The Nomogram of Clitoral Length and Width in Iranian Term and Preterm Neonates.

Background and Objectives: Clitoromegaly is an important parameter in the evaluation of ambiguous genitalia in neonates, but the normative data for clitoral size in newborns have racial/ethnic differences. The present study aimed to determine clitoral length (CL) and clitoral width (CW) values and establish cutoff measurement to define clitoromegaly in both term and preterm Iranian neonates for the first time. Methods: A total number of 580 female newborn infants delivered at 28-42 weeks of gestation were enrolled in the study, and their CL and CW were measured on the first 72 h of birth. Data about birth weight (BW), body length (BL), and head circumference (HC) of newborns; mothers' age; and gestational age (GA) were recorded, too. Results were presented as mean ± standard deviation (SD) for quantitative variables and were summarized by frequency (percentage) for categorical variables. Backward stepwise regression analysis was used for prediction of CL and CW. Results: Among 580 Iranian female newborns studied, 187 were term neonates and the other 393 newborns were preterm. Mean ± SD values of CL were 6.11 ± 0.39 mm in term infants and 5.45 ± 0.64 mm in preterm infants (P < 0.001). Mean ± SD values of CW were 4.22 ± 0.43 in term infants and 3.68 ± 0.53 in preterm infants (P < 0.001). Regression analysis showed that CL was correlated with GA considered by last menstrual period, BL, BW, and HC; and CW was associated with GA, BL, and BW. Conclusion: This study suggests normative values (mean + 1, 2, and 3 SD) of CL and CW according to GA, which can be used as a reference for Middle East's newborns, especially Iranian newborn babies.

Evaluation of combined left ventricular function using the myocardial performance index in children with chronic kidney disease.

BACKGROUND: Myocardial dysfunction that complicates the initial stages of chronic kidney disease (CKD) has not been yet fully characterized in young patients. We aimed to assess the clinical usefulness of myocardial performance index obtained by pulsed-wave Doppler method (PWD-MPI) in predicting early disturbances of global left ventricular (LV) function in children with CKD stages 2-4. In addition, we evaluated the clinical utility of tissue Doppler imaging (TDI) as a tool for calculating MPI in comparison with the conventional method. METHODS: Standard echocardiography was performed in 34 patients aged 3-18 years and for 35 age-matched healthy control subjects. PWD-MPI was calculated from Doppler spectra of mitral inflow and LV outflow. To obtain TDI-MPI, time intervals were measured from mitral annulus. RESULTS: The mean values of both PWD-MPI and TDI-MPI of the patients were significantly different from those of the control subjects. Using receiver operating characteristics curve analysis, TDI-MPI yielded a better predictive discrimination for separating patients with versus those without myocardial dysfunction than PWD-MPI. Using a PWD-MPI >0.36 as the cutoff value, myocardial dysfunction was found with a sensitivity of 64.7% and specificity of 97%. The sensitivity and specificity of TDI-MPI >0.34 in identification of LV dysfunction were 91% and 82%, respectively. TDI-MPI was correlated with that measured by PWD (P < 0.004, r = 0.57). CONCLUSIONS: Subtle abnormalities of LV function develop early when renal insufficiency is mild to moderate. MPI, measuring by PWD and TDI, are appropriate indicators of overall LV function in young patients with CKD.