Reference Values For Children Research Articles

Cortical auditory evoked potential in babies and children listeners

IntroductionCortical auditory evoked potentials have been increasingly used in research and audiological routines. However, there is a lack of studies with a large number of children who are stratified by age group. These would help clarify the variations in latency and amplitude of cortical auditory evoked potentials, and thus help establish reference values in children of different ages. ObjectiveTo identify the variation in latency and amplitude of the cortical auditory evoked potentials and to establish reference values for the pediatric population. MethodsThis was a cross-sectional study. Subjects were born at term and presented with no auditory complaints. A total of 105 children, of up to 6 years and eleven months old, who were divided into 7 age groups, named 1, 2, 3, 4, 5, 6 and 7, participated in the study. The tests were carried out using Biologic Navigator Pro. Initially, brainstem auditory evoked potential testing was performed in order to investigate the electrophysiological threshold of the subjects. Then, cortical auditory evoked potentials were elicited through oddball paradigm with tone burst differing in frequency, 750Hz (frequent) and 1000Hz (rare), and stimuli differing in speech: /ba/ (frequent) and /da/ (rare). In this study, descriptive and comparative analyzes of tonal and speech stimuli were performed for the age groups. ResultsSignificant differences were observed when comparing cortical auditory evoked potentials with speech stimulus in the right ear for P2 amplitude, for P1 latency the left ear, for P2 amplitude of the left ear; and for P1 amplitude of the left ear when performed with tonal stimuli. ConclusionThe obtained results can be considered as reference values of latency and amplitude of cortical auditory potentials in infants and children, and be used for monitoring their cortical auditory development.

Investigation of pediatric specifications for the Salivary Multi Test® saliva test system

BackgroundDental caries and gingivitis are the main diseases in pediatric dentistry, and the saliva test is useful for their diagnosis. For children, it is important that the saliva test be simple and easily performed because their degree of cooperation varies. In this sense, the Salivary Multi Test® (SMT®) is superior to other tests. However, the reference value for the SMT® was only reported for adults. Therefore, the aim of our research was to evaluate the usefulness of the SMT® in children. MethodsWe investigated 125 pediatric patients, aged 3 to 18 years, who came to the Pediatric Dental Clinic at Hiroshima University Hospital. We obtained rinse water (oral rinsing for 10 seconds with 3 ml of distilled water) from boys and girls. Then, we examined cariogenic bacteria level, acidity, occult blood, buffer capacity, leukocyte level, protein level, and ammonia level (SMT® factors) using the rinse water with the SMT®. Additionally, in order to investigate the relevance between these SMT® factors and DMF or PMA, we evaluated the decayed-missing-filled (DMF) tooth for the morbidity state of caries and the papilla-marginal-attached (PMA) index for the morbidity state of the gingiva. ResultsWe were able to perform the tests even for children who were not cooperative due to their age. Many SMT® factors changed significantly with age. The leukocyte and protein levels changed according to PMA. Our results suggest that the SMT® reference value for children should be referred to, not that for adults, and that SMT® factors represent the severity of gingivitis in children.

Establishment of normal reference values of NT-proBNP and its application in diagnosing acute heart failure in children with severe hand foot and mouth disease [corrected

Hand, foot, and mouth disease (HFMD), caused by enteroviruses, is an acute contagious disease in children. Some severe infections caused by human enterovirus 71 (HEV71) lead to rapid death in children with acute heart failure (HF). N-terminal probrain natriuretic peptide (NT-proBNP) is an important indicator of HF; however, its normal reference values in children and role in HFMD remain unclear.This study aimed to investigate the correlation between NT-proBNP and heart function and establish normal reference values of NT-proBNP in children with HFMD aged 0 to 18 years.In this study, 95% normal reference values were established in 1031 healthy children aged 0 to 18 years. The correlation between NT-proBNP and left ventricular ejection (LVEF) was analyzed in 392 children with HFMD using Spearman correlation and receiver operating characteristic analysis.NT-proBNP levels were negatively correlated with LVEF in 392 children with HFMD. The median NT-proBNP level was 921 pg/mL in the early cardiorespiratory failure group, but only 55 pg/mL in the nervous system involvement group. Serum NT-proBNP levels were negatively correlated with age. The normal reference value in the neonatal period (0 to <1 month) and adolescence (13–18 years) was 250.0 to 3987.0 pg/mL and 20.0 to 145.0 pg/mL, respectively.NT-proBNP levels can reflect the severity of HFMD and discriminate the second stage from the third stage of HFMD effectively. NT-proBNP is a useful biomarker to predict the early stage of severe HFMD in children with HF. Different ages fit with different normal reference values of NT-proBNP in children.

An Exponential Regression Model Reveals the Continuous Development of B Cell Subpopulations Used as Reference Values in Children.

B lymphocytes are key players in humoral immunity, expressing diverse surface immunoglobulin receptors directed against specific antigenic epitopes. The development and profile of distinct subpopulations have gained awareness in the setting of primary immunodeficiency disorders, primary or secondary autoimmunity and as therapeutic targets of specific antibodies in various diseases. The major B cell subpopulations in peripheral blood include naïve (CD19+ or CD20+IgD+CD27−), non-switched memory (CD19+ or CD20+IgD+CD27+) and switched memory B cells (CD19+ or CD20+IgD−CD27+). Furthermore, less common B cell subpopulations have also been described as having a role in the suppressive capacity of B cells to maintain self-tolerance. Data on reference values for B cell subpopulations are limited and only available for older age groups, neglecting the continuous process of human B cell development in children and adolescents. This study was designed to establish an exponential regression model to produce continuous reference values for main B cell subpopulations to reflect the dynamic maturation of the human immune system in healthy children.

Echocardiographic right ventricular function reference values in pediatrics: Which is the best mathematical model to define Z-scores?

Echocardiographic assessment of right ventricle (RV) function has become essential in pediatric cardiology. The aim of our study was to determine the most appropriate mathematical model for RV function reference values in children. Normal children aged 0 to 18 years referred to the pediatric cardiology consultation were screened in this prospective cross-sectional study. Each RV parameters (S’, E’, A’ waves, TEI index, TAPSE) was modeled with four explanatory variables: age, size, weight and body surface area. Four different mathematical models were applied: a linear model, a polynomial model of degree 2, a linear regression model by spline with free knot, and a polynomial regression model of degree 2 by spline with a free knot. The choice of the best explanatory variable and modelization method was made on the basis of the model's coefficient of determination ( R 2 ). We included 314 normal children aged 2 days to 18 years (46% female, 88 infants, 26 neonates, 226 children). The modelization of the RV variables over all ages did not follow a linear model, with the lowest coefficients of determination in the four explanatory variables. The quadratic spline model best adjusted the modelization of all RV variables. No model accurately explained the TEI index in any of the four explanatory variables. The S’ wave was best modelized by the quadratic spline model with the weight. The knot at 6.86 kg corresponded to the curves’ break. The E’ wave was best modelized by the quadratic spline model with the age. The knot at 0.29 years corresponded to the curve's break. The A’ wave was best modelized by the quadratic model with the size. The knot at 81 cm corresponded to the break of the curve. The TAPSE was best modelized by the quadratic spline model with the weight. The knot at 9.04 kg corresponded to the curve's break. The quadratic spline model best applies to echocardiographic RV reference values in pediatrics.

Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control.

Classic spirometry is effort dependent and of limited value in assessing small airways. Peripheral airway involvement, and relation to poor control, in asthma, has been highlighted recently. Forced oscillation technique (FOT) offers an effort-independent assessment of overall and peripheral lung mechanics. We studied the association between lung function variables, obtained either by spirometry or multifrequency (5, 11 and 19Hz) FOT, and asthma diagnosis and control. Spirometry measures, resistance at 5 (R5) and 19Hz (R19), reactance at 5Hz (X5), resonant frequency (fres ), resistance difference between 5-19Hz (R5-R19) and Asthma Control Test scores were determined in 234 asthmatic and 60 healthy subjects (aged 13-39years). We used standardized lung function variables in logistic regression analyses, unadjusted and adjusted for age, height, gender and weight. Lower FEV1 /FVC (OR [95% CI] 0.47 [0.32, 0.69]) and FEF50 (0.62 [0.46, 0.85]) per standard deviation increase, and higher R5 (3.31 [1.95, 5.62]) and R19 (2.54 [1.65, 3.91]) were associated with asthma diagnosis. Independent predictive effects of FEV1 /FVC and R5 or R19, respectively, were found for asthma diagnosis. Lower FEV1 /FVC and altered peripheral FOT measures (X5, fres and R5-R19) were associated with uncontrolled asthma (P-values<.05). Resistance FOT measures were equally informative as spirometry, related to asthma diagnosis, and, furthermore, offered additive information to FEV1 /FVC, supporting a complementary role for FOT. Asthma control was related to FOT measures of peripheral airways, suggesting a potential use in identifying such involvement. Further studies are needed to determine a clinical value and relevant reference values in children, for the multifrequency FOT measurements.

A clinical importance of natriuretic peptides in pediatric practice

Natriuretic peptides (NUP) are peptide hormones secreted by cardiomyocytes in response to a volume overload of the heart. Emphasis in the article is placed on the history of NUP discovery, their chemical structure and pathophysiological mechanisms of action. The data on determination of NUP reference values in children with cardiac pathologies are analyzed. A NUP clinical significance in early diagnosis of heart failure in children, including those with congenital heart defects is shown. Also considered is NUP dynamics after surgical correction of congenital heart defects. A conclusion is drawn that NUP play an important prognostic role in evaluating early and late postoperative periods and disease outcomes on a whole.Received 11 October 2016. Accepted 22 December 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsAll authors contributed equally at all stages of the research.

Monitoring and Dose Assessment for Children Following a Radiation Emergency Part I: Reference Values for In Vitro Bioassay.

Following a radiation emergency, children may be internally contaminated by the radionuclide(s) involved. Timely assessment of the contamination informs the need for medical treatment for those persons who had significant intakes and reassures those whose intakes are not a medical concern. In vitro bioassay reference values for children of all ICRP age groups are derived for 30 contamination scenario/radionuclide combinations involving 13 radionuclides. These bioassay values are derived from an intake that leads to a 70-y committed effective dose of 50 mSv or a 30-d RBE-weighted absorbed dose to the lungs of 0.2 Gy-Eq, depending on which criterion is more strict. These values are presented in a collection of lookup tables that can be used directly as references.

Estimation of zinc levels among children with malnutrition at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwestern Nigeria

Objective: Zinc plays a critical role in many body functions and its deficiency is associated with impaired cognitive function, behavioral problems, memory impairment, growth retardation, increased incidence of diarrhoea and recurrent infections. Although severe zinc deficiency is not common, mild to moderate deficiency is quite common globally. It is estimated that some form of zinc deficiency affects about one third of the world population, with estimates ranging from 4% to 73% across sub Saharan Africa. To determine the prevalence of zinc deficiency among malnourished children at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.Methods: Study was descriptive cross-sectional, carried out at the Paediatric department of UDUTH, Sokoto from April 2013 to June 2014. It was conducted among children aged between 6 and 60 months who presented to the OPD and those that were admitted into paediatric wards of UDUTH with malnutrition. Children with similar characteristics that were well nourished served as controls. Cohorts were recruited consecutively until the required sample size was obtained. 5mls of venous blood was taken for serum zinc analysis from each child.Results: A total of 550 children were studied with 275 apiece for cohorts. The mean age of the malnourished children was 26.2±14.6 months compared to 28.2±17.0 months recorded for the controls (p=0.157).The mean serum zinc levels for the study subjects 13.5±3.3μmol/Lwas significantly lower than that of the controls (15.8±1.9μmol/L) (t=9.42, df=548, p=0.0001).Conclusion: The prevalence of zinc deficiency among both malnourished children and the controls was 0% using WHO reference value for children below the age of 5 years. Prophylactic doses of zinc should be given in all malnourish children in situation where mineral mix is not added to feed or f75 and f100 are not available. There is need to adhere to and use recommended cut off values recommended by WHO for defining zinc deficiency by researchers.Keywords: zinc, malnutrition, Sokoto

Dexa Body Composition Assessment in 10-11 Year Healthy Children.

IntroductionObesity is a growing health problem associated with metabolic derangements and cardiovascular disease. Accumulating evidence links the accumulation of visceral adipose tissue (VAT) to these obesity related health risks in adults. Childhood obesity is associated with a lifetime risk of cardiovascular disease and poses a serious challenge to future health care. In children, there is much less data on the prevalence and gender differences of visceral obesity than in adults. This study aims to provide reference values for VAT in children 10–11 years of age.MethodsIn a cross-sectional study performed in the north western part of theNetherlands, healthy children of 10–11 years of age, were recruited from primary schools. Anthropometric data consisting of height, weight, waist circumference (WC) and BMI were measured. Body composition was measured using DXA, providing measures for bone mineral content, total fat mass (TFM), lean body mass (LBM) and VAT.Results217 children were eligible for this study. Girls appeared to have a greater TFM (31.4% vs 27.5% of total body weight (TBW); P < .01) but lower VAT (0.3% vs 0.5% of TBW;P < .01) than boys, whereas boys had higher LBM (65.4% vs 69.3% TBW;P < .01). Median VAT area (cm2) was 41.1 for boys and 22.4 for girls (P < .01). Moderate to strong correlations were found for WC and BMI with VAT (boys: r = .664 and r = .630; Girls r = .699 and r = .546 respectively all P < .001).DiscussionThis study shows gender specific differences in VAT percentiles in healthy non-obese 10–11 year old children as measured by DXA that may serve as reference values in children. Independent of BMI and WC, girls tend to have more TFM but less VAT and LBM than boys.

Incremento de lipoproteína(a) en paciente pediátrico asociado a síndrome nefrótico

A common complication in paediatric patients with nephrotic syndrome (NS) is hyperlipidaemia. About 20% of children do not respond to treatment with corticosteroids, presenting with a cortico-resistant NS (CRNS), which can progress to kidney failure. It has been observed that paediatric patients with CRNS have an elevated low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and triglycerides levels, as well as elevated Lipoprotein-a [Lp (a)] levels.The case is presented of a 5 year old boy, diagnosed with CRNS, presenting with dyslipidaemia with increased LDL-c, Apo-B100, and Lp(a) levels. After the poor prognosis of the renal function, immunosuppressant treatment was started with tacrolimus and atorvastatin to control dyslipidaemia. Although tacrolimus causes an elevation of total cholesterol and LDL-c, the significant alterations of the children lipid profile suggest the existence of a high cardiovascular risk. In these cases, it would be interesting to have reference values in children in our health area.

Establishment of reference values of α-tocopherol in plasma, red blood cells and adipose tissue in healthy children to improve the management of chylomicron retention disease, a rare genetic hypocholesterolemia.

BackgroundChylomicron retention disease (CMRD), a rare genetic hypocholesterolemia, results in neuro-ophtalmologic damages, which can be prevented by high doses of vitamin E during infancy. In these patients, plasma vitamin E concentration is significantly reduced due to defects of chylomicron secretion. Vitamin E in adipose tissue (AT) and red blood cells (RBC) have been proposed as potential relevant biomarkers of vitamin E status but no reference values in children are available. The objectives were (i) to establish age-reference intervals in healthy children for α-tocopherol in plasma, red blood cells (RBC) and adipose tissue (AT) and (ii) to determine the variations of α-tocopherol in patients with CMRD after oral treatment with vitamin E.MethodsThis prospective study included 166 healthy children (1 month - 18 years) and 4 patients with CMRD. Blood and AT were collected in healthy children during a scheduled surgery and in patients before and after a 4-month treatment with α-tocopherol acetate.ResultsThe reference ranges for α-tocopherol were 11.9 - 30 μmol/L in plasma, 2.0 - 7.8 μmol/L packed cells in RBC and 60 - 573 nmol/g in AT. α-tocopherol levels in plasma correlated with those of RBC (r = 0.31; p < 0.01).In patients with CMRD after 4 months treatment, α-tocopherol concentrations remained less than 70 % of the control values in plasma, increased by 180 % to reach normal values in RBC, and remained stable in the normal range in AT.ConclusionThis study establishes pediatric reference intervals for α-tocopherol in plasma, RBC and AT. These values will be beneficial in assessing accurate α-tocopherol status in children and to optimize the monitoring of rare diseases such as CMRD. Our data suggest that RBC α-tocopherol, appears as a relevant biomarker to appreciate the effectiveness of treatment with α-tocopherol in patients with a rare primary hypocholesterolemia. The biopsy of AT could be used at diagnosis to assess the severity of the vitamin E deficiency and periodically after a long duration of vitamin E therapy to assess whether the treatment is effective, based on reference intervals defined in this study.

Normative data for calcaneal broadband ultrasound attenuation among children and adolescents from Colombia: the FUPRECOL Study.

Quantitative ultrasound (QUS) has been found to be a safe and reliable method for evaluating bone mineral density (BMD). Using calcaneal QUS techniques, the current study contributes to remedying this gap in the literature by establishing normative data among children and adolescents from Colombia. Minimal data on BMD changes are available from populations in developing countries. BMD reference values for children and adolescents have not been published for a Latin-American population. The aim of this study was to establish a normal reference range of calcaneal broadband ultrasound attenuation (BUA) in Colombian children and adolescents with ages ranging from 9 to 17.9 years. A sample of 1001 healthy Colombian youth (boys n = 445 and girls n = 556), children, and adolescents (9-17.9 years old) participated in the study. A calcaneus QUS parameter (BUA) was obtained for boys and girls, stratified by age group. Furthermore, height, weight, fat mass percentage, and body mass index were measured. Centile smoothed curves for the third, tenth, 25th, 50th, 75th, 90th, and 97th percentiles were calculated using the LMS method (L [curve Box-Cox], M [curve median], and S [curve coefficient of variation]). Mean (± SD) values for the participants' anthropometric data were 12.9 ± 2.3 years of age, 45.2 ± 11.5 kg weight, 1.51 ± 0.1 m height, 19.5 ± 3.1 kg/m(2) BMI, and 69.5 ± 17.1 dB/MHz BUA. Overall, all variables were significantly higher in boys except in BMI and body fat percentage. Girls generally had higher mean calcaneal BUA (dB/MHz) values than the boys, except in the age ranges 16 and 17.9, p > 0.05. In addition, the BUA (dB/MHz) increased with age throughout childhood and adolescence and reached a plateau by age 15-17.9 for girls. For the first time, our results provide sex- and age-specific BUA reference values for Colombian children and adolescents aged 9-17.9 years. A more specific set of reference values is useful for clinicians and researchers and informs clinical practice to monitor bone mineral status.

Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: Clinical and radiological evaluations in young children

BackgroundIn children with cerebral palsy (CP), overactivity of the peroneus longus (PL) muscle is a major contributor to pes planovalgus. This retrospective study assessed whether abobotulinumtoxinA injections into a PL showing premature activity on electromyography (EMG) clinically improved foot morphology in children with CP. MethodsStudy participants were <6 years old, had a diagnosis of CP, good functional abilities (Gross Motor Function Classification System level 1 or 2), equinovalgus (initial contact with the hallux or head of the first metatarsal) and overactive PL on EMG. The fore-, mid- and hindfoot were evaluated clinically and radiologically before and after injection of abobotulinumtoxinA (6–7 U/kg) into the PL. Radiological data were compared with reference values for children without pes planovalgus. ResultsIn total, 16 children (8 males; 10 hemiplegia, 6 diplegia; mean age: 3.2±1.5 years) received treatment. Mean pre-and post-treatment angles in clinical assessment of dorsiflexion of the talocrural articulation did not differ with both knees flexed (24.4±7.5 vs. 22.2±8.0 degrees; P=0.19) or extended (17.2±8.0 vs. 16.6±6.8 degrees; P=0.36). Radiographic data pre-treatment versus reference data revealed forefoot pronation (metatarsal stacking angle 2.1±8.3 vs. 8.0±2.9 degrees; P=0.002), midfoot planus (lateral talo-first metatarsal 28.5±15.0 vs. 13.0±7.5 degrees; P<0.001; talocalcaneal angle 54.6±8.6 vs. 49.0±6.9 degrees; P=0.004) and significantly decreased calcaneus dorsiflexion, without hindfoot equinus (calcaneal pitch angle 7.9±6.0 vs. 17.0±6.0 degrees; P<0.001). After treatment, the metatarsal stacking angle did not differ from reference values (P=0.15). As compared with before treatment, treatment improved mean angles for metatarsal stacking (2.1±8.3 vs. 7.1±3.9 degrees, respectively, P=0.002), lateral talo-first metatarsal and talocalcaneal (both P<0.001), with no change in the hindfoot. ConclusionPL may be an early target for abobotulinumtoxinA treatment in pes planovalgus associated with premature PL activity in children with CP.

Metallic Profile of Whole Blood and Plasma in a Series of 99 Healthy Children.

In recent years, special emphasis has been put on heavy metals. Children are very sensitive to accumulation of metals. Furthermore, as regards elements, the reference values in children are scarce in the literature as it is difficult to obtain the large quantity of blood necessary to analyze many metals by the conventional atomic absorption spectrometry technique. An inductively coupled plasma mass spectrometry (ICP-MS) procedure that uses a reduced sample of 0.3 mL whole blood or plasma is adapted to multielemental determinations. We applied a previously validated technique for adults that simultaneously quantifies 25 elements by ICP-MS in whole blood and 23 in plasma in a series of 99 healthy children ranging from under 5 years to <18 years, without exposure to metal or drug-containing metals. The aims of the study were to compare metallic concentrations according to the age among children and metallic concentration differences between children and adults. The blood and plasma pediatric metallic profile is a practical useful tool for many purposes in clinical toxicology, forensic toxicology and any cases of metal environmental exposure.

Korean research project on the integrated exposure assessment of hazardous substances for food safety.

Objectives:This survey was designed to conduct the first nationwide dietary exposure assessment on hazardous substances including the intakes of functional food and herbal medicine. In this paper, we introduced the survey design and the results of the dietary exposure status and internal exposure levels of lead (Pb), cadmium (Cd), and mercury (Hg).Methods:We selected 4867 subjects of all ages throughout Korea. We conducted a food survey, dietary survey, biomonitoring, and health survey.Results:Pb and Cd were the highest (median value) in the seaweed (94.2 μg/kg for Pb; 594 μg/kg for Cd), and Hg was the highest in the fish (46.4 μg/kg). The dietary exposure level (median value) of Pb was 0.14 μg/kg body weight (bw)/d, 0.18 μg/kg bw/d for Cd, and 0.07 μg/kg bw/d for Hg. Those with a blood Pb level of less than 5.00 μg/dL (US Centers for Disease Control and Prevention, reference value for those 1 to 5 years of age) were 99.0% of all the subjects. Those with a blood Cd level with less than 0.30 μg/L (German Federal Environmental Agency, reference value for non-smoking children) were 24.5%. For those with a blood Hg level with less than 5.00 μg/L (human biomonitoring I, references value for children and adults, German Federal Environmental Agency) was 81.0 % of all the subjects.Conclusions:The main dietary exposure of heavy metals occurs through food consumed in a large quantity and high frequency. The blood Hg level and dietary exposure level of Hg were both higher than those in the European Union.

Measurement of Fine-Motor Skills in Young Children with Visual Impairment

Insight into the typical motor development of children with visual impairment (VI) is necessary in order to recognise whether children with VI are at risk of motor developmental problems, and to evaluate the effectiveness of exercise interventions. In 2003 the ManuVis was published with reference values for children with VI of ages from 6 to 11 years. This paper reports on a follow-up study of the ManuVis focused on: a) comparison of fine motor skills between children with VI and normal sighted (NS) children; b) sampling norm-references for children with VI in the 4-11 years age range to increase validity; and c) test-retest and inter-rater reliability. In total 256 children with VI and 162 NS children were included in the study. The results demonstrated that children with VI needed significantly more time than NS children to perform all test items, especially at younger ages. Performance time decreased in both children with VI and NS children from the younger to the older age groups, but NS children reached their minimum at a younger age. Test-retest reliability on the items varied from moderate to excellent and inter-rater reliability was excellent. The results suggest that children with VI have slower and more prolonged motor learning than NS children. The ManuVis differentiates between typical and atypical fine-motor performance of children with VI between 4 and 9 years of age, and is useful for monitoring fine-motor skills in children with VI from 4 years to (at least) 11 years.

Hand-Held Dynamometry Isometric Torque Reference Values for Children and Adolescents.

To establish hand-held dynamometry (HHD) maximal isometric muscle torque (MIT) reference values for children and adolescents who are developing typically. The MIT of 10 upper and lower limb muscle groups was assessed in 351 Caucasian youth (4 years 2 months to 17 years) using a standardized HHD protocol, previously shown to be feasible, valid, and reliable. The mean MIT and 95% confidence interval of the mean for all muscle groups, for each of the 14 age groups (1 year age span for each group), and for each sex, were reported in both absolute (Nm) and normalized (Nm/kg) values. These HHD reference values may be helpful in the identification of muscle strength impairments in several pediatric populations, especially when bilateral impairments are present.

Concentration of Serum and Urine Creatinine in Children and Adolescents

Creatinine is a general marker as a screening test for renal disease. This study was conducted to provide basic data about pediatric concentration for serum and urine creatinine. The data from the 2011 Korean National Health and Nutrition Examination Survey was used. Analysis was done on 488 Children and Adolescents (boys 278, girls 210) aged 10 to 19, the Jaffe reaction method was used to gather the data. The highest serum creatinine levels were found in boys aged 19 to 20 years, the mean being 0.97 mg/dL (min 0.81 mg/dL, max 1.14 mg/dL). The levels showed increase over those in the 10 year old group. The highest urine creatinine levels were found aged 19 to 20 years, and the mean was 222.68 mg/dL (min 133 mg/dL, max 324 mg/dL). In the case of girls, the highest serum creatinine levels were found with those aged between 18 and 19, the mean being 0.71 mg/dL (min 0.49 mg/dL, max 0.84 mg/dL). The levels showed increase over the 11 to 18 year old group. The highest urine creatinine levels were found aged 14 to 15 years, and the mean was 218.44 mg/dL (min 131 mg/dL, max 321 mg/dL). The mean difference in serum creatinine in all age groups was statistically significant except for those aged 10 to 14, that of urine creatinine in all age groups was not significant statistically except for those aged 12 to 13, 17 to 18. Therefore, it is suggested that reference values for children and adolescents should be divided into different groups according to gender, further studies are needed using complementing data of the pediatrics.

Fatigue and carnitine levels over multiple cycles of chemotherapy in children and adolescents

PurposeFatigue in childhood cancer is a pervasive and distressing symptom described as a “lack of energy”. Carnitine is a micronutrient used to transport long chain fatty acids into muscle mitochondria. Some chemotherapy drugs interfere with the carnitine network. Both carnitine and fatigue relate to physical energy and may be influenced by chemotherapy. Using a repeated measures design, change in carnitine levels and change in fatigue in childhood cancer patients receiving ifosfamide, cisplatin, or doxorubicin were examined over multiple chemotherapy cycles. The influence of carnitine levels on fatigue was evaluated. Methods and SampleFifty-eight patients, between ages 3 and 18 years, within two months from diagnosis and receiving cisplatin, doxorubicin, and/or ifosfamide chemotherapy drugs, participated. Measurements included carnitine plasma levels and self-reported fatigue using established child or adolescent fatigue scales and were collected during the 2nd cycle of chemotherapy, and repeated on alternating cycles up to cycle 8. The Parent Fatigue Scale was used for children under age 7. Key ResultsTotal and free carnitine levels did not change significantly for the group. Fatigue decreased significantly in children age 7–12 (p = 0.04). Relationships between fatigue and carnitine were not significant. ConclusionsChanges in carnitine plasma levels were not significant in this sample of patients. The carnitine levels remained within the reference values for children and were not associated with fatigue levels. School-age children may be more resilient to fatigue over the trajectory of treatment. Further research is needed into the biologic mechanisms of fatigue.