RESUMEN
OBJECTIVE: To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study. STUDY DESIGN: We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function. RESULTS: The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), forced expiratory flow from 25% exhalation to 75% exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2% of patients demonstrated an obstructive pattern (FEV(1)/FVC <67%), and 14.5% demonstrated a restrictive pattern (FVC and FEV(1) <80% predicted; FEV(1)/FVC >80%). Patients with a Haller index of 7 are >4 times more likely to have an FVC of ≤80% than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern. CONCLUSIONS: Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.
Asunto(s)
Flujo Espiratorio Forzado/fisiología , Tórax en Embudo/diagnóstico , Insuficiencia Respiratoria/etiología , Capacidad Vital/fisiología , Adolescente , Niño , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Tórax en Embudo/complicaciones , Tórax en Embudo/fisiopatología , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Radiografía Torácica , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/fisiopatología , Índice de Severidad de la Enfermedad , Espirometría , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the utility of weight-for-length (defined as gm/cm(3), known as the "ponderal index") as a complementary measure of growth in infants in neonatal intensive care units (NICUs). STUDY DESIGN: This was a secondary analysis of infants (n=1214) of gestational age 26 to 29 weeks at birth, included in a registry database (1991-2003), who had growth data at birth and discharge. Weight-for-age and weight-for-length were categorized as small (<10th percentile), appropriate, or large (>90th percentile). RESULTS: Statistical agreement between the weight-for-age and weight-for-length measures was poor (kappa=0.02 at birth, 0.10 at discharge; Bowker test for symmetry, P< .0001). From birth to discharge, the percentage of small-for-age infants increased from 12% to 21%, the percentage of small-for-length infants decreased from 10% to 4%, the percentage of large-for-age infants remained similar (<1%), and the percentage of large-for-length infants increased from 5% to 17%. At discharge, 92% of the small-for-age infants were appropriate or large-for-length, and 19% of the appropriate-for-age infants were large-for-length. CONCLUSIONS: Weight-for-age and weight-for-length are complementary measures. Weight-for-length or other measures of body proportionality should be considered for inclusion in routine growth monitoring of infants in the NICU.
Asunto(s)
Antropometría/métodos , Composición Corporal , Trastornos de la Nutrición del Lactante/prevención & control , Recien Nacido Prematuro/crecimiento & desarrollo , Recién Nacido de muy Bajo Peso/crecimiento & desarrollo , Factores de Edad , Índice de Masa Corporal , Peso Corporal , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Ohio , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: A 4-year longitudinal study was conducted to determine the prevalence of overweight, detect shifts in body mass index (BMI) distribution, and determine which adolescents were at risk for pathologic weight gain. STUDY DESIGN: BMI was analyzed in 1746 adolescents in years 1 (2001-2002) through 4 (2004-2005) of a school-based study. Changes in BMI-Z according to baseline BMI category were examined with general linear modeling. RESULTS: In year 1, the prevalence of at risk for overweight (BMI = 85th-95th percentile) and overweight (BMI > or = 95th percentile) was 19.1% and 18.1%, respectively. Between years 1 and 4, the cohort exhibited no increase in the prevalence of at risk for overweight (19.1% versus 17.2%) or overweight (18.2% versus 18.8%; P > .5). The mean BMI Z-score (BMI-Z) for the cohort was identical in years 1 and 4 (0.66 +/- 1.0 Z-score units). Although the overall cohort exhibited stability in BMI-Z, individuals at the lowest categories of BMI-Z (year 1 BMI Z-score < 0) exhibited significant increases in BMI Z-score by year 4 (P < .01), with lean girls gaining more than lean boys (P for difference < .007). CONCLUSION: The study cohort exhibited stability in adiposity during 3 years of follow-up. However, lean adolescents, particularly girls, experienced significant increases in BMI-Z, beyond that expected for age- and sex-related growth.