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van der Klift F, Orriëns LB, Spek B, Sellers D, E Erasmus C, van Hulst K. Reliability and validity of the Mini-Eating and Drinking Ability Classification System (Mini-EDACS) among Dutch preschoolers with cerebral palsy. J Pediatr Rehabil Med 2025:18758894251330469. [PMID: 40170383 DOI: 10.1177/18758894251330469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025] Open
Abstract
PurposeThis study aimed to translate the English version of the Mini-Eating and Drinking Ability Classification System (Mini-EDACS) into Dutch and assess its psychometric properties and applicability among preschool-aged children with cerebral palsy (CP) in the Netherlands.MethodsForty-eight children with CP (18-36 months) were included. Inter-rater reliability of the Dutch version of the Mini-EDACS was assessed between two speech and language therapists (SLTs) and between two SLTs and parents. Construct validity was established by hypothesis testing regarding the expected strength of the correlation between Mini-EDACS level and sum score of (a) the Pediatric Eating Assessment Tool (PEDI-EAT-10) and (b) the Montreal Children's Hospital Feeding Scale (MCH-FS).ResultsThe level of agreement for Mini-EDACS level was almost perfect between SLTs (weighted kappa (kw) = 0.83) and substantial between parents and SLTs (parents vs SLT-1: kw = 0.77; parents vs SLT-2: kw = 0.70).Kendall's tau-b correlation between Mini-EDACS and PEDI-EAT-10 was 0.66 (p < 0.001), slightly lower than hypothesized, and 0.52 (p < 0.001) between Mini-EDACS and MCH-FS, aligning with the hypothesis. Applicability was found to be good.ConclusionThe Dutch version of the Mini-EDACS showed sufficient inter-rater reliability, construct validity and applicability and can be used in clinical care in the Netherlands to promote unambiguous communication between healthcare professionals and parents.
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Affiliation(s)
| | - Lynn B Orriëns
- Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Bea Spek
- Amsterdam UMC|University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Diane Sellers
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Corrie E Erasmus
- Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, the Netherlands
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Peneva P, Pancheva R, Nikolova SP. Respiratory Microbiota and Health Risks in Children with Cerebral Palsy: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2025; 12:358. [PMID: 40150639 PMCID: PMC11941506 DOI: 10.3390/children12030358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/05/2025] [Accepted: 03/12/2025] [Indexed: 03/29/2025]
Abstract
Children diagnosed with cerebral palsy (CP) frequently face a range of intricate health challenges that go beyond their main condition. Respiratory problems represent one of the most crucial factors contributing to morbidity and mortality. This review employed a systematic approach to identify and collate recent findings on the respiratory microbiota in children with CP. The review emphasizes notable microbial alterations in the respiratory systems of children with CP, marked by a decrease in beneficial bacteria (such as Corynebacterium spp. and Dolosigranulum spp.) and an increase in opportunistic pathogens like Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumonia. These changes probably increase the vulnerability of children with CP to frequent respiratory infections, ongoing inflammation, and infections that are resistant to antibiotics. Key factors influencing the composition of microbiota include living in urban areas, socioeconomic factors, seasonal variations, vaccination status, dietary habits, breastfeeding, etc. Although new research has shed significant light on this topic, there are still considerable gaps in our understanding of how these microbial communities develop and interact with the immune responses of the host. Future research should focus on longitudinal studies to track microbiota changes over time and identify interventions that optimize respiratory health in CP.
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Affiliation(s)
- Pavlina Peneva
- First Department of Internal Disease, Faculty of Medicine, Medical University, 9002 Varna, Bulgaria
| | - Rouzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University, 9002 Varna, Bulgaria;
| | - Silviya P. Nikolova
- Department of Social Medicine and Healthcare Organization, Faculty of Public Health, Medical University, 9002 Varna, Bulgaria;
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van Hulst K, van Ijken E, van Vliet L. Thickening liquids for pediatric dysphagia: a perspective from clinical practice. Postgrad Med 2025; 137:113-120. [PMID: 39898786 DOI: 10.1080/00325481.2025.2457318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 12/03/2024] [Accepted: 01/16/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND Dysphagia is a common condition in infants and young children, particularly among those with neurodevelopmental disabilities. The management of pediatric dysphagia requires customized approaches based on individual clinical features. This report describes our experience in managing pediatric dysphagia using a locust bean- and xanthan gum-based thickener (ThickenUp® Junior), which offers stable consistency and preserves the original taste of liquids. CASE REPORT Four cases were discussed to highlight the use of the new thickener. Each case illustrates different aspects of dysphagia management, such as improving swallowing safety, enhancing oral control, and maintaining nutritional intake through tailored thickening strategies. Our experience demonstrates the importance of using specialized thickening agents to prevent aspiration pneumonia and, ultimately, improve the well-being of affected children. We also highlighted the importance of individualized treatment plans, which consider each child's unique needs. A comprehensive evaluation by a multidisciplinary team led to an effective treatment strategy tailored to the child's specific condition and challenges. CONCLUSIONS The new locust bean- and xanthan gum-based thickener is effective in managing dysphagia and preventing complications in infants and young children. Such agents can improve swallowing safety, enhance oral control, and maintain nutritional intake, ultimately improving the well-being of the affected children.
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Affiliation(s)
- Karen van Hulst
- Department of Rehabilitation, Amalia Children's Hospital, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther van Ijken
- Department of Rehabilitation, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Dias BLS, Duarte LMR, Fava D, de Lima FM. Outpatient Management of Clinical Comorbidities in Children With Cerebral Palsy in Low- and Middle-Income Countries. Child Care Health Dev 2025; 51:e70052. [PMID: 39985221 DOI: 10.1111/cch.70052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 11/15/2024] [Accepted: 01/31/2025] [Indexed: 02/24/2025]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common physical disability of childhood. Its prevalence in low-and middle-income countries (LMICs) is over 3/1000 live births, about double the 1.6/1000 in high income countries (HICs). Multimorbidity is highly prevalent in CP. In LMICs, there are higher rates of prevalence, severity, comorbidities and mortality in children with CP. The evidence base for the recommendations in CP emanates overwhelmingly from studies conducted in HICs. Research conducted in LMICs settings, involving local clinicians, considering local context and investigating local solutions are urgently needed. METHODS This scoping review aimed to identify and synthesise current evidence on management of clinical comorbidities in children with CP in LMICs. The Joanna Briggs Institute guidelines were followed for the data extraction and analysis phases. The following questions guided the scoping review: What are the main clinical comorbidities in children with CP? What are the gold standards for diagnosis and treatment of these comorbidities? What options do we have to diagnose and treat these comorbidities in LMICs when gold standards are not available? RESULTS A total of 22 188 citations were identified by our search strategy, with 21 380 remaining after the removal of 808 duplicates. After screening titles and abstracts, 1918 citations progressed to full text review. A total of 194 articles met the eligibility criteria and were included in the review. The guiding questions of the review were answered for the following morbidities: respiratory impairments, dysphagia and aspiration, gastroesophageal reflux disease, drooling, obstructive sleep apnea syndrome, malnutrition, constipation, epilepsy, sleep disorders, spasticity, dystonia, pain, hip disorders, scoliosis and osteoporosis. CONCLUSION This article highlights the need for interventions adapted to the realities of LMICs. Empowering paediatricians and healthcare professionals in LMICs is crucial for early diagnosis and proactive interventions. Specific guidelines for LMICs can better guide professionals in managing these complex conditions.
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Affiliation(s)
| | | | - Daniela Fava
- SARAH Network of Rehabilitation Hospitals, Brasília, Brazil
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Anpalagan K, Jacoby P, Stannage K, Leonard H, Langdon K, Gibson N, Nagarajan L, Wong K, Downs J. Hospitalizations Following Complex Hip Surgery in Children with Intellectual Disability: A Self-Controlled Case Series Analysis. J Pediatr 2025; 278:114435. [PMID: 39674541 DOI: 10.1016/j.jpeds.2024.114435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 12/03/2024] [Accepted: 12/10/2024] [Indexed: 12/16/2024]
Abstract
OBJECTIVE To evaluate the associations between complex hip surgery and subsequent hospitalizations in children with intellectual disability, including a subset of children with cerebral palsy. STUDY DESIGN We conducted a retrospective cohort study using linked administrative, health, and disability data from Western Australia. Children born between 1983 and 2009 who underwent complex hip surgery by end 2014 were included (intellectual disability, n = 154; subset with cerebral palsy, n = 91). A self-controlled case series analysis using Poisson regression was used to estimate the age-adjusted associations of complex hip surgery on all-cause hospitalizations and when the principal diagnosis was lower respiratory tract infection or epilepsy, for periods following the individual's first major hip surgery, compared with the year before surgery. RESULTS Age adjusted incidence of all-cause hospitalizations decreased after surgery (year 1: incidence rate ratio [IRR] 0.87 [95% CI, 0.74-1.02]; year 6: IRR 0.57 [95% CI, 0.46-0.72]). The incidence of hospitalizations for lower respiratory tract infection increased (year 1: IRR, 1.03 [95% CI, 0.72-1.51]; year 6: IRR 2.08 [95% CI, 1.18-3.68]). The incidence of hospitalizations for epilepsy decreased (year 1: IRR 0.93 [95% CI, 0.57, 1.54]; year>6: IRR 0.72 [95% CI, 0.34-1.55]) after surgery. A similar pattern was observed for the subset of children with or without cerebral palsy. CONCLUSION Complex hip surgeries are associated with fewer hospitalizations overall but not respiratory hospitalizations for children with intellectual disability. Fewer hospitalizations suggest benefits for better musculoskeletal alignment.
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Affiliation(s)
- Keerthi Anpalagan
- Centre for Child Health Research, The Kids Research Institute Australia, The University of Western Australia, Perth, Australia
| | - Peter Jacoby
- Centre for Child Health Research, The Kids Research Institute Australia, The University of Western Australia, Perth, Australia
| | | | - Helen Leonard
- Centre for Child Health Research, The Kids Research Institute Australia, The University of Western Australia, Perth, Australia
| | | | - Noula Gibson
- Centre for Child Health Research, The Kids Research Institute Australia, The University of Western Australia, Perth, Australia; Physiotherapy Department, Perth Children's Hospital, Perth, Australia; Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Lakshmi Nagarajan
- Centre for Child Health Research, The Kids Research Institute Australia, The University of Western Australia, Perth, Australia; Neurology Department, Perth Children's Hospital, UWA, Perth, Australia
| | - Kingsley Wong
- Centre for Child Health Research, The Kids Research Institute Australia, The University of Western Australia, Perth, Australia
| | - Jenny Downs
- Centre for Child Health Research, The Kids Research Institute Australia, The University of Western Australia, Perth, Australia; Curtin School of Allied Health, Curtin University, Perth, Australia.
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Zhao Y, Ying D, Ouyang C, Li X, Xiong Z, Liao Z, Lu W, Zhong Y, Feng Z. Enhancing motor function in children with cerebral palsy: A Comparative study of pediatric tuina and conventional rehabilitation. J Bodyw Mov Ther 2025; 41:1-7. [PMID: 39663073 DOI: 10.1016/j.jbmt.2024.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 08/07/2024] [Accepted: 10/13/2024] [Indexed: 12/13/2024]
Abstract
OBJECTIVE This study explores the impact of combining Pediatric Tuina (PT) with conventional rehabilitation on motor function in children diagnosed with cerebral palsy (CP). METHODS This controlled trial involved 115 CP-affected children aged 1 month to 13 years. They were allocated into an experimental group (n = 57) receiving PT and conventional rehabilitation, and a control group (n = 58) receiving only conventional rehabilitation for three months. The GMFM-88 scale was employed for evaluating motor function at the start and end of the treatment period. RESULTS Compared to the conventional rehabilitation group, the combination of PT and standard rehabilitation therapy showed significant improvement in motor function among children with CP after 3 months. There were no significant differences in baseline characteristics between the two groups. Children in the PT combined with the standard rehabilitation therapy group exhibited more prominent improvements in motor function (supine and rolling: experimental group 47.88 ± 5.02 vs control group 42.86 ± 10.30; sitting: experimental group 45.16 ± 18.52 vs control group 35.59 ± 18.97; total score: experimental group 147.88 ± 75.59 vs control group 118.90 ± 77.87; P = 0.045). Furthermore, there was a significant increase in scores for children after the combination therapy (pre-treatment 105.39 ± 85.76 vs post-treatment 147.88 ± 75.59; P = 0.045). CONCLUSION PT, when used in conjunction with conventional rehabilitation methods, significantly enhances motor function in children with CP. The study advocates for further extensive research to validate and understand the broader implications of PT in CP treatment.
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Affiliation(s)
- Yue Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China.
| | - Dexia Ying
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Chengfeng Ouyang
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Xunxin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Zhichao Xiong
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Ziqin Liao
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Wenhui Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Yingjun Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China.
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
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Calderone A, Militi D, Cardile D, Corallo F, Calabrò RS, Militi A. Swallowing disorders in cerebral palsy: a systematic review of oropharyngeal Dysphagia, nutritional impact, and health risks. Ital J Pediatr 2025; 51:57. [PMID: 39985076 PMCID: PMC11846443 DOI: 10.1186/s13052-025-01903-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/09/2025] [Indexed: 02/24/2025] Open
Abstract
Cerebral palsy (CP) is a permanent disorder affecting movement and posture due to nonprogressive brain issues, often leading to various sensory, cognitive, and musculoskeletal challenges. Among these complications, oropharyngeal dysphagia (OPD) is prevalent, impacting up to 85% of children with CP and resulting in significant nutritional deficits. This systematic review aims to explore the prevalence and types of OPD in CP patients, its effects on nutritional status, and its associated health complications, emphasizing the need for thorough assessment and intervention to mitigate risks. The review adheres to PRISMA guidelines, searching five major databases (PubMed, Web of Science, Embase, Cochrane Library, and Scopus) without time range restrictions to capture studies addressing swallowing disorders and their impact on nutritional status in CP. This review has been registered on Open OSF (n) 3KUQX. Individuals with CP often experience swallowing impairments, including delayed pharyngeal transit and aspiration. Research indicates that 81.5% of kids with CP suffer from dysphagia, commonly associated with reduced motor skills and general health. Moreover, as a result of these swallowing difficulties, nutritional complications may occur, with elevated levels of gastroesophageal symptoms causing malnutrition and growth delays, which require thorough evaluations and personalized interventions for successful treatment. Tools like the Videofluoroscopic Swallowing Study were identified as primary methods for evaluation, but assessment remains limited by methodological inconsistencies. This systematic review underscores the significant health impacts of OPD in children with CP, which affects nutrition and overall well-being. Future research should address the need for standardized evaluation methods and effective interventions to balance nutritional needs with practical mealtime strategies.
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Affiliation(s)
- Andrea Calderone
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, C.da Casazza, S.S. 113, Messina, 98124, Italy
| | - David Militi
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, 98125, Italy
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, C.da Casazza, S.S. 113, Messina, 98124, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, C.da Casazza, S.S. 113, Messina, 98124, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, C.da Casazza, S.S. 113, Messina, 98124, Italy.
| | - Angela Militi
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, 98125, Italy
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Sorhage A, Blackmore AM, Byrnes CA, Agnew C, Webster EFM, Mackey A, Chong J, Hill TM, Han DY, Stott NS. Eating and drinking abilities and respiratory and oral health in children and young adults with cerebral palsy. Dev Med Child Neurol 2025. [PMID: 39973209 DOI: 10.1111/dmcn.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 01/09/2025] [Accepted: 01/15/2025] [Indexed: 02/21/2025]
Abstract
AIM To investigate the potential risk factors of respiratory illness (ethnicity, oral health, and eating and drinking ability) in children and young adults with cerebral palsy (CP). METHOD This was an observational study using a validated CP Respiratory and Oral Health questionnaire with 90 participants (median age 12 years [range: 1-26 years]; 51 males; and 26 New Zealand Māori). RESULTS Multivariate analysis, accounting for ethnicity and Gross Motor Function Classification System (GMFCS) levels, showed that those participants who were classified in Eating and Drinking Ability Classification System (EDACS) levels III to V reported more previous respiratory disease episodes (odds ratio [OR] = 4.13, 95% confidence interval [CI] = 1.12-15.2, p = 0.033), increased daily/weekly respiratory symptoms (OR = 9.14, 95% CI = 2.03-41.2, p = 0.004), and increased mealtime respiratory symptoms (OR = 13.8, 95% CI = 2.48-76.8, p = 0.002). Both EDACS levels III to V and GMFCS levels IV and V were independently associated with increased propensity to reflux or seizures (OR = 8.16, 95% CI = 1.77-37.5, p = 0.007; OR = 3.37, 95% CI = 1.09-10.4, p < 0.034). Mealtime symptoms of vomiting or regurgitation (relative risk = 1.58, 95% CI = 1.17-2.13, p = 0.032) and daily coughing (relative risk = 1.55, 95% CI = 1.14-2.11, p = 0.023) were associated with a higher risk of reporting one or more oral health symptoms. Toothache was more common in participants classified in EDACS levels III to V (χ2, p = 0.021). INTERPRETATION Children with CP classified in EDACS levels III to V are at a higher risk of respiratory disease and toothache and should be screened appropriately. Regurgitation or vomiting of food and daily coughing are linked with poorer oral health.
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Affiliation(s)
- Alexandra Sorhage
- Paediatric Orthopaedics, Starship Children's Health, Auckland, New Zealand
| | - A Marie Blackmore
- Telethon Kids Institute, Perth, WA, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Catherine A Byrnes
- Paediatric Respiratory Services, Starship Children's Health, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Caitlin Agnew
- Hospital & Specialist Dentistry Regional Service, Auckland, New Zealand
| | - Emily F M Webster
- Kidz First Children's Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Anna Mackey
- Paediatric Orthopaedics, Starship Children's Health, Auckland, New Zealand
| | - Jimmy Chong
- Paediatric Rehabilitation, Starship Children's Health, Auckland, New Zealand
| | - Timothy M Hill
- Kidz First Children's Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Dug Yeo Han
- Starship Research and Innovation, Starship Children's Health, Auckland, New Zealand
| | - Ngaire Susan Stott
- Paediatric Orthopaedics, Starship Children's Health, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Saito Y, Arai Y, Omae T, Watanabe K, Saiki Y, Tanaka T, Hosoda C, Tamasaki-Kondo A, Maegaki Y, Okada K. Prevention of chronic pneumonia in children with severe motor and intellectual disabilities by long-term tobramycin inhalation: Its benefits and limitations. Brain Dev 2025; 47:104317. [PMID: 39787993 DOI: 10.1016/j.braindev.2024.104317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 12/19/2024] [Accepted: 12/23/2024] [Indexed: 01/12/2025]
Abstract
AIM To determine the effect of long-term tobramycin (TOB) inhalation therapy on recurrent pneumonia among ventilator-dependent children with profound neurological disabilities. METHODS TOB inhalation was performed in eight series of trials in seven ventilator-dependent children who had intratracheal Pseudomonas aeruginosa and suffered from recurrent pneumonia. Their age at the initiation of therapy was 68 ± 50 months (mean ± standard deviation), whereas the duration of treatment was 30 ± 22 months. The participants were followed after the termination of therapy for a period of 38 ± 32 months. RESULTS The annual rate of pneumonia was 5.6 episodes per year (n = 8) preceding the initiation of inhalation, which decreased to 3.7 (n = 8), 1.6 (n = 5), and 0.67 (n = 3) in the periods of 0-12, 12-24, and 24-36 months after initiation, respectively. The rates were 1.0 (n = 6), 0.6 (n = 5), and 1.4 (n = 5) in the periods of 0-12, 12-24, and 24-36 months after the termination of therapy. INTERPRETATION Extended TOB inhalation therapy was effective in decreasing the morbidity of pneumonia in ventilator-dependent children with severe motor and intellectual disabilities.
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Affiliation(s)
- Yoshiaki Saito
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, National Rehabilitation Center for Disabled Children, Tokyo, Japan.
| | - Yuto Arai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takanori Omae
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Keisuke Watanabe
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, Akita University Hospital, Japan
| | - Yusuke Saiki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, Tottori Prefectural Rehabilitation Center for Children with Disabilities, Yonago, Japan
| | - Toshiaki Tanaka
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, Belland General Hospital, Sakai, Japan
| | - Chika Hosoda
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Hiroshima City Education and Rehabilitation Center for Children, Hiroshima City Social Welfare Corporation, Hiroshima, Japan
| | - Akiko Tamasaki-Kondo
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Hakuai Child Development, Home Care Support Clinic, Yonago, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kensaku Okada
- Division of Infectious Diseases, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
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Jarock C, Sheriko J, Hurtubise K. Exploring the Parental Perspectives and Experiences With the Use of a Home Mechanical Insufflation-Exsufflation Device. Respir Care 2025; 70:48-55. [PMID: 39964856 PMCID: PMC11824876 DOI: 10.1089/respcare.11689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2025]
Abstract
Background: A mechanical insufflation-exsufflation (MI-E) device is a commonly used tool for airway clearance in children with an ineffective cough. Whereas the device has been shown to have multiple benefits, limited evidence exists regarding parents' experiences with its home use in the Canadian context. This study's objective was to explore the perspectives and experiences of parents who receive service through the IWK Health Centre and use an MI-E device at home with their child. Methods: The study used an interpretive description design. Semi-structured interviews, conducted with 9 participants, were audio recorded and transcribed verbatim. Transcripts were analyzed using a reflective thematic process. Results: Seven mothers and 2 fathers were interviewed. Following analysis, 3 themes were identified: (1) Learning about the MI-E device described participants' journey from becoming aware of the device to acquiring knowledge and skills about its use; (2) using the device detailed the integral role the MI-E device played in their lives, including decisions around use, and parental role; and (3) changing lives outlined the physical, emotional, and social benefits the device provided to the child and their family. Conclusions: Participants provided detailed descriptions of their journey from learning to integrating the MI-E device into their child's daily routine and family life. Its multiple associated benefits improved the child's and their family's quality of life. However, better education on its use was highlighted as a need for both parents and the health care professionals who work with them.
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Affiliation(s)
- Carolyn Jarock
- Ms. Jarock is affiliated with IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jordan Sheriko
- Dr. Sheriko is affiliated with Department of Pediatrics, Medicine, Dalhousie University, Rehabilitation Services, IWK Health, Halifax, Nova Scotia, Canada
| | - Karen Hurtubise
- Dr. Sheriko is affiliated with Department of Pediatrics, Medicine, Dalhousie University, Rehabilitation Services, IWK Health, Halifax, Nova Scotia, Canada
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Apostolou G, Cooper MS, Antolovich G, Vandeleur M, Frayman KB. The management of Pseudomonas aeruginosa respiratory infection in children with cerebral palsy: A narrative review. Pediatr Pulmonol 2024; 59:3170-3177. [PMID: 39347603 DOI: 10.1002/ppul.27284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 08/23/2024] [Accepted: 09/14/2024] [Indexed: 10/01/2024]
Abstract
Children with cerebral palsy have increased respiratory morbidity and mortality. Infection with Pseudomonas aeruginosa (PA) is associated with poorer outcomes, yet there are no formal guidelines to inform treatment of respiratory infection in children with cerebral palsy. This review explores the existing literature regarding management of PA-infection in children with cerebral palsy, with the aim of synthesising clinical recommendations and identifying gaps in current understanding. Medline (Ovid), PubMed and Embase were searched using keywords. Full-text articles involving the paediatric population and antimicrobial therapy were included. There was no limit on date of publication. Four retrospective case series were identified. Respiratory microbiology, in samples collected from a range of sites along the respiratory tract, was reported in three studies. Patients who received PA-specific antibiotics clinically improved. Two studies suggest that the use of suppressive inhaled anti-pseudomonal therapy may improve respiratory morbidity in the chronic setting. There is minimal evidence to guide management of PA respiratory infection in children with cerebral palsy. Children with cerebral palsy are at risk of developing bronchiectasis, so in the absence of high-quality evidence, management should be informed by extrapolating from the non-cystic fibrosis bronchiectasis guidelines. Further research examining surveillance and management of PA-infection in this population is required given that early intervention may prevent irreversible lung damage.
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Affiliation(s)
- Georgia Apostolou
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Monica S Cooper
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Giuliana Antolovich
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Moya Vandeleur
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Katherine B Frayman
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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de Oliveira TA, Drumond VZ, Kimura ACRS, de Arruda JAA, Pani SC, Mesquita RA, da Rocha NB, Abreu LG. Comprehensive assessment of periodontal health in cerebral palsy: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2024; 44:1547-1557. [PMID: 39080876 DOI: 10.1111/scd.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/14/2024] [Accepted: 07/19/2024] [Indexed: 11/14/2024]
Abstract
AIMS Cerebral palsy (CP) is the term for a set of neurological disorders resulting from brain damage that impairs motor function. The aim of the present study was to perform a systematic review of the literature to determine whether individuals with CP are at a greater risk of negative periodontal health outcomes compared to those without CP. METHODS This study followed the recommendations of the MOOSE guidelines. Electronic searches were conducted in the PubMed, Web of Science, Scopus, Ovid, Embase, and PsycInfo databases. Observational studies assessing periodontal outcomes in individuals with CP were included. Risk of bias was appraised using the Newcastle-Ottawa scale. Meta-analyses were conducted and the results were presented using standardized mean differences (SMD), odds ratios (OR), and 95% confidence intervals (CI). The strength of the evidence was also assessed. RESULTS A total of 316 records were retrieved from the electronic databases, 17 of which were included in the qualitative synthesis. Meta-analyses revealed significantly higher scores in individuals with CP compared to those without CP for the oral hygiene index (SMD = 0.47 [95% CI: 0.17-0.78, I2 = 80%), gingival index (SMD = 0.75 [95% CI: 0.39-1.11], I2 = 79%), plaque index (SMD = 0.70 [95% CI: 0.07-1.33], I2 = 93%), and calculus index (SMD = 0.98 [95% CI: 0.76-1.20], I2 = 0%). However, no significant difference was found between groups for the prevalence of gingivitis (OR = 1.27 [95% CI: 0.28-5.66], I2 = 93%). The risk of bias for the outcome assessment and statistical tests was low. The strength of the evidence was deemed very low. CONCLUSION Individuals with CP may experience more significant negative periodontal health outcomes compared to those without CP.
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Affiliation(s)
| | - Victor Zanetti Drumond
- Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - José Alcides Almeida de Arruda
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sharat Chandra Pani
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Najara Barbosa da Rocha
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Martin‐Sanchez C, Barbero‐Iglesias FJ, Amor‐Esteban V, Martin‐Sanchez M, Martin‐Nogueras AM. Benefits of inspiratory muscle training therapy in institutionalized adult people with cerebral palsy: A double-blind randomized controlled trial. Brain Behav 2024; 14:e70044. [PMID: 39295105 PMCID: PMC11410885 DOI: 10.1002/brb3.70044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 08/13/2024] [Accepted: 08/25/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Respiratory health problems are one of the main causes of morbidity and mortality in adult people with cerebral palsy (CP). The influence of respiratory muscle training has not yet been studied in this population group. The objective of the study was to evaluate and compare the efficacy of two protocols with inspiratory muscle training (IMT), low intensity and high intensity, to improve respiratory strength and pulmonary function in adults with CP. METHODS The study was a controlled, randomized, double-blind trial with allocation concealment. Twenty-seven institutionalized CP patients were recruited and randomly distributed in the high-intensity training group (HIT) or low-intensity training group (LIT). Over 8 weeks, an IMT protocol was followed 5 days/week, 10 series of 1 min with 1 min rest between them. HIT trained with a load of 40% of the maximum inspiratory pressure (MIP) and LIT with 20%. Respiratory strength and pulmonary function were evaluated. RESULTS After IMT intervention, MIP, maximum expiratory pressure, forced expiratory volume in 1 s (FEV1) and peak expiratory flow increased in both groups; in HIT 29%, 19%, 13%, and 8%, respectively (p = 0.000, p = 0.000, p = 0.002, p = 0.001) and in LIT 17%, 7%, 3%, and 4%, respectively (p = 0.000, p = 0.000, p = 0.049, p = 0.113). All the improvements were significantly higher in HIT than in LIT. CONCLUSION Inspiratory muscle training improved respiratory muscle strength and pulmonary function in adults with CP. Training with a 40% MIP load improved all the evaluated parameters and was the most effective treatment for adults with CP.
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Affiliation(s)
- Carlos Martin‐Sanchez
- Nursing and Physiotherapy DepartmentUniversity of SalamancaSalamancaSpain
- NEUROUSAL Research Group (Investigation in Neurorehabilitation)SalamancaSpain
| | | | | | | | - Ana Maria Martin‐Nogueras
- Nursing and Physiotherapy DepartmentUniversity of SalamancaSalamancaSpain
- NEUROUSAL Research Group (Investigation in Neurorehabilitation)SalamancaSpain
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14
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Nahar A, Jain S, Paul S. Advances in Cerebral Palsy Treatment. RECENT PATENTS ON ENGINEERING 2024; 18. [DOI: 10.2174/1872212118666230822124440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 01/05/2025]
Abstract
Background:Cerebral palsy is a complex neurodevelopmental disorder with various etiological factors and treatment options. This narrative review aimed to summarize the causes of cerebral palsy, identify areas needing additional research in treatment approaches, and highlight areas requiring further investigation. In order to provide a thorough overview of management techniques to lessen the effects of the illness and its consequences, this review has drawn data from a number of studies.Introduction:Prematurity increases the risk of brain damage during the developing stage and accounts for a sizable fraction of cerebral palsy cases. In a sizable portion of cases, maternal diabetes and hypertension are listed as the main causes. Damage to the brain tissue results from hypoxic-ischemic injuries sustained during pregnancy that upset the equilibrium of oxidants and antioxidants. To alter the oxidative stress pathway and ease related issues, pharmacological treatments, such as therapeutic hypothermia, free radical inhibition therapy, and mitochondrial therapy, have been proposed. Therapeutic strategies, such as physiotherapy, occupational therapy, speech therapy, and surgical interventions, have added quality to the lives of the children. Some of the most recent developments in this area include the development of biomarkers for muscle activity detection, machine learning to predict the types of cerebral palsy and abnormal movements, disease prediction with eye images, wireless inertia measuring unit for spasticity detection, computerbased video analysis of typical and atypical infants, identification of intellectual disabilities with algorithms, and deep learning methods for predicting cerebral palsy.Methods:This narrative review is based on a careful analysis of numerous researches conducted on cerebral palsy, which have served as the basis for statistical distribution. It reviews the causes of cerebral palsy, available treatments, and ongoing research with the goal of providing physicians and researchers in the field with useful information. The objectives, study questions, inclusion criteria, and search approach have all been outlined in a thorough protocol. To find pertinent research published up to September 2021, a literature search was carried out using electronic databases, including Google Scholar, PubMed, Cochrane Library, Scopus, and Web of Science. A combination of pertinent keywords, such as "cerebral palsy," "management," "technology," "wearable technology," "prematurity," and "artificial intelligence," has been used in the search approach.Results:Recent advances in the field include the discovery of biomarkers for the detection of muscle activity, machine learning algorithms to predict the types of cerebral palsy and abnormal movements, disease prediction using eye images, wireless inertia measuring units for the detection of spasticity, computer-based video analysis for the detection of atypical infants, and algorithms to identify intellectual disabilities. Additionally, employing technologies, like virtual reality systems, electrical stimulators, activity trackers, machine learning, and deep learning approaches, has shown promise in evaluating, diagnosing, and predicting treatment outcomes linked to gait, upper limb, and lower limb function.Conclusion:Future research should examine the clinical application of nanomedicine, stem cell therapy, and cutting-edge therapeutic strategies to prevent hypoxic-ischemic damage in the developing brain. Additionally, research is required to effectively assist children with severe speech difficulties using alternate communication modalities and cutting-edge computational tools. The outcomes for people with cerebral palsy can be improved by combining interdisciplinary efforts with cutting-edge technological interventions.
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Affiliation(s)
- Anjuman Nahar
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Shruti Jain
- Department of ECE, Jaypee University of Information Technology, Solan, Himachal Pradesh, India
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
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15
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Spoto G, Accetta AS, Grella M, Di Modica I, Nicotera AG, Di Rosa G. Respiratory Comorbidities and Complications of Cerebral Palsy. Dev Neurorehabil 2024; 27:194-203. [PMID: 38992903 DOI: 10.1080/17518423.2024.2374959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 04/29/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Respiratory complications are the most frequent cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP) and represent the leading cause of hospitalizations. Several factors negatively influence the respiratory status of these children: lung parenchymal alterations and factors modifying the pulmonary pump function of chest and respiratory muscles, as well as concomitant pathologies that indirectly affect the respiratory function, such as sleep disorder, malnutrition, epilepsy, and pharmacological treatments. Early management of respiratory complications can improve the global health of children with CP and enhance quality of life for them and their caregivers.
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Knight Lozano R, Shannon H, Gilby J, Goddard S, Turner L, Marsden J. Community-based respiratory health measures in children and young people with cerebral palsy: A scoping review. Dev Med Child Neurol 2024; 66:849-862. [PMID: 38269611 DOI: 10.1111/dmcn.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
AIM To identify, map, and describe outcome measurement domains and instruments used within a community setting to assess respiratory health in children and young people aged 1 to 18 years, diagnosed with cerebral palsy (CP). METHOD A scoping review methodology informed structured searches in nine databases, grey literature, and registries, conducted in August 2021 (updated in February 2023). Articles were screened for eligibility by two independent researchers. Any outcome measurement instruments used to assess respiratory health or associated impact were extracted, categorized, and mapped to health and health-related domains of the International Classification of Functioning, Disability, and Health. RESULTS Seventy-six outcome measurement instruments were identified across 78 articles worldwide between 1970 and 2023. These were categorized into 'Body functions and structures' (n = 20), 'Activity and performance' (n = 22), and 'Participation and quality of life' (n = 19), with a further 15 mapped to 'Health care resources use'. INTERPRETATION No consensus of 'what' to measure and 'how' to measure respiratory health in children and young people with CP was found. Moreover, many measures were not replicable in individuals with more severe forms of CP, excluding those at increased risk of respiratory-related morbidity and mortality. Further research is required to agree important outcome domains and associated measures in research and clinical practice. WHAT THIS PAPER ADDS A limited number and size of experimental designs were found. Seventy-six measures were identified to assess respiratory health in cerebral palsy. No consensus was found in 'what' or 'how' to measure respiratory health. Many measures were not replicable in children and young people at risk of poorer respiratory health outcomes. Children and young people with comorbidities and learning disability were frequently excluded from studies.
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Affiliation(s)
| | - Harriet Shannon
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Sian Goddard
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Leanne Turner
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
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17
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Menezes KKP, Avelino PR, Alvarenga MTM, Nascimento LR. Inspiratory Training for Improving Respiratory Strength, Pulmonary Function, and Walking in Cerebral Palsy: A Meta-Analysis. Pediatr Phys Ther 2024; 36:207-215. [PMID: 38568267 DOI: 10.1097/pep.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE To investigate the effects of inspiratory strength training on respiratory muscle strength, pulmonary function, and walking capacity in children with cerebral palsy, with Gross Motor Function Classification System I to III. METHODS Searches were conducted in CINAHL, LILACS, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases. The outcomes of interest were respiratory muscle strength, pulmonary function, and walking capacity. The quality was assessed by PEDro Scale. The Grading of Recommendations Assessment, Development, and Evaluation system was used to summarize the quality of evidence. RESULTS Inspiratory strength training increased the strength of inspiratory muscles and may increase the strength of the expiratory muscles. No changes were observed in pulmonary function or walking capacity. CONCLUSIONS This systematic review provides moderate-quality evidence that inspiratory strength training is effective for increasing inspiratory muscle strength in children with cerebral palsy. Benefits may be carried over to improving expiratory muscle strength but were not observed on pulmonary function or walking capacity.
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Affiliation(s)
- Kênia K P Menezes
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Drs Menezes and Avelino and Ms Alvarenga); Department of Physical Therapy, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil (Dr Nascimento)
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18
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Vennard H, Buchan E, Davies P, Gibson N, Lowe D, Langley R. Paediatric sleep diagnostics in the 21st century: the era of "sleep-omics"? Eur Respir Rev 2024; 33:240041. [PMID: 38925792 PMCID: PMC11216690 DOI: 10.1183/16000617.0041-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 06/28/2024] Open
Abstract
Paediatric sleep diagnostics is performed using complex multichannel tests in specialised centres, limiting access and availability and resulting in delayed diagnosis and management. Such investigations are often challenging due to patient size (prematurity), tolerability, and compliance with "gold standard" equipment. Children with sensory/behavioural issues, at increased risk of sleep disordered breathing (SDB), often find standard diagnostic equipment difficult.SDB can have implications for a child both in terms of physical health and neurocognitive development. Potential sequelae of untreated SDB includes failure to thrive, cardiopulmonary disease, impaired learning and behavioural issues. Prompt and accurate diagnosis of SDB is important to facilitate early intervention and improve outcomes.The current gold-standard diagnostic test for SDB is polysomnography (PSG), which is expensive, requiring the interpretation of a highly specialised physiologist. PSG is not feasible in low-income countries or outwith specialist sleep centres. During the coronavirus disease 2019 pandemic, efforts were made to improve remote monitoring and diagnostics in paediatric sleep medicine, resulting in a paradigm shift in SDB technology with a focus on automated diagnosis harnessing artificial intelligence (AI). AI enables interrogation of large datasets, setting the scene for an era of "sleep-omics", characterising the endotypic and phenotypic bedrock of SDB by drawing on genetic, lifestyle and demographic information. The National Institute for Health and Care Excellence recently announced a programme for the development of automated home-testing devices for SDB. Scorer-independent scalable diagnostic approaches for paediatric SDB have potential to improve diagnostic accuracy, accessibility and patient tolerability; reduce health inequalities; and yield downstream economic and environmental benefits.
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Affiliation(s)
- Hannah Vennard
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Elise Buchan
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Philip Davies
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Neil Gibson
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - David Lowe
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ross Langley
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
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Naidoo L, Pillay M, Naidoo U. Who really decides? Feeding decisions 'made' by caregivers of children with cerebral palsy. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e14. [PMID: 38572900 PMCID: PMC11019338 DOI: 10.4102/sajcd.v71i1.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND There are no definitive guidelines for clinical decisions for children with cerebral palsy (CP) requiring enteral feeds. Traditionally, medical doctors made enteral feeding decisions, while patients were essentially treated passively within a paternalistic 'doctor knows best' approach. Although a more collaborative approach to decision-making has been promoted globally as the favoured model among healthcare professionals, little is known about how these decisions are currently made practically. OBJECTIVES This study aimed to identify the significant individuals, factors and views involved in the enteral feeding decision-making process for caregivers of children with CP within the South African public healthcare sector. METHOD A single-case research design was used in this qualitative explorative study. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis. RESULTS Four primary individuals were identified by the caregivers in the decision-making process: doctors, speech therapists, caregivers' families and God. Four factors were identified as extrinsically motivating: (1) physiological factors, (2) nutritional factors, (3) financial factors and (4) environmental factors. Two views were identified as intrinsically motivating: personal beliefs regarding enteral feeding tubes, and feelings of fear and isolation. CONCLUSION Enteral feeding decision-making within the South African public healthcare sector is currently still dominated by a paternalistic approach, endorsed by a lack of caregiver knowledge, distinct patient-healthcare provider power imbalances and prescriptive multidisciplinary healthcare dialogues.Contribution: This study has implications for clinical practice, curriculum development at higher education training facilities, and institutional policy changes and development, thereby contributing to the current knowledge and clinical gap(s) in the area.
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Affiliation(s)
- Lavanya Naidoo
- Discipline of Speech-Language Therapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and Department of Speech Language Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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20
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Boerwinkle VL, Manjón I, Sussman BL, McGary A, Mirea L, Gillette K, Broman-Fulks J, Cediel EG, Arhin M, Hunter SE, Wyckoff SN, Allred K, Tom D. Resting-State Functional Magnetic Resonance Imaging Network Association With Mortality, Epilepsy, Cognition, and Motor Two-Year Outcomes in Suspected Severe Neonatal Acute Brain Injury. Pediatr Neurol 2024; 152:41-55. [PMID: 38198979 DOI: 10.1016/j.pediatrneurol.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND OBJECTIVES In acute brain injury of neonates, resting-state functional magnetic resonance imaging (MRI) (RS) showed incremental association with consciousness, mortality, cognitive and motor development, and epilepsy, with correction for multiple comparisons, at six months postgestation in neonates with suspected acute brain injury (ABI). However, there are relatively few developmental milestones at six months to benchmark against, thus, we extended this cohort study to evaluate two-year outcomes. METHODS In 40 consecutive neonates with ABI and RS, ordinal scores of resting-state networks; MRI, magnetic resonance spectroscopy, and electroencephalography; and up to 42-month outcomes of mortality, general and motor development, Pediatric Cerebral Performance Category Scale (PCPC), and epilepsy informed associations between tests and outcomes. RESULTS Mean gestational age was 37.8 weeks, 68% were male, and 60% had hypoxic-ischemic encephalopathy. Three died in-hospital, four at six to 42 months, and five were lost to follow-up. Associations included basal ganglia network with PCPC (P = 0.0003), all-mortality (P = 0.005), and motor (P = 0.0004); language/frontoparietal network with developmental delay (P = 0.009), PCPC (P = 0.006), and all-mortality (P = 0.01); default mode network with developmental delay (P = 0.003), PCPC (P = 0.004), neonatal intensive care unit mortality (P = 0.01), and motor (P = 0.009); RS seizure onset zone with epilepsy (P = 0.01); and anatomic MRI with epilepsy (P = 0.01). CONCLUSION For the first time, at any age, resting state functional MRI in ABI is associated with long-term epilepsy and RSNs predicted mortality in neonates. Severity of RSN abnormality was associated with incrementally worsened neurodevelopment including cognition, language, and motor function over two years.
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Affiliation(s)
- Varina L Boerwinkle
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina.
| | - Iliana Manjón
- University of Arizona College of Medicine - Tucson, Tucson, Arizona
| | - Bethany L Sussman
- Division of Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona
| | - Alyssa McGary
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, Arizona
| | - Lucia Mirea
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, Arizona
| | - Kirsten Gillette
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Jordan Broman-Fulks
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Emilio G Cediel
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Martin Arhin
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Senyene E Hunter
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Sarah N Wyckoff
- Division of Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona
| | - Kimberlee Allred
- Division of Neonatology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Deborah Tom
- Division of Neonatology, Phoenix Children's Hospital, Phoenix, Arizona
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Marpole R, Blackmore AM, Wilson AC, Cooper MS, Depiazzi J, Langdon K, Moshovis L, Geelhoed E, Bowen A, Gibson N. Can RESPiratory hospital Admissions in children with cerebral palsy be reduced? A feasibility randomised Controlled Trial pilot study protocol (RESP-ACT). BMJ Open 2024; 14:e076730. [PMID: 38365293 PMCID: PMC10875547 DOI: 10.1136/bmjopen-2023-076730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/11/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The most common cause of morbidity and mortality in children with severe cerebral palsy (CP) is respiratory disease. BREATHE-CP (Better REspiratory and Airway Treatment and HEalth in Cerebral Palsy) is a multidisciplinary research team who have conducted research on the risk factors associated with CP respiratory disease, a systematic review on management and a Delphi study on the development of a consensus for the prevention and management of respiratory disease in CP. These strategies have not been investigated; therefore, it is not known if implementation is feasible, if they improve patient outcomes or if they are acceptable for families. METHODS AND ANALYSIS Mixed-method feasibility pilot randomised controlled trial with economic analysis. Twenty children with CP aged 0-12 years who are at risk of respiratory disease will be followed up for 1 year. All children will receive baseline assessments for comparison. The control group will receive usual care from their treating teams. The intervention group will receive comprehensive assessments from physiotherapy, speech pathology and respiratory medicine. An individualised investigation and treatment plan will then be made. Participants in both groups will complete fortnightly patient-reported outcome surveys to assess symptoms and health service use. Analysis will include assessments of acceptability through qualitative interviews, implementation by ability to recruit, randomise and retain, practicality including costs of intervention and hospitalisation, and explore efficacy through quality-of-life surveys and decreased health service use for respiratory-related symptoms. ETHICS AND DISSEMINATION Ethics and governance approvals have been obtained through Child and Adolescent Health Service Human Research Ethics Committee. At completion, this study will lead to the design of the definitive protocol to test intervention efficacy that maximises recruitment, retention and adherence to interventions. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12620000114943).
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Affiliation(s)
- Rachael Marpole
- Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Cerebral Palsy Alliance, Forestville, New South Wales, Australia
| | - A Marie Blackmore
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew C Wilson
- Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Monica S Cooper
- Department of Neurodevelopment & Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julie Depiazzi
- Physiotherapy Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Katherine Langdon
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Kids Rehab, Perth Children's Hospital, Nedlands, Perth, Australia
| | - Lisa Moshovis
- Therapy Services, Ability Centre, Coolbinia, Western Australia, Australia
| | - Elizabeth Geelhoed
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Asha Bowen
- Menzies School of Health Research, Casuarina, Northern Territory of Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Noula Gibson
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Physiotherapy Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
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22
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Kolumbán E, Szabados M, Hernádfői M, Nguyen Do To U, Nagy R, Zolcsák Á, Müller KE, Sipos Z, Veres DS, Szőllősi A, Hegyi P, Garami M, Túri I. Supplementary Respiratory Therapy Improves Pulmonary Function in Pediatric Patients with Cerebral Palsy: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:888. [PMID: 38337582 PMCID: PMC10856351 DOI: 10.3390/jcm13030888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Despite medical advances, individuals with cerebral palsy (CP) face significant respiratory challenges, leading to heightened hospitalization rates and early mortality among this population. We hypothesize that integrating supplementary respiratory therapy into standard rehabilitation will result in significant improvements in pulmonary function, enhanced respiratory muscle strength, and an overall increase in the quality of life among pediatric patients with CP. METHODS A systematic search of literature across five databases was conducted, and random-effects meta-analyses were performed to assess the impact of supplementary respiratory therapy on (a) pulmonary function: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1 ratio, peak expiratory flow (PEF), and (b) respiratory muscle strength: maximal inspiratory and expiratory pressure (MIP, MEP), and (c) quality of life. Certainty of evidence was determined by the GRADE assessment. RESULTS Analysis of data from 11 eligible randomized controlled trials revealed clinically meaningful changes in pulmonary function. We found a relevant mean difference (MD) in absolute PEF of 0.50 L/s (95% confidence interval (CI): 0.19; 0.82 p = 0.0107). The certainty of the evidence ranged from moderate to high. CONCLUSIONS This study presents current evidence on the impact of various supplementary respiratory therapies for CP patients classified under gross motor function classification level I-IV, demonstrating clinically meaningful improvements in pulmonary function and respiratory muscle strength. These improvements suggest the potential for an enhanced quality of life. Our findings hold the promise of serving as a foundational reference for potential revisions to conventional rehabilitation care, incorporating supplementary respiratory therapy.
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Affiliation(s)
- Erika Kolumbán
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary;
| | - Márton Szabados
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Pediatric Center, Semmelweis University, 1083 Budapest, Hungary
| | - Márk Hernádfői
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Bethesda Children’s Hospital, 1146 Budapest, Hungary;
| | | | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Heim Pál National Pediatric Institute, 1089 Budapest, Hungary;
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Ádám Zolcsák
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Department of Biophysics and Radiation Biology, Semmelweis University, 1089 Budapest, Hungary
| | - Katalin Eszter Müller
- Heim Pál National Pediatric Institute, 1089 Budapest, Hungary;
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Department of Family Care Methodology, Faculty of Health Sciences, Semmelweis University, 1088 Budapest, Hungary
| | - Zoltán Sipos
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Institute of Bioanalysis, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Dániel Sándor Veres
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Department of Biophysics and Radiation Biology, Semmelweis University, 1089 Budapest, Hungary
| | | | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Institute of Pancreatic Diseases, Semmelweis University, 1085 Budapest, Hungary
| | - Miklós Garami
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- Pediatric Center, Semmelweis University, 1083 Budapest, Hungary
| | - Ibolya Túri
- Centre for Translational Medicine, Semmelweis University, 1094 Budapest, Hungary (M.H.); (R.N.); (Á.Z.); (D.S.V.); (P.H.); (M.G.); (I.T.)
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary;
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23
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Sharifian-Dorche M, La Piana R. General approach to treatment of genetic leukoencephalopathies in children and adults. HANDBOOK OF CLINICAL NEUROLOGY 2024; 204:335-354. [PMID: 39322388 DOI: 10.1016/b978-0-323-99209-1.00012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Despite the enormous advancements seen in recent years, curative therapies for patients with genetic leukoencephalopathies are available for only a relatively small number of disorders. Therefore, symptomatic treatment and preventive management of the multiple clinical manifestations of patients with genetic leukoencephalopathies are critical in their care. The goals of the symptomatic treatment are to improve patients' quality of life, increase their survival, and reduce the impact on medical resources and related expenses. The coordinated work of a multidisciplinary team, including all specialists involved in the care of these patients, is the gold standard approach to manage and treat their complex and evolving clinical picture. Along with a multidisciplinary team, the relationship and close collaboration with the patient and their caregivers are essential. Their insight into the disease manifestations and management of the different issues should be integrated with the assessments of the multidisciplinary team to prevent clinical complications and preserve the quality of life of patients and their caregivers. Genetic leukoencephalopathies are very heterogeneous in terms of age of onset, clinical features, and disease course. However, many clinical features and problems are shared by most forms. Consequently, common therapeutic strategies apply to the majority of these diseases. This chapter presents the symptomatic approach for shared core clinical features presented by patients with genetic leukoencephalopathies divided by systems and, for each system, the specificities of some genetic leukoencephalopathies.
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Affiliation(s)
- Maryam Sharifian-Dorche
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Roberta La Piana
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada; Department of Diagnostic Radiology, McGill University, Montreal, QC, Canada.
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24
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Yesmin MF, Chowdhury MRK, Bornee FA, Kader M, Mondal MNI, Hossain M, Rashid M. Urban-rural difference in factors associated with childhood functional difficulty in Bangladesh: a cross-sectional study. Front Public Health 2023; 11:1270853. [PMID: 38026377 PMCID: PMC10652778 DOI: 10.3389/fpubh.2023.1270853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Early childhood functional difficulty poses a substantial worldwide public health challenge, leading to adverse effects on children's quality of life and overall productivity. Moreover, it represents a significant social and economic problem in Bangladesh. Therefore, the current study aimed to identify factors contributing to childhood functional difficulty in Bangladesh within the context of urban-rural areas. Methods A nationally representative cross-sectional survey data from Multiple Indicator Cluster Survey (MICS), 2019 in Bangladesh was used in this study. Chi-square test and multivariable logistic regression analyses were carried out to identify factors associated with childhood functional difficulty. Results Functional difficulties were found in approximately 3.3% of children 2-4 years of age in urban areas and 2.5% in rural areas. Having a mother with functional difficulties and undernutrition were identified as significant factors common in both urban and rural areas. Further, mothers who had no formal education (AOR = 2.76, 95%CI = 1.18-6.45) and experienced infant death (AOR = 1.94, 95%CI = 1.01-3.70) were identified as significant factors of functional difficulty in urban areas. On the other hand, in rural areas, no access to mass media, children with acute respiratory infection (ARI) (AOR = 2.13, 95%CI = 1.39-3.28), female sex (AOR = 0.69, 95%CI = 0.53-0.91), child undernutrition (AOR = 1.73, 95%CI = 1.32-2.27) and poorer socio-economic status (AOR = 1.95, 95%CI = 1.08-3.55) were found significant factors. Conclusion Functional difficulty was found to be present in one out of every 35 children age 2 to 4 years in Bangladesh. Childhood functional difficulties were reported slightly higher in urban areas as compared to rural areas. Reducing childhood difficulties in urban areas demands comprehensive strategies: quality healthcare, inclusive education, community support, better information systems, and collaboration. To achieve urban-rural parity in child health, address disparities in economic development, healthcare, and education, especially for girls.
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Affiliation(s)
- Mst Farjana Yesmin
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Mohammad Rocky Khan Chowdhury
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Farzana Akhter Bornee
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Manzur Kader
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Md Nazrul Islam Mondal
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Mohammad Hossain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Mamunur Rashid
- Department of Public Health and Sports Science, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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25
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Petkus KD, Noritz G, Glader L. Examining the Role of Sublingual Atropine for the Treatment of Sialorrhea in Patients with Neurodevelopmental Disabilities: A Retrospective Review. J Clin Med 2023; 12:5238. [PMID: 37629280 PMCID: PMC10455410 DOI: 10.3390/jcm12165238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Sialorrhea is common in children with neurodevelopmental disabilities (NDD) and is reported in >40% of children with cerebral palsy (CP). It causes a range of complications, including significant respiratory morbidity. This single-center retrospective chart review aims to document sublingual atropine (SLA) utilization to guide further study in establishing its role in secretion management for children with NDD. A chart review was completed for patients with NDD ≤ 22 years of age treated with SLA at a free-standing children's hospital between 1 January 2016 and 1 June 2021. Descriptive statistics were generated to summarize findings. In total, 190 patients were identified, of which 178 met inclusion criteria. The average starting dose for SLA was 1.5 mg/day, or 0.09 mg/kg/day when adjusted for patient weight. Eighty-nine (50%) patients were prescribed SLA first line for secretion management while 85 (48%) patients tried glycopyrrolate prior to SLA. SLA was used after salivary Botox, ablation, and/or surgery in 16 (9%) patients. This study investigates SLA as a potential pharmacologic agent to treat sialorrhea in children with NDD. We identify a range of prescribing patterns regarding dosing, schedule, and place in therapy, highlighting the need for further evidence to support and guide its safe and efficacious use.
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Affiliation(s)
- Kayla Durkin Petkus
- Division of Complex Care, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (G.N.); (L.G.)
- Department of Pharmacy, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Garey Noritz
- Division of Complex Care, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (G.N.); (L.G.)
| | - Laurie Glader
- Division of Complex Care, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (G.N.); (L.G.)
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26
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Jawed A, Mowry M. Strengthening Equitable Access to Care and Support for Children with Cerebral Palsy and Their Caregivers. CHILDREN (BASEL, SWITZERLAND) 2023; 10:994. [PMID: 37371227 DOI: 10.3390/children10060994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Cerebral palsy is one of the most prevalent groups of motor disorders affecting children and adults across the world. As increasingly more children with cerebral palsy are living longer into adulthood, it is ever more crucial to ensure access to timely and needed early intervention from the onset of diagnosis, on a continuum, to optimize medical, developmental, socio-emotional, and academic outcomes for these children over time. The American Academy of Pediatrics (AAP), in collaboration with the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM), substantially revised the clinical practice guidelines for cerebral palsy in 2022, after their prior publication of the guidelines in 2006. The revised guidelines account for a range of considerations that are in line with the biopsychosocial, risk and resilience, and family-centered care models as well as promote a more strengths-based approach to care. Furthermore, there is increased emphasis in the guidelines on promoting equitable access to care as part of contributing towards health equity for all children with cerebral palsy. In addition, the 2022 guidelines clearly present recommendations for earlier diagnosis of cerebral palsy, potentially as early as infancy, as the basis for activating access to early intervention services for children that can bolster their neuroplasticity and global development from an earlier age onward. We consolidate the existing literature on caregiver perceptions, beliefs and concerns surrounding earlier diagnosis of cerebral palsy and connect them to the recommendations in the revised guidelines. We also delineate several considerations surrounding education for healthcare providers and caregivers of children in navigating the chronicity of cerebral palsy in both community and healthcare contexts. There is a scant amount of literature on cerebral palsy across traditional and nontraditional sources of media in published studies, which we also review. Lastly, we present a wealth of recommendations for further research and practice that account for the revised 2022 guidelines, caregiver preferences and acceptability of care, and health equity as the bases for strengthening equitable access to care for children with cerebral palsy on a continuum as they transition into adulthood.
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Affiliation(s)
- Aysha Jawed
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Social Work, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
| | - Michelle Mowry
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Nursing, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
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27
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Chen JX, Shi XL, Liang CS, Ma XG, Xu L. Anesthesia management in a pediatric patient with complicatedly difficult airway: A case report. World J Clin Cases 2023; 11:2482-2488. [PMID: 37123316 PMCID: PMC10130984 DOI: 10.12998/wjcc.v11.i11.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/31/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Reports on perioperative anesthesia management in pediatric patients with difficult airways are scarce. In addition to relatively more difficulties in the technique of endotracheal intubation, the time for manipulation is restricted compared to adults. Securing the airways safely and avoiding the occurrence of hypoxemia in these patients are of significance.
CASE SUMMARY A 9-year-old boy with spastic cerebral palsy, severe malnutrition, thoracic scoliosis, thoracic and airway malformation, laryngomalacia, pneumonia, and epilepsy faced the risk of anesthesia during palliative surgery. After a thorough preoperative evaluation, a detailed scheme for anesthesia and a series of intubation tools were prepared by a team of anesthesiologists. Awake fiberoptic intubation is the widely accepted strategy for patients with anticipated difficult airways. Given the age and medical condition of the patient, we kept him sedated with spontaneous breathing during endotracheal intubation. The endotracheal intubation was completed on the second attempt after the failure of the first effort. Fortunately, the surgery was successful without postoperative complications.
CONCLUSION Dealing with difficult airways in the pediatric population, proper sedation allows time to intubate without interrupting spontaneous breathing. The appropriate endotracheal intubation method based on the patient’s unique characteristics is the key factor in successful management of these rare cases.
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Affiliation(s)
- Jia-Xiang Chen
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
- Department of Anesthesiology, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518038, Guangdong Province, China
| | - Xiao-Li Shi
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
| | - Chang-Sheng Liang
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
| | - Xing-Gang Ma
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
| | - Liang Xu
- Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
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28
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Mellodge P, Saavedra S, Tran Poit L, Pratt KA, Goodworth AD. Quantifying States and Transitions of Emerging Postural Control for Children Not Yet Able to Sit Independently. SENSORS (BASEL, SWITZERLAND) 2023; 23:3309. [PMID: 36992020 PMCID: PMC10054170 DOI: 10.3390/s23063309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
Objective, quantitative postural data is limited for individuals who are non-ambulatory, especially for those who have not yet developed trunk control for sitting. There are no gold standard measurements to monitor the emergence of upright trunk control. Quantification of intermediate levels of postural control is critically needed to improve research and intervention for these individuals. Accelerometers and video were used to record postural alignment and stability for eight children with severe cerebral palsy aged 2 to 13 years, under two conditions, seated on a bench with only pelvic support and with additional thoracic support. This study developed an algorithm to classify vertical alignment and states of upright control; Stable, Wobble, Collapse, Rise and Fall from accelerometer data. Next, a Markov chain model was created to calculate a normative score for postural state and transition for each participant with each level of support. This tool allowed quantification of behaviors previously not captured in adult-based postural sway measures. Histogram and video recordings were used to confirm the output of the algorithm. Together, this tool revealed that providing external support allowed all participants: (1) to increase their time spent in the Stable state, and (2) to reduce the frequency of transitions between states. Furthermore, all participants except one showed improved state and transition scores when given external support.
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Affiliation(s)
- Patricia Mellodge
- Department of Electrical and Computer Engineering, College of Engineering, Technology, and Architecture, University of Hartford, West Hartford, CT 06117, USA
| | - Sandra Saavedra
- Physical Therapy Program, College of Health Sciences, Western University of Health Sciences-Oregon, Lebanon, OR 97355, USA;
| | | | - Kristamarie A. Pratt
- Department of Rehabilitation Sciences, College of Education, Nursing and Health Professions, University of Hartford, West Hartford, CT 06117, USA;
| | - Adam D. Goodworth
- Department of Kinesiology, Westmont College, Santa Barbara, CA 93108, USA;
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29
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Zielinski D. Pulmonary complications with complex chronic neurological disorders. Dev Med Child Neurol 2023; 65:152-153. [PMID: 35972849 DOI: 10.1111/dmcn.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/04/2023]
Affiliation(s)
- David Zielinski
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Quebec, Canada
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30
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Tamura F, Kikutani T, Machida R, Isoda T, Hobo K, Yamada H, Kodama M, Genkai S, Mizukami M, Tanaka Y, Sakuda T, Furuya H, Takahashi N. Usefulness of Telemedicine for Disabled Children Receiving Feeding Therapy. Dysphagia 2023; 38:425-434. [PMID: 35768661 PMCID: PMC9244222 DOI: 10.1007/s00455-022-10482-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/10/2022] [Indexed: 01/27/2023]
Abstract
We performed a retrospective cohort study using medical records of 374 pediatric patients who visited a university dental clinic specializing in dysphagia rehabilitation in Japan between 2019 and 2020 to clarify the usefulness of telemedicine among disabled children receiving feeding therapy. The primary outcome was the feeding developmental stage confirmed at the final evaluation. Propensity score matching was performed between individuals in two treatment groups (in-person and telemedicine) before the final analysis using patients' age, sex, primary disease, gross motor function, and feeding developmental stage as covariates. A total of 36 patients were enrolled in each of the in-person and telemedicine groups. The initial evaluation for the propensity score matched population using the χ2 test showed no significant difference between the two groups in any parameter. The feeding developmental stage evaluated at the final evaluation using the Wilcoxon signed-rank test significantly improved compared with the stage at the initial evaluation in both groups (in-parson group, p = 0.007; telemedicine group, p = 0.013). The difference in level achieved at the final evaluation revealed that the most common level was "unchanged," followed by "improvement by one level" in both groups, indicating that there was no significant difference in the efficacy of feeding therapy between the two groups (p = 0.314). Our results show that telemedicine can achieve the same therapeutic outcomes as in-person therapy to improve feeding function in children with disabilities when receiving feeding therapy.
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Affiliation(s)
- Fumiyo Tamura
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan.
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan.
| | - Takeshi Kikutani
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Reiko Machida
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Tomoko Isoda
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Kimiko Hobo
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Hiroyuki Yamada
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Miho Kodama
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Sae Genkai
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Miki Mizukami
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Yuko Tanaka
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Taeko Sakuda
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Hiroyasu Furuya
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
| | - Noriaki Takahashi
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tama Oral Rehabilitation Clinic, Koganei-shi, Tokyo, Japan
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31
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Wahyuni LK. Multisystem compensations and consequences in spastic quadriplegic cerebral palsy children. Front Neurol 2023; 13:1076316. [PMID: 36698899 PMCID: PMC9868261 DOI: 10.3389/fneur.2022.1076316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Spastic quadriplegic cerebral palsy (CP) is a permanent neuromuscular disorder causing limitation on all four limbs following a lesion on the developing brain. Most children with spastic quadriplegic CP are identified to be Gross Motor Function Classification System (GMFCS) level V, thus they have more comorbidities compared to other types at lower levels. Spastic quadriplegic CP is characterized by weak and inactive postural muscles of the neck and trunk, hence, they will undergo a total body extension as a compensatory mechanism leading to an atypical movement pattern, that give rise to multisystem consequences that reduce their quality of life. The relationship between atypical movement patterns, compensatory strategies, and multisystem consequences have not yet been explored. In fact, these multisystem consequences aggravate their condition and make movement much more atypical, forming a vicious cycle. This review aimed to provide a summary and highlight the mechanism of atypical movement pattern, multisystem compensations, and consequences in spastic quadriplegic CP children. It is true that central nervous system (CNS) lesion in CP is non-progressive, however the multisystem consequences may impair overall function over time. An understanding of how compensatory strategy and multisystem consequences in spastic quadriplegic CP offers the opportunity to intervene as early as possible to improve their quality of life.
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Affiliation(s)
- Luh Karunia Wahyuni
- Physical Medicine and Rehabilitation Department, Dr. Cipto Mangunkusumo Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Chen DW, Billings KR, Ida JB, Lavin J, Ghadersohi S, Valika T. Salivary gland surgery and nonviral respiratory-related hospitalizations in children with neurodevelopmental impairment. Int J Pediatr Otorhinolaryngol 2022; 163:111362. [PMID: 36327912 DOI: 10.1016/j.ijporl.2022.111362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Neurodevelopmentally impaired (NI) children with chronic sialorrhea are at elevated risk for aspiration and respiratory tract infections. Direct resection or ligation ("DROOL") of the submandibular glands (SMG) with parotid duct ligation are surgical interventions intended to decrease salivary output. The objective of this study is to determine the impact of DROOL surgery on the incidence of nonviral respiratory-related (NVR) post-procedure hospital encounters including emergency department visits and admissions. METHODS Retrospective case series of NVR related outcomes after DROOL surgery in children performed at a single institution, tertiary referral center. RESULTS A total of 35 gastrostomy tube-dependent patients (60% male, average age 8.2 [SD 6.0] years) with NI underwent DROOL surgery (86% SMG excision). Pre- and post-surgical follow-up time was 3.6 and 3.2 years, respectively. Presurgical and postsurgical NVR hospital encounters occurred in 28 (80%) and 14 (40%) patients, respectively (p < 0.01). Mean (SD) postoperative NVR hospital encounters occurred less frequently when compared to presurgical period (0.4 [0.6] vs. 1.0 [1.2] per year, p < 0.01) with average change of -0.7 encounters per year (SD 1.4, 95% CI -1.0 to -0.2). Patients with encounters within a year preceding DROOL (OR 4.9, p = 0.04, 95% CI 1.1-22.8), or those with at least 3 preoperative encounters (OR 8.0, p = 0.01, 95% CI 1.6-40.3) were significantly associated with a postsurgical NVR event. Fewer patients used anti-sialorrhea medication postoperatively compared to preoperatively (60% vs. 17%, p < 0.01). No patient developed surgical site complications requiring operative interventions. CONCLUSIONS DROOL surgery for chronic sialorrhea in patients with NI was associated with decreased hospitalization and ED visits for NVR respiratory events post-procedurally. Sialorrhea may be an actionable source of recurrent respiratory illnesses requiring hospitalizations. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Diane W Chen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Kathleen R Billings
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Jonathan B Ida
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Jennifer Lavin
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Saied Ghadersohi
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Taher Valika
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA.
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Respiratory Health Inequities among Children and Young Adults with Cerebral Palsy in Aotearoa New Zealand: A Data Linkage Study. J Clin Med 2022; 11:jcm11236968. [PMID: 36498542 PMCID: PMC9739165 DOI: 10.3390/jcm11236968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Respiratory disease is a leading cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP). This study describes the prevalence of CP-related respiratory disease and the non-modifiable risk factors for respiratory-related hospital admissions in the Aotearoa New Zealand population. (2) Methods: New Zealand Cerebral Palsy Register (NZCPR) participant data and de-identified data from the National Minimum Dataset and Pharmaceutical Dispensing Collections were linked to identify all respiratory-related hospital admissions and respiratory illness-related antibiotic exposure over 5 years in individuals with CP (0−26 years). (3) Results: Risk factors for respiratory-related hospital admissions included being classified Gross Motor Function Classification System (GMFCS) IV or V compared to GMFCS I [OR = 4.37 (2.90−6.58), p < 0.0001; OR = 11.8 (7.69−18.10), p < 0.0001, respectively,]; having ≥2 antibiotics dispensed per year [OR = 4.42 (3.01−6.48), p < 0.0001]; and being of Māori ethnicity [OR = 1.47 (1.13−1.93), p < 0.0047]. Māori experienced health inequities compared to non-Māori, with greater functional disability, and also experienced greater antibiotic dispensing than the general population. (4) Conclusion: Māori children and young adults have a higher risk of respiratory-related illness. Priority should be given to the screening for potentially modifiable risk factors for all children with CP from diagnosis onwards in a way that ensures Māori health equity.
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Perioperative Care of Children with Severe Neurological Impairment and Neuromuscular Scoliosis- A Practical Pathway to Optimize Peri-Operative Health and Guide Decision Making. J Clin Med 2022; 11:jcm11226769. [PMID: 36431246 PMCID: PMC9696380 DOI: 10.3390/jcm11226769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Neuromuscular scoliosis is a common feature in children with severe neurological impairment (SNI), including those with severe cerebral palsy. Surgical correction of scoliosis is the mainstay of treatment. This group of patients also have associated medical complexity. The complication rates post-surgery are high, although, for many, they are worth the risk. There are currently no published practice guidelines or care pathways for children with SNI who are undergoing scoliosis corrective surgery. In response to the high uptake of this surgery, coupled with the expected complication rates, our hospital established a perioperative clinic. The purpose of this paper is to describe our perioperative approach. This clinic has developed into a service beyond perioperative care and, with the collaborative meeting, enables shared decision-making to identify the right candidate for surgery. The process involves surgical expertise, understanding the family and child at the centre, and optimisation of medical care pre- and post-surgery. In this paper, we describe the process in a step-by-step manner. We provide clinical vignettes, as well as the proformas that we use, and we highlight the benefits of the team-based process.
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A Review on Recent Advances of Cerebral Palsy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2622310. [PMID: 35941906 PMCID: PMC9356840 DOI: 10.1155/2022/2622310] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 12/04/2022]
Abstract
This narrative review summarizes the latest advances in cerebral palsy and identifies where more research is required. Several studies on cerebral palsy were analyzed to generate a general idea of the prevalence of, risk factors associated with, and classification of cerebral palsy (CP). Different classification systems used for the classification of CP on a functional basis were also analyzed. Diagnosis systems used along with the prevention techniques were discussed. State-of-the-art treatment strategies for CP were also analyzed. Statistical distribution was performed based on the selected studies. Prevalence was found to be 2-3/1000 lives; the factors that can be correlated are gestational age and birth weight. The risk factors identified were preconception, prenatal, perinatal, and postnatal categories. According to the evidence, CP is classified into spastic (80%), dyskinetic (15%), and ataxic (5%) forms. Diagnosis approaches were based on clinical investigation and neurological examinations that include magnetic resonance imaging (MRI), biomarkers, and cranial ultrasound. The treatment procedures found were medical and surgical interventions, physiotherapy, occupational therapy, umbilical milking, nanomedicine, and stem cell therapy. Technological advancements in CP were also discussed. CP is the most common neuromotor disability with a prevalence of 2-3/1000 lives. The highest contributing risk factor is prematurity and being underweight. Several preventions and diagnostic techniques like MRI and ultrasound were being used. Treatment like cord blood treatment nanomedicine and stem cell therapy needs to be investigated further in the future to apply in clinical practice. Future studies are indicated in the context of technological advancements among cerebral palsy children.
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Smith S, Flanigan M, Haynes S, Michael A, Wolff T. Evaluating a community respiratory physiotherapy service for children with neurodisability. BMJ Open Qual 2022; 11:e001683. [PMID: 35241438 PMCID: PMC8896052 DOI: 10.1136/bmjoq-2021-001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/12/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Children with neurodisability are at an increased risk of respiratory problems and complications, which often result in prolonged, frequent hospital admissions and are the biggest cause of mortality in this client group. The Children's Community Respiratory Physiotherapy Service (CCRPS) was established in 2010 to support children with severe neurodisabilities at home during acute chest infections and to prevent emergency department attendances and hospital admissions. This service evaluation looked at patient/parent satisfaction and prevented admissions to ensure clinical and cost-effectiveness, despite the rising demand for the service. METHODS Over a 3-month period, patients and parents/carers on the CCRPS caseload were given a Picker feedback survey following 100 emergency visits from the team. The number of prevented hospital admissions for respiratory tract infection over 12 months (April 2019-March 2020) was identified from existing CCRPS data and hospital admissions costs saved were estimated. RESULTS The Picker survey responses were extremely positive with all respondents reporting that they felt well looked after and that the main reason for the emergency visit was dealt with well. Based on key indicators, the CCRPS prevented 182 hospital admissions for respiratory tract infection in 2019/2020, equating to 1638 bed days and estimated cost savings ranging between £751 728 and £1 009 986. CONCLUSIONS The Picker survey response demonstrates the positive impact that the CCRPS has on both quality of life and experience for patients and families. The CCRPS rapid response service prevents hospital admissions for respiratory tract infections in children and young people with severe neurodisability and the cost savings from admissions prevented allows the service to more than pay for itself.
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Affiliation(s)
- Samantha Smith
- The Children's Development Centre, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Moira Flanigan
- The Children's Development Centre, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sarah Haynes
- The Children's Development Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Anastasia Michael
- The Children's Development Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Toni Wolff
- The Children's Development Centre, Nottingham Children's Hospital, Nottingham, UK
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Marpole R, Langdon K, Wilson A. Gastrostomy feeding in children with severe cerebral palsy in Western Australia. Acta Paediatr 2022; 111:680-681. [PMID: 34905225 DOI: 10.1111/apa.16214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rachael Marpole
- Respiratory and Sleep Medicine CAHS Nedlands WA Australia
- Department of Paediatrics University of Western Australia Perth WA Australia
| | - Katherine Langdon
- Kid’s Rehab WACAHS Nedlands WA Australia
- Telethon Kids Institute Nedlands WA Australia
| | - Andrew Wilson
- Respiratory and Sleep Medicine CAHS Nedlands WA Australia
- Department of Paediatrics University of Western Australia Perth WA Australia
- Wal‐Yan Respiratory Research CentreTelethon Kids Institute Nedlands WA Australia
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Fiori S, Moretti E, Amador C, Martinelli A, Scaramuzzo RT, Controzzi T, Battini R, Filippi L, Guzzetta A, Gargani L. Lung ultrasound in young children with neurological impairment: A proposed integrative clinical tool for deaeration-detection related to feeding. Front Pediatr 2022; 10:932409. [PMID: 35967558 PMCID: PMC9363586 DOI: 10.3389/fped.2022.932409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Infants and children with neurological impairment, such as cerebral palsy (CP), often experience abnormal ingestion functions, including oropharyngeal dysphagia and gastroesophageal reflux disease, which led to aspiration-related respiratory complications, morbidity, hospitalization, or death. There is a lack of evidence-based, repeatable, infant-friendly instrumental procedures to assess aspiration-risk in infants with CP or other neurological disorders, with also a lack of clinical assessment measures to support the use of more invasive diagnostic techniques. To this purpose, in the current study we explore the feasibility of lung ultrasound (LUS), to assess lung deaeration possibly related to aspiration during meal, in a cohort of 35 subjects affected by CP or other encephalopathies, and 10 controls in the same age-range. We coupled LUS procedure with meal caregiver administration for each child. Our results support the feasibility of this innovative approach in the clinical setting. Exploratory findings revealed a number of lung abnormalities likely related to abnormal ingestion function in subjects. Subgroup analyses revealed possible differences in LUS abnormalities between CP and other encephalopathies, possibly related to different mechanism of disease or dysfunction. Also, some evidences arose about the possible relationship between such LUS abnormalities and feeding and swallowing abilities in CP or other encephalopathies. LUS showed preliminarily feasibility and effectiveness in detecting meal-related LUS abnormalities in a dynamic manner in the clinical setting. This approach demonstrated usefulness as a potential tool for improving assessment and management in complex care of infants and young children with severe neurological disorders.
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Affiliation(s)
- Simona Fiori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | | | | | | | | | - Tiziana Controzzi
- Department of Neonatal Intensive Care Unit, Santa Chiara Hospital, Pisa, Italy
| | - Roberta Battini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Luca Filippi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Neonatal Intensive Care Unit, Santa Chiara Hospital, Pisa, Italy
| | - Andrea Guzzetta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology National Research Council of Italy (CNR), Pisa, Italy.,Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Liba Z, Kraus J, Necas T, Necas J, Klugar M, Krsek P. Movement disorders, cerebral palsy and vaccination. Eur J Paediatr Neurol 2022; 36:143-150. [PMID: 34979476 DOI: 10.1016/j.ejpn.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
This review focused on vaccination in children with movement disorders, including cerebral palsy and the movement disorders triggered by vaccination in children with and without neurological disabilities. The following clinical questions were addressed: 1) Can children with movement disorders be vaccinated? 2) Can vaccination trigger movement disorders in children without neurological disabilities? 3) Can vaccination trigger movement disorders in children with neurological disabilities? and 4) Is there any consensus of care concerning vaccination in children with movement disorders? Following the PRISMA reporting guidelines, 1096 records were identified and 34 relevant papers were included. No evidence that vaccinations are contraindicated for children with movement disorders was noticed. Several reports of neurological adverse events, including movement disorders in children without neurological disabilities after various types of vaccination, were found. The reporting rates were low, the causality was controversial, and patient outcomes were mostly favourable. There was limited (if any) evidence in our search that any vaccination leads to any movement disorder exacerbation. Finally, no generally accepted consensus or standards of care concerning vaccination in patients with movement disorders were found. In summary, we found few precautions for vaccination in this group of patients and concluded that general best practice guidelines for immunization should be followed. In addition, influenza and pneumococcal vaccines are recommended because they can reduce morbidity and mortality in individuals severely affected by movement restrictions.
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Affiliation(s)
- Zuzana Liba
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Josef Kraus
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Tomas Necas
- Department of Paediatrics, Tomas Bata Regional Hospital, Havlickovo nabrezi 600, 76001, Zlin, Czech Republic.
| | - Jiri Necas
- General Practitioner, Masarykovo namesti 1130, 76012, Vizovice, Czech Republic.
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, The Czech Republic Centre for Evidence-Based Healthcare, JBI Centre of Excellence, Masaryk University GRADE Centre, Institute of Biostatistics and Analyses, Masaryk University, 625 00, Brno, Czech Republic
| | - Pavel Krsek
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
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Morrison L, Suresh S, Leclerc MJ, Kapur N. Symptom care approach to non-invasive ventilatory support in children with complex neural disability. J Clin Sleep Med 2021; 18:1145-1151. [PMID: 34928205 DOI: 10.5664/jcsm.9836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is a major cause of morbidity and mortality among pediatric patients with severe neurological disabilities such as cerebral palsy. Despite increasing use of non-invasive ventilation (NIV) in this group, there remains a lack of consensus about its role and indications. We aim to explore the indications, acceptability, and outcomes of a cohort of children with severe, complex neurological disability and SDB, managed with NIV. METHODS Data was retrospectively extracted on children with severe neurological disabilities (GMFCS V equivalent) initiated on NIV in Queensland over a 5-year period. Demographic, clinical, hospitalization, and polysomnography data was collected, as well as caregiver-reported side effects and NIV adherence. RESULTS Fourteen (median age 9.1 years; 6F) children were included, 8 with cerebral palsy and 6 with other complex neurological disabilities. Obstructive sleep apnea was the most common indication for NIV (n=12). The median (IQR) apnea-hypopnea index improved on NIV [Pre-NIV 21.3 (IQR 10.0-28.2) vs. Post-NIV 12.2 (IQR 2.8-15.2)], although this was not statistically significant. There was significant improvement in proportion of time spent with SpO2<95% (22.2% Pre-NIV vs. 7.85% Post-NIV; p<0.05). Reported side effects were minimal. There was no reduction in hospital admissions in the 12 months post-NIV initiation. CONCLUSIONS Our findings suggest that NIV improves polysomnography parameters among children with severe neurological disability. Long-term outcomes and overall impact on quality of life remain unclear. Ethical issues and overall benefit must be considered before embarking on this mode of therapy.
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Affiliation(s)
| | - Sadasivam Suresh
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, School of Medicine, University of Queensland
| | - Mary Josee Leclerc
- Department of Respiratory & Sleep Medicine, Children's Health Queensland Hospital and Health Service
| | - Nitin Kapur
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, School of Medicine, University of Queensland
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Effects of Malted Rice Amazake on Constipation Symptoms and Gut Microbiota in Children and Adults with Severe Motor and Intellectual Disabilities: A Pilot Study. Nutrients 2021; 13:nu13124466. [PMID: 34960021 PMCID: PMC8705246 DOI: 10.3390/nu13124466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
Constipation is a frequent complication in patients with severe motor and intellectual disabilities (SMID). The aim of this study was to investigate changes in constipation symptoms and gut microbiota associated with the intake of malted rice amazake, a fermented food in Japan, in patients with SMID. Ten patients consumed the test food for six weeks, and their physical condition, dietary and medication status, and constipation assessment scale (CAS) were investigated. Comprehensive fecal microbiome analysis using the 16S rRNA sequence method was performed. The results showed a significant decrease in CAS, and a significant increase in Lactobacillales and decrease in Escherichia-Shigella after consuming malted rice amazake. To investigate the difference in the effects of malted rice amazake consumption, based on the characteristics of the original gut microbiota, the patients were grouped according to the similarity of their gut microbiota before the intervention; Firmicutes-rich Group 1 (n = 5), Actinobacteria-rich Group 2 (n = 4), and Proteobacteria-rich Group 3 (n = 1). The CAS decreased in Groups 1 and 2. The relative abundance of Bifidobacterium showed an increasing tendency both overall and in Group 1, but it was originally higher in Group 2. Our results suggest that malted rice amazake consumption reduces constipation symptoms and simultaneously changes the gut microbiota, but the changes may vary depending on the original composition of the gut microbiota.
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Jonsson U, Eek MN, Sunnerhagen KS, Himmelmann K. Health Conditions in Adults With Cerebral Palsy: The Association With CP Subtype and Severity of Impairments. Front Neurol 2021; 12:732939. [PMID: 34777202 PMCID: PMC8581638 DOI: 10.3389/fneur.2021.732939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022] Open
Abstract
Aim: To determine the prevalence of common health conditions in adults with cerebral palsy (CP) and to identify associations with the CP subtype or the severity of impairments. Methods: A population-based, cross-sectional study of 153 adults with CP born from 1959 to 1978 (87 males, 66 females; median age 48 years 3 months, range 37–58 years; 41% with unilateral spastic, 36% bilateral spastic, 19% dyskinetic, and 4% with ataxic CP). Data was gathered through interviews, physical assessments, and medical record reviews. Results: The most common health conditions in adults with CP were pain 65%, upper gastrointestinal disorders 33%, dysphagia 29%, epilepsy 29%, and depression 27%. Cerebral palsy subtype was significantly associated with the presence of pain (p = 0.029), gastrointestinal (p < 0.001), and respiratory disorders (p = 0.006). A more severe physical impairment was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), respiratory disorders (p < 0.001), and pressure ulcers (p < 0.001). Intellectual disability was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), pneumonia (p = 0.001) epilepsy (p = 0.001), and pressure ulcers (p < 0.001), but with a lower prevalence of pain (p < 0.004) and hypertension (p = 0.043). Conclusion: The prevalence of several common health conditions is related to the CP subtype and severity of impairments, indicating that CP plays a role in the development of these health conditions. Follow-up of adults with CP needs to include not only impairments, but general health as well. Increased attention directed toward signs of gastrointestinal and respiratory disorders in individuals with either dyskinetic CP, gross motor function classification system (GMFCS) levels IV–V, or intellectual disability, is recommended.
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Affiliation(s)
- Ulrica Jonsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Habilitation and Health, Adult Habilitation, Gothenburg, Sweden
| | - Meta N Eek
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina Stibrant Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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DellaBadia K, Tauber D. Respiratory concerns in children with medical complexity. Curr Probl Pediatr Adolesc Health Care 2021; 51:101072. [PMID: 34657813 DOI: 10.1016/j.cppeds.2021.101072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Children with medical complexity (CMC) are a diverse group of children affected by a spectrum of chronic disorders and physiologic abnormalities. Due to their underlying disorders, they disproportionately experience respiratory comorbidities and complications. Respiratory-related complications that arise in this population often begin subtly and progress over time and can result in lung injury, respiratory insufficiency, and eventual chronic respiratory failure. CMC make up a substantial proportion of pediatric hospitalizations and healthcare expenditures, with respiratory-related illness being one of the leading causes of admission. It is, therefore, important for the practitioner caring for these children to have knowledge of the common respiratory concerns in this population as well as prevention and management strategies. This review will describe the most common respiratory concerns in CMC and will provide an overview of diagnosis and management.
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Affiliation(s)
- Kristine DellaBadia
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Danna Tauber
- Division of Pulmonary and Sleep Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
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Eryilmaz F, Ahmed F, Rehmani AK, Karimi S, Qazi A, Mustafa S, Zulfiqar A, Nadeem Z, Sultan AA, Farooque U. Scoliosis and Gastroesophageal Reflux Disease in Adults. Cureus 2021; 13:e15359. [PMID: 34239791 PMCID: PMC8245622 DOI: 10.7759/cureus.15359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Degenerative scoliosis most commonly presents with lower back pain. Literature suggests that adults who have degenerative scoliosis are at greater risk of both hiatal hernia and gastroesophageal reflux disease (GERD). The objective of this study was to evaluate scoliosis as being the risk factor of GERD in adults. Materials and methods This prospective study was conducted at Dow University of Health Sciences over a period of two years (May 2018 to April 2020). The investigation included 210 participants with spinal disorders. The mean age was 71.6±9.6 years. The X-rays of the participants’ whole spine were taken in a standing position, in the sagittal and coronal planes. Symptoms of GERD were measured through the quality of life and utility evaluation survey technology (QUEST) score, taking six points as cutoff values. The evaluation was done using radiographs to determine any relationship between spinal disorders and GERD. Negative values were analyzed in a right-sided convex curve while positive values in the left-sided convex curve were viewed in the coronal plane. Degenerative scoliosis was explained as a lumbar/thoracolumbar Cobb angle of more than 10 degrees. Univariate and multivariate logistic regression analyses were done to assess the risk factors related to GERD. Results Out of 210 patients, 146 were found to have degenerative scoliosis at the level of the lumbar and thoracolumbar spine. Fifty-two patients had a right convex curve, and 94 had a left convex curve. Sixty-nine patients had GERD. According to the analysis of the multivariate logistic regression, the Cobb angle was highly related to GERD (p-value <0.05 and odds ratio of 1.031). The participants were grouped according to the Cobb angle of curve at the lumbar spine (less than 30 degrees with a large right-sided convex curve, 30 and more with a small curve, and more than 30+ degrees with a large left-sided convex curve). The study revealed that a large left-sided convex curve was highly related to GERD, with a p-value <0.05 and odds ratio of 10.935. Conclusions The left-sided large convex curve at the thoracolumbar or lumbar spine, especially when the Cobb angle was more than 30 degrees, was highly associated with GERD. Therefore, the symptoms of GERD should be monitored in the elderly population with degenerative scoliosis.
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Affiliation(s)
- Fahri Eryilmaz
- Neurological Surgery, Hitit University Corum Erol Olcok Training and Research Hospital, Corum, TUR
| | - Faheem Ahmed
- Orthopedic Surgery, Trauma Centre, Civil Hospital, Karachi, PAK
| | - Asim K Rehmani
- Neurological Surgery, National Medical Center, Karachi, PAK
| | - Sundas Karimi
- Orthopedic Surgery, Dow University Hospital, Karachi, PAK
| | - Aamna Qazi
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sufyan Mustafa
- Medicine, Dow Medical College, Civil Hospital, Karachi, PAK
| | - Arif Zulfiqar
- Medicine and Surgery, Dow Medical College, Karachi, PAK
| | - Zubia Nadeem
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Ayyaz A Sultan
- Hematology/Oncology, California Cancer Associates for Research and Excellence, Fresno, USA
| | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
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Huang YC, Wu MC, Wang YH, Wei JCC. Do Children With Constipation Have Increased Risk of Asthma? Real-World Data From a Nationwide Population-Based Cohort Study. Front Pediatr 2021; 9:714406. [PMID: 34527646 PMCID: PMC8435704 DOI: 10.3389/fped.2021.714406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Asthma is one of the most burdensome childhood disorders. Growing evidence disclose intestinal dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microbiota. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess whether pediatric constipation influence the risk of developing asthma by a nationwide population-based cohort study. Methods: We analyzed 10,363 constipated patients and 10,363 individuals without constipation between 1999 and 2013 from Taiwan's National Health Insurance Research Database. Analysis of propensity score was utilized to match age, sex, comorbidities, and medications at a ratio of 1:1. In addition, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and a stratified analysis were performed. Results: After adjustment for age, sex, comorbidities, and medications, constipated patients had a 2.36-fold greater risk of asthma compared to those without constipation [adjusted hazard ratio (aHR): 2.36, 95% C.I. 2.04-2.73, p < 0.001]. Furthermore, the severity of constipation is associated with an increased risk of asthma; the adjusted hazard ratio was 2.25, 2.85, and 3.44 within < 3, 3-12, and ≥12 times of laxatives prescription within 1 year, respectively (p < 0.001). Conclusion: Constipation was correlated with a significantly increased risk of asthma. Pediatricians should be aware of the possibility of asthma in constipated patients. Further research is warranted to investigate the possible pathological mechanisms of this association.
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Affiliation(s)
- Yen-Chu Huang
- Division of Pediatric Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Meng-Che Wu
- Division of Pediatric Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,College of Medicine, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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