Characteristics and outcome of brachial plexus birth palsy in neonates

Aim: To relate pregnancy characteristics to extent and reversibility of brachial plexus birth palsy (BPBP) in neonates. Methods: Retrospective case–control study: newborns with a registered diagnosis of BPBP (n = 168) 1990–2005 were compared to data from a randomly selected control group (n = 1000). Characteristics were related to the level of injury, reversibility and outcome. Results: Among 51 841 newborns, 168 cases with BPBP were found (incidence 3.2/1000 newborns/year). Extent and reversibility of lesion did not differ with respect to characteristics of mothers, foetuses or deliveries. Children with C5–C6 and C5–C6–C7 injuries had complete recovery in 86% and 38%, respectively. Global injuries (C5‐Th1) always had permanent disability. Accelerators (foetal weight gain >35 g/day after 32 weeks of gestation) and foetuses with estimated weight deviation ≥ +22% at 32 weeks were at seven‐ and ninefold increased risk of BPBP. Parous women were at doubled risk as compared to nulliparous women. Conclusion: Maternal and foetal characteristics influence risk of BPBP, but not the extent of injury or reversibility of injury. Because of the high risk of permanent disability and modest risk of low Apgar or pH among newborns with BPBP, the recommendation of prompt delivery may need to be re‐evaluated.     

Exploring consensus in practice with youth who are sexually abusive: findings from a Delphi study of practitioner views in the United Kingdom and the Republic of Ireland

This article presents the findings of a study exploring current levels of consensus among practitioners in the United Kingdom (UK) and the Republic of Ireland (ROI) about good practice in relation to youth who are sexually abusive. A three-stage Delphi procedure was used to survey the views of 78 practitioners, experienced in this field, on a range of matters relating to preferred responses to this population. The exercise indicated high levels of agreement that youth who are sexually abusive should be seen as a group clinically distinct from adult sex offenders and that all of their developmental needs, and their problematic behavior, should be targeted in intervention. A strong level of consensus was found among respondents about the goals and content of ideal practice with this user group, although there was less consensus about the theoretical models that should underpin practice.     

Childhood head injury: causes,outcome, and outcome predictors

Head injury is the most common cause of death following trauma among children in most developed and underdeveloped countries. Management of the head-injured child remained conservative in the hands of the general and orthopedic surgeons until October 2000 in our center. To determine outcome and outcome-predictors in children managed nonoperatively for head injury in Ilorin, Nigeria, a 10-year retrospective study of children managed for head injury was done. Outcome was measured by Glasgow outcome scoring. Clinical variables including age, gender, and postresuscitation Glasgow coma score were tested against Glasgow outcome score by linear regression analysis. During the study period (1989-1999), 267 children (173 males and 94 females) aged 16 years and below with head injuries were admitted. Their injuries were due mostly to road traffic accidents (64.1%) and falls (30.7%). Other injuries were domestic, sport-related, or due to assaults or the fall of collapsed walls, water-pots, and coconut shells on victims' heads. Head injuries were isolated in 60% of patients but associated with skeletal, facial, and spinal injuries in 58, 18, and seven cases, respectively. They were mild in 100 (37.5%), moderate in 73 (27.3%), but severe in 94 (35.2%) cases. Outcome was good in 207 (77.5%) but fatal in 38 (14.2%) children. Only age (p=0.0206) and coma score (p=0.0000), but not gender (p= 0.3043), could predict outcome. Outcome was good in more than 75% of cases of head-injured children managed nonoperatively. It varied with the patient's age and postresuscitation Glasgow coma score.     

Cerebral palsy in Victoria, Australia: mortality and causes of death

OBJECTIVE: To study the causes of death and the characteristics of children with cerebral palsy that had died over a 25-year period in Victoria, Australia. METHODOLOGY: Names of children that had died were collected from the Victorian Cerebral Palsy Register. Their hospital records were studied and information was gathered about age of death, motor impairment, the presence or absence of associated disabilities and cause of death. RESULTS: One hundred and fifty-five children had died during the period 1970-95. The majority of children had severe spastic quadriplegia, intellectual disability and epilepsy. The predominant cause of death was pneumonia, although for many children who died at home the cause was unknown. CONCLUSIONS: Children with cerebral palsy are a diverse group and those with a severe motor deficit have a reduced life expectancy. Lung disease remains an important cause of morbidity and mortality for this group. Further information about the causes of death is needed, particularly for those children that die at home.     

Development of pediatric pulmonology in the United Kingdom, Europe, and Australasia

The organization of medicine in Europe, the UK and the Commonwealth countries was always much less formal than in the USA for many years and pediatricians interested in pediatric lung disease and asthma often started off as adult internists or specialists in adult pulmonary medicine. The early leaders in developing a special interest in the breathing of children during the 1940s and 1950s were predominantly physiologists and clinicians who began to apply physiological techniques to the study lung function in healthy and sick infants and children. A major contribution to our understanding of the epidemiology of wheezing in children was the early establishment of a cohort study in Australia which is still yielding important information. It was during the early 1970s that pediatric pulmonary "politics" began to emerge in the UK when pediatricians interested in lung diseases began to arrange an informal society and meet regularly under the auspices of the British Paediatric Association. In fairly characteristic fashion, pulmonology in Europe was represented for a while by several different societies but due to the efforts of some dedicated enthusiasts there finally emerged the Paediatric Assembly of the European Respiratory Society (ERS) and its first Head, Max Zach, went to become President of the ERS itself. Despite some early doubts abut the future for pediatric pulmonology as a specialty in Europe and Australasia it is clearly flourishing as shown by the rising membership of the professional societies and the constant stream of high quality basic science and clinical publications.     

Congenital heart disease: incidence and inheritance

Congenital heart disease occurs in approximately 1 per cent of liveborn children, but in a much higher percentage of those aborted spontaneously or stillborn. To detect as many as possible with CHD, including those with mild lesions, very intensive studies are needed. Studies that are not so intensive, especially those done before modern diagnostic techniques were in general use, considerably underestimated the incidence of CHD in liveborn children. It appears that the incidence of CHD and of the various individual lesions does not differ in different countries or at different times, providing the ascertainment of CHD is complete and accurate. The commonest form of CHD is the ventricular septal defect, which occurs in 30 to 40 per cent of all children with CHD. The risks of recurrence in siblings and of transmission to future generations depends on the exact mode of inheritance involved. Approximately 5 to 8 per cent of CHD is due to gross chromosomal abnormalities, and the recurrence risk is that of the chromosomal derangement itself. Because many children with these chromosomal lesions die in infancy or have reduced fertility, the risk to future generations is relatively low. About 3 per cent of CHD is due to classical Mendelian gene effects, with correspondingly high recurrence risks in first-degree relatives. Most CHD has lower risks of recurrence and transmission than those predicted by Mendelian single-gene action. The popular explanation for their inheritance has been the interaction of polygenic effects and the environment, but recent studies of the recurrence and transmission risks of various forms of CHD do not fit this model well. The alternative model is a single gene defect modulated by random events. The recurrence risks for future siblings are 2 to 6 per cent, and for offspring are 1 to 10 per cent, but in a few families the recurrence and transmission risks may be much higher.     

Obstetrical brachial plexus palsy: an analysis of 105 cases

Obstetrical brachial plexus palsy (OBPP) remains a dramatic consequence after complicated childbirth. An increasing number of methods are being developed for the physical therapy and the early repair of the nerve lesions in OBPP, including neuroma excision and nerve grafting, neurolysis and neurotization. Secondary deformities of the shoulder, forearm, and hand can be reconstructed using soft tissue and skeletal procedures. In this article we analyze our approach to 105 patients to obtain optimal functional outcome in patients with OBPP.