Newborn infant parasympathetic evaluation for the assessment of analgosedation adequacy in infants treated by mechanical ventilation - a multicenter pilot study.

INTRODUCTION: Adequate analgosedation is important in infants treated in pediatric/neonatal intensive care units (P/NICUs), because both too deep and insufficient analgosedation is disadvantageous. To assess the severity of pain, several behavioral and behavioral-physiological scales are used, but their usefulness is limited. It is therefore justified to search for additional methods to assess the adequacy of analgosedation in these patients. The aim of the present study is to evaluate the usefulness of Newborn Infant Parasympathetic Evaluation (NIPE) in the assessment of analgosedation quality in infants requiring mechanical ventilation, who are treated in P/NICUs. MATERIAL AND METHODS: We performed simultaneously 180 COMFORT-B assessments and heart rate variability measurements using a NIPE monitor in 30 mechanically ventilated infants receiving analgosedation. A generalized linear mixed model with the logit link function was used in order to perform logistic regression analysis to assess the relationship between NIPEi/NIPEm and deep sedation. RESULTS: The multivariable logistic regression model showed that NIPEi and NIPEm values were higher when analgosedation was deep as compared to when it was moderate or insufficient (OR (95% CI): NIPEm - 1.065 (1.007-1.126), p = 0.03; NIPEi - 1.068 (1.016-1.123), p = 0.01). CONCLUSIONS: The NIPE indexes are significantly higher in patients whose assessment on the behavioral scale indicates deep analgosedation as compared to those in whom it indicates moderate or insufficient analgosedation. Allowing continuous monitoring, the NIPE device may be a valuable assisting tool in the assessment of analgosedation quality in mechanically ventilated newborns and infants.

Available Instruments to Assess Pain in Infants.

Pain assessment in newborns and infants is challenging for clinicians. Although behavioral and behavioral-physiological scales are validated pain assessment instruments, their use in this age group has significant limitations. In this review, we summarize the methods currently available for assessing pain in neonates and infants. It is possible that these pain detection methods are also useful for assessing the quality of anesthesia and analgosedation in these populations. Further research should be aimed at confirming the usefulness of these tools in infants and identifying additional pain assessment options for clinical practice.

Newborn Infant Parasympathetic Evaluation Index for the Assessment of Procedural Pain in Nonanesthetized Infants: A Multicenter Pilot Study.

OBJECTIVE: The aim of this study is to evaluate the ability of the Newborn Infant Parasympathetic Evaluation (NIPE) index to detect the response to nociceptive stimuli in nonanesthetized infants and to compare these results to simultaneous scoring by behavioral scales. STUDY DESIGN: Thirty-six nonanesthetized infants admitted to neonatal/pediatric intensive care unit (N/PICUs) were enrolled to the study. Due to faulty records of the data, three patients had to be excluded. To detect pain caused by noxious stimuli, the heart-rate-variability-derived NIPE index and behavioral pain scales designed for measuring procedural pain in nonverbal children were used. RESULTS: Forty-one painful events were available for analysis. We observed in the whole group a statistically significant decrease in NIPE values at 1, 2, and 3 minutes after a painful stimulus, in comparison to the NIPE value at rest and the statistically significant differences between the minimum NIPE value within 3 minutes after the stimulus in comparison to NIPE value at rest in the whole group, as well as in the subgroups of moderate and severe pain. Receiver operating characteristic (ROC) analysis has shown the strong sensitivity and specificity of the NIPE in detecting the noxious stimuli (ROC AUC: 0.767). We also found that the stronger the sensation of pain was, the more rapidly NIPE reached its lowest value. DISCUSSION: Our study indicates that the painful procedures are associated with a significant decrease in the NIPE value within 3 minutes after a noxious stimulus. Based on our observation, the minimum value within 3 minutes from the painful procedure seems to be the most distinctive value.

Procedural Pain Assessment in Infants Without Analgosedation: Comparison of Newborn Infant Parasympathetic Evaluation and Skin Conductance Activity - A Pilot Study.

Objective: New technologies to measure pain responses, such as heart rate variability and skin conductance hold promise in the development of tools that can be reliable and quantifiable of detecting pain. The main objective of this study was to assess the capability of two monitors i.e., Newborn Infant Parasympathetic Evaluation (NIPE) and Skin Conductance Algesimeter for detecting procedural pain in non-anesthetized infants. Materials and Methods: Thirty-three non-anesthetized infants were enrolled to the study. To detect pain caused by heel stick, NIPE, and Skin Conductance monitors and behavioral pain scales were used. Three minutes before and just after heel stick, pain was evaluated by behavioral scales, and simultaneously over the whole period by NIPE and SCA. Results: A statistically significant decrease of NIPE Index and an increase of SCA values were found after the HS procedure. There were no statistically significant differences between the decrease in NIPEi values and the increase in PPS values between subgroups based on pain assessment by behavioral-scale scores. Conclusion: Both NIPE and SCA can be useful for detection of procedural pain and may constitue an additional valuable tool for better handling of pain among patients treated in NICUs. More studies on larger groups of patients are needed.

Theoretical basis for the use of non-invasive thermal measurements to assess the brain injury in newborns undergoing therapeutic hypothermia.

The aim of this paper is to propose a new non-invasive methodology to estimate thermogenesis in newborns with perinatal asphyxia (PA) undergoing therapeutic hypothermia (TH). Metabolic heat production (with respect to either a neonate's body mass or its body surface) is calculated from the newborn's heat balance, estimating all remaining terms of this heat balance utilising results of only non-invasive thermal measurements. The measurement devices work with standard equipment used for therapeutic hypothermia and are equipped with the Global System for Mobile Communications (GSM), which allows one to record and monitor the course of the therapy remotely (using an internet browser) without disturbing the medical personnel. This methodology allows one to estimate thermogenesis in newborns with perinatal asphyxia undergoing therapeutic hypothermia. It also offers information about instantaneous values of the rate of cooling together with values of remaining rates of heat transfer. It also shows the trend of any changes, which are recorded during treatment. Having information about all components of the heat balance one is able to facilitate comparison of results obtained for different patients, in whom these components may differ. The proposed method can be a new tool for measuring heat balance with the possibility of offering better predictions regarding short-term neurologic outcomes and tailored management in newborns treated by TH.

Skin conductance measurement for the assessment of analgosedation adequacy in infants treated with mechanical ventilation: A multicenter pilot study.

BACKGROUND: Patients treated in neonatal/pediatric intensive care units (N/PICUs) are frequently exposed to pain. To assess its severity, several behavioral and behavioral-physiological scales are used, but their usefulness is limited. It is therefore justified to search for additional methods to assess the adequacy of analgesia and sedation in these patients. OBJECTIVES: To evaluate the usefulness of skin conductance (SC) measurement in the assessment of analgosedation quality in infants requiring mechanical ventilation treated in N/PICUs. MATERIAL AND METHODS: Thirty infants aged 6-208 days treated in 6 N/PICUs, mechanically ventilated and receiving analgosedation, were included for the study. Simultaneous COMFORT-B assessment and SC measurement using SCA (skin conductance algesimeter) monitor were performed. Due to technical problems, not all of the SC records could be interpreted, and finally 412 simultaneous assessments on the COMFORT-B scale and SC measurements in 29 patients were analyzed. RESULTS: We found a statistically significant correlation between the COMFORT-B scoring and the SC measurements. Additionally, SC was significantly lower when the behavioral score indicated deep sedation, in comparison to periods when it indicated moderate or insufficient analgosedation. CONCLUSIONS: Skin conductance measurements are comparable with the COMFORT-B rating in mechanically ventilated infants receiving analgosedation. The SCA monitor may be of value in the assessment of analgosedation quality, and in particular may identify the situation where sedation is deep. Further research is needed regarding the suitability of this device in clinical practice.

Methods for assessing the severity of perinatal asphyxia and early prognostic tools in neonates with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.

Despite the progress in perinatal care, perinatal asphyxia (PA) remains a significant problem in neonatology. The development of therapeutic hypothermia (TH) has improved the prognosis, but it still remains uncertain in hypoxic neonates. The evaluation of the severity of ischemia/hypoxia after birth is crucial to the choice of treatment, and with accurate long-term prognosis, appropriate further patient care can be planned. This article presents various methods for the preliminary assessment of brain damage and prognosis in newborns with PA treated with TH. The importance of assessing the neurological condition and the usefulness of laboratory and electrophysiological testing and imaging are discussed. New methods are also noted, which are at the stage of clinical trials. A combination of the prognostic tests presented in this article can provide greater prognostic accuracy for predicting long-term neurological outcomes in infants with hypoxic-ischemic encephalopathy (HIE) undergoing TH than either of these tests independently. Acknowledging the limitations of individual tools in certain clinical situations and the integration of the information available from multiple biomarkers may help improve the accuracy of prognostication.

The management of unanticipated difficult airways in children of all age groups in anaesthetic practice - the position paper of an expert panel.

Children form a specific group of patients, as there are significant differences between children and adults in both anatomy and physiology. Difficult airway may be unanticipated or anticipated. Difficulties encountered during intubation may cause hypoxia, hypoxic brain injury and, in extreme situations, may result in the patient's death. There are few paediatric difficult-airway guidelines available in the current literature, and some of these have significant limitations. This position paper, intended for unanticipated difficult airway, was elaborated by the panel of specialists representing the Polish Society of Anaesthesiology and Intensive Care as well as the Polish Neonatal Society. It covers both elective intubation and emergency situations in children in all age groups. An integral part of the paper is an algorithm. The paper describes in detail all stages of the algorithm considering some modification in specific age groups, i.e. neonates.

Evidence of a significant vitamin D deficiency among 9-13-year-old Polish children: results of a multicentre study.

PURPOSE: To evaluate the extent to which the population of Polish preadolescents is vitamin D deficient and to assess seasonal variations in vitamin D status. PARTICIPANTS AND METHODS: A total of 720 healthy children aged 9-13 years (409 girls, 311 boys) residing in 6 representative geographical locations in Poland were studied. A parental-assisted questionnaire provided data on nutritional habits, vitamin D supplements and sun exposure. Serum concentration of 25-hydroxyvitamin was determined twice, after the winter in March and after the summer in October. RESULTS: In March, vitamin D deficiency (25-50 nmol/L) was found in 64%, and severe deficiency (< 25 nmol/L) in 20.2% of children. In October, the deficiency and severe deficiency were still noticed in 25.9 and 0.1% of children, respectively. The mean serum concentration of 25-OHD was 52% higher in October (55.4 ± 14.0 nmol/L) than in March (36.4 ± 13.5 nmol/L), (p < 0.01). In children with 25-OHD < 50 nmol/L in March, their 25-OHD concentration increased by 64% through March to October (32.5 ± 8.2 vs. 53.2 ± 7.9 nmol/L, p < 0.01). An association was found between 25-OHD concentration and regular consumption of vitamin D supplements, cod-liver oil and fish. CONCLUSIONS: The majority of preadolescent Polish boys and girls show vitamin D deficiency after the winter period, although a distinct amelioration over summertime is found in this age group. There is a need to implement effective prevention and intervention strategies in the management of vitamin D deficiency among schoolchildren in Poland, with the supplementation throughout the entire year.

The assessment of skeletal status in young patients with Turner syndrome by 2 densitometric techniques: Phalangeal quantitative ultrasound and dual energy X-ray absorptiometry.

BACKGROUND: Studies using dual energy X-ray absorptiometry (DXA) demonstrate a reduction in bone mineral density (BMD) in children and adolescents with Turner syndrome (TS). However, these studies do not take into account changes in bone size, which influence BMD in the case of short-statured patients. Phalangeal quantitative ultrasound (phQUS) measurements have shown an ability to reveal changes due to skeletal growth, aging, and bone and mineral disorders. There is limited data on bone mineral status in girls with TS assessed by 2 different techniques, i.e., DXA and phQUS. OBJECTIVES: The aim of this study was to investigate the potential negative impact of TS on bone status and to assess whether densitometric values were related to former fractures. MATERIAL AND METHODS: In 43 TS girls aged 5-18 years, we evaluated bone status by 2 different densitometric techniques, DXA and phQUS. RESULTS: The mean lumbar spine areal bone mineral density (LS aBMD) Z-score was significantly lower than 0 (the hypothetical mean) compared to the reference population (p < 0.001). The mean LS aBMD height-adjusted Z-score did not differ significantly from 0. The amplitude-dependent speed of sound (Ad-SoS) Z-score was significantly lower than 0 compared with a Polish reference population. There were no significant differences between fractured and fracture-free patients as regards Ad-SoS Z-score and LS aBMD height-adjusted Z-score. CONCLUSIONS: Girls with TS have normal bone density adjusted for height, but significantly decreased phQUS values. Neither DXA nor phalangeal Ad-SoS can identify young TS patients with former fractures.

Quantitative Ultrasound Measurement at the Hand Phalanges Does Not Reveal Skeletal Disturbances in Children With Bronchial Asthma: A Longitudinal Observation.

OBJECTIVES: To assess the skeletal status in asthmatic children treated with inhaled corticosteroids in a longitudinal observation by quantitative ultrasound (US) measurement at the hand phalanges. METHODS: Thirty-four children were studied prospectively. Quantitative US measurements were performed at baseline and after a mean ± SD of 2.35 ± 0.20 years. The obtained results were compared to age-, sex-, and body size-matched control participants selected from a database of previously examined healthy children. Individual changes in the amplitude-dependent speed of sound (Ad-SoS) during the follow-up period were also analyzed. RESULTS: The mean age of the asthmatic children was 10.6 ± 2.5 years. The mean Ad-SoS in the asthmatic children at baseline was 1940.5 ± 49.6 m/s, and the mean Z score was -0.26 ± 0.80. Corresponding values at the follow-up examination were 1976.2 ± 63.6 m/s and -0.18 ± 1.16. The results did not differ significantly in comparison to the healthy controls. The analysis of individual changes in Ad-SoS revealed that 18 participants had a significant increase in this parameter (ie, exceeding the least significant change threshold), and 16 did not have a significant change in their values. No one had a significant decrease in Ad-SoS. CONCLUSIONS: Quantitative US at the hand phalanges applied as a diagnostic tool revealed no essential differences in the pattern of skeletal development between asthmatic children treated with inhaled glucocorticosteroids and healthy controls.

Quantitative ultrasound bone measurements in pre-pubertal children with type 1 diabetes.

This case-control study aimed to assess bone status in children with type 1 diabetes mellitus (T1DM). Fifty-seven pre-pubertal patients (37 boys, aged 7.9 ± 2.5 years, T1DM duration 3.1 ± 1.6 years) and 171 age-matched healthy controls (111 boys) were studied. Quantitative ultrasound (QUS) was used to measure amplitude dependent speed of sound (Ad-SoS) at hand phalanges (expressed as standard deviation score [SDS]). Anthropometric and disease-related data (including mean HbA(1c) from whole T1DM duration [T], last year [Y], examination day [D]) were collected. Mean Ad-SoS SDS in patients -0.13 ± 1.32 (95% confidence interval [CI] -0.48, 0.22) was similar to that of controls. Subgroups discriminated according to HbA(1c) D, Y and T (cut-off 7.0%) did not differ regarding analyzed parameters. In patients, Ad-SoS SDS was comparable for both genders. Multivariable stepwise regression analysis showed significant negative influence of diabetes duration on Ad-SoS SDS. QUS findings in pre-pubertal children with T1DM do not differ from those in healthy children. Disease duration seems to affect negatively Ad-SoS SDS. However, independent prospective studies are needed to elucidate the true associations.

Assessment of skeletal status by quantitative ultrasound at the hand phalanges in children with bronchial asthma--a pilot study.

The aim of the study was to assess the skeletal status by quantitative ultrasound measurement at hand phalanges in asthmatic children treated with inhaled corticosteroids. Sixty-nine (69) children with a mean age of 10.9 ± 2.6 y and 251 controls matched for age and body size were enrolled into the study. The mean value of amplitude-dependent speed of sound in asthmatic children was 1953.8 ± 60.2 m/s and the mean Z-score was -0.05 ± 1.02; the corresponding values in the controls were 1951.0 ± 53.9 m/s and -0.26 ± 1.05, respectively. The results did not differ between the asthmatic and the healthy (control) children. A cumulative dose of inhaled steroids was identified in a stepwise regression analysis as a factor with potentially negative influence on bone status. In conclusion, the skeletal status in asthmatic children, assessed by quantitative ultrasound, shows no difference in comparison with healthy children. Nonetheless, special caution is necessary in case of long-term corticosteroid therapy, in which a slightly negative influence of treatment on the skeleton cannot be excluded.

[The assessment of bone status in women with rheumatoid arthritis]. / Ocena stanu koscca u kobiet z reumatoidalnym zapaleniem stawów.

The aim of the study was to evaluate the skeletal status by means of several technics (bone densitometry, radiography, ultrasound) in females with rheumatoid arthritis in comparison with healthy controls. Therefore, the evaluation of the progress of osteoporosis and the assessment of clinical utility of various methods were possible. Dual X-ray absorptiometry measurements were performed at following skeletal sites: spine, proximal femur, forearm. Quantitative ultrasound measurements included calcaneus and hand phalanges, and radiography allowed for calculation of metacarpal index. Laboratory Variables include indictors of activity of disease. The progress of the disease was assessed by Steinbrocker stages, all patients completed a health assessment questionnaire (HAQ), and activity of the disease was assessed by DAS 28. In the study 104 women we evaluated (62 with rheumatoid arthritis as defined by ACR and 42 healthy controls in mean of 54.2 +/- 5.1). The mean age in patients was 56.5 +/- 9.9 years, and the mean disease duration 167.8 +/- 126.1 months. 21 (34%) were in II stage of the disease according to Steinbrocker stages. All measured skeletal variables were significantly lower in patients than in controls (p < 0.0001). The results of the study indicate that in women with rheumatoid arthritis bone status is seriously affected. All used methods allowed for comparable diagnosis of bone deterioration. A high ratio of subjects with low bone density indicates that patients with rheumatoid arthritis ought o be routinely evaluated towards osteoporosis followed by antiresorptive therapy.

Quantitative ultrasound measurements at hand phalanges in children and adolescents: a longitudinal study.

The purpose of this longitudinal study was to characterize changes in quantitative ultrasound (QUS) values over a 1-y period in healthy boys and girls aged 7 to 12 y at baseline and assess the relation between the increase in anthropometric parameters and amplitude dependent speed of sound (Ad-SoS). A total of 269 children completed the study (139 girls and 130 boys). Ultrasound measurements were performed with a DBM Sonic 1200 device (IGEA, Carpi, Italy), which measures the Ad-SoS, m/s. Girls had significantly higher QUS values than boys at first and second measurements (p < 0.01 and p < 0.00001, respectively). Both girls and boys experienced statistically significant increases in Ad-SoS and all anthropometric parameters over a 1-y period. When the studied group was divided into age groups by year, the differences in QUS values between genders were significant only for 11 and 12 y groups at baseline (p < 0.02 and p < 0.01, respectively) and second visit (p < 0.00001 and p < 0.001, respectively). Stepwise regression analyses models with Ad-SoS at baseline and after 1 y as dependent variables showed a strong correlation between Ad-SoS and Tanner stage in girls but not in boys. In the entire survey group, only 21.5% of the boys and 41% of the girls experienced increases in Ad-SoS more than least significant change. This article suggests that QUS measurements allow the investigation of longitudinal changes and give reliable information about skeletal status in a manner similar to other methods.

Quantitative ultrasound and peripheral bone densitometry in patients with genetic disorders.

The aim of the study was comparison of quantitative ultrasound and densitometric peripheral measurements in subjects with genetic disorders. The study included 52 subjects (35 boys and 17 girls) in mean age 13.1 +/- 4.8 y. Patients with following disorders were evaluated: Down syndrome (n = 21), Martin-Bell syndrome (n = 14) and other (n = 17). There were no additional factors potentially influencing bone metabolism. Bone status was assessed by quantitative ultrasound at the hand phalanges using DBM Sonic 1200 (IGEA, Italy), which measures amplitude-dependent speed of sound (Ad-SoS [m/s]) and bone densitometry at the calcaneus and forearm by the use of PIXI (GE, USA), which measures bone mineral density (BMD, g/cm2). Ad-SoS correlated significantly with forearm and calcaneus BMD in the whole group (r = 0.66, p < 0.000001 and r = 0.51, p < 0.0001, respectively), in females (r = 0.58, p < 0.05 and r = 0.5, p < 0.05) and in males (r = 0.70, p < 0.000001 and r = 0.54, p < 0.001). Calcaneus BMD correlated with wrist BMD in the whole group, in females and males: r = 0.66, p < 0.000001, r = 0.67, p < 0.01 and r = 0.75, p < 0.0001, respectively. These coefficients of correlation were compared and did not reveal significant differences in the whole group and in the gender subgroups. ROC analysis of Ad-SoS values versus calcaneus and forearm BMD showed area under curve 0.89 for forearm BMD and 0.79 for calcaneus BMD (subjects with Ad-SoS T-score below -3.2 were considered as abnormal). Age correlated significantly with Ad-SoS, forearm and calcaneus BMD (r ranged from 0.53 to 0.9, p from 0.05 to 0.000001). In all patients and males, age more strongly influenced Ad-SoS than calcaneus BMD (p < 0.05). Also, body weight and height correlated significantly with Ad-SoS, forearm and calcaneus BMD, except for correlation between forearm BMD and height in female patients (r from 0.58 to 0.84, p < 0.05). Generally, in multiple stepwise regression analysis of age and body size on skeletal parameters, age had positive influence, and body size was a positive or a negative factor. In conclusion, both quantitative ultrasound and peripheral densitometry may be recommended for the assessment of skeletal status in subjects with genetic disorders, although measurements of phalanges seem to be more sensitive for detecting age-related bone changes.

Longitudinal changes in ultrasound measurements: a parallel study in subjects with genetic disorders and healthy controls.

Disturbances in skeletal status in subjects with genetic disorder may increase their fracture risk. The aim of the study was longitudinal observation of phalangeal speed of sound changes across the bone over a period of 2 y in 24 patients (14 boys and 10 girls, mean age 9.63 +/- 1.8 y.) and 24 age-matched healthy controls (14 boys and 10 girls, mean age 9.65 +/- 1.71 y.). Weight and height did not differ between patients and controls at baseline and follow-up. Patients with the following disorders were evaluated: 7 with Down syndrome, 6 nonspecific mental retardations of unknown etiology, 5 Martin-Bell syndrome and 6 with other diseases. In patients and controls, no factors potentially influencing bone metabolism (except for genetic disorder) were present. Bone status was assessed by quantitative ultrasound at hand phalanges using DBM Sonic 1200 (IGEA, Carpi, Italy), which measures amplitude-dependent speed of sound (Ad-SoS [m/s]). At baseline, Ad-SoS and Z-score were significantly lower in patients than in controls (1892 +/- 51 m/s versus 1936 +/- 43 m/s, p < 0.01 and -1.47 +/- 1.43 versus -0.14 +/- 1.04, p < 0.001, respectively. In follow-up, Ad-SoS and Z-score increased significantly in patients (1892 +/- 51 m/s to 1934 +/- 48 m/s, p < 0.0001 and -1.47 +/- 1.43 to -0.76 +/- 1.00, p < 0.01, respectively) and in controls (1936 +/- 43 m/s to 1976 +/- 60 m/s and -0.14 +/- 1.04 to 0.31 +/- 1.08, p < 0.05, respectively). Follow-up Ad-SoS and Z-Score were significantly lower in patients (p < 0.01). Longitudinal changes in Ad-SoS, Z-score weight did not differ between patients and control, and height increased more in controls (13.2 +/- 2.8 cm versus 11.4 +/- 5.9 cm, p < 0.05)+). In patients, Ad-SoS increased by 42 m/s (2.22%), and in controls increased by 40 m/s (2.07%). Difference in Ad-SoS between patients and controls was 44 m/s at baseline and 42 m/s at follow-up. Using the value of the least significant change (LSC = 20.5 m/s), in 16 patients (67%) and in 18 controls (75%) Ad-SoS showed an increase greater than the LSC, in one control (4%) a decrease greater than the LSC and in rest of subjects studied remained unchanged (33% patients and 19% controls) over a period of observation. In conclusion, despite comparable improvement in measured ultrasound parameter in patients and controls observed over a study duration, the difference between them remained stable.

Comparison of phalangeal ultrasound and dual energy X-ray absorptiometry in healthy male and female adolescents.

The aims of this study were to determine if there is a correlation between dual energy X-ray absorptiometry (DXA) and phalangeal quantitative ultrasound (QUS) in identifying children and adolescents with low bone density, and to assess if body size influences the results of the two techniques to the same degree. Measurements were performed in 67 girls and 83 boys aged 14 to 19 y using DBM Sonic 1200 (IGEA, Carpi, Italy) and the DXA equipment (LUNAR Radiation Corp., Madison, WI, USA). Twelve adolescents (eight males and four females) reported a past history of nonosteoporotic fractures. Lumbar spine bone mineral density (LS BMD), total body bone mineral density (TB BMD) and total body bone mineral content (TB BMC) correlated positively with age, height, BMI and weight, in both genders. Amplitude-dependent speed of sound (Ad-SOS) was positively correlated with age, height and Tanner stages in both genders and negatively correlated with BMI in females. TB BMD, TB BMC and LS BMD positively correlated with Ad-SOS only in males. In females, there were no significant correlations between Ad-SOS, TB BMD, TB BMC and LS BMD measurements. Twelve teenagers with previous fractures (high impact fractures) were found to have lower DXA and QUS values than age-matched teenagers without fractures but the statistical significance was found only in relation to TB BMD values (p = 0.02). In conclusion, we obtained results similar to those that have been reported by other authors using different QUS techniques. Furthermore, the Ad-SOS measurements taken at the distal metaphysis of the proximal phalanges correlate poorly with LS BMD and TB BMD measured by DXA in growing subjects.