Paula Piekkala

Prevalence of headache at preschool age in an unselected child population

In a representative study of 5356 five-year-old children, 4405 (82.2%) could be traced for follow-up. Headache occurred in 861 (19.5%) of them; highly frequently in 0.2%, fairly frequently in 0.5%, less frequently in 4.3% and infrequently in 14.5%. Type of dwelling was the only predictor of housing standard, the risk of headache being about 1.5–fold in children living in other than one-family houses. Low economic status of the family, nursery day care and an increasing number of leisure activities were additional risk factors. Compared with infrequent or no headache, those with highly frequent or fairly frequent headache were at a 1.4–fold risk of temper tantrums. The risk of stomach ache was 8.9–fold in children with infrequent headache and 13.7–fold in those with fairly frequent or frequent headache compared with children with no headache.

Factors Affecting the Occurrence of Acute Otitis Media during the First Year of Life

ABSTRACT. A regional birth cohort of 5356 infants was enrolled into a follow‐up study in order to investigate the determinants of the development of infectious diseases in children. The infants were examined at three months, six months and twelve months of age by the physicians at the well‐baby clinics. At these occasions the number of episodes of acute otitis media in the infants, the duration of breast‐feeding, the number of siblings, the type of day care, parental smoking, the presence of animal pets at home and the number and type of other illnesses than otitis were registered. Two thirds of the infants had no episodes of acute otitis media. The median age for the first episode of acute otitis media was eight months. About 10% of the infants had experienced recurrent otitis media (three episodes or more) during their first year of life. Significant associations were found between the occurrence of acute otitis media and the number of siblings, the type of day care, the sex of the infant, the duration of breast feeding, maternal socioeconomic status and prematurity.

Growth of 519 Small for Gestational Age Infants during the First Two Years of Life

ABSTRACT. The physical growth of 519 small for gestational age infants (SGA), with a birth weight below the 10th percentile on our own growth curve, born in the region of University Central Hospital of Turku during the period June 1,1981‐May 31, 1982, was studied. The study population consists of 4 517 term, appropriate for gestational age (AGA) infants, 488 term SGA infants, 320 preterm AGA infants and 31 preterm SGA infants. The degree of intrauterine growth retardation (IUGR) seemed to have an effect on physical growth in term SGA infants. Those term SGA infants with a low Ponderal Index (PI) (type II) were taller and had a larger head circumference at the age of 24 months than term SGA infants with adequate PI (type I). Among the preterm SGA infants the degree of IUGR seemed to have no effect on later growth. Smoking is still one of the main risk factors associated with poor intrauterine growth. In this study we also found that smoking has an effect on later growth; the children of smoking mothers were smaller than those of non‐smoking mothers in the AGA group. Among the SGA infants the infants of non‐smoking mothers were bigger than those of smoking mothers. This difference could be explained by other factors associated with SGA. We found that in spite of the catch‐up growth during the first months, 26% of the severely SGA infants (birth weight below the 2.5th percentile) still had a weight below the 2.5th percentile at the age of 24 months.

Prevalence of Migraine and Other Headaches in Early Puberty

A representative epidemiological study on the occurrence of migraine and other headaches in Finnish schoolchildren 14 years of age is presented. The investigation covered 3863 pupils, accounting for 94.2% of the total of 4101 mentally normal children, who went to school in two big Finnish cities. There were 1954 boys and 1909 girls in the study. They were given a one-page questionnaire with four questions concerning the frequency and the nature of headache in themselves and their family members. Considerable attention was paid to the wording and unambiguity of each question. The forms were filled in under the control of the home-room teacher, whose check-up of the answers was intended to remove discrepancies between the filled-in forms and the childrens complaints. For the clinically working physician, especially the general practitioner, it is worthwhile noticing that during the last 12 months not less than 68% of the 14-year-old schoolchildren had suffered from headache. Headache had been less frequent in the boys (65%) than in the girls (71%). In 10.2% of the schoolchildren migraine attacks had occurred. Again, the boys had migraine less frequently (6.7%) than the girls (13.8%). The combination of individual migraine factors, which occurred in one third of the cases, was unilateral pain and migraine in other family members. The figures are similar to those in another investigation of headaches in schoolchildren.

Perinatal events and neonatal morbidity: An analysis of 5380 cases

The associations between perinatal events and neonatal morbidity were examined in a regional population of 5 380 newborns weighing 500 g or more. Perinatal mortality was 6.9%, and neonatal mortality was 3.0%. The low birth weight (less than 2500 g) rate was 3.8%. The incidence of prematurity (gestational age less than 37 weeks) was 6.6%. Respiratory distress syndrome was found in 0.9%, nonhaemolytic hyperbilirubinaemia in 16.5%, hypoglycaemia in 0.5%, septic infection in 0.8%, asphyxia in 4.0%, intracerebral haemorrhage in 0.3%, and cerebral symptoms in 0.7%. Maternal toxaemia, multiple pregnancy and maternal short stature were associated with spontaneous prematurity and a birthweight below the 10th percentile. Prematurity was associated with respiratory distress syndrome, hyperbilirubinaemia, hypoglycaemia, infection, low Apgar scores, asphyxia and intracerebral haemorrhage. Placental complications were associated with spontaneous prematurity, low Apgar scores and asphyxia. Premature rupture of the membranes was associated with spontaneous prematurity, infection, low Apgar scores and asphyxia.

The young adult with cerebral palsy and his chances of employment.

Eighty-six CP patients aged 15 to 27 years and followed from six to 25 years by one of the authors were examined to look at the functional and working capacity and the employment situation of these patients. Their age was 15-16 years in 26 (30%) and 17-27 years in 60 (70%) of cases. There were 47 males and 39 females. Sixty-eight patients (79%) suffered from a spastic, 9 ones (10.5%) from a dyskinetic and another 9 cases from an ataxic syndrome. The vocational training consisted of vocational college in two (2.5%), vocational school in six (7%), vocational course college or on-the-job training in three (3.5%) cases. Five were acquiring vocational training and 70 (81%) lacked it. Ten patients (12%) were normally employed and working regularly, 39 (45%) were attending normal school, and 13 (15%) were able to work but unemployed at the time of investigation. Four patients (5%) were in sheltered work and the remaining twenty ones (23%) were totally unable to work. The spastic patients were remarkably better employed than those with a dyskinetic or ataxic syndrome.

Advances in Perinatal Care and Declining Regional Neonatal Mortality in Finland, 1968-82

ABSTRACT. Neonatal mortality (NNM) was investigated in the region of the University Central Hospital of Turku (UCHT), Finland, during a 15‐year period from 1968 till 1982. During the study period 81620 livebom infants were born. The NNM rate declined from 13.5 in 1968 to 3.0 in 1982 during the study period. Significant declines occurred in NNM due to respiratory distress syndrome (RDS) and asphyxia. The decline in NNM was more obvious during the early neonatal period (0‐6 days after birth) and in the low birth weight (LBVV) group (BW less than 2500 g). We believe that centralization of obstetric and neonatal services in risk cases and the new neonatal intensive care accounted for the decline in NNM.

The somatic growth of a regional birth cohort of 351 preterm infants during the first two years of life

The somatic growth of a regional birth cohort of 351 preterm infants was followed during their first two years. The measurements of weight, height, head and thorax circumferences took place at the well-baby clinics run by public health nurses at 3, 6, 12, 18 and 24 months of conceptional age. The growth of the preterm infants was compared with that of their term peers with uncomplicated course of pregnancy, labour, delivery and neonatal period. The preterm infants without intrauterine growth retardation caught up the term control infants by three months of conceptional age. The preterm small-for-gestational age infants remained smaller than the preterm appropriate-for-gestational age or the control infants in all measures throughout their first two years of life. Birth weight rather than gestational age predicted the growth outcome in preterm infants. Moderate or severe respiratory distress had no impact on the future growth of the infants in the present material. Prematurity as such does not seem to influence the growth of preterm infants.

Fetal and neonatal mortality of small-for-gestational age infants

Fetal and neonatal mortality of small-for-gestational age (SGA) infants in 1968–1982 were studied in the region of the University Central Hospital of Turku, Finland. During the study period, there were 254 fetal and 127 neonatal deaths in SGA infants. The fetal mortality rate of SGA infants declined from 49.9/1000 to 14.0/1000. The neonatal mortality rate of SGA infants declined from 23.8/1000 to 8.3/1000. The severely SGA infants with a birth weight below the 2.5th percentile had three times higher neonatal mortality rates than SGA infants with a birth weight between the 2.5th and the 10th percentiles. The main causes of fetal deaths were maternal diseases, placental and cord complications and fetal malnutrition, even though there was a decline in all these groups. Malformations remained the main cause of neonatal death during the study period, while there was a decline in deaths due to asphyxia and respiratory distress syndrome (RDS). The high mortality rates of SGA infants emphasize the need for early diagnosis and special attention during pregnancy, delivery and the neonatal period.

Infant mortality in a region of Finland, 1968–1982

Infant mortality in a region of Finland with about 450000 people and 5400 annual births was examined during a 15-year period, 1968–1982. Total infant mortality declined from 15.8 per 1000 live births in 1968 to 5.0 in 1982. The lowering of neonatal mortality accounted for the decline, as postneonatal mortality remained at the same level throughout the study period. Despite a decrease of nearly 80%, perinatal disorders remained the leading category of primary causes of death. Mortality from congenital malformations decreased by 50%, mortality from sudden infant death syndrome increased from 0.2 to 0.9 per 1000 live births while mortality from accidents, infectious diseases and other diseases remained minor causes of death with no change in frequency. In the low birth weight category, postponement of deaths from early to late neonatal and postneonatal periods occurred, but total infant mortality in the low birth weight category declined by about 60%. During the last two 3-year periods, decrease in birth weight-specific infant mortality was found in the 500–999 g and >2500 g categories. The reasonably high standard of living, good educational level of mothers, well organized primary maternal and child health services and the rapid advances in obstetric and neonatal care equally available and regionalized, have contributed to the favourable progress in infant mortality in Finland.