an important role in fetal growth and is precociously expressed.

Assessment of skeletal maturity of the hand-wrist and knee: A comparison among methods.

This study evaluated the influence of height growth and nutritional status on skeletal maturation of the knee and hand‐wrist. Radiographs of 589 subjects (250 girls and 339 boys) from 2 to 15 years were rated according to Greulich‐Pyle, TW‐20 bone and TW‐RUS, RWT knee, and FELS hand‐wrist methods and a method combining FELS and RWT indicators. The subjects were referred to the Genoa University Paediatric Department from 1980 to 1987 for short stature, simple obesity, or acute diseases. Bone age was closer to chronological age using the RWT knee method rather than the hand‐wrist methods, while bone age assessed at the hand‐wrist was closely related to height and BMI. When skeletal maturation was delayed, Greulich‐Pyle, TW‐20‐bone, TW‐RUS, and FELS bone ages tended to be lower than RWT knee estimates. Conversely, if maturation was advanced the hand‐wrist estimates tended to be higher than RWT knee bone ages. The combined estimates are close to FELS bone age values. These findings show true intraindividual variability of skeletal maturity at the hand‐wrist and knee. A certain “laziness” in knee maturation seems to be confirmed. Am. J. Hum. Biol. 12:610–615, 2000.

Trichorhinophalangeal syndrome type I in monozygotic twins discordant for hip pathology. Report on the morphological evolution of cone-shaped epiphyses and the unusual pattern of skeletal maturation

Abstract A pair of monozygotic twin girls with trichorhinophalangeal syndrome type I (TRPS I), followed from 8.3 to 16.1 years of age, is described. Both showed typical dysmorphic features and severe short stature, but only one had Perthes-like changes in the right capital femoral epiphysis. The radiographic findings and evolutionary changes of phalangeal cone-shaped epiphyses (PCSE) of the hands are illustrated in this report. The unusual bone maturation and growth of the twins are also described. Both presented poor growth and delayed bone age until about 13 years, followed by marked acceleration of bone age and stunted pubertal height spurt.

Longitudinal distance standards of fetal growth

Background. Most ultrasonographic fetal growth norms are derived from cross‐sectional data or from longitudinal data treated as coming from cross‐sectional studies, although only longitudinal models may detect particular aspects of fetal growth shape, such as peak of growth velocity.

Comparison of growth retarding effects induced by two different glucocorticoids in prepubertal sick children: An interim long-term analysis

SummaryThe low interference with growth expected in child for a cortisol analogue, deflazacort (DFZ), prompted us to verify if DFZ could affect growth less than prednisone (PDN). An interim analysis relative to 27 girls and 38 boys (out of 100 expected) age 3–12 yrs, after a median period of 14 mo.s is reported. Children with connective tissues (CTD) and glomerular disorders (KD) were randomly allocated to DFZ or PDN. Anthropometric measurements and maturity ratings were performed. Mean daily doses of PDN (or DFZ equivalent), from 0.57 to 0.64 mg/kg (DFZ 0.92 to 0.94 mg/kg) to induce control and from 0.19 to 0.93 mg/kg (DFZ 0.34 to 0.36 mg/kg) to maintain disease under control were given in CTD and KD, respectively. The increase in bone age delay over time was significantly>for PDN(-4.0 mo/yr) than DFZ (-1.8 mo/yr) in the overall group. The increases in statural age delay and loss over time were significantly> for PDN (-5.9 and-5.9 mo/yr) than DFZ (-2.4 and-2.4 mo/yr), only in children with “taller” midparents. Although doses of DFZ 1.1–1.8 times those of PDN were given, growth retardation in PDN-treated children was nevertheless 2.3–2.5 times that in DFZ-ones.

FELS, Greulich‐Pyle, and Tanner‐Whitehouse bone age assessments in a group of Italian children and adolescents

Assessments of skeletal maturity are usually made from handwrist radiographs, using either the method of Greulich‐Pyle (GP) or Tanner‐Whitehouse (TW). Recently the FELS method has been developed, and it represents a potentially valuable approach to skeletal age assessment. The present study evaluates the accuracy and precision of FELS skeletal age assessments compared with ratings by the GP and TW methods in a group of Italian children and adolescents. The hand‐wrist radiographs of subjects (171 males and 156 females 1 to 17 years) referred to the “Istituto di Puericultura e Medicina Neonatale” of the University of Genoa in Italy between 1985 and 1990 were assessed according to each method. Two independent observers rated the radiographs and one observer reassessed them after 6 months or more. GP estimates rather closely match chronological age; TW ratings tend to overestimate chronological age by 7–9 months around puberty, mainly in boys; and the FELS method tends to overestimate chronological age by amounts that increase with chronological age. The degree of precision of skeletal age assessments is within the usually accepted limits. Higher levels of repeatability and reproducibility are apparent for the FELS estimates than for GP and TW assessments. Thus, skeletal maturity is likely to be adequately interpreted by the FELS method as well as by the more commonly used GP and TW systems in Italian children and adolescents.

A METHODOLOGICAL NOTE ON THE CONSTRUCTION OF PRENATAL GROWTH STANDARDS

The accurate monitoring of prenatal growth constitutes an important pait in the modern perinatal care, since it allows gynaecologists and obstetricians to assess the health conditions of the fetus and to detect possible developmental abnormalities. In this context, it is widely known that the so-called intrauterine giOwth retardation (IUGR) on less frequently, the excess of growth (16) result in higher risk of perinatal mortality and morbidity and are risk factors for psychomotor sequelae and long term handicaps (3). The early prediction of anomalous fetal growth may be the basis of rational choices äs regards the time of delivery and the intrapartum management, which should take place in a hospital provided with adequate neonatal care unit.