Life Expectancy Of Children Research Articles

Impact of injury-related deaths on life expectancy in China, 2016.

This study aimed to illustrate the impact of injury-related deaths on life expectancy in China in 2016 and to identify the high-risk population. Standard life tables were used to calculate life expectancy and cause-eliminated life expectancy by utilizing mortality data from the national mortality surveillance system. In 2016, the life expectancy of Chinese residents was 78.91 years. After eliminating injury-related mortality, the life expectancy of the residents increased by 1.13 years, which was higher in male and rural residents compared with female and urban residents. The life expectancy on the Eastern and Central regions increased slowly compared with the Western region. The greatest influencing factor on life expectancy was road traffic injuries, followed by falls. Falls had a greater impact on life expectancy for children under 5 years old and those aged over 65 years. This study indicates that deaths caused by injury had a noteworthy impact on life expectancy in China. More attention should be paid to road traffic injuries, and effective preventive measures should be taken to reduce deaths related to injury to increase the life expectancy of residents, especially in children under 5 years and adults over 65 years. By reducing the deaths caused by injury, the life expectancy level is likely to further improve.

Pulmonary Function by Spirometry in Children with Perinatal HIV Infection

Background: In an age of antiretroviral therapy, the life expectancy of children perinatally infected with Human Immunodeficiency Virus (HIV) has significantly increased. At the same time, however, pulmonary pathologies secondary to opportunistic infections have decreased thanks to increased diagnostics and access to antiretroviral therapy (ART). Despite this, in these children an immune dysregulation is maintained due to chronic infection. There is evidence that these patients have increased probability of presenting with abnormalities in pulmonary function, mainly with chronic obstructive clinical pictures (25% - 40% of perinatally infected adolescents display some anomaly in the spirometry), which predisposes them to increased risk of chronic pulmonary disease. Since lung development occurs mainly during infancy, patients perinatally infected with HIV may suffer consequences. This can be secondary to opportunistic infections, chronic inflammation due to the virus, and immunologic effects of ART, mainly in non-industrialized countries, where late diagnosis is frequent. Methodology: An analytical, observational, cross-sectional study was conducted at Roosevelt Hospital Pediatric infectious disease clinic, from January to December 2019. A sample of 76 patients was obtained, out of a population of 362 patients. A total of 62 subjects, who met the criterion of reproducibility in the spirometry, were analyzed. Results were analyzed with percentages and the association of variables using the chi-squared test (χ2). Results: A decrease in pulmonary function was found in 34% of patients, mild obstructive pattern (16%) predominating. Significant association between basal viral load greater than 100,000 cp/ml and a decrease in Forced expiratory flow 25 - 75 (FEF 25-75) (p 0.046) and in relationship between forced expiratory volume and forced vital capacity (FEV1/ FVC p = 0.024) was observed, as well as a non-statistically significant relationship between advanced clinical stage at diagnosis and decreased pulmonary function. Conclusions: The prevalence of decreased pulmonary function related to advanced clinical stage and elevated basal viral load (>100,000 cps/ml) is higher than that reported in other studies (25%) and has an influence in the long-term decrease in pulmonary function.

Pediatric Differentiated Thyroid Carcinoma: Outcome in Response to Initial Treatment

Introduction: Though the differentiated thyroid carcinoma in children is a common pediatric endocrine malignancy, its prognosis is excellent with a proper initial treatment. Objectives: This is to evaluate the initial treatment patern for a good prognosis with longterm outcome in pediatric DTC patients. Methods: This study is a prospective one done in BSMMU during a period of 10 years in 52 post-operative pediatric DTC patients after excluding the follow-up missing patients. These patients are yet in a regular follow-up were outcome evaluated with clinical, pathological & imaging studies. Results: All the patients got initial treatment of total thyroidectomy. About half of the group had undergone neck dissection along with total thyroidectomy. Forty six patients had taken 131-I therapy. The survival is 100%. Conclusion: The life expectancy for children with DTC is excellent. However, many patients experience adverse effects from thyroid surgery, resulting in life long complications. Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 143-148

Groundbreaking study examines ADHD, life expectancy in children and adults

The persistence of attention deficit hyperactivity disorder (ADHD) to adulthood has been linked to a nearly 13 percent reduction in estimated life expectancy, according to the first study to employ health and lifestyle factors for estimating life expectancy in children and adults with ADHD. The research signals the need for more awareness of ADHD as a broader public health issue, said researchers.

Use of Ultrasound in Pediatric Renal Stone Diagnosis and Surgery

Pediatric urolithiasis is on the rise globally and incidence rates have risen by 6-10% annually over the past couple of decades. Given the increasing incidence, high likelihood of recurrence, and long life expectancy of children, the use of ionizing radiation in the diagnosis, management, and follow up of pediatric urolithiasis has been scrutinized recently and many institutions and organizations have emphasized the use of non-ionizing imaging modality such as ultrasound. This review examines the use of ultrasound in the diagnosis and treatment of pediatric urolithiasis. Specifically, the role of ultrasound in shockwave lithotripsy, percutaneous nephrolithotomy, and, more recently, ureteroscopy will be examined.

Radiation dose comparison in brain CT examinations among 3 public hospitals

Introduction The higher risk from radiation and the longer life expectancy of children render the estimation of the radiation dose a vital need especially for common radiation-induced procedures like Brain CT. However, effective doses from pediatric Brain CT procedures are scarce in literature. Purpose The aim of this presentation is to estimate effective doses for pediatric Brain CT examinations performed in 2 public pediatric hospitals and 1 public general hospital. Materials and methods For that purpose, 160 patients from pediatric hospital 1 (PH1), 130 patients from pediatric hospital 2 (PH2), and 16 patients from general hospital (GH) underwent Brain CT examinations by utilizing age-adjusted scanning protocols was retrospectively reviewed. Acquisition and dosimetric data were extracted from the DICOM header. Age- specific DLP to effective dose conversion coefficients, according to ICRP 103, were applied to console-displayed DLP data. Results The effective doses for the age categories of 0–1 y, 1–5 y, 5–10 y and 10–15 y were 3.6 ± 1.3 mSv, 3.9 ± 1.6 mSv, 2.9 ± 1.4 mSv, and 2.8 ± 1.1 mSv for PH1, no data for 0–1 y, 2.4 ± 1.4 mSv, 2.3 ± 0.9 mSv, and 2.2 ± 0.8 mSv for PH2 and 3.6 ± 1.3 mSv, 2.5 ± 1.3 mSv, 1.3 ± 0.8, and 1.7 ± 1.0 mSv for PH, respectively. Conclusion Although CT protocols varied in terms of acquisition parameters and scanning mode, this variety is not depicted in the effective doses which are comparable among the various hospitals for the same age group. Either way, thorough optimization of CT scanning protocols is vital in each and every hospital that treats pediatric patients.

Mucopolysaccharidosis I; Parental beliefs about the impact of disease on the quality of life of their children.

BackgroundHematopoietic stem cell transplants, alongside enzyme replacement therapy and good multi-disciplinary care, have dramatically improved the life expectancy in children with Mucopolysaccharidosis (MPS) I, with better objective and functional outcomes. Despite these improvements, children with both the attenuated (non-Hurler) and severe (Hurler) variants of the disease have marked residual morbidity. Children with MPS I suffer with head and neck disease including obstructive sleep apnoea and hearing loss. The impact of these on quality of life has been poorly researched and no previous work has been published looking at patients’ perception of their own health, an important domain when considering the impact of treatment.MethodsThis exploratory qualitative study aimed to discover the effect of head and neck disease, alongside that of MPS I as a whole, on the quality of life of affected children.A grounded theory approach was used to conduct this study. Children and their parents were invited to participate in semi-structured interviews. The transcribed interviews were coded and emergent themes explored until saturation occurred.ResultsThe families of eleven children with MPS I were interviewed, five with Hurler’s and six with the attenuated non-Hurler’s. Important themes to emerge were- the fear of dying associated with obstructive sleep apnoea, difficulties communicating at school due to the delayed acquisition of language, chronic pain and restricted mobility, physical differences and restricted participation in social activities such as sports secondary to the musculoskeletal disease burden. The overall theme running through the analysis was the desire to fit in with ones peers.ConclusionParents and children with MPS 1 worry about ‘fitting-in’ with broader society. The presence of airway disease has a profound impact on the emotional well being of parents whilst language delay and musculoskeletal disease have the biggest impact on the quality of life of the children themselves. It is important to understand the impact of MPS I on the quality of life of children and their families so that we may improve future treatment and management of this sub-group of children who have an increasing life span.

Long-term life expectancy for children with ependymoma and medulloblastoma.

There is a paucity of long-term follow-up data for children with intracranial ependymoma (IE) and medulloblastoma (MB). What happens to these children 20, 30, or 40 years after diagnosis? Do they have potential for a normal lifespan? The purpose of this study was to ascertain the long-term survival potential in children with MB or IE who have survived 5 years from diagnosis. A retrospective analysis was conducted using the SEER Program. Children (ages 0-19 years) from 1973 to 2011 with a diagnosis of MB or IE were identified. A cohort was created of potentially cured patients who survived 5 years from diagnosis. Cox proportional hazards models and Kaplan-Meier estimates were utilized to analyze long-term survival. We identified 876 patients with MB and 474 patients with IE who were alive 5 years from diagnosis. Patients with MB had a 30-year overall survival (OS) and cancer-specific survival (CSS) of 70.2% and 80.1%, respectively. Patients with IE had a 30-year OS and CSS of 57.3% and 68.8%, respectively. When comparing MB with IE, MB had improved CSS (P = 0.04) and trended toward increased OS (P = 0.10). A significant number of deaths due to disease occur for several decades after treatment for both IE and MB. Despite this, the potential for long-term survival exists in 5-year survivors of both histologies. If alive at 5 years from diagnosis, patients with MB tend to have a lower risk of death from disease compared to those with IE.

Abstract O.60: Kawasaki Disease Complicated by Coronary Artery Aneurysms: Mortality and 40-year Outcomes

Background: Long-term outcomes and life expectancy for children with a previous history of Kawasaki disease (KD), particularly those with coronary artery aneurysms (CAA), remain to be determined. Methods: An inception cohort of all patients with KD assessed at The Hospital for Sick Children in Toronto between 1978 and 2013 was assembled. Patient outcomes were obtained throughout their pediatric and adult clinical follow-up as long as available. Prevalence of outcomes over time was modelled with Kaplan-Meier survival curves. Life tables from Statistics Canada were used to obtain age/gender specific cumulative mortality for the general population. Results: The cohort included 2,623 KD patients, of whom 410 (16%) had coronary artery involvement (215 dilatation, 57 non-giant CAA and 138 giant CAA). Average follow-up for patients with coronary artery involvement was 6.7 years (13.3 years for giant CAA); 57 and 34 patients had at least 15 and 25 years of follow-up, respectively. No patients with coronary artery dilatation or non-giant CAA had revascularization or a myocardial infarct. Freedom from revascularization (14 events) for patients with giant CAA was 90±6%, 87±7% and 80±13% at 10, 20 and 40 years of follow-up. Freedom from myocardial infarct (11 events) was 94±4%, 92±5% and 89±7% at 5, 20 and 40 years. For patients without coronary artery involvement, 3 (0.1%) deaths were recorded, one secondary to complications of macrophage activation syndrome during the acute phase of KD and 2 from cancer. No deaths were noted for patients with coronary artery dilatation or non-giant CAA, although clinical follow-up was more limited. For patients with giant CAA, 3 deaths (2.2%) were noted, 2 related to CAA complications and 1 from non-medical cause. Cumulative mortality for patients with giant CAA was 1.5% at 10 years of age (expected mortality 0.7%, HR: 2.2 (0.3-11.5), p=0.08) and 3.1% at 40 years of age (expected 2.3%, HR: 1.3 (0.4-4.0), p=0.37). Conclusions: Despite risks of myocardial infarction and revascularization, patients with giant CAA had life-expectancy similar to that of the general population up to the fourth decade of life. Additional follow-up will be necessary to determine if these trends continue into later decades.

PO-0761 Clinical And Evolutive Peculiarities Of The Bronchopulmonary Dysplasia And Wilson-mikity Syndrome In Premature Children

Background Bronchopulmonary dysplasia (BPD) and Wilson-Mikity syndrom (WMS) are specific respiratory diseases in premature infants, and utilisation of advanced management techniques will increase the prognosis and life expectancy in children with BPD and WMS. Aim To assess clinical features and impact of BPD and WMS on the appearance of chronic pulmonary diseases in premature children. Methods The study pressents the results of a clinical and evolutive analysis of 10 children with BPD and 4 with WMS that were born premature with a brith weigth of 700–1400 g, gestational age 31.92 ± 2,28 weeks. Results The comparative analysis showed clinical and explorative differences in children with BPD and those with WMS. Though the prematurity degree was similar, the onset of clinical signs in children with WMS was later comparing with those with BPD (9,5 ±2,37 vs 1,4 ± 0.14 days of life, p < 0.01). Respiratory symptoms in the first year of life were less persistent in children with WMS versus those with BPD, who still presented with suggestive imagistic sings (diffuse pulmonary nodular infiltrates accompanied by cystic changes and areas of hiperinflation). Pulmonary pathology progressed inchildren with BPD, causing death in 2 children at 3–5 months of life due to severe complication. In children with WMS, in evolution was favourable with fewer exacerbations, in 1 case with complete involution confirmed radiologically by the age of 1 year. Conclusion BPD in premature children has high risks of progression into cronic pulmonary disease and death. In WMS the clinical signs appear later, are less severe and their evolution is more favourable.

Review of life expectancy in children with cerebral palsy: Should we preserve life in severely disabled children?

Review of life expectancy in children with cerebral palsy: Should we preserve life in severely disabled children?

Palliative Care Answers the Challenges of Transitioning Serious Illness of Childhood to Adult Medicine

Advances in the field of medicine have improved the overall life expectancy in children. Consequently, many children with previously lethal diseases now live into adulthood. There is an urgent need to develop approaches that assist with the transition of care from pediatrics to adult medicine. Palliative care, by virtue of its unique skills, is ideally positioned to play a part in this transition. This report will summarize the urgency for proper transition modalities and then introduce palliative care as a proposed solution for current challenges in transition. Along the way, it will touch on financial and workforce obstacles to this solution and will offer a potential funding option.

Changes in Infectious Disease Mortality in Children During the Past Three Decades

Our aim was to evaluate changes in infectious disease mortality in children in Finland from 1969 to 2004. We especially wanted to find out whether infection mortality could be further reduced by means of existing vaccines not included in national vaccination program. We analyzed infectious disease mortality in Finland using data obtained from the official Cause of Death statistics for 1969 to 2004. Annual mortality rates were calculated in proportion to those at risk of dying. Infection mortality rates were calculated separately for neonates and children who were 1 month to 15 years. Childhood mortality due to infectious diseases decreased by 89%, from 0.12% in 1969 to 0.013% in 2004, and neonatal mortality by 69%, from 0.50% to 0.16%. Pneumonia, central nervous system infections and septicemia were the most common fatal infections in childhood. There were slightly more deaths due to all infections and respiratory tract infections in years marked by epidemics of respiratory syncytial virus. We estimated that pneumococcal conjugate vaccines would have prevented 2 deaths annually in our population, rotavirus vaccines 1 to 2 deaths, influenza vaccine 1 death and varicella vaccine 0.7 death. We found that even though mortality from infectious diseases in childhood decreased markedly during the period concerned, it could have been further reduced by means of existing vaccines. Even though the number of deaths prevented would have been small, the number of years of life saved would have been great because the life expectancy of children is long.

Life expectancy of children from the hospital of Santa Creu in Barcelona

On the premise of high infant mortality in the early medieval period, this paper attempts an approach to life expectancy of children taken in at the Santa Creu hospital in Barcelona, during the first half of the 15th century. One of the functions of the hospital was to host foundlings and ensure their survival and integration into society. To fulfil these functions a set of documents were drafted, although only parts of then survive, providing interesting information on the topic of this paper. We present data on mortality in the various stages of childhood, the incidence of outbreaks of epidemics, the information we have been able to obtain on diseases the remedies, causes of death and infant burials.

Entrance Surface Dose from Pediatric Diagnostic X-ray Examinations in a Developing World Setting: Are We ‘ALARA Principle’ Compliant?

Background: Radiation protection in paediatric radiology requires special attention than in adult because children are more sensitive to radiation and at higher risk. This risk is explained by the longer life expectancy in children which allows for harmful effects of radiation to manifest and their developing organs and tissues being more sensitive to radiation. Hence, the need for determination of appropriate radiation dose for paediatric patients. Aims: To estimate entrance skin dose (ESD) received by paediatric patients during diagnostic x-ray examinations. Materials and Methods: A total of 253 paediatric patients undergoing various x-ray examinations between June 2011 and December, 2012 ia teaching hospital in the South West Nigeria were considered in this study. This hospital has no dedicated x-ray

ICRP PUBLICATION 121: Radiological Protection in Paediatric Diagnostic and Interventional Radiology

Paediatric patients have a higher average risk of developing cancer compared with adults receiving the same dose. The longer life expectancy in children allows more time for any harmful effects of radiation to manifest, and developing organs and tissues are more sensitive to the effects of radiation. This publication aims to provide guiding principles of radiological protection for referring clinicians and clinical staff performing diagnostic imaging and interventional procedures for paediatric patients. It begins with a brief description of the basic concepts of radiological protection, followed by the general aspects of radiological protection, including principles of justification and optimisation. Guidelines and suggestions for radiological protection in specific modalities – radiography and fluoroscopy, interventional radiology, and computed tomography – are subsequently covered in depth. The report concludes with a summary and recommendations.The importance of rigorous justification of radiological procedures is emphasised for every procedure involving ionising radiation, and the use of imaging modalities that are non-ionising should always be considered. The basic aim of optimisation of radiological protection is to adjust imaging parameters and institute protective measures such that the required image is obtained with the lowest possible dose of radiation, and that net benefit is maximised to maintain sufficient quality for diagnostic interpretation. Special consideration should be given to the availability of dose reduction measures when purchasing new imaging equipment for paediatric use. One of the unique aspects of paediatric imaging is with regards to the wide range in patient size (and weight), therefore requiring special attention to optimisation and modification of equipment, technique, and imaging parameters. Examples of good radiographic and fluoroscopic technique include attention to patient positioning, field size and adequate collimation, use of protective shielding, optimisation of exposure factors, use of pulsed fluoroscopy, limiting fluoroscopy time, etc. Major paediatric interventional procedures should be performed by experienced paediatric interventional operators, and a second, specific level of training in radiological protection is desirable (in some countries, this is mandatory). For computed tomography, dose reduction should be optimised by the adjustment of scan parameters (such as mA, kVp, and pitch) according to patient weight or age, region scanned, and study indication (e.g. images with greater noise should be accepted if they are of sufficient diagnostic quality). Other strategies include restricting multiphase examination protocols, avoiding overlapping of scan regions, and only scanning the area in question. Up-to-date dose reduction technology such as tube current modulation, organ-based dose modulation, auto kV technology, and iterative reconstruction should be utilised when appropriate.It is anticipated that this publication will assist institutions in encouraging the standardisation of procedures, and that it may help increase awareness and ultimately improve practices for the benefit of patients.

Evaluation of Cystic Fibrosis Transition Program From Pediatric to Adult Care

PURPOSE: As the life expectancy for children with cystic fibrosis (CF) has steadily increased, so has the need to transition the care from pediatric to adult specialists. The Cystic Fibrosis Foundation (CFF) has mandated that CF centers provide age-appropriate CF care to maintain accreditation, with the goal that patients be transitioned by 21 years of age. In this study, we evaluated the experiences and opinions of patients in our adult CF center who went through a formal transition versus those who did not, in attempt to evaluate the overall process and to identify means for improvement.

When children with sickle‐cell disease become adults: Lack of outpatient care leads to increased use of the emergency department

Young adults with sickle-cell disease have increased emergency department (ED) utilization and increased risk of mortality for unclear reasons. Emergency Department Reliance (EDR) differentiates excessive ED use due to increased need in chronic illness from increased use due to limited access to outpatient care. A higher EDR has been used to define excessive reliance on the ED and thus access to care issues leading to increased ED utilization. We conducted a retrospective cohort study of sickle-cell disease patients within the Wisconsin Medicaid database over a 5-year period to examine EDR during the transition period from childhood to adulthood. The study population included four distinct groups: (1) children, (2) patients transitioning from pediatric to adult providers, (3) young adults, and (4) adults age 31-45. Rates of visits per year were calculated for ED visits and outpatient visits for all diagnoses and sickle-cell disease-related diagnoses. Overall, we found increased EDR among the transition group and young adults compared to children and adults for sickle-cell disease-related diagnoses. These findings suggest access to care issues play a significant role in the increased ED utilization seen during the transition period from pediatric to adult providers in sickle-cell disease.

A Markov model to analyze cost-effectiveness of screening for severe combined immunodeficiency (SCID)

ObjectiveTo evaluate the cost-effectiveness of universal neonatal screening for T cell lymphocytopenia in enhancing quality of life and life expectancy for children with severe combined immunodeficiency (SCID). MethodsDecision trees were created and analyzed to estimate the cost, life years, and quality adjusted life years (QALYs) across a population when universal screening for lack of T cells is used to detect SCID, as implemented in five states, compared to detection based on recognizing symptoms and signs of disease. Terminal values of each tree limb were derived through Markov models simulating the natural history of three cohorts: unaffected subjects; those diagnosed with SCID as neonates (early diagnosis); and those diagnosed after becoming symptomatic and arousing clinical suspicion (late diagnosis). Models considered the costs of screening and of care including hematopoietic cell transplantation for affected individuals. Key decision variables were derived from the literature and from a survey of families with children affected by SCID, which was used to describe the clinical history and healthcare utilization for affected subjects. Sensitivity analyses were conducted to explore the influence of these decision variables. ResultsOver a 70-year time horizon, the average cost per infant was $8.89 without screening and $14.33 with universal screening. The model predicted that universal screening in the U.S. would cost approximately $22.4million/year with a gain of 880 life years and 802 QALYs. Sensitivity analyses showed that screening test specificity and disease incidence were critical driving forces affecting the incremental cost-effectiveness ratio (ICER). Assuming a SCID incidence of 1/75,000 births and test specificity and sensitivity each at 0.99, screening remained cost-effective up to a maximum cost of $15 per infant screened. ConclusionAt our current estimated screening cost of $4.22/infant, universal screening for SCID would be a cost effective means to improve quality and duration of life for children with SCID.

The collagen VI-related myopathies: muscle meets its matrix

The collagen VI-related myopathy known as Ullrich congenital muscular dystrophy is an early-onset disease that combines substantial muscle weakness with striking joint laxity and progressive contractures. Patients might learn to walk in early childhood; however, this ability is subsequently lost, concomitant with the development of frequent nocturnal respiratory failure. Patients with intermediate phenotypes of collagen VI-related myopathy display a lesser degree of weakness and a longer period of ambulation than do individuals with Ullrich congenital muscular dystrophy, and the spectrum of disease finally encompasses mild Bethlem myopathy, in which ambulation persists into adulthood. Dominant and recessive autosomal mutations in the three major collagen VI genes-COL6A1, COL6A2, and COL6A3-can underlie this entire clinical spectrum, and result in deficient or dysfunctional microfibrillar collagen VI in the extracellular matrix of muscle and other connective tissues, such as skin and tendons. The potential effects on muscle include progressive dystrophic changes, fibrosis and evidence for increased apoptosis, which potentially open avenues for pharmacological intervention. Optimized respiratory management, including noninvasive nocturnal ventilation together with careful orthopedic management, are the current mainstays of treatment and have already led to a considerable improvement in life expectancy for children with Ullrich congenital muscular dystrophy.