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1.
Pediatr Radiol ; 49(5): 646-651, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30712160

RESUMO

BACKGROUND: Resistivity index (RI) of the pericallosal artery as is commonly measured during head ultrasound (US) examination in neonates. Some studies have shown that RI measured with gentle compression of the fontanelle provides additional information in cases of neonatal brain anomalies. OBJECTIVE: The purpose of this study was to establish normal RI values with and without compression in a large population of neonates with normal cranial ultrasound as a function of gestational age. MATERIALS AND METHODS: The authors of this retrospective study reviewed the RI of 323 infants with normal gray-scale cranial US and with a gestational age ranging 26-42 weeks. We conducted the exams both with and without compression of the anterior fontanelle and we studied changes in RI depending on gestational age, gender and type of delivery. RESULTS: Infants with a gestational age of more than 35 weeks tended to have a lower RI (P=0.011). The compression of the anterior fontanelle emphasized the change in RI with increasing gestational age, with higher gestational ages having a lower RI (P<0.001). The results concerning the percentage change between baseline RI and RI with compression showed that infants with higher gestational ages have a smaller percentage change in RI (P=0.002). CONCLUSION: We established the normal values for RI from 26 weeks to 42 weeks of gestation. The results of the study show the importance of taking the gestational age into consideration when evaluating the RI.


Assuntos
Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiologia , Fontanelas Cranianas/diagnóstico por imagem , Fontanelas Cranianas/fisiologia , Ultrassonografia Doppler Transcraniana/métodos , Resistência Vascular/fisiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos
2.
Am J Emerg Med ; 37(1): 127-132, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30366745

RESUMO

Hydrocephalus carries significant morbidity in the infant population. Although clinical symptoms are often nonspecific, hydrocephalus is easily identified using transfontanellar sonography. In this review, we provide the emergency physician with a succinct overview of infant hydrocephalus and the point-of-care ultrasound (POCUS) technique for identification of this pathology.


Assuntos
Fontanelas Cranianas/diagnóstico por imagem , Serviço Hospitalar de Emergência , Hidrocefalia/diagnóstico por imagem , Testes Imediatos , Pontos de Referência Anatômicos , Diagnóstico Diferencial , Humanos , Lactente , Recém-Nascido , Ultrassonografia
4.
J Matern Fetal Neonatal Med ; 32(3): 493-501, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28942698

RESUMO

OBJECTIVE: The objective of this study is to determine the main neuroimaging findings of microcephalic newborns with possible Zika virus (ZIKV) intrauterine infection using transfontanellar cranial ultrasound. METHODS: We performed a retrospective study to describe the main neuroimaging findings in newborns with microcephaly and possible association with congenital ZIKV infection. Microcephaly was defined in the postnatal period using transfontanellar cranial examination which was performed using both two- (2D) and three-dimensional (3D) ultrasound. RESULTS: One hundred and fifty newborns with microcephaly were identified during the study period. The mean ± (standard deviation - SD) of cephalic perimeter was 28.5 ± 4.2 cm (range, 25-38 cm). Transfontanellar neuroimaging patterns detected cerebral calcifications, neuronal migrational abnormalities, dysgenesis of the corpus callosum, and cerebellar atrophy in 34.9%, 31.1%, 26%, and 16.2%, respectively. Hydrocephalus was seen in 28% of overall newborns. A history of maculopapular rash was present in almost half of the mothers (46.1%). CONCLUSION: Neuroimaging patterns by means of transfontanellar ultrasound are accurate and diagnostic investigations of brain pathology in newborns affected by microcephaly and possible intrauterine ZIKV infection.


Assuntos
Fontanelas Cranianas/diagnóstico por imagem , Microcefalia/diagnóstico , Neuroimagem/métodos , Complicações Infecciosas na Gravidez , Infecção por Zika virus/complicações , Infecção por Zika virus/diagnóstico , Fontanelas Cranianas/patologia , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/virologia , Recém-Nascido , Masculino , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Estudos Retrospectivos , Ultrassonografia/métodos , Zika virus/fisiologia , Infecção por Zika virus/congênito
5.
Pediatr Neurol ; 91: 27-33, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30573329

RESUMO

OBJECTIVES: We assessed the clinical characteristics of primary intracranial hypertension (PIH) in children using a newly recommended threshold for cerebrospinal fluid opening pressure (280 mm H2O). METHOD: Cross-sectional study of patients age ≤21 years who had a lumbar puncture done for evaluation of PIH. Patients were excluded if lumbar puncture was done for a suspected infection, seizure, mental status changes, multiple sclerosis, or Guillain-Barre syndrome. Cases were identified using a text-search module followed by manual review. We performed χ2 analysis for categorical data and Mann-Whitney U test for continuous data, followed by a binary logistic regression. RESULTS: We identified 374 patients of whom 67% were female, median age was 13 years interquartile range (11 to 16 years), and admission rate was 24%. Using an opening pressure cutoff of 250 mm H2O, 127 patients (34%) were identified as having PIH, whereas using the new cutoff 105 patients (28%) met PIH criteria. Predictors for PIH included optic disc edema or sixth nerve palsy using both old, odds ratio (OR) 7.6 (4.3, 13.5), and new cutoffs, OR 9.7 (95% confidence interval 5.1, 18.5). Headache duration ≤61 days is predictive of PIH using the new cutoff OR 4.1 (95% confidence interval 1.3, 12.8). A model is presented which stratifies patients into groups with low (7%), medium (18%), and high (greater than 42%) risk of PIH. CONCLUSIONS: A higher cerebrospinal fluid opening pressure threshold in the criteria of PIH is associated with PIH patients with a different symptom profile. Children with optic disc edema, bulging fontanel or sixth nerve palsy, are at increased risk for PIH.


Assuntos
Doenças do Nervo Abducente/diagnóstico , Pressão do Líquido Cefalorraquidiano/fisiologia , Fontanelas Cranianas , Hipertensão Intracraniana/diagnóstico , Papiledema/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Adolescente , Criança , Fontanelas Cranianas/fisiopatologia , Estudos Transversais , Feminino , Humanos , Hipertensão Intracraniana/fisiopatologia , Masculino , Papiledema/fisiopatologia , Prognóstico , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/fisiopatologia , Estudos Retrospectivos
6.
Math Biosci Eng ; 15(4): 905-932, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30380315

RESUMO

The paper is devoted to the analysis of electroencephalography (EEG) in neonates. The goal is to investigate the impact of fontanels on EEG measurements, i.e. on the values of the electric potential on the scalp. In order to answer this clinical issue, a complete mathematical study (modeling, existence and uniqueness result, realistic simulations) is carried out. A model for the forward problem in EEG source localization is proposed. The model is able to take into account the presence and ossification process of fontanels which are characterized by a variable conductivity. From a mathematical point of view, the model consists in solving an elliptic problem with a singular source term in an inhomogeneous medium. A subtraction approach is used to deal with the singularity in the source term, and existence and uniqueness results are proved for the continuous problem. Discretization is performed with 3D Finite Elements of type P1 and error estimates are proved in the energy norm (H¹-norm). Numerical simulations for a three-layer spherical model as well as for a realistic neonatal head model including or not the fontanels have been obtained and corroborate the theoretical results. A mathematical tool related to the concept of Gâteau derivatives is introduced which is able to measure the sensitivity of the electric potential with respect to small variations in the fontanel conductivity. This study attests that the presence of fontanels in neonates does have an impact on EEG measurements.


Assuntos
Eletroencefalografia/estatística & dados numéricos , Modelos Neurológicos , Encéfalo/anatomia & histologia , Encéfalo/fisiologia , Simulação por Computador , Fontanelas Cranianas/anatomia & histologia , Fontanelas Cranianas/fisiologia , Condutividade Elétrica , Análise de Elementos Finitos , Humanos , Imageamento Tridimensional , Recém-Nascido , Conceitos Matemáticos , Modelos Anatômicos , Crânio/anatomia & histologia , Crânio/fisiologia
7.
PLoS One ; 13(10): e0202454, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30365494

RESUMO

BACKGROUND: Anterior fontanelle is the largest, prominent and most important fontanelle, which is used for clinical evaluation. It is mainly characterized by its size and shape variation and is possibly influenced by gender, race and genetics. Understanding the variation of anterior fontanelle is used for recognition of different medical disorders and abnormal skeletal morphogenesis. OBJECTIVE: To determine the mean size of anterior fontanelle among term neonates on the first day of life born at University of Gondar Hospital, Gondar Town, Northwest Ethiopia, 2018. METHODS: Descriptive cross sectional study design was undertaken in 384 term and apparently healthy neonates, using standard methods. Descriptive analysis, student t-test, one way ANOVA and Pearson correlation coefficient were implemented. RESULTS: In this study, the mean size of anterior fontanelle in term neonates was 3.00 ± 0.62 cm (range 1.70-5.50 cm). The mean size of anterior fontanelle was 3.10 ± 0.66 cm for males, and 2.88 ± 0.57 cm for females. There was statistically significant difference in anterior fontanelle size in neonates of different genders (p<0.001), mode of delivery (p<0.001) and duration of labour (p = 0.006). However, the size of anterior fontanelle was not significantly affected by the birth order, onset of labour and socio-demographic variables of the mother except occupation of the mother (p = 0.01). There was a significant positive correlation between the mean size of anterior fontanelle with birth weight (r = 0.11; p = 0.04) and head circumference (r = 0.17; p = 0.001). CONCLUSIONS: At term, male neonates had significantly larger anterior fontanelle than female neonates and anterior fontanelle size has a direct relationship with birth weight and head circumference.


Assuntos
Cefalometria/métodos , Fontanelas Cranianas/anatomia & histologia , Crânio/anatomia & histologia , Peso ao Nascer/fisiologia , Fontanelas Cranianas/fisiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Idade Gestacional , Hospitais , Humanos , Recém-Nascido , Masculino , Valores de Referência , Fatores Sexuais , Crânio/fisiologia
8.
Sci Rep ; 8(1): 11824, 2018 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-30087390

RESUMO

For infants with acute progressive hydrocephalus, invasive drainage of cerebrospinal fluid (CSF) is performed until a ventriculo-peritoneal shunt can be inserted. Surrogate markers of intracranial pressure (ICP) may help optimise the timing of invasive procedures. To assess whether RI with/without fontanel compression helps distinguish between infants with normal (<5 cmH2O), mild (5-11 cmH2O), and moderate (>11 cmH2O) ICP elevation, 74 ICP measures before/after CSF removal and 148 related Doppler measures of the middle cerebral artery were assessed. Higher RI was associated with fontanel compression, elevated ICP, and their interaction (all p < 0.001). Without compression, differences in RI were observed between normal and moderate (p < 0.001) and between mild and moderate ICP elevation (p = 0.033). With compression, differences in RI were observed for all pairwise comparisons among normal, mild, and moderate ICP elevation (all p < 0.001). Without compression, areas under the receiver-operating characteristic curve for prediction of mild and moderate ICP elevation were 0.664 (95% confidence interval (CI), 0.538-0.791; p = 0.020) and 0.727 (95% CI, 0.582-0.872; p = 0.004), respectively, which improved to 0.806 (95% CI, 0.703-0.910; p < 0.001) and 0.814 (95% CI, 0.707-0.921; p < 0.001), respectively, with compression. RI with fontanel compression provides improved discrimination of infants with absent, mild, and moderate ICP elevation.


Assuntos
Fontanelas Cranianas/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Hipertensão Intracraniana/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Derivações do Líquido Cefalorraquidiano/métodos , Circulação Cerebrovascular , Fontanelas Cranianas/fisiopatologia , Fontanelas Cranianas/cirurgia , Drenagem/métodos , Humanos , Hidrocefalia/fisiopatologia , Recém-Nascido , Hipertensão Intracraniana/fisiopatologia , Pressão Intracraniana , Punções , Curva ROC , Reprodutibilidade dos Testes , Reologia/métodos
9.
Int Forum Allergy Rhinol ; 8(10): 1204-1210, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29883049

RESUMO

BACKGROUND: The ostiomeatal complex (OMC), comprising a small natural maxillary sinus ostium and narrow infundibulum, transmits the air diffusion into the antrum and mucociliary transport from the antrum, and is considered a key area in chronic rhinosinusitis (CRS). Thin membranous anterior and posterior fontanelle areas below the OMC can rupture forming a perforation, accessory maxillary ostium (AMO), that increases antral airflow changing the anatomy and function of the sinus. The purpose of this study was to report the first case series of CRS patients who had undergone repair of fontanelle defects aiming to reconstruct normal structures. METHODS: Between 2011 and 2017, a total of 157 perforations were diagnosed and repaired in 121 of 525 consecutive endoscopic sinus operations performed by the author. Defects were 3 mm to 4 mm in size (range, 1 mm to 7 mm). A flap cut from the undersurface of the middle turbinate was used. In total, 101 patients received concurrent balloon catheter dilation (BCD), while 15 patients had only an AMO repair. The mean endoscopic follow-up time was 16 weeks (range, 1 to 188 weeks). RESULTS: Overall, 101 perforations were closed, 21 open, and 17 partially open. A history of earlier endoscopic sinus surgery (ESS) or BCD surgery, presence of nasal polyposis or whether the repair was made without simultaneous BCD did not influence the closure rate. Postoperative febrile sinusitis occurred in 26 patients. CONCLUSION: Repair of AMO is in theory a beneficial and technically feasible office procedure with only transient side effects. Three out of 4 perforations were closed after repair.


Assuntos
Seio Maxilar/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Retalhos Cirúrgicos/transplante , Conchas Nasais/transplante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Doença Crônica , Fontanelas Cranianas/anormalidades , Fontanelas Cranianas/cirurgia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
10.
J Neurosurg Pediatr ; 22(3): 323-329, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29856300

RESUMO

OBJECTIVE Anterior fontanel size and closure time can be useful clinical signs for the early diagnosis of diseases. Knowing age-related normal variations is important to decide on further investigations. The authors of this study aimed to describe fontanel size variation according to age, determine fontanel closure time, and identify the optimal method for assessing fontanel size. METHODS For this prospective cohort study, 321 healthy term babies who fulfilled the inclusion criteria were consecutively recruited. Percentile charts for the mean anterior fontanel size and oblique measurements from birth to 24 months of age were created. RESULTS The mean fontanel closure time was 9.7 ± 5.0 months (girls 10.3 ± 4.7 months, boys 9.2 ± 5.1 months). No differences were observed between the traditional method and oblique measurements. Early fontanel closure was not associated with microcephaly. CONCLUSIONS Oblique measurements can be used because they are as accurate as the traditional method. Children with fontanels measuring above the 95th percentile should be monitored closely and investigated further for potentially associated diseases.


Assuntos
Fontanelas Cranianas/fisiologia , Suturas Cranianas/fisiologia , Crânio/crescimento & desenvolvimento , Estatura , Peso Corporal , Cefalometria , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
11.
Indian J Pediatr ; 85(11): 984-988, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29744744

RESUMO

OBJECTIVE: To measure the size of the anterior fontanelle (AF) in healthy late-preterm and term newborns and correlate it with birth weight, gestational age, gender, occipito-frontal circumference, small for gestational age status and birth weight z-score. METHODS: This was an observational study carried out from October 2013 through April 2015 at a tertiary care hospital. Newborns ≥ 34 wk gestation were enrolled. Fontanelle edge was palpated with index finger and size calculated by adding anterior-posterior and transverse diameters and dividing by two. RESULTS: A total of 1010 neonates were enrolled. The mean AF size was 2.23 ± 0.52 cm (mean ± SD). There was a significant decrease in the size of the AF with advancing gestational maturity on one-way ANOVA (F = 31.30) (P < 0.001) and also by increasing birth weight (F = 20.34) (P < 0.001). There was no significant difference in the mean AF size between males; 2.21 ± 0.54 cm and females; 2.25 ± 0.55 cm (mean ± SD) (P = 0.575). There was a strong correlation between AF size with increasing birth weight; correlation (r) = 0.985. In small for gestational age neonates the AF was larger, 2.27 ± 0.55 (mean ± SD) and a strong correlation between birth weight z-score and AF size was noted (r = 1.012). CONCLUSIONS: The mean AF size in late-preterm and term Indian newborns in a mixed community hospital was 2.23 ± 0.52. A strong correlation was found between AF size with increasing birth weight and with birth weight z-score in small for gestational age babies.


Assuntos
Fontanelas Cranianas/anatomia & histologia , Recém-Nascido , Recém-Nascido Prematuro , Peso ao Nascer , Cefalometria , Feminino , Idade Gestacional , Humanos , Índia , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Valores de Referência , Fatores Sexuais
12.
Am J Rhinol Allergy ; 32(1): 52-56, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29336291

RESUMO

BACKGROUND: Endoscopic transsphenoidal skull base surgery (ETSS) is now considered the criterion standard approach for resection of pituitary adenomas and other midline anterior skull base lesions. Normal sinonasal structures are resected during ETSS, which raises concerns for nasal morbidity and patient-based outcome. OBJECTIVE: To perform a surgical outcome assessment by examining whether the extent of ETSS approaches affected patient-specific sinonasal quality of life as measured by the 22-item Sino-Nasal Outcome Test (SNOT-22). METHODS: A single-center prospective cohort study of patients operated on by the same skull base team between 2012 and 2016. Patients with completed pre- and postoperative SNOT-22 were included. The primary outcome was SNOT-22 scores at preoperative, 0-1 month, 2-4 months, >5 months follow-up. Age, sex, tumor pathology, surgical procedure, and intraoperative cerebral spinal fluid leak repair were also obtained. RESULTS: Of the 249 ETSS performed, 148 patients (59%) had at least one completed SNOT-22; 45 (18%) met the inclusion criteria. Sinonasal quality of life based on SNOT-22 at the 0-1-month follow-up was significantly worse than the presurgical levels (p < 0.05). However, there was a return of SNOT-22 scores to preoperative levels at 2-4 months (p > 0.05), which was sustained at >5 months (p > 0.05). Factors such as the extent of ETSS, a previous nasal surgery, repair of an intraoperative cerebral spinal fluid leak, and the tumor pathology did not affect SNOT-22 scores at any follow-up intervals (p > 0.05). CONCLUSION: Sinonasal quality of life worsened after ETSS at 0-1 month follow-up but returned to preoperative levels at 2-4 months and remained at postoperative levels >5 months. Analysis of these data will allow us to educate our patients that the anticipated nasal morbidity after ETSS is usually only transient and should be expected to recover to preoperative levels.


Assuntos
Fontanelas Cranianas/cirurgia , Endoscopia/métodos , Seios Paranasais/cirurgia , Neoplasias Hipofisárias/cirurgia , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Osso Esfenoide/cirurgia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/patologia , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Resultado do Tratamento
13.
J Cardiothorac Vasc Anesth ; 32(4): 1648-1654, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29331554

RESUMO

OBJECTIVE: Transfontanelle ultrasound is a noninvasive method for assessing cerebral blood flow in neonates and infants. The authors applied this technique as a point-of-care tool, before and after modified Blalock-Taussig shunt procedure, to evaluate cerebral perfusion. DESIGN: Retrospective, observational study. SETTING: Tertiary care children's hospital. PARTICIPANTS: Ten infants undergoing modified Blalock-Taussig shunt procedure. OBSERVATION: Transfontanelle ultrasound examinations with modified resistive index were analyzed before and after the modified Blalock-Taussig shunt procedure. MEASUREMENTS AND MAIN RESULTS: Two infants died and 2 patients required a revision procedure due to shunt thrombosis. Baseline-modified resistive index and regional cerebral oxygenation were comparable between the right and left hemisphere. However, after the procedure, the modified resistive index decreased at both sides of the internal carotid arteries compared with baseline values (p value right side = 0.012, left side = 0.036) and was greater at the ipsilateral internal carotid arteries with the shunt (p = 0.012, mean difference = 0.07, 95% confidence interval [CI] 0.02-0.12). Four infants with the large patent ductus arteriosus presented diastolic reverse flows at both internal carotid arteries at baseline. However, the diastolic reverse flow disappeared after the procedure. An infant who developed diastolic reverse flow after the procedure, died. CONCLUSIONS: Transfontanelle ultrasound is a feasible tool for assessing the pattern of shunt flow and cerebral perfusion before and after the modified Blalock-Taussig shunt procedure. The transfontanelle ultrasound examinations may have potential role in assessing "over-shunting," but it needs more studies.


Assuntos
Procedimento de Blalock-Taussig/métodos , Circulação Cerebrovascular/fisiologia , Fontanelas Cranianas/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Monitorização Intraoperatória/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos
14.
J Craniofac Surg ; 29(1): 21-24, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29227405

RESUMO

BACKGROUND: Craniosynostosis, or a premature fusion of 1 or more cranial vault sutures, results in characteristic head shape deformities. In previous reports, an osseous prominence at the anterior fontanelle has been suggestive of adjacent suture fusion and local elevation in intracranial pressure (ICP). This prominence has been termed the "volcano" sign, and has been described in the anterior fusion of the sagittal suture and serves as an indication for surgery. METHODS: Two patients presented for head shape evaluation with mild metopic ridging and anterior fontanellar osseous convexities consistent with the volcano sign. Low-dose computed tomography imaging was performed in both patients due to concern for underlying craniosynostosis with elevated locoregional ICP. RESULTS: In both patients, imaging was significant for a localized, superior forehead metopic fusion, as well as a bony, convex prominence at the site of the ossified anterior fontanelle. There were no other clinical or radiologic signs or symptoms to suggest elevated ICP. Surgery was not indicated in either patient. CONCLUSIONS: Here the authors present 2 patients with osseous convexities at the site of the closed anterior fontanelle without signs or symptoms of elevated ICP, or classic signs of metopic synostosis. The authors hypothesize that this pattern may be due to a form of mechanically induced premature fusion of a normal metopic suture that is focused superiorly at the bregma, with minimal resultant restriction of overall skull growth. This is in contrast to metopic synostosis, which primarily has a sutural pathology and leads to characteristic findings of hypotelorism and trigonocephaly.


Assuntos
Craniossinostoses , Hipertensão Intracraniana , Crânio/crescimento & desenvolvimento , Cefalometria/métodos , Fontanelas Cranianas/diagnóstico por imagem , Suturas Cranianas/diagnóstico por imagem , Craniossinostoses/complicações , Craniossinostoses/diagnóstico , Craniossinostoses/fisiopatologia , Humanos , Lactente , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/prevenção & controle , Masculino , Tomografia Computadorizada por Raios X/métodos
15.
Pediatr Res ; 83(4): 784-790, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29166376

RESUMO

BackgroundBacterial infections account for a significant proportion of neonatal and infant mortality globally. We aimed to identify predictors of death in infants with probable serious bacterial infection (PSBI) defined as signs/symptoms of possible serious bacterial infection along with baseline C-reactive protein (CRP) ≥12 mg/l.MethodsWe did a secondary analysis using the data collected from 700 infants with PSBI who participated in a randomized controlled trial in India in which zinc or placebo was given in addition to the standard antibiotics. Logistic regression was used to estimate the associations between relevant variables and death within 21 days.ResultsThose infants who were fed cow's milk or formula before the illness episode had 3.7-fold (95% confidence interval (CI) 1.5-9.3) and 5.3-fold (95% CI 2.0-13.6) higher odds of death, respectively. Lethargy (odds ratio (OR) 2.4, 95% CI 1.1-5.4) and CRP (OR 1.9, 95% CI 1.1-3.3) were also independent predictors of death. In the model including only clinical features, female gender (OR 2.25, 95% CI 1.0-5.0), abdominal distention (3.7, 95% CI 1.1-12.3), and bulging fontanelle (5.8, 95% CI 1.1-30.5) were also independent predictors for death.ConclusionFormula or cow milk feeding prior to the illness, lethargy at the time of presentation, and high serum CRP levels predicted death in infants with PSBI.


Assuntos
Infecções Bacterianas/mortalidade , Mortalidade Infantil , Sepse/microbiologia , Abdome , Animais , Infecções Bacterianas/epidemiologia , Proteína C-Reativa/análise , Bovinos , Fontanelas Cranianas , Interpretação Estatística de Dados , Feminino , Humanos , Índia/epidemiologia , Lactente , Fórmulas Infantis , Recém-Nascido , Modelos Logísticos , Masculino , Leite/química , Razão de Chances , Controle de Qualidade , Análise de Regressão , Fatores de Risco , Sepse/epidemiologia , Atenção Terciária à Saúde/organização & administração , Zinco/uso terapêutico
16.
J Bone Miner Metab ; 36(6): 700-709, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29128970

RESUMO

Skull changes are poorly described in vitamin D insufficiency [serum 25-hydroxyvitamin D (s-25(OH)D) 25-50 nmol/L]. We aimed to investigate factors associated with cranial anthropometrics in infants, especially s-25(OH)D. In infants 2.5-6 months old from the Odense Child Cohort, associations between cord and pregnancy s-25(OH)D and anterior fontanel area (n = 765), head circumference (HC, n = 1776) and head shape (n = 1527) were investigated along with other factors. Age was corrected for preterm birth. The mean (SD) s-25(OH)D in early pregnancy was 65.97 (21.33) nmol/L; late pregnancy 78.61 (27.18) nmol/L; and cord 47.1 (21.7) nmol/L. At median (IQR) age 3.7 (2.5-5.9) months, the fontanel area was 225 (0-1690) mm2, and mean (SD) HC was 41.5 (1.5) cm. Asymmetric/flat head shape was present in 846 infants (55.3%). No associations were found between cord, early or late pregnancy s-25(OH)D and any cranial measure by univariate or adjusted analysis. Among significant, independent associations in multivariate analysis, fontanel area was associated inversely with gestational age (GA); HC was associated directly with GA, maternal pre-pregnancy overweight and caesarean section and inversely with smoking; and asymmetrical head shape showed a novel association with male sex: adjusted OR = 1.54 (95% CI 1.25; 1.89), p < 0.001. Other associations with asymmetrical head shape included parity 3+, gestational age and maternal age 30+ years (all protective). In conclusion, neither pregnancy nor cord s-25(OH)D was associated with fontanel size, HC or asymmetrical head shape despite a high prevalence of cord s-25(OH)D < 50 nmol/L. Lower GA was associated with larger fontanel size, lower HC and asymmetrical head shape, and boys more frequently had asymmetrical head shape, probably due to heavier heads.


Assuntos
Antropometria , Sangue Fetal/metabolismo , Crânio/anatomia & histologia , Vitamina D/análogos & derivados , Adulto , Criança , Estudos de Coortes , Fontanelas Cranianas/anatomia & histologia , Feminino , Humanos , Lactente , Masculino , Gravidez , Vitamina D/sangue , Deficiência de Vitamina D/sangue
17.
Zhonghua Er Ke Za Zhi ; 55(8): 602-607, 2017 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-28822436

RESUMO

Objective: To observe the development of the anterior fontanel (AF) in healthy Chinese children from 1 to 36 months, and to assess the relationship between the closure of the AF and physical development in Chinese children. Method: This was a cross-sectional evaluation of the AF in a series of 104 147 healthy children between June 2015 and October 2015 from nine cities in China. The size and closure of AF of the children were measured and recorded, and the age for the closure of AF was calculated using probit analysis. The data in 2015 were compared with the data from the same surveys in 1985, 1995 and 2005 respectively. Result: (1) Totally, 104 147 healthy children (52 216 boys and 51 931 girls; range 1 month to 36 months) from nine cities enrolled in this cross-sectional study. (2)The size of AF gradually decreased with age, and the mean size of AF was 2.0(95% confidence interval (CI)2.0-2.1) cm at the age of 1 month, 0.6(95% CI 0.5-0.6) cm at the ages of 12-14 months, and 0.0(95% CI 0.0-0.0) cm at the ages of 21-23 months, respectively. (3) The percentage for the closure of AF was 0.1% at the age of 3 months, 67.5% at the ages of 15-17 months. The oldestt age for closure was 35 months. The mean age for the closure of AF was 14.5 months (95% CI 14.4-14.6), and the 3rd and 97th centiles of the age for the closure of AF were 6.6 and 22.4 months. (4) Over the past 30 years from 1985 to 2015, no significant change was found regarding the mean age for the closure of AF in children from urban area, contrarily, the mean age was 1.1 months earlier in suburban area. (5) The height and weight of children in the closed AF group were significantly higher than those of children in unclosed AF group(all P<0.01), but no significant difference was found regarding the head circumference between the two groups. Conclusion: The size of AF at 1 month was maximum, then decreases gradually with age, and the mean age for the closure of AF was 14.5 (95% CI 14.4-14.6) months. No significant correlation was found between the development of AF and the head circumference, but there was a positive correlation between the development of AF and the height and weight. There was no significant change regarding the secular trend of the age for the closure of AF.


Assuntos
Fontanelas Cranianas/fisiologia , Crescimento/fisiologia , Estatura , Peso Corporal , Criança , Pré-Escolar , China , Cidades , Estudos Transversais , Feminino , Humanos , Lactente , Masculino
18.
Childs Nerv Syst ; 33(6): 909-914, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28396968

RESUMO

PURPOSE: Fontanelles are a regular feature of infant development in which two segments of bone remain separated, leaving an area of fibrous membrane or a "soft spot" that acts to accommodate growth of the brain without compression by the skull. Of the six fontanelles in the human skull, the anterior fontanelle, located between the frontal and parietal bones, serves as an important anatomical diagnostic tool in the assessment of impairments of the skull and brain and allows access to the brain and ventricles in the infant. METHODS: Using a standard database search, we conducted a review of the anterior fontanelle, including its embryology, anatomy, pathology, and related surgical implications. CONCLUSIONS: The diagnostic value of the anterior fontanelle, through observation of its shape, size, and palpability, makes the area of significant clinical value. It is important that clinicians are aware of the features and associated pathologies of this area in their everyday practice.


Assuntos
Fontanelas Cranianas/anatomia & histologia , Fontanelas Cranianas/embriologia , Fontanelas Cranianas/cirurgia , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/cirurgia , Idade Gestacional , Humanos , Recém-Nascido
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