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Romeo DM, Pironi V, Velli C, Sforza E, Rigante D, Giorgio V, Leoni C, De Rose C, Kuczynska EM, Limongelli D, Ruiz R, Agazzi C, Mercuri E, Zampino G, Onesimo R. Ligamentous laxity in children with achondroplasia: Prevalence, joint involvement, and implications for early intervention strategies. Eur J Med Genet 2024; 68:104930. [PMID: 38428804 DOI: 10.1016/j.ejmg.2024.104930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/30/2023] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
Achondroplasia (ACH), the most common form of skeletal dysplasia, is characterized by severe disproportionate short stature, rhizomelia, exaggerated lumbar lordosis, brachydactyly, macrocephaly with frontal bossing and midface hypoplasia. Ligamentous laxity has been reported as a striking feature of ACH, but its prevalence and characteristics have not been systematically evaluated yet. There is growing evidence that ligamentous laxity can be associated with chronic musculoskeletal problems and may affect motor development leading to abnormal developmental trajectories. This study aimed to assess the prevalence of ligamentous laxity in children with ACH through standardized tools, the Beighton scale and its modified version for preschool-age children. A total of 33 children (mean age 6.4 ± 3.2 years; age range 1-12.5 years) diagnosed with ACH by the demonstration of a pathogenic variant in the FGFR3 gene and 33 age- and sex-matched healthy controls were included in the study. Both ligamentous laxity assessment and neurological examinations were performed; medical history was also collected from caregivers. Children with ACH showed a 2 times higher risk of ligamentous laxity than the group without skeletal dysplasia (OR = 2.2; 95% CI = 1.0 to 4.7), with 55% of children meeting the diagnostic criteria for hypermobility. No significant difference in ligamentous laxity was observed between males and females. Joint involvement analysis revealed characteristic patterns, with knee hypermobility observed in 67% of patients, while rare was elbow hypermobility. Longitudinal assessments indicated a decreasing trend in ligamentous laxity scores over time, suggesting a potential decrease in hypermobility issues during adulthood. The findings of this study provide valuable insights into the prevalence and characteristics of ligamentous laxity in ACH. Implementation of standardized ligamentous laxity assessments might guide patients' follow-up and facilitate early interventions, helping to prevent pain and improve outcomes and quality of life for such patients. Further prospective studies are needed to explore the natural history of ligamentous laxity in ACH and investigate the potential impact of emerging pharmacological treatments upon hypermobility.
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Affiliation(s)
- Domenico Marco Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A, Gemelli, IRCCS, 00168, Rome, Italy.
| | - Virginia Pironi
- Child Neurology and Psychiatry Unit, AUSL della Romagna, Ospedale Infermi, Rimini, Italy; Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
| | - Chiara Velli
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | | | - Donato Rigante
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Valentina Giorgio
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
| | - Cristina De Rose
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
| | - Eliza Maria Kuczynska
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
| | | | - Roberta Ruiz
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | | | - Eugenio Mercuri
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Agostino Gemelli IRCCS, 00168, Rome, Italy.
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168, Roma, Italy.
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Romeo DM, Velli C, Sini F, Pede E, Cicala G, Cowan FM, Ricci D, Brogna C, Mercuri E. Neurological assessment tool for screening infants during the first year after birth: The Brief-Hammersmith Infant Neurological Examination. Dev Med Child Neurol 2024. [PMID: 38287208 DOI: 10.1111/dmcn.15871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/31/2024]
Abstract
AIM To develop a short version of the original Hammersmith Infant Neurological Examination (HINE) to be used as a screening tool (Brief-HINE) and to establish if the short examination maintains good accuracy and predictive power for detecting infants with cerebral palsy (CP). METHOD Eleven items were selected from the original HINE ('visual response'; 'trunk posture'; 'movement quantity'; 'movement quality'; 'scarf sign'; 'hip adductor angles'; 'popliteal angle'; 'pull to sit'; 'lateral tilting'; 'forward parachute reaction'; 'tendon reflexes') identifying those items previously found to be more predictive of CP in both low- and high-risk infants. In order to establish the sensitivity of the new module, the selected items were applied to existing data, previously obtained using the full HINE at 3, 6, 9, and 12 months, in 228 infants with typical development at 2 years and in 82 infants who developed CP. RESULTS Brief-HINE scores showed good sensitivity and specificity, at each age of assessment, for detecting infants with CP. At 3 months, a score of less than 22 was associated with CP with a sensitivity of 0.88 and a specificity of 0.92; at 6, 9, and 12 months, the cut-off scores were less than 25 (sensitivity 0.93; specificity 0.87), less than 27 (sensitivity 0.95; specificity 0.81), and less than 27 (sensitivity 1; specificity 0.86) respectively. The presence of more than one warning sign, or items that are not optimal for the age of assessment, imply the need for a full examination reassessment. INTERPRETATION These findings support the validity of the Brief-HINE as a routine screening method and the possibility of its use in clinical practice.
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Affiliation(s)
- Domenico M Romeo
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Chiara Velli
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Sini
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Pede
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Graziamaria Cicala
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Daniela Ricci
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients-International Agency for the Prevention of Blindness (IAPB) Italia Onlus, Rome, Italy
| | - Claudia Brogna
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
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Romeo DM, Moro M, Pezone M, Venezia I, Mirra F, De Biase M, Polo A, Turrini I, Lala MR, Velli C, Sini F, Dragone D, Mercuri E, Brogna C. Relationship and New Prospectives in Joint Hypermobility in Children with Autism Spectrum Disorder: Preliminary Data. J Pers Med 2023; 13:1723. [PMID: 38138950 PMCID: PMC10744756 DOI: 10.3390/jpm13121723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Autism spectrum disorder (ASD) and joint hypermobility (JH) are considered two different etiological and clinical entities that most often appear in childhood. Despite growing increased research showing a co-occurrence for both conditions, a link between them is rarely established in clinical settings, and the relationship between ASD and JH has not so far been completely investigated in all age groups of ASD children. This preliminary study examined a cohort of 67 non-syndromic ASD children aged 2-18 years (sex ratio M:F = 12:1) showing different degrees of cognitive impairment and autism severity, using the Beighton scale and its revised version. A total of 63% of ASD patients aged 2-4 years and 73% of ASD patients aged ≥5 years presented significant scores of hypermobility. No significant correlation was found comparing total laxity score and cognitive assessments and severity of autistic symptomatology (p > 0.05). The results suggest that JH could be considered as a clinical characteristic of ASD patients and it needs to be assessed in order to schedule a better rehabilitation program.
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Affiliation(s)
- Domenico Marco Romeo
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | - Marianna Moro
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Mariangela Pezone
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Ilaria Venezia
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Federica Mirra
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Margherita De Biase
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Agnese Polo
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Ida Turrini
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | - Maria Rosaria Lala
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
| | - Chiara Velli
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | - Francesca Sini
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | | | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
| | - Claudia Brogna
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.R.); (M.M.); (M.P.); (I.V.); (F.M.); (M.D.B.); (A.P.); (E.M.)
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (I.T.); (C.V.); (F.S.)
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Luciano R, Romeo DM, Mancini G, Sivo S, Dolci C, Velli C, Turriziani Colonna A, Vento G, Romagnoli C, Mercuri EM. Response to the comment on: "neurological development and iron supplementation in healthy late-preterm neonates: a randomized double-blind controlled trial". Eur J Pediatr 2023; 182:2933-2934. [PMID: 37000257 DOI: 10.1007/s00431-023-04928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Rita Luciano
- Department of Woman and Child Health and Public Health, Neonatology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, University of Sacred Heart, Largo Agostino Gemelli, 8 - 00168, Child Health Area, Catholic, Rome, Italy.
| | | | - Giuseppina Mancini
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - Serena Sivo
- Pediatric Neurology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Carolina Dolci
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - Chiara Velli
- Pediatric Neurology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Arianna Turriziani Colonna
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Neonatology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, University of Sacred Heart, Largo Agostino Gemelli, 8 - 00168, Child Health Area, Catholic, Rome, Italy
| | - Costantino Romagnoli
- Department of Woman and Child Health and Public Health, Neonatology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Child Health Area, Rome, Italy
| | - Eugenio Maria Mercuri
- Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, University of Sacred Heart, Child Health Area, Rome, Catholic, Italy
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Romeo DM, Venezia I, De Biase M, Sini F, Velli C, Mercuri E, Brogna C. The Use of the 6MWT for Rehabilitation in Children with Cerebral Palsy: A Narrative Review. J Pers Med 2022; 13:jpm13010028. [PMID: 36675689 PMCID: PMC9863513 DOI: 10.3390/jpm13010028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Assessing and improving walking abilities is considered one of the most important functional goals of physical therapy in children with cerebral palsy. However, there is still a gap in knowledge regarding the efficacy of treatment targeting the walking capacity of children with CP, as well as their responsiveness to the treatment. The 6 min walk test (6MWT) is a reliable tool to measure this function in children with CP, although less has been known about its potential efficacy to assess changes in the walking abilities associated with interventions. The aim of the present narrative review is to increase the amount of knowledge regarding the use of the 6MWT as a reliable measure to evaluate the effect of interventions on walking capacity in children with CP.
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Affiliation(s)
- Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630156307; Fax: +39-0630154363
| | - Ilaria Venezia
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Margherita De Biase
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Sini
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Chiara Velli
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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Romeo DM, Apicella M, Velli C, Brogna C, Ricci D, Pede E, Sini F, Coratti G, Gallini F, Cota F, Bovis F, Vento G, Mercuri E. Hammersmith Infant Neurological Examination in low-risk infants born very preterm: a longitudinal prospective study. Dev Med Child Neurol 2022; 64:863-870. [PMID: 35298030 DOI: 10.1111/dmcn.15201] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 12/11/2022]
Abstract
AIM To describe the profile of global and single items of the Hammersmith Infant Neurological Examination (HINE) in a population of low-risk infants born very preterm during the first year of life. METHOD The HINE was performed at 3, 6, 9, and 12 months' corrected age in a population of low-risk infants born preterm with a gestational age of fewer than 32 weeks and with normal or minimal changes on neuroimaging. RESULTS A total of 174 infants born preterm (96 males, 78 females; mean gestational age = 27 weeks [SD = 1.8], range 23-31 weeks) fulfilled the inclusion criteria. The 10th centile cut-off score with median and range was reported for the HINE global and subsection scores. A progressive increase in global HINE scores was observed. Most of the single items, especially those related to tone, posture, and reflexes, showed progressive maturation. INTERPRETATION Our results, which provide longitudinal data for single-item and global scores in a population of low-risk infants born very preterm, can be used as a reference in both clinical and research settings to monitor early neurological signs in these infants. These data could be used as normative data when examining low-risk infants born preterm.
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Affiliation(s)
- Domenico M Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Massimo Apicella
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Chiara Velli
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Daniela Ricci
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients-International Agency for the Prevention of Blindness Italia ONLUS, Rome, Italy
| | - Elisa Pede
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Francesca Sini
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Giorgia Coratti
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Francesca Gallini
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
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7
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Luciano R, Romeo DM, Mancini G, Sivo S, Dolci C, Velli C, Turriziani Colonna A, Vento G, Romagnoli C, Mercuri EM. Neurological development and iron supplementation in healthy late-preterm neonates: a randomized double-blind controlled trial. Eur J Pediatr 2022; 181:295-302. [PMID: 34291331 PMCID: PMC8760203 DOI: 10.1007/s00431-021-04181-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
Late-preterm infants (LPT) are at increased risk for long-term neurodevelopmental sequelae and iron deficiency. The aim of the study is to assess the positive effect of iron supplementation on psychomotor development in healthy LPT. We designed a randomized placebo-controlled double-blind trial dividing the newborns into two groups. Every patient was assessed using the Griffiths Mental Development Scales (GMDS)-II edition at 12-month post-conceptional age. The study was performed at the Neonatology Unit of our Hospital, in Italy. Sixty-six healthy LPT infants born between 340⁄7 and 366⁄7 weeks of gestational age were enrolled in the study. One group received martial prophylaxis from the third week of life to 6 months of post-conceptional age (2 mg/kg/day of iron pidolate), the other received placebo. Fifty-two of the enrolled infants were assessed using the GMDS at 12-month of post-conceptional age. Statistical analysis of the mean scores of the Griffiths subscales was performed. There was a difference in the mean developmental quotient (DQ) (p < 0.01) between the two groups: iron group mean DQ 121.45 ± 10.53 vs placebo group mean DQ 113.25 ± 9.70. Moreover, mean scores of the Griffiths subscales A, B, and D showed significant differences between the two groups (scale A p < 0.05, scale B p < 0.02, scale D p < 0.01, respectively).Conclusions: We recommend that all LPT neonates receive iron supplementation during the first 6 months of life in order to improve their 1-year neurodevelopmental quotient. What is Known: • Late-preterm infants (LPT) are at increased risk for long-term neurodevelopmental sequelae and also for iron deficiency. • Iron deficiency is an independent risk factor for adverse neurological outcomes. What is New: • Healthy late-preterm who received iron supplementation during the first 6 months of life achieved better neurological outcomes at 12-month post-conceptional age than LPT who received placebo. • Our study strongly supports the need for the implementation of martial prophylaxis in LPT neonates.
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Affiliation(s)
- R. Luciano
- Neonatology Unit, Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - D. M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - G. Mancini
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - S. Sivo
- Pediatric Neurology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - C. Dolci
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - C. Velli
- Pediatric Neurology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - A. Turriziani Colonna
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - G. Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - C. Romagnoli
- Neonatology Unit, Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - E. M. Mercuri
- Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
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Romeo DM, Velli C, Lucibello S, Ferrantini G, Leo G, Brogna C, Cota F, Ricci D, Gallini F, Romagnoli C, Vento G, Mercuri E. Joint Laxity in Preschool Children Born Preterm. J Pediatr 2018; 197:104-108. [PMID: 29650414 DOI: 10.1016/j.jpeds.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/27/2017] [Accepted: 02/01/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the prevalence of joint laxity in children born preterm assessed in the first 2 years, the relationship between joint laxity and motor performance at preschool age, and possible changes over time in a subgroup of children followed longitudinally. STUDY DESIGN The revised scale of Beighton Score was used to evaluate joint laxity in a population of 132 preschool children born preterm between 24 and 32 weeks of gestational age. All were assessed for joint laxity between 12 and 24 months of age. Children also performed the Movement Assessment Battery for Children-Second Edition between the age of 3 years and 6 months and 4 years; the age at onset of independent walking also was recorded. RESULTS The total Beighton Score ranged between 0 and 8. Twenty percent of the cohort showed joint laxity. No differences related to sex or gestational age were observed. Children born preterm with joint laxity achieved later independent walking and achieved lower scores on Movement Assessment Battery for Children-Second Edition than those without joint laxity. In 76 children born preterm, an assessment for joint laxity was repeated once between 25 and 36 months and again after >36 months. No statistically significant difference was observed between the 3 assessments. CONCLUSIONS The Beighton Score can be used to assess generalized joint laxity in children born preterm. As the presence of joint laxity influenced motor competences, the possibility to early identify these infants in the first 2 years is of interest to benefit from early intervention and potentially improve gross motor skills and coordination.
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Affiliation(s)
- Domenico M Romeo
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Chiara Velli
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Simona Lucibello
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Gloria Ferrantini
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Giuseppina Leo
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Daniela Ricci
- National Centre of Services and Research for Prevention of Blindness and Rehabilitation of Visually Impaired, Rome, Italy
| | - Francesca Gallini
- Neonatal Intensive Care Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Costantino Romagnoli
- Neonatal Intensive Care Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
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9
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Sgandurra G, Olivieri I, Casarano M, DI Pietro R, Menici V, Velli C, Sini F, Lucibello S, Romeo DM, Cioni G, Battini R. Inter and intra-rater reliability and minimal detectable difference of Movement Disorder-Childhood Rating Scale. Eur J Phys Rehabil Med 2017; 54:48-57. [PMID: 28714297 DOI: 10.23736/s1973-9087.17.04661-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Movement Disorder-Childhood Rating Scales (MD-CRS) have been designed in two forms (0-3 and 4-18 years) to accurately evaluate various movement disorders in children. AIM The aim of this study is to evaluate the MD-CRS reliability when used by clinicians and professionals of rehabilitation after a one-day training on scoring it. DESIGN This is a measurement-focused study of video-recorded sessions. SETTING Video session carried out inpatient and outpatient. POPULATION Children with different types of movement disorders. METHODS After brief training in scoring MD-CRS, five health professionals (a resident doctor, a child neurologist and three physical therapists) independently scored 40 patient videotapes, of children with movement disorders for inter-rater reliability. In addition, the resident doctor scored 80 videos of 40 patients evaluated twice for intra-rater reliability. Reliability was assessed by Intraclass Correlation Coefficient (ICC) and was calculated separately for the two forms of the scale and for each score (Index I, Index II and Global Index). Standard Error of Measurement (SEM) and Minimal Detectable Difference (MDD) were also calculated. RESULTS For both forms, inter-rater reliability of Global Index and Index I were good with an ICC ranged between 0.83 and 0.95. Instead, results of Index II were substantially moderate for both forms, with an ICC of 0.53 and 0.57, respectively. Intra-rater reliability for all Indexes in both forms was substantial or almost perfect, with values of ICCs ranging from 0.74 to 0.99. MDD values were between 0.05 and 0.17. CONCLUSIONS MD-CRS 0-3 and MD-CRS 4-18 remain reliable clinical measurement tools for evaluation of movement disorders in developmental age when used by clinicians and professionals of rehabilitation after a specific short training. CLINICAL REHABILITATION IMPACT MD-CRS 0-3 and MD-CRS 4-18 appear to be a promising outcome measurement tool in large scale studies with children and adolescents affected by various movement disorders either to verify natural history of the disorder or to plan pharmacological and/or surgical intervention programs.
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Affiliation(s)
- Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Olivieri
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Manuela Casarano
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Roberta DI Pietro
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Valentina Menici
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Chiara Velli
- Department of Child Neurology and Psychiatry, Fondazione Policlinico Universitario A. Gemelli, Sacro Cuore Catholic University, Rome, Italy
| | - Francesca Sini
- Department of Child Neurology and Psychiatry, Fondazione Policlinico Universitario A. Gemelli, Sacro Cuore Catholic University, Rome, Italy
| | - Simona Lucibello
- Department of Child Neurology and Psychiatry, Fondazione Policlinico Universitario A. Gemelli, Sacro Cuore Catholic University, Rome, Italy
| | - Domenico M Romeo
- Department of Child Neurology and Psychiatry, Fondazione Policlinico Universitario A. Gemelli, Sacro Cuore Catholic University, Rome, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy -
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10
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Romeo DM, Lucibello S, Musto E, Brogna C, Ferrantini G, Velli C, Cota F, Ricci D, Mercuri E. Assessing Joint Hypermobility in Preschool-Aged Children. J Pediatr 2016; 176:162-6. [PMID: 27339250 DOI: 10.1016/j.jpeds.2016.05.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/12/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To provide a revision of the Beighton score adapted for children younger than the age of 5 years, to apply the revised version in a cohort of preschool age children, and to verify the reliability of the revised version in a cohort of preschool children with genetic syndromes associated with hypermobility. STUDY DESIGN The revised Beighton score was applied in a population of preschool children to evaluate joint hypermobility in 5 parts of the body, bilaterally (passive dorsiflexion of the fifth finger; passive hyperextension of the elbow; passive hyperextension of the knee; passive apposition of the thumb to the flexor side of the forearm; passive dorsiflexion of the ankle joint). The frequency distribution of the total scores was calculated with a range between 0 and 10. RESULTS A total of 284 healthy preschool children (146 boys and 138 girls) and 26 preschool children with genetic disorders (15 boys and 11 girls) were assessed. Mean age was 33.6 ± 12.7 months. A score ≤4 was found in more than 90% of the whole cohort; therefore, a cut-off score >4 was used to identify hypermobility. Twenty-two of the 284 (7%) healthy children and 23 of the 26 children (89%) with genetic syndromes associated with hypermobility had a score >4. The joints reporting a greater incidence of hypermobility were "apposition of the thumb to the forearm" and "passive dorsiflexion of the ankle," in 34% and 22% respectively. No differences related to sex or age were observed. CONCLUSIONS The revised version of the Beighton score can be used to define generalized hypermobility for children up to 5 years of age and to assess and follow-up longitudinally patients with isolated hypermobility or those in whom the laxity is associated with other clinical features.
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Affiliation(s)
| | | | - Elisa Musto
- Pediatric Neurology Unit, Catholic University Rome, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Catholic University Rome, Rome, Italy; Unit of Child and Adolescent NeuroPsychiatry, Laboratory of Molecular Psychiatry and Neurogenetics, University "Campus Bio-Medico," Rome, Italy
| | | | - Chiara Velli
- Pediatric Neurology Unit, Catholic University Rome, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Catholic University Rome, Rome, Italy
| | - Daniela Ricci
- Pediatric Neurology Unit, Catholic University Rome, Rome, Italy; National Centre of Services and Research for Prevention of Blindness and Rehabilitation of Visually Impaired, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Catholic University Rome, Rome, Italy
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