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Dam M, Lynggaard LS, Jónsson ÓG, Saulyte Trakymiene S, Palk K, Jarvis K, Andrés-Jensen L, Tuckuviene R, Albertsen BK. Sequelae and post-thrombotic syndrome after venous thromboembolism in acute lymphoblastic leukemia survivors treated on the NOPHO ALL2008 protocol. Pediatr Blood Cancer 2024; 71:e30937. [PMID: 38480517 DOI: 10.1002/pbc.30937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 04/24/2024]
Abstract
The treatment of acute lymphoblastic leukemia (ALL) is frequently complicated by toxicity, including venous thromboembolism (VTE) affecting roughly 8% of patients. VTE can lead to post-thrombotic syndrome (PTS), a group of signs and symptoms developed as a complication to deep venous thrombosis (DVT), imposing risk of permanent disability and reduced quality of life (QoL). PTS prevalence ranges from 0% to 70%, reflecting very heterogenous cohorts and assessment tools. We aimed to estimate sequelae, including PTS and QoL in children and adults (<45 years old) who had a DVT during ALL treatment. PTS and QoL scores were obtained through use of Villalta and Modified Villalta Scale, PedsQL, and Short Form-36 questionnaires. The cohort comprised 20 children (<18 years) and seven adults (median age: 12.9 years, range: 2-44 years) at the time of DVT diagnosis. In total, 25 ALL survivors underwent PTS examination. The examination took place when survivors were 7-48 years (median age: 20.3 years, median follow-up time 6.8 years). QoL was assessed correlating cases with three matching ALL survivors without VTE. Two adults (15.4%) showed mild or moderate PTS. Eight children (66.7%) were diagnosed with mild PTS, while three cases had collaterals as sole symptoms. Pain or symptoms affecting daily life were reported by 16%. No difference in QoL was found (p = .9). This study underscores the need for comprehensive population-based investigations with validation of PTS instruments in ALL survivors.
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Affiliation(s)
- Merete Dam
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line Stensig Lynggaard
- Department of Hematology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Sonata Saulyte Trakymiene
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Katrin Palk
- The North Estonia Medical Centre, Tallinn, Estonia
| | - Kirsten Jarvis
- Department of Paediatric Haematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruta Tuckuviene
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitte Klug Albertsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Myhr KA, Andrés-Jensen L, Strøier Larsen B, Kunkel JB, Kristensen CB, Vejlstrup N, Køber L, Pecini R. Sex-and age-related variations in myocardial tissue composition of the healthy heart: A native T1 mapping cohort study. Eur Heart J Cardiovasc Imaging 2024:jeae070. [PMID: 38469906 DOI: 10.1093/ehjci/jeae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/23/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024] Open
Abstract
AIMS Cardiovascular diseases manifest differently in males and females, potentially influenced by inherent sex- and age-related differences in myocardial tissue composition. Such inherent differences are not well-established in the literature. With this study using cardiac magnetic resonance (CMR) native T1 mapping, we aim to determine the effect of sex and age on myocardial tissue composition in healthy individuals. METHODS AND RESULTS CMR native T1 mapping was performed in 276 healthy individuals (55% male, age 8---84 years) on a 1.5 Tesla scanner using a MOLLI 5(3)3 acquisition scheme. Additionally, 30 healthy participants (47% male, age 24-68 years) underwent a 1-year follow-up CMR to assess the longitudinal changes of native T1. Mean native T1 values were 1000±22 ms in males and 1022±23 ms in females (mean difference [MD]=22 ms, 95% CI [17, 27]). Female sex was associated with higher native T1 in multivariable linear regression adjusting for age, heart rate, left ventricular mass index, and blood T1 (β=10 ms, 95% CI [3.4, 15.8]). There was no significant interaction between sex and age (p=0.27). Further, age was not associated with native T1 (β=0.1 ms, 95% CI [-0.02, 0.2]), and native T1 did not change during a 1-year period (MD -4 ms, 95% CI [-11, 3]). CONCLUSION Female sex was associated with higher native T1; however, there was no association between age and native T1. Additionally, there was no evidence of an interaction between sex and age. Our findings indicate intrinsic sex-based disparities in myocardial tissue composition.
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Affiliation(s)
- Katrine Aagaard Myhr
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Pediatric Hematology/Oncology, Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Copenhagen Oncology Research Laboratory (Bonkolab), Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Juliane Maries Vej 8, 2100 Copenhagen, Denmark
| | - Bjørn Strøier Larsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 32, 2400 Copenhagen, Denmark
| | - Joakim Bo Kunkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Charlotte Burup Kristensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
- Department of Cardiology, Clinical Sciences, Lund University, Sölvegatan 19, 221 84 Lund, Sweden
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Redi Pecini
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
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Fridh MK, Schmidt-Andersen P, Andrés-Jensen L, Thorsteinsson T, Wehner PS, Hasle H, Schmiegelow K, Larsen HB. Children with cancer and their cardiorespiratory fitness and physical function-the long-term effects of a physical activity program during treatment: a multicenter non-randomized controlled trial. J Cancer Surviv 2023:10.1007/s11764-023-01499-7. [PMID: 38057671 DOI: 10.1007/s11764-023-01499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE We aimed to determine the effects of a classmate-supported, supervised, in-hospital physical activity program during treatment primarily on cardiorespiratory fitness and secondarily on physical function. METHODS A multicenter non-randomized controlled intervention study including children diagnosed with cancer, 6-18 years at diagnosis treated with chemo-/radiotherapy. The intervention comprised (i) an educational session on cancer in the child's school class; (ii) selection of two "ambassadors"-classmates who were co-admitted, supporting the child's everyday hospital life; and (iii) supervised in-hospital physical activity from diagnosis and throughout intensive treatment. One-year post-treatment, physical testing included cardiorespiratory fitness (primary outcome), Sit-to-Stand test, Timed-Up-and-Go, and Handgrip Strength. RESULTS The intervention group included 75 of 120 children (61% boys, 13.4 ± 3.1 years); the control groups included 33 of 58 children with cancer (58% boys, 13.5 ± 2.5 years), and 94 age- and sex-matched children without a cancer history. One-year post-treatment, cardiorespiratory fitness tended to be higher in the intervention group (37.0 ± 6.0 mL/kg/min) than in the patient control group with cancer (32.3 ± 9.7 mL/kg/min) (mean difference 4.7 [0.4 to 9.1], p = 0.034). The intervention group performed better in the secondary outcomes. Compared with community controls, both patient groups had lower cardiorespiratory fitness. The patient control group had lower Sit-to-Stand, Timed Up and Go, and Handgrip Strength, while the intervention group had strength comparable to that of the community controls. CONCLUSIONS Peer-supported, supervised, in-hospital physical activity during treatment may improve cardiorespiratory fitness and muscle strength 1-year post-treatment in children with cancer; however, survivors continue to have lower cardiorespiratory fitness than community controls. IMPLICATIONS FOR CANCER SURVIVORS Children with cancer may benefit from in-hospital physical activity in improving long-term cardiorespiratory fitness and muscle strength.
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Affiliation(s)
- Martin Kaj Fridh
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Peter Schmidt-Andersen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- The University of Copenhagen, Faculty of Health Science, Institute for Clinical Medicine, Copenhagen, Denmark
- Department of Occupational Therapy and Physiotherapy, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Troels Thorsteinsson
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- The University of Copenhagen, Faculty of Health Science, Institute for Clinical Medicine, Copenhagen, Denmark.
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Laumann RD, Pedersen LL, Andrés-Jensen L, Mølgaard C, Schmiegelow K, Frandsen TL, Als-Nielsen B. Hyperlipidemia in children and adolescents with acute lymphoblastic leukemia: A systematic review and meta-analysis. Pediatr Blood Cancer 2023; 70:e30683. [PMID: 37776083 DOI: 10.1002/pbc.30683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The established association between acute lymphoblastic leukemia (ALL) and hyperlipidemia has, in some studies, been linked to toxicities such as pancreatitis, thrombosis, and osteonecrosis. However, a systematic review investigating the incidence, management, and clinical implications of hyperlipidemia during childhood ALL treatment is lacking. OBJECTIVES Systematically assess the incidence of hyperlipidemia during ALL treatment, explore associations with risk factors and severe toxicities (osteonecrosis, thrombosis, and pancreatitis), and review prevalent management strategies. METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data synthesis was descriptive, and a meta-analysis of hypertriglyceridemia and risk of severe toxicities was performed. RESULTS We included 13 studies with 3,425 patients. Hyperlipidemia incidence varied widely (6.7%-85%) but with inconsistent definitions and screening strategies across studies. Evidence regarding risk factors was conflicting, but age (> 10 years) and treatment with asparaginase and glucocorticosteroids seem to be associated with hyperlipidemia. Hypertriglyceridemia (grade 3/4) increased the risk for osteonecrosis (odds ratio (OR): 4.27, 95% confidence interval (CI): 2.77-6.61). No association could be established for pancreatitis (OR: 1.60, 95% CI: 0.53-4.82) or thrombosis (OR: 2.45, 95% CI: 0.86-7.01), but larger studies are needed to confirm this. CONCLUSION The overall evidence of this systematic review is limited by the small number of studies and risk of bias. Our review suggests that hypertriglyceridemia increases the risk for osteonecrosis. However, larger studies are needed to explore the clinical implications of hyperlipidemia and randomized trials investigating hyperlipidemia management and its impact on severe toxicities.
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Affiliation(s)
- Renate Dagsdottir Laumann
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Louise Lindkvist Pedersen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Pediatric Nutrition Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Leth Frandsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bodil Als-Nielsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
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5
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Skipper MT, Albertsen BK, Schmiegelow K, Andrés-Jensen L. Long-term effects of asparaginase-associated pancreatitis. Pediatr Blood Cancer 2023:e30528. [PMID: 37376950 DOI: 10.1002/pbc.30528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
Pancreatitis is a common and severe toxicity that occurs during asparaginase treatment for acute lymphoblastic leukemia, and has received increasing attention during the last decades. However, no consensus regarding follow-up exists. In this commentary, we highlight potential long-term health-related effects following asparaginase-associated pancreatitis, thereby providing clinicians with a framework when following these patients during and after cessation of therapy.
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Affiliation(s)
- Mette Tiedemann Skipper
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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6
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Borch-Johnsen L, Andrés-Jensen L, Folke F, Espersen MM, Amstrup SL, Frederiksen MS, Gjaerde LK, Hjelvang BR, Kristoffersen MJ, Lundby-Christensen L, Schrøder M, Spangenberg KB, Lund S, Cortes D. Development of video tutorials to help parents manage children with acute illnesses using a modified Delphi method. Acta Paediatr 2023. [PMID: 37129464 DOI: 10.1111/apa.16805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Abstract
AIM Children often fall sick, which causes concern among parents. Online health information can be confusing and difficult to understand. We aimed to produce simple, informative video tutorials on the symptoms ill children present. METHODS We used a modified Delphi method to produce video tutorials on the symptoms fever, vomiting & diarrhea, abdominal pain, breathing difficulties, sore throat, red eyes, earache, and rash. We identified the most common symptoms in acutely ill children. During the first consensus round, experts rated statements on out-of-hospital management from existing health information. Video tutorials were produced from statements rated to be included. Second consensus involved video showings and editing. Two videos were evaluated in focus groups by parents. RESULTS During the first round, experts rated median 79 (40-154) statements for each symptom. Panels consisted of median seven (6-11) experts, primarily. Panels reached consensus on inclusion, neutral, or exclusion in 83% of statements. Second round led to adjustments to the videos and final approval by experts. Most parents evaluated the videos as "informative, easy to understand, and calming". CONCLUSION We produced video tutorials on the common symptoms ill children present using a modified Delphi method. Feedback from parents in focus groups was positive.
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Affiliation(s)
- L Borch-Johnsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Emergency Medical Services Capital Region, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - L Andrés-Jensen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - F Folke
- Emergency Medical Services Capital Region, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Gentofte, Denmark
| | | | - S L Amstrup
- Region Headquarter, Capital Region of, Denmark
| | - M S Frederiksen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Copenhagen, Denmark
| | - L K Gjaerde
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - B R Hjelvang
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - M J Kristoffersen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - L Lundby-Christensen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Naestved, Slagelse and Ringsted, Slagelse, Denmark
| | - M Schrøder
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - K B Spangenberg
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital- North Zealand, Hilleroed, Denmark
| | - S Lund
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - D Cortes
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Emergency Medical Services Capital Region, Denmark
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7
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Nielsen CG, Thomsen BL, Als-Nielsen B, Conyers R, Jeha S, Mateos MK, Mlynarski W, Pieters R, Rathe M, Schmiegelow K, Andrés-Jensen L. Physician-defined severe toxicities occurring during and after cancer treatment: Modified consensus definitions and clinical applicability in the evaluation of cancer treatment. Front Pediatr 2023; 11:1155449. [PMID: 37181427 PMCID: PMC10171426 DOI: 10.3389/fped.2023.1155449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 05/16/2023] Open
Abstract
Overall survival after cancer is increasing for the majority of cancer types, but survivors can be burdened lifelong by treatment-related severe toxicities. Integration of long-term toxicities in treatment evaluation is not least important for children and young adults with cancers with high survival probability. We present modified consensus definitions of 21 previously published physician-defined Severe Toxicities (STs), each reflecting the most serious long-term treatment-related toxicities and representing an unacceptable price for cure. Applying the Severe Toxicity (ST) concept to real-world data required careful adjustments of the original consensus definitions, translating them into standardized endpoints for evaluating treatment-related outcomes to ensure that (1) the STs can be classified uniformly and prospectively across different cohorts, and (2) the ST definitions allow for valid statistical analyses. The current paper presents the resulting modified consensus definitions of the 21 STs proposed to be included in outcome reporting of cancer treatment.
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Affiliation(s)
- Camilla Grud Nielsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Birthe Lykke Thomsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Bodil Als-Nielsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rachel Conyers
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Pharmacogenomics, Stem Cell Biology, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Children’s Cancer Centre, The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Sima Jeha
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN, United States
| | - Marion K. Mateos
- Kids Cancer Centre, Sydney Children’s Hospital Randwick, Sydney, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, NSW, Australia
- Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, Lodz, Poland
| | - Rob Pieters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Mathias Rathe
- Department of Pediatric Hematology and Oncology, Hans Christian Andersen’s Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Correspondence: Liv Andrés-Jensen
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8
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Hansen-Nord E, Lindman J, Ingerslev MD, Andrés-Jensen L, Carlsen EM. [Not Available]. Ugeskr Laeger 2022; 184:V01220069. [PMID: 36426816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intrauterine growth restriction (IUGR) is a potential complication associated with maternal SARS-CoV-2 infection. Danish guidelines recommend ultrasound follow-up from gestational age (GA) 24+0 in SARS-CoV-2-positive pregnant women who experience reduced fetal movements. This is a case report of severe IUGR (-51%) after maternal infection at GA 22+1 in a healthy unvaccinated 28-year-old woman. Positive PCR-tests for SARS-CoV-2 from placenta and child, along with massive placental inflammatory findings, suggested IUGR caused by maternal infection. This implies that follow-up from earlier GA may be warranted.
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Affiliation(s)
- Erika Hansen-Nord
- Neonatalafsnittet, Børne- og Ungeafdelingen, Københavns Universitetshospital - Hvidovre Hospital
| | - Johanna Lindman
- Gynækologisk-obstetrisk Afdeling, Københavns Universitetshospital - Hvidovre Hospital
| | - Marie Dines Ingerslev
- Gynækologisk-obstetrisk Afdeling, Københavns Universitetshospital - Hvidovre Hospital
| | - Liv Andrés-Jensen
- Neonatalafsnittet, Børne- og Ungeafdelingen, Københavns Universitetshospital - Hvidovre Hospital
| | - Emma Malchau Carlsen
- Neonatalafsnittet, Børne- og Ungeafdelingen, Københavns Universitetshospital - Hvidovre Hospital
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9
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Mathiesen S, Andrés-Jensen L, Nielsen MM, Sørensen K, Ifversen M, Jahnukainen K, Juul A, Müller K. Male gonadal function after pediatric hematopoietic stem cell transplantation: a systematic review. Transplant Cell Ther 2022; 28:503.e1-503.e15. [DOI: 10.1016/j.jtct.2022.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/08/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022]
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10
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Topperzer MK, Roug LI, Andrés-Jensen L, Pontoppidan P, Hoffmann M, Larsen HB, Schmiegelow K, Sørensen JL. Twelve tips for postgraduate interprofessional case-based learning. Med Teach 2022; 44:130-137. [PMID: 33761309 DOI: 10.1080/0142159x.2021.1896691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Based on developing, implementing, and evaluating postgraduate interprofessional case-based learning, we have written these twelve tips for health education planners who wish to apply case-based learning in the clinical setting. Interprofessional case-based learning engages participants in a structured manner towards uncovering decisions processes and patterns of action that resemble the clinical reality in which various healthcare professionals handle multifaceted tasks related to the optimal patient treatment. Postgraduate interprofessional case-based learning has the potential to break down traditional hierarchical structures as interactions generate respectful behaviour. We present two models of case-based learning to assist in standardising, structuring, and systematising postgraduate interprofessional case-based learning. We have created 12 practical tips for the design, implementation, and evaluation of successful postgraduate interprofessional case-based learning integrated into the existing clinical setting.
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Affiliation(s)
- Martha Krogh Topperzer
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Louise Ingerslev Roug
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Pontoppidan
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Hoffmann
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Paediatric Oncology Research Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jette Led Sørensen
- Department of Clinical Medicine, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Andrés-Jensen L, Attarbaschi A, Bardi E, Barzilai-Birenboim S, Bhojwani D, Hagleitner MM, Halsey C, Harila-Saari A, van Litsenburg RRL, Hudson MM, Jeha S, Kato M, Kremer L, Mlynarski W, Möricke A, Pieters R, Piette C, Raetz E, Ronceray L, Toro C, Grazia Valsecchi M, Vrooman LM, Weinreb S, Winick N, Schmiegelow K. Severe toxicity free survival: physician-derived definitions of unacceptable long-term toxicities following acute lymphocytic leukaemia. Lancet Haematol 2021; 8:e513-e523. [PMID: 34171282 DOI: 10.1016/s2352-3026(21)00136-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
5-year overall survival rates have surpassed 90% for childhood acute lymphocytic leukaemia, but survivors are at risk for permanent health sequelae. Although event-free survival appropriately represents the outcome for cancers with poor overall survival, this metric is inadequate when cure rates are high but challenged by serious, persistent complications. Accordingly, a group of experts in paediatric haematology-oncology, representative of 17 international acute lymphocytic leukaemia study groups, launched an initiative to construct a measure, designated severe toxicity-free survival (STFS), to quantify the occurrence of physician-prioritised toxicities to be integrated with standard cancer outcome reporting. Five generic inclusion criteria (not present before cancer diagnosis, symptomatic, objectifiable, of unacceptable severity, permanent, or requiring unacceptable treatments) were used to assess 855 health conditions, which resulted in inclusion of 21 severe toxicities. Consensus definitions were reached through a modified Delphi process supplemented by two additional plenary meetings. The 21 severe toxicities include severe adverse health conditions that substantially affect activities of daily living and are refractory to therapy (eg, refractory seizures), are without therapeutic options (eg, blindness), or require substantially invasive treatment (eg, cardiac transplantation). Incorporation of STFS assessment into clinical trials has the potential to improve and diversify treatment strategies, focusing not only on traditional outcome events and overall survival but also the frequencies of the most severe toxicities. The two major aims of this Review were to: prioritise and define unacceptable long-term toxicity for patients with childhood acute lymphocytic leukaemia, and define how these toxicities should be combined into a composite quantity to be integrated with other reported outcomes. Although STFS quantifies the clinically unacceptable health tradeoff for cure using childhood acute lymphocytic leukaemia as a model disease, the prioritised severe toxicities are based on generic considerations of relevance to any other cancer diagnosis and age group.
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Affiliation(s)
- Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andishe Attarbaschi
- Department of Pediatric Hematology-Oncology, St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Edit Bardi
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Pediatric Oncology and Immunology, Kepler University Clinic, Linz, Austria
| | - Shlomit Barzilai-Birenboim
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Deepa Bhojwani
- Department of Pediatrics, Children's Hospital Los Angeles, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Christina Halsey
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Children's Haemato-Oncology Unit, Royal Hospital for Children, Glasgow, UK
| | - Arja Harila-Saari
- Women's and Children's Health, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | | | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Motohiro Kato
- Department of Pediatrics, University of Tokyo, Tokyo, Japan
| | - Leontien Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology & Hematology, Medical University of Lodz, Lodz, Poland
| | - Anja Möricke
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Rob Pieters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Caroline Piette
- Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
| | - Elizabeth Raetz
- Department of Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Leila Ronceray
- Department of Pediatric Hematology-Oncology, St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Claudia Toro
- Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Lynda M Vrooman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sigal Weinreb
- Department of Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Naomi Winick
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.
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Andrés-Jensen L, Skipper MT, Mielke Christensen K, Hedegaard Johnsen P, Aagaard Myhr K, Kaj Fridh M, Grell K, Pedersen AML, Leisgaard Mørck Rubak S, Ballegaard M, Hørlyck A, Beck Jensen R, Lambine TL, Gjerum Nielsen K, Tuckuviene R, Skov Wehner P, Klug Albertsen B, Schmiegelow K, Frandsen TL. National, clinical cohort study of late effects among survivors of acute lymphoblastic leukaemia: the ALL-STAR study protocol. BMJ Open 2021; 11:e045543. [PMID: 33563628 PMCID: PMC7875271 DOI: 10.1136/bmjopen-2020-045543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION More than 90% of patients diagnosed with childhood acute lymphoblastic leukaemia (ALL) today will survive. However, half of the survivors are expected to experience therapy-related chronic or late occurring adverse effects, reducing quality of life. Insight into underlying risk trajectories is warranted. The aim of this study is to establish a Nordic, national childhood ALL survivor cohort, to be investigated for the total somatic and psychosocial treatment-related burden as well as associated risk factors, allowing subsequent linkage to nation-wide public health registers. METHODS AND ANALYSIS This population-based observational cohort study includes clinical follow-up of a retrospective childhood ALL survivor cohort (n=475), treated according to a common Nordic ALL protocol during 2008-2018 in Denmark. The study includes matched controls. Primary endpoints are the cumulative incidence and cumulative burden of 197 health conditions, assessed through self-report and proxy-report questionnaires, medical chart validation, and clinical examinations. Secondary endpoints include organ-specific outcome, including cardiovascular and pulmonary function, physical performance, neuropathy, metabolic disturbances, hepatic and pancreatic function, bone health, oral and dental health, kidney function, puberty and fertility, fatigue, and psychosocial outcome. Therapy exposure, acute toxicities, and host genome variants are explored as risk factors. ETHICS AND DISSEMINATION The study is approved by the Regional Ethics Committee for the Capital Region in Denmark (H-18035090/H-20006359) and by the Danish Data Protection Agency (VD-2018-519). Results will be published in peer-reviewed journals and are expected to guide interventions that will ameliorate the burden of therapy without compromising the chance of cure.
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Affiliation(s)
- Liv Andrés-Jensen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Tiedemann Skipper
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Martin Kaj Fridh
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kathrine Grell
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - A M L Pedersen
- Section of Oral Medicine/Oral Biology and Immunopathology, Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | | | - Martin Ballegaard
- Department of Neurology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Arne Hørlyck
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Beck Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine-Lise Lambine
- Department of Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Ruta Tuckuviene
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, Odense University Hospital, Odense, Denmark
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Thomas Leth Frandsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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Topperzer MK, Hoffmann M, Larsen HB, Rosthøj S, Nersting J, Roug LI, Pontoppidan P, Andrés-Jensen L, Lausen B, Schmiegelow K, Sørensen JL. Interprofessional versus monoprofessional case-based learning in childhood cancer and the effect on healthcare professionals' knowledge and attitudes: study protocol for a randomised trial. BMC Health Serv Res 2020; 20:1124. [PMID: 33276789 PMCID: PMC7718682 DOI: 10.1186/s12913-020-05980-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/26/2020] [Indexed: 02/01/2023] Open
Abstract
Background Interprofessional education in childhood cancer is a multifaceted field involving multiple healthcare professionals with general and specialised knowledge and skills. Complex treatment, care and rehabilitation require continuous professional development and maintenance of healthcare professionals’ competencies in their field of expertise. However, limited knowledge exists in comparing interprofessional and monoprofessional education. Only a few randomised studies have evaluated the effectiveness and efficiency of interprofessional education. The objective of this single-centre, investigator-initiated cluster randomised trial is to study the effect of interprofessional versus monoprofessional case-based learning on healthcare professionals’ knowledge of gastrointestinal side effects and attitudes towards team collaboration. Methods This study will randomise healthcare professionals to participate in either the experimental interprofessional group or the control monoprofessional group of case-based learning. The topic of the case-based intervention will be gastrointestinal side effects, one of six categories identified in a three-round Scandinavian Delphi study as relevant for interprofessional education in childhood cancer. The primary outcome is the self-reported questionnaire Assessment of Interprofessional Team Collaboration Scale. Secondary outcomes are measured by the self-reported questionnaires Readiness for Interprofessional Learning Scale Questionnaire, Safety Attitudes Questionnaire, and knowledge will be evaluated using a multiple-choice quiz. Participants will receive the self-reported questionnaires about 2 weeks before and 1 month after the intervention. On the day of the intervention, participants will answer a multiple-choice quiz before and after the case-based learning. Linear mixed models will be used to compare differences between the two groups in mean scores postintervention, adjusting for preintervention scores. Discussion This study will provide insight into the differences between interprofessional and monoprofessional case-based learning and how it affects healthcare professionals’ knowledge of gastrointestinal side effects and attitudes towards team collaboration. Trial registration The intervention was registered at Clinical Trials.gov: NCT04204109 on December 102,019 and with the National Committee on Health Research Ethics: H-19087506 December 112,019 and the Danish Data Protection Agency: P-2019-637 October 152,019. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05980-2.
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Affiliation(s)
- Martha Krogh Topperzer
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Marianne Hoffmann
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Susanne Rosthøj
- Section of Biostatistics, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Jacob Nersting
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Louise Ingerslev Roug
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Peter Pontoppidan
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Liv Andrés-Jensen
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Birgitte Lausen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jette Led Sørensen
- Juliane Marie Centre, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Andrés-Jensen L, Jørgensen FS, Thorup J, Flachs J, Madsen JL, Maroun LL, Nørgaard P, Vinicoff PG, Olsen BH, Cortes D. The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort. Arch Dis Child 2016; 101:819-24. [PMID: 27217581 DOI: 10.1136/archdischild-2015-309784] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/29/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Antenatal ultrasound diagnosed anomalies of the kidney and urinary tract (AUDAKUT) are reported in 0.3%-5% on prenatal ultrasound (US) and 0.3%-4.5% on postnatal US. The anterior-posterior diameter of the renal pelvis (APD) is an essential measurement. Series with low threshold values of APD prenatally and postnatally will include healthy infants. It is important to avoid follow-up of such infants. INTERVENTIONS In 2006, new Danish guidelines for AUDAKUT were introduced. AIM OF STUDY Investigations of incidences and type of AUDAKUT based on Danish guidelines, including long-term follow-up. DESIGN Cohort study. SETTING Copenhagen University Hospital Hvidovre and Copenhagen University Hospital Rigshospitalet, Denmark. PATIENTS Consecutive cases with AUDAKUT in the second and third trimesters, which were either terminated before 22 completed weeks of gestation or born in the 8-year period January 2006-December 2013. Patients were followed until June 2014. RESULTS 50 193 live born children and 24 terminated fetuses (0.05%) were included. The prevalence of AUDAKUT was only 0.39% prenatally, 0.29% at first postnatal US and 0.22% at the end of follow-up, including terminated cases. The greater the prenatal and postnatal APD, the higher risk of febrile urinary tract infection (fUTI) and surgical intervention, and lower probability of resolution. 25% of the identified patients had fUTI and/or surgery. CONCLUSIONS We recommend threshold values of APD at least 10 mm in the third trimester and in general at least 12 mm at first postnatal US for intensive follow-up. In this largest to date unselected birth cohort of AUDAKUT, the incidences of clinically significant AUDAKUT were in the lowest range of those previously published.
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Affiliation(s)
- Liv Andrés-Jensen
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Finn Stener Jørgensen
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Thorup
- Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Julie Flachs
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jan Lysgaard Madsen
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Lisa Leth Maroun
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pernille Nørgaard
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Pablo Gustavo Vinicoff
- Department of Radiology and Ultrasound, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Beth Härstedt Olsen
- Department of Radiology and Ultrasound, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Dina Cortes
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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