Prevalence of small for gestational age (SGA) and short stature in children born SGA who qualify for growth hormone treatment at 3 years of age: Population-based study.

BACKGROUND: To treat children born small for gestational age (SGA) with severe short stature, treatment with growth hormone (GH) has been approved in the USA, Europe, and Japan, but no population-based studies have reported their prevalence. The aims of this study were to investigate the prevalence of SGA and short stature in children born SGA who qualify for GH treatment at 3 years of age in a Japanese population. METHODS: A population-based study was conducted in Kobe, Japan with 27 228 infants who were born between 2006 and 2008 and followed until 3 years of age. Prevalence of birthweight (BW) or birth length (BL) ≤ -2.0 standard deviation scores (SDS) for gestational age (GA; definition of SGA) was calculated. Short children born SGA who qualify for GH treatment at 3 years of age were estimated using the following criteria: BW and BL below the 10th percentile for GA, BW or BL ≤ -2.0 SDS for GA, and 2.5 SDS below the mean height for age. RESULTS: The prevalence of SGA was 3.5%. The estimated prevalence of short stature in children born SGA who met the criteria for GH treatment was 0.06%. The prevalence in infants born <34 weeks (0.39%) was significantly higher than that in infants born 34-41 weeks GA (0.05%, P = 0.02). CONCLUSIONS: The prevalence of SGA and short stature in children born SGA who qualify for GH treatment is approximately 1 of 30 infants and 1 of 1800 children, respectively. The risk is increased when children are born <34 weeks GA.

Incidence of short stature at 3†years of age in late preterm infants: a population-based study.

OBJECTIVES: This study aimed to investigate the incidence of short stature at 3 years of age in a Japanese cohort of late preterm infants who were born at 34-36 weeks' gestational age (GA). We compared these late preterm infants with term infants (37-41 weeks' GA), and evaluated the effect of birth weight on the incidence of short stature. METHODS: A longitudinal population-based study of 26 970 neonates who were born between 34 weeks' and 41 weeks' GA in 2006-2008 was conducted in Kobe, Japan. Of these neonates, 1414 were late preterm and 25 556 were term infants. The late preterm infants were then divided into three subgroups based on birth weight as determined by Japanese neonatal anthropometric charts for GA at birth: large-for-GA (n=140), appropriate-for-GA (AGA, n=1083), and small-for-GA (SGA, n=191). The incidence of short stature at 3 years of age was calculated in the late preterm group and compared with that in the term group, and between the AGA and SGA groups with late preterm birth. RESULTS: The incidence of short stature in the late preterm group was 2.9%, which was significantly higher than that in the term group (1.4%). Late preterm SGA infants developed short stature with a significantly higher (9.4%) incidence than that of late preterm AGA infants (2.1%). CONCLUSIONS: The incidence of short stature in 3-year-old children who were late preterm infants has a 2-fold higher risk than that in term infants. The risk of developing short stature is increased 4.5-fold if they are SGA.

[Evaluation of the flu call center and medical system data on pandemic (H1N1) 2009 influenza. Comparison of cases in Kobe city and Ibaraki prefecture].

OBJECTIVES: To make recommendations on the revision of the Pandemic Influenza National Action Plan and Guidelines, we reviewed the data from the flu call center and medical institutions in Kobe city and compared them with data from Ibaraki prefecture. METHODS: The overall duration of study from May 2009 to December 2009 was divided into 4 periods; we analyzed details of the calls received by the call center and examined the correlation between them and cases who were seen at medical institutions in Kobe. We used a mathematical model to approximate the cumulative growth curve of the number of calls received by the call center and the number of cases attending fever clinics in Kobe. We compared the above data with data from Ibaraki because the total number of confirmed cases of pandemic (H1N1) 2009 influenza was similar: Kobe identified the first confirmed case of the influenza in Japan, while Ibaraki reported their first case 1 month later. RESULTS: Following the report of the initial domestic case, the Kobe call center received 30,067 calls in a month. A "delayed sigmoid curve" fitted well for both the rise in the number of calls at the call center and of cases attending the fever clinics. "Feeling sick despite no overseas travel history" was the most common reason for call. More than 2,000 calls/day were received, and the responses to such calls were instructions to consult a general medical institution (40%), instructions to refer to a fever clinic (8%), guidance on home care or how to manage underlying disorders, and listening to callers' anxieties and complaints. The numbers of calls decreased towards the end ofJuly; the number of calls increased again when outbreaks were reported in schools and a death due to influenza was confirmed. After November, on an average, 500 calls/day were received; most were complaints regarding vaccination. Unlike Kobe, Ibaraki did not experience a surge in the number of calls to the call center or consultations to fever clinics within a short period of time. CONCLUSION: The outbreak of pandemic (H1N1) 2009 influenza showed different call patterns and medical consultations in different regions. The time of disease outbreak and the availability of medical resources differ among regions; hence, each municipality should act practically and flexibly according to the situation in their locality.

[Polio virus detection in stool by the pathogen surveillance system of Japan. An observational study].

OBJECTIVES: To examine the applicability of data on polio virus detection in stool by the Pathogen Surveillance System of Japan (PSSJ) for the evaluation of polio virus retention status in a regional community after oral polio vaccination (OPV). METHODS: (1) Data for the city of Kobe (part of the PSSJ data): Cases of polio virus detection in stool reported to Kobe City Public Health Center from January 1, 2000 to June 30, 2010 were examined regarding time duration from vaccination to detection as well as age and gender. (2) PSSJ data: Cases of polio virus detection in stool reported to PSSJ from January 1, 2000 to December 31, 2010 were examined regarding the serological types of the virus as well as age and gender. A logistic regression analysis was used to derive odds ratios for the relationship between age and serological type of polio virus in stool. RESULTS: Thirty-one cases (33 stool samples) were identified in the Kobe city data. Of these, 96.8% were in children two years old or younger and 54.8% were girls. The time duration between vaccination and detection of all the cases was within two months from vaccination. From the PSSJ data, 852 cases were identified. Of these, 97.3% were two years old or younger and 54.6% were girls. The proportion of serological types was different by age group: for those under one year old, the type 1 virus accounted for 33.2%; type 2, 44.8%; and type 3, 22.0%. In the one year old or older age group, these types accounted for 22.8%, 27.6% and 49.6%, respectively. Notably, the type 3 virus was detected more for the older age group. (odds ratio 3.4, 95% confidence interval 2.5-4.6). CONCLUSION: The duration before detection and the serological types of polio virus in stool from the PSSJ and Kobe City data are consistent with the results of the prior studies that have evaluated the shedding of polio virus in stool after the administration of OPV. Since the PSSJ data are collected from a relatively wide range of samples, we conclude that the PSSJ data accurately represent polio virus retention status in a regional community after OPV. The current situation of polio virus shedding in stool cannot be ignored, and further consideration needs to be given to improving the accuracy of the PSSJ data, because Japan is to switch over to inactive polio vaccines in the near future.