Growth of Trunk and Legs of Children With Myelomeningocele

Abstract

SUMMARY Total body length and body segments (crown‐rump length, sub‐ischeal length) of 78 children with myelomeningocele were measured at regular intervals during growth for a mean duration of 4‐4 years. These children were shown to have defective growth, with an increased upper segment/lower segment ratio. It was found that the higher the level of the meningocele the greater the growth defects. However, the relationship was statistically significant only for the first seven years of life. It is concluded that neurological damage was mainly responsible for defective growth during the first years of life, but that other factors independent of the level of the meningocele also come into play in later years. RÉSUMÉ L'étude conceme les valeurs anthropométriques de longueur couche et de segments de 78 sujets atteints de myelomingocele mesurés régulièrement au cours de la croissance pendant une durée moyenne de 4 ans et demi. II est mis en evidence un defaut de croissance avec augmentation du rapport segment supérieur, segment inférieur. Plus le niveau myèlomérique des paralysies est haut, plus de défaut de croissance est important: mais cette corrélation n'est statistiquement significative que jusqu'a l'âge de 7 ans. Des tables de prédictions sont proposées pour ces classes d'âge. Les auteurs concluent que si l'atteinte neurologique est le principal responsable des défauts de croissance dans les 7 premières années de la vie, d'autres facteurs indépendants du niveau lésionnel interviennent ensuite en plus ou en moins et masquent alors le rôle persistant de l'extension paralytique. ZUSAMMENFASSUNG Wachstum von Rumpf und Beinen bei Kindern mil Myelomeningocele Bei 78 Kindern mit Myelomeningocele wurden während der Wachstumsphase in regelmäßigen Abständen, im Mittel über 4‐4 Jahre, die Gesamtkörperlange und Körpersegmente (Scheitel‐Steiß‐Länge, sub‐ischeale Länge) gemessen. Je höher die Meningocele lokalisiert war, desto größer war die Wachstumsverminderung. Diese Relation war jedoch nur in den ersten sieben Lebensjahren signifikant. Die Autoren vertreten die Meinung, daß in den ersten sieben Jahren hauptsächlich die neurologische Schädigung für die Wachstumsverminderung verantwortlich ist, daß aber in den späteren Jahren andere Faktoren ins Spiel kommen, die von der Lokalisation der Meningocele unabhängig sind. RESUMEN Crecimiento de tronco y piernas en niños con mielomeningocele La longitud total del cuerpo y de segmentos del cuerpo (coronilla‐rabadilla y subisquial) de 78 niflos con mielomeningocele, fueron medidas a intervalos regulares durante el crecimiento por un promedio de 4‐4 años. Se halló que cuanto más alto era el meningocele, tanto mayores eran los defectos de crecimiento. Sin embargo, la relatión era estadísticamente significativa sólo durante los primeros siete años de edad. Se concluye que la lesión neurológica era el mayor responsable del defecto de desarrollo durante el primer año de vida, pero que otros factores independientes del nivel del meningocele juegan también un papel en los años posteriores.

Obesity and Myelomeningocele: Anthropometric Measures

“…As demonstrated in Tables 3 through 5 and Figures 1 and 2, we would agree with the observation that arm span is not equivalent to height for all patients with meningomyelocele (20,21) because of deformities of the spine and lower extremities in many of these children (1)(2)(3)(10)(11)(12). That arm span is not equivalent to height is, we believe, irrelevant to the stated objective of this paper.…”

“…The increasing divergence after age 8 years is due to the added effect of scoliosis (10,12) during this time of rapid growth (15) associated with the beginning of puberty (32). The difference in the widening of the discrepancy between height and arm span is less evident in the intermediate paralyzed group (LL2) (Tables 3-5, Figure 2) and less so in the least paralyzed (LL3) (Tables 3-5, Figure 3) because of less severe paralysis (1) and a lower frequency of scoliosis (12).…”

“…These children have a high incidence of decreased height or linear length secondary to kyphosis, scoliosis, abnormal vertebrae, and lower extremity hypoplasia associated with their myelomeningocele (3,4,6,(10)(11)(12). A number of studies have reported the value of using arm span as a substitute for estimating body functions (eg, pulmonary function, growth) and for calculating medication dosages for people with scoliosis or when height or length are difficult to obtain (13)(14)(15)(16)(17)(18)(19).…”

Growth in pre-pubertal children with myelomeningocele (MMC) on growth hormone (GH): The KIGS experience

“…Patients with this complex disorder often show disturbed growth of the lower limbs and the spine resulting in short stature [1][2][3][4][5][6]. As known from studies on adults with MMC [1,6,7], short stature is most present in patients with higher motor level of lesion (thoracic and upper lumbar levels), thus senso-motor and trophic neurological deficits and orthopaedic anomalies were assessed as the growth limiting factors.…”

Best Practices in Nutrition for Children With Myelomeningocele

“…17 Arm span measurements are not typically used in children with MMC secondary to growth issues seen in older children with a higher level lesion, with the differences most notable in the lower extremities. 18 However, some studies have shown that the use of arm span measurements is accurate during growth hormone treatment. 19,20 Children with MMC have higher rates of precocious puberty and an earlier growth spurt 21 ; however, their final adult height is shorter in relation to their peers, 10,21-24 even after Table 1.…”