Advanced skeletal maturity in children and adolescents with myelomeningocele

Roiz, Ronald; Mueske, Nicole M.; Speybroeck, Alexander Van; Ryan, Deirdre; Gilsanz, Vicente; Wren, Tishya A. L.

doi:10.3233/prm-170458

Cited by 5 publications

(6 citation statements)

References 42 publications

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“…Subsequently, these etiologies must be ruled out when more concerning symptoms are present 4,6,7,12 . More rarely, advanced skeletal maturity and precocious puberty has been observed in the setting of CNS disease, such as tumors involving the hypothalamus, including pinealomas and benign hamartomas, gliomas or astrocytomas, congenital brain disorders, acquired injures, or infection 12,13 . It is important to remember that precocious puberty is rare.…”

Section: Discussionmentioning

confidence: 99%

Pathologic acne in pre‐pubertal children: A case series and review on when to refer to pediatric endocrinology

Shope

Ritter

Matlock

et al. 2022

Pediatric Dermatology

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Acne vulgaris is an extremely common chronic disease of the pilosebaceous unit.Despite its ubiquity, acne in the childhood years of approximately ages 1-6 years is exceedingly rare. Physicians should be suspicious of underlying systemic disease processes in patients of this age who present with onset of acne lesions, as pre-pubertal acne in childhood has a distinctly different pathology than that of other age groups. Through a case series, we highlight the importance of a thorough work-up and provide a review on when to refer to pediatric endocrinology to rule out precocious puberty and tumors as the cause of prepubertal acne. K E Y W O R D S acne vulgaris; bone and bones; child; child, preschool; puberty, precocious 1 | BACKGROUND Acne vulgaris is a common disease of the pilosebaceous unit affecting up to 85% of people over the course of their lifetime. 1,2 It is characterized by the triad of inflammation, abnormal keratinocyte shedding, and increased sebum production in the setting of Cutibacterium acnes (C. acnes) overgrowth. Acne can be classified clinically by the number and type of lesions present and the amount of skin involved, or based on morphology. 3,4 Characteristic lesions are either comedones, which are described as open (blackheads) versus closed (whiteheads), or inflammatory, which includes erythematous papules, nodules, and cyst-like nodular lesions. 3 The differential diagnosis for papular facial eruptions includes angiofibromas seen in tuberous sclerosis complex, periorificial dermatitis, folliculitis, and keratitis pilaris. 3 To make a diagnosis of acne the typical comedones or inflammatory lesions must be present.Most cases of acne occur during the peripubertal time period, with less common occurrence during the neonatal and infantile time periods (Table 1). 5 Very rarely, acne can occur in mid-childhood, ages 1-6 years. 6 Sandoval and colleagues, as part of the National Ambulatory Medical Care Data Survey, found that of the 50 million acne visits over a 6-year time period, only 0.9% were visits for mid-childhood

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Section: Discussionmentioning

confidence: 99%

Pathologic acne in pre‐pubertal children: A case series and review on when to refer to pediatric endocrinology

Shope

Ritter

Matlock

et al. 2022

Pediatric Dermatology

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“…In more detailed analyses, we also examined the effects of neurosegmental level and pubertal development. Both age and pubertal stage were included in these analyses since youth with SB may exhibit early maturation both in terms of pubertal ( 36 ) and bone ( 37 ) development. These analyses revealed that the only bone deficits evident before puberty were reduced cancellous density in both metaphyses and weighted area in the proximal metaphysis (likely due to the reduced cancellous density).…”

Section: Discussionmentioning

confidence: 99%

Quantitative Computed Tomography Assessment of Bone Deficits in Ambulatory Children and Adolescents with Spina Bifida: Importance of Puberty

et al. 2020

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Pathologic fractures of the femur and tibia are common in youth with spina bifida (SB). These fractures may be associated with deficient bone accrual due to decreased ambulation and skeletal loading. This prospective cohort study used quantitative computed tomography (QCT) to assess three‐dimensional (3D) bone properties in children and adolescents with SB. Eighty‐three ambulatory youth with SB underwent QCT imaging of the tibia at up to four annual visits between ages 6 to 16 years (294 total visits averaging 3.5 visits/patient). A total of 177 controls without disability and 10 non‐ambulatory youth with SB underwent imaging once. Bone geometric properties (cortical bone area, cross‐sectional area, cortical thickness, cortical density, and moments of inertia) were measured at the mid‐diaphysis (50% of bone length); cross‐sectional area, cancellous density, and density‐weighted area were measured in the proximal (13% of bone length) and distal (90% of bone length) metaphyses. Bone properties were compared between the ambulatory SB and control participants, among SB neurosegmental subgroups (sacral, low lumbar, mid lumbar and above) as a function of pubertal stage (prepubertal, pubertal, postpubertal), and considering SB type (myelomeningocele, lipomyelomeningocele) using linear mixed effects models adjusted for sex, age, height percentile, and body mass index (BMI) percentile. Only cancellous density of both metaphyses and weighted area of the proximal metaphysis differed between ambulatory children with SB and controls before puberty. However, significant deficits in all bone properties manifested during and after puberty as moderate bone growth in the SB group failed to keep pace with the large increases normally observed during puberty. The bone deficits primarily affected patients with myelomeningocele, and similar deficits were observed at all neurosegmental levels except that cancellous density was closer to normal in the sacral group. Descriptive analysis of the 10 non‐ambulatory youth with SB showed greater bone deficits than ambulatory children, particularly for cancellous density in the distal metaphysis. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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“…There may be several factors associated with decreased rates of leg length discrepancy in patients that underwent prenatal repair for myelomeningocele. Leg length discrepancy in patients with myelomeningocele may be due to hip dislocation, flexion contractures, atypical skeletal development, and physeal fractures [8,[11][12][13]. Patients that undergo prenatal repair are noted to have better motor development and ability to ambulate [9], which may results in lower risks of flexion contractures and fractures due to disuse osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic outcomes of prenatal versus postnatal repair of myelomeningocele

Swarup

Talwar

Howell

et al. 2020

Journal of Pediatric Orthopaedics B

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Myelomeningocele, characterized by extrusion of the spinal cord through a spinal canal defect, is the most common form of spina bifida, often resulting in lifelong disability and significant orthopaedic issues. A randomized controlled trial (RCT) has shown the efficacy of prenatal repair in decreasing the need for shunting and improving motor outcomes. However, no studies have evaluated the effects of prenatal repair on orthopaedic outcomes. The purpose of this study was to determine the rates of orthopaedic conditions in patients with prenatal and postnatal repair of myelomeningocele and compare the rates of treatment required. This study analyzes the relevant outcomes from a prospective RCT (Management of Myelomeningocele Study). Eligible women were randomized to prenatal or postnatal repair, and patients were evaluated prospectively. Outcomes of interest included rates of scoliosis, kyphosis, hip abnormality, clubfoot, tibial torsion, and leg length discrepancy (LLD) at 12 and 30 months. The need for orthopaedic intervention at the same time points was also evaluated. Statistical analyses included descriptive statistics and univariate analyses. Data for the full cohort of 183 patients were analyzed (91 prenatal, 92 postnatal). There were no differences in rates of scoliosis, kyphosis, hip abnormality, clubfoot or tibial torsion between patients treated with prenatal or postnatal repair. The rate of LLD was lower in the prenatal repair group at 12 and 30 months (7 vs. 16% at 30 months, P = 0.047). The rates of patients requiring casting or bracing were significantly lower in patients treated with prenatal repair at 12 and 30 months (78 vs. 90% at 30 months, P = 0.036). Patients treated with prenatal myelomeningocele repair may develop milder forms of orthopaedic conditions and may not require extensive orthopaedic management.

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Advanced skeletal maturity in children and adolescents with myelomeningocele

Cited by 5 publications

References 42 publications

Pathologic acne in pre‐pubertal children: A case series and review on when to refer to pediatric endocrinology

Pathologic acne in pre‐pubertal children: A case series and review on when to refer to pediatric endocrinology

Quantitative Computed Tomography Assessment of Bone Deficits in Ambulatory Children and Adolescents with Spina Bifida: Importance of Puberty

Orthopaedic outcomes of prenatal versus postnatal repair of myelomeningocele

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