Grand Rapids, MI, United States
Grand Rapids, MI, United States

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Shafferman A.,University of Alabama at Birmingham | Birmingham J.D.,Helen Devos Childrens Hospital | Cron R.Q.,University of Alabama at Birmingham
Pediatric Rheumatology | Year: 2014

We report an 11-week-old female who presented with Kawasaki disease (KD) complicated by macrophage activation syndrome (MAS). The infant presented to the hospital with persistent fever, cough, diarrhea, and emesis, among other symptoms. Her condition quickly began to decompensate, and she developed classic features (conjunctivitis, rash, cracked lips, distal extremity edema) prompting a diagnosis of acute KD. The patient was treated with standard therapy for KD including three doses of intravenous immunoglobulin (IVIG), aspirin, and high dose glucocorticoids with no change in her condition. Due to a high suspicion for MAS, high dose anakinra therapy was initiated resulting in dramatic clinical improvements. She also received one dose of infliximab for concern for coronary artery changes, and over the course of several months, anakinra and high dose glucocorticoids were tapered. Nearly complete reversal of echocardiogram changes were observed after 8 months, and the infant is now off all immunosuppressive therapy. In this case report, we briefly review the importance of early recognition of MAS in pediatric patient populations with rheumatic diseases, and we suggest early initiation of anakinra therapy as a rapid and effective treatment option. © 2014 Shafferman et al.; licensee BioMed Central Ltd.


Laurson K.R.,Illinois State University | Eisenmann J.C.,Michigan State University | Eisenmann J.C.,Helen DeVos Childrens Hospital | Welk G.J.,Iowa State University
American Journal of Preventive Medicine | Year: 2011

Background: To date, several studies have been published outlining reference percentiles for BMI in children and adolescents. In contrast, there are limited reference data on percent body fat (%BF) in U.S. youth. Purpose: The purpose of this study was to derive smoothed percentile curves for %BF in a nationally representative sample of U.S. children and adolescents. Methods: Percent fat was derived from the skinfold thicknesses of those aged 518 years from three cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES) IV (19992000, 20012002, and 20032004; N=8269). The LMS (L=skewness, M=median, and S=coefficient of variation) regression method was used to create age- and gender-specific smoothed percentile curves of %BF. Results: Growth curves are similar between boys and girls until age 9 years. However, whereas %BF peaks for boys at about age 11 years, it continues to increase for girls throughout adolescence. Median %BF at age 18 years is 17.0% and 27.8% for boys and girls, respectively. Conclusions: Growth charts and LMS values based on a nationally representative sample of U.S. children and adolescents are provided so that future research can identify appropriate cut-off values based on health-related outcomes. These percentiles are based on skinfolds, which are widely available and commonly used. Using %BF instead of BMI may offer additional information in epidemiologic research, fitness assessment, and clinical settings. © 2011 American Journal of Preventive Medicine.


Laurson K.R.,Illinois State University | Eisenmann J.C.,Michigan State University | Eisenmann J.C.,Helen DeVos Childrens Hospital | Welk G.J.,Iowa State University
American Journal of Preventive Medicine | Year: 2011

Background: Multiple screening tools, such as BMI and skinfold-derived percent body fat (%BF), are available to identify youth at risk of excess adiposity. However, poor classification agreement among these tools can be problematic for those interpreting test results. Purpose: The purpose of this study was to investigate the validity of using BMI as an estimate of %BF in youth and to identify optimal BMI thresholds for identifying at-risk children and adolescents based on %BF. Methods: Percent body fat was derived from the skinfold thicknesses of children aged 518 years from three cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES [19992004]; N=8269). Stature and body mass from the same data set were used to calculate BMI. Receiver operating characteristic (ROC) analysis was employed to determine the optimal BMI thresholds for detecting previously created %BF standards. Results: The optimal BMI percentile associated with the low risk %BF threshold was the 83rd and 80th in boys and girls, respectively. The selected BMI percentiles associated with the higher risk threshold were the 92nd and 90th in boys and girls, respectively. Overall, classification accuracy when using BMI percentiles to identify the two %BF risk groups ranged from 86.9% to 89.1%. Conclusions: BMI and skinfold-derived %BF demonstrate reasonable agreement when used to classify adiposity status in children and adolescents. © 2011 American Journal of Preventive Medicine.


Eisenmann J.C.,Michigan State University | Eisenmann J.C.,Helen DeVos Childrens Hospital | Laurson K.R.,Illinois State University | Welk G.J.,Iowa State University
American Journal of Preventive Medicine | Year: 2011

Background: Although aerobic fitness has been well studied, establishing developmental patterns from previous studies has some limitations including selection bias and the statistical modeling of growth-related data. Purpose: The purpose of this study was to develop age-, gender-, and race-specific smoothed percentiles for aerobic fitness using the LMS (L=skewness, M=median, and S=coefficient of variation) statistical procedure in a large, multiethnic, nationally representative sample of U.S. adolescents aged 1218 years. Methods: Data from the National Health and Nutrition Examination Survey (NHANES [19992000 and 20012002]) were combined. In all, 2997 subjects (1478 boys and 1519 girls) completed a treadmill exercise test from which maximal oxygen consumption (VO 2max) was estimated from heart rate response. Percentile curves were determined by using the LMS procedure, which fits smooth percentile curves to reference data. Results: Separate LMS curves were initially prepared for each gender and race; however, since the overall distribution of the data was not different for whites, blacks, and Hispanics, the participants were combined, and separate centile curves were prepared for boys and girls. Specific percentile values were created from the LMS curves, and the age- and gender-specific values for LMS are provided for calculation of individual z-scores (SD scores). In general, there is a slight increase in estimated VO 2max of boys aged 1215 years and then it remains stable. In girls, there is slight decrease in estimated VO 2max across ages 1218 years. Boys have higher values than girls at every age-specific percentile. Conclusions: This study presents age- and gender-specific percentiles for U.S. youth aged 1218 years based on NHANES (19992002), and adds to the recent application of the LMS statistical procedure for the construction of growth percentiles for a variety of outcomes. Comparisons are made to current FITNESSGRAM ® thresholds. © 2011 American Journal of Preventive Medicine.


Welk G.J.,Iowa State University | Laurson K.R.,Illinois State University | Eisenmann J.C.,Helen DeVos Childrens Hospital | Cureton K.J.,University of Georgia
American Journal of Preventive Medicine | Year: 2011

Background: Cardiovascular fitness has important implications for current and future health in children. Purpose: In this paper, criterion-referenced standards are developed for aerobic capacity (an indicator of cardiovascular fitness) based on receiver operating characteristic (ROC) curves. Methods: The sample was drawn from participants aged 1218 years in the National Health and Nutrition Examination Survey (19992002, N=1966). Subjects completed a treadmill exercise test from which maximal oxygen uptake (VO2max) was estimated from heart rate response. Metabolic syndrome was classified using previously published standards based on the National Cholesterol Education Program/Adult Treatment Panel III adult values at age 20 years. Using aerobic fitness z-scores as the test and metabolic syndrome as the criterion, ROC curve analysis was used to identify aerobic-capacity thresholds. Results: The area under the curve (AUC) value for boys (83.1%) was high, indicating good utility for detecting risk of metabolic syndrome with aerobic fitness values. The AUC for girls (77.2%) was slightly below the recommended value of 80%. Although the ROC plots identified a defensible point for classifying levels of fitness, the approach in the present study was to establish two independent thresholds, one aimed at high specificity and one aimed at high sensitivity. The resulting z values for the low- and higher-risk threshold lines were then converted back to VO 2max estimates using published LMS (L=skewness, M=median, and S=coefficient of variation) parameters. Values at the low-risk threshold ranged from 40 to 44 mL/kg/min for boys and from 38 to 40 mL/kg/min for girls. Conclusions: In summary, aerobic fitness can be used with moderate accuracy to differentiate between adolescents with and without metabolic syndrome. Age- and gender-specific aerobic-capacity thresholds for creating separate risk groups were identified using nationally representative growth percentiles. © 2011 American Journal of Preventive Medicine.


Laurson K.R.,Illinois State University | Eisenmann J.C.,Michigan State University | Eisenmann J.C.,Helen DeVos Childrens Hospital | Welk G.J.,Iowa State University
American Journal of Preventive Medicine | Year: 2011

Background: Few studies have identified health-related criterion standards of percent body fat (%BF) in U.S. youth. Further, existing standards are static thresholds (e.g., 25%, 30%) and do not account for normal growth and maturation. Purpose: The purpose of this study was to identify thresholds of %BF in youth linked to metabolic syndrome in a large sample of U.S. children and adolescents. Methods: Percent fat was derived from the skinfold thicknesses of those aged 1218 years, from the National Health and Nutrition Examination Survey (NHANES [19992004, N=1966]). Metabolic syndrome was classified using previously published standards based on the National Cholesterol Education Program/Adult Treatment Panel III adult values at age 20 years. Using %BF z-scores as the test and metabolic syndrome as the criterion, receiver operating characteristic (ROC) curve analysis was used to identify %BF thresholds. Results: ROC analysis indicated that %BF can be used with moderate accuracy to identify metabolic syndrome in adolescents. %BF thresholds of 22.3% and 35.1% in boys and 31.4% and 38.6% in girls (at age 18 years) were found to be indicative of "low" and "high" metabolic syndrome risk. Conclusions: Age- and gender-specific %BF thresholds for creating separate risk groups were identified in relation to metabolic syndrome status. The selected thresholds identify adolescents with unfavorable metabolic profiles. These values could be extrapolated to younger children using previously created %BF centiles, which potentially allows for earlier identification and intervention of at-risk youth if tracking of current %BF was maintained. © 2011 American Journal of Preventive Medicine.


Junewick J.J.,Helen DeVos Childrens Hospital | Junewick J.J.,Michigan State University
American Journal of Roentgenology | Year: 2011

OBJECTIVE. The purpose of this article is to review pediatric craniocervical junction injuries in the context of embryology, developmental anatomy, and biomechanics. CONCLUSION. The craniocervical junction is functionally and developmentally distinct from the rest of the spine, and mechanistic models often fail to explain these injuries. Various developmental features and complex anatomy likely contribute to injury in this region in children. Some of the injury patterns at the craniocervical junction in children are similar to adults, but many are unique. © American Roentgen Ray Society.


Halanski M.A.,University of Wisconsin - Madison | Cassidy J.A.,Helen DeVos Childrens Hospital
Journal of Spinal Disorders and Techniques | Year: 2013

BACKGROUND:: To compare the routine use of posterior-based (Ponte) osteotomies to complete inferior facetectomies in thoracic idiopathic scoliosis. Hypokyphosis is common in thoracic adolescent idiopathic scoliosis. The use of pedicle screw fixation in deformity correction can exacerbate this hypokyphosis. We hypothesized that by utilizing posterior-based Ponte osteotomies rather than facetectomies, we could improve coronal plane correction and decrease the loss of kyphosis during curve correction. METHODS:: The radiographs and clinical charts of patients with idiopathic scoliosis (Lenke types I, II) who underwent isolated thoracic posterior spinal fusion utilizing primarily pedicle screw constructs from January 2008 to August 2010 were reviewed. Maximum preoperative Cobb angle, thoracic kyphosis (T5-T12), levels instrumented, number of posterior-based osteotomies, operative time, estimated blood loss, and postoperative residual coronal Cobb angle and kyphosis were recorded. Operative time per level, blood loss per level, percent main curve correction, and change in thoracic kyphosis was calculated. Patients having undergone complete inferior facetectomies and those with multilevel Ponte osteotomies were then compared. RESULTS:: Eighteen patients underwent posterior spinal fusion with osteotomies and 19 patients had complete inferior facetectomies during this time period. The osteotomy cohort had a larger preoperative Cobb angle [59±10 vs. 52±8 (mean±SD); P=0.03]. No difference was observed in the preoperative kyphosis (22±15 vs. 25±12) or in levels fused (9±1 vs. 8±1). Patients with routine osteotomies had them performed at 76% of the levels instrumented. No significant difference was found in terms of percentage of coronal plane correction (84% in both groups), average postoperative kyphosis 28±8 versus 25±7, or the change in kyphosis 6±14 versus 0±2 degrees, in the osteotomy and the facetectomy groups, respectively. Estimated blood loss per level was significantly higher in the osteotomy group (97±42 mL vs. 66±25 mL; P=0.01) as was time per level 31±5 versus 23±3 minutes/level (P<0.001). CONCLUSIONS:: This study shows a significantly higher blood loss and operative time associated with the use of routine posterior osteotomies in the thoracic spine without a significant improvement in coronal or sagittal correction. Copyright © 2011 by Lippincott Williams & Wilkins.


Eisenmann J.C.,Helen DeVos Childrens Hospital
Pediatrics | Year: 2011

This article provides descriptive information on the assessments conducted in stage 3 or 4 pediatric obesity-management programs associated with National Association of Children's Hospital and Related Institutions hospitals enrolled in FOCUS on a Fitter Future. Eighteen institutions completed a survey that considered the following assessments: patient/family medical history physical examination blood pressure body size and composition blood chemistry aerobic fitness resting metabolic rate muscle strength and flexibility gross motor function spirometry sedentary behavior and physical activity dietary behavior and nutrition and psychological assessments. Frequency distributions were determined for each question. Overall the results indicate that most programs that participated in this survey were following 2007 Expert Committee assessment recommendations however a variety of measurement tools were used. The variation in assessment tools protocols etc is partially caused by the program diversity dictated by personnel both in terms of number and duties. It also shows the challenges in standardizing methodologies across clinics if we hope to establish a national registry for pediatric obesity clinics. In addition to providing a better understanding of the current assessment practices in pediatric obesity-management programs the results provided herein should assist other clinics/hospitals that are developing pediatric obesity programs. Copyright © 2011 by the American Academy of Pediatrics.


Walia R.,West Virginia University | Kunde S.,Helen DeVos Childrens Hospital | Mahajan L.,Cleveland Clinic
Current Opinion in Pediatrics | Year: 2014

Purpose of review The use of transplanted fecal material for the treatment of diarrheal illness dates back to the fourth-century China. While fecal microbiota transplant has gained increasing popularity over the past 50 years for the treatment of refractory Clostridium difficile infections (RCDIs) in adults, it has only been recently utilized in children. The purpose of this article is to review the use of fecal microbiota transplant (FMT) in the treatment of pediatric RCDIs. Recent findings Minimal pediatric data, including few case reports and series, document the successful use of FMT for treatment of RCDI in the past 2 years. Patients in these reports included otherwise healthy children, those with inflammatory bowel disease as well as significantly immunocompromised children. Donor fecal infusion via nasogastric tube, gastroscope or colonoscope in children aged 16 months and older demonstrated a high rate of symptom resolution and organism eradication. No complications to date have been reported in children who have undergone FMT. Summary FMT is emerging as a well-tolerated and effective treatment for RCDI in not only adults but also children. © 2014 Wolters Kluwer Health-Lippincott Williams & Wilkins.

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