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Rokkanen R, Aarnivala H, Pokka T, Niinimäki R. Chemotherapy-related toxicities follow a typical pattern in children treated for acute lymphoblastic leukaemia. Acta Paediatr 2024; 113:1103-1111. [PMID: 38178211 DOI: 10.1111/apa.17092] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
AIM Acute lymphoblastic leukaemia (ALL) therapy has been associated with a significant burden of toxicities. The aim of this study was to describe the full spectrum of toxic effects associated with childhood ALL. METHODS Toxicity-related data were collected from the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-2008 toxicity registry, in which data on 19 clinically relevant toxicities were registered during ALL treatment, and from patient medical records. All patients treated according to the NOPHO ALL-2008 protocol in Oulu University Hospital between 2008 and 2020 were included in the study. RESULTS The cohort consisted of 73 patients, 38 of whom were male. Mean age at diagnosis was 6.6 ± 4.2 (range 1.4-16.0) years. All but one of the patients developed at least one treatment-related toxicity and more than half had multiple toxicities. Female sex and older age were associated with a higher tendency towards toxicity. The most common toxicity was vincristine-induced peripheral neuropathy, which was observed in 70 patients. Most toxicities were moderate or severe, but even mild toxicities often affected leukaemia treatment. CONCLUSION Moderate and severe treatment-related toxicities are common, and most toxicities occur in a typical pattern in relation to the treatment phases.
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Affiliation(s)
- Roosa Rokkanen
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Henri Aarnivala
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Riitta Niinimäki
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
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Sievänen H, Kari J, Aarnivala H, Becker S, Huurre A, Långström S, Palmu S. Success and complications in lumbar punctures of pediatric patients with leukemia: a study protocol for a randomized clinical crossover trial of a bioimpedance needle system versus conventional procedure. Trials 2023; 24:464. [PMID: 37475006 PMCID: PMC10360266 DOI: 10.1186/s13063-023-07498-4] [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: 08/31/2022] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children. At present, the long-term survival from pediatric ALL is well over 90%. However, the probability of event-free survival is reduced if the lumbar puncture (LP) procedures at the beginning of the patient's intrathecal therapy cause blood leakage into the spinal canal and blast cells contaminate the cerebrospinal fluid. According to the literature, such traumatic LP procedures concern one out of five pediatric patients with ALL. Recently, a novel medical device measuring the tissue bioimpedance at the tip of a spinal needle was found feasible in pediatric patients with ALL. The LP procedure was successful at the first attempt in 80% of procedures, and the incidence of traumatic LPs was then 11%. The purpose of the present study is to compare the bioimpedance spinal needle system with the standard clinical practice resting on a conventional spinal needle and investigate its efficacy in clinical practice. METHODS The study is a multicenter, randomized, two-arm crossover noninferiority trial of pediatric hemato-oncology patients that will be conducted within the usual clinical workflow. Patients' LP procedures will be performed alternately either with the IQ-Tip system (study arm A) or a conventional Quincke-type 22G spinal needle (study arm B). For each enrolled patient, the order of procedures is randomly assigned either as ABAB or BABA. The total number of LP procedures will be at least 300, and the number of procedures per patient between two and four. After each study LP procedure, the performance will be recorded immediately, and 1-week diary-based and 4-week record-based follow-ups on symptoms, complications, and adverse events will be conducted thereafter. The main outcomes are the incidence of traumatic LP, first puncture success rate, and incidence of post-dural puncture headache. DISCUSSION The present study will provide sound scientific evidence on the clinical benefit, performance, and safety of the novel bioimpedance spinal needle compared with the standard clinical practice of using conventional spinal needles in the LP procedures of pediatric patients with leukemia. TRIAL REGISTRATION ISRCTN ISRCTN16161453. Registered on 8 July 2022.
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Affiliation(s)
| | | | - Henri Aarnivala
- Department of Pediatric Hematology and Oncology, Oulu University Hospital, Oulu, Finland
| | - Stefan Becker
- Department of Pediatric Hematology and Oncology, Kuopio University Hospital, Kuopio, Finland
| | - Anu Huurre
- Department of Pediatric and Adolescent Hematology and Oncology, Turku University Hospital, Turku, Finland
| | - Satu Långström
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Sauli Palmu
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.
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Launonen AM, Vuollo V, Aarnivala H, Heikkinen T, Pirttiniemi P, Valkama AM, Harila V. A longitudinal study of facial asymmetry in a normal birth cohort up to 6 years of age and the predisposing factors. Eur J Orthod 2023:7111788. [PMID: 37036798 PMCID: PMC10389059 DOI: 10.1093/ejo/cjad012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVES This prospective, population-based cohort study aimed to investigate the development of facial asymmetry up to 6 years of age using a three-dimensional (3D) soft tissue imaging method in a normal population. In addition, the study sought to identify potential predisposing factors to facial asymmetry. METHODS A total of 102 newborns were enrolled in the study at birth. 3D stereophotogrammetric images of the head and face were analysed at the ages of 12 months (T1), 3 years (T2), and 6 years (T3). The surface-based analysis involved the calculation of the average distance (mm) and the symmetry percentage (%) between the original and mirrored surfaces. For landmark-based analysis, the distance of facial landmarks to the facial midline was examined. RESULTS The final analysis included 70 (68.6%) subjects. Surface-based analysis showed a significant improvement of facial symmetry from T1 to T3 in all facial areas. Landmark-based analysis showed that upper facial landmarks were located, on average, slightly on the left and lower facial landmarks slightly on the right in relation to the facial midline (P < 0.001). LIMITATIONS The size of the study population was limited. Facial posture may affect the reliability of the results, especially in younger children. CONCLUSION Facial asymmetry is detectable in early childhood and tends to reduce with age in young children. The lower face deviates slightly to the right, and the upper face to the left in relation to the facial midline. Possible predisposing factors for facial asymmetry at the age of 6 years include deformational plagiocephaly, sleeping position, and previous facial asymmetry.
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Affiliation(s)
- Anniina M Launonen
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu, Finland
| | - Ville Vuollo
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu, Finland
| | - Henri Aarnivala
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Group, Oulu, Finland
| | - Tuomo Heikkinen
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu, Finland
| | - A Marita Valkama
- Medical Research Center Oulu, Oulu, Finland
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Group, Oulu, Finland
| | - Virpi Harila
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu, Finland
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Pöyry H, Aarnivala H, Huhtamäki H, Pokka T, Renko M, Valmari P, Tapiainen T. Parental Ability to Assess Pediatric Vital Signs. J Pediatr 2023; 252:177-182.e2. [PMID: 35973446 DOI: 10.1016/j.jpeds.2022.08.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate parents' ability to accurately assess their child's heart and respiratory rates (RRs) in the context of potential utility for telehealth visits. STUDY DESIGN In this controlled study of 203 child-parent pairs, parents measured their child's heart rate (HR) using 4 methods: palpation, auscultation, and 2 photoplethysmographic smartphone applications. Parents measured RR by inspecting the child and tapping the smartphone application. The gold standards were electrocardiogram for the HR and the child's breaths measured by a health care professional for 60 seconds for the RR. We plotted the measurements using a Bland-Altman plot with 95% limits of agreement. RESULTS Parents underestimated HR by palpation with a calculated bias of -18 beats per minute (bpm) (SD, 19), with limits of agreement ranging from -56 to 19 bpm. Parents overestimated and underestimated HR by auscultation with limits of agreement ranging from -53 to 46 bpm. Smartphone applications did not improve the accuracy of measurements. The accuracy of parental RR measurements was low. For young children, bias was -0.8 breaths per minute (brpm) (SD, 9.8) with limits of agreement from -20 to 19 brpm, and for older children, bias was 0.9 brpm (SD 7.4) with limits of agreement from 6 to 15 brpm. The sensitivity of parental subjective opinion to recognize accelerated RR was 37% (95% CI, 25%-51%). CONCLUSION Parents were not able to assess their child's RR or HR accurately. Digital remote assessment of children should not rely on parental measurements of vital signs.
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Affiliation(s)
- Hilla Pöyry
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland.
| | - Henri Aarnivala
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland
| | - Heikki Huhtamäki
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland
| | - Marjo Renko
- Department of Pediatrics, The University of Eastern Finland and Kuopio University Hospital, Finland
| | - Pekka Valmari
- Department of Pediatrics, Lapland Central Hospital, Rovaniemi, Finland
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland; Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland; Biocenter Oulu, University of Oulu, Finland.
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Aarnivala H, Tapiainen T, Peltoniemi O, Niinimäki R. Intrathecal tobramycin and pausing induction chemotherapy for pediatric acute lymphoblastic leukemia facilitate successful management of disseminated Pseudomonas aeruginosa infection and meningitis. Pediatr Blood Cancer 2021; 68:e28928. [PMID: 33522127 DOI: 10.1002/pbc.28928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Henri Aarnivala
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital and PEDEGO Unit, University of Oulu, Oulu, Finland
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital and PEDEGO Unit, University of Oulu, Oulu, Finland
| | - Outi Peltoniemi
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital and PEDEGO Unit, University of Oulu, Oulu, Finland
| | - Riitta Niinimäki
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital and PEDEGO Unit, University of Oulu, Oulu, Finland
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Launonen AM, Aarnivala H, Kyteas P, Vuollo V, Heikkinen T, Kau CH, Pirttiniemi P, Harila V, Valkama AM. A 3D Follow-Up Study of Cranial Asymmetry from Early Infancy to Toddler Age after Preterm versus Term Birth. J Clin Med 2019; 8:jcm8101665. [PMID: 31614700 PMCID: PMC6832468 DOI: 10.3390/jcm8101665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 11/16/2022] Open
Abstract
Preterm infants are at higher risk for both symmetrical and asymmetrical head molding. This study involved 3D stereophotogrammetry to assess the cranial growth, molding, and incidence of deformational plagiocephaly (DP) in preterm children compared to term born children. Thirty-four preterm infants and 34 term born controls were enrolled in this study from Oulu University Hospital, Finland. Three-dimensional head images were obtained at the age of 2–4 months (T1), 5–7 months (T2), 11–13 months (T3), and 2.5–3 years (T4) from the term equivalent age (TEA). There was no statistically significant difference in oblique cranial length ratio (OCLR), cephalic index (CI), or weighted asymmetry score (wAS) between the two groups. Occipital flattening, defined by flatness score (FS) was statistically significantly greater in the preterm group than in the term group at T1–T4 (p < 0.05). In both groups, OCLR improved gradually over time. There were no instances, in either group, of severe DP and no moderate DP after T2. Results indicate that DP affects preterm and full-term children almost equally during the first three years of life, and cranial asymmetry resolves at a similar rate in both preterm and term groups after three months of corrected age. Preterm infants present with more occipital flattening than full-term children.
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Affiliation(s)
- Anniina M Launonen
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland.
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, Oulu, Finland.
| | - Henri Aarnivala
- Medical Research Center Oulu, Oulu, Finland.
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
- PEDEGO Research Group, University of Oulu, Oulu, Finland.
| | - Panagiotis Kyteas
- Department of Orthodontics, University of Alabama, Birmingham, AL 35294-0007, USA.
| | - Ville Vuollo
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland.
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, Oulu, Finland.
| | - Tuomo Heikkinen
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland.
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, Oulu, Finland.
| | - Chung H Kau
- Department of Orthodontics, University of Alabama, Birmingham, AL 35294-0007, USA.
| | - Pertti Pirttiniemi
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland.
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, Oulu, Finland.
| | - Virpi Harila
- Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland.
- Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, Oulu, Finland.
| | - A Marita Valkama
- Medical Research Center Oulu, Oulu, Finland.
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
- PEDEGO Research Group, University of Oulu, Oulu, Finland.
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Aarnivala H, Vuollo V, Heikkinen T, Harila V, Holmström L, Pirttiniemi P, Valkama AM. Accuracy of measurements used to quantify cranial asymmetry in deformational plagiocephaly. J Craniomaxillofac Surg 2017; 45:1349-1356. [PMID: 28615136 DOI: 10.1016/j.jcms.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/10/2016] [Revised: 04/24/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Various measurements are used to quantify cranial asymmetry in deformational plagiocephaly (DP), but studies validating cut-off values and comparing the accuracy of such measurements are lacking. In this study, we compared the accuracy of four different measurements in classifying children with and without DP diagnosed by visual assessment, and sought to determine their optimal cut-off values. STUDY DESIGN Two experts rated 407 3D craniofacial images of children aged between 3 and 36 months old using the Argenta classification. We then measured the following asymmetry-related variables from the images: Oblique Cranial Length Ratio (OCLR), Diagonal Difference (DD), Posterior Cranial Asymmetry Index (PCAI), and weighted Asymmetry Score (wAS). We created receiver operating characteristic curves to evaluate the accuracy of these variables. RESULTS All variables performed well, but OCLR consistently provided the best discrimination in terms of area under the curve values. Subject's age had no clear effect on the cut-off values for OCLR, PCAI, and wAS; however, the cut-off for DD increased monotonically with age. When subjects with discrepant expert ratings were excluded, the optimal cut-off values for DP (Argenta class ≥ 1) across all age-groups were 104.0% for OCLR (83% sensitivity, 97% specificity), 10.5% for PCAI (90% sensitivity, 90% specificity), and 24.5 for wAS (88% sensitivity, 90% specificity). CONCLUSION We recommend using OCLR as the primary measurement, although PCAI and wAS may also be useful in monitoring cranial asymmetry. The threshold of relative asymmetry required for a deformation to appear clinically significant is not affected by the child's age, and DD has no additional utility in monitoring DP compared to using only OCLR.
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Affiliation(s)
- Henri Aarnivala
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland; PEDEGO Research Group, University of Oulu, Oulu, Finland.
| | - Ville Vuollo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland; Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Tuomo Heikkinen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Lasse Holmström
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Medical Research Center Oulu, University of Oulu, Oulu, Finland; Department of Orthodontics, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - A Marita Valkama
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland; PEDEGO Research Group, University of Oulu, Oulu, Finland
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Aarnivala H, Vuollo V, Harila V, Heikkinen T, Pirttiniemi P, Holmström L, Valkama AM. The course of positional cranial deformation from 3 to 12 months of age and associated risk factors: a follow-up with 3D imaging. Eur J Pediatr 2016; 175:1893-1903. [PMID: 27624627 DOI: 10.1007/s00431-016-2773-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 05/26/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
Deformational plagiocephaly is reported in up to 46.6 % of healthy infants, with the highest point prevalence at around 3 months of age. Few prospective studies on the natural course of skull deformation have been conducted, and we know of no studies using 3D imaging starting from the highest point prevalence period. In this prospective, population-based cohort study, we describe the course of cranial asymmetry and shape in an unselected population using 3D stereophotogrammetry and investigate factors associated with late cranial deformation and failure to recover from previous deformation. We evaluated 99 infants at 3, 6, and 12 months of age. We acquired 3D craniofacial images and performed structured clinical examinations and parental interviews at each visit. Eight outcome variables, representing different aspects of cranial shape, were calculated from a total of 288 3D images. Scores of asymmetry-related variables improved throughout the observation period. However, the rate of correction for cranial asymmetry decreased as the infants grew older, also in relation to the rate of head growth, and a significant amount of asymmetry was still present at 12 months. Positional preference at 3 months predicted an unfavorable course of cranial asymmetry after 3 months, increasing the risk for DP persisting. What is known: • The prevalence of deformational plagiocephaly spontaneously decreases after the first months of life. • Limited neck range of motion and infant positional preference increase the risk of deformational plagiocephaly during the first months of life. What is new: • Positional preference at 3 months predicts an unfavorable spontaneous course of deformation also from three to 12 months of age, presenting a potential target for screening and treatment. • The spontaneous rate of correction for cranial asymmetry decreases after 6 months of age, also in relation to the rate of head growth.
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Affiliation(s)
- Henri Aarnivala
- Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland. .,Medical Research Center Oulu, University of Oulu, Oulu, Finland. .,PEDEGO Research Group, University of Oulu, Oulu, Finland.
| | - Ville Vuollo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Tuomo Heikkinen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Lasse Holmström
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - A Marita Valkama
- Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland.,PEDEGO Research Group, University of Oulu, Oulu, Finland
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Vuollo V, Holmström L, Aarnivala H, Harila V, Heikkinen T, Pirttiniemi P, Valkama AM. Analyzing infant head flatness and asymmetry using kernel density estimation of directional surface data from a craniofacial 3D model. Stat Med 2016; 35:4891-4904. [PMID: 27383684 DOI: 10.1002/sim.7032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 02/10/2016] [Revised: 05/11/2016] [Accepted: 06/13/2016] [Indexed: 11/12/2022]
Abstract
Infant skull deformation is analyzed using the distribution of head normal vector directions computed from a 3D image. Severity of flatness and asymmetry are quantified by functionals of the kernel estimate of the normal vector direction density. Using image data from 99 infants and clinical deformation ratings made by experts, our approach is compared with some recently suggested methods. The results show that the proposed method performs competitively. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ville Vuollo
- Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland. .,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland. .,Department of Mathematical Sciences, University of Oulu, Oulu, Finland.
| | - Lasse Holmström
- Department of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Henri Aarnivala
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.,Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Group, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Tuomo Heikkinen
- Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Pertti Pirttiniemi
- Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Arja Marita Valkama
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.,Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Group, University of Oulu, Oulu, Finland
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