Validating scoring systems for fracture healing in infants and young children: pilot study.

BACKGROUND: Recent studies have analysed birth-related clavicular fractures to propose time frames for healing that could be applied to dating of all fractures in cases of suspected child abuse. OBJECTIVE: To assess differences in healing rates between femoral fractures and birth-related clavicular fractures in infants and young children. MATERIALS AND METHODS: A retrospective 5-year pilot study of femoral fractures in children younger than 3 years of age was performed. Anonymised radiographs were independently scored by two radiologists for stages of fracture healing. In cases of reader disagreement, radiographs were independently scored by a third radiologist. RESULTS: In total, 74 radiographs (30 children) met the inclusion criteria. Fracture healing evolved over time with subperiosteal new bone formation (SPNBF) appearing first, followed by callus then remodelling. A power calculation for a single proportion, with a level of confidence of 95% and a margin of error of 5%, showed that in a definitive study, 359 radiographs would be required. CONCLUSION: Although the overall pattern of healing is similar, in this small pilot study, the earliest times for SPNBF and callus formation in femoral fractures appeared to lag behind healing of birth-related clavicular fractures. Remodelling appeared earlier than remodelling of clavicular fractures. A power calculation has determined numbers of femoral radiographs (359) required for a definitive study.

Intestinal obstruction secondary to adhesions in an infant with cystic fibrosis.

We report the case of a 9-week-old boy with cystic fibrosis (CF) who presented with intestinal obstruction. He was initially diagnosed with distal intestinal obstruction syndrome (DIOS) and started on laxatives and gastrograffin. This conservative management was unsuccessful and he therefore underwent an exploratory laparotomy. Despite not having undergone any previous surgery, extensive intra-abdominal adhesions were identified as the cause of the intestinal obstruction. The only previous abdominal pathology occurred in the neonatal period prior to his diagnosis of CF, when he was managed conservatively for possible necrotising enterocolitis. We hypothesise that this episode was associated with a subclinical bowel perforation that led to the formation of intra-abdominal adhesions. Although DIOS is the commonest cause of intestinal obstruction in children with CF, this case highlights that surgical causes should always be considered. It also demonstrates that the intra-abdominal adhesions can occur in the absence of previous surgery.

Pulmonary Embolism in a 3-Year-Old Boy with Nephrotic Syndrome.

We present the case of a 3-year-old boy with nephrotic syndrome with mild respiratory symptoms who was shown by ventilation-perfusion scan to have pulmonary embolism. He responded well to anticoagulant therapy.

Magnetic resonance imaging and T2 relaxometry of cerebral white matter and hippocampus in children born preterm.

The objective of this study was to determine whether intelligence and minor motor impairments in children who are born preterm without major disability are associated with cerebral white matter (CWM) and hippocampal abnormalities on magnetic resonance imaging (MRI). A total of 103 preterm children were studied at age 7 y with detailed magnetic resonance brain scans, including a T2-mapping sequence from which T2 relaxation times of the CWM and hippocampal formations were calculated. All of the children had no major motor disability, attended normal school, and had undergone assessment of IQ and a test for minor motor impairment (MMI). Twenty children had visible lesions on MRI, which were associated with lower IQ and more frequent MMI. Mean (SD) IQ was 90 (14.1). Twenty-five children were shown to have MMI (Movement ABC at below the fifth centile). This group was shown to have significantly longer T2 relaxation times for CWM (mean difference 2.1 ms right, 3.1 ms left) but not the hippocampus than the children without MMI. These differences persisted when only children without visible lesions on scans were considered (mean difference 1.5 ms bilaterally). There was no significant correlation between IQ and T2 relaxation times. Children who are born preterm without subsequent major neurodisability may, in addition to visible lesions on MRI scans, have a diffuse abnormality of CWM, manifest as an increase in T2 relaxation time. This abnormality shows a close correlation with minor motor impairment but not with full-scale IQ.