Small for gestational age children

Small-for-gestational-age (SGA) children have been the subject of scientific interest over the last century. Since 2013, the 10th percentile for height and/or weight for the corresponding gestational age has been used as a cut-off to define the condition. This specific population group is characterized by multiple early and late complications.The aim of the present paper is to review the data in the literature regarding the prevalence, early and late complications associated with SGA delivery.The most commonly used cut-offs for defining an SGA child are the 2,3rd, 3rd, and 10th percentiles. Using a different definition and curves results in a large difference in prevalence. The presented cohort is characterized by a variety of early and late complications. Early complications include mortality, hypoglycemia, and hypothermia. Mortality in this cohort can be several times higher compared to children born adequate for their gestational age (AGA). Hypoglycemia, especially prolonged and unrecognized, can lead to permanent brain damage. Hypothermia was more common in the group of children born SGA compared to those born AGA.Late complications can develop at any stage of a person’s life. This group includes metabolic disorders, hypertension, precocious puberty, and reduced bone density. To date, an increased cardiovascular risk has been repeatedly demonstrated in adults born SGA. Studies have shown that those born SGA are likely to develop metabolic complications as early as infancy. The most common metabolic disorders are insulin resistance, impaired glucose tolerance and type 2 diabetes mellitus

Chronic Kidney Disease, Bone Changes and Physiotherapy

Chronic Kidney Disease (CKD) is a complex, multisystem process. There are multiple changes in terms of etiology, development of the process and the complications in adults and children.The current review discusses the new aspects in the literature in regard to CKD, focusing mainly on the bone changes and physical activity in patients in pediatric population. Renal osteodystrophy is linked not only to decreased bone density, due to decreased production of vitamin D, but also to rickets changes. So far there is no data in the literature for physiotherapy treatment, currently practiced with children with CKD. Studies in recent years pay attention to physical activity in the pediatric population

Design and specific features of the Programme for Early Detection and Follow-Up of Full-Term and Preterm Children, Born Small for Their Gestational Age

In 2007 the International Consensus for Management of Children Born Small for Their Gestational Age (SGA) was published. SGA birth is connected to many complications in different periods of life. Often in practice children born with small sizes are underestimated and not always referred timely to а pediatric endocrinologist. Thеse children represent а significant part of children with growth problems. In our country there is not enough information for the condition and algorithm for its follow-up. Having all this in mind, Varna Pediаtric Endocrine Society (VAPES) and Bulgarian Neonatology Association (BNА) created the Programme for Early Detection and Follow-Up of Full-Term and Pre-Term Children, Born SGA. The current publication presents the design of the study. The Programme is scientifically applied investigation for early detection of full-term and preterm SGA children, aiming to facilitate timely diagnosis of syndromes and conditions connected to SGA births and, if needed, to recommend additional testing, including genetic. Through the Programme we expect to update the data for the prevalence of SGA births and SGA children without postnatal catch-up in our country. At the end of the Programme, we will evaluate its cost-effectiveness and will create an algorithm for detection and treatment of these children

Initial results from the treatment with growth hormone of short, small for gestational age children

Introduction: Growth is important indicator of a child`s health. According to the literature, every year between 3 and 7% children are born with birth length and/or weight less than the 10th percentile for the corresponding gestational age. From those born short for gestational age (SGA), one in every ten children cannot catch up in growth. Recently, these children are defined in the literature as “short, SGA children”. Namely, in those children, especially in those untreated, metabolic and cardiovascular changes can be seen with age. In Bulgaria there is still no reimbursement for growth hormone (GH) treatment of this indication, and treatment is supported by a nation-wide charity (The Bulgarian Christmas).Aim: The aim of this article is to assess patients born SGA, without catch-up growth, regarding the age at start of the treatment, duration and effect of growth hormone treatment.Patients and Methods: Patients’ data was collected retrospectively from the maintained VECRED record. Statistical analysis was conducted by means of the SPSS programme. The most important factors regarding growth hormone treatment efficacy were assessed.Results: Currently at the center there are 43 SGA patients with short stature at an average age of 10.3 ± 7.1 y (1.7–40.1), 26 (60.5%) at an average age of 10.3 ± 4.2 y (3.7–17.3) are treated with growth hormone and 17 (39.5%) are just followed. The average age when the GH treatment was initially started is 6.5 ± 3.7 y (1.4–12.1). The gender distribution of the group is nearly 1:1 (22 boys:21 girls). The most common specific diagnosis is Silver-Russell Syndrome (22, 51.2%), followed by Noonan syndrome (3, 6.9%), Di George Syndrome (2, 4.7%), Lowe syndrome, etc. On the average the treatment duration is 39.3 ± 30.2 months (4–120). From the start of the treatment until the current survey, the height of the patients has increased with 1.23 ± 1.8 SDS.Conclusion: Growth hormone treatment in short SGA children leads to good results and that is why it is currently an accepted standard worldwide. This is also confirmed by the current results

MULTIPRED2: A computational system for large-scale identification of peptides predicted to bind to HLA supertypes and alleles

MULTIPRED2 is a computational system for facile prediction of peptide binding to multiple alleles belonging to human leukocyte antigen (HLA) class I and class II DR molecules. It enables prediction of peptide binding to products of individual HLA alleles, combination of alleles, or HLA supertypes. NetMHCpan and NetMHCIIpan are used as prediction engines. The 13 HLA Class I supertypes are A1, A2, A3, A24, B7, B8, B27, B44, B58, B62, C1, and C4. The 13 HLA Class II DR supertypes are DR1, DR3, DR4, DR6, DR7, DR8, DR9, DR11, DR12, DR13, DR14, DR15, and DR16. In total, MULTIPRED2 enables prediction of peptide binding to 1077 variants representing 26 HLA supertypes. MULTIPRED2 has visualization modules for mapping promiscuous T-cell epitopes as well as those regions of high target concentration – referred to as T-cell epitope hotspots. Novel graphic representations are employed to display the predicted binding peptides and immunological hotspots in an intuitive manner and also to provide a global view of results as heat maps. Another function of MULTIPRED2, which has direct relevance to vaccine design, is the calculation of population coverage. Currently it calculates population coverage in five major groups in North America. MULTIPRED2 is an important tool to complement wet-lab experimental methods for identification of T-cell epitopes. It is available at http://cvc.dfci.harvard.edu/multipred2/