Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition

INTRODUCTION@#The growing years are paramount for bone growth and mineral accrual. Children with long-term neurological condition (LTNC) have multiple risk factors for poor bone health and fragility fractures. In Singapore, this has not been studied systematically. Therefore, we aimed to evaluate the risk factors associated with fragility fractures in children with LTNC.@*METHODS@#In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC on follow-up in the paediatric neurology clinic and patients who presented with fracture to the paediatric orthopaedic clinic. Information on patients' demographics, medical history, intervention, biochemical bone markers and fracture history was collected.@*RESULTS@#In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (Gross Motor Function Classification System [GMFCS] V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or were on oral pureed diet. Furthermore, 60% were on anticonvulsants. The fracture rate was 3% in this population and was associated with low-impact activities such as transfer and dressing. Only 7.4% and 33% of the patients had undergone measurements of vitamin D and calcium levels, respectively.@*CONCLUSION@#The local prevalence of fragility fractures in children with LTNC on follow-up at the neurology clinic was found to be 3%. Risk factors identified were limited ambulation and compromised nutritional status associated with feeding difficulty. Recommendations to optimise bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight children, avoiding vitamin D deficiency and ensuring adequate calcium intake.

Diagnóstico de neurodiscapacidad en el periodo neonatal en México, resultados de una encuesta realizada al personal de salud / Neurodisability diagnosis in the neonatal period in Mexico, results of a survey of health personnel

Introducción: En México existe incertidumbre acerca de los recursos humanos y tecnológicos disponibles para el diagnóstico de la neurodiscapacidad, es por eso que el objetivo de este estudio fue conocer la disponibilidad de dichos recursos, así como identificar la existencia de programas para establecer el diagnóstico en el periodo neonatal, en los diferentes centros de trabajo del país. Material y métodos: Durante el XVI Congreso Nacional de Neonatología que celebró la Federación Nacional de Neonatología de México, en febrero de 2011 en Cancún, México, se realizó una encuesta entre los pediatras, neonatólogos, enfermeras y personal de salud del país. Resultados: El 65% respondió que en su lugar de trabajo cuentan con programas de tamizaje para retinopatía del prematuro, sordera, parálisis cerebral, epilepsia y retraso mental; también los encuestados mencionaron tener los siguientes especialistas en sus instituciones: neurólogos, oftalmólogos y personal para la detección de problemas de sordera. Conclusiones: El panorama es sombrío, ya que en todas las áreas de cobertura se reporta menos del 70% de estos recursos. Se hace notar que para la detección de la ceguera y la sordera se cuenta con más recursos disponibles. El resto de los problemas investigados presenta graves indicadores negativos, por lo tanto, es urgente legislar en el campo de acción de la neonatología, cuestionando la eficacia y seguridad de algunos de los tratamientos y su contribución al daño neurológico.

Introduction: In Mexico there is uncertainty about the human and technological resources available for the diagnosis of neurodisability, so the objective of the present study was: to determine the availability of those resources and to identify the existence of programs to establish the diagnosis in the neonatal period, in different workplaces in the country. Material and methods: During the Sixteenth National Congress of Neonatology, held by the National Federation of Neonatology of Mexico, in February 2011 in Cancún, Mexico. It was conducted a survey among pediatricians, neonatologists, nurses, and health personnel working in the country. Results: 65% answered that in their workplace have screening programs for: retinopathy of prematurity, deafness, cerebral palsy, mental retardation epilepsy, also the respondents mentioned that count with the following specialists at their institutions: neurologists, ophthalmologist and personal for the detection of deafness. Conclusions: The picture is bleak; in all areas reported coverage less than 70%. It is noted that for detection of blindness and deafness there are more resources available. The rest of the problems investigated have severe negative indicators. So it is urgent to legislate currently in the field of neonatology, questioning the efficacy and safety of some treatments and their contribution to neurological damage.