Ibrahim Duran

Nephrocalcinosis in preterm infants: a single center experience

The risk of nephrocalcinosis in preterm infants is considerable, but conflicting numbers are given for the actual incidence (10–65%). Furosemide induced hypercalciuria is said to be the main risk factor. We examined retrospectively the incidence, causes and outcome of nephrocalcinosis in preterm infants born in our hospital from 1988 to 1998 (n=2190). An abnormal renal echogenicity or nephrocalcinosis was seen in 31 infants (29.7±3.3 weeks gestational age; 1307±690 g birth weight). Nephrocalcinosis was diagnosed in 16, hyperechoic kidneys (HK) in 10 and Tamm-Horsfall kidneys in 5 infants. Main risk factors were low gestation age and birth weight, length of hospitalization, variations in acid-base status, length of assistant ventilation and hypercalciuria at diagnosis. The incidence of nephrocalcinosis was 0.73% [1.7% for low birth weight infants (VLBW)]. Taking the cases of nephrocalcinosis and HK together, incidence was calculated to be 1.2% overall and 2.5% for VLBW infants, but increased to 7% in 1998. The follow-up showed persisting nephrocalcinosis or hyperechoic kidneys in 8/26 preterm infants. In conclusion, the incidence of nephrocalcinosis was lower in our population than is usually reported. The numbers have, however, increased over the past few years. From the follow-up it was obvious that long-term observation of preterm infants is necessary and that complications might arise in the long run.

Neuromuscular training based on whole body vibration in children with spina bifida: a retrospective analysis of a new physiotherapy treatment program

IntroductionSpina bifida is the most common congenital cause of spinal cord lesions resulting in paralysis and secondary conditions like osteoporosis due to immobilization. Physiotherapy is performed for optimizing muscle function and prevention of secondary conditions. Therefore, training of the musculoskeletal system is one of the major aims in the rehabilitation of children with spinal cord lesions.Intervention and methodsThe neuromuscular physiotherapy treatment program Auf die Beine combines 6xa0months of home-based whole body vibration (WBV) with interval blocks at the rehabilitation center: 13xa0days of intensive therapy at the beginning and 6xa0days after 3xa0months. Measurements are taken at the beginning (M0), after 6xa0months of training (M6), and after a 6-month follow-up period (M12). Gait parameters are assessed by ground reaction force and motor function by the Gross Motor Function Measurement (GMFM-66). Sixty children (mean age 8.71u2009±u20094.7xa0years) who participated in the program until February 2014 were retrospectively analyzed.ResultsWalking velocity improved significantly by 0.11xa0m/s (pu2009=u20090.0026) and mobility (GMFM-66) by 2.54 points (pu2009=u20090.001) after the training. All changes at follow-up were not significant, but significant changes were observed after the training period. Decreased contractures were observed with increased muscle function.ConclusionSignificant improvements in motor function were observed after the active training period of the new neuromuscular training concept. This first analysis of the new neuromuscular rehabilitation concept Auf die Beine showed encouraging results for a safe and efficient physiotherapy treatment program which increases motor function in children with spina bifida.

The functional muscle-bone unit in children with cerebral palsy

SummaryOur results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using only age- and height-adjusted bone mineral content (BMC) and areal bone mineral density (aBMD). When applying the functional muscle-bone unit diagnostic algorithm (FMBU-A), the prevalence of positive results decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP.IntroductionThe prevalence of bone health deficits in children with cerebral palsy (CP) might be overestimated because age- and height-adjusted reference percentiles for bone mineral content (BMC) and areal bone mineral density (aBMD) assessed by dual-energy X-ray absorptiometry (DXA) do not consider reduced muscle activity. The aim of this study was to compare the prevalence of positive DXA-based indicators for bone health deficits in children with CP to the prevalence of positive findings after applying a functional muscle-bone unit diagnostic algorithm (FMBU-A) considering reduced muscle activity.MethodsThe present study was a monocentric retrospective analysis of 297 whole body DXA scans of children with CP. The prevalence of positive results of age- and height-adjusted BMC and aBMD defined as BMC and aBMD below the P3 percentile and of the FMBU-A was calculated.ResultsIn children with CP, the prevalence of positive results of age-adjusted BMC were 33.3% and of aBMD 50.8%. Height-adjusted results for BMC and aBMD were positive in 16.8 and 36.0% of cases. The prevalence of positive results applying the FMBU-A regarding BMC and aBMD were significantly (pxa0<xa00.001) lower than using age- and height-adjusted BMC and aBMD (8.8 and 14.8%).ConclusionsOur results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using age- and height-adjusted BMC and aBMD. When applying the FMBU-A, the prevalence decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP.

Are there effects of age, gender, height, and body fat on the functional muscle-bone unit in children and adults?

SummaryThe aim was to describe the effect of age, gender, height, different stages of human life, and body fat on the functional muscle-bone unit. All these factors had a significant effect on the functional muscle-bone unit and should be addressed when assessing functional muscle-bone unit in children and adults.IntroductionFor the clinical evaluation of the functional muscle-bone unit, it was proposed to evaluate the adaptation of the bone to the acting forces. A frequently used parameter for this is the total body less head bone mineral content (TBLH-BMC) determined by dual-energy X-ray absorptiometry (DXA) in relation to the lean body mass (LBM by DXA). LBM correlates highly with muscle mass. Therefore, LBM is a surrogate parameter for the muscular forces acting in everyday life. The aim of the study was to describe the effect of age and gender on the TBLH-BMC for LBM and to evaluate the impact of other factors, such as height, different stages of human life, and of body fat.MethodsAs part of the National Health and Nutrition Examination Survey (NHANES) study, between the years 1999–2006 whole-body DXA scans on randomly selected Americans from 8xa0years of age were carried out. From all eligible DXA scans (1999–2004), three major US ethnic groups were evaluated (non-Hispanic Whites, non-Hispanic Blacks, and Mexican Americans) for further statistical analysis.ResultsFor the statistical analysis, the DXA scans of 8190 non-Hispanic White children and adults (3903 female), of 4931 non-Hispanic Black children and adults (2250 female) and 5421 of Mexican-American children and adults (2424 female) were eligible. Age, gender, body height, and especially body fat had a significant effect on the functional muscle-bone unit.ConclusionsWhen assessing TBLH-BMC for LBM in children and adults, the effects of age, gender, body fat, and body height should be addressed. These effects were analyzed for the first time in such a large cohort.

Alleviation of Motor Impairments in Patients with Cerebral Palsy: Acute Effects of Whole-body Vibration on Stretch Reflex Response, Voluntary Muscle Activation and Mobility

Introduction Individuals suffering from cerebral palsy (CP) often have involuntary, reflex-evoked muscle activity resulting in spastic hyperreflexia. Whole-body vibration (WBV) has been demonstrated to reduce reflex activity in healthy subjects, but evidence in CP patients is still limited. Therefore, this study aimed to establish the acute neuromuscular and kinematic effects of WBV in subjects with spastic CP. Methods 44 children with spastic CP were tested on neuromuscular activation and kinematics before and immediately after a 1-min bout of WBV (16–25u2009Hz, 1.5–3u2009mm). Assessment included (1) recordings of stretch reflex (SR) activity of the triceps surae, (2) electromyography (EMG) measurements of maximal voluntary muscle activation of lower limb muscles, and (3) neuromuscular activation during active range of motion (aROM). We recorded EMG of m. soleus (SOL), m. gastrocnemius medialis (GM), m. tibialis anterior, m. vastus medialis, m. rectus femoris, and m. biceps femoris. Angular excursion was recorded by goniometry of the ankle and knee joint. Results After WBV, (1) SOL SRs were decreased (pu2009<u20090.01) while (2) maximal voluntary activation (pu2009<u20090.05) and (3) angular excursion in the knee joint (pu2009<u20090.01) were significantly increased. No changes could be observed for GM SR amplitudes or ankle joint excursion. Neuromuscular coordination expressed by greater agonist–antagonist ratios during aROM was significantly enhanced (pu2009<u20090.05). Discussion The findings point toward acute neuromuscular and kinematic effects following one bout of WBV. Protocols demonstrate that pathological reflex responses are reduced (spinal level), while the execution of voluntary movement (supraspinal level) is improved in regards to kinematic and neuromuscular control. This facilitation of muscle and joint control is probably due to a reduction of spasticity-associated spinal excitability in favor of giving access for greater supraspinal input during voluntary motor control.

Diagnostic performance of body mass index to identify excess body fat in children with cerebral palsy

To assess the diagnostic performance of body mass index (BMI) cut‐off values according to recommendations of the World Health Organization (WHO), the World Obesity Federation (WOF), and the German Society for Adiposity (DAG) to identify excess body fat in children with cerebral palsy (CP).

Reference centiles for the gross motor function measure and identification of therapeutic effects in children with cerebral palsy

RATIONALE, AIMS, AND OBJECTIVESnChildren with cerebral palsy (CP) can show an increase in gross motor function until the age of 9 to 10xa0years under the standard of care. Additionally, the motor development can have large individual fluctuations. Therefore, in clinical setting, it is not trivial to estimate the effect of an additional therapeutic intervention at this age interval. The study aim was to develop a method which allows quantification of the gross motor function changes over 6xa0months of the individual child with CP.nnnMETHODnThe present study was a single center retrospective analysis. Data were collected in children with CP who participated in a rehabilitation program between 2006 and 2016. The gross motor function of the children was measured with the Gross Motor Function Measurement (GMFM-66). Reference centiles for the GMFM-66 were created with data before starting the rehabilitation program. The variability of the evolution of the GMFM-66 was assessed with data at the start and the end of a 6-month observational phase of standard of care.nnnRESULTSnIn total, the GMFM-66 data of 919 children before starting the rehabilitation program were available (age 6.49xa0±xa02.49xa0years, GMFCS-level I-V). For 515 study participants (6.76xa0±xa02.30xa0years, GMFCS-level I-V), data were also available at the start and the end of a 6-month observational phase.nnnCONCLUSIONSnThe presented method helps to guide the clinician to track the individual patients gross motor development and assess the additional effect of an additionally applied intervention while taking into account the expected progression of gross motor function under standard of care.

TBS as a Tool to Differentiate the Impact of Antiresorptives onCortical and Trabecular Bone in Children With OsteogenesisImperfecta

INTRODUCTION/BACKGROUNDnOsteogenesis imperfecta is a hereditary connective tissue disorder, resulting in low bone mass and high bone fragility. Dual-energy X-ray absorptiometry (DXA) and in adulthood also the trabecular bone score (TBS) are well established to assess bone health and fracture risk. The purpose of this investigation was to assess the usefulness of TBS in respect to different treatment regimes in children with osteogenesis imperfecta. Changes of areal bone mineral density (aBMD) and TBS using DXA scans of children treated with antiresorptive therapies were evaluated.nnnMETHODOLOGYnDXA scans (aBMD, TBS) of 8 children with OI were evaluated. The scans were taken during a 1 yr period of treatment with bisphosphonates and during 1 yr pilot trial using denosumab. Changes of aBMD and TBS during both treatment regimens were compared.nnnRESULTSnDuring bisphosphonate treatment aBMD increased about 6.2%, while TBS increased about 2.1%. The difference between aBMD and TBS before and after bisphosphonate treatment was not significant (pu202f=u202f0.25). During denosumab treatment aBMD increased around 25.1%, while TBS increased 6.7%. The change of aBMD was significant (pu202f=u202f0.007), as was the difference between aBMD and TBS (p < 0.001).nnnCONCLUSIONSnDenosumab had a significant effect on both aBMD and TBS but was significantly more pronounced in aBMD. These results suggest a stronger effect of denosumab on cortical bone and the growth plate in comparison to bisphosphonates. Beside the lack of paediatric reference data and the small sample size, the results suggest TBS to be a useful tool for monitoring skeletal changes during development, growth, and antiresorptive therapy in children with OI.