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Indian Pediatr 2020;57:92 |
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Clippings
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Neetu Sharma
Email:
[email protected]
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A big-data approach to producing descriptive anthropometric
references: A feasibility and validation study of paediatric growth
charts (Lancet Digital Health. 2019;1:e413-e423)
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WHO international growth standards or national charts are not always
found to be perfectly caliberated with the growth of contemporary
children in many countries. This study used a novel big-data approachto
generate new national growth charts for French children. 32 randomly
sampled primary care pediatricians and ten volunteer general
practitioners were recruited, who used the same electronic medical
records software, from which all physical growth data for children born
from Jan 1, 1990, and aged1 month to 18 years by Feb 8, 2018, with birth
weight greater than 2500 g was extracted. Growth charts for weight and
height were derived by using generalized additive models for location,
scale, and shape with the Box-Cox power exponential distribution. It
included 1458468 height and 1690340 weight measurements from 238102
children, in comparison to measurements for a median of 17000 children
used for growth charts produced in the past worldwide. When compared,
all height SD and weight percentile curves were distinctly above those
for the existing French national growth charts, as early as age 1 month,
with an average difference of 0·75 SD for height and 0·50 SD for weight
for both sexes. Comparison with national cross-sectional surveys showed
satisfactory calibration, with generally good fit for children aged 5-6
years and 10-11 years in height and weight and small differences at age
14-15 years.
The need to update height growth charts cannot be debated; however,
caution should be exercised for updating weight growth charts, in the
context of the increasing prevalence of childhood overweight and obesity
worldwide.
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Should paediatricians initiate orthopaedic hip dysplasia
referrals for infants with isolated asymmetric skin folds?(J
Child Orthop. 2019;13:593-9)
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Asymmetric skin folds (ASFs) around the hips in children are often
considered an early clinical sign for diagnosing developmental dysplasia
of the hip (DDH). This study was done with the purpose to see the
utility of isolated ASFs as a screening tool for DDH in a series of
patient referred for evaluation. It was a retrospective review of 66
(mean age 6.4 months) consecutive patients between 0 and 12 months of
age referred to orthopedic clinics for isolated ASFs. All received
pelvic radiographs or ultrasound; 79% were found to have acetabular
dysplasia. 36 (55%) were considered normal by their treating physician,
and 25 (38%) were considered dysplastic and underwent brace treatment.
One hip with an isolated ASF was found to have a dislocated hip on
radiograph prior to their initial orthopedic visit. Thus, isolated ASFs
can be an indicator of mild dysplasia and warrant further workup or
referral.
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Systematic review and meta-analysis of virtual reality in
pediatrics: Effects on pain and anxiety (Anesth Analg. 2019;129:1344-53)
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Medical procedures often evoke pain and anxiety in pediatric patients.
Virtual reality (VR) is a relatively new intervention that can be used
to provide distraction during, or to prepare patients for, medical
procedures. The review assessed the effectiveness of VR on reducing pain
and anxiety in pediatric patients undergoing medical procedures.The
study showed that the overall weighted standardized mean difference
(SMD) for VR was 1.30 (95% CI, 0.68-1.91) on patient-reported pain (14
studies) and 1.32 (95% CI, 0.21-2.44) on patient-reported anxiety (7
studies). It also showed a significant effects of VR on pediatric pain
when observed by caregivers (SMD = 2.08; 95% CI, 0.55-3.61) or
professionals (SMD = 3.02; 95% CI, 0.79-2.25). The results suggested
that VR interventions for pain reduction were more efficacious for
younger than for older children (P = .015). More specifically,
the effect size of VR on pain decreased with 0.26 when age increased
with 1 year. For anxiety reduction also, it were more efficacious for
younger than for older children (P = .023). However, there was a
difference in effect of VR for different medical procedures,so one
should be careful when generalizing the suggested effect for VR to
clinical practice.
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Autonomous early detection of eye disease in childhood
photographs (Science Advances. 2019;5: eaax6363)
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The reflection of visible light by the choroidal and retinal blood
vessels causes the human pupil to appear red when examined by a handheld
direct ophthalmoscope or photographed with a camera flash. Absence of
red reflex can be a symptom of common and rare childhood eye
disorders.The authors of this study aimed to evaluate the clinical
utility of screening photographic leukocoria by using a free Smartphone
application (CRADLE: Computer-Assisted Detector of Leukocoria) available
as White Eye Detector. They retrospectively analyzed 52,982 longitudinal
photographs of children, collected by parents, casual in nature, before
enrollment in this study. The cohort included 20 children with
retinoblastoma, Coats’ disease, cataract, amblyopia, or hyperopia and 20
control children. For 80% of children with eye disorders, the
application detected leukocoria in photographs taken before diagnosis by
1.3 (95% CI, 0.4 to 2.3) years.
Eventhough, this may not replace routine newborn and
pediatric eye evaluation, these appears no harm in asking the parents to
keep clicking pictures of their kids.
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