Kinavey C. Adolescents born with spina bifida: experiential worlds and biopsychosocial developmental challenges. Issues Compr Pediatr Nurs. 2007 Oct-Dec;30(4):147-64.
The author used phenomenological (interpretive) ethnography to investigate the experience of physical disability and its attached meanings in relation to self, world, and other for adolescents born with spina bifida. Multiple in-depth interviews were conducted with 11 late-stage adolescents (aged 18-24 years). Analysis of their narrative accounts illustrated commonalities with respect to the biopsychosocial impact of living with the physical disability of spina bifida. The theme, "Experiencing self as dissimilar other" is reported upon. Findings imply that youth born with spina bifida face biological, psychological, and social challenges that might interfere with normative developmental tasks of adolescence, including identity formation. Greater emphasis needs to be directed toward humanizing and emancipating the physical and social environment for youth with physical disabilities to maximize developmental opportunities and potential while fostering positive identity.
PMID: 18041630 [PubMed - in process]
Wednesday, December 19, 2007
Maternal flu or fever, medication use, and neural tube defects: a population-based case-control study in Northern China.
Z, Li Z. Maternal flu or fever, medication use, and neural tube defects: a population-based case-control study in Northern China. Birth Defects Research, Part A: Clinical and Molecular Teratology. 2007 Apr;79(4):295-300.
BACKGROUND: Maternal exposure to flu or fever has been associated with increased risk for neural tube defects (NTDs); however, few studies have considered the effects of medications on the effects of flu or fever. We evaluated the effect of maternal flu or fever, medication use (antibiotics, antipyretics), and their joint effect on NTDs.
METHODS: Data came from an ongoing population-based case-control study of infants with external malformations in northern China. The case group included 363 infants with NTDs identified between January 2003 and June 2005. Controls were 523 newborn infants without identified congenital anomalies matched by county, sex, maternal ethnic group, and the closest date of conception for infants with any major external malformation. Data were collected by a trained health worker through face-to-face interviews after delivery. RESULTS: NTD risks were significantly associated with maternal flu or fever (adjusted odds ratio [AOR] = 3.93, 95% CI: 2.48-6.23) and antipyretic use (AOR = 4.86, 95% CI: 1.33-17.78), but not with antibiotic use (AOR = 1.75, 95% CI: 0.91-3.38) after adjusting for potential confounders. NTD risk associated with maternal antipyretic use was markedly higher for anencephaly (AOR = 7.03, 95% CI: 1.70-29.04) than for spina bifida (AOR = 3.98, 95% CI: 0.95-16.74). Mothers with flu or fever who were also using antipyretics showed a markedly higher AOR for anencephaly (14.75 vs. 4.52), spina bifida (16.30 vs. 3.85), and all NTDs combined (13.91 vs. 4.04) than mothers with flu or fever who were not using antipyretics. Maternal antibiotics did not markedly change the effects of flu or fever on anencephaly (4.17 vs. 4.83), spina bifida (5.08 vs. 4.21), and all NTDs combined (5.05 vs. 4.29).
CONCLUSIONS: Maternal flu or fever and antipyretic use during the periconceptional period increases the risk for NTDs. Maternal exposure to antipyretics together with flu or fever results in a markedly higher risk of NTDs than exposure to flu or fever alone.
PMID: 17216625
BACKGROUND: Maternal exposure to flu or fever has been associated with increased risk for neural tube defects (NTDs); however, few studies have considered the effects of medications on the effects of flu or fever. We evaluated the effect of maternal flu or fever, medication use (antibiotics, antipyretics), and their joint effect on NTDs.
METHODS: Data came from an ongoing population-based case-control study of infants with external malformations in northern China. The case group included 363 infants with NTDs identified between January 2003 and June 2005. Controls were 523 newborn infants without identified congenital anomalies matched by county, sex, maternal ethnic group, and the closest date of conception for infants with any major external malformation. Data were collected by a trained health worker through face-to-face interviews after delivery. RESULTS: NTD risks were significantly associated with maternal flu or fever (adjusted odds ratio [AOR] = 3.93, 95% CI: 2.48-6.23) and antipyretic use (AOR = 4.86, 95% CI: 1.33-17.78), but not with antibiotic use (AOR = 1.75, 95% CI: 0.91-3.38) after adjusting for potential confounders. NTD risk associated with maternal antipyretic use was markedly higher for anencephaly (AOR = 7.03, 95% CI: 1.70-29.04) than for spina bifida (AOR = 3.98, 95% CI: 0.95-16.74). Mothers with flu or fever who were also using antipyretics showed a markedly higher AOR for anencephaly (14.75 vs. 4.52), spina bifida (16.30 vs. 3.85), and all NTDs combined (13.91 vs. 4.04) than mothers with flu or fever who were not using antipyretics. Maternal antibiotics did not markedly change the effects of flu or fever on anencephaly (4.17 vs. 4.83), spina bifida (5.08 vs. 4.21), and all NTDs combined (5.05 vs. 4.29).
CONCLUSIONS: Maternal flu or fever and antipyretic use during the periconceptional period increases the risk for NTDs. Maternal exposure to antipyretics together with flu or fever results in a markedly higher risk of NTDs than exposure to flu or fever alone.
PMID: 17216625
High prevalence of NTDs in Shanxi Province: a combined epidemiological approach.
Gu X, Lin L, Zheng X, Zhang T, Song X, Wang J, Li X, Li P, Chen G, Wu J, Wu L, Liu J.
High prevalence of NTDs in Shanxi Province: a combined epidemiological approach. Birth Defects Research, Part A: Clinical and Molecular Teratology. 2007 Oct;79(10):702-7.
BACKGROUND: Shanxi Province has historically reported a high prevalence of NTDs. In order to establish baseline rates for NTDs and discuss the risk factors associated with sociodemographic, maternal characteristics, and geographic factors, we performed the present study using an approach combining population and hospital-based methodologies.
METHODS: We used chi(2) and Fisher's exact tests to evaluate variation in the prevalence by selected covariates and computed crude ORs and 95% CIs. Adjusted odds ratios (AORs) were performed using logistic regression with all the covariates included in the model.
RESULTS: The overall NTD prevalence during the 3 year study period was 199.38 per 10,000 births, with a higher NTD prevalence clustered in 46 villages within this geographic area. However, no statistical significance was found between NTD prevalence and the elevation of the villages or their distance from coal plants. AORs revealed women aged 20 and above had a lower risk of NTDs compared to those younger than 20 (AOR range 0.4-0.5). A higher risk of NTDs was observed among female infants (AOR 1.50; 95% CI: 1.04-2.17), women with four or more previous births (AOR 2.80; 95% CI: 1.20-6.52), and a previous history of birth defects (AOR 3.23; 95% CI: 1.46-7.12).
CONCLUSIONS: This study has documented a high prevalence of NTDs in Shanxi. Similar variations to other reports were found in the risk of NTDs by maternal demographic characteristics and a clustering of NTDs in certain villages that require further exploration.
PMID: 17729293
High prevalence of NTDs in Shanxi Province: a combined epidemiological approach. Birth Defects Research, Part A: Clinical and Molecular Teratology. 2007 Oct;79(10):702-7.
BACKGROUND: Shanxi Province has historically reported a high prevalence of NTDs. In order to establish baseline rates for NTDs and discuss the risk factors associated with sociodemographic, maternal characteristics, and geographic factors, we performed the present study using an approach combining population and hospital-based methodologies.
METHODS: We used chi(2) and Fisher's exact tests to evaluate variation in the prevalence by selected covariates and computed crude ORs and 95% CIs. Adjusted odds ratios (AORs) were performed using logistic regression with all the covariates included in the model.
RESULTS: The overall NTD prevalence during the 3 year study period was 199.38 per 10,000 births, with a higher NTD prevalence clustered in 46 villages within this geographic area. However, no statistical significance was found between NTD prevalence and the elevation of the villages or their distance from coal plants. AORs revealed women aged 20 and above had a lower risk of NTDs compared to those younger than 20 (AOR range 0.4-0.5). A higher risk of NTDs was observed among female infants (AOR 1.50; 95% CI: 1.04-2.17), women with four or more previous births (AOR 2.80; 95% CI: 1.20-6.52), and a previous history of birth defects (AOR 3.23; 95% CI: 1.46-7.12).
CONCLUSIONS: This study has documented a high prevalence of NTDs in Shanxi. Similar variations to other reports were found in the risk of NTDs by maternal demographic characteristics and a clustering of NTDs in certain villages that require further exploration.
PMID: 17729293
Birth defects in uncles and aunts from Irish families with neural tube defects
Byrne J. Birth defects in uncles and aunts from Irish families with neural tube defects. Birth Defects Reseach, Part A: Clinical Molecular Teratology. 2007 Nov 28;
BACKGROUND:: Previous studies suggested an excess of matrilineal cases of neural tube defects among distant relatives in NTD families. There is little information on patterns of heredity of other birth defects among distant relatives.
METHODS:: Between 1995 and 2003, 78 nuclear families and 373 uncles and aunts were interviewed about birth defects among uncles and aunts in Irish families with an NTD.
RESULTS:: Among 783 total uncles and aunts, those related through the mother had more birth defects overall than those related through the father (8.4 vs. 4.0%, p = 0.01). The excess persisted after controlling with logistic regression models for maternal and paternal age, gender of uncle/aunt, proband's NTD diagnosis, and year of birth (OR 2.52; 95% CI: 1.29, 4.91; p = 0.007). Among individual birth defects, significant excesses over expected rates were seen for spina bifida, congenital heart defects, and syndactyly.
CONCLUSIONS:: This study of reported birth defects suggests that maternal uncles and aunts in Irish families have significantly more birth defects than paternal uncles and aunts. These results, if confirmed, support the hypothesis that NTD relatives carry a susceptibility to other birth defects, preferentially on the mother's side of the family, suggesting opportunities for prevention. Birth Defects Research (Part A) 2007.
PMID: 18044714
BACKGROUND:: Previous studies suggested an excess of matrilineal cases of neural tube defects among distant relatives in NTD families. There is little information on patterns of heredity of other birth defects among distant relatives.
METHODS:: Between 1995 and 2003, 78 nuclear families and 373 uncles and aunts were interviewed about birth defects among uncles and aunts in Irish families with an NTD.
RESULTS:: Among 783 total uncles and aunts, those related through the mother had more birth defects overall than those related through the father (8.4 vs. 4.0%, p = 0.01). The excess persisted after controlling with logistic regression models for maternal and paternal age, gender of uncle/aunt, proband's NTD diagnosis, and year of birth (OR 2.52; 95% CI: 1.29, 4.91; p = 0.007). Among individual birth defects, significant excesses over expected rates were seen for spina bifida, congenital heart defects, and syndactyly.
CONCLUSIONS:: This study of reported birth defects suggests that maternal uncles and aunts in Irish families have significantly more birth defects than paternal uncles and aunts. These results, if confirmed, support the hypothesis that NTD relatives carry a susceptibility to other birth defects, preferentially on the mother's side of the family, suggesting opportunities for prevention. Birth Defects Research (Part A) 2007.
PMID: 18044714
Saturday, November 24, 2007
Tethered cord syndrome in children: a review
Bui CJ, Tubbs RS, Oakes WJ. Tethered cord syndrome in children: a review. Neurosurgical Focus. 2007;23(2):1-9.
The treatment of a patient with symptoms of a tethered spinal cord and in whom a fatty infiltrated terminal filum is found is controversial. The authors review their experience and the literature regarding this aspect of occult spinal dysraphism. From experience, transection of a fatty terminal filum in patients with symptoms related to excessive caudal cord tension is a minor procedure that generally yields good results. The most problematic issue in the literature is what patients and symptoms are best suited to surgical treatment.
PMID: 17961017
The treatment of a patient with symptoms of a tethered spinal cord and in whom a fatty infiltrated terminal filum is found is controversial. The authors review their experience and the literature regarding this aspect of occult spinal dysraphism. From experience, transection of a fatty terminal filum in patients with symptoms related to excessive caudal cord tension is a minor procedure that generally yields good results. The most problematic issue in the literature is what patients and symptoms are best suited to surgical treatment.
PMID: 17961017
Interpreting changes in the epidemiology of anencephaly and spina bifida following folic acid fortification of the U.S. grain supply
Besser LM, Williams LJ, Cragan JD. Interpreting changes in the epidemiology of anencephaly and spina bifida following folic acid fortification of the U.S. grain supply in the setting of long-term trends, Atlanta, Georgia, 1968-2003. Birth Defects Research. Part A: Clinical Molecular Teratology . 2007 Nov;79(11):730-6.
BACKGROUND:: The prevalence of anencephaly (AN) and spina bifida (SB) was declining long before fortification of enriched grains in the U.S. with folic acid. We examined whether changes in these defects surrounding fortification could be distinguished from preexisting trends.
METHODS:: We used data from the Metropolitan Atlanta Congenital Defects Program to identify three ascertainment periods: Period 1 (1968-1981), prenatal diagnoses rarely made; Period 2 (1981-1993), prenatal diagnoses made but not ascertained; Period 3 (1994-2003), prenatal diagnoses ascertained. We compared the annual percent change (APC) in AN and SB for each period using Poisson regression, then compared prevalences during each period for categories of pregnancy outcome, sex, race, gravidity, and maternal age.
RESULTS:: The prevalence of AN (N = 434) and SB (N = 663) declined during 1968-2003. The APCs in Periods 1, 2, and 3, respectively, were -6.9%, -2.9%, and -6.8% for AN, and -7.1%, -7.0%, and -6.2% for SB; 95% confidence intervals around the APCs for Periods 2 and 3 overlapped for both defects. Prevalence ratios (PRs) for females relative to males decreased for AN (2.3 in Period 1; 1.2 in Period 3); PRs for whites relative to blacks or African Americans decreased for both AN (2.7 in Period 1; 1.2 in Period 3) and SB (2.5 in Period 1; 1.1 in Period 3).
CONCLUSIONS:: Our analysis suggests that changes in AN and SB surrounding folic acid fortification (Period 3) could be part of preexisting trends. This must be considered when evaluating prevention efforts. Birth Defects Research (Part A) 79:730-736, 2007. (c) 2007 Wiley-Liss, Inc.
PMID: 17990332
BACKGROUND:: The prevalence of anencephaly (AN) and spina bifida (SB) was declining long before fortification of enriched grains in the U.S. with folic acid. We examined whether changes in these defects surrounding fortification could be distinguished from preexisting trends.
METHODS:: We used data from the Metropolitan Atlanta Congenital Defects Program to identify three ascertainment periods: Period 1 (1968-1981), prenatal diagnoses rarely made; Period 2 (1981-1993), prenatal diagnoses made but not ascertained; Period 3 (1994-2003), prenatal diagnoses ascertained. We compared the annual percent change (APC) in AN and SB for each period using Poisson regression, then compared prevalences during each period for categories of pregnancy outcome, sex, race, gravidity, and maternal age.
RESULTS:: The prevalence of AN (N = 434) and SB (N = 663) declined during 1968-2003. The APCs in Periods 1, 2, and 3, respectively, were -6.9%, -2.9%, and -6.8% for AN, and -7.1%, -7.0%, and -6.2% for SB; 95% confidence intervals around the APCs for Periods 2 and 3 overlapped for both defects. Prevalence ratios (PRs) for females relative to males decreased for AN (2.3 in Period 1; 1.2 in Period 3); PRs for whites relative to blacks or African Americans decreased for both AN (2.7 in Period 1; 1.2 in Period 3) and SB (2.5 in Period 1; 1.1 in Period 3).
CONCLUSIONS:: Our analysis suggests that changes in AN and SB surrounding folic acid fortification (Period 3) could be part of preexisting trends. This must be considered when evaluating prevention efforts. Birth Defects Research (Part A) 79:730-736, 2007. (c) 2007 Wiley-Liss, Inc.
PMID: 17990332
Management of Infection After Instrumented Posterior Spine Fusion in Pediatric Scoliosis
Ho C, Skaggs DL, Weiss JM, Tolo VT. Management of Infection After Instrumented Posterior Spine Fusion in Pediatric Scoliosis. Spine. 2007 Nov 15;32(24):2739-2744.
STUDY DESIGN.: Case series retrospective review.
OBJECTIVE.: To identify what factors predict successful eradication of infection after I&D of an infected posterior spinal fusion with instrumentation.
SUMMARY OF BACKGROUND DATA.: The treatment of infection of instrumented spine fusions in children has few clear guidelines in the literature. METHODS.: The medical records of patients who required a surgical irrigation and debridement (I&D) for infection after posterior spinal fusion and instrumentation for scoliosis from 1995 to 2002 were retrospectively reviewed.
RESULTS.: Fifty-three patients were identified with the following underlying diagnoses: 21 patients (40%) idiopathic scoliosis, 10 patients (23%) cerebral palsy, 3 patients (6%) spina bifida, 1 patient (2%) congenital scoliosis, and 17 patients (32%) other. There were 31 patients (58%) with surgery <6 months from initial fusion, and 22 (42%) patients >6 months. Of the 43 patients with implant retained at the time of the first I&D, 20 patients required a second I&D (47%). Of the 10 patients with complete implant removal, 2 patients required a second I&D (20%). Coagulase-negative Staphylococcus was the most prevalent organism, growing in 25 (47%) of the cultures. Of patients with idiopathic scoliosis, 8 of 21 (38%) required a second I&D; of the patients with other diagnoses, 14 of 32 (44%) required a second I&D, which was not a significant difference (P > 0.05).
CONCLUSION.: To the best of our knowledge, this is the largest reported series of spinal implant infections. When children with an infection after posterior spinal fusion with instrumentation undergo irrigation and debridement, there is a nearly 50% chance that the infection will remain if all spinal implants are not removed. As nearly 50% of the infections were caused by coagulase-negative Staphylococcus, we recommend that prophylactic antibiotic coverage for this organism is used at the time of the initial spinal fusion.
PMID: 18007254
STUDY DESIGN.: Case series retrospective review.
OBJECTIVE.: To identify what factors predict successful eradication of infection after I&D of an infected posterior spinal fusion with instrumentation.
SUMMARY OF BACKGROUND DATA.: The treatment of infection of instrumented spine fusions in children has few clear guidelines in the literature. METHODS.: The medical records of patients who required a surgical irrigation and debridement (I&D) for infection after posterior spinal fusion and instrumentation for scoliosis from 1995 to 2002 were retrospectively reviewed.
RESULTS.: Fifty-three patients were identified with the following underlying diagnoses: 21 patients (40%) idiopathic scoliosis, 10 patients (23%) cerebral palsy, 3 patients (6%) spina bifida, 1 patient (2%) congenital scoliosis, and 17 patients (32%) other. There were 31 patients (58%) with surgery <6 months from initial fusion, and 22 (42%) patients >6 months. Of the 43 patients with implant retained at the time of the first I&D, 20 patients required a second I&D (47%). Of the 10 patients with complete implant removal, 2 patients required a second I&D (20%). Coagulase-negative Staphylococcus was the most prevalent organism, growing in 25 (47%) of the cultures. Of patients with idiopathic scoliosis, 8 of 21 (38%) required a second I&D; of the patients with other diagnoses, 14 of 32 (44%) required a second I&D, which was not a significant difference (P > 0.05).
CONCLUSION.: To the best of our knowledge, this is the largest reported series of spinal implant infections. When children with an infection after posterior spinal fusion with instrumentation undergo irrigation and debridement, there is a nearly 50% chance that the infection will remain if all spinal implants are not removed. As nearly 50% of the infections were caused by coagulase-negative Staphylococcus, we recommend that prophylactic antibiotic coverage for this organism is used at the time of the initial spinal fusion.
PMID: 18007254
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