To describe the trends for and severity of dyskinetic cerebral palsy in a European collaborative study between cerebral palsy registers, the Surveillance of Cerebral Palsy in Europe (SCPE).
The prevalence of dyskinetic cerebral palsy was calculated in children born in 1976–1996. Walking ability, accompanying impairments and perinatal adverse events were analysed.
578 children had dyskinetic cerebral palsy, of whom 70% were born at term. The prevalence per 1000 live births increased from 0.08 in the 1970s to 0.14 in the 1990s. For the 386 children (70%) with a birth weight of >=2500 g, the increase was significant (0.05 to 0.12). There was a concurrent decrease in neonatal mortality among children with a birth weight of >=2500 g. Overall, 16% of the children walked without aids, 24% with aids and 59% needed a wheelchair. Severe learning disability was present in 52%, epilepsy in 51% and severe visual and hearing impairment in 19% and 6%, respectively. Accompanying impairments increased with motor severity. In children born in 1991–1996, perinatal adverse events, that is an Apgar score of <5 at 5 min and convulsions before 72 h, had occurred more frequently compared with children with bilateral spastic cerebral palsy (BSCP, n = 4746). Children with dyskinetic cerebral palsy had more severe cognitive and motor impairments than children with BSCP.
The prevalence of dyskinetic cerebral palsy appears to have increased in children with a normal birth weight. They have frequently experienced perinatal adverse events. Most children have a severe motor impairment and several accompanying impairments.
To examine practice changes in the conduct of radiological investigations in Australia following urinary tract infection (UTI).
Observational study using data from the national Medicare database over the 15-year period July 1993 to June 2008 for four investigations: renal ultrasound (renal US), micturating cystourethrography (MCU), intravenous pyelography (IVP) and nuclear medicine isotope scanning of the renal tract (NM). Rates per 100 000 children in the age groups 0–4 years and 5–14 years were calculated for each test.
Australian medical practice, including private and public medical settings.
The rates of performance of renal US remained fairly constant throughout the study period in both age groups, while those for MCU, IVP and NM showed a strong falling trend over time for each test in both age groups. For the more invasive tests (MCU, IVP and NM) the total number performed per annum fell from 11 169 (costing $2 032 621) to 3361 (costing $689 742) in the last 10 years.
There have been very marked practice changes over the last 10–15 years. This trend followed the publication of scientific evidence which has raised doubts about the benefit of performing these investigations.
Toddlers in Pune, India, accustomed to low dietary calcium intake but vitamin D replete have low serum ionised calcium and inappropriately raised serum inorganic phosphorus concentrations together with elevated serum parathyroid hormone (PTH) concentrations. We hypothesised that dietary calcium deficiency leads to end organ resistance to PTH, thus resulting in mild hypocalcaemia and hyperphosphataemia, and that this would be reversed by oral calcium supplementation.
51 subjects (25 male; mean (SD) age 2.4 (0.8) years) from an urban slum in Pune were randomised to 500 mg of oral calcium supplement or placebo, daily, for 8 weeks. All subjects received 20 mg of oral elemental iron, daily, as 90% had a serum ferritin concentration <12 µg/l. All subjects were examined for clinical stigmata of rickets and had a wrist radiograph performed. Serum concentrations of ionised calcium, phosphorus, PTH and fibroblast growth factor-23 (FGF-23) were measured at the start and end of the trial.
No subject had clinical or radiological evidence of rickets. There was a significant increase in mean serum ionised calcium concentration (p<0.001) in the supplemented but not the placebo group (p = 0.32). The decrease in mean serum phosphorus concentration in the supplemented group was greater (p<0.001) than in the placebo group (p = 0.003). Mean serum PTH fell in the calcium supplemented (p = 0.001) but not in the placebo (p = 0.303) group. The mean serum FGF-23 concentration did not change in response to calcium supplementation.
From these data the authors conclude that low dietary calcium intake is associated with resistance to PTH.
With complete case referral for prolonged parenteral nutrition (PN) beyond term equivalent, serving a stable population of 1.25 million people, we describe the long-term outcome and survival of patients referred to an intestinal failure (IF) nutrition support team over the first 8 years of existence at a regional paediatric centre, and extrapolate to potential numbers of national home parenteral nutrition (HPN) cases and intestinal transplantation data.
Retrospective analysis detailing patient demographics, interventions, use of HPN, occurrence of intestinal failure-associated liver disease (IFALD), and outcomes of enteral adaptation, survival, and referral for and receipt of organ transplantation.
23 patients were referred over 8 years, 20 being PN dependent within the neonatal period. Diagnoses included short bowel syndrome (SBS) (18), neuromuscular abnormalities (4) and congenital enterocyte disorder (1). 12 696 days of PN were delivered with 314 confirmed episodes of sepsis at a median of 12 episodes per patient. 144 central venous catheters (CVCs) were required at a median of four per patient. IFALD occurred in 17 (73%) patients, with 10 (44%) referred for transplant assessment. Thirteen (56%) children received HPN. Overall mortality was 44%. A significant predictor for survival in the SBS group was residual bowel >40 cm (82% vs 28%, p = 0.049).
Survival for IF at 56% was lower than reported from non-UK supra-regional centres, and nationally collected data, possibly reflecting pre-selected referral populations. Data from regional centres with complete ascertainment may be important both when counselling parents and when planning regional and national HPN and IF specialist services.
To investigate associations between weight status and body size perception in children in the UK.
Cross-sectional survey.
School-based sample in the UK.
399 children (205 boys, 194 girls) aged 7–9 years.
Perceived body size was assessed using a visual method (Children's Body Image Scale, matching to images representing body mass indexes (BMI) from 3rd to 97th percentiles) and verbal descriptors from "too thin" to "too fat". BMI (converted to BMI SD scores using UK data) was assessed and demographic information was recorded.
Modest associations between actual and perceived body size were found with visual (r = 0.43, p<0.001) and verbal (r = 0.41, p<0.001) methods, but there was a consistent response bias towards underestimation. Using visual matching, most children (45%) underestimated their body size, with significantly greater underestimation (p<0.001) at higher BMI. A gender-by-weight group interaction (p = 0.001) showed that at lower weights girls were more accurate than boys, but at higher weights girls were less accurate. Using the verbal scale, the majority of children reported their body size as "just right" in all weight groups (52–73%), with no sex differences.
Children can estimate their body size using visual or verbal methods with some accuracy, but show greater underestimation at higher weights, especially in girls. These findings suggest that underestimation is more widespread than has been assumed, which has implications for health education among school-aged children.
There is limited knowledge of the accuracy of height and weight measurements from child health records, despite widespread use for research and clinical care. We assess the accuracy of such measurements, using research measurements as the gold standard.
We compare height/length and weight measurements from clinics of the Avon Longitudinal Study of Parents and Children with routinely collected child health records within 2 months of the clinic date at age 4 (n = 345), 8 (n = 1051), 12 (n = 139), 18 (n = 649), 25 (n = 183), and 43 months (n = 123). To adjust for age differences at measurement, growth data were converted into standard deviation scores using the UK 1990 growth reference.
Mean weight standard deviation score (SDS) differences were <=0.08, with mean predicted differences <=0.1 kg (eg, mean predicted difference at 8 months –0.011 kg, 95% level of agreement –0.64 to 0.62 kg). Mean height SDS differences were <=0.45, with mean predicted differences <=0.9 cm (eg, mean predicted difference at 8 months –0.59 cm, 95% level of agreement –3.84 to 2.66 cm). There was indication of lower accuracy at 4 months old (mean predicted height difference at 4 months –0.91 cm, 95% level of agreement –4.61 to 2.79 cm), but this decreased when the age difference between measurements was reduced. Routine measurements slightly overestimated heights of tall children and underestimated those of short children, but otherwise differences were not associated with sex, social class, birth weight, birth length, or maternal anthropometry.
Routinely collected child health record height/length and weight data are compatible with no systematic bias, at least in children over 8 months old, supporting their use in clinical practice and research.
To collect normal data on blood pressure (BP) in healthy children aged 4–8 and to compare measurements of BP made in the same subjects with a sphygmomanometer and a portable automated oscillometric BP monitor (Omron HEM 711 with child cuff).
Cross-sectional observational study of 764 children. BP measurements were made at school, using both a sphygmomanometer and an Omron HEM 711. Immediately after the BP measurement children were asked to state which device they preferred (if any).
Children had no preference for whether the sphygmomanometer or the Omron was used. Bland-Altman plots showed a lack of consistency between the two methods of BP measurement. With systolic BP there was a trend for the Omron to underestimate when low and overestimate when high.
Children were equally distributed in their preference for BP device. There was a wide variation between the two methods of BP measurement, which suggests that comparison of automated BP measurements with normative data obtained by sphygmomanometer is not valid.
Measurements at the end of puberty of neonates short for gestational age (SGA-L) are scant.
To determine the correlation between birth length and weight in neonates, with height and weight at age 17 years.
385 full-term neonates, measuring less than 48 cm (SGA-L) and 585 full-term neonates, measuring 48 cm or greater (adequate birth length for gestational age; AGA-L) were included. 234 SGA-L and 359 AGA-L were identified at age 17 years.
Comparison of the two groups revealed that both sexes born SGA-L were also shorter at age 17 years than those born AGA-L (girls 158.9 cm (SD 7.6) vs 164.2 cm (SD 64) (p<0.001) and boys 167.3 cm (SD 8.7) vs 173.8 cm (SD 7.1) (p<0.001)). The subjects born SGA-L also weighed significantly less than those born AGA-L (p<0.001) both at birth and at age 17 years.
Children born SGA-L become short adults and weigh less at age 17 years than children with a normal birth length.
Each winter seasonal respiratory virus infections account for large variations in unplanned admission to UK paediatric intensive care units (PICU). The emergence of pandemic influenza A(H1N1) has been associated with a notable predominance in children and may be expected to have a significant impact on PICU provision.
To derive conservative projections for PICU demand from current data and examine the effect of regional variations in bed provision.
PICU demand was estimated with the FluSurge 2.0 model using age-stratified data for the UK population and recently published conservative estimates for epidemiological parameters. The data suggest that a significant proportion of current total capacity may be required at the peak of the pandemic. Variation in per capita critical care provision across the UK leads to a wide range in potential impact at a regional level.
Contingency measures for children needing paediatric intensive care are needed to absorb the likely increase in activity expected due to pandemic influenza this winter. Because of variations in provision by region, the role of paediatric retrieval services will be especially important.
Obesity is considered a polygenic and multifactorial disorder and different single nucleotide polymorphisms (SNP) are involved. Studies concerning their impact on weight loss in lifestyle intervention are scarce.
The effect of two different SNP (INSIG2: rs7566605, FTO: rs9939609) was analysed on the change of weight status in a one-year lifestyle intervention among 280 overweight children (mean age 10.8 years, mean body mass index (BMI) 28.1 kg/m2).
The children reduced their mean SDS-BMI by –0.28 (95% CI –0.32 to –0.23). Modelling the impact of different genotypes and their statistical interactions on SDS-BMI change adjusting for age, gender and baseline BMI or SDS-BMI, respectively, revealed that the combination of the CC genotype in INSIG2 and the AA genotype in FTO was significantly associated with the lowest degree of overweight reduction, but even with an increase in overweight (SDS-BMI change +0.51; 95% CI 0.22 to 0.79).
These findings provide some evidence that the effects of different genotypes aggravate each other concerning weight change.
The study was aimed to evaluate the relationship between pharmacy supply, self-reported treatment adherence and HIV viral load in HIV-infected children.
A retrospective (52 weeks) cohort study was conducted through the review of the existing databases. Pharmacy supply was classified as "home delivery" when the medications were delivered home and as "in pharmacy pick-up" when they were picked up at the pharmacy. Adherence was assessed through retrospective (3 days recall) self-report. Fisher’s exact model, univariate and multivariate logistic regression analyses were used.
The study collected data on 140 HIV-infected children (<18 years). Adherence, pharmacy supply information and HIV viral loads were obtained from clinical and research databases.
The data from 127 HIV-infected children (60 boys and 67 girls; mean age 9.9 years) were collected.
Complete adherence (100%) was reported in only 24% of patients. With 40% of patients being rarely or never completely adherent, 64% of children achieved undetectable viral loads during the study period.
No association between pharmacy supply and self-reported adherence was found (p = 0.605). Self-reported adherence (p = 0.0328) and age (p = 0.025) were the significant predictors of reaching undetectable viral loads. Adolescents (>13 years) were significantly less likely to reach undetectable viral loads than children under 13 years (odds ratio 0.38; 95% CI 0.16 to 0.89).
In our study, pharmacy supply was not associated with self-reported adherence. Most importantly, adherence and age were significant predictors of reaching undetectable viral loads.
Current best practice for treating acute severe pain in children is to administer intravenous or intranasal opioid. Intranasal diamorphine offers less traumatic analgesia than the potentially difficult and distressing intravenous route. However, there has been no direct comparison of intranasal and intravenous diamorphine nor are there pharmacokinetic data for intranasal diamorphine in children.
To compare plasma morphine concentration–time profiles following intranasal and intravenous diamorphine administration.
Observational.
A&E department in a city-centre paediatric teaching hospital.
Children, aged 3–13 years, with isolated limb fracture.
An intravenous catheter was sited and baseline blood taken. The first 12 children received intravenous diamorphine (0.1 mg/kg), and the subsequent 12 intranasal diamorphine (0.1 mg/kg) in 0.2 ml sterile water drops. Subsequent samples were taken at 2, 5, 10, 20, 30 and 60 min.
Plasma morphine radioimmunoassay.
Peak plasma morphine concentrations were higher (median 109 vs 36 nmol/l), and occurred earlier (median 2 vs 10 min), with greater area under the curve (3761 vs 1794 nmol/l/h) following intravenous compared to intranasal diamorphine (all p<0.001, Mann–Whitney U test). Higher plasma concentrations at 60 min (47 vs 32 nmol/l) were also observed following intravenous diamorphine (p = 0.01, Mann–Whitney U test).
Our evidence supports the wider use of diamorphine administration by nasal drops in children, as it shows that adequate plasma levels of morphine are usually achieved. However, we demonstrated significantly attenuated and delayed peak plasma morphine levels with lower levels at 1 h with intranasal compared with intravenous diamorphine.