title: Increased perinatal intracranial pressure and brainstem dysfunction predict early puberty in boys with myelomeningocele.
abstract: BACKGROUND
  Children with myelomeningocele (MMC) run an increased risk of developing early or precocious puberty (E/PP).
  
  
  OBJECTIVE
  To identify risk factors for E/PP in boys with MMC.
  
  
  METHODS
  Boys born between 1970 and 1992, treated for MMC at the University Children's Hospital, Uppsala, were identified. Thirty-eight boys were eligible to be included. Medical records were examined retrospectively. Early puberty was defined as pubertal signs before the age of 10 years and 2 months. Precocious puberty was defined as the appearance of these signs before 9 years of age. Increased intracranial pressure perinatally was defined as wide sutures, bulging fontanelles and increased/increasing head circumference at birth and/or during the first week after birth. Early brainstem dysfunction was defined as severe and persistent feeding and respiratory problems before the age of 3 months despite proper control of the hydrocephalus.
  
  
  RESULTS
  Of the 38 boys, 8 (21%) had E/PP, which was strongly associated with increased intracranial pressure perinatally and also with early brainstem dysfunction. Multivariate regression analysis showed early brainstem dysfunction to have the highest explanatory value regarding the occurrence of early puberty.
  
  
  CONCLUSIONS
  Increased intracranial pressure perinatally and brainstem dysfunction early in life are strong predictors of E/PP in boys with MMC.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Lemm.Proos@kbh.uu.se
authors.forename: Lemm A
authors.initials: LA
authors.lastname: Proos
authors.forename: Torsten
authors.initials: T
authors.lastname: Tuvemo
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ahlsten
authors.forename: Jan
authors.initials: J
authors.lastname: Gustafsson
authors.forename: Margareta
authors.initials: M
authors.lastname: Dahl
mesh_terms: D001933:Brain Stem / Q000503:physiopathology*; D002648:Child; D019959:Feeding and Eating Disorders of Childhood / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D015994:Incidence; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000150:complications*; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000503:physiopathology*; D015999:Multivariate Analysis; D011627:Puberty; D011629:Puberty, Precocious / Q000453:epidemiology / Q000209:etiology*; D012044:Regression Analysis; D012120:Respiration Disorders / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors