الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Linear growth is one of the most sensitive indicators of health assessment during childhood, and is affected by several pediatric diseases. The height of child results from the initial length at birth and the rate of growth over time. Assessment of growth therefore is an essential and large component of pediatric medicine. Accurate measurements of growth and the analysis of growth parameters are crucial for prompt recognition of growth abnormalities. Short stature is one of the most common causes of referral to pediatric endocrinology clinics. Altered growth potential may result from several causes such as; disturbances of the endocrine system, altered nutrition or chronic diseases. Adult height is largely genetically predetermined, and height variations can be explained by genetic factors, together with environmental factors which play a pivotal role. Short stature, is not a disease per se, but is a manifestation of several diseases. In the present study, the prevalence of short stature was found to be 4.2% among the studied children attended Eshataby University Hospital’s clinics. This prevalence does not reflect the actual prevalence of short stature in Alexandria since the actual prevalence is much higher, but it reflects the hospital prevalence among the attended children during the specific time for the selected group. The known recorded figure of short stature in Egypt ranged from 21.3% - 28.9%.
Most of the studied sample were referred from endocrinology clinic (more than half of the recorded prevalence (2.61%), representing 13% of the endocrinology clinic patients). This in agree with other studies where they recorded the same finding. Male sex was slightly predominant than female sex where male sex constituted 53.9% while female sex constituted 46.1%. More than two thirds, (70.6%) of the studied sample aged 4years and above. This finding could be mostly either a coincidental finding due to the selected age group of the present study or may be due to the request of spending couple of years to make short stature evident and needs seeking of pediatric advice.
In addition, most of the maternal age of the selected sample were young (96.7%). On the other hand, the prevalence of consanguineous marriages was recorded similarly as that of the general populations where 32.8% were resulted from consanguineous parents most of them (30.6%) were first cousins. Consanguinity has been a long-standing social habit among Egyptians. Estimates of consanguinity ratios in different parts of Egypt ranged from 29 up to 50%. Parental education was higher among the fathers (60.5% secondary and post graduate) compared to the maternal one (44.4%) The EDHS 2014 revealed a modest difference in prevalence of stunting among children of mothers who had completed secondary education or higher, namely 24.5%, compared to 19.4% among children of mothers with no education. Referring to mid parental height36.7% was found short compared to 63.3% had average mid parental height. It was found that, 90% of the children’s heights would fall within 1.5 SDS (approximately two centile spaces) of their mid-parental heights. In the mean time, most of the selected sample (86.7%), resulted from para 1-3 with mean ±SD 2.48±1.05. This finding might be due to young maternal age of the selected sample and hence it neutralize the effect of parity in the present study since most of them resulted from young maternal age (96.7%). Prematurity was recorded in only 17.8% which is one and half folds more than prematurity in general population (10%). However, rates vary considerably, from approximately 6% in Sweden to 18% in Malawi Low amniotic fluid or oligohydramnios, was recorded in 11.1% and usually it is associated with diminished fetal movement, pulmonary hypoplasia growth retardations and other complications. Oligohydramnios usually results from renal problems and in turn associated with decreased linear growth. Low birth weight was recorded in 13.3% which might reflect the percentage of prematurity in this study none of the included cases had microcephaly.
Underweight was recorded in two fifth (40.6%) of the cases which may be secondary to malnutrition reported in 28.3% of the selected cases, in addition to the other cases who had other medical problems (32.2%). Both conditions are usually associated with decrease in the linear growth especially weight and height. Delayed bone age was recorded in three quarter of the cases (75%) which slightly higher than the subtypes of short stature (70.6%) which are usually associated with delayed bone age Such as Constitutional SS, Idiopathic SS and short stature associated with other problems. Idiopathic short stature constituted two thirds of the selected sample (67.8%) with slightly lower percentage of familial short stature (29.4%) than constitutional short stature (31.2%), and still lower than those associated with other health problems (non isolated short stature (32.2%). The least percentage was of idiopathic short stature (7.2%) which we failed to categorized them under delineated subgroup of short stature. Possible genetic causes and unidentified genetic causes were recorded in 33.9%, while non genetic causes or unknown cause constituted (66.1%) (42.2% and 23.9% respectively).This reflect the important role of genetic as an etiological factor. The significance of positive family history was denied if we related it to bone age (p=0.573), short stature subtypes (p=0.671), short stature classification (p=0.595) and mode of inheritance (p=0.298). Studying the different risk factors and its association with the mode of inheritance revealed negative association with all risk factors except with gestational age (p=0.029) and mode of delivery (p=0.001). This positive association was expected since both of them do not reflect a direct relationship but it reflects the presence of health problems which might affect the height as shown previously. On the other hand studying the association of short stature subtypes and risk factors revealed a significance association between mid parental height (p=<0.001), weight at birth, (p=0.002), prenatal complications (p=0.029), positive dietary history (p=048), positive medication history (p=<0.001), mode of inheritance (p=0.001) and bone age assessment (p=<0.001). These risk factors are usually associated with medical problems which might affect the resulted linear growth and that is why we have to investigate these risk factors among short stature patients. On the other hand studying the association of isolated and pathological short stature and possible risk factors revealed no significant association between all studied risk factors and either isolated or pathological short stature except bone age assessment (p=0.001) and mode of inheritance (p=<0.001). These findings reflect the importance of these risk factors on studying and evaluation of short stature. On the other hand, significant relationship was found between mid parental height and both bone age assessment (p=<0.001) and short stature subtypes (p=<0.001). Neither mode of inheritance, birth weight nor birth height were significantly associated with mid parental height. The positive finding between endocrine diseases and other risk factors was found for the mode of inheritance (p=<0.001). Referring to significance of bone age assessment and its relation to studied risk factors, positive association was found for parental consanguinity (p=0.022) and short stature subtypes (p=<0.001). Follow up study for the following 6 months after the first visit and after relevant intervention revealed a statistical significant difference in mean of length throughout the study period, being significantly increased after 3 and 6 months compared to baseline. The increase was more significant after 6 months compared to 3 months. Similar findings were found regarding the weight, where significant difference of weight was found throughout the study period being significantly increased after 3 months and after 6 months. On the other hand we noticed, statistical significant difference between children achieved different height velocities and birth weight. No statistical significance difference was recorded between the achieved height velocities and parental consanguinity (p=0.179) or gestational age. Studying the other risk factors revealed a significant association with weight (p=0.01) and dietary history (p= 0.07) regarding the height velocity 44.4% of the children had height velocity less than (-2 SD), 10.6% of them had height velocity between (-2 SD and less than (-1 SD) and 45% had height velocity (≥-1 SD). Univariant analysis to test the different variables affecting the height revealed that none of these factors are significantly associated with height velocity improvement (p≤0.05). Both univariate and multivariate analysis for the parameters affecting short stature classification; bone age assessment, mid parental height, and mode of inheritance revealed significant difference in univariate analysis in all variables were recorded , while in multivariate analysis, revealed statistical significance difference only in bone age assessments and mode of inheritance the constant finding in all analysis.