Natasha Bear

Interobserver reliability of the Australian Spasticity Assessment Scale (ASAS)

The aim of this paper is to present the Australian Spasticity Assessment Scale (ASAS) and to report studies of its interrater reliability. The ASAS identifies the presence of spasticity by confirming a velocity‐dependent increased response to rapid passive movement and quantifies it using an ordinal scale.

Factors Associated with Respiratory Illness in Children and Young Adults with Cerebral Palsy

OBJECTIVE To describe associations between respiratory illness and its potential predictors in children and young adults with cerebral palsy (CP). STUDY DESIGN Cross-sectional survey of self- and caregiver-reported respiratory symptoms for individuals aged up to 26 years with CP. Respiratory illness was indicated by 2 outcomes: (1) ≥1 respiratory hospitalizations in the past year; and (2) ≥2 courses of antibiotics for respiratory symptoms in the past year. ORs were calculated using univariate and multivariate logistic regression. RESULTS There were 551 participants, aged 1-26 years, distributed across all gross motor function classification scale (GMFCS) levels. In univariate analyses, factors significantly associated with respiratory hospitalizations were weekly respiratory symptoms (OR 2.31, 95% CI 1.78-3.00), respiratory symptoms during meals (OR 3.23, 95% CI 1.50-5.80), gastroesophageal reflux (OR 3.01, 95% CI 1.71-5.31), coughing or choking on saliva (OR 4.36, 95% CI 2.38-8.01), current asthma (OR 3.56, 95% CI 1.97-6.42), age (0-3 years) (OR 3.24, 95% CI 1.19-8.80, compared with 13-17 years), seizures (OR 3.45, 95% CI 1.96-6.08), and scoliosis (OR 2.14, 95% CI 1.16-3.97). Nonambulatory individuals (GMFCS IV-V) were at significantly increased risk of hospitalizations only if they had food modifications and/or nasogastric or gastrostomy tube feeds (OR 5.36, 95% CI 2.89-9.96, compared with GMFCS I-III with no food modifications and no tube). All factors, except seizures and scoliosis, were significantly associated with multiple courses of antibiotics in univariate analyses. CONCLUSIONS Oromotor dysfunction is strongly associated with respiratory illness in patients with CP.

Prevalence of symptoms associated with respiratory illness in children and young people with cerebral palsy

1 Therapy and Health Services, Ability Centre, Mount Lawley, WA; 2 Physiotherapy, Princess Margaret Hospital for Children, Perth, WA; 3 Telethon Kids Institute, The University of Western Australia, Perth, WA; 4 Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA; 5 Perth Children’s Hospital Project, Princess Margaret Hospital for Children, Perth, WA; 6 Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA; 7 School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.

Physician training programs significantly improve diagnosis in cases coded as anaphylaxis over time: A major factor compounding time-trend data?

Allergy training programs have improved physician recognition and correct coding of anaphylaxis. This may be a confounding factor in studies relying on coding data to assess time trends in anaphylaxis presentation.

Direct infant UV light exposure is associated with eczema and immune development

Background Suboptimal vitamin D levels during critical periods of immune development have emerged as an explanation for higher rates of allergic diseases associated with industrialization and residing at higher latitudes. Objective We sought to determine the effects of early postnatal vitamin D supplementation on infant eczema and immune development. Methods By using a double‐blind randomized controlled trial, newborn infants were randomized to receive vitamin D supplementation (400 IU/d) or a placebo until 6 months of age. Some infants also wore personal UV dosimeters to measure direct UV light (290‐380 nm) exposure. Infant vitamin D levels were measured at 3 and 6 months of age. Eczema, wheeze, and immune function outcomes were assessed at 6 months of age. Results At 3 (P < .01) and 6 (P = .02) months of age, vitamin D levels were greater for the vitamin D–supplemented group than the placebo group, but there was no difference in eczema incidence between groups. Infants with eczema were found to have had less UV light exposure (median, 555 Joules per square meter [J/m2; interquartile range, 322‐1210 J/m2]) compared with those without eczema (median, 998 J/m2 [interquartile range, 676‐1577 J/m2]; P = .02). UV light exposure was also inversely correlated with IL‐2, GM‐CSF, and eotaxin production to Toll‐like receptor ligands. Conclusion This study is the first to demonstrate an association between greater direct UV light exposures in early infancy with lower incidence of eczema and proinflammatory immune markers by 6 months of age. Our findings indicate that UV light exposure appears more beneficial than vitamin D supplementation as an allergy prevention strategy in early life. Graphical abstract Figure. No Caption available.

Infective respiratory syncytial virus is present in human cord blood samples and most prevalent during winter months

Background Human respiratory syncytial virus (RSV) remains the most common cause of severe lower respiratory tract disease amongst infants, and continues to cause annual epidemics of respiratory disease every winter worldwide. Demonstrating placental transmission of viable RSV in human samples is a major paradigm shift in respiratory routes considered likely for RSV transmission. Methods Droplet digital PCR (ddPCR) was used to identify RSV present in cord blood mononucleocytes (CBM). CBMs testing positive for RSV were treated with phytohemagglutinin (PHA), PHA and nitric oxide (NO) or PHA, NO and palivizumab, and co-cultured with HeLa cell monolayers. Subsequent immuno-staining for RSV was used to visualize infective viral plaques. Results RSV was detected in 26 of 45 samples (57.7%) by ddPCR. CBM’s collected in winter were more likely to test positive for RSV (17/21 samples, risk = 80%, OR = 7.08; 95% CI 1.80–27.80; p = 0.005) compared to non-winter months (9/24 samples, 37.5%). RSV plaques were observed in non-treated and treated co-cultured HeLa monolayers. Conclusions Demonstrating active RSV in CBMs suggests in utero transmission of infective virus to the fetus without causing overt disease. This is likely to have an important impact on immune development as well as future virus-host interactions, thereby warranting further investigation.

P49: ARE TIME-TREND DATA SIGNIFICANTLY INFLUENCED BY IMPROVEMENT IN DIAGNOSING ANAPHYLAXIS OVER TIME?

OFC. Forty three percent of the challenges (473) were conducted at SCH. There was no significant difference between the rates of OFC clinical reaction at SCH (113/473 – 24%) compared to the regional sites, independently or combined, with an average reaction rate of 24% (range 13–31%). Anaphylaxis was seen at all but one site. This occurred in 14% of those that reacted at SCH (16/113) and at an average of 16% (24/154) in regional children (range 0–23%).