Journal of pediatric and adolescent gynecology最新文献

{"title":"Inaction Despite Motivation: Assessing Systemic and Personal Barriers to Pediatricians' Post-Dobbs Emergency Contraception Utilization.","authors":"Elizabeth Hovel, Michelle Pickett, Alexis Visotcky, Kelsey Porada, Wendi Ehrman, Margaret Thew, Vanessa McFadden","doi":"10.1016/j.jpag.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.03.006","url":null,"abstract":"<p><strong>Purpose: </strong>Following the US Supreme Court's Dobbs vs Jackson Women's Health (Dobbs) decision and subsequent changes to abortion access, increasing emergency contraception (EC) access for adolescents is vital. The first step is understanding providers' knowledge, attitude and practices regarding EC post-Dobbs.</p><p><strong>Methods: </strong>This cross-sectional internet-based survey was sent to providers within three general pediatric primary care systems from November 2023 to January 2024. Questions addressed EC knowledge, attitudes (perceived barriers and desired support to increase EC prescription) and practices post-Dobbs.</p><p><strong>Results: </strong>There were 51 participants. Most (81%) providers felt adolescent EC prescription was more important post-Dobbs, but very few (7%) had changed their own prescribing practices. Overall, providers had a mean knowledge score of 71%. Providers closer to training had a higher EC knowledge score (77% vs 68%, p = 0.02), as did providers who were generally willing to provide EC (72% vs 58%, p=0.004). Providers in urban and rural areas were more likely to have prescribed EC than suburban counterparts (54% urban, 40% rural, 16% suburban, p = 0.04). Various barriers were elicited, most commonly relating to lack of awareness and knowledge about EC. Over half of respondents noted they would be more likely to prescribe EC with clinical decision support built into the EMR (69%), an order set in the electronic medical record (57%), and education sessions (55%).</p><p><strong>Discussion: </strong>This study highlights a strong need to bolster provider EC education in pediatrics and address systems factors that will facilitate easier, more confident EC prescription.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EFFECTS OF COMBINED HORMONAL CONTRACEPTIVES (CHC) ON BONE HEALTH IN ADOLESCENT GIRLS - A SYSTEMATIC REVIEW.","authors":"Leek Mei Lim, Wogud Ben Said, Pallavi Latthe","doi":"10.1016/j.jpag.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.03.004","url":null,"abstract":"<p><strong>Objectives: </strong>To summarize the effects of combined hormonal contraceptives (CHC) on bone health in adolescent girls.</p><p><strong>Design: </strong>A systematic search was performed using the following databases: Medline, EMBASE, CINAHL and Cochrane Library clinical trials register, from inception to July 2024.</p><p><strong>Eligibility: </strong>Intervention and cohort studies that assessed the use of CHC on bone health in adolescent girls aged 10-19years old were included.</p><p><strong>Data synthesis: </strong>Four randomized control trials and eight observational studies (n =2689) were included.</p><p><strong>Conclusion: </strong>Current evidence indicates that the use of CHC in post-menarchal adolescent girls reduce bone accrual compared to non-users. The negative impact on bone accrual is likely related to the estrogen dose in the CHC preparation, the regimen used and the duration of use.</p><p><strong>Prospero registration number: </strong>PROSPERO CRD 42024574905 on 31 July 2024.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Transdermal Estrogen Therapy on Bone and Neurobehavioral Health in Youth with Premature Ovarian Insufficiency: A Case-Control Study.","authors":"Halley Wasserman, Heidi J Kalkwarf, Mekibib Altaye, Kimberly Yolton, Catherine M Gordon","doi":"10.1016/j.jpag.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.03.005","url":null,"abstract":"<p><strong>Study objective: </strong>Estrogen replacement therapy (ERT) improves bone and neurocognitive health in adult women with premature ovarian insufficiency (POI). However, the response in adolescents is largely unknown. We aimed to assess the impact of transdermal estrogen replacement therapy (TDE2) in adolescents with POI on these outcomes.</p><p><strong>Methods: </strong>Nine adolescents with idiopathic POI, naïve to ERT, and 9 controls with regular menses matched for age, race and BMI were recruited between 2018-2023 for a 24-month study. Primary bone health outcomes were changes in lumbar spine BMD Z-score and 3% distal radius trabecular volumetric BMD. Primary neurocognitive outcomes were quality of life (CHQ-87 survey) and memory (ChAMP).</p><p><strong>Results: </strong>Adolescents with POI experienced significant increases in BMD Z-scores at all DXA skeletal sites (lumbar spine ∆ +0.68, total hip ∆ +0.37, femoral neck ∆ +0.56, total body less head ∆ +0.82, all p<0.05). Control participants exhibited an increase in BMD Z-score at the total body less head (∆ 0.43, p=0.034) with no significant change at other skeletal sites. There were no significant changes from baseline to 24 months in pQCT measures. Total memory index significantly increased in both groups from baseline to 24 months (controls ∆ +17.2, cases ∆ +24.6, p=0.041 and 0.001 respectively), but there was no difference between groups. There were no other significant differences in neurocognitive outcomes among or between groups.</p><p><strong>Conclusions: </strong>Central BMD increased in adolescents with idiopathic POI in response to TDE2, but peripheral BMD measures were unchanged. The impact on neurocognitive outcomes in these adolescents remains uncertain.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal factors during pregnancy and pubertal timing in offspring: A systematic review of the literature.","authors":"Siyu Zhou, Bregje C D van Uden, Margot Smets, Lisa Kamperdijk, Jiexin Tang, Hristiyanna I Ivanova, Joost Daams, Theodorus B Twickler, Tanja G M Vrijkotte","doi":"10.1016/j.jpag.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.jpag.2025.03.003","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review aims to identify, assess the quality of and synthesize evidence on non-genetic maternal factors, such as psychological factors, lifestyle, nutrition, and endocrine conditions that may be associated with pubertal timing in male and female offspring.</p><p><strong>Methods: </strong>The search was conducted in Medline, Embase, PsycInfo and Web of Science. The reference lists of retrieved articles were checked to avoid missing relevant studies. There were no restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa Scale. This review has been registered on PROSPERO (CRD42023394102). A best-evidence approach was applied to qualitatively summarize the findings and draw conclusions on the level of evidence.</p><p><strong>Results: </strong>The search yielded 4199 studies, of which 73 were included in this systematic review. In both boys and girls, there is strong evidence of a positive association between maternal gestational weight gain and an earlier pubertal timing, while no association was found with maternal substance use, thyroid dysfunction or gestational hypertension. In addition, there is insufficient evidence of an association with maternal psychological factors, smoking, diet, physical activity, pre-pregnancy weight/BMI, diabetes, menstruation related disorders and steroid medication use.</p><p><strong>Conclusions: </strong>This review provides a comprehensive overview of the quality and consistency of existing evidence regarding maternal factors during pregnancy that may be associated with the pubertal timing in their offspring. This review may serve as an orientation for future research initiatives, with a particular focus on exploring these associations among male offspring and in low- and middle-income countries.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5. Evaluating an Adolescent and Young Adult-Focused Medication Abortion Curriculum for Pediatric Trainees","authors":"Julia Raney ,&nbsp;Chelsea Garnett ,&nbsp;Amanda Bryson ,&nbsp;Lisa Mihaly ,&nbsp;Sara Buckelew ,&nbsp;Marissa Raymond-Flesch","doi":"10.1016/j.jpag.2025.01.017","DOIUrl":"10.1016/j.jpag.2025.01.017","url":null,"abstract":"<div><h3>Background</h3><div>22 states ban or restrict abortion, limiting access for adolescents and young adults (AYAs) and reducing number of abortion providers. Further, AYA-focused medication abortion (MAB) curricula are lacking. We developed, implemented, and evaluated an AYA-focused MAB curriculum for pediatric trainees (pediatric residents, nurse practitioner students, and medical students).</div></div><div><h3>Methods</h3><div>Using Kern's Six Steps, we designed a curriculum of four online modules (videos with readings on adolescent pregnancy options counseling, MAB provision, post-abortion care, and harm reduction strategies) and a 2-hour workshop (module review, a values clarification exercise, and a clinical case). Adolescent themes included AYA-specific barriers and health equity concerns, developmental considerations, and confidentiality concerns. 9 workshops were held over the 2023-2024 academic year. Pre- and post-surveys assessed key components of behavior change according to Social Cognitive Theory including learner satisfaction, knowledge, intentions, values, and self-efficacy. McNemar test and Wilcoxon signed-rank test assessed differences in quantitative pre/post results; we analyzed open-ended responses using a thematic content approach. This study received IRB approval.</div></div><div><h3>Results</h3><div>29 of 53 participants completed both surveys (54%); most learners were pediatric residents (52%) or nurse practitioner students (45%), with one medical student also participating (3%). Learners’ cumulative knowledge score increased after curriculum completion (60% vs 90%; p&lt;.001). Overall intentions to provide, refer, and advocate for MAB did not change significantly (average of 3 questions on a Likert scale 1-5: 4.3 vs 4.3; p=.92). Similarly, learners' feelings around caring for patients seeking abortions did not change significantly (average of 7 questions on a Likert scale 1-5: 4.4 vs 4.4, p=.76). After completion, learners felt fairly or completely confident in counseling on pregnancy (72%) and abortion options (66%), determining medical eligibility (88%), and providing anticipatory guidance (89%). 85% of learners rated the overall curriculum excellent or outstanding. In open-ended responses, learners described the curriculum as highly valuable.</div></div><div><h3>Conclusions</h3><div>This AYA-focused MAB curriculum improved pediatric trainees' knowledge of MAB management with learners feeling fairly confident or greater to perform key aspects of MAB care after curriculum completion. Intentions to provide MABs did not change significantly, possibly due to high pre-scores. While values scores did not shift significantly, many learners noted this curriculum was a valuable contribution to their pediatric training.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 221-222"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"55. Incidence, Indications, and Complications of Cesarean Delivery Among Adolescent Childbirths: National Inpatient Sample 2019-2021","authors":"Ting Yu Wu,&nbsp;Margarita Berwick","doi":"10.1016/j.jpag.2025.01.088","DOIUrl":"10.1016/j.jpag.2025.01.088","url":null,"abstract":"<div><h3>Background</h3><div>Cesarean deliveries in the United States have increased over the recent decades. The impact of this increase on the adolescent population has not been precisely defined.</div></div><div><h3>Methods</h3><div>We performed a 3-year cross-sectional analysis of cesarean deliveries in individuals aged 10 to 19 years captured in the National Inpatient Sample from 2019 to 2021.</div></div><div><h3>Results</h3><div>Cesarean deliveries in individuals aged 10-19 represented 2.67 % of all cases. Geographically, over half of adolescent births occurred in rural areas (57.3 %), followed by urban areas (25.7 %), and least frequently in suburban regions (16.9 %). 38.9% of the individuals in the sample were identified as White, 29% as Hispanic, and 26.1 % as Black. Multifetal gestations accounted for 2.9 %. Among the most common diagnoses associated with cesarean, non-reassuring fetal status was documented in 41.4 % of cases, labor dystocia in 27 %, and repeat operation in 11.3 %. Notably, the incidence of failed TOLAC was 21.6 %. Incidence of commonly noted delivery complications was 10.7 % for meconium in amniotic fluid, 6 % for chorioamnionitis, 3.2 % for placental abruption, 2.9 % for multifetal gestation, and 2 % for malpresentation. Common maternal complications included anemia at 23 %, obesity at 15.4 %, mental health disorders at 11.1 %, gestational hypertension at 8.8 %, postpartum hemorrhage at 4.4 %, and blood transfusion at 3.5 %. Among severe complications, cases of placenta accreta spectrum, hysterectomy, and bowel or bladder injury were noted, though the incidence was very small (less than 0.1 % for all).</div></div><div><h3>Conclusions</h3><div>Cesarean delivery in adolescents is common, with indications similar to those previously reported in adult populations. Complications, including severe complications like placenta accreta disorders, organ injuries, and hysterectomy, did occur in this age group. Given the risk of complications and potential for future morbidity from repeat cesareans, monitoring rates of cesarean delivery in this age group and efforts for safe prevention of primary cesarean are warranted. These findings reaffirm the need to provide comprehensive obstetric and neonatal care to address complex health issues surrounding childbearing in this age group.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 255"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"42. Fertility intentions among transgender and non-binary youth","authors":"Julia Eisenberg ,&nbsp;Sarah Felleman ,&nbsp;Beth Schwartz ,&nbsp;Benjamin Bear ,&nbsp;Anne Kazak ,&nbsp;Rebecca Mercier","doi":"10.1016/j.jpag.2025.01.075","DOIUrl":"10.1016/j.jpag.2025.01.075","url":null,"abstract":"<div><h3>Background</h3><div>Transgender and non-binary individuals may experience gender dysphoria, distress associated with the incongruence between one's gender identity and sex assigned at birth. Gender-affirming treatments are used to alleviate gender dysphoria by facilitating physical changes more closely aligned with one's gender identity but may affect fertility. Research investigating the fertility intentions of transgender and non-binary adolescents is limited, with no studies of non-binary youth. Our objective was to assess fertility intentions and future parenting goals in a cohort of gender diverse adolescents seen in a multidisciplinary pediatric gender program and assess how those goals differ by gender identity.</div></div><div><h3>Methods</h3><div>This is a retrospective chart review of all gender diverse patients who were seen at the Nemours Gender Wellness Program from 2015-2020. Abstracted data include patient demographics, fertility intentions, referrals, and procedures. Descriptive statistical analysis was performed using frequency counts, percentages, medians and standard deviations. Comparisons were made between transgender and gender non-binary patients. Categorical variables were compared using chi-square and Fisher exact tests; continual variables were compared with t-tests or mann-whitney testing as appropriate for non-parametric variables.</div></div><div><h3>Results</h3><div>Of the 189 included patients, most were White (83%) and non-Hispanic (90%). Participant ages ranged from 5-18 years, with a median of 15.00 (SD 2.5) years. 168 (88%) individuals identified as transgender and 21 (11%) as non-binary. Of the participants that discussed fertility intention during their visit, more transgender adolescents were interested in future parenting than non-binary youth (35% vs. 20%, p=0.01). The majority of participants from both groups did not express any interest in current parenting (100%), future pregnancy (95%) or desire for biological children (59%). However, 31% of participants were interested in a Reproductive Endocrinology and Infertility consult and/or fertility preservation procedure, with no differences between groups.</div></div><div><h3>Conclusions</h3><div>Within our cohort, transgender individuals were more likely than non-binary individuals to express an interest in future parenting. Despite this, most patients in both groups were not interested in biological children or fertility preservation. Understanding fertility intentions among gender diverse adolescents can help inform counseling on gender-affirming care and improve treatment strategies for this population.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 249"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"28. Differences in Vaginoplasty When Performed in Childhood Versus Adulthood: A National Surgical Quality Improvement Program Study","authors":"Jourdin Batchelor ,&nbsp;Frances Grimstad ,&nbsp;Ava Scatoni ,&nbsp;Elizabeth Boskey ,&nbsp;Jessica Shim","doi":"10.1016/j.jpag.2025.01.061","DOIUrl":"10.1016/j.jpag.2025.01.061","url":null,"abstract":"<div><h3>Background</h3><div>Vaginoplasties are performed for a variety of congenital or acquired indications from childhood through adulthood. There are considerable gaps in understanding whether the conditions treated by vaginoplasty or the associated risk of complications differ between pediatric and adult patients. This study aimed to assess types of vaginoplasties, underlying diagnoses, and complication rates in children and adults using large multicenter databases.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized data from the American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases from 2012 to 2021. Children (aged &lt; 18 years) and adults (greater than or equal to 18 years) who underwent vaginoplasty for any reason were identified using Current Procedural Terminology (CPT) codes for vaginoplasties performed. Multivariable logistic regression analyzed differences in diagnoses, surgeon specialties, and 30-day complications. This study was exempt from Institutional Review Board approval.</div></div><div><h3>Results</h3><div>We identified 232 children (mean age 6.2 years) and 209 adults (mean age 36.7 years) who underwent vaginoplasty. Surgical specialty differed between children and adults. Pediatric urology performed the majority of vaginoplasties in children, whereas plastic surgery performed the majority in adults (75% vs 70%, p&lt; 0.001). Gynecology performed a similar percentage of procedures in both groups. The type of vaginoplasty also varied. Children underwent vaginoplasties coded as both with and without grafts (57291, 57292, 57335), but adults only underwent vaginoplasties coded with grafts (57335). Surgical indication also significantly differed with 97% of childhood vaginoplasties being for urethrovaginal conditions and 85% of adult vaginoplasties being for gender dysphoria. Overall, 30-day complications were comparable and relatively low in both groups. Adults were more likely to have a documented wound dehiscence (0% vs 5%; p&lt; 0.001). Wound dehiscence occurred in isolated urethrovaginal procedures and gender dysphoria cases, with 82% of all disruptions found in the latter group.</div></div><div><h3>Conclusions</h3><div>We identified differences in surgery type, surgeon specialty, and diagnoses when comparing vaginoplasties performed in children and adults. Although complications were low overall, wound dehiscence was more common in adults, likely due to complexity in gender affirming vulvovaginoplasties. More research is needed to understand these differences, to optimize surgical techniques, and improve patient care across all ages.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 243-244"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"31. Effective Management of Multi-Resistant Neonatal Breast Abscess Through Early and Precise Care.","authors":"Carolina Pastene ,&nbsp;Claudia Moya ,&nbsp;Mónica Muñoz ,&nbsp;Magdalena Castro ,&nbsp;Carolina Carrasco ,&nbsp;Camila Yañez ,&nbsp;Isabel Fuentealba","doi":"10.1016/j.jpag.2025.01.064","DOIUrl":"10.1016/j.jpag.2025.01.064","url":null,"abstract":"<div><h3>Background</h3><div>Neonatal breast abscess is a rare but significant condition, typically occurring in full-term infants due to the spread of skin flora, often Staphylococcus aureus, to the breast parenchyma. This condition, if not treated promptly, can result in serious complications such as breast hypoplasia or scarring. Recognizing early signs and appropriate management are crucial for a favorable outcome.</div></div><div><h3>Case</h3><div>We present the case of a 1-month-old female infant, full-term at 39+5 weeks gestation, with no prior medical history or hospitalizations, and up-to-date on her immunizations. She developed a right-sided breast abscess, presenting with a firm, warm, erythematous swelling with induration and tenderness. The patient had no fever but was tachycardic. Laboratory results showed a white blood cell count of 19.55 × 10³/µl and C-reactive protein of 25 mg/L. Breast ultrasound revealed a poorly defined hypoechoic lesion measuring 30 × 22 mm with a central, irregular liquid collection of 13 × 10 mm. Despite intravenous Cloxacillin, the patient showed no improvement by the third day. Surgical drainage was performed with the support of interventional radiology, extracting 2 cc of pus under ultrasound guidance. Cultures revealed multi-resistant Staphylococcus aureus. Vancomycin treatment was initiated, with dose adjustments made after the fifth dose. The infant was treated successfully, followed by a 10-day course of oral Cotrimoxazole. Full recovery was observed, with no further complications. Ethics Approval: This case was reviewed and approved by the Ethics Committee of Hospital Dr. Luis Calvo Mackenna, in accordance with institutional guidelines.</div></div><div><h3>Comments</h3><div>This case emphasizes the importance of early diagnosis, timely surgical intervention, and the selection of appropriate antibiotic therapy, particularly in cases involving multi-resistant pathogens. Prompt treatment is critical to prevent complications such as damage to developing breast tissue. The adjustment of antibiotic dosing in young infants, as demonstrated with Vancomycin in this case, is crucial due to their unique pharmacokinetics, ensuring therapeutic effectiveness while minimizing toxicity. Additionally, the role of interventional radiology in enhancing precision during abscess drainage in neonatal patients is highlighted, contributing to successful outcomes and minimizing potential complications. Financial Disclosure: The authors have no financial relationships relevant to this case to disclose.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 244-245"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"21. Case report: Premature ovarian insufficiency as a cause of primary amenorrhea","authors":"Daniela Capella,&nbsp;Ignacia Reyes","doi":"10.1016/j.jpag.2025.01.054","DOIUrl":"10.1016/j.jpag.2025.01.054","url":null,"abstract":"<div><h3>Background</h3><div>Premature ovarian insufficiency (POI) is the loss of ovarian function in women under 40 years, diagnosed through amenorrhea or oligomenorrhea and two elevated follicle-stimulating hormone (FSH) levels. Its prevalence ranges from 1% to 3.7%, with 1 in 10,000 cases in women under 20 years. In 70-90% of cases the etiology is unknown. Known causes include Turner syndrome, fragile X syndrome, autoimmunity, infections and iatrogenic. Untreated POI can lead to osteoporosis, cardiovascular risk, Alzheimer's disease, mental health disorders and infertility. We present a case of POI manifesting as primary amenorrhea, with the aim of emphasizing the need of early identification and treatment.</div></div><div><h3>Case</h3><div>A 16-year-old girl with no prior medical history presented with primary amenorrhea. Her physical exam showed a height of 172 cm, 10 cm above her target height. She had Tanner stage 2 in breasts and pubic hair, anatomically normal female external genitalia and hypoestrogenized mucous membranes. Lab tests showed FSH levels of 69 mIU/ml and undetectable anti-Müllerian hormone. The gynecological ultrasound indicated uterine length of 52 mm and ovarian volumes of less than 1cc. POI was suspected and confirmed with a second elevated FSH level. Investigations into possible etiologies were carried out, revealing a 46 XX karyotype, negative fragile X premutation studies, normal thyroid function and negative thyroid antibodies. A genetic evaluation was requested, which included testing for 53 genes in Disorders of Sexual Development Panels, all of which were negative. Additionally, to rule out the diagnosis of Triple X syndrome, which can cause tall stature and POI, an extended karyotype with 50 metaphases was requested, and the result is pending. Due to prolonged hypoestrogenism, a bone densitometry was performed, with normal results. The patient began low-dose transdermal estradiol, gradually increasing to 2 mg over two years, after which she had her first menstrual bleed. Monthly cyclic micronized progesterone was added. During treatment, she progressed to Tanner stage 5 for breast and pubic hair development, and her final height was 175 cm. Serial ultrasounds indicated progressive uterine growth, reaching 77 mm by age 20.</div></div><div><h3>Comments</h3><div>POI is a very rare diagnosis in women under 20 years, especially as a cause of primary amenorrhea. In our case, the patient presented arrested puberty at Tanner stage 2. While the cause is often unknown, ruling out common causes and monitoring for conditions like osteoporosis is crucial. Hormonal treatment should always be initiated promptly and continued until the average age of menopause to prevent hypoestrogenism-related complications.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 240"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}