Specialists affiliated with the Center for Bone Health provide consultative services to support the management of hospitalized infants and children who have disorders of bone and mineral metabolism. Our experts are available to evaluate children throughout the Hospital and develop personalized management plans, in collaboration with various other specialties, to care for patients at risk for fragile bones and metabolic bone disease.
Babette S. Zemel, PhD The study team, which included experts in genetics as well as bone biology, compiled data from approximately 11,000 bone density measurements that were conducted as part of the Bone Mineral Density in Childhood Study (BMDCS), a project headed by Babette S. Zemel, PhD, Associate Program Director of the Clinical and Translational Research Center, Director of the Bionutrition Core Laboratory at CHOP and first author of the study. Once the genetic markers were identified, the researchers used a variant-to-gene mapping method to look for both underlying causal variants as well as corresponding effector genes. They further investigated specific genetic markers, or loci, to characterize their impact on osteoblast function.
Lifestyle choices influence 20-40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al.  published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation . [Table: see text] Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years-a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one's genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.
This year in sub-Saharan Africa, roughly 1.2 million babies will be born to mothers infected with human immunodeficiency (HIV) virus. Over a million of these exposed infants will not acquire HIV but still have a mortality rate that is twice that of unexposed children whose mothers do not have HIV. Most will die from common infections, including pneumonia, before they reach 2 years old. To address these tragic statistics, researchers at CHOP conducted a study to determine what factors, such as low birthweight, non-breastfeeding, malnutrition, exposure to combination antiretroviral therapy in utero, or pneumonia severity, acted as mediators for the poor pneumonia outcomes of HIV exposed but uninfected children.
The research team conducted a cohort study of 352 HIV-uninfected children, 1 to 23 months old and with clinically defined pneumonia, who were recruited at a hospital in Gaborone, Botswana. Two hundred forty-five of the children were unexposed, while 107 were exposed but uninfected. With the primary outcome defined as treatment failure at 48 hours, the researchers found that children exposed but uninfected by HIV had worse pneumonia outcomes than those who were not exposed at all. However, non-breastfeeding mediated nearly half of the effect of HIV exposure on pneumonia mortality, contributing evidence to the benefits of breastfeeding for HIV-exposed but uninfected children.
BMDCS was a multicenter, longitudinal study of bone accrual in healthy children and adolescents performed at five U.S. clinical centers (CCs). Detailed information about the study participants, inclusion/exclusion criteria, and study procedures have been published. The study provided longitudinal measurement of bone mass, linear growth, sexual and skeletal maturation, dietary intake, physical activity, and health history. This study, supported through NICHD's Pediatric Growth and Nutrition Branch, offered an unprecedented opportunity to identify predictors of peak bone mass, a major determinant of osteoporosis in later adulthood.
The careful implementation of the longitudinal protocol, with relatively few dropouts in a large diverse cohort of healthy children, enabled BMDCS investigators to collect valuable data on linear growth, the timing of puberty, bone age, nutrition, and exercise over a 6-year period. In 2010, a genome-wide association study was initiated to further study the BMDCS cohort and identify the underlying genetic determinants of peak bone mass and bone mineral accrual in childhood.
"We don't know whether the effects we found have long-term consequences for health and development, but the question merits further study," said Stallings. In addition to replication studies by other researchers, she added that ideally the children in this cohort should be followed later into childhood and adolescence.
The best of these children's hospitals demonstrate a strong desire not only to apply current medical knowledge to today's illnesses, but to advance the field of pediatrics by extending their knowledge and expertise to the next generation of pediatric specialists. In evaluating the most amazing children's hospitals in the world, our editors looked for facilities that provided comprehensive care while still dedicating extra time and effort to the key specialties and programs that make them the best at what they do. As such, these facilities act as referral centers for the sickest children who require the most informed and aggressive care available.
After evaluating these and dozens of other candidates, it is the opinion of our editors that these are in fact the most amazing children's hospitals on the planet. We list them here by number of points awarded in accordance with our rating and ranking system. In cases where two or more facilities received the same amount of points, we listed them alphabetically by hospital name.
With a 395-bed capacity, Boston Children's hospital is one of the largest pediatric healthcare institutions in the United States. Although most of the hospital's 25,000 admissions and 557,000 visits per year are from children birth through 21 years old, the hospital also treats unborn children beginning at 15 weeks gestation. As a comprehensive care facility, the hospital treats patients suffering from a variety of illnesses and conditions including heart conditions, cancer, diabetes, and more. In addition to being recognized by many organizations for its exemplary care, Boston Children's Hospital also hosts one of the largest pediatric research enterprises in the world, the John F. Enders Pediatric Research Laboratories. Of the 1,100 scientists that make up its research community, nine are members of the National Academy of Sciences and eleven are members of the Institute of Medicine.
At over 2 million square feet, Children's of Alabama is the third largest pediatric hospital in the United States. In 2014, doctors at the hospital cared for children from 41 different states and four foreign countries. The hospital also serves as the primary teaching hospital for the University of Alabama at Birmingham, offering aspiring physicians residency programs in medicine, surgery, and research. Its strong community partnerships enable the hospital to provide unique enrichment activities year round for their young patients including trips to the local botanical gardens, zoo, and public library, for instance. It is Children's of Alabama's mission to not only care for kids, but to advocate for them as well and to educate the public about issues that affect the health and well-being of children.
The Mayo Eugenio Litta Children's Hospital is a 85-bed state-of-the-art pediatric medical facility that is a part of the internationally recognized Mayo Clinic. It is a comprehensive children's care center that includes a 28-bed neonatal intensive care unit and a 14-bed pediatric intensive care unit as well as an emergency room, heliport, surgery suites, and specialized diagnostic and treatment facilities. The hospital employs over 150 board certified physicians who perform complex and life-saving procedures every day including organ transplants, bone marrow transplants, and heart surgery. Child life professionals are also on staff to teach children coping skills helpful in dealing with pain as well as the stress of illness and treatment. Family services include spiritual care, education, and a family support space within each pediatric care unit. 2b1af7f3a8