Occipital-frontal Circumference Research Articles

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Introduction: Patients with hydrocephalus, which is the most pediatric neurological disorder, undergo Cerebrospinal fluid (CSF) diversion through third ventriculostomy or ventriculo-peritoneal shunt. Up to date, the optimal hydrocephalus treatment modality is not clear. Aim: We compared the outcome of endoscopic third ventriculostomy (ETV) versus ventriculo-peritoneal shunt (VP shunt) as a second surgical intervention in management of Infant hydrocephalus concerning success rate and complications. Patients and Methods: We conducted an observational study of 52 children with hydrocephalus (congenital or acquired) in whom CSF diversion was performed using either ETV or VP shunt in randomized control trial. Results: During the period examined, 52 children, 26 underwent ETV and 26 underwent VP shunt. The mean age was 11.0 ± 4.3 months in ETV and 11.3 ± 4.7 months in VP shunt. Postoperative infection in the ETV group was lower than in the VP shunt group (23.1% vs. 53.8% P = 0.045). Regarding operating time, In ETV group operation duration was 46.9 min and 64.3 min in the V-P shunt group (P = 0.13). There was no statistically significant difference between the two study groups regarding the rate of obstruction, change in occipital frontal circumference (OFC) or the need of revision surgery. One year survival for VP shunt group vs. ETV group was 46.2% vs. 65.4% respectively. Conclusion: ETV associated with lower rates of postoperative infection and shorter operation time with no significant difference in rates of obstruction, change in OFC and revision surgery in comparison to VP shunt.

The growth of assisted reproductive treatment-conceived children from birth to 5\xa0years: a national cohort study

BackgroundBirth weight and early child growth are important predictors of long-term cardiometabolic disease risk, in line with the Developmental Origins of Health and Disease hypothesis. As human assisted reproductive technologies (ARTs) occur during the sensitive periconceptional window of development, it has recently become a matter of urgency to investigate risk in ART-conceived children.MethodsWe have conducted the first large-scale, national cohort study of early growth in ART children from birth to school age, linking the register of ART, held by the UK’s Human Fertilisation and Embryology Authority, to Scottish maternity and child health databases.ResultsIn this study of 5200 ART and 20,800 naturally conceived (NC) control children, linear regression analysis revealed the birthweight of babies born from fresh embryo transfer cycles is 93.7 g [95% CI (76.6, 110.6)g] less than NC controls, whereas babies born from frozen embryo transfer (FET) cycles are 57.5 g [95% CI (30.7, 86.5)g] heavier. Fresh ART babies grew faster from birth (by 7.2 g/week) but remained lighter (by 171 g), at 6–8 weeks, than NC babies and 133 g smaller than FET babies; FET and NC babies were similar. Length and occipital-frontal circumference followed the same pattern. By school entry (4–7 years), weight, length and BMI in boys and girls conceived by fresh ART and FET were similar to those in NC children.ConclusionsART babies born from fresh embryo transfer grow more slowly in utero and in the first few weeks of life, but then show postnatal catch up growth by school age, compared to NC and FET babies. As low birth weight and postnatal catch-up are independent risk factors for cardiometabolic disease over the life-course, we suggest that further studies in this area are now warranted.

Fluctuant Mass on an Infant’s Scalp

A term infant has the following scalp examination [click on the video]. Of the options shown in Fig 1A (A, B, C, or D) of the top of an infant’s head, what is the most likely location of the involved area in this infant? Video. Click here to view the video. Figure 1A. Locations for potential collections that are exterior and interior to an infant’s skull. The video of this newborn shows a moderate-to-large fluctuant mass gathered in the dependent portion of the neonate’s scalp. Upon gentle tapping of the boggy collection, there is a clearly visible fluid wave. This finding is most consistent with a subgaleal hemorrhage. Subgaleal hemorrhage is a serious, potentially fatal event in a newborn. It is caused by the rupture of large, bridging, emissary veins that connect the scalp veins to the intracranial dural sinuses. When these veins rupture, blood accumulates between the periosteum and the galeal aponeurotica, a large potential space composed of loose connective tissue. This space extends without restriction across the cranium and can hold as much as 260 mL of blood. (1) (Note: The average total blood volume in a term infant is 80–90 mL/kg.) A hemorrhage of …

The Influence of Different Caregivers on Infant Growth and Development in China.

An increasing number of parents in China ask grandparents or babysitters to care for their children. Modern parents are often the only child in their family because of China's One-Child Policy and thus may lack interaction with siblings. Accordingly, the present study aimed to explore whether different caregivers affect the physical and development of infants in China. In total, 2,514 infants were enrolled in our study. We assessed their weight-for-age, supine length-for-age, weight-for-length, occipital-frontal circumference, and Denver Developmental Screening Test (DDST) results and recorded their general parental information and their primary caregivers. The weights and lengths of 12-month-old infants under the care of babysitters were significantly lower than those of infants under the care of parents or grandparents (P < 0.05). Additionally, 12-month-old infants under the care of babysitters had the lowest DDST pass rate (75%) among the three groups (χ2 = 11.819, P = 0.012), especially for the fine motor-adaptive and language domains. Compared to 12-month-old infants under the care of parents and babysitters, infants under the care of grandparents were more likely to be overweight or obese (P < 0.001). The study showed that caregivers had a dominant role in the physical and cognitive development of the infants. Specifically, compared with infants raised by grandparents and parents, 12-month-old infants under the care of babysitters had partially suppressed lengths and weights and lagged cognitively. The 12-month-old infants under the care of grandparents were more overweight than those cared for by parents and babysitters.

Assessment of Vitamin D Levels in Healthy Infants: A Cross-Sectional Survey Highlighting the Relationship of Vitamin D with Feeding Habits

Objective: To know and assess the levels of Vitamin D in healthy infants without having the signs of Vitamin D deficiency on radiological and clinical aspects.&#x0D; Methods: This was a cross-sectional study carried out at Baqai Medical University Hospital Karachi. The sampling technique used was non-probability consecutive. Total 145 infants were included in this cross sectional study that were apparently healthy and showed no features of Vitamin D defi- ciency clinically and radiologically within the age of two to six month. Sample size calculated was 145. Infants on Vitamin D supplementation, with renal, hepatic or congenital heart disease, gastrointesti- nal problems, low birth weight and intrauterine growth retardation were excluded from the study.&#x0D; Results: The feeding habits were breast feeding, formula feeding and mixed feeding as 62 (72.7%), 41 (28.3%) and 42 (29%) respectively. Vitamin D level were defined in three categories in which 57 (39.3%) were deficient, 39 (27%) were insufficient and 49 (33.8%) were found to be sufficient. Vitamin D levels were compared with weight to know the significance. It was discovered that Vitamins D and weight had a significant association with p-value of 0.02. There was no difference observed in length and Vitamin D levels with a p-value of 0.155 and OFC (occipital-frontal circumference) and Vitamin D levels with p-value of 0.491.&#x0D; Conclusion: Frequency of Vitamin D deficiency and insufficiency is quite common even in apparently healthy infants. The levels of Vitamin D in normal healthy infants of two to six month of age were defi- cient. Furthermore, Vitamin D deficiency was related to the feeding habits of the infants. The infants on breast feeding had sufficient Vitamin D levels in most cases whereas it was deficient in formula and mixed feed of infants.

A prospective longitudinal study of postnatal dentoalveolar and palatal growth: The anatomical basis for CAD/CAM‐assisted production of cleft‐lip‐palate feeding plates

This study describes the dentoalveolar and palatal growth during the first months of life. Knowledge concerning this development is essential to avoid unwanted events such as mucosal ulcerations or restriction of growth when cleft-lip and palate (CLP) patients are treated. The results involve the generation of CAD/CAM CLP-feeding plates. Intraoral impressions from 32 healthy newborns were taken monthly for 5months, supplemented by measurements of body weight, length, and occipital-frontal head circumference. The casts were digitalized, and two observers manually selected defined anatomical landmarks on virtual 3-D models. The distances between these landmarks were evaluted. Statistical analysis included an inter-rater agreement analysis and the determination of growth. In total, 213 casts were analyzed, with 65 models excluded because of inaccuracies in impression-taking or cast production. Overall longitudinal growth was 20.3%, whereas transversal growth reached a maximum of 21.1%. Vertical growth was 32.4% at the tuberal level. On the basis of these results, a semiautomated series of feeding plates allowing for monthly expansion could be generated. The acquired data serve as a useful reference for other pediatric and orthofacial investigations and treatments. One such application is the automated, fully virtual manufacture of CLP-feeding plates based on only one impression-taking. Our data reveal when caution is needed to prevent ulceration. The series of plates generated can minimize the time-consuming impression-taking and the production of further plaster models. The method of measurement is suitable for documentary purposes. Clin. Anat. 30:846-854, 2017. © 2017 Wiley Periodicals, Inc.

Macrocephaly associated with the DICER1 syndrome.

BackgroundGermline mutations in DICER1 increase the risk of various tumors, including pleuropulmonary blastoma. Macrocephaly and symmetric overgrowth has been reported in some, but not all, patients with mosaic DICER1 RNase IIIb mutations; the prevalence of these features in individuals with constitutional germline DICER1 mutations is unknown.MethodsWe analyzed prospectively collected auxology data from 67 DICER1 mutation carriers and 43 family controls. We assessed differences between groups using an exact test for proportions and generalized estimating equations for continuous dependent variables.ResultsTwenty-eight DICER1 mutation carriers (42%) were macrocephalic, and none had an occipital-frontal circumference (OFC) below the 3rd centile, which significantly differed from family controls, of whom five were macrocephalic (12%) and two had OFC below the 3rd centile (5%) (P<0.001). DICER1 mutation carriers were taller than familial controls after controlling for gender (P=0.048), but similar proportions of both groups were above the 97th centile of population norms. Head circumference remained increased after adjusting for differences in height.ConclusionsFor the first time, we establish macrocephaly as a common finding in the DICER1 syndrome. Like some of the other tumor-predisposition disorders, macrocephaly may be a useful, albeit a subtle, clinical clue to the DICER1 syndrome diagnosis.

Diminished growth and lower adiposity in hyperglycemic very low birth weight neonates at 4 months corrected age.

Characterize the relationship between neonatal hyperglycemia and growth and body composition at 4 months corrected age (CA) in very low birth weight (VLBW) preterm infants. A prospective study of VLBW appropriate-for-gestation infants (N=53). All blood glucose measurements in the first 14 days and nutritional intake and illness markers until discharge were recorded. Standard anthropometrics and body composition via air displacement plethysmography were measured near term CA and 4 months CA. Relationships between hyperglycemia and anthropometrics and body composition were examined using multivariate linear regression. Infants with >5 days of hyperglycemia were lighter (5345 vs 6455 g, P⩽0.001), shorter (57.9 vs 60.9 cm, P⩽0.01), had smaller occipital-frontal head circumference (39.4 vs 42.0 cm, P⩽0.05) and were leaner (percent body fat 15.0 vs 23.8, P⩽0.01) at 4 months CA than those who did not have hyperglycemia, including after correcting for nutritional and illness factors. Neonatal hyperglycemia in VLBW infants is associated with decreased body size and lower adiposity at 4 months CA independent of nutritional deficit, insulin use and illness. Downregulation of the growth hormone axis may be responsible. These changes may influence long-term growth and cognitive development.

Head circumference alone at birth, is it practical?

Head circumference alone at birth, is it practical?

Role of intraoral distractors in management of cranial synostosis: An initial experience.

Objective:The objective of the following study is to evaluate the results of strip craniectomy with distraction osteogenesis, using the intraoral distractor devices, as a modality of treatment for craniosynostosis.Materials and Methods:Two cases of cranial synostosis were selected for this study. The cases were operated for strip craniectomy with distraction osteogenesis using a pair of miniaturized intraoral distractor devices. Distraction was carried out after a latency period of 4 days at a rate of 0.5 mm twice a day. Total separation of osteotomized segments achieved was in the range of 25-28 mm.Results:Both patients were evaluated clinico-radiologically at 3, 6 and 12 months postoperatively. There was an increase in the occipital frontal circumference with improvement in the contour of the skull. Both the cases showed marked improvement of bowel habits, bladder control and cognitive behavior. Radiologically copper-beaten appearance reduced considerably suggesting improved intracranial pressure.Conclusion:Combination of distraction osteogenesis with strip craniectomy for the management of craniosynostosis is an effective treatment modality with promising results.

Neonatal hyperglycemia and diminished long-term growth in very low birth weight preterm infants

To investigate the association between early hyperglycemia and growth and development from hospital discharge to 2 years corrected age (CA) in very low birth weight (VLBW) infants. Blood glucose levels during the first 14 days after birth, weight, length and occipital-frontal circumference (OFC) at birth, hospital discharge and 4, 12 and 24 months CA, Bayley developmental scores at 12 and 24 months CA, and information on multiple clinical variables were recorded on VLBW preterm infants (N=80). The relationships between hyperglycemia, growth and developmental scores were determined using linear mixed effects regression. Hyperglycemia was a strong predictor of poor rate of increase in weight, length and OFC until 24 months CA. Hyperglycemia was not associated with lower scores on the Bayley scales. Neonatal hyperglycemia was associated with poor physical growth until at least 2 years CA in this cohort of VLBW preterm infants.

Biochemical screening and PTEN mutation analysis in individuals with autism spectrum disorders and macrocephaly

Unlike some other childhood neurodevelopmental disorders, no diagnostic biochemical marker has been identified in all individuals with an autism spectrum disorder (ASD). This deficit likely results from genetic heterogeneity among the population. Therefore, we evaluated a subset of individuals with ASDs, specifically, individuals with or without macrocephaly in the presence or absence of PTEN mutations. We sought to determine if amino or organic acid markers could be used to identify individuals with ASDs with or without macrocephaly in the presence or absence of PTEN mutations, and to establish the degree of macrocephaly in individuals with ASDs and PTEN mutation. Urine, blood and occipital-frontal circumference (OFC) measurements were collected from 69 individuals meeting DSM-IV-TR criteria. Urine and plasma samples were subjected to amino and organic acid analyses. PTEN was Sanger-sequenced from germline genomic DNA. Germline PTEN mutations were identified in 27% (6/22) of the macrocephalic ASD population. All six PTEN mutation-positive individuals were macrocephalic with average OFC+4.35 standard deviations (SDs) above the mean. No common biochemical abnormalities were identified in macrocephalic ASD individuals with or without PTEN mutations. In contrast, among the collective ASD population, elevation of urine aspartic acid (87%; 54/62), plasma taurine (69%; 46/67) and reduction of plasma cystine (72%; 46/64) were observed. PTEN sequencing should be carried out for all individuals with ASDs and macrocephaly with OFC ≥2SDs above the mean. A proportion of individuals with ASDs may have an underlying disorder in sulfur amino acid metabolism.

Exome sequencing overrides formal genetics: ASPM mutations in a case study of apparent X‐linked microcephalic intellectual deficit

Exome sequencing overrides formal genetics: <i><scp>ASPM</scp></i> mutations in a case study of apparent X‐linked microcephalic intellectual deficit

Comparison of the head circumference measurement between Down syndrome and normal children

Introduction: Growth and development assessment in children is measured by the head circumference measurement or as known as occipital-frontal circumference. In cases of genetic abnormalities such as Down syndrome which is caused by extra chromosome 21, give distinct features in the craniofacial profile, hence the author finds it is useful to observe the changes in their growth, mainly the head circumference. The purpose of this research is to analized comparison between head circumference measurement in children with Down syndrome in Sekolah Luar Biasa-C and normal children, Methods: Type of this research is analytical with surveying technique, using cross sectional studies on 20 children with Down syndrome and 160 normal children 6 to 13 years old. The sample subject. Based on anthropometry landmark on point Glabella to Opisthocranion, measurement is taken using a non-stretchable, flexible measuring tape. Result: There are significant differences between the head circumference of children in both group according to age and gender; except age 6 male, with the mean value of children with Down syndrome compare to normal circumference measurement were smaller 3 to 5 cm behind the normal children in this research. Conclusion: The head circumference of the children with Down syndrome over all from age 6 to 13 years old were smaller than the regular children in same age and same gender.

Personalized Assessment of kV Cone Beam Computed Tomography Doses in Image-guided Radiotherapy of Pediatric Cancer Patients

To develop a quantitative method for the estimation of kV cone beam computed tomography (kVCBCT) doses in pediatric patients undergoing image-guided radiotherapy. Forty-two children were retrospectively analyzed in subgroups of different scanned regions: one group in the head-and-neck and the other group in the pelvis. Critical structures in planning CT images were delineated on an Eclipse treatment planning system before being converted into CT phantoms for Monte Carlo simulations. A benchmarked EGS4 Monte Carlo code was used to calculate three-dimensional dose distributions of kVCBCT scans with full-fan high-quality head or half-fan pelvis protocols predefined by the manufacturer. Based on planning CT images and structures exported in DICOM RT format, occipital-frontal circumferences (OFC) were calculated for head-and-neck patients using DICOMan software. Similarly, hip circumferences (HIP) were acquired for the pelvic group. Correlations between mean organ doses and age, weight, OFC, and HIP values were analyzed with SigmaPlot software suite, where regression performances were analyzed with relative dose differences (RDD) and coefficients of determination (R(2)). kVCBCT-contributed mean doses to all critical structures decreased monotonically with studied parameters, with a steeper decrease in the pelvis than in the head. Empirical functions have been developed for a dose estimation of the major organs at risk in the head and pelvis, respectively. If evaluated with physical parameters other than age, a mean RDD of up to 7.9% was observed for all the structures in our population of 42 patients. kVCBCT doses are highly correlated with patient size. According to this study, weight can be used as a primary index for dose assessment in both head and pelvis scans, while OFC and HIP may serve as secondary indices for dose estimation in corresponding regions. With the proposed empirical functions, it is possible to perform an individualized quantitative dose assessment of kVCBCT scans.

Malrotation in Silver-Russell Syndrome: a case report.

Silver-Russell syndrome (SRS) is a rare, heterogeneous, genetic disorder; characterize by intrauterine and postnatal growth retardation, normal occipital-frontal circumference, body asymmetry and distinctive facial features. 90% of parents of children with SRS complain feeding problems but specific gastro-intestinal diseases have not been recognized as major features. We report a 6 years male child with SRS having malrotation of gut; needs surgery.

Growth in the neonatal period after repeat courses of antenatal corticosteroids: data from the ACTORDS randomised trial

ObjectiveTo determine the effect of repeated antenatal corticosteroids on postnatal changes in weight, linear growth and head circumference.MethodsMothers who entered the repeated dose of antenatal steroids (ACTORDS) trial were randomised...

TU-C-BRB-02: Personalized Assessment of KV-CBCT Doses in Image Guided Radiotherapy of Pediatric Cancer Patients

Purpose: To develop an empirical method for estimation of doses to critical structures of children undergoing kV‐CBCT imaging for image‐guidedradiotherapy. Methods: Forty pediatric patients were retrospectively assorted into four groups by gender and scanned sites with approval of IRB. Critical structures in CTimages were delineated on Eclipse treatment planning system and were subsequently packaged into patient CT phantoms for Monte Carlo simulations. A benchmarked EGS4 Monte Carlo code was used to calculate 3D dose distributions produced by High‐quality head and Pelvic protocols that were pre‐defined by manufacturer. The ratios of irradiated volume over longitudinal length (V/L) and the equivalent sphere diameters (ESDs) were calculated by Eclipse. In accordance with the scanned region, either occipital‐frontal circumferences (OFCs) or hip circumferences (HIPs) were calculated by DICOMan software. Regression was performed with SigmaPlot software suite where average standard errors of estimate (SEEs) were compared to evaluate the accuracy of regression and reliability of various parameters. Results: For both sexes, mean doses of all critical structures were observed to decrease linearly with the increase of all physical parameters including age, weight, V/L, ESD, OFC, and HIP. As suggested by smaller standard errors of estimates, OFC and weight are recommended for head dose estimation while ESD and weight are more appropriate for pelvic/abdominal dose regression. Unique empirical functions for the estimation of doses to critical organs for male or female patients are presented which make a personalized dose assessment readily feasible. Conclusions: Using Monte Carlo simulations in a population of 40 selected children, kV‐CBCT doses were found highly correlated with body sizes of children. Considering uneven body development levels among children of same age, OFC and weight are recommended primarily for dose estimation in head, while weight and ESD are preferred for pelvic dose assessment. This work was partially supported by National Basic Research Subject (973) of China (No.2011CB707701), China Scholarship Council (No. 2010601107), and Joint Research Foundation of Beijing Education Committee, China (No. JD100010607)

Postnatal growth of preterm born children ≤ 750 g at birth

Background Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development. Aims To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5. Study design Retrospective cohort study. Subjects One hundred one children with a BW ≤ 750 g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands. Outcome measures Height (Ht), weight (Wt), occipital–frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years. Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥−1), mildly delayed (−2 ≤ Z-score <−1) or severely delayed (Z-score <−2). AGA (Ht, Wt or OFC at birth ≥−2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <−2 SDS) infants. Results Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥−2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%). Conclusions Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥−2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.

Analysis of prevalence and degree of macrocephaly in patients with germline PTEN mutations and of brain weight in Pten knock-in murine model

PTEN Hamartoma Tumour Syndrome (PHTS) includes Cowden syndrome (CS), Bannayan-Riley-Ruvalcaba syndrome (BRRS), and other conditions resulting from germline mutation of the PTEN tumour suppressor gene. Although macrocephaly, presumably due to megencephaly, is found in both CS and BRRS, the prevalence and degree have not been formally assessed in PHTS. We evaluated head size in a prospective nested series of 181 patients found to have pathogenic germline PTEN mutations. Clinical data including occipital-frontal circumference (OFC) measurement were requested for all participants. Macrocephaly was present in 94% of 161 evaluable PHTS individuals. In patients ≤ 18 years, mean OFC was +4.89 standard deviations (SD) above the population mean with no difference between genders (P = 0.7). Among patients >18 years, average OFC was 60.0 cm in females and 62.8 cm in males (P < 0.0001). To systematically determine whether macrocephaly was due to megencephaly, we examined Pten(M3M4) missense mutant mice generated and maintained on mixed backgrounds. Mice were killed at various ages, brains were dissected out and weighed. Average brain weight for Pten(M3M4) homozygous mice (N = 15) was 1.02 g compared with 0.57 g for heterozygous mice (N = 29) and 0.49 g for wild-type littermates (N = 24) (P < 0.0001). Macrocephaly, secondary to megencephaly, is an important component of PHTS and more prevalent than previously appreciated. Patients with PHTS have increased risks for breast and thyroid cancers, and early diagnosis is key to initiating timely screening to reduce patient morbidity and mortality. Clinicians should consider germline PTEN testing at an early point in the diagnostic work-up for patients with extreme macrocephaly.