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Arnold R.W.,Alaska Blind Child Discovery | Arnold A.W.,Alaska Blind Child Discovery | Armitage M.D.,Alaska Blind Child Discovery | Shen J.M.,Childrens Clinic | And 2 more authors.
Binocular Vision and Strabology Quarterly | Year: 2013

Background: New photoscreening models promise to detect amblyopia risk factors early in hopes of reducing permanent pediatric monocular and binocular vision impairment. The 3 commercially available interpreted photoscreeners had not yet been compared. Methods: This is a prospective, observational screening study following AAPOS guidelines on pediatric patients with and without developmental delays. 270 patients in a pediatric eye practice aged 4.7 +/- 4 years with 7% special needs. From December 2011 through March 2012, the Plusoptix, the iScreen, and the Pediavision SPOT were applied before confirmatory exam in a clinical pediatric eye practice. Results: The inconclusive rate ranged from 1-4% (iScreen) to 12% (Plusoptix). Sensitivity ranged from 72% (iScreen) to 84% (Plusoptix) and specificity ranged from 68% (SPOT) to 94% (Plusoptix). The iScreen can provide results in 99% of high risk patients.. Conclusions: In this cohort with high pre-screening prevalence, the 2011 photoscreeners had favorable validation that is expected to improve with further clinical study. Pediatricians have practical technology with a recognized procedure code to assist in amblyopia reduction. © A Medical Scientific ePeriodical. Source


Wald E.R.,University of Wisconsin - Madison | Jagodzinski T.D.,Childrens Clinic | Moyer S.C.L.,University of Wisconsin - Madison | Wald A.,University of Wisconsin - Madison | And 2 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2011

OBJECTIVES: The aim of the study was to validate a brief Bowel Habit Questionnaire (BHQ) with prospectively obtained data from a 14-day diary and to determine whether the BHQ predicts the development of medically significant constipation (MSC) during the following year. MATERIALS AND METHODS: The BHQ was distributed to parents of children ages 5 to 8 years during health supervision visits. Both the BHQ and subsequent diary were scored to indicate constipation if at least 2 of the following were reported: infrequent bowel movements, stool accidents, straining, avoidance, discomfort with defecation, or passing large stools >25% of the time. One year later, the BHQ was repeated to assess for MSC, defined as medical encounters about constipation or use of enemas, suppositories, laxatives, or stool softeners. RESULTS: MSC was reported for 57 (13.7%) of 416 children on the first BHQ. Paired BHQ and diary data were obtained for 269 children; 54 (20.1%) had diary scores indicating constipation. BHQ had a sensitivity of 59.6% (95% confidence interval [CI] 46.7%-71.4%) and a specificity of 82.6% (95% CI 77.0%-87.1%). One year later, 11 children (5.2%) had developed new-onset MSC; 7 (63.6%) of these children had initial BHQ scores of at least 2. Positive and negative predictive values for MSC were 19.4% (95% CI 9.8%-35.0%) and 97.7% (94.2%-99.1%), respectively. CONCLUSIONS: Parents often do not recognize constipation in young school-age children and most constipated children remain untreated. A brief screening questionnaire in this population proved to be valid but only moderately sensitive; efforts to improve sensitivity are needed before recommending it for routine use. Copyright © 2011 by ESPGHAN and NASPGHAN. Source


Tatishvili N.,Iashvili Childrens Central Hospital | Gabunia M.,Aversi Clinic | Laliani N.,Childrens Clinic
European Journal of Paediatric Neurology | Year: 2010

Three hundred-forty-eight out of a regional population of 1272 newborn infants were randomly chosen and followed neurologically until age of two years to study the epidemiology of neurodevelopmental disorders, and to reveal the main factors influencing outcome. The most frequent neonatal pathologies were low Apgar scores - 45 (3.5%), neonatal sepsis - 28 (2.2%), neonatal seizures - 26 (2.0%), neonatal sepsis complicated with bacterial meningitis - 13 (1.0%), traumatic injury of peripheral nerves - 7 (0.6%), intracranial hemorrhages - 4 (0.3%) and CNS malformations - 3 (0.2%). At the age of 24 months abnormal development was identified in 29 cases (8.5%) of children, comprising global developmental delay in five (1.5%), unclassified motor problems (hypotonia without ataxia) in four (1.2%), cerebral palsy in three (0.9%), behavioral/sleep disorders in 12 (3.5%) and epilepsy in five (1.5%). The most significant single risk factors for abnormal neurodevelopmental outcome were maternal age, chorioamnionitis, gestational age <37 weeks, pathological delivery, and a low (<5) Apgar score at 5 min after birth. Coexistence of several risk factors increased the probability of an adverse outcome. © 2009 European Paediatric Neurology Society. Source


Birkebaek N.H.,Aarhus University Hospital | Wolthers O.D.,Childrens Clinic | Heuch C.,Aarhus University Hospital | Balslev T.,Viborg Regional Hospital | And 2 more authors.
Journal of Pediatric Endocrinology and Metabolism | Year: 2011

Objective: To report on the effect of growth hormone (GH) treatment on final height (FH) and to describe the insulin-like growth factor (IGF) system, ghrelin, and adiponectin (ADPN) in children with Seckel syndrome. Subjects and results: Four severely growth-retarded Iraqi siblings (two girls and two boys) with Seckel syndrome were referred at ages 16.5, 14.4, 12.4, and 10.4 years. They were born at term, but their growth was retarded and birth weight ranged between 1 and 1.5 kg. The children were healthy and had a normal response to GH provocative test. Long-term GH treatment of the youngest brother and sister increased the FH by 7.2 and 3.4 cm, respectively, compared with their older brother and sister. At FH, body mass index standard deviation scores (BMISDS) ranged from-3.0 to-3.9. Serum levels of immunoreactive IGF-1, bioactive IGF-1, and IGF-binding protein 3 were all within normal to high range before GH treatment and increased after GH treatment. Fasting plasma ghrelin remained severely reduced. Despite low BMISDS, plasma ADPN was moderately reduced and showed an almost complete absence of the low-molecular-weight subform. Conclusion: This is the first report on the effect of GH treatment on FH in children with Seckel syndrome. GH may have increased FH. In addition to growth defects and reduced BMISDS, patients with Seckel syndrome are characterized by low fasting ghrelin levels, low total ADPN, and near deficiency of the low-molecular-weight ADPN subform. The possible significance of the hormonal changes requires further investigations. © 2011 by Walter de Gruyter Berlin Boston. Source


Danne T.,Childrens Hospital on the Bult | Kordonouri O.,Childrens Hospital on the Bult | Holder M.,Childrens Clinic | Remus K.,Childrens Hospital on the Bult | And 3 more authors.
Diabetes Technology and Therapeutics | Year: 2011

Background: Severe hypoglycemic episodes are a barrier for achieving optimal glycemic control. Sensor-augmented pump (SAP) therapy with insulin in combination with a novel mechanism of automatic insulin shutoff (low glucose suspend [LGS]) can be used to prevent and reduce hypoglycemia. In a prospective study, we investigated the effect of the LGS algorithm on the frequency of hypoglycemia in children and adolescents with type 1 diabetes under real-life conditions. Methods: Twenty-one patients with type 1 diabetes (10.8±3.8 years old, duration of diabetes 5.9±3.0 years, pump therapy for 3.7±1.7 years, glycated hemoglobin level 7.8±1.1%) from three pediatric centers used the Paradigm ® Veo ™ system (Medtronic Minimed, Northridge, CA) during two subseqent time periods: SAP without LGS for 2 weeks and then SAP with LGS enabled for 6 weeks. The primary objective was to assess the frequency of hypoglycemic episodes when using the LGS feature with an insulin delivery shutoff of a maximum of 2 h at a sensor glucose level below 70 mg/dL (3.9 mmol/L). Results: In total, 1,298 LGS alerts occurred (853 shorter than 5 min). Forty-two percent of LGS activations (>5 min) lasted less than 30 min, whereas 24% had a duration of 2 h. The number of hypoglycemic excursions (average/day) was reduced during SAP+LGS (<70 mg/L, 1.27±0.75 vs. 0.95±0.49, P=0.010; ≤40 mg/dL, 0.28±0.18 vs. 0.13±0.14, P=0.005) as was the time spent in hypoglycemia (average minutes/day, 101±68 vs. 58±33, P=0.002) without significant difference in the mean glucose level (145±23 vs. 148±19 mg/dL). No episodes of severe hyperglycemia or diabetic ketoacidosis were observed following LGS activation. Conclusions: The present investigation provides evidence that SAP with LGS reduces the frequency of hypoglycemia without compromising safety. © 2011 Mary Ann Liebert, Inc. Source

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