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Piro E, Schierz IAM, Giuffrè M, Cuffaro G, La Placa S, Antona V, Matina F, Puccio G, Cimador M, Corsello G. Etiological heterogeneity and clinical variability in newborns with esophageal atresia. Ital J Pediatr 2018; 44:19. [PMID: 29373986 PMCID: PMC5787270 DOI: 10.1186/s13052-018-0445-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/02/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The aim of this study was to define different characteristics of infants with esophageal atresia and correlations with neonatal level of care, morbidity and mortality occurring during hospital stay. METHODS Charts of all newborns with esophageal atresia (EA) admitted to our University NICU between January 2003 and November 2016 were reviewed and subdivided in four groups related to different clinical presentations; EA as an isolated form (A), with a concomitant single malformation (B), as VACTERL association (C), and in the context of a syndrome or an entity of multiple congenital anomalies (D). RESULTS We recruited 67 infants with EA (with or without tracheoesophageal fistula), distributed in groups as follows: A 31.3%, B 16.4%, C 26.8% and D 25.3%. Type of atresia was not statistically different among different groups. Mortality was higher in groups C and D, especially if associated with congenital heart defects. In survivors, we found different auxological evolution and prognostic profiles considering duration in days of invasive mechanical ventilation and total parenteral nutrition, as well as length of stay and corrected gestational age at discharge. CONCLUSIONS In the context of genetic and syndromic entities, subjects with VACTERL association showed a lower mortality rate although a higher and more complex level of intensive care was noted in comparison to infants without VACTERL genetic and syndromic entities.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/epidemiology
- Anal Canal/abnormalities
- Cohort Studies
- Databases, Factual
- Esophageal Atresia/diagnosis
- Esophageal Atresia/epidemiology
- Esophageal Atresia/genetics
- Esophagus/abnormalities
- Female
- Genetic Predisposition to Disease/epidemiology
- Gestational Age
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/genetics
- Hospital Mortality
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Kidney/abnormalities
- Length of Stay
- Limb Deformities, Congenital/diagnosis
- Limb Deformities, Congenital/epidemiology
- Limb Deformities, Congenital/genetics
- Male
- Prognosis
- Retrospective Studies
- Risk Assessment
- Spine/abnormalities
- Survival Analysis
- Trachea/abnormalities
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Affiliation(s)
- Ettore Piro
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Ingrid Anne Mandy Schierz
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giovanni Cuffaro
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Simona La Placa
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Vincenzo Antona
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Federico Matina
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giuseppe Puccio
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Marcello Cimador
- Pediatric Surgical Unit. A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
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Intervention for Feeding Difficulties in Children With a Complex Medical History: A Randomized Clinical Trial. J Pediatr Gastroenterol Nutr 2018; 66:152-158. [PMID: 28753179 DOI: 10.1097/mpg.0000000000001683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE This study aimed to compare outcomes of different multidisciplinary feeding therapy approaches in children with feeding difficulties. METHODS Children aged 2 to 6 years with feeding difficulties and a medically complex history (MC) were recruited. Children with feeding difficulties and a nonmedically complex history (NMC) were included as a comparison group. Participants attended a clinical assessment, and eligible participants were randomized to receive targeted feeding intervention incorporating either operant conditioning or systematic desensitization. Parents could elect to receive intervention in an intensive (10 sessions in a week) or weekly (10 sessions during 10 weeks) format. Both groups received immersive parent training. A review was completed 3 months post-intervention. RESULTS In total, 98 participants were eligible to participate (MC, n = 43; NMC, n = 55). Data from 20 children from the MC group (47%) and 41 children from the NMC group (75%) were included in the final analysis. Clinically significant improvements were observed following both arms of therapy, consistent with previous research. Parents of children in the MC arm were significantly more likely to elect for intensive intervention than weekly (MC = 12/20, 60%; 12/41, 29%; P = 0.02). CONCLUSIONS Both therapy protocols were considered clinically effective. The difference in attrition rates between the etiological groups suggests primary differences in how service delivery should be managed. Progress for the medically complex child may be slower while medical issues are stabilized, or while the focus for parents shifts to other developmental areas. In planning services for a medically complex group, therefore, it is essential that consideration be given to medical and family needs.
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Wertz A, Ha JF, Driver LE, Zopf DA. Pediatric laryngeal cleft repair and dysphagia. Int J Pediatr Otorhinolaryngol 2018; 104:216-219. [PMID: 29287871 DOI: 10.1016/j.ijporl.2017.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/15/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe changes in diet and swallow function in patients with a laryngeal cleft after surgical repair of the laryngeal cleft. METHODS Retrospective case series performed using chart review. Primary outcomes were diet and swallow function before and after laryngeal cleft repair. Clinical evaluation and video fluoroscopic swallow studies (VFSS) were used to assess pre- and post intervention swallowing. RESULTS 16 pediatric patients were included in this study. Preoperatively, 14 (88%) patients had diet restrictions. Postoperatively, 12 (75%) patients tolerated a regular diet without limitation. 4 (25%) patients had no reduction in diet restrictions over the course of this study. For the 10 patients who transitioned to a regular diet postoperatively, a median of 300 days (range: 26 days - 3 years) passed to document achieving a regular diet. This was corroborated by an increase in normal oral and pharyngeal phase swallow function on VFSS postoperatively when compared with preoperative VFSS results. CONCLUSION Dysphagia improves in most patients after laryngeal cleft repair. The range in time to a normal diet was wide. This may facilitate improved preoperative counseling and preparation of families' expectations.
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Affiliation(s)
- Aileen Wertz
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Health System, C.S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, United States.
| | - Jennifer F Ha
- School of Surgery, University of Western Australia, Stirling Highway, Nedlands, 6008 Western Australia, Australia; Department of Paediatric Otorhinolaryngology - Head & Neck Surgery, Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6009 Western Australia, Australia
| | - Lynn E Driver
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Health System, C.S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, United States; Department of Speech Language Pathology, University of Michigan Health System, C.S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, United States
| | - David A Zopf
- Department of Otolaryngology - Head & Neck Surgery, University of Michigan Health System, C.S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, United States
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Abstract
UNLABELLED Aim The aims of this study were to examine the prevalence and potential correlates of feeding difficulties in infants who underwent cardiac surgery in the neonatal period and to investigate resource utilisation by infants with feeding difficulties. METHODS All neonates who underwent their first cardiac surgery at the Heart Centre for Children, The Children's Hospital at Westmead, between January and December, 2009 were included. Demographic, preoperative, intraoperative, and postoperative data were collected via electronic medical records. For the purpose of this study, feeding difficulty was defined as the requirement for ongoing tube feeding at the time of discharge home or transfer to another hospital. RESULTS Out of a total of 79 neonates, 24 (30%) were discharged home or transferred to another hospital with a feeding tube. Feeding difficulties were associated with the presence of a genetic syndrome (p<0.0001), assisted feeding preoperatively (odds ratio (OR)=4.4, p=0.03), and having a palliative procedure before biventricular repair (OR=5.1, p=0.02). Infants with feeding difficulties had significantly more reviews by speech pathologists (M=5.9, SD=7.9), dieticians (M=5.9, SD=5.4), and cardiac clinical nurse consultants (M=1.2, SD=1.4) compared with those without feeding difficulties. CONCLUSIONS This study identified factors that can be used in the early recognition of infant feeding difficulties, to help guide the direction of limited health resources, as well as being focal points for future research and clinical practice improvement.
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Bertapelli F, Agiovlasitis S, Machado MR, do Val Roso R, Guerra-Junior G. Growth charts for Brazilian children with Down syndrome: Birth to 20 years of age. J Epidemiol 2017; 27:265-273. [PMID: 28320584 PMCID: PMC5463025 DOI: 10.1016/j.je.2016.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/29/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The growth of youth with Down syndrome (DS) differs from that of youth without DS, and growth charts specific to DS have been developed. However, little is known about the growth of Brazilian youth with DS. The objective of this study was to construct growth charts for Brazilian youth with DS and compare the growth data with the Child Growth Standards of the World Health Organization (WHO) and charts for children with DS from other studies. METHODS Mixed longitudinal and cross-sectional data were collected at University of Campinas, 48 specialized centers for people with intellectual disabilities, and two foundations for people with DS between 2012 and 2015. A total of 10,516 growth measurements from birth to 20 years of age were available from 938 youth with DS (53.7% boys) born between 1980 and 2013. The Lambda Mu Sigma method was applied to construct the curves using generalized additive models for location, scale, and shape. RESULTS Length/height-for-age, weight-for-age, and head circumference-for-age percentile curves were generated for Brazilian boys and girls from birth to 20 years of age. Differences in growth of Brazilian youth ranged from -0.8 to -3.2 z-scores compared to WHO standards, and -1.9 to +1.3 compared to children with DS in other studies. CONCLUSIONS These specific growth charts may guide clinicians and families in monitoring the growth of Brazilian children and adolescents with DS.
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Affiliation(s)
- Fabio Bertapelli
- CAPES Foundation, Ministry of Education of Brazil, Brazil; Growth and Development Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil.
| | | | - Maira Rossmann Machado
- Growth and Development Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil
| | - Raísa do Val Roso
- Growth and Development Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil
| | - Gil Guerra-Junior
- Growth and Development Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil; Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil
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van den Engel-Hoek L, Harding C, van Gerven M, Cockerill H. Pediatric feeding and swallowing rehabilitation: An overview. J Pediatr Rehabil Med 2017; 10:95-105. [PMID: 28582882 DOI: 10.3233/prm-170435] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on supporting growth, nutrition and hydration, the development of feeding activities, and ensuring safe swallowing with the aim of preventing choking and aspiration pneumonia. Pediatric feeding and swallowing disorders can be divided into four groups: transient, developmental, chronic or progressive.This article provides an overview of the available literature about the rehabilitation of feeding and swallowing disorders in infants and children. Principles of motor control, motor learning and neuroplasticity are discussed for the four groups of children with feeding and swallowing disorders.
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Affiliation(s)
- Lenie van den Engel-Hoek
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Celia Harding
- City University, the Royal Free Hospital, London, UK
| | - Marjo van Gerven
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen Cockerill
- Evelina London Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
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57
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Hudson A, Macdonald M, Friedman J, Blake K. CHARGE syndrome gastrointestinal involvement: from mouth to anus. Clin Genet 2017; 92:10-17. [DOI: 10.1111/cge.12892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/01/2016] [Accepted: 10/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A. Hudson
- Dalhousie Medical School; Halifax Canada
| | | | - J.N. Friedman
- Department of Pediatrics; The Hospital for Sick Children, University of Toronto; Toronto Canada
| | - K. Blake
- Division of Medical Education; Dalhousie University Faculty of Medicine; Halifax Canada
- Department of Pediatrics; IWK Health Centre; Halifax Canada
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Paes EC, de Vries IAC, Penris WM, Hanny KH, Lavrijsen SW, van Leerdam EK, Rademaker MM, Veldhoen ES, Eijkemans RMJC, Kon M, Breugem CC. Growth and prevalence of feeding difficulties in children with Robin sequence: a retrospective cohort study. Clin Oral Investig 2016; 21:2063-2076. [PMID: 27868158 PMCID: PMC5487830 DOI: 10.1007/s00784-016-1996-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/01/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVES In addition to breathing problems, patients with Robin sequence (RS) often encounter feeding difficulties (FD). Data regarding the occurrence of FD and possible influencing factors are scarce. The study aim was to elucidate these factors to improve treatment strategies. MATERIAL AND METHODS A retrospective comparative cohort study was conducted, consisting of 69 infants diagnosed with both RS and a cleft palate and 64 isolated cleft palate only (iCPO) infants. Data regarding FD, growth, and airway intervention were collected during the first 2 years of life. A systematic review of the literature was conducted to identify reported FD in RS patients. RESULTS RS patients had more FD (91 %) than iCPO patients (72 %; p = 0.004). Also, nasogastric (NG)-tube feeding was necessary more frequently and for a longer period (both p < 0.001). Growth was lower in RS than iCPO infants (p = 0.008) and was not affected by the kind of airway management (conservative/surgical; p = 0.178), cleft palate grade (p = 0.308), or associated disorders (p = 0.785). By contrast, surgical intervention subtype did significantly affect growth. Mean reported FD for RS in the literature is 80 % (range = 47-100 %), and 55 % (range = 11-100 %) of infants need NG-tube feeding. CONCLUSIONS FD is present in a large proportion of infants with RS, which indicates the need for early recognition and proper treatment to ensure optimal growth. Growth during the first 2 years of life is significantly lower in RS patients than iCPO patients, which indicates the need for careful attention and long-term follow-up. CLINICAL RELEVANCE This study indicates the need for early recognition and proper treatment of FD in RS to ensure optimal growth. In addition, growth needs careful attention and long-term follow-up.
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Affiliation(s)
- Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Iris A C de Vries
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Wouter M Penris
- Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Karlijn H Hanny
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Selma W Lavrijsen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Elselien K van Leerdam
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Maaike M Rademaker
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Rene M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
- Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
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Mangatt M, Wong K, Anderson B, Epstein A, Hodgetts S, Leonard H, Downs J. Prevalence and onset of comorbidities in the CDKL5 disorder differ from Rett syndrome. Orphanet J Rare Dis 2016; 11:39. [PMID: 27080038 PMCID: PMC4832563 DOI: 10.1186/s13023-016-0418-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/30/2016] [Indexed: 11/27/2022] Open
Abstract
Background Initially described as an early onset seizure variant of Rett syndrome, the CDKL5 disorder is now considered as an independent entity. However, little is currently known about the full spectrum of comorbidities that affect these patients and available literature is limited to small case series. This study aimed to use a large international sample to examine the prevalence in this disorder of comorbidities of epilepsy, gastrointestinal problems including feeding difficulties, sleep and respiratory problems and scoliosis and their relationships with age and genotype. Prevalence and onset were also compared with those occurring in Rett syndrome. Methods Data for the CDKL5 disorder and Rett syndrome were sourced from the International CDKL5 Disorder Database (ICDD), InterRett and the Australian Rett syndrome Database (ARSD). Logistic regression (multivariate and univariate) was used to analyse the relationships between age group, mutation type and the prevalence of various comorbidities. Binary longitudinal data from the ARSD and the equivalent cross-sectional data from ICDD were examined using generalized linear models with generalized estimating equations. The Kaplan-Meier method was used to estimate the failure function for the two disorders and the log-rank test was used to compare the two functions. Results The likelihood of experiencing epilepsy, GI problems, respiratory problems, and scoliosis in the CDKL5 disorder increased with age and males were more vulnerable to respiratory and sleep problems than females. We did not identify any statistically significant relationships between mutation group and prevalence of comorbidities. Epilepsy, GI problems and sleep abnormalities were more common in the CDKL5 disorder than in Rett syndrome whilst scoliosis and respiratory problems were less prevalent. Conclusion This study captured a much clearer picture of the CDKL5 disorder than previously possible using the largest sample available to date. There were differences in the presentation of clinical features occurring in the CDKL5 disorder and in Rett syndrome, reinforcing the concept that CDKL5 is an independent disorder with its own distinctive characteristics.
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Affiliation(s)
- Meghana Mangatt
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Anatomy, Physiology & Human Biology, the University of Western Australia, Perth, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Barbara Anderson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Stuart Hodgetts
- School of Anatomy, Physiology & Human Biology, the University of Western Australia, Perth, WA, Australia.,Western Australian Neuroscience Research Institute, Perth, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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Abstract
The birth of a child with significant medical problems poses challenges for most families. Congenital orofacial clefting is a common condition affecting families worldwide. Orofacial clefting requires long-term medical care and can affect multiple body systems. Having a child with a chronic medical condition such as cleft lip or palate creates many psychosocial ramifications for a family. This article describes the importance of medical social work involvement in the coordinated care for children with cleft lip and palate. Specific cases spanning prenatal care through adolescence are used to highlight the variety of complex psychosocial situations encountered in the multidisciplinary cleft team setting.
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Affiliation(s)
- Alison Kaye
- a Pediatric Plastic and Cleft Surgery , Children's Mercy Hospital , Kansas City , Missouri , USA
| | - Sandra Lybrand
- b Department of Social Work , Children's Mercy Hospital , Kansas City , Missouri , USA
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Packing and Problematic Feeding Behaviors in CHARGE Syndrome: A Qualitative Analysis. Int J Pediatr Otorhinolaryngol 2016; 82:107-15. [PMID: 26857326 DOI: 10.1016/j.ijporl.2016.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/07/2016] [Accepted: 01/09/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To understand packing and problematic feeding behaviors during mealtime in individuals with CHARGE syndrome. Packing, or holding food in one's cheeks without swallowing, is an adverse feeding behavior that has been described in children with autism and Down syndrome, and in those transitioning from tube to oral feeding. It has never been described in detail in CHARGE syndrome, a genetic disorder with a high prevalence of feeding difficulties, tube feeding, and otorhinolaryngological issues. METHODS A mixed methods approach used descriptive and qualitative content analysis of interviews with parents of children, adolescents, and adults with CHARGE syndrome. Individuals had previously or were currently experiencing packing or overstuffing one's mouth with food during eating. RESULTS Twenty parents completed a phone interview, describing their child/adult's (2-32 years) adverse feeding behaviors. Individuals had a higher proportion of cleft palates (40%) in comparison to the general CHARGE population (15-20%). Parents reported food packing most commonly with bread and pasta (33%), and reported that food was held in cheeks for hours after a meal had ended (35%). Packing was reported to prolong mealtimes for over an hour (30%). Parents were worried about choking during eating (30%). Food packing was also reported in individuals who had never needed G/J tube feeding or feeding therapy, in addition to those who had needed both. CONCLUSION This study provides an in-depth description of parents' experiences with packing and adverse feeding behaviors in individuals with CHARGE syndrome. These feeding behaviors are an important addition to the knowledge of the highly prevalent feeding difficulties in this genetic disorder. Individualized evaluation of feeding behavior should be a part of the standard otolaryngologic and feeding team practice for these patients.
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Kaye A, Thaete K, Snell A, Chesser C, Goldak C, Huff H. Initial Nutritional Assessment of Infants With Cleft Lip and/or Palate: Interventions and Return to Birth Weight. Cleft Palate Craniofac J 2016; 54:127-136. [PMID: 26882024 DOI: 10.1597/15-163] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and quantify cleft team practices with regard to nutritional support in the neonatal period Design : Retrospective review. SETTING Tertiary pediatric hospital. PATIENTS One hundred consecutive newborn patients with a diagnosis of cleft lip and/or cleft palate between 2009 and 2012. MAIN OUTCOME MEASURES Birth weight, cleft type, initial cleft team weight measurements, initial feeding practices, recommended nutritional interventions, and follow-up nutritional assessments. RESULTS All patients in the study were evaluated by a registered dietitian and an occupational feeding therapist. Average birth weight and average age at the first cleft team visit were similar for each cleft type: cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP). The calculated age (in days) for return to birth weight was significantly different between cleft types: CL = 13.58 days, CLP = 15.88 days, and CP = 21.93 days. Exclusive use of breast milk was 50% for patients with CL, 30.3% for patients with CLP, and 21.4% for patients with CP. Detailed nutritional interventions were made for 31 patients at the first visit: two with CL, 14 with CLP, and 15 with CP. CONCLUSIONS Distinct differences were seen in neonatal weight gain between cleft types. There was significantly greater total weight gain for patients with CL at their first visit and significantly slower return to birth weight for patients with isolated CP. Patients with CL required far fewer interventions at the initial assessment and were more likely to be provided breast milk exclusively or in combination with formula. Infants with CP were far less likely to receive any breast milk. Patients with CLP and CP required frequent nutritional interventions.
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Baudon JJ, Renault F, Flores-Guevara R, Vazquez MP. Outcomes of Neonatal Bulbar Weakness. Pediatrics 2016; 137:peds.2015-3004. [PMID: 26659817 DOI: 10.1542/peds.2015-3004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Neonatal bulbar weakness (BW) has various etiologies and a broad prognostic range. We aimed to report outcomes in a large series of children with neonatal BW and explore the association of orofacial electrodiagnostic data with outcome. METHODS We retrospectively reviewed the files of children who presented with facial, lingual, laryngeal, or pharyngeal weakness at birth and who underwent electrodiagnostic studies combining conventional needle electromyography (EMG) of orofacial muscles, blink responses, and EMG during bottle-feeding. Outcome measures included the need for prolonged respiratory assistance and enteral feeding, as well as sensorimotor and cognitive impairments. RESULTS Of 175 patients, 73% had developmental disorders, 25% suffered from acquired brain damage, and 2% had no apparent underlying disorders. Motor or mental impairment was observed in 71%; death occurred in 16%. Outcomes were not significantly different when comparing developmental disorders versus acquired brain damage or neurogenic versus normal detection EMG. Abnormal blink responses were associated with higher frequencies of respiratory assistance (P = .03), gastrostomy (P = .025), and death (P = .009); moderate or severe oropharyngeal incoordinations were associated with higher frequencies of respiratory assistance (P = .006), prolonged enteral feeding (P < .0001), and gastrostomy (P = .0002). CONCLUSIONS Orofacial electrodiagnostic studies provide supplementary information to help the pediatrician anticipate the management and prognosis of young infants with BW.
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Affiliation(s)
- Jean-Jacques Baudon
- Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France
| | - Francis Renault
- Clinical Neurophysiology Unit, Hôpital Armand-Trousseau, Assistance Publique - Hôpitaux de Paris, Paris, France;
| | - Roberto Flores-Guevara
- Clinical Neurophysiology Unit, Hôpital Armand-Trousseau, Assistance Publique - Hôpitaux de Paris, Paris, France; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Marie-Paule Vazquez
- Faculté de Médecine René Descartes, Université Paris 5, Paris, France; and Department of Maxillofacial Surgery, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
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van den Engel-Hoek L, de Groot IJM, de Swart BJM, Erasmus CE. Feeding and Swallowing Disorders in Pediatric Neuromuscular Diseases: An Overview. J Neuromuscul Dis 2015; 2:357-369. [PMID: 27858755 PMCID: PMC5240596 DOI: 10.3233/jnd-150122] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Feeding and swallowing problems in infants and children have a great impact on health and wellbeing. The aim of this study was to provide an overview of recognized feeding and swallowing problems in different groups of children with neuromuscular diseases, based on relevant literature and expert opinion, and to propose recommendations for the assessment and treatment of these problems. Almost all pediatric neuromuscular diseases are accompanied by feeding and swallowing problems during the different phases of deglutition, problems that give rise to a wide variety of signs and symptoms, which emphasizes the importance of a comprehensive feeding and swallowing assessment by a speech and language therapist.
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Affiliation(s)
- Lenie van den Engel-Hoek
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bert J M de Swart
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Donders Centre for Neuroscience, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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LaMantia AS, Moody SA, Maynard TM, Karpinski BA, Zohn IE, Mendelowitz D, Lee NH, Popratiloff A. Hard to swallow: Developmental biological insights into pediatric dysphagia. Dev Biol 2015; 409:329-42. [PMID: 26554723 DOI: 10.1016/j.ydbio.2015.09.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 12/16/2022]
Abstract
Pediatric dysphagia-feeding and swallowing difficulties that begin at birth, last throughout childhood, and continue into maturity--is one of the most common, least understood complications in children with developmental disorders. We argue that a major cause of pediatric dysphagia is altered hindbrain patterning during pre-natal development. Such changes can compromise craniofacial structures including oropharyngeal muscles and skeletal elements as well as motor and sensory circuits necessary for normal feeding and swallowing. Animal models of developmental disorders that include pediatric dysphagia in their phenotypic spectrum can provide mechanistic insight into pathogenesis of feeding and swallowing difficulties. A fairly common human genetic developmental disorder, DiGeorge/22q11.2 Deletion Syndrome (22q11DS) includes a substantial incidence of pediatric dysphagia in its phenotypic spectrum. Infant mice carrying a parallel deletion to 22q11DS patients have feeding and swallowing difficulties that approximate those seen in pediatric dysphagia. Altered hindbrain patterning, craniofacial malformations, and changes in cranial nerve growth prefigure these difficulties. Thus, in addition to craniofacial and pharyngeal anomalies that arise independently of altered neural development, pediatric dysphagia may result from disrupted hindbrain patterning and its impact on peripheral and central neural circuit development critical for feeding and swallowing. The mechanisms that disrupt hindbrain patterning and circuitry may provide a foundation to develop novel therapeutic approaches for improved clinical management of pediatric dysphagia.
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Affiliation(s)
- Anthony-Samuel LaMantia
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Sally A Moody
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Thomas M Maynard
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Beverly A Karpinski
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Irene E Zohn
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Center for Neuroscience Research, Children's National Health System, Washington D.C., USA
| | - David Mendelowitz
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Norman H Lee
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Anastas Popratiloff
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
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Engel-Yeger B, Hardal-Nasser R, Gal E. The relationship between sensory processing disorders and eating problems among children with intellectual developmental deficits. Br J Occup Ther 2015. [DOI: 10.1177/0308022615586418] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Sensory processing disorders are prevalent among children with intellectual developmental deficits and negatively impact their daily routines. Eating, which is a major part of daily routines, is known to be frequently impaired among children with intellectual developmental deficits. This study aimed to examine the relationships between sensory processing disorders and eating problems in children with different levels of intellectual developmental deficit. Method Participants were 91 children aged 4 to 9 years: 25 with mild intellectual developmental deficits, 32 with moderate intellectual developmental deficits and 34 with severe/profound intellectual developmental deficits. All participants were recruited from special education kindergartens/schools for children with intellectual developmental deficits. Participants' primary caregiver in school completed the screening tool of eating problems and the short sensory profile. Findings Significant correlations between sensory processing disorders and eating problems were found in each intellectual developmental deficit level ( r = −.40, p ≤ .05 to r = −.57, p ≤ .001), but most correlations were found among children with moderate and severe/profound level. Energy level significantly predicted aspiration frequency; smell/taste sensitivity significantly predicted food selectivity and food refusal frequency. Conclusion Eating problems should be screened among children with intellectual developmental deficits according to intellectual developmental deficit severity and other related factors such as sensory processing disorders. Applying this approach in occupational therapy intervention may contribute to a child's adaptive behaviour and performance in daily routines.
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Affiliation(s)
- Batya Engel-Yeger
- Head of Occupational Therapy Department, University of Haifa, Haifa, Israel
| | - Reem Hardal-Nasser
- Occupational Therapist, MSc, Special Education Schools & Kindergarten of Bet Adnan, Yarca, Israel
| | - Eynat Gal
- Senior lecturer, Occupational Therapy Department, University of Haifa, Haifa, Israel
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Fraga DFB, Pereira KDR, Dornelles S, Olchik MR, Levy DS. Avaliação da deglutição em lactentes com cardiopatia congênita e síndrome de Down: estudo de casos. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201514613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo teve por objetivo realizar avaliação fonoaudiológica da deglutição em lactentes com diagnóstico de síndrome de Down e cardiopatia congênita (DSAV tipo A de Rastelli) internados na unidade 2A e Unidade de Tratamento Intensivo Pediátrica da instituição de origem, com suspeita de dificuldade de deglutição, encaminhados ao serviço de fonoaudiologia. Trata-se de uma pesquisa de caráter descritivo-qualitativo, nessa foi possível avaliar dois lactentes durante o período de janeiro a outubro de 2012. Utilizou-se um protocolo de perfil da amostra para a coleta de dados sobre histórico clínico e diagnósticos dos prontuários dos pacientes, além do instrumento de avaliação para prontidão do prematuro para alimentação oral proposto por Fujinaga (2002) para avaliação clínica da deglutição. Os pacientes apresentaram como resultados a presença de disfagia orofaríngea e escores baixos inviabilizando a alimentação exclusivamente por via oral. A conduta terapêutica foi de estimulação oral e volume de alimentação controlado para alimentação oral. Os achados corroboram a literatura no que diz respeito à relação entre disfagia, cardiopatia congênita, síndromes genéticas e alterações miofuncionais orofaciais. Conclui-se que a disfagia apresentou-se como um sintoma dificultante para a alimentação por via oral de forma segura e eficaz para todos os lactentes estudados. Estudos prospectivos com um número maior de sujeitos são necessários para contribuir com a série de casos e, desta forma, identificar outros fatores de risco para disfagia bem como condutas terapêuticas específicas para crianças com síndrome de Down e distúrbios da deglutição associados.
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Menier I, Dejonkheere C, Baou O, Moreno ME, Mattioni V, Madre C. Prévention des troubles de l’oralité en réanimation pédiatrique : mise au point et expérience récente de l’hôpital Robert Debré. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tongue Pressure During Swallowing in Adults with Down Syndrome and Its Relationship with Palatal Morphology. Dysphagia 2014; 29:509-18. [DOI: 10.1007/s00455-014-9538-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
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Osborn AJ, de Alarcon A, Tabangin ME, Miller CK, Cotton RT, Rutter MJ. Swallowing function after laryngeal cleft repair: More than just fixing the cleft. Laryngoscope 2014; 124:1965-9. [DOI: 10.1002/lary.24643] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 12/11/2013] [Accepted: 02/07/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Alexander J. Osborn
- Division of Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Alessandro de Alarcon
- Division of Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Division of Speech and Language Pathology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Meredith E. Tabangin
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Claire K. Miller
- Division of Speech and Language Pathology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Robin T. Cotton
- Division of Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Michael J. Rutter
- Division of Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Aerodigestive and Esophageal Center; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
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Thoyre SM, Pados BF, Park J, Estrem H, Hodges EA, McComish C, Van Riper M, Murdoch K. Development and content validation of the Pediatric Eating Assessment Tool (Pedi-EAT). AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:46-59. [PMID: 24097795 DOI: 10.1044/1058-0360(2013/12-0069)] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE In this article, the authors describe the development and content validation of a parent-report measure of problematic eating behaviors: the Pediatric Eating Assessment Tool (Pedi-EAT). METHOD In Phase I, items were generated from parents' descriptions of problematic feeding behaviors of children, review of literature, and review of existing eating-related instruments. In Phase II, interdisciplinary experts on pediatric eating behaviors rated the items for clarity and relevance using content validity indices (CVI) and provided feedback on the comprehensiveness of the instrument. In Phases III and IV, 2 groups of parents of children with and without feeding difficulties participated in cognitive interviews to gain respondent feedback on content, format, and item interpretation. The authors analyzed interviews using matrix display strategies. RESULTS Experts rated the total scale CVI > .90 for both relevance and clarity; item CVI ranged from .67 to 1.0 for relevance and .5 to 1.0 for clarity. Analysis of each item with low scores, along with experts' and parents' feedback, resulted in refinement of the items, scoring options, and directions. Experts and parents added additional items. Readability after refinements was acceptable at less than a 5th-grade level. CONCLUSION The Pedi-EAT was systematically developed and content validated with input from researchers, clinicians, and parents.
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Sales AVMN, Cola PC, Jorge AG, Peres FM, Santos RRDD, Giacheti CM, Silva RGD. Análise quantitativa da deglutição orofaríngea em indivíduo gastrostomizado com Lipofuscinose Ceróide Neuronal: relato de caso. REVISTA CEFAC 2013. [DOI: 10.1590/s1516-18462013000600036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A presença de disfagia orofaríngea infantil na população com afecções genéticas ainda é pouco estudada. O objetivo deste estudo foi analisar o tempo de trânsito oral total (TTOT) e o tempo de trânsito faríngeo (TTF) em um indivíduo com diagnóstico genético clínico de Lipofuscinose Ceróide Neuronal (LCN) com disfagia orofaríngea grave. Indivíduo com LCN, 3 anos de idade, gastrostomizado há dois anos e sem via oral parcial, histórico de déficit de ganho de peso anterior a via alternativa de alimentação, porém sem complicações pulmonares. A deglutição orofaríngea foi estudada por meio de videofluoroscopia de deglutição e análise quantitativa da deglutição com uso de software específico para tal avaliação. Na análise quantitativa do TTOT e TTF constatou-se, respectivamente, 45,37 segundos (padrão de normalidade em criança é de 4 segundos) e de 4,53 segundos para o TTF. Constatou-se significante aumento nos tempos de trânsito orofaríngeo neste indivíduo, sendo que a disfagia orofaríngea, parte do quadro desta criança com diagnóstico de LCN, deve ser investigada e acompanhada durante a evolução da doença. Uma avaliação da deglutição orofaríngea e acompanhamento nos indivíduos com esta condição genética deve ser realizada, considerando que essa alteração pode fazer parte do fenótipo desta condição e também pelo impacto que esse aumento nos tempos da deglutição pode ocasionar na condição nutricional e pulmonar desta população.
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Castilla-Fernández Y, Boix H, Macaya A, Vázquez E, Gratacòs M, Roig-Quilis M. Brainstem dysgenesis during the neonatal period: diagnosis and management. J Perinat Med 2013; 41:445-53. [PMID: 23348216 DOI: 10.1515/jpm-2012-0261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/20/2012] [Indexed: 11/15/2022]
Abstract
AIMS To report our neonatal management experience in patients who received a diagnosis of brainstem dysgenesis (BSD). PATIENTS AND METHODS This study retrospectively reviewed the medical records of 15 neonates with BSD diagnosed between 1984 and 2011. Data on the perinatal period, physical examination, laboratory findings, and management by systems were systematically analyzed. RESULTS All cases were sporadic. Cocaine abuse and misoprostol use were recorded in two pregnancies. The reason for admission was prematurity (2 of 15), respiratory distress (8 of 15), gastroschisis (1 of 15), and abnormal neurological examination (4 of 15). Clinically, the most commonly affected cranial nerves were the 7th (13 of 15), 9th (11 of 15), 10th (8 of 15), 5th (7 of 15), 12th (7 of 15), 6th (3 of 15), 4th (1 of 15), and 3rd (1 of 15). Five patients required positive pressure ventilation during delivery room resuscitation, three had difficult airways, and two needed tracheostomy during admission. Most patients required nasogastric tube feeding shortly after birth, and four patients had a gastrostomy on discharge. Two patients died of respiratory and cardiac failure. Electromyography and nerve conduction velocity were used to exclude generalized neuromuscular disorders, and in conjunction with other neurophysiological and gastrointestinal tract studies, helped uncover the extent of brainstem involvement in most cases. Cranial magnetic resonance imaging supported the diagnosis in more than half of the patients. CONCLUSIONS Early diagnosis of BSD is mainly clinical, difficult to establish unless suspected, and crucial to prevent complications. Neonatal care of patients with BSD requires a comprehensive approach that must take into consideration the etiological, anatomical, and pathogenic aspects contributing to the clinical manifestations of this disorder. Care should be provided by multidisciplinary teams, in which neonatologists, pediatric neurologists, nutritionists, physical therapists, and other professionals participate, depending on the associated morbidity in order to improve its management and prognosis.
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O’Neill AC, Richter GT. Pharyngeal Dysphagia in Children with Down Syndrome. Otolaryngol Head Neck Surg 2013; 149:146-50. [DOI: 10.1177/0194599813483445] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Pharyngeal dysphagia (PD) in children with Down syndrome (DS) has not been examined. This study aims to describe the incidence, duration, and precipitating factors of PD in a large cohort of children with DS. Study Design Case series with chart review. Setting Tertiary care children’s hospital. Methods The International Classification of Diseases, Ninth Revision ( ICD-9) code for DS was used to identify all children treated at a single institution from 1992 to 2012. Patient charts were reviewed for signs, symptoms, and documentation of PD. Videofluoroscopic swallow studies (VFSS) established the final diagnosis of PD in affected patients. Otolaryngologic interventions and their impact on PD were also explored. Results A total of 228 patients with the ICD-9 code for DS were found. Twenty-seven patients (11.8%) were excluded due to record deficiencies. Thus, of the 201 children with DS who were available for complete review, 116 (57.7%) had and established diagnosis of PD by VFSS. The mean age at first diagnosis of PD was 1.69 years. At the time of the study, the cohort mean age was 7.45 years, with only 20 patients demonstrating resolution of PD. Patients with a tracheotomy or significant neurologic delays were more likely to have worsening or prolonged PD. Laryngeal clefts were identified in 3 patients, whereas 78 (67%) underwent surgery for upper airway obstruction that did not consistently improve PD. Conclusion This study suggests that PD is common, persistent, and should be routinely explored in children with DS. Intervention for upper airway obstruction had a limited role for PD in this study cohort.
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Affiliation(s)
- Ashley C. O’Neill
- Department of Audiology and Speech Pathology, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Gresham T. Richter
- Department of Otolaryngology–Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas, USA
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Abstract
Although poorly recognized and studied, congenital sucking, swallowing, and/or feeding disorders are common. They can be the symptoms that reveal a neuromuscular disease, or that complicate a neuromuscular disease. It is essential to know feeding physiology during fetal and infant development in order to understand the variety of its disorders and to direct correctly diagnostic and therapeutic processes. A good semiological analysis will identify the symptoms. Several investigations help to determine the mechanism of the trouble (fiber endoscopy, videofluoroscopy, facial and swallowing electromyography, esophageal manometry, etc.). Other investigations, in addition to clinical assessments, help to identify the cause of the whole picture (peripheral electromyography, brain MRI, genetic or metabolic investigations, etc.). The main causes of sucking, swallowing, and feeding disorders are lesions of the brainstem (malformations of the posterior fossa, neonatal brainstem tumors, agenesis of cranial nerves, clastic lesion of the posterior brain, craniovertebral anomalies, syndromes that involve the rhombencephalic development such as Pierre Robin sequence, CHARGE syndrome, etc.). Suprabulbar lesions, neuromuscular disorders, peripheral esophageal, digestive, and laryngeal anomalies and dysfunctions can also be involved. The main principles of the management of congenital sucking, swallowing, and feeding disorders are the following: cure the cause if possible, facilitate the sucking reflex, preventing deleterious consequences of aspiration, preventing malnutrition, and preventing posttraumatic anorexia. Advice can be given to caregivers and physiotherapists who take charge of these children.
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Affiliation(s)
- Véronique Abadie
- Department of Pediatrics, Hôpital Necker-Enfants Malades, Université Paris Descartes and the national reference centre for Pierre Robin syndromes and sucking and swallowing congenital disorders, France.
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Percutaneous gastrostomy tubes in children with Pierre Robin sequence: efficacy, maintenance and complications. Pediatr Radiol 2012; 42:566-73. [PMID: 22130827 DOI: 10.1007/s00247-011-2301-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/14/2011] [Accepted: 09/28/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children with Pierre Robin sequence (PRS) have significant oropharyngeal abnormalities, with respiratory and feeding difficulties. Gastrostomy tubes (G-tube) provide a means for nutrition. OBJECTIVE To evaluate the safety and efficacy of percutaneous G-tube insertion in children with PRS. MATERIALS AND METHODS Of 120 children with PRS (1996-2009), 40 were referred for G-tube insertion; clinical details were reviewed in 37/40 children (18M, 19F) at three time periods: (1) pre-G-tube insertion, (2) at G-tube insertion, (3) at G-tube removal. RESULTS Pre-G-tube: 32/37 were term infants; 5 were preterm; 16/37 children were ≤ 10th weight percentile. At G-tube insertion, mean age was 66 days, mean weight 4.4 kg (1.1-7.0 kg); 19 dropped ≥10 weight percentiles; 12 tolerated nil by mouth; 2/37 were intubated for the procedure. All G-tubes were successfully placed, with five minor technical issues. Early postprocedure, there were eight minor complications and two dislodgements (classified as major). At G-tube removal mean G-tube dwell time was 2 years, with an average of 3.6 maintenance procedures per child, approximately 3 tube changes/1,000 tube days. At G-tube removal, 76% had maintained or increased weight centiles. CONCLUSION G-tubes in PRS provide a safe method for nutrition until children feed adequately by mouth.
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Abstract
INTRODUCTION Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is the most common cause of neonatal hypoglycemia. Feeding plays a major role in its management. We evaluated the magnitude of food aversion among our patients with PHHI. METHODS A retrospective medical record review was conducted for patients with PHHI managed during the last 15 years. Demographic and clinical data were retrieved, and descriptive data were generated. RESULTS Forty-two patients (18 were male and 24 were female) were managed for PHHI over the study period. Thirty-three patients had subtotal pancreatectomy, and 9 were managed medically, with a mean follow-up of 5 years. Nineteen patients (45%) had aversion to food, and 9 of them were developmentally delayed. Of 14 patients assessed by a speech pathologist, 5 had aversive sensory behavior, 4 had dysfunctional pharyngeal swallowing, and 5 had a normal assessment. Ten were managed with oral feeding, 4 had gastrostomy feedings, and 5 were managed with oral and nasogastric tube feeds for various periods. CONCLUSIONS Food aversion is significantly prevalent among patients with PHHI. The presence of food aversion appears to be independent of developmental delay. Aggressive measures to manage food aversion could help in the management of patients with PHHI.
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Sooben RD. Breastfeeding patterns in infants with Down's syndrome: A literature review. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjom.2012.20.3.187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Roja D. Sooben
- Roja D. Sooben Senior Lecturer in Learning Disability Nursing, School of Nursing, Midwifery and Social Work, University of Hertfordshire
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Abstract
Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2-2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain. Children with CP can have swallowing problems with severe drooling as one of the consequences. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Early attention should be given to dysphagia and excessive drooling and their substantial contribution to the burden of a child with CP and his/her family. This review displays the important functional and anatomical issues related to swallowing problems in children with CP based on relevant literature and expert opinion. Furthermore, based on our experience, we describe a plan for approach of investigation and treatment of swallowing problems in cerebral palsy.
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Solomons N. Treacher Collins syndrome. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2012. [DOI: 10.1080/16070658.2012.11734401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease. Cardiol Young 2011; 21:303-9. [PMID: 21272426 DOI: 10.1017/s1047951110001976] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM We thought of assessing the prevalence and predictors of feeding disorders in patients with congenital heart defects after neonatal cardiac surgery. METHODS Retrospective study of 82 consecutive neonates (48 males, 34 females) who underwent surgery for congenital heart defects from 1999 to 2002. Information was taken from patient charts and nursing notes. The presence of a feeding disorder was assessed by a questionnaire sent to the paediatricians when the child was 2 years of age. A feeding disorder was defined as a need for tube feeding, inadequate food intake for age, or failure to thrive. Data were analysed with descriptive statistics and logistic regression. RESULTS Feeding disorders occurred in 22% of the study population. Reoperation and early feeding disorders were identified as independent risk factors for later feeding disorders (odds ratio 5.8, p 0.01; odds ratio 20.7, p 0.02). There was a trend towards more feeding disorders in patients with neurological abnormalities during the first hospital stay. CONCLUSION Feeding disorder is a frequent, long-term sequela after neonatal cardiac surgery. Patients with congenital heart defects who undergo multiple cardiac surgeries and those with early feeding disorders are at risk of developing later feeding disorders. Patients with these risk factors need to be selected for preventive strategies.
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Abstract
Cleft palate, a malformation of the secondary palate development, is one of the most common human congenital birth defects. Palate formation is a complex process resulting in the separation of the oral and nasal cavities that involves multiple events, including palatal growth, elevation, and fusion. Recent findings show that transforming growth factor beta (TGF-β) signaling plays crucial roles in regulating palate development in both the palatal epithelium and mesenchyme. Here, we highlight recent advances in our understanding of TGF-β signaling during palate development.
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Affiliation(s)
- J Iwata
- Center for Craniofacial Molecular Biology, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA
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84
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Al-Zubeidi D, Rahhal RM. Safety techniques for percutaneous endoscopic gastrostomy tube placement in Pierre Robin Sequence. JPEN J Parenter Enteral Nutr 2011; 35:343-5. [PMID: 21282476 DOI: 10.1177/0148607110381268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pierre Robin Sequence (PRS) is a craniofacial anomaly characterized by a triad of micrognathia, glossoptosis, and cleft palate. Infants with PRS frequently have feeding problems that may require supplemental nutrition through a nasogastric or gastrostomy tube. Very few published studies have illustrated the most appropriate method for securing an enteral feeding route in this patient population. One case report described a major complication leading to death from airway compromise following percutaneous endoscopic gastrostomy (PEG) tube placement. The authors describe a case of an infant with PRS who underwent successful PEG tube placement without complications, and they highlight certain techniques to improve procedure success and patient safety.
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Affiliation(s)
- Dina Al-Zubeidi
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Iowa, Iowa City 52241, USA
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85
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Beaton EA, Simon TJ. How might stress contribute to increased risk for schizophrenia in children with chromosome 22q11.2 deletion syndrome? J Neurodev Disord 2010; 3:68-75. [PMID: 21475728 PMCID: PMC3056992 DOI: 10.1007/s11689-010-9069-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 11/26/2010] [Indexed: 01/19/2023] Open
Abstract
The most common human microdeletion occurs at chromosome 22q11.2. The associated syndrome (22q11.2DS) has a complex and variable phenotype with a high risk of schizophrenia. While the role of stress in the etiopathology of schizophrenia has been under investigation for over 30 years (Walker et al. 2008), the stress–diathesis model has yet to be investigated in children with 22q11.2DS. Children with 22q11.2DS face serious medical, behavioral, and socioemotional challenges from infancy into adulthood. Chronic stress elevates glucocorticoids, decreases immunocompetence, negatively impacts brain development and function, and is associated with psychiatric illness in adulthood. Drawing knowledge from the extant and well-developed anxiety and stress literature will provide invaluable insight into the complex etiopathology of schizophrenia in people with 22q11.2DS while suggesting possible early interventions. Childhood anxiety is treatable and stress coping skills can be developed thereby improving quality of life in the short-term and potentially mitigating the risk of developing psychosis.
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Affiliation(s)
- Elliott A Beaton
- Department of Psychiatry and Behavioral Sciences and the M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817 USA
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86
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Schaller F, Watrin F, Sturny R, Massacrier A, Szepetowski P, Muscatelli F. A single postnatal injection of oxytocin rescues the lethal feeding behaviour in mouse newborns deficient for the imprinted Magel2 gene. Hum Mol Genet 2010; 19:4895-905. [DOI: 10.1093/hmg/ddq424] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabienne Schaller
- Institute of Biology of Development of Marseille Luminy, CNRS UMR 6126 and
- Mediterranean Institute of Neurobiology (INMED), INSERM U901, Parc Scientifique de Luminy, BP 13, 13273 Marseille Cedex 09, France and
- Université de la Méditerranée, UMR S901 Aix-Marseille 2, 13009Marseille, France
| | - Françoise Watrin
- Institute of Biology of Development of Marseille Luminy, CNRS UMR 6126 and
- Mediterranean Institute of Neurobiology (INMED), INSERM U901, Parc Scientifique de Luminy, BP 13, 13273 Marseille Cedex 09, France and
- Université de la Méditerranée, UMR S901 Aix-Marseille 2, 13009Marseille, France
| | - Rachel Sturny
- Institute of Biology of Development of Marseille Luminy, CNRS UMR 6126 and
- Université de la Méditerranée, UMR S901 Aix-Marseille 2, 13009Marseille, France
| | - Annick Massacrier
- Mediterranean Institute of Neurobiology (INMED), INSERM U901, Parc Scientifique de Luminy, BP 13, 13273 Marseille Cedex 09, France and
- Université de la Méditerranée, UMR S901 Aix-Marseille 2, 13009Marseille, France
| | - Pierre Szepetowski
- Mediterranean Institute of Neurobiology (INMED), INSERM U901, Parc Scientifique de Luminy, BP 13, 13273 Marseille Cedex 09, France and
- Université de la Méditerranée, UMR S901 Aix-Marseille 2, 13009Marseille, France
| | - Françoise Muscatelli
- Institute of Biology of Development of Marseille Luminy, CNRS UMR 6126 and
- Mediterranean Institute of Neurobiology (INMED), INSERM U901, Parc Scientifique de Luminy, BP 13, 13273 Marseille Cedex 09, France and
- Université de la Méditerranée, UMR S901 Aix-Marseille 2, 13009Marseille, France
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87
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Thompson BL, Levitt P. The clinical-basic interface in defining pathogenesis in disorders of neurodevelopmental origin. Neuron 2010; 67:702-12. [PMID: 20826303 PMCID: PMC2940830 DOI: 10.1016/j.neuron.2010.08.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2010] [Indexed: 02/08/2023]
Abstract
Human cognitive and social-emotional behaviors are heterogeneous, underscoring the challenges in modeling pathogenesis in disorders of neurodevelopmental origin in which these domains are dysfunctional. In general, animal models for these disorders are built to emulate our understanding of the clinical diagnosis, with mixed results. We suggest the utility of model systems lies in the use of different strategies to perturb hierarchical circuit development, to examine the behavioral dimensions that are most impacted, and to discern the capacity for, and heterogeneity of, neuroadaptation that will then inform treatment strategies.
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Affiliation(s)
- Barbara L Thompson
- Department of Cell and Neurobiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
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88
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Chávez CJ, Ortega P, Leal J, D'Escrivan A, González R, Miranda LE. [Vitamin A deficiency and nutritional status in patients with Down's syndrome]. An Pediatr (Barc) 2010; 72:185-90. [PMID: 20153273 DOI: 10.1016/j.anpedi.2009.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 09/29/2009] [Accepted: 10/20/2009] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Vitamin A deficiency (VAD) is a worldwide public health problem. Epidemiological studies of VAD prevalence have been conducted in individuals with chromosome load and genetic potential compared with the general population; however, there are few studies in patients with Down's syndrome (DS). The objective of this study was to determine the prevalence of VAD and analyse nutritional status in patients with DS. METHODS A prospective and cross-sectional study was performed, with 50 karyotypically normal (KN) individuals (10.4+/-3.7 years old) and 38 randomly selected patients with DS (8.2+/-4.1 years old). Serum retinol was determined by HPLC using the Bieri method, with an international reference standard to define VAD (serum retinol <20 microg/dL). The data were analysed using the SAS/STAT statistical program. RESULTS The prevalence of VAD was 18.4% in individuals with DS and 4% in KN individuals (OR: 5.42; 95% CI=0.93-40.64; p=0.02). Children with DS between two and six years old shown a significativily lower serum retinol (p=<0.05).The patients with DS also showed a significant decrease in height and weight compared to KN (p=<0.001). CONCLUSIONS The prevalence of VAD detected in patients with DS could be considered a public health problem. Also, the chromosome 21 trisomy represent a risk factor associated with VAD.
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Affiliation(s)
- C J Chávez
- Instituto de Investigaciones Biológicas, Universidad del Zulia, Maracaibo, Venezuela.
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89
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Abstract
PURPOSE OF REVIEW There is increased recognition in the range of feeding and swallowing problems that occur in conjunction with congenital and acquired pediatric conditions. Differential diagnosis and management of these problems is often not straightforward and requires consideration and collaboration between multiple disciplines that are involved in the care of this special population. This article reviews recent investigations across disciplines regarding the cause and evaluation of pediatric feeding and swallowing issues, intervention efficacy, and available evidence to guide clinical practice. RECENT FINDINGS Knowledge of the basis for feeding issues associated with a variety of causes has advanced. Recent investigations of specific feeding and swallowing issues accompanying prematurity, selected diagnoses, and congenital syndromes are described. Significant advancements in the objective analysis of nonnutritive sucking have been made and provide increased understanding of the precursors for transition to oral feeding. Preliminary evidence regarding the effectiveness of selected clinical interventions to treat feeding and swallowing issues is highlighted. SUMMARY Research is increasingly available to guide practitioners in evidence-based evaluation and management of pediatric feeding and swallowing issues. These continued advancements increase our understanding of the causes of pediatric dysphagia, the efficacy of treatment, and underscore the opportunities for continued research for best practice in clinical evaluation and management.
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Affiliation(s)
- Claire Kane Miller
- Cincinnati Children's Hospital Medical Center, Aerodigestive and Sleep Center/Interdisciplinary Feeding Team, Cincinnati, Ohio 45229, USA.
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