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Humeral head ossification center in congenital heart disease
S Lohitkul1, S Jaovisidha, K Thongchaiprasit
1Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Proximal humeral ossification center (PHOC) visualization is delayed in preterm infants with congenital heart disease (HD). Full-term infants with HD show no significant delay in PHOC ossification compared to normal infants.
Area of Science:
- Pediatric cardiology
- Neonatal radiology
- Skeletal development
Background:
- Congenital heart disease (HD) is a significant concern in neonates.
- Assessing bone growth in infants with HD is crucial for understanding developmental impacts.
- The proximal humeral ossification center (PHOC) is a potential indicator of skeletal maturation.
Purpose of the Study:
- To evaluate the ossification timing of the proximal humeral ossification center (PHOC) in infants with acyanotic and cyanotic congenital heart disease (HD).
- To compare PHOC ossification in infants with HD against a control group of normal infants.
- To determine if gestational age (term vs. preterm) influences PHOC ossification delays in infants with HD.
Main Methods:
- Retrospective review of medical records and chest radiographs of infants diagnosed with congenital HD.
- PHOC presence or absence was recorded monthly from birth up to 3 months corrected age.
- Comparison of ossification data against a control group of 260 normal Korean infants.
Main Results:
- Preterm infants with acyanotic HD showed significantly delayed PHOC appearance at 1, 2, and 3 months corrected age compared to normal infants.
- Full-term infants with either acyanotic or cyanotic HD exhibited a significant delay in PHOC appearance only at 1 month corrected age.
- Two cyanotic preterm infants did not show PHOC ossification by 3 months corrected age.
Conclusions:
- Delayed PHOC ossification is a significant finding in preterm infants with congenital HD.
- Full-term infants with congenital HD do not demonstrate a significant delay in PHOC ossification beyond 1 month corrected age.
- PHOC ossification timing may serve as a biomarker for skeletal development in high-risk infant populations.
Abstract:
The objective of this study was to evaluate the ossification (visualization) of proximal humeral ossification center (PHOC) which may indicate bone growth in infants with acyanotic and cyanotic congenital heart disease (HD) compared to normal infants. The medical records and chest radiographs within 3 months after birth of infants who were diagnosed as congenital HD by echocardiography or cardiac catheterization from 1989 to 1999 were reviewed. The PHOC was recorded from chest radiograph as presence or absence in every one-month interval since birth. In all cases, the corrected age of 0 month was defined as 40 weeks post conception. We used a study of 260 normal Korean infants as the normal population in this study. We found that from 67 cases enrolled in this study; 10 cases were excluded because of lack of complete medical records and sequential chest radiographs. In the remaining 57 cases, the average gestational age of the infants was 38.1 +/- 2.7 weeks and the average birth weight was 2860.5 +/- 597.7 grams. Female to male ratio was 1.28:1. The infants were classified by gestational age as term (75.4%) and pre-term (24.6%). Types of congenital HD were diagnosed from echocardiogram (96.5%) and cardiac catheterization (3.5%) of cases; and were divided as acyanotic HD (64.9%) and cyanotic HD (35.1%). The ossification of PHOC in acyanotic full-term infants at 0, 1, 2, and 3 months was 24.0 per cent, 32.0 per cent, 72.0 per cent and 88.0 per cent; in cyanotic full-term infants it was 27.8 per cent, 33.3 per cent, 77.8 per cent, and 94.4 per cent; and in acyanotic pre-term infants was 8.3 per cent, 8.3 per cent, 25.0 per cent, and 41.7 per cent, respectively. There were 2 cyanotic pre-term infants who did not show ossification of PHOC until 3 months. In full-term infants with both types of HD; the appearance of PHOC was significantly later than normal at 1 month corrected age (p = 0.000002) but not significant at 0, 2, and 3 months (p > 0.05); whereas, in pre-term infants with acyanotic HD, the appearance was later than normal at 1, 2, and 3 months (p = 0.02, p = 0.01, and p = 0.0002, respectively). We concluded that the ossification of PHOC is significantly later than normal in pre-term infants with congenital HD, but not significant in full-term infants with congenital HD.