Factors associated with growth and blood pressure patterns in children with sickle cell anemia: Silent Cerebral Infarct Multi‐Center Clinical Trial cohort

Abstract

Individuals with sickle cell anemia (SCA) exhibit delayed growth trajectories and lower blood pressure (BP) measurements than individuals without SCA. We evaluated factors associated with height, weight, and BP and established reference growth curves and BP tables using data from the Silent Cerebral Infarct MultiCenter Clinical (SIT) Trial (NCT00072761). Quantile regression models were used to determine the percentiles of growth and BP measurements. Multivariable quantile regression was used to test associations of baseline variables with height, weight, and BP measurements. Height and weight measurements were collected from a total of 949 participants with median age of 10.5 years [Interquartile range (IQR) 8.2-12.9] and median follow-up time of 3.2 years (IQR 1.8-4.7, range 0-12.9). Serial BP measurements were collected from a total of 944 and 943 participants, respectively, with median age of 10.6 years (IQR 5 8.3-12.9 years), and median follow-up time of 3.3 years (IQR 5 1.7-4.8). Multivariable quantile regression analysis revealed that higher hemoglobin measurements at baseline were associated with greater height (P < 0.001), weight (P 5 0.000), systolic BP (P < 0.001), and diastolic BP (P 5 0.003) measurements. We now provide new reference values for height, weight, and BP measurements that are now readily available for medical management.

Severe anemia early in life as a risk factor for sickle-cell kidney disease

“…Participants were categorized as hypertensive based on disease norms if their systolic or diastolic blood pressure was .95th percentile based on age and sex. 15 "Early severe anemia" was categorized as Hb ,8.0 g/dL on their earliest complete blood count (CBC) between 12 and 24 months of age. 14 We analyzed age, sex, blood pressure, laboratory variables, and current therapy from the visit that coincided with identification of MiA and an early CBC to identify associations with MiA using t tests and x 2 tests for continuous and categorical variables, respectively.…”

Unmasking hypertension in children and adolescents with sickle/beta‐thalassemia

“…The reference BP tables by age in 949 patients with SCD from the Silent Cerebral Infract Multicenter Clinical (SIT) trial were also used to assess office BP status. 16 These tables' thresholds differ from those of the ESH 2016 as they are not based on healthy population, but on a SCD cohort including patients that may be hypertensive.…”

World Health Organization’s Growth Reference Overestimates the Prevalence of Severe Malnutrition in Children with Sickle Cell Anemia in Africa

“…The SIT trial recruited participants from four high-income countries, including the United States, Canada, France, and United Kingdom, between December 2004 and November 2013 [20]. Wolf et al constructed reference percentiles for weight, height, and body mass index (BMI) for males and females with SCA, which are readily available for medical use [17]. Wolf et al constructed the growth charts, using serial height and weight measurements from a total of 949 participants with a median age of 8.2 years (interquartile range (IQR) 6.4-10.4) and a median follow-up time of 3.2 years (IQR: 1.8-4.7, range 0-12.9).…”

“…Often-cited disease-specific growth charts for chronic disease include Down syndrome [12,15,16], Turner syndrome [10,14], and cystic fibrosis [11,13]. Wolf et al constructed reference percentiles for weight, height, and blood pressure measurements for male and female children with SCA between five and 15 years of age [17]. However, this study did not include the expected body mass index (BMI) percentiles, the standard metric for assessment of severe malnutrition [18].…”

“…To address the gap in knowledge regarding the appropriate anthropometric standard in children with SCA, we tested the hypothesis that the WHO growth reference [18] in children with SCA overestimates the prevalence of severe malnutrition when compared to a growth reference specifically constructed using longitudinal anthropometric measurements of children with SCA living in high-income countries [17]. We also tested the hypothesis that severe malnutrition in children with SCA would be associated with lower mean hemoglobin levels or abnormal transcranial Doppler measurements (>200 cm/s).…”