Outcome and prognostic factors for children with supratentorial primitive neuroectodermal tumors treated with carboplatin during radiotherapy: A report from the Children's Oncology Group

Background

Supratentorial PNETs (sPNET) are uncommon embryonal malignancies of the central nervous system whose prognosis has historically been poor. We evaluated the outcome and prognostic factors of children with sPNET treated prospectively on a Children's Oncology Group trial.

Procedure

Following surgery, patients received craniospinal radiotherapy with concurrent carboplatin followed by six months of maintenance chemotherapy with cyclophosphamide and vincristine.

Results

Five‐year overall survival (OS) and progression‐free survival (PFS) for all patients was 58 ± 7% and 48 ± 7%. For patients with pineoblastoma (n = 23), five‐year OS and PFS was 81 ± 9% and 62 ± 11%. Extent of resection but not M‐stage was prognostic. Five‐year OS and PFS for 37 patients with non‐pineal tumors (NPsPNET) was 44 ± 8% and 39 ± 8%, significantly worse than for PB (P = 0.055 and 0.009 respectively). Extent of resection and major radiotherapy deviations were prognostic. Five year OS was 59 +/? 11.4% for those undergoing complete resection versus 10.4 +/? 7% for those who did not (P = 0.017). Central pathologic review called 14 (38%) “classic” sPNET, 8 (22%) “undifferentiated” and 13 (35%) “malignant gliomas.” There was no significant difference between the subgroups, although survival distributions approached significance when the combined “classic” and “undifferentiated” group was compared to the “malignant gliomas.”

Conclusions

Carboplatin during RT followed by 6 months of non‐intensive chemotherapy is a feasible treatment strategy for patients with sPNET. Aggressive surgical resection should be attempted if feasible. The classification of supratentorial small cell malignancies can be difficult. Pediatr Blood Cancer 2015;62:776–783. © 2015 Wiley Periodicals, Inc.

     

Augmented therapy improves outcome for pediatric high risk acute lymphocytic leukemia: results of Children's Oncology Group trial P9906

Background

The augmented BFM regimen improves outcome for children with NCI high acute lymphoblastic leukemia (ALL). Patient age, sex, and presenting white blood cell count (WBC) can be used to identify a subset of approximately 12% of children with B‐precursor ALL that had a 5‐year continuous complete remission (CCR) rate of only about 50% on earlier Pediatric Oncology Group (POG) trials.

Procedures

Children's Oncology Group trial P9906 evaluated a modified augmented BFM regimen in 267 patients with particularly high risk B‐precursor ALL. Minimal residual disease (MRD) was assessed in blood at day 8 and in marrow at day 29 of induction and correlated with outcome.

Results

The 5‐year CCR probability for patients in P9906 was significantly better than that observed for similar patients on POG trials 8602/9006 (62.2 ± 3.7% vs. 50.6 ± 2.4%; P = 0.0007) but similar to POG 9406 (63.5 ± 2.4%; P = 0.81). Interim analysis showed poor central nervous system (CNS) control, especially in patients with initial WBC ≥100,000/microliter. Day 29 marrow MRD positive (≥0.01%) vs. negative patients had 5 year CCR rates of 37.1 ± 7.4% vs. 72.6 ± 4.3%; day 8 blood MRD positive vs. negative patients had 5 year CCR rates of 57.1 ± 4.6% vs.83.6 ± 6.3%. End induction marrow MRD predicted marrow but not CNS relapse. In multivariate analysis, day 29 MRD > 0.01%, initial WBC ≥ 100,000/µl, male gender, and day 8 blood MRD > 0.01% were significant prognostic factors.

Conclusions

Augmented BFM therapy improved outcome for children with higher risk ALL. Day 8 blood and day 29 marrow MRD were strong prognostic factors in these patients. Pediatr Blood Cancer 2011; 57: 569–577. © 2011 Wiley‐Liss, Inc.

     

Incidence of bacteremias and invasive mycoses in children with acute non‐lymphoblastic leukemia: Results from a multi‐center Italian study

Background

Data on the epidemiology of bacteremias and invasive fungal diseases (IFD) in children with acute myeloid leukemia (AML) are scarce.

Design and Methods

In a multi‐center, retrospective study, we analyzed proportion, rate per 1,000 person‐days at risk, and cumulative risk of bacteremias and IFD in children with AML.

Results

Between January 1998 and December 2005, 240 children were treated for AML at 8 Italian Centers, for a total of 521 treatment courses and 63,232 person‐days at risk. Bacteremia was observed in 32% of treatment courses and IFD was seen in 10% (P < 0.0001), with rates of 2.62 and 0.84, respectively (P < 0.001). There was a significantly higher frequency of IFD during relapse treatment: proportion 15% versus 9% (P = 0.05), rate 2.10 versus 0.64 (P = 0.008) and cumulative risk 32% versus 12% (P = 0.007), while there were no differences in the proportion, rate and cumulative risk of bacteremia during front‐line or relapse treatment. The epidemiology of bacteremias and IFD was different during front‐line therapy for M3 as compared to other types of AML, but the differences were not statistically significant.

Conclusions

Severe infectious complications are frequent during the treatment of pediatric AML, especially during relapse treatment, and bacteremias are more frequent than IFD. Pediatr Blood Cancer. 2010;55:1103–1107. © 2010 Wiley‐Liss, Inc.

     

Outcome after first relapse in children with acute lymphoblastic leukemia: a report based on the Dutch Childhood Oncology Group (DCOG) relapse all 98 protocol

Background

We report on the treatment of children and adolescents with acute lymphoblastic leukemia (ALL) in first relapse. The protocol focused on: (1) Intensive chemotherapy preceding allogeneic stem cell transplantation (SCT) in early bone marrow relapse; (2) Rotational chemotherapy in late relapse, without donor; (3) Postponement of cerebro‐spinal irradiation in late isolated CNS relapse; and (4) Treatment in very late bone marrow relapse with chemotherapy only.

Methods

From January 1999 until July 2006 all 158 Dutch pediatric patients with ALL in first relapse were recorded. Ninety‐nine patients were eligible; 54 patients with early and 45 with late relapse. Eighteen patients had an isolated extra‐medullary relapse; 69 patients had bone marrow involvement only.

Results

Five‐years EFS rates for early and late relapses were 12% and 35%, respectively. For early relapses 5 years EFSs were 25% for patients transplanted; 0% for non‐transplanted patients. For late relapses 5 years EFS was 64% for patients treated with chemotherapy only, and 16% for transplanted patients. For very late relapses EFS was 58%.

Conclusions

Our data suggest the superiority of SCT for early relapse patients. For late relapses a better outcome is achieved with chemotherapy only using the rotational chemotherapy scheme. The most important factor for survival was interval between first CR and occurrence of the first relapse. Pediatr Blood Cancer 2011; 57: 210–216. © 2011 Wiley‐Liss, Inc.

     

Infliximab regulates monocytes and regulatory T cells in Kawasaki disease

Background

The effect of infliximab (IFX ) on immune cells has not been fully reported in Kawasaki disease (KD ). To investigate the mechanism of IFX in KD , we examined changes in the abundance of CD 14⁺CD 16⁺ activated monocytes, regulatory T cells (T_reg) cells, and T‐helper type 17 (Th17) cells following treatment with IFX .

Methods

We collected peripheral blood from patients with i.v. immunoglobulin (IVIG )‐resistant KD and analyzed absolute CD 14⁺CD 16⁺ monocyte, T_reg (CD 4⁺CD 25⁺FOXP 3⁺) and Th17 cell (CD 4⁺IL ‐17A⁺) counts on flow cytometry. We also measured changes in serum soluble interleukin (IL )‐2 receptor (IL ‐2R), IL ‐6, and tumor necrosis factor (TNF )‐α on enzyme‐linked immunosorbent assay.

Results

T_reg cells and Th17 cells significantly increased after IFX treatment compared with baseline (126 ± 85 cells/μL vs 62 ± 53 cells/μL, P < 0.01; 100 ± 111 cells/μL vs 28 ± 27 cells/μL, P < 0.05, respectively). In contrast, in a subgroup of patients with CD 14⁺CD 16⁺ monocytes above the normal range before IFX , the CD 14⁺CD 16⁺ monocytes significantly decreased following IFX treatment (72 ± 51 cells/μL vs 242 ± 156 cells/μL, P < 0.05).. Serum TNF ‐α did not change, but soluble IL ‐2R and IL ‐6 decreased after IFX treatment.

Conclusion

IFX could downregulate activated monocytes and upregulate T_reg cells towards the normal range. IFX treatment thus contributes to the process of attenuating inflammation in KD .

     

Nutritional therapy complications in children with ultra‐short bowel syndrome include growth deficiency but not cholestasis

Aim

Children with ultra‐short bowel syndrome (USBS) have not been extensively studied to date because the condition is rare. The aim of the study was to assess the nutritional status of children with USBS receiving home parenteral nutrition, using citrulline serum concentration and cholestasis.

Methods

We studied 17 patients with USBS, with a median age of 6.6 years and median duration of parenteral nutrition of 6.6 years. The study was carried out at The Children's Memorial Health Institute, Warsaw, from January 2014 to January 2015.

Results

The median standard deviation score (SDS) was ?1.2 for body mass according to chronological age, ?1.72 according to height and ?0.59 according to height for age. Patients requiring seven days per week parenteral nutrition had a citrulline concentration below 10 μmol/L. Decreased bone‐mineral density was observed in 87% of the patients. Low values of 25‐hydroxyvitamin D were found in 53% of the children. None of the patients had elevated conjugated bilirubin levels above 34.2 μmol/L.

Conclusion

Children with USBS were growth deficient according to their chronological age, with frequent abnormal bone mineralisation and vitamin D deficiency. Children requiring parenteral nutrition seven days a week had citrulline concentrations below 10 μmol/L. Cholestasis was not seen.

     

Virus detection in critically ill children with acute respiratory disease: a new profile in view of new technology

Aim

To describe the epidemiology of critically ill children admitted to a paediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analysed for the three most prevalent viruses and in those with and without viral co‐infection.

Methods

Patients admitted to the PICU (2004–2014) with acute respiratory disease were included. Analyses were performed utilising each respiratory viral infection or multiple viral infections as an exposure.

Results

There were 1766 admissions with acute respiratory disease of which 1372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95% CI: 1.06–4.56). Sixty‐three admissions had two or more viruses detected, and the combination of RSV and Rhinovirus/enterovirus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections.

Conclusion

Higher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.

     

Prospective evaluation for respiratory pathogens in children with sickle cell disease and acute respiratory illness

Background

Human rhinovirus (HRV), human coronavirus (hCoV), human bocavirus (hBoV), and human metapneumovirus (hMPV) infections in children with sickle cell disease have not been well studied.

Procedure

Nasopharyngeal wash specimens were prospectively collected from 60 children with sickle cell disease and acute respiratory illness, over a 1‐year period. Samples were tested with multiplexed‐PCR, using an automated system for nine respiratory viruses, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Bordetella pertussis. Clinical characteristics and distribution of respiratory viruses in patients with and without acute chest syndrome (ACS) were evaluated.

Results

A respiratory virus was detected in 47 (78%) patients. Nine (15%) patients had ACS; a respiratory virus was detected in all of them. The demographic characteristics of patients with and without ACS were similar. HRV was the most common virus, detected in 29 of 47 (62%) patients. Logistic regression showed no association between ACS and detection of HRV, hCoV, hBoV, hMPV, and other respiratory pathogens. Co‐infection with at least one additional respiratory virus was seen in 14 (30%) infected patients, and was not significantly higher in patients with ACS (P = 0.10). Co‐infections with more than two respiratory viruses were seen in seven patients, all in patients without ACS. Bacterial pathogens were not detected.

Conclusion

HRV was the most common virus detected in children with sickle cell disease and acute respiratory illness, and was not associated with increased morbidity. Larger prospective studies with asymptomatic controls are needed to study the association of these emerging respiratory viruses with ACS in children with sickle cell disease. Pediatr Blood Cancer 2014;61:507–511. © 2013 Wiley Periodicals, Inc.

     

Treatment of Langerhans cell histiocytosis with a modified risk‐adapted protocol—experience from a tertiary cancer institute in India

Background

Involvement of risk‐organs (RO+) in Langerhans cell histiocytosis (LCH) and inadequate early response identifies patients at high risk for relapse and mortality requiring intensive salvage therapy including stem cell transplant, adding cost and toxicity. To mitigate this, we used a standard induction, augmented with metronomic etoposide, and prolonged maintenance—similarly augmented for RO+, and retrospectively analyzed its impact.

Procedure

LCH patients from 2009 through 2014 were included. Patients received standard vinblastine and prednisolone therapy weekly till week 25 for RO+. Single site (SS) and multisystem (MS) without risk organ involvement (RO?) received 3‐weekly pulses from week 13 till week 25. Maintenance was 3‐weekly vinblastine and 5‐day prednisolone pulses, daily 6‐mercaptopurine (60 mg/m²) and weekly methotrexate (15 mg/m²) for 18 and 9 months for RO+ and MSRO?, respectively. RO+ also received oral etoposide (50 mg/m²) for 21 of every 28‐day cycle for the first year.

Results

Fifty consecutive patients were analyzed. Median age was 36 months (4–189 months). SS, MSRO?, and RO+ were 29 (58%), 12 (24%), and nine (18%), respectively. Four were lost to follow‐up and excluded from further evaluation. On response evaluation at week 6, 24 (52%) had no active disease (NAD), 17 (37%) had AD‐better (where AD is active disease), and one (2%) had AD‐worse. In RO+, eight (66.6%) had AD‐better and three (25%) had NAD. Forty‐five patients had NAD by week 12. Three patients relapsed. With median follow‐up of 39 months (8–84), 5‐year event free survival was 85.6% (RO? and SS), and 100% for RO+. One patient's death in remission from unrelated causes resulted in overall survival of 97%.

Conclusions

RO+LCH receiving oral etoposide augmented induction and maintenance had early and durable responses. Prolonging maintenance lowered reactivation rates in RO+ and RO?LCH, resulting in excellent survival.

     

Perspectives on periviability counselling and decision‐making differed between neonatologists in the United States and the Netherlands

Aim

American guidelines suggest that neonatal resuscitation be considered at 23 weeks of gestation, one week earlier than in the Netherlands, but how counselling practices differ at the threshold of viability is unknown. This pilot study compared prenatal periviability counselling in the two countries.

Methods

In 2013, a cross‐sectional survey was sent to 121 Dutch neonatologists as part of a nationwide evaluation of prenatal counselling. In this pilot study, the same survey was sent to a convenience sample of 31 American neonatologists in 2014. The results were used to compare the organisation, content and decision‐making processes in prenatal counselling at 24 weeks of gestation between the two countries.

Results

The survey was completed by 17 (55%) American and 77 (64%) Dutch neonatologists. American neonatologists preferred to meet with parents more frequently, for longer periods of time, and to discuss more intensive care topics, including long‐term complications, than Dutch neonatologists. Neonatologists from both countries preferred shared decision‐making when deciding whether to initiate intensive care.

Conclusion

Neonatologists in the United States and the Netherlands differed in their approach to prenatal counselling at 24 weeks of gestation. Cross‐cultural differences may play a role.

     

Quality of life in children with retinoblastoma after enucleation in China

Objective

To study the quality of life of Chinese pediatric patients with retinoblastoma (RB) after enucleation and the influencing factors.

Methods

A questionnaire survey was performed on 71 cases of pediatric patients with RB after enucleation and 80 cases of healthy children, using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL? 4.0).

Results

The social dimension scores, school dimension scores, and total scores for the PedsQL? 4.0 among the pediatric patients with RB were statistically significantly lower than those of healthy children. The influencing factors were unilateral/bilateral affected eyes, diagnosis age, and ocular prosthesis satisfaction.

Conclusion

Early discovery, timely treatment, increased eye salvage rate, and cosmetic effects of ocular prosthesis were key factors for increasing the quality of life of pediatric patients with RB. Attention should be paid to the health, social, and school development of pediatric patients with RB.

     

Early risk predictors for impaired numerical skills in 5‐year‐old children born before 32 weeks of gestation

Aim

To unravel risk predictors for impaired numerical skills at 5 years of age in a population‐based cohort of very preterm infants.

Methods

Between January 2003 and August 2006, we prospectively enrolled all infants born in Tyrol with <32 weeks of gestation. A total of 161 of 223 preterm infants (participation rate 72.2%) had a detailed examination at 5 years of age including cognitive assessment (Hannover‐Wechsler Intelligence Test for preschool children, third edition (HAWIVA‐III) or Snijders‐Oomen Nonverbal Intelligence Test (SON‐R)). In 135 children, numerical abilities were assessed with the dyscalculia test TEDI‐MATH. The association between pre‐ and postnatal factors and impaired numerical skills was analyzed by means of logistic regression analysis.

Results

Dyscalculia test showed delayed numerical skills (TEDI‐MATH Sum T‐score <40) in 27 of 135 children tested (20.0%). In half of the children tested, delayed numerical abilities were related to lower IQ scores. Smoking in pregnancy, intracerebral haemorrhage and chronic lung disease were predictive of delayed numerical skills at 5 years of age in the multivariate analysis.

Conclusion

This study identified risk predictors for impaired numerical skills in preterm infants. Our data support the role of both pre‐ and perinatal factors in the evolution of mathematical deficits.

     

Surgical management of children and adolescents with upfront completely resected hepatocellular carcinoma

Background

Hepatocellular carcinoma (HCC) is an aggressive malignant neoplasm that is often chemoresistant. Complete surgical resection remains the mainstay of therapy. The role of liver transplantation (LT) in pediatric HCC is in evolution, as is the role of adjuvant chemotherapy for stage I disease.

Methods

A retrospective review of patients < 18 years of age with completely resected HCC treated with surgical intervention alone at our institution from 2004 to 2015 was conducted.

Results

Twelve patients with a median age of 12 years (range = 1–17; number of females = 7) with upfront resected HCC (Evans stage I) were identified. Four patients had HCC without identifiable risk factors (fibrolamellar‐HCC = 2; early HCC arising in focal nodular hyperplasia = 1, well‐differentiated [wd] HCC = 1). Four patients had early or wd‐HCC in the context of portosystemic shunts (Abernethy = 2; mesocaval shunt and portal vein thrombosis = 2). Four patients had moderate to wd‐HCC in the context of pre‐existing liver disease with cirrhosis (progressive familial intrahepatic cholestasis type‐2 = 2, alpha‐1 antitrypsin deficiency = 1, Alagille syndrome = 1). Seven patients underwent LT (multifocal = 5; solitary = 2); five exceeded Milan criteria (MC) by imaging. Five patients underwent complete resection (segmentectomy = 2; hemihepatectomy = 3). Ten patients received no adjuvant chemotherapy. All patients are alive without evidence of disease with a median follow‐up of 54.1 months (range = 28.1–157.7 months).

Conclusions

Pediatric and adolescent patients with upfront, completely resected HCC can be effectively treated without chemotherapy. LT should be considered for nonmetastatic HCC, especially in the context of pre‐existing chronic liver disease, even when the tumor exceeds MC. Distinct pediatric selection criteria are needed to identify patients most suitable for LT.

     

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants

Aim

Regurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer‐reviewed expert recommendations on their management.

Methods

National and international guidelines and peer‐reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised.

Results

Regurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first‐line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non‐breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation.

Conclusion

By providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.

     

Detection of gastro‐oesophageal reflux in the neonatal unit

Aim

To determine whether a pH probe or multichannel intraluminal impedance (MII) more frequently detected gastro‐oesophageal reflux and test the hypothesis that acid reflux was associated with lower baseline impedance.

Methods

A prospective study of infants in whom reflux was suspected and evaluated using combined pH and multichannel impedance. Studies were considered abnormal if the acid index was >10% or there were >79MII reflux events in 24 hours. The acid index was the percentage of total study time with a pH

Results

Forty‐two infants [median gestational age 31 (range 23–42) weeks] were assessed. Only nine infants (21%) had abnormal studies, seven detected by pH monitoring, one by MII monitoring and one by both techniques (p = 0.04). After correcting for gestational age and post‐natal age, baseline impedance remained negatively correlated with the acid index (r = ?0.34, p = 0.038) and the maximum ACT (r = ?0.44, p = 0.006).

Conclusion

Clinical suspicion of reflux was frequently incorrect, and reflux was more frequently detected by a pH probe. The inverse relationship of acid reflux to baseline impedance suggests that mucosal disruption may result from acid reflux in this population.

     

Sustained participation in annual continuous quality improvement activities improves quality of care for Aboriginal and Torres Strait Islander children

Aim

To determine whether participation in the continuous quality improvement (CQI) Audit and Best Practice for Chronic Disease programme improved care and outcomes for Indigenous children.

Methods

Data were collected from 59 Australian primary health‐care centres providing services to Indigenous people and participating in the programme (February 2008 and December 2013). Indigenous children aged less than 2 years and centres that completed three or more consecutive annual audits within the 6‐year study period were included. Crude and adjusted logistic generalised estimating equation models were used to examine the effect of year of audit on the delivery of care. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Outcomes were related to age‐relevant health issues, including prevention and early intervention. These included administrative, health check, anticipatory guidance and specific health issues.

Results

During the audit period, there were 2360 files from 59 centres. Those that had a recall recorded, improved from 84 to 95% (OR 2.44, 95% CI 1.44–4.11). Hearing assessments improved from 52 to 89% (OR 1.37, 95% CI 1.22–1.54). Improvement in anticipatory guidance, treatment and follow‐up of medical conditions was almost universal.

Conclusion

We documented significant improvements in quality of care of Indigenous children. Outcomes and their corresponding treatment and follow‐ups improved over time. This appears to be related to services participating in annual CQI activities. However, these services may be more committed to CQI than others and therefore possibly better performing.

     

Possible effect of maternal safe food preparation behavior on child malnutrition in Benin,Africa

Background

In many developing countries, faulty complementary feeding practises and frequently contaminated foods are contributing factors to child malnutrition. The aims of this study were to evaluate the nutrition status of, and clarify the maternal safe food preparation behaviors associated with malnutrition in, children aged <5 years in Cotonou, Benin.

Methods

This study targeted 300 mother–child pairs visiting the University Hospital of Mother and Child Cotonou Lagoon. Mothers were interviewed using a structured questionnaire. Child height/length and weight measurements were determined and Z ‐scores were calculated using the 2006 World Health Organization Child Growth Standards. Children with Z ‐score < ?2 were considered to have stunting or be underweight. On logistic regression analysis, significant variables on bivariate analysis, the associations of which were clarified in previous studies, were established as independent variables. Approximately 80% of the children who participated in this study were aged < 1 year. Being underweight was analyzed as a dependent variable.

Results

Regarding nutrition status, 11.0% of the children had stunting and 14.7% were underweight. On logistic regression analysis, underweight was correlated significantly with birthweight. As a remarkable point, food refrigeration was statistically significant. Food refrigeration can possibly be regarded as a maternal safe food preparation behavior.

Conclusions

Maternal safe food preparation behaviors can prevent child malnutrition, even after considering biological and socioeconomic factors.

     

Influence of fitness on health status among survivors of acute lymphoblastic leukemia

Introduction

We aimed to determine the prevalence of self‐reported adverse health status among childhood acute lymphoblastic leukemia (ALL) survivors and to identify associations between components of physical fitness and health status.

Methods

Participants included 365 ALL survivors (mean age at evaluation of 28.6 ± 5.9 years) and 365 age‐, sex‐, and race‐matched community controls. Self‐report of poor general health, poor mental health, functional impairments, and activity limitations were used to describe adverse health status. Fitness was evaluated by assessing flexibility, muscular strength and endurance, peak oxygen uptake, and balance. Generalized linear models were used to examine associations between fitness metrics and health status.

Results

Survivors were more likely than controls to report poor general health (20.6% vs. 10.4%, risk ratio [RR] = 2.0, 95% confidence intervals [CI] = 1.4–2.9), poor mental health (28.0% vs. 14.5%, RR = 1.9, 95% CI = 1.4–2.6), functional impairments (10.5% vs. 4.1%, RR = 2.5, 95% CI = 1.4–4.6), and activity limitations (29.0% vs. 14.4%, RR = 2.0, 95% CI = 1.5–2.7). Survivors whose balance scores were more than 1.5 standard deviations below the mean of the control population were more likely to report poor general health (RR = 1.7, 95% CI = 1.1–2.8), poor mental health (RR = 1.9, 95% CI = 1.3–2.8), and functional limitations (RR = 2.5, 95% CI = 1.2–56). Survivors with low strength were more likely to report poor general health (RR = 1.8, 95% CI = 1.1–3.1), functional impairments (RR = 4.2, 95% CI = 1.7–10.4), and activity limitations (RR = 1.8, 95% CI = 1.2–2.8).

Conclusions

ALL survivors, particularly those with poor balance and reduced muscular strength, are at increased risk for adverse health status.

     

Gender disparities in preterm neonatal outcomes

Aim

From birth to old age, males generally have poorer disease outcomes compared to females. Preterm infants display a marked gender disparity in disease outcomes, and the underlying mechanisms are not well delineated. Our aim was to review the literature on clinical outcomes between preterm infants of different genders and discuss the potential mechanisms underlying the differences observed.

Methods

A literature review was undertaken for experimental and clinical research related to gender differences in preterm outcomes.

Results

Preterm male infants appear to have consistently worse outcomes compared to females, and the aetiology of these differences, while mostly undetermined, is likely multifactorial.

Conclusion

The male disadvantage in preterm outcomes is likely multifactorial with hormonal, genetic and immunological differences likely playing key roles. Gender is an important variable in preterm outcome and should be considered when designing clinical and experimental research.