Growth curves in Down syndrome: Implications for clinical practice

Abstract

Growth curves have been developed for individuals with Down syndrome (DS) in several countries. However, in order to facilitate the preparation of clinical guidelines it is necessary to verify the eligibility of these curves. The search was conducted according to the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). It was conducted between July 2012 and June 2013 in MEDLINE/PubMed and BIREME. The inclusion and exclusion criteria were applied to identify the studies and a total of 16 relevant articles were selected. The aspects analyzed in the articles consisted of sample size, number of observations, age group, anthropometric variables, standard deviation scores (SDS), type of study, collection and analysis of data, participants, inclusion/exclusion criteria and outcomes. The mean, standard deviations (SDs) and percentiles for sex and age were used to develop the curve of weight, height, and head circumference. The individuals with DS presented growth between -0.4 and -4.0 SDS in comparison to healthy controls. The variation in these observations can be explained by genetic differences, secular trends in growth and disease status. Regarding the limitations identified, it was observed that most of the studies did not provide data concerning the number of individuals and observations, mean values and respective SDs by sex and age. In addition, most studies did not use LMS methods to evaluate asymmetry, the median and data variability. In conclusion, the results of this review demonstrated that in order to avoid false diagnoses in children and adolescents with DS new growth curves must be developed.

Posterior fusion of the occipital axis in children with upper cervical disorder using both C2 pedicle and laminar screws (C2 hybrid screws)

“…Occipital and cervical surgeries for children are challenging for surgeons because of immature bone quality and small osseous structures [9][10][11][12][13][14][15] . When C1 shows hypoplasty, it should be skipped, and the lower instrumented vertebra should be considered as C2.…”

Nutrition assessment and indicators of visceral fat and subcutaneous fat in children with Down syndrome

“…3 Children with DS are shorter than children without DS. 4,5 Some studies propose that children with DS with moderate to severe cardiac abnormalities are shorter than those who present slight abnormalities or absence of them. However, other studies find no association.…”

“…However, other studies find no association. 4 It is postulated that the deficiency in growth would be related to a predisposition to overweight. 6 Growth standards for the general population are not appropriate for individuals with DS, given that their use could diagnose nutritional status (NS) incorrectly.…”

Evaluación nutricional e indicadores de grasa visceral y subcutánea en niños con síndrome de Down

“…Los niños con SD presentan una menor talla comparado con niños sin SD 4,5 . Algunos estudios proponen que los niños con SD con moderadas a graves anormalidades cardiacas presentan menor talla que aquellos que presentan leve o ausencia de estas anormalidades.…”

“…Algunos estudios proponen que los niños con SD con moderadas a graves anormalidades cardiacas presentan menor talla que aquellos que presentan leve o ausencia de estas anormalidades. Sin embargo, otros estudios no encontraron asociación 4 . Se postula que la deficiencia en el crecimiento estaría relacionada con la predisposición al sobrepeso 6 .…”