Cord Blood Platelet Gel as a Treatment of Occipital Pressure Injuries in Newborns: Report of Two Cases

Background: A Pressure Ulcer (PU) is a severe event and could create discomfort to newborns. In newborns, one of mostly stricken location by PU is occipital area. Recent studies have highlighted that Cord Blood Platelet Gel (CBPG) might be a better alternative compared to traditional treatment. We report two cases of occipital PU treated with CBPG. Case report: Two male infants showing occipital PU were treated with standard local treatment, but no improvement was observed. After parental informed consent was obtained, CBPG application on PU was performed every 48 h. In these two cases of PU, a fast improvement in healing was observed since the first application of CBPG. The PU healed resulted in a scar after 53 and 50 days (Case 1 and Case 2, respectively) from development. No complications or infections were reported. Conclusions: CBPG contains many angiogenetic and growth factors, these characteristics make it indicated in treating soft tissue injuries. It would seem to be safe and an effective treatment of neonatal PUs reducing the time of the healing and the hospitalization and the infectious risks. Further studies are needed to evaluate long term aesthetic and functional results of PU treated with CBPG.

Non-inferiority of liquid thyroxine in comparison to tablets formulation in the treatment of children with congenital hypothyroidism

Objectives The aim of the current prospective randomized control study was to assess efficacy, safety, and non-inferiority of a new liquid L-thyroxine formulation dissolved in glycerol and water (T4® drops, produced by a Greek pharmaceutical Company, Uni-Pharma, Athens, Greece) in comparison to the standard Tablets form (T4® tablets, Uni-Pharma, Athens, Greece) in the substitutive treatment of children with congenital hypothyroidism (CH). Methods Thirty-nine children with CH, aged 3–12 years old, were enrolled in the study, after parental Informed Consent has been obtained, while three patients were lost from follow-up. At baseline, all participants had normal thyroid-stimulating hormone (TSH) and Free T4 values. Patients were randomly subdivided according to the assigned treatment in Group A (n=17)-Tablet Form and Group B (n=19)-Liquid Form. TSH and Free T4 levels were evaluated at 0, 2, 4, and 6 months. Results TSH values showed a statistically significant difference (p=0.017) between groups only at six months (Group A having higher TSH levels than Group B, albeit within the normal range), while Free T4 levels had no statistical difference throughout the six month study period and were always within the normal range. Moreover, dose adjustments were more frequent in Group A (p=0.038) during the six months. Liquid L-thyroxine substitutive treatment exhibited no statistically significant adverse effects in comparison to the widely used tablets. Conclusions Levothyroxine (LT4) as liquid solution formulation is safe and noninferior to the widely used L-thyroxine Tablets, with less need for dose adjustment, and can therefore be safely used in the treatment of children with CH.

Case for persuasion in parental informed consent to promote rational vaccine choices

There have been calls for mandatory vaccination legislation to be introduced into the UK in order to tackle the national and international rise of vaccine-preventable disease. While some countries have had some success associated with mandatory vaccination programmes, the Royal College of Paediatrics and Child Health (RCPCH) insist this is not a suitable option for the UK, a country which has seen historical opposition to vaccine mandates. There is a lack of comprehensive data to demonstrate a direct link between mandatory vaccination legislation and increased uptake. While there are examples whereby there has been an improvement, some studies suggest that comparable results can be obtained by strongly recommending vaccinations instead. The RCPCH insist that healthcare workers are ideally placed to engage and inform parents to make every interaction a ‘vaccine opportunity’. This paper calls for a principled, rational approach to interpretations of autonomy which underpin parental informed consent. MacLean’s concept of mutual persuasion could be a vehicle to ensuring parents are suitably informed of both the material risks associated with vaccine choices and to consider the rationality of their decisions, while ultimately upholding parental autonomy. It is argued that this, alongside infrastructural improvement, could create a more sustainable, long-term improvement in childhood vaccination rates in the UK than mandatory vaccination.

Single-stage feminization genitoplasty in girls with congenital adrenal hyperplasia in infancy

Introduction. Single-stage feminization genitoplasty under the age of 12 months is recommended by the international consensus on the treatment of girls with congenital adrenal hyperplasia (CAH).The study objective is to evaluate the results of feminization plasty of the external genitals in infancy.Materials and methods. The single-stage feminization genitoplasty results is performed in 11 patients from 6 to 18 months age old with various forms of CAH. The single-stage feminization surgery included clitoroplasty with preservation of the head, dorsal neurovascular bundle, labioplasty and various forms of introitoplasty depending on the level of hypospadias.Results. Recurrence of hypospadias and urethro-vaginal fistula were obtained in 3 (36 %) girls. Given the structural features of the small pelvis in girls at infancy and early age, a good result of single-stage feminization genitoplasty is possible when using an apron-shaped mucous flap with mild and middle hypospadias and urogenital mobilization with severe hypospadias in combination with prolonged glucoand mineralocorticoid compensation of CAH.Conclusion. Indications for single-stage feminization genitoplasty, given the large percentage of complications, should be placed with extreme caution. Surgical intervention is justified in case of recurrent urinary tract infection and dysfunctional urination.The authors declare no conflict of interest.There is given the parental informed consent to the children’s participation in the study.

The validity of parental-reported body height and weight: a comparison with objective measurements of 7-8-year-old Czech children

The values of body weight and height can be recorded in various ways. Self-reports and parental-report methods are amongst the most typical ways to collect data. These methods have advantages, but also limits. Anthropometric measures are recommended to improve measurement precision. The aim of this study was to investigate whether the parental-reported body weight and height of 7-8-year-old Czech children corresponded with the measured body weight and height. Data concerning children’s body weight and body height were collected via parental informed consent and anthropometric measurements. The research sample consisted of 388 children from 7 to 8 years-old (boys, n = 176; girls, n = 162). Only children with parental informed consent were included. Correlations between parental-reported and measured data were analysed with the Pearson correlation coefficient to examine the strength of linear dependence between the two methods. The differences between parental-reported and measured data were tested using the Wilcoxon signed-rank test. P-values below α = 0.05 were considered statistically significant. Parents manifested a tendency to underestimate body weight and especially the body height of their children. This trend was seen in boys and girls in both age groups. Out of the 338 children with parent-reported height, parents under-reported their child’s height by 1 cm or more in 37.1% of the children, 39.6% of the parents reported a height within 0.99 cm of the measured height, and 23.3% of parents over-reported their child’s height by 1 cm or more. The same number of children had parent-reported weights, parents under-reported their child’s weight by 1 kg and more in 25.2% of the children, 57.7% of the parents reported a weight within 0.99 kg of the measured weight, and 17.1% of the parents over-reported their child’s weight by 1 kg or more. The Pearson correlation coefficient between the measured and parental-reported height and weight revealed a statistically significant strong positive linear relationship in both genders (rheight = 0.912, rweight = 0.943; all p< 0.001). The differences between the measured and parental-reported height and weight were not significantly different (all p< 0.05). The high agreement and correlation between measured and parental-reported body height and weight suggest that parental-report methods can be an appropriate alternative to objective measurement and can be used as a valid tool to classify body height and weight for large population studies of Czech children in school-based research when anthropometric measures are not available.

Different Viewpoints: International Perspectives On Newborn Screening/Različita Gledišta: Međunarodne Perspektive U Vezi Sa Testiranjem Novorođenčadi

Summary Newborn blood-spot screening to detect potentially treatable disorders is widely practiced across the globe. However, there are great variations in practice, both in terms of disorders covered, screening technologies, disease definition, information provision, parental informed consent, and storage and disposal of residual specimens, partly reflecting the degree to which screening is the subject of explicit legislation (and thus public and media pressure) or is embedded in a general health care system and managed at an executive level. It is generally accepted that disorders to be screened for should comply with the ten Wilson and Jungner criteria, but the way that compliance is assessed ranges from broadly-based opinion surveys to detailed analysis of quantitative data. Consequently, even countries with comparable levels of economic development and health care show large differences in the number of disorders screened for. There are several areas on which there are no generally accepted guidelines: how should parents be informed about screening and to what extent should they be encouraged to regard screening as an option to choose to refuse? Is DNA mutation analysis acceptable as part of a screening protocol? How soon should the blood samples be destroyed once screening has been completed? As technology advances and the potential scope of screening expands at both the metabolite and genome level, challenging policy issues will have to be faced.

Comparison of the effect of semi-rigid ankle bracing on performance among injured v. non-injured adolescent female hockey players

Objective. To determine the comparative proprioceptive performance of injured v. non-injured adolescent female hockey players wearing an ankle brace.Methods. Data were collected from 100 high school players who belonged to the Highway Secondary School Hockey League, KwaZulu-Natal, via voluntary parental informed consent and player assent. Players completed an injury questionnaire probing the prevalence and nature of hockey injuries (March - August 2013). Subsequently, players completed a Biodex proprioceptive test with and without an ankle brace. Probability was set at p≤0.05.Results. Twenty-two players sustained ankle injuries within the 6-month study period (p<0.001). Injured players performed similarly without bracing (right anterior posterior index (RAPI) 2.8 (standard deviation (SD) 0.9); right medial lateral index (RMLI) 1.9 (0.7); left anterior posterior index (LAPI) 2.7 (0.9); left medial lateral index (LMLI) 1.7 (0.6)) compared with bracing (RAPI 2.7 (1.4); RMLI 1.8 (0.6); LAPI 2.6 (1.0); LMLI 1.5 (0.6)) (p>0.05). However, bracing improved the ankle stability of the non-injured group (RAPI 2.2 (0.8); RMLI 1.5 (0.5); LAPI 2.4 (0.9); RMLI 1.5 (0.5)) compared with their performance without a brace (RAPI 2.5 (1.0); RMLI 1.8 (0.8); LAPI 2.8 (1.1); LMLI 1.8 (0.6)) (p<0.05).Conclusion. Ankle bracing did not enhance the stability of injured ankles. However, ankle bracing has an ergogenic effect that enhances the stability of healthy ankles.

Bruxism in children: Effectiveness of bite splints

Purpose: The aim of this study was to evaluate the effectiveness of bite splints in the treatment of children with bruxism, reduction or elimination of symptoms and effective use of the dental appliance by patients. Methods: The sample consisted of 30 children with bruxism, aged 7 to 10 years, attending the Pediatric Dentistry Clinic of the University of Southern Santa Catarina. After approval by the ethics committee and parental informed consent agreement, children underwent anamnesis, physical examination, and alginate molding for fabrication of acrylic bite splints. The children were reassessed after 15 days and after 4, 8 and 12 months of splinting use through new clinical examination and questionnaires. Results: The use rate of bite splints shows that there was a positive correlation (rP=0.9961) between the decrease in use and time elapsed. The parafunctional habit of bruxism was no longer observed in 76.7% of the sample. It was observed that both symptoms evaluated, headache and muscular discomfort, showed a behavior that, if present at the beginning of treatment, declined during follow-up. No splint wear and tear was observed. Conclusion: There was a significant reduction in parafunctional activity, headache and muscular discomfort with the use of bite splints. The higher the persistence of patients, the higher the use rate of bite splints.