LITORALNOGENITALATIO - PDF document

LITORALNOGENITALATIO 9.Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded toinclude extremely premature infants. J Pediatr.10.Donovan EF, Tyson JE, Ehrenkranz RA, Verter J, WrightLL, Korones SB, Human Development Neonatal Research Network. J11.Witchel SF, Lee PA. Ambiguous genitalia. 12.Kutlu HA, Akbiyik F. Clitoral length in female newborns:13.Callegari C, Everett S, Ross M, Brasel JA. Anogenital14.Arbuckle TE, Hauser R, Swan SH, Mao CS, Longnecker15.Jarrett OO, Ayoola OO, Ritzen M. Clitoral and penile sizes16.Litwin A, Aitkin I, Merlob P. Clitoris length assessment in Copyright of Indian Pediatrics 2016 For personal use only. Not for bulk copying or unauthorized posting to listserv/websites LITORALNOGENITALATIOTIOet al.[2] reported a mean value of 5.9 mm in babies of Jewishorigin and 6.6 mm in Bedouin babies. Riley andRosenbloom reported a mean clitoral length of 3.27 mm inwhite and 3.66 mm in black neonates [3]. In a study onNigerien babies, the mean value was 7.5 mm [15]. Ourresults more closely resemble the values reported by Rileyand Rosenbloom [3]. However, Callegari, , Callegari, not record any ethnic variability despite havingpopulations from Hispanic, black and white backgrounds.While Litwin, et al. [16] observed a strong negativecorrelation between birth weight and clitoral length, wedid not find any correlation of clitoris length andgestational age. Our results of AGD are in consonance withAGD are in consonance withethnic variability is minimal for this parameter.In most of the published studies [6,7,8,11], verniercalipers were used to measure clitoral length and AGD. Wemeasurements. This demanded careful handling toavoid injury, and considerable practice because ofdifficulty of these procedures and indistinct soft tissuelandmarks. The accuracy and standardization of otherThe accuracy and standardization of other Clitoromegaly may indicate intrauterine exposure totestosterone or other androgens [12]. Moreover, certainapparently small genita

lia [3]. AGD and AGR areVariations in AGD may occur due to prenatal exposure toandrogens and endocrine disrupting chemicals. Asstudies demonstrate the utility of AGD as a marker of uteroantiandrogen effects, its measurement has beenadvocated by the United States Environmental Protectiontates Environmental ProtectionWe have generated normative data for the clitoralIndian newborns. These values can be used as referencestandard in the assessment of clitoromegaly, ambiguousgenitalia, virilizing effects and suspected in uterodesign of work and revising manuscript; AH: analysing of data,drafting; TKS: interpretation of work and revising; BB:drafting. All authors have agreement to be accountable for allCompeting interests1.Oberfield SE, Mondok A, Shahrivar F, Klein JF, Levine2.Phillip M, De Boer C, Pilpel D, Karplus M, Sofer S.3.Riley WJ, Rosenbloom AC. Clitoral size in infancy. J4.McIntyre BS, Barlow NJ, Foster PM. Male rats exposed to5.Mylchreest E, Wallace DG, Cattley RC, Foster PM. Dose-during late gestation. Toxicol Sci. 2000;55:143-51. 6.Thankamony A, Ong KK, Dunger DB, Acerini CL, Hughes7.Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM.8.Salazar-Martinez E, Romano-Riquer P, Yanez-Marquez E,•Limited data on clitoral length is available from some populations.•Normative data for clitoral length and anogenital ratios in Indian newborns with gestational age-wise percentile Copyright of Indian Pediatrics 2016 For personal use only. Not for bulk copying or unauthorized posting to listserv/websites LITORALNOGENITALATIOTABLE II UMMARYENITALTRATIFIEDESTATIONALIRTHNo.Mean (SD)PC5PC10PC25PC50PC75PC90PC95PC99Week 32-33283.7 (1.31)2.02.03.03.04.56.06.07.0Week 34193.8 (1.40)1.02.03.03.05.06.06.06.0Week 35143.3 (2.33)1.01.02.02.54.05.06.07.0Week 36323.0 (1.33)1.02.02.03.03.54.06.07.0Week 37104.8 (3.05)2.02.03.03.08.08.08.08.0Week 38472.9 (1.48)1.01.02.03.03.05.06.08.0Week 39802.8 (1.29)1.52.02.02.03.05.05.57.0Week 401363.1 (1.47)1.02.02.03.03.05.06.09.0Week 41-42123.2 (1.27)1.02.02.53.04.04.06.0

6.0Week 32-33280.8 (0.20)0.60.60.80.80.91.31.31.3Week 34191.0 (0.31)0.80.8 0.81.01.21.5 2.0 2.0Week 35140.8 (0.11)0.60.80.80.91.01.01.01.0Week 36320.9 (0.19)0.70.70.80.91.01.21.21.5Week 37100.9 (0.23)0.70.70.80.91.01.31.51.5Week 38470.9 ( 0.26)0.70.70.81.01.01.51.52.0Week 39801.0 (0.26)0.80.80.81.01.21.51.51.8Week 401361.0 (0.30)0.70.80.81.01.21.51.52.0Week 41-42121.1 (0.36)0.70.80.91.01.31.52.02.0Week 32-33282.7 (0.30)2.02.52.52.82.83.03.13.2Week 34193.0 (0.52)2.52.52.83.03.04.04.54.5Week 35142.8 (0.25)2.52.52.72.82.83.03.53.5Week 36322.7 (0.44)2.32.52.52.73.03.53.54.0Week 37102.7 (0.57)1.51.92.52.82.93.43.83.8Week 38472.9 (0.59)2.52.52.62.83.03.54.54.5Week 39802.9 (0.42)2.52.62.82.83.03.64.04.5Week 401363.1 (0.57)2.52.52.82.93.24.04.54.5Week 41-42123.1 (0.72)2.52.52.72.93.53.75.05.0Week 32-33280.3 (0.06)0.20.30.30.30.30.40.40.5Week 34190.3 (0.06)0.30.30.30.30.40.40.50.5Week 35140.3 (0.04)0.20.30.30.30.30.30.40.4Week 36320.3 (0.09)0.20.20.30.30.40.50.50.7Week 37100.4 (0.11)0.30.30.30.30.40.50.60.6Week 38470.3 (0.08)0.20.20.30.30.40.40.50.7Week 39800.3 (0.06)0.30.30.30.30.40.40.40.5Week 401360.3 (0.06)0.20.30.30.30.40.40.40.5Week 41-42120.3 ( 0.07)0.30.30.30.30.40.40.50.5Abbreviations: SD = standard deviation; PC = percentile. Copyright of Indian Pediatrics 2016 For personal use only. Not for bulk copying or unauthorized posting to listserv/websites LITORALNOGENITALATIOwith the same set of instruments. The weight wasby a non-stretchable tape. The clitoris length and AGDDigimatic Vernier Caliper), with resolution of 0.01 mmassistant (neonatology staff nurse) with both hips flexedand light pressure exerted on the infant’s thighs and therestraining hands resting on the baby’s abdomen. Thehand. AGD was measured from the centre of the anus tothe posterior convergence of the fourchette andanogenital ratio (AGR) was calculated as AGD dividedStatistyical analysis: f for statisticalquantified as Spearman’s rank correlation coefficient rho(r). Statistica version 6 (Tulsa, Oklahoma: StatSo

ft Inc.,2001) and MedCalc version 11.6 (Mariakreke, Belgium:MedCalc Software 2011) softwares were used forOut of the 415 neonates enrolled for the study, 37 wereTableAGD and AGR were 10.2 (2.78) mm and 0.34 (0.07) mm,respectively.length, AGD and AGR are presented in Table. Thedifference in mean clitoris length between term and=0.008), and in AGDand AGR, it was 1.05 mm (respectively.=0.06). Weak correlations were found between the=0.02). The AGD had weakclitoral length, AGD and AGR were 3.1 mm, 10.2 mmand 0.34 mm, respectively. The clitoral length showed noremaining almost constant at 3 mm. Thus normative datagestational age. There was also no correlation betweenlength, head circumference and birth weight. Although acriteria for clitoromegaly [11,12]; we suggest a clitorallength cut-off of 6 mm.The study had a few limitations. This was a singleinstitution-based study, and even all institutionallyTABLE I UMMARYOPULATIONMeasurement95% CI5th10th25thMedian75th90th95th99thof meanpercentilepercentilepercentilepercentilepercentilepercentilepercentilepercentile2.61(0.61)2.55-2.671.251.752.302.703.003.253.504.0032.8(2.03)32.6-33.029.030.031.533.034.035.035.536.045.9(3.25)45.5-46.339.540.045.047.048.049.049.051.03.1(1.54)3.0-3.31.02.02.03.04.05.06.09.01.02(0.28)0.99-1.040.70.80.81.01.11.51.52.02.96(0.52)2.91-3.022.52.52.72.83.03.754.04.50.336-0.3490.250.290.290.330.390.430.460.60 Copyright of Indian Pediatrics 2016 For personal use only. Not for bulk copying or unauthorized posting to listserv/websites Clitoral Length and Anogenital Ratio in Indian Newborn GirlsHATTERJEEOUMITAAMANTAAPASASANTAOYCHOWDHURYUPAISWASFrom the Departments of Pediatric Medicine and Neonatology, Medical College, Kolkata; Department ofPharmacology, Institute ofResearch (IPGME&R); Department ofKolkata, West Bengal, India.Correspondence to: Dr Rakesh Mondal, Professor, Pediatrics and Pediatric Rheumatologist, Department of Pediatrics, MedicalCollege, Kolkata; 88 college street, Kolkata 700 073, West Bengal, India. ivanrakesh2001@gmail

.comReceived: May 26, 2015; Initial review: August 07, 2015; Accepted: February 02, 2016.: To generate normative data on clitoris length,anogenital distance and anogenital ratio in Indian newborns.Cross-sectional study.Neonatal unit of a tertiary care teaching hospital inKolkata.Participants:stable without critical illness or chromosomal anomaly, andwithout any vulval hematoma or genital abnormalities.Measurements were recorded using a digitalan assistant, while the investigator measured clitoral length bygently retracting the labia majora. Anogenital distance (centre ofanogenital ratio (anogenital distance divided by the distance fromGestational age- and birthweight-wise in utero [1-3]. Theanti-androgen effects [4,5]. Data of the normal AGD inassess endocrine effect on newborn genitalia. Althoughstudies on neonatal clitoral length and AGD [6-8] arefor clitoral length and AGD in newborn Indian girls in aon two days of the week (Tuesday and Thursday), in theobtaining written informed consent. The study receivednormative values of clitoral length, anogenital distance andanogenital ratios.Resultscohort while anogenital distance and anogenital ratio were 10.2(2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance andanogenital ratio have been generated. There was no correlationbetween clitoral length and gestational age, body length, headanogenital distance.: The normative values generated can serve asreference standard in the assessment of clitoromegaly,ambiguous genitalia, virilizing effects and suspected differentiation, Dysmorphology, Neonate RRRREEEESSSSEEEEAAAARRRRCCCCH PH PH PH PAAAAPPPPEEEERRRRmedication affecting development of fetal genitalia, andmodified Fenton’s chart were excluded. Gestational ages chart were excluded. Gestational ageborn by breech delivery, those with vulval hematoma or Copyright of Indian Pediatrics 2016 For personal use only. Not for bulk copying or unauthorized posting to listserv/websi