Normative Values For Children Research Articles

Kidney volume normative values in Central European children aged 0-19years: a multicenter study.

The currently available kidney volume normative values in children are restricted to small populations from single-centre studies not assessing kidney function and including none or only a small number of adolescents. This study aimed to obtain ultrasound-based kidney volume normative values derived from a large European White/Caucasian paediatric population with normal kidney function. After recruitment of 1427 children aged 0-19years, 1396 individuals with no history of kidney disease and normal estimated glomerular filtration rate were selected for the sonographic evaluation of kidney volume. Kidney volume was correlated with age, height, weight, body surface area and body mass index. Kidney volume curves and tables related to anthropometric parameters were generated using the LMS method. Kidney volume predictors were evaluated using multivariate regression analysis with collinearity checks. No clinically significant differences in kidney volume in relation to height were found between males and females, between supine and prone position and between left and right kidneys. Males had, however, larger age-related kidney volumes than females in most age categories. For the prediction of kidney volume, the highest coefficient correlation was observed for body surface area (r = 0.94), followed by weight (r = 0.92), height (r = 0.91), age (r = 0.91), and body mass index (r = 0.67; p < 0.001 for all). This study presents LMS-percentile curves and tables for kidney volume which can be used as reference values for children aged 0-19years.

Rapid, Low-Cost Measurement of Carotid Artery Distensibility in Children with Sickle Cell Disease Using Compact Point-of-Care Ultrasound

Introduction: Silent cerebral infarction (SCI) is common in children with sickle cell disease and is linked to cognitive decline, poor academic performance, and overt stroke (DeBaun, 2014). Currently, the only clinical approach to identify patients at risk of SCI involves MRI screening for school-age children (DeBaun, 2020). However, this method is costly, not easily accessible, and often requires sedation, making implementation difficult. Moreover, prophylactic therapies, such as chronic blood transfusion, have shown minimal success in preventing SCI progression. Arterial stiffening is tightly linked with the development of stroke and SCIs in heart disease and elderly populations (Mattace-Raso, 2006). However, prior work in sickle cell disease on central arterial stiffening is inconclusive and arterial stiffness of the cerebrovascular is largely unknown, especially in children (Pikilidou, 2015). Therefore, the goal of this work was to determine the feasibility of compact, point of care ultrasound in the assessment of arterial stiffening of the carotid arteries and establish normative values in children with sickle cell disease. Methods: All studies were performed with IRB approval and with informed consent. The study population included 16 pediatric patients (14.75 ± 4.54 years, 11 Male, hemoglobin 9.72± 1.78 g/dL) recruited from the Blood and Cancer Center at Dell Children's Hospital in Austin, TX. All participants had their vitals taken and their right common carotid artery imaged in supine position following at least 10 minutes rest. Imaging was performed by an experienced imaging professional (AB, 10 years experience) using a Butterfly IQ + ultrasound probe (Burlington, MA) and an Apple smartphone (Cupertino, CA) in the B-mode vascular setting. Three to ten second recordings of the carotid artery were recorded at a rate of approximately 20 frames per second. In house MATLAB scripts were developed for semiautomated cross sectional area segmentation across the cardiac cycle to calculate vessel lumen area (Figure 1). Strain was calculated using the ratio of change in systolic and diastolic area over diastolic area, and distensibility (1/stiffness) was calculated as strain/ln[SBP/DBP] (Godia, 2007). Univariate and stepwise multiple analysis was performed to determine the correlates of arterial distensibility. Results: We measured an average distensibility of 0.23 ± 0.10 (a.u) across patients. A statistically significant inverse relationship between systolic pressure and distensibility (p=0.039, R 2=0.53) was measured. Upon multivariate analysis, systolic blood pressure was the only predictor of carotid distensibility. All other factors (sex, age, height, weight, hemoglobin concentration, and diastolic blood pressure) showed a statistically insignificant relationship (p&amp;gt;0.05). Further Applications: Our study shows it is possible to rapidly and inexpensively measure a metric of cerebral arterial stiffness in children with sickle cell disease and that arterial stiffness is linked with systolic blood pressure. Silent cerebral infarcts in children are known to be linked with systolic blood pressure, male gender and increase with age during adolescence (DeBaun, 2012). Whether arterial stiffening predicts the prevalence and progression of SCI and the role of point of care ultrasound is an ongoing area of research.

Pediatric optic nerve and globe measurements on magnetic resonance imaging: establishing norms for children.

Normal optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) may be beneficial for describing optic nerve pathway abnormality reflecting increased intracranial pressure. Nonetheless, magnetic resonance imaging (MRI) measurement of the normal ONSD range and its associations with clinical factors and eyeball transverse diameter (ETD) are not well established in children. To establish normal OND, ONSD, ETD, and OND/ONSD and ONSD/ETD measurements in children and their associations with age and sex. We evaluated and analyzed 336 brain MRI studies of children aged 0.5 months to 18 years. We measured a total of 672 optic nerves. The OND and ONSD were measured 1 cm anterior to the optic foramina and 3 mm behind the optic disc on an axial T2 sequence. The mean OND 3 mm and 1 cm, ONSD 3 mm and 1 cm, and ETD were 0.23 ± 0.05 mm and 0.16 ± 0.04 mm, 0.53 ± 0.08 mm and 0.38 ± 0.06 mm, and 2.3 ± 0.13, respectively. Only ONSD 1 cm was independent of age (P = 0.247). ONSD 3 mm and ETD were significantly wider in boys compared to girls and significantly influenced by age (both P < 0.001). Age at scan and ETD were significantly correlated (P < 0.001). We established MRI-based OND, ONSD, ETD, and ONSD/ETD and OND/ONSD ratio normative values in children, which can be helpful in pediatric populations with disease.

Cervical vestibular evoked myogenic potentials in healthy children: Normative values for bone and air conduction.

To characterize cervical vestibular evoked myogenic potentials (c-VEMPs) in bone conduction (BC) and air conduction (AC) in healthy children, to compare the responses to adults and to provide normative values according to age and sex. Observational study in a large cohort of healthy children (n = 118) and adults (n = 41). The c-VEMPs were normalized with the individual EMG traces, the amplitude ratios were modeled with the Royston-Wright method. In children, the amplitude ratios of AC and BC c-VEMP were correlated (r = 0.6, p < 0.001) and their medians were not significantly different (p = 0.05). The amplitude ratio was higher in men than in women for AC (p = 0.04) and BC (p = 0.03). Children had significantly higher amplitude ratios than adults for AC (p = 0.01) and BC (p < 0.001). Normative values for children are shown. Amplitude ratio is age-dependent for AC more than for BC. Confidence limits of interaural amplitude ratio asymmetries were less than 32%. Thresholds were not different between AC and BC (88 ± 5 and 86 ± 6 dB nHL, p = 0.99). Mean latencies for AC and BC were for P-wave 13.0 and 13.2 msec and for N-wave 19.3 and 19.4 msec. The present study provides age- and sex-specific normative data for c-VEMP for children (6 months to 15 years of age) for AC and BC stimulation. Up to the age of 15 years, c-VEMP responses can be obtained equally well with both stimulation modes. Thus, BC represents a valid alternative for vestibular otolith testing, especially in case of air conduction disorders.

Achalasia in Children and Adolescents

Pediatric achalasia is a rare disorder of the esophagus that results in functional obstruction at gastroesophageal junction and impedes antegrade movement of bolus into stomach. Children present with vomiting/regurgitation, dysphagia, weight loss, and nocturnal and respiratory symptoms. Diagnosis may be delayed as symptoms mimic common pediatric disorders. Diagnosis follows adult diagnostic pathways yet remains challenging given absence of normative values in children. Treatment goals are to reduce symptoms, improve esophageal emptying, and prevent megaesophagus. Laparoscopic myotomy, pneumatic dilation, and peroral endoscopic myotomy are definite treatment options in children. Follow-up is necessary to monitor/treat reflux and complications, disease recurrence/persistence, and megaesophagus.

Normative values for ureteral diameter in children.

Assessment of the ureter is a fundamental part of the radiologic evaluation of the urinary tract. Abnormal ureteral dilation warrants further investigation to assess the etiology, which includes obstruction and/or reflux. Despite this fundamental need, there are no established normative values in children based on imaging. To provide normative values for ureteral diameter in pediatric patients with age-related ranges. We retrospectively reviewed all magnetic resonance (MR) urography studies and chose only normal ureters for assessment. The images were analyzed on commercially available software to assess maximum internal diameter. Manual measurements were done in cases where the images were below the resolution for automated assessment. Maximum intraluminal ureteral diameters were measured in upper, mid and lower thirds and the average of the three maximum ureteral diameters was used to obtain the average widest internal ureteral diameter. Multivariable linear regression was performed to test the association between the calculated diameter and gender. Differences in sizes between the left and right ureter were assessed using paired Wilcoxon signed rank test. One hundred twenty-one MR urography studies were selected, which included 160 ureter units. The diameter increases progressively with age, ranging from 3.2mm during infancy to 5.0mm in patients older than 16years of age. After 9years of age, the average widest internal ureteral diameter is slightly larger in males compared to females (odds ratio [OR]=1.91, 95% confidence interval [CI] [1.63, 2.25], P<0.0001). The right ureter was slightly larger than the left (3.9mm vs. 3.7mm, P=0.004) among 39 patients in whom both right and left ureter units were included. The average mid ureteral diameter is widest, followed by the distal third then proximal third. We present the normative values for the average widest internal ureteral diameter based on laterality and different segments. In the pediatric population, 3.8mm should be considered the average widest internal ureteral diameter.

Arrhythmogenic Right Ventricular Cardiomyopathy: Improvement of Diagnosis and Risk Stratification by Implementation of Echocardiographic Normative Values in Children.

A recent review on arrhythmogenic right ventricular cardiomyopathy (ARVC) in pediatric 28 patients highlights the diagnostic challenge and its´ important therapeutic consequences in this 29 rare disease [1]. ARVC leads to fibro-fatty infiltration of predominantly the right ventricular 30 (RV) myocardium and typically manifests beyond 10 years of age, causing arrhythmias and 31 sudden cardiac death. For diagnosis, the "Task Force Criteria" [2] are used, defining major 32 and minor criteria from 2D echocardiography, cardiac magnetic resonance imaging 33 (MRI), tissue characterization, electrocardiogram (ECG), RV angiography, arrhythmias, and 34 family history. Echo and MRI criteria include right ventricular outflow tract (RVOT) 35 dimension and RV function parameters. However, these "Task Force Criteria" were designed 36 for patients above 14 years of age, and do not incorporate pediatric normative values. RVOT 37 dimensions for example, are assessed as mm/m² body surface area (BSA) derived from the 38 parasternal short (PSAX) and parasternal long axis (PLAX). For pediatric patients the cut-off 39 values for RVOT dimensions included in the "Task Force Criteria" are not appropriate. 40However, normative values for the RV size and for RVOT dimensions in children exist [3,4]. 41

Myocardial Parametric Mapping by Cardiac Magnetic Resonance Imaging in Pediatric Cardiology and Congenital Heart Disease.

Parametric mapping, that is, a pixel-wise map of magnetic relaxation parameters, expands the diagnostic potential of cardiac magnetic resonance by enabling quantification of myocardial tissue-specific magnetic relaxation on an absolute scale. Parametric mapping includes T1 mapping (native and postcontrast), T2 and T2* mapping, and extracellular volume measurements. The myocardial composition is altered in various disease states affecting its inherent magnetic properties and thus the myocardial relaxation times that can be directly quantified using parametric mapping. Parametric mapping helps in the diagnosis of nonfocal disease states and allows for longitudinal disease monitoring, evaluating therapeutic response (as in Thalassemia patients with iron overload undergoing chelation), and risk-stratification of certain diseases. In this review article, we describe various mapping techniques and their clinical utility in congenital heart disease. We will also review the available literature on normative values in children, the strengths, and weaknesses of these techniques. This review provides a starting point for pediatric cardiologists to understand and implement parametric mapping in their practice.

Norm Determination Study of Trail Making Test, Enhanced Cued Recall Test and Clock Drawing Test for Turkish Sample Between 6-18 Years of Age.

Introduction:The aim of this study was to determine the developmental stages-specific normative values of Trial Making Test (TMT), Enhanced Cued Recall Test (ECRT) and Clock Drawing Test (CDT) which are commonly used in adults for the evaluation of cognitive functions affected by psychiatric and neurological diseases and developmental disorders for a healthy Turkish sample between 6-18 years of age.Method:A total of 249 primary and secondary school students between 6-18 years of age and living in Ankara and educated in public and/or private schools participated in the study. Primary analysis was conducted by appropriate ANOVA and/or MANOVA for 2 (Developmental Stage: Middle-Late Childhood (6-11 years) and Adolescence (12-18 years)) x 2 (Gender: Female and Male) factorial design. In addition, another group of ANOVA and/or MANOVA analyses for 3 (Adolescence Sub-Stages) x 2 (Gender) was also performed for the adolescence stage that was sub-grouped as early (12-13 years), middle (14-15 years) and late (16+ years).Results:Normative values were determined both for two different developmental stages and for the adolescence sub-stages. Comparisons indicated that main effect of gender and interactions were non-significant for all tests. On the other hand, the main effects of the developmental stage and adolescence sub-stages were significant for many of the test scores.Conclusion:As a result of the study, three neuropsychological tests and their normative values for children and adolescents were presented as available for use in future research.

The effectiveness of personalized kinesitherapy on an inclined plane at degree I scoliosis in children: X-ray monitoring

The purpose is to evaluate the effectiveness of complex treatment of grade I scoliosis in children on an inclined plane. Material and methods. Throughout 2021, 42 children with degree I scoliosis aged from 8 to 13 years old (average age 10.5 years) were under observation. All patients with degree I scoliotic disease were prescribed complex treatment, which included personalized kinesitherapy on an inclined plane (Evminov's board), massage, electrical stimulation of the back muscles, and cholecalciferol intake (if indicated). Two groups of patients were identified: Group I – children with grade I scoliosis before treatment (42 persons) and Group II – children with grade I scoliosis in the process of treatment (37 persons). Re-examination was carried out 4-5 months after the start of the course. Results. 45.2 % of children in Group I had complaints of cerebroasthenic nature, which remained in only 12 % of patients in Group II. No clinical signs of hypocalcemia were revealed in the examined children during the initial and repeated laboratory examination. When analyzing the indicators of ultrasound densitometry, 14.3 % of children in Group I had initial signs of osteopenia (Z-Score); 25-hydroxycalciferol was at the lower limit of the normative values in children before the start of treatment. Regression of scoliosis was noted in 80.9 % of children of Group II, according to X-ray data, in 3 patients of this group there was a stable clinical and instrumental picture. Conclusions. The application of an inclined plane for children in the treatment of degree I scoliosis gives a positive result – regression of the spinal deformity. The results indicate the need to develop medical and social programs for the prevention and treatment of degree I scoliotic deformity of the spine in children in general educational institutions at physical education lessons. Key words: children, degree 1 scoliosis, inclined plane, kinesitherapy, radiography, densitometry.

Evaluation of the Optic Disc and Macula in Healthy Children Using Optical Coherence Tomography Angiography

Objectives:To perform the measurements of the optic disc and macula in healthy children using optical coherence tomography angiography (OCTA) in order to determine the normative data values and compare these by age, gender, spherical equivalent (SE), and axial length (AL).Materials and Methods:A total of 146 eyes belonging to 146 healthy children (74 girls, 72 boys) aged 6 to 16 years were included in this prospective study. Refraction and biometry measurements were performed. Retinal nerve fiber layer thickness (RNFLT), central macular volume, and central macular thickness (CMT) were measured by optical coherence tomography (OCT) after dilatation. Using the OCTA device, foveal avascular zone (FAZ) area, vascular density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the macula, and the VD of the radial peripapillary capillary plexus (RPCP) of the optic disc were recorded.Results:The mean age of the study group was 11.27±3 years, the mean AL was 23.39±1.18 mm and the mean SE was -1.31±1.61 diopters. The mean FAZ area was 0.3±0.09 mm2, the mean SCP-VD was 43.88±3.4%, the mean DCP-VD was 39.6±3.55%, and the mean RPCP-VD was 52.47±3.42%. When the relationship between the OCTA measurements and the SE and AL values were analyzed, there was no statistical significance (p>0.05). When age and OCTA measurements were compared, only DCP-VD values were found to significantly decrease with increasing age (p=0.015). There was no significant difference in OCTA measurements based on gender (p>0.05). Similarly, no statistical age-based differences were observed in RNFLT, CMV and CMT values (p>0.05).Conclusion:With its short procedure time and no dye requirement, OCTA can be safely used in the evaluation of the optic disc and macular perfusion in children. Determination of normative values in children will be useful in detecting pathologic changes in tissue in patients with retinal diseases.

Extended steep ramp test normative values for 19\u201324-year-old healthy active young adults

PurposeTo extend currently available sex and age-specific normative values in children and adolescents for the peak work rate (WRpeak) attained at the steep ramp test (SRT) to healthy active young adults.MethodsHealthy male and female participants aged between 19 and 24 years were recruited. After screening and anthropometric measurements, participants performed a SRT on a cycle ergometer (increments of 25 W/10 s), monitoring and recording SRT-WRpeak, heart rate (HR), and blood pressure (BP) at rest and directly after peak exercise.ResultsFifty-seven participants (31 males and 26 females; median age of 21.3 years) volunteered and were tested. Anthropometrics, resting BP and lung function were all within normal ranges. Ninety-three percent of the participants attained a peak HR (HRpeak) > 80% of predicted (mean HRpeak 87 ± 5% of predicted). No differences were found in resting and peak exercise variables between females and males, except for absolute SRT-WRpeak (350 W [Q1: 306; Q3: 371] and 487 W [Q1: 450; Q3: 517], respectively) and SRT-WRpeak normalized for body mass (relative SRT-WRpeak; 5.4 ± 0.5 and 6.2 ± 0.6 W/kg, respectively). Low-to-moderate correlations (ρ [0.02–0.71]) were observed between SRT-WRpeak and anthropometric variables for females and males separately. Extended reference curves (8–24-year-old subjects) for SRT performance show different trends between male and female subjects when modelled against age, body height, and body mass.ConclusionsThe present study provides sex-, age-, body height-, and body mass-related normative values (presented as reference centiles) for absolute and relative SRT performance throughout childhood and early adulthood.

Assessment of iodine status among school age children and pregnant women of Belarus in 2017–2018

Background. Despite the measures taken by the Government of Belarus, the problem of iodine deficiency among the population remains actual.&#x0D; Aims. To determine iodine sufficiency in children and pregnant women living in Belarus.&#x0D; Materials and methods. The study included 873 schoolchildren aged 9–12 years of both sexes, of which 650 children were in regular schools, and the remaining children in boarding schools. A separate group consisted of 700 practically healthy pregnant women (during gestation from 16 to 36 weeks). Questioning, determination of urinary iodine concentration and thyroid volume with ultrasound was carried out.&#x0D; Results. Urine iodine median was 191 µg/L in the 873 children in 16 regions of Belarus. Thyroid volume corresponds to the normative values in children. According to the survey, 81% of households used iodized salt, constantly – 46%. Indicator of iodine sufficiency of 700 pregnant women (median urinary iodine concentration was 121 µg /l) is a non-optimal for this population group.&#x0D; Conclusions. Currently adequate iodine supplementation in school age children has been achieved. The prevalence of thyroid gland diseases caused by iodine deficiency in children decreased significantly. In pregnant women iodine supply is still insufficient.

Abstract P233: Blood Pressure Variability and Rhythmicity in Adolescents With Spurious Hypertension

Objective: Spurious hypertension (sHTN) is characterized by elevated systolic blood pressure (BP) in peripheral arteries but normal central BP. The BP variability and characteristics of BP rhythms in sHTN is unknown. We therefore analyzed BP variability and rhythmicity in adolescents with sHTN in comparison with other forms of hypertension (HTN). Patients and Methods: We studied 265 children (54 girls; 15.1 ±2.5 years) referred with arterial HTN, in whom secondary HTN was excluded. We assessed BP levels - office BP, ABPM, central systolic BP (cSBP), systolic BP average real variability (SBPARV) and mean MAP rhythmicity (amplitudes and acrophases). Anova with TukeyHSD post hoc test was used to compare groups. One tailed t-test was used to compare MAP amplitudes and acrophases with normative values for children with Bonferroni correction for multiple tests. Results: 115 subjects had white coat hypertension (WCH; office BP&gt;95 th perc+ABPM&lt;95 th perc), 25 had ambulatory prehypertension (preHTN; office BP&lt;95 th perc+ABPM&lt;95 th perc+ABPM load &gt;25%), 43 had sHTN (office BP+ABPM &gt;95th perc+cSBP&lt;95 th perc), 82 had true hypertension (tHTN; office BP+ABPM+cSBP &gt;95th perc. There were no significant differences between groups in age, weight and BMI. The median SBPARV was 8.87 in WCH, 8.63 in preHTN, 9.25 in sHTN and 9.28 in tHTN (not significantly different between groups). The prevalence of 24h rhythms ranged from 77 to 88%, not significantly from norms or among groups. The prevalence of 12h rhythms was not significantly different compared to norms and ranged from 50 to 60% (NS among groups). There were also no significant differences in the prevalence of 8h and 6h rhythms. All groups had significantly decreased 24h amplitudes compared to norms, but not significantly different among groups. There were no differences in 12h, 8h and 6 amplitudes between WCH, preHTN, sHTH, tHTN and norms. 24h acrophases were significantly prolonged in sHTN, 12h acrophases were significantly prolonged in preHTN, sHTN and tHTN. Conclusions: Adolescents with spurious hypertension have significantly lower prevalence of 24h rhythms, decreased 24h amplitudes and prolonged 24h and 12h acrophases suggesting increased sympathetic drive similarly to patients with other hypertensive phenotypes.

Video Head Impulse Tests with a Remote Camera System: Normative Values of Semicircular Canal Vestibulo-Ocular Reflex Gain in Infants and Children.

The video head impulse test (VHIT) is widely used to identify semicircular canal function impairments in adults. But classical VHIT testing systems attach goggles tightly to the head, which is not tolerated by infants. Remote video detection of head and eye movements resolves this issue and, here, we report VHIT protocols and normative values for children. Vestibulo-ocular reflex (VOR) gain was measured for all canals of 303 healthy subjects, including 274 children (aged 2.6 months–15 years) and 26 adults (aged 16–67). We used the Synapsys® (Marseilles, France) VHIT Ulmer system whose remote camera measures head and eye movements. HITs were performed at high velocities. Testing typically lasts 5–10 min. In infants as young as 3 months old, VHIT yielded good inter-measure replicability. VOR gain increases rapidly until about the age of 6 years (with variation among canals), then progresses more slowly to reach adult values by the age of 16. Values are more variable among very young children and for the vertical canals, but showed no difference for right versus left head rotations. Normative values of VOR gain are presented to help detect vestibular impairment in patients. VHIT testing prior to cochlear implants could help prevent total vestibular loss and the resulting grave impairments of motor and cognitive development in patients with residual unilateral vestibular function.

HbA1c but not diabetes duration predicts increased arterial stiffness in adolescents with poorly controlled type 1 diabetes.

The prevalence of macrovascular complications is probably underestimated in children with type 1 diabetes (T1D). Arterial stiffness (AS) is a subclinical marker of cardiovascular (CV) risk. The most validated, non-invasive method for AS measurement is pulse wave velocity (PWV). Only a few PWV studies have been performed in children with T1D. To explore the risk factors associated with AS in adolescents with suboptimally controlled T1D. Seventy-seven adolescents with T1D were included (39 girls, 38 boys) in this study. The adolescents had a median age of 16 yr (IQR 14-17), median duration of T1D was 9 yr (IQR 6-16), and HbA1c 71 mmol/mol (median, IQR 62-81). PWV was measured as the carotid-femoral pulse transmission time and converted into standard deviation scores (SDS) (adjusted for gender and age) using normative values for children. The risk factors assessed were HbA1c, T1D duration, treatment modality, serum lipids, and blood pressure (BP) measured via ambulatory blood pressure monitoring (ABPM). The PWV did not differ from the reference data (median PWV was 5.1 m/s, i.e., -0.01 SDS). A significant positive association was observed between PWV-SDS and HbA1c (p = 0.001), total cholesterol (p = 0.003), LDL-cholesterol (p = 0.003), but not T1D duration (p = 0.78) according to the univariate analyses. In the multivariate model, the only significant variable that remained positively associated with PWV-SDS was HbA1c (p = 0.03). Most adolescents with suboptimally controlled T1D have normal mean PWV compared to a healthy reference population. Chronic hyperglycemia, not T1D duration, is the main predictor of AS in adolescents.

Electrochemical skin conductance for quantitative assessment of sweat function: Normative values in children

ObjectivesThe Sudoscan™ system (Impeto Medical, Paris, France) has been recently proposed as a standardized, easy, painless tool for sudomotor function assessment. It is now used as an additional diagnostic tool in small fibre neuropathy. So far, no work has been published in children. The aim of this study was to measure electrochemical skin conductance (ESC) using the Sudoscan™ system in children in order to assess its feasibility and to provide normative values. Methods100 children were included in the study: 55 girls and 45 boys, age rank 2–17, mean 10.5y. They were accompanying their brother or sister who came as outclinic patients in the Department of Paediatrics or the Department of Paediatric surgery of the University Hospital. ResultsAll subjects underwent the test. It was performed without any difficulty, except for some of the youngest who sometimes had some trouble in keeping calm for 3min over the plates. 4 subjects who took the test were excluded from the analysis (2 diabetic patients and 2 having had previous chemotherapy). ESC was quite stable along childhood with an overall 80.1μS value for hands and 81.9μS for feet, very similar to what is observed in adults. ConclusionMaturation process seems to occur early in life, in accordance to sudomotor control when assessed by sympathetic skin response, which is also recorded early in infancy. SignificanceESC measurement is a simple and easy-to-perform test that can be performed in the clinical setting in children in 5min.

Histologic vs pH Probe Results in Laryngopharyngeal Reflux

Objective: Laryngopharyngeal reflux (LPR) is well documented in children. However, methods of obtaining accurate diagnosis are controversial. As a prelude to establishing normative values in children, we retrospectively reviewed comparison data of 63 consecutive children tested by pH probe and post-cricoid biopsy. Method: Sixty-three consecutive patients with symptoms of reflux without evidence of sinusitis, allergic rhinitis, or adenoid disease were studied by pH probe (Restech Dx Measurement System, San Diego, California) simultaneous with posterior cricoid biopsy (our previous diagnostic method). All testing was done through outpatient ambulatory surgery under general anesthesia. Results: Of the 63 total patients (age 6 months-17 years), 37 (60%) were positive for reflux by probe with a negative biopsy. Eleven (17%) tested negative to probe and biospy. Ten (15%) were excluded (pulled probe). Five (8%) were positive by probe and biopsy. Conclusion: Normative values in children have not been determined in this instrument. We believe it may offer a satisfactory diagnostic tool. These results, and previous studies, suggest that pH probe testing is superior to histologic diagnosis in determining LPR. However, normative values must be determined in children prior to further comparative studies.

Reference values for acoustic rhinometry in children at baseline and after decongestion

Acoustic rhinometry is widely used for objective evaluation of nasal dimensions. However, there is a lack of agreement on the normative values in children at baseline, and especially after decongestion. The purpose of this study was to determine the reference values for Finnish school children for acoustic rhinometry in non-decongested and decongested noses, and to find out which of the potential predictors (age, sex, body surface area (BSA) and height) would be the most useful one(s). The study included 124 children aged between 6.90 and 13.84 years with no permanent nasal symptoms. At baseline, the mean total minimal cross-sectional area (MCA) was 0.752 cm2, and the mean total volume between 0 - 3 cm (VOL) was 4.00 cm3. After decongestion, the total MCA was 0.794 cm2, and the VOL was 4.38 cm3. There was a significant correlation between MCA and age, between VOL and height, and between VOL and BSA at baseline and after decongestion. We found no difference in the values between boys and girls. We conclude that acoustic rhinometry is a suitable objective method to monitor the changes in mucosal swelling and nasal obstruction in children. Age and height or BSA of a child can be suggested as predictive factors.

Relationship between oculomotor scanning determined by the DEM test and a contextual reading test in schoolchildren with reading difficulties

The relationship between oculomotor scanning and reading in poor readers of primary school age is not well known. This study was designed to assess this relationship by determining mean Developmental Eye Movement (DEM) test times and reading speeds in a Spanish non-clinical population of children with poor reading skills but without dyslexia. We conducted a cross-sectional study on 81 poor readers (8-11 years of age) in the third to fifth grades recruited from 11 elementary schools in Madrid, Spain. In each subject with best spectacle correction, oculomotor scanning was measured using the DEM test, and reading speed (words per minute) was assessed by a standardized Spanish contextual reading test. Mean horizontal DEM times were higher than normative values for children in the third, fourth and fifth grades, by 20 seconds, 12 seconds, and 3 seconds respectively. Mean reading speeds were 18 words per minute lower than the norm for the third and fourth grades respectively, and 30 words per minute lower than the norm for the fifth grade. Reading speeds were significantly related to horizontal DEM times (r = -0.53, p < 0.0001). Thus, children showing a longer, or worse, horizontal DEM time achieved lower reading speeds. Poor readers showed poor horizontal scanning as assessed by the DEM test that was related to a slow reading speed. This test should be used by optometric clinicians as a screening tool to help identify poor reading skills in school children at an early stage.