Biomedical subjects

Derek Stephens

Publications and source records attributed to Derek Stephens.

At least 37 records · Page 2Linked to original sources

PubMed2004

The impact of SARS on a tertiary care pediatric emergency department.

BACKGROUND: The Greater Toronto Area (GTA) was considered a "hot zone" for severe acute respiratory syndrome (SARS) in 2003. In accordance with mandated city-wide infection control measures, the Hospital for Sick Children (HSC) drastically reduced all services while maintaining a fully operational emergency department. Because of the GTA health service suspensions and the overlap of SARS-like symptoms with many common childhood illnesses, this introduced the potential for a change in the volumes of patients visiting the emergency department of the only regional tertiary care children's hospital. METHODS: We compared HSC emergency department patient volumes, admission rates and length of stay in the emergency department in the baseline years of 2000-2002 (non-SARS years) with those in 2003 (SARS year). The data from the prior years were modeled as a time series. Using an interrupted time series analysis, we compared the 2003 data for the periods before, during and after the SARS periods with the modeled data for significant differences in the 3 aforementioned outcomes of interest. RESULTS: Compared with the 2000-2002 data, we found no differences in visits, admission rates or length of stay in the pre-SARS period in 2003. There were significant decreases in visits and length of stay (p < 0.001) and increases in admission rates (p < 0.001) during the periods in 2003 when there were new and active cases of SARS in the GTA. All 3 outcomes returned to expected estimates coincident with the absence of SARS cases from September to December 2003. INTERPRETATION: During the SARS outbreak in the GTA, the HSC emergency department experienced significantly reduced volumes of patients with low-acuity complaints. This gives insight into utilization rates of a pediatric emergency department during a time when there was additional perceived risk in using emergency department services and provides a foundation for emergency department preparedness policies for SARS-like public health emergencies.

Canada↗

PubMed2004

The effects of carbon dioxide on oxygenation and systemic, cerebral, and pulmonary vascular hemodynamics after the bidirectional superior cavopulmonary anastomosis.

OBJECTIVES: We investigated the effects of different CO(2) tensions on oxygenation, pulmonary blood flow (Qp), cerebral blood flow, and systemic blood flow (Qs) after the bidirectional superior cavopulmonary anastomosis (BCPA). BACKGROUND: Hypoxemia refractory to management of a high pulmonary vascular resistance index (PVRI) may complicate recovery from the BCPA. METHODS: After BCPA, CO(2) was added to the inspired gas of mechanically ventilated patients. The Qp, Qs, PVRI, and systemic vascular resistance index (SVRI) were calculated from oxygen consumption, intravascular pressures, and oxygen saturations. Cerebral blood flow was estimated by near infrared spectroscopy and transcranial Doppler. RESULTS: In nine patients (median age 7.1, range 2 to 23 months), arterial oxygen tension increased significantly (p < 0.005) from 36 +/- 6 mm Hg to 44 +/- 6 to 50 +/- 7 mm Hg at arterial carbon dioxide tensions (PaCO(2)) of 35, 45, and 55 mm Hg, respectively and decreased to 40 +/- 8 mm Hg at PaCO(2) 40 mm Hg. At a PaCO(2) of 55 and 45 compared with 35 mm Hg, Qp, cerebral blood flow, and Qs increased significantly, PVRI, Qp/Qs, and the ratio of Qp to inferior vena caval blood flow were unchanged, but SVRI decreased. CONCLUSIONS: We have demonstrated that after the BCPA, systemic oxygenation, Qp, Qs, and cerebral blood flow increased and SVRI decreased at CO(2) tensions of 45 and 55 mm Hg compared with 35 mm Hg. We suggest that hypoxemia after the BCPA is ameliorated by a higher PaCO(2) and that low PaCO(2) or alkalosis may be detrimental. Hypercarbic management strategies may allow earlier progression to the BCPA, which may contribute to reducing the interval morbidity in patients with a functional single ventricle.

Carbon Dioxide↗

PubMed2004

Epstein-Barr virus in pediatric multiple sclerosis.

CONTEXT: Infection with common viruses, particularly Epstein-Barr virus (EBV), has been postulated to contribute to the pathobiology of multiple sclerosis (MS). Detailed virological studies in pediatric MS have not been previously reported. OBJECTIVE: To evaluate whether children with MS are more likely to be seropositive for EBV or other common viruses than their healthy age-matched peers. DESIGN, SETTING, AND PATIENTS: Case-control study of viral samples collected from March 1994 to February 2003 from 30 pediatric MS patients, 90 emergency department controls matched 3:1 with the MS patients by year of birth, and 53 healthy control children. MAIN OUTCOME MEASURES: Archived serum samples were analyzed for the presence of IgG antibodies directed against EBV viral capsid antigens, nuclear antigens, and early antigens, cytomegalovirus, parvovirus B19, herpes simplex virus, and varicella zoster. RESULTS: Serological evidence for remote EBV infection was present in 83% of pediatric MS patients compared with 42% of emergency department and healthy controls (P<.001). Five pediatric MS patients were negative for all 3 EBV antigens. Pediatric MS patients were less likely than controls to have been exposed to herpes simplex virus (P =.003), while seropositivity for cytomegalovirus, parvovirus B19, and varicella zoster did not differ between MS patients and controls. CONCLUSION: These results suggest an association between EBV infection and pediatric MS.

Adolescent↗

PubMed2004

Oxygen saturation as a predictor of prolonged, frequent bronchodilator therapy in children with acute asthma.

OBJECTIVES: To examine if the initial oxygen saturation (SaO2) in the Emergency Department is a useful predictor of prolonged frequent bronchodilator therapy (FBT) in children with acute asthma. STUDY DESIGN: Prospective cohort study of 273 children, 1 to 17 years of age, requiring systemic corticosteroids. Patients were categorized as needing FBT for >4 hours (n=166) versus >4 hours (n=107) and >12 hours (n=79) versus >12 hours (n=194). Multiple logistic regression determined the association between SaO2 and these outcomes. RESULTS: Baseline SaO2 remains a significant independent predictor of FBT for >4 hours (OR=0.81) and >12 hours (OR=0.84); 91% of patients with SaO2 of 90% to 91% had FBT >4 hours and 80% of patients with SaO2 of < or =89% had FBT >12 hours. Children with SaO2 of < or =91% are 14.7 and 12.0 times more likely to require FBT for >4 hours and >12 hours, respectively, than those with SaO2 of 98% to 100%. The interval likelihood ratios for FBT >4 hours were 12.3 for SaO2 of < or =89%, 6.5 for 90% to 91%, but only 1.8 for 92% to 93%. The likelihood ratios for FBT >12 hours decreased from 9.8 for SaO2 of < or =89% to 3.5 for SaO2 of 90% to 91%. CONCLUSIONS: SaO2 is a useful predictor of FBT >4 hours if it is < or =91% and of FBT >12 hours if it is < or =89%.

Acute Disease↗

PubMed2004

Anaerobic muscle performance of children after long-term recovery from Guillain-Barré syndrome.

The aim of this study was to evaluate anaerobic muscle performance in children after long-term recovery from Guillain-Barré syndrome (GBS). Participants were recruited from all children and adolescents with GBS admitted to The Hospital for Sick Children, University of Toronto, Canada, between 1988 and 1995. We assessed 17 children (nine males, eight females; mean age at GBS diagnosis 7 years 11 months, SD 4 years 2 months; mean age at testing 14 years 1 month) more than two years after acute GBS. Participants completed the Wingate anaerobic test to evaluate mean and peak muscle power. For mean arm muscle power (mean 47.5% [SD 17.4%] of normal), only two participants were in the normal range. For mean leg muscle power (mean 83% [SD 28.3%] of normal), 15 participants were in the normal range. For arm peak power (mean 92.6% [SD 20.7%] of normal), 12 participants were in the normal range. For leg peak power (mean 116.3% of normal, SD 15.8%), all participants were in the normal range. Detailed manual muscle testing with the modified Medical Research Council scale was done on 34 muscle groups. Data were pooled to give a mean arm and leg muscle strength score (9.7, SD 0.30 and 9.4, SD 0.50 respectively). Pearson's correlations of muscle endurance with arm and leg strength were not significant. Children with GBS have excellent long-term recovery of peak muscle power. Muscle endurance, measured by mean muscle power, was normal in the legs but markedly low in the arms. Pediatric rehabilitation programs after GBS should specifically target endurance of arm muscles.

Adolescent↗

PubMed2004

Metastatic rhabdomyosarcoma: a retrospective review of patients treated at the hospital for sick children between 1989 and 1999.

Children with metastatic rhabdomyosarcoma (RMS) continue to fare poorly (3-year survival 20-30%). Various therapies, including end-intensification with high-dose chemotherapy and stem cell support, have been used in an attempt to improve the outcome of these patients. The authors reviewed their clinical experience over a 10-year period to identify predictors of outcome in these patients. The authors reviewed the clinical characteristics, treatment, and outcome of all patients with metastatic RMS diagnosed and treated at the Hospital for Sick Children between 1989 and 1999. Kaplan-Meier curves were generated to compare survival and failure-free survival of different subgroups of patients. Differences between groups were analyzed using univariate analysis and the log-rank test. Seventeen patients with metastatic RMS were identified. Thirteen patients were treated with standard chemotherapy +/- radiotherapy and four received high-dose end-intensification therapy with stem cell support. The estimated 3-year overall survival (OS) and failure-free survival rates for all patients were 35% (95% CI 13-58) and 29% (95% CI 18-40), respectively. Patients with embryonal histology, metastases confined to the lung, and age younger than 10 years had a 3-year OS of 100%, compared with an OS of 0% for the remaining patients (P < 0.0006). The median follow-up for the five survivors was 5.5 years. The authors have identified a subset of children with metastatic RMS having embryonal histology, age less than 10 years, and only pulmonary metastases who have favorable survival outcomes when treated with chemotherapy with or without stem cell support.

Child↗

PubMed2004

Comparison of the temporal artery and rectal thermometry in children in the emergency department.

OBJECTIVE: Rectal thermometry, the criterion standard of temperature measurement in young children, has numerous disadvantages. This study examined the agreement between rectal versus a new temporal artery professional model (TAPM) thermometer and rectal versus a home device temporal artery consumer model (TACM) thermometer, investigated if the TAPM can safely screen for rectal fever, and determined if parents can detect rectal fever using the TACM. DESIGN, OUTCOME MEASURES, AND SUBJECTS: In this cross-sectional agreement emergency department study, 327 children <24 months of age had their temperature measured rectally and by the TAPM and TACM by a single nurse and using the TACM by the parents. Agreements were analyzed by the Bland Altman plots. Temperature cutoff to detect rectal fever > or =38.0 degrees C and > or =38.3 degrees C with sensitivities of > or =90% and > or =95%, respectively, was determined for the TAPM. RESULTS: The mean difference between the rectal minus TAPM was -0.19 degrees C +/- 0.66 degrees C, and minus the TACM home device, it was +0.11 degrees C +/- 0.66 degrees C. The sensitivities of TAPM temperature of > or =37.7 degrees C to detect rectal fever > or =38.0 degrees C and > or =38.3 degrees C were 90% (95% confidence interval: 0.83; 0.94) and 97% (95% confidence interval: 0.92; 0.99), respectively. The parents detected 67% and 73% of rectal fevers 38.0 degrees C and > or =38.3 degrees C, respectively. CONCLUSIONS: The TAPM thermometer cannot replace the rectal. However, TAPM temperature of <37.7 degrees C can be safely used as a screen to exclude rectal fever > or =38.3 degrees C in infants 3 to 24 months of age. The TACM home device has insufficient ability to detect rectal fever. A multicenter trial is needed to validate these results across multiple emergency departments and numerous observers.

Child, Preschool↗

PubMed2004

Nutrition risk factors for survival in the elderly living in Canadian long-term care facilities.

OBJECTIVES: To determine the role of nutritional parameters in influencing the risk of mortality in institutionalized elderly. DESIGN: A prospective cohort study in which subjects had several nutritional parameters measured at baseline and were followed for 19 months. Time to death and mortality were recorded starting immediately after enrollment. SETTING: Fourteen long-term care facilities (LTCFs). PARTICIPANTS: Four hundred eight elderly long-term care residents aged 60 and older who resided in the facility for more than 6 weeks. MEASUREMENTS: At baseline, knee height, weight, mid-arm circumference (MAC), skin-fold thickness, and fat-free mass using bioelectric impedance analysis were measured. Covariates included demographic factors, length of stay in the facility, functional status, and medical diagnoses. Cox proportional hazards regression analysis was used to identify independent predictors of mortality. Results are reported as mean+/-standard error of the mean (SEM). RESULTS: Overall, mortality rate was 28.4%. Univariate predictors included male sex, body mass index, MAC, and triceps skin fold. In multivariate analysis, male sex (hazard ratio (HR)=1.7, 95% confidence interval (CI)=1.2-2.7, P=.0096) and MAC less than 26 cm were significantly associated with increased risk of mortality (HR=4.8, 95% CI: 2.8-8.3, P<.0001). CONCLUSION: Among this elderly population living in LTCFs, MAC is the best nutritional predictor of mortality.

Aged↗

PubMed2003

Effects of therapeutic hypercapnia on mesenteric ischemia-reperfusion injury.

Hypercapnic acidosis protects against direct lung injury in in vivo and ex vivo models, however, lung injury/acute respiratory distress syndrome commonly occurs after a nonpulmonary etiology. We investigated whether therapeutic hypercapnia (TH)-deliberate elevation of carbon dioxide (CO2) tension-would protect against lung injury after splanchnic ischemia-reperfusion injury in an in vivo model. TH was associated with preservation of lung mechanics, attenuation of protein leakage, and improved oxygenation compared with control conditions. Lung protection was therapeutic as well as prophylactic. Protection was dose-dependent, but inspired CO2 concentrations above 5.0% were associated with little additional lung protection. Before lung injury, increasing FICO2 resulted in a dose-dependent increase in PaO2. Lung protection with hypercapnia occurred despite pulmonary artery pressures that were greater than observed with normocapnia. Reperfusion increased lipid peroxidation (tissue 8-isoprostane concentration) in the bowel, liver, and lung, and caused histologically apparent bowel injury; however, none of these effects was altered by TH. Therefore, TH-induced by adding CO2 to inspired gas-provides consistent protection against lung injury in terms of lung permeability, oxygenation, and lung mechanics after mesenteric ischemia-reperfusion. These data further support the emerging evidence for ongoing physiologic study of TH at the bedside.

Animals↗

PubMed2003

Vesicoureteral reflux in infants with isolated antenatal hydronephrosis.

Standardized evaluation of all newborns with antenatally recognized hydronephrosis (ANH) at The Hospital for Sick Children (HSC) has included voiding cystourethrography (VCUG). This paper reviews this protocol to determine: (1) the prevalence of vesicoureteral reflux (VUR) in isolated ANH and (2) the value of performing VCUG in cases of mild hydronephrosis, defined as renal pelvis dilatation <10 mm on postnatal ultrasonography (US). A retrospective chart review was performed on infants referred with ANH. The inclusion criterion was isolated ANH. Exclusion criteria were (1) presence of additional genitourinary abnormalities and (2) no VCUG. Pelviectasis was categorized according to the anteroposterior diameter of the renal pelvis. There were 111 infants with isolated ANH. All except 3 underwent VCUG. There were 68 children (63%) with normal postnatal US or mild pelviectasis (<10 mm). VUR was detected in 16 patients, of whom 10 had mild or absent pelvic dilatation. There was no correlation between the degree of pelviectasis on postnatal US and the presence or severity of VUR ( P=0.567 and P=0.802). VUR was detected in 15% of children with isolated ANH, many of whom had normal postnatal US or mild postnatal pelviectasis. VCUG is the only reliable test for detecting postnatal VUR.

Adult↗

PubMed2003

Serum lipids, glucose homeostasis and abdominal adipose tissue distribution in protease inhibitor-treated and naive HIV-infected children.

OBJECTIVE: To determine the extent and degree of abnormalities of serum lipids, glucose homeostasis and abdominal adipose tissue distribution in protease inhibitor (PI)-treated and PI-naive HIV-infected children. DESIGN: A cross-sectional study involving HIV-infected children, 3-18 years of age, in a paediatric tertiary care centre. MAIN OUTCOME MEASURES: Total, HDL and LDL-cholesterol, triglycerides, glucose, insulin, proinsulin and C-peptide were determined in the fasting state. Insulin resistance was assessed using the homeostatic model assessment-insulin resistance (HOMA-IR). Abdominal adipose tissue distribution was determined by single-slice computed tomography at the umbilical level. RESULTS: Thirty PI-treated and 20 PI-naive children were evaluated (76% prepubertal). PI-treated children had significantly higher total cholesterol (P = 0.0021), LDL-cholesterol (P = 0.019) and triglycerides (P = 0.0018). Serum glucose, insulin, proinsulin and C-peptide, the insulin : glucose ratio, HOMA-IR and abdominal adipose tissue distribution were similar in the two groups. Clinical and immunological HIV categories, viral load, CD4 cell count and stavudine therapy were not significantly associated with serum lipids, insulin resistance or abdominal adipose tissue distribution. The predictor variable most strongly associated with fasting serum insulin and HOMA-IR was the Tanner stage. Age was the most significant predictor variable of the visceral : subcutaneous adipose tissue ratio. CONCLUSION: In this cohort of predominantly prepubertal HIV-infected children, PI therapy was associated with an atherogenic dyslipidemia but not with insulin resistance or abnormal abdominal adipose tissue distribution. The results suggest that children, particularly prepubertal children, are less susceptible than adults to PI-induced changes in glucose homeostasis and abdominal adipose tissue distribution.

Abdomen↗

PubMed2003

Inhaled NO inhibits platelet aggregation and elevates plasma but not intraplatelet cGMP in healthy human volunteers.

Effects of inhaled nitric oxide (NO) on human platelet function are controversial. It is uncertain whether intraplatelet cGMP mediates the effect of inhaled NO on platelet function. We investigated the effect of 30 ppm inhaled NO on platelet aggregation and plasma and intraplatelet cGMP in 12 subjects. We performed platelet aggregation studies by using a photooptical aggregometer and five agonists (ADP, collagen, epinephrine, arachidonic acid, and ristocetin). During inhalation, the maximal extent of platelet aggregation decreased by 75% with epinephrine (P < 0.005), 56% with collagen (P < 0.005), and 20% with arachidonic acid (P < 0.05). Responses to ADP (8% P > 0.05) and ristocetin (5% P > 0.05) were unaffected. Platelet aggregation velocity decreased by 64% with collagen (P < 0.005), 60% with epinephrine (P < 0.05), 33% with arachidonic acid (P < 0.05), and 14% with ADP (P > 0.05). Plasma cGMP levels increased from 2.58 +/- 0.43 to 9.99 +/- 5.57 pmol/ml (P < 0.005), intraplatelet cGMP levels were unchanged (means +/- SD: 1.96 +/- 0.58 vs. 2.71 +/- 1.67 pmol/109 platelets; P > 0.05). Inhaled NO inhibits platelet aggregation via a cGMP independent mechanism.

Administration, Inhalation↗

PubMed2003

Use of complementary and alternative medicine by pediatric rheumatology patients.

OBJECTIVE: To assess how often the patients in The Hospital for Sick Children's rheumatology clinic use complementary and alternative medicine (CAM), and the type of CAM used. METHODS: Cross-sectional descriptive survey study in a tertiary care referral center. RESULTS: We found that 90 (64%) of 141 respondents used at least 1 form of CAM; 45 (50%) of these 90 used more than 1 form. Duration of illness was positively associated with the use of CAM; the difference in the mean length of illness between users (4.12 +/- 3.60 years) and nonusers (2.82 +/- 3.23 years) was 1.3 years (P = 0.04). Of the 41 respondents with more than 1 illness, 32 used CAM, compared with 57 of 96 who had only 1 illness (P = 0.036). CONCLUSION: Health care providers must be aware of their patients' possible use of CAM, especially those with more than 1 illness.

Arthritis↗

PubMed2003

Renal complications following heart transplantation in children: a single-center study.

Renal dysfunction is common following heajt transplantation (Tx) in adults, but little is known in children. Thus, a retrospective chajt review was performed in children who underwent heajt Tx at the Hospital for Sick Children between April 1994 and April 1999. The inclusion criteria were: age <18 years, survival >1 year post-Tx. The Schwajtz formula was used to calculate glomerular filtration rate (GFR). Decreased GFR was defined as <80 mL/min/1.73 m2. Changes in GFR were analyzed using Repeated Measures Analysis of Variance. Forty-one eligible children were included. The mean age at Tx was 7 years (range: 1 month to 16.7 years). The mean F/UP was 33 +/- 17 months, with 32/41 patients followed for at least 24 months. The GFR was decreased in 42% pre-Tx, and in 7.3% at the last F/UP (p = 0.0001). GFR did not decline significantly with time after Tx; in fact, GFR increased in the first year and remained stable afterwards (p = 0.0002). Acute renal dysfunction (ARD) episodes were common (12/41 children). Hypertension was diagnosed in 76% of children during the first year post-Tx, but persisted in only 11 (27%). GFR improves in the majority of children following heajt Tx. ARD episodes are frequent in the post-Tx period. Hypertension is common but does not persist.

Adolescent↗

PubMed2003

A prospective study: growth and nutritional status of children treated with the ketogenic diet.

OBJECTIVE: To assess the nutritional status of children treated with the classic and medium-chain triglyceride (MCT) ketogenic diets. DESIGN: A prospective, nonrandomized study design was used to measure nutrient intakes, growth, and biochemical indexes of children, age 1 to 16 years, with intractable epilepsy before and after 4 months' treatment with the classic and MCT ketogenic diets. None of the children had been on earlier dietary regimens. SUBJECTS: Of 58 children asked to participate in the study between September 1998 and July 2000, consent was obtained for 30 children. Fourteen children on the classic diet and 11 children on the MCT diet completed the study (83% completed). Statistical analysis performed Paired t tests were done on anthropometric and biochemical indexes. Nutrient intakes were compared with Dietary Reference Intakes (DRIs). RESULTS: Both groups had statistically significant height increases of 2 to 3 cm (P<.05), but did not have significant increases in height/age percentiles. Weight percentiles decreased by approximately 10 percentiles for both diets; P=.043 for classic diet and.051 for MCT diet. Nutrient intakes from the diet and vitamin and mineral supplements met the DRIs except for phosphorus (both diets) and folate (classic diet). All biochemical indexes, including albumin, remained within the normal range. For the MCT diet, there was a 0.7 decrease in the ratio of total cholesterol to high-density lipoprotein ratios (P<.0009) at 4 months. APPLICATIONS: When treating children on a ketogenic diet, clinicians should recommend adequate intake of energy and protein, a higher proportion of unsaturated to saturated dietary fats, and consider vitamin and mineral supplements.

Adolescent↗

PubMed2003

Long-term outcome in children with Guillain-Barré syndrome.

OBJECTIVE: To determine the long-term sequelae and early predictors of sequelae for children with Guillain-Barré syndrome (GBS) after the introduction of intravenous gammaglobulin (IVIG). Study design A cross-sectional case series of children with GBS, at least 2 years after recovery, was performed. Manual muscle strength testing was done on 34 muscle groups. The functional independence measure was used to assess function. A chart review was completed, identifying acute factors that may predict long-term sequelae. RESULTS: Forty-seven children with GBS were identified, of whom 30 received IVIG. Persisting long-term muscle weakness with at least one muscle group at a grade 6 level (muscle moves the joint against gravity but only minimal resistance to an applied force) was found in 23% of cases. Each patient had a perfect score on the functional independence measure. Long-term muscle weakness was predicted by young age (P =.03) and a rapid progression to maximal weakness (P =.03). CONCLUSIONS: Despite the introduction of IVIG, 23% of children with GBS had evidence of long-term mild muscle weakness, with minimal impact on function. Young age and a rapid progression during the acute GBS period predicted long-term sequelae.

Activities of Daily Living↗

PubMed2003

Brief psychoeducational parenting program: an evaluation and 1-year follow-up.

OBJECTIVE: Despite recognition of the need for parenting interventions to prevent childhood behavioral problems, few community programs have been evaluated. This report describes the randomized controlled evaluation of a four-session psychoeducational group for parents of preschoolers with behavior problems, delivered in community agencies. METHOD: In 1998, 222 primary caregivers, recruited through community ads, filled out questionnaires on parenting practices and child behavior. Parents were randomly assigned to immediate intervention or a wait-list control. The intervention comprised three weekly group sessions and a 1-month booster, the focus being to support effective discipline (using the video 1-2-3 Magic) and to reduce parent-child conflict. RESULTS: Using an intent-to-treat analysis, repeated-measures analyses of variance indicated that the parents who received the intervention reported significantly greater improvement in parenting practices and a significantly greater reduction in child problem behavior than the control group. The gains in positive parenting behaviors were maintained at 1-year follow-up in a subset of the experimental group. CONCLUSIONS: This brief intervention program may be a useful first intervention for parents of young children with behavior problems, as it seems both acceptable and reasonably effective.

Adult↗

PubMed2003

Independent walking after neonatal arterial ischemic stroke and sinovenous thrombosis.

Few studies have examined walking after neonatal arterial ischemic stroke and sinovenous thrombosis. We looked at the development of walking in a retrospective and consecutive cohort study of 88 term and near-term neonates. We used Kaplan-Meier survival curves and Cox proportional hazards models to assess (1) sex, (2) stroke type (arterial ischemic stroke or sinovenous thrombosis), (3) number of cerebral hemispheres with infarction, and (4) presence of neonatal comorbidity as predictors of the probability over time of starting to walk independently. These variables were assessed as predictors of parent-reported gait normality using the chi-square test on 2 x 2 contingency tables. Seventy-five of 83 survivors (90.4%, 95% confidence interval = 81.9-95.7) walked with a median time of first steps at 13 months of age (95% confidence interval = 12-14). Only bilateral strokes were associated with a lower probability over time of initiating independent walking (hazard ratio = 0.41, P = .04). Parents reported normal gait for 58 of 75 walkers (77.3%, 95% confidence interval = 67.8-86.8). No variables predicted parent-reported gait normality. Our findings suggest that most survivors of neonatal arterial ischemic stroke and sinovenous thrombosis walk with a gait that appears normal to parents, but bilateral infarctions decrease the probability over time of starting to walk independently.

Brain Ischemia↗