Strokes in children: a systematic review.

CONTEXT: Pediatric strokes lead to significant morbidity and mortality. To date, no systematic review has been available to guide the initial diagnostic approach to pediatric stroke. OBJECTIVE: The objective of this review was to elucidate the current data regarding etiologies of stroke in children and then develop an initial diagnostic evaluation for the pediatric patient presenting to the emergency department with a stroke. DATA SOURCE: Using the PubMed engine, the MEDLINE database was searched using the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guidelines. STUDY SELECTION: The inclusion and exclusion criteria were established a priori. Studies must have extractable data regarding first strokes in pediatric patients with clear diagnostic categories. DATA EXTRACTION: A standardized tool was developed to extract demographic data and stroke etiologies. RESULTS: Twelve studies were found that met the inclusion criteria. From these studies, a total of 1455 children aged between 21 days and 20 years were available to assess the etiologies of stroke. CONCLUSIONS: In pediatric patients, the etiologies of stroke are varied and differ for children with ischemic stroke versus hemorrhagic stroke. With the present systematic review, a guide to the initial evaluation of stroke is presented.

A retrospective review of newborn screening for congenital hypothyroidism and newborn thyroid disease at a major medical center.

Objective. To study the frequency of congenital hypothyroidism (CH)/thyroid disorders at a major, urban medical center. Methods. We conducted a retrospective review of a preexisting database for 2007 to 2011. Infants were classified as having CH, secondary/tertiary hypothyroidism, thyroid-binding globulin deficiency, and other types of newborn thyroid dysfunctions. Results. A total of 353 (50%) abnormal newborn screens were found to be normal and 42% were abnormal on repeat. Of the latter, 14% had true CH, 1% had thyroid-binding globulin deficiency, and 27% had other causes of thyroid dysfunction. The 5-year incidence of CH at NYP Morgan Stanley Children's Hospital was significantly greater than in New York City, New York State, and Upstate New York. Conclusion. The incidence of CH and other thyroid dysfunctions were greater in our population for 2007 to 2010, after which there was an unexplained decline. The study underlines the importance of continued newborn screening for thyroid dysfunction.