ABSTRACT
AIM: Children with motor disabilities are at increased risk of compromised bone health. This study evaluated prevalence and risk factors of low bone mass and fractures in these children. METHOD: This cross-sectional cohort study evaluated bone health in 59 children (38 males, 21 females; median age 10 y 11 mo) with motor disability (Gross Motor Function Classification System levels II-V). Bone mineral density (BMD) in the lumbar spine was measured with dual-energy X-ray absorptiometry; BMD values were corrected for bone size (bone mineral apparent density [BMAD]) and skeletal maturity, and compared with normative data. Spinal radiographs were obtained to assess vertebral morphology. Blood biochemistry included vitamin D concentration and other parameters of calcium homeostasis. RESULTS: Ten children (17%) had sustained in total 14 peripheral fractures; lower-limb fractures predominated. Compression fractures were present in 25%. The median spinal BMAD z-score was -1.0 (range -5.0 to 2.0); it was -0.6 in those without fractures and -1.7 in those with fractures (p=0.004). Vitamin D insufficiency was present in 59% of participants (serum 25-hydroxyvitamin D <50 nmol/l) and hypercalciuria in 27%. Low BMAD z-score and hypercalciuria were independent predictors for fractures. INTERPRETATION: Children with motor disability are at high risk of peripheral and vertebral fractures and low BMD. Evaluation of bone health and prevention of osteoporosis should be included in the follow-up.
Subject(s)
Bone Density/physiology , Bone Diseases/diagnostic imaging , Bone Diseases/physiopathology , Disability Evaluation , Movement Disorders/diagnosis , Movement Disorders/physiopathology , Absorptiometry, Photon/instrumentation , Bone Diseases/epidemiology , Child , Cohort Studies , Cross-Sectional Studies , Female , Finland/epidemiology , Fractures, Bone/diagnostic imaging , Fractures, Bone/epidemiology , Humans , Hypercalciuria/epidemiology , Male , Movement Disorders/epidemiology , Osteoporosis/diagnosis , Predictive Value of Tests , Prevalence , Risk Factors , Vitamin D Deficiency/epidemiologyABSTRACT
OBJECTIVE: To evaluate the efficacy of different antipyretic agents and their highest recommended doses for preventing febrile seizures. DESIGN: Randomized, placebo-controlled, double-blind trial. SETTING: Five hospitals, each working as the only pediatric hospital in its region. PARTICIPANTS: A total of 231 children who experienced their first febrile seizure between January 1, 1997, and December 31, 2003. The children were observed for 2 years. INTERVENTIONS: All febrile episodes during follow-up were treated first with either rectal diclofenac or placebo. After 8 hours, treatment was continued with oral ibuprofen, acetaminophen, or placebo. MAIN OUTCOME MEASURE: Recurrence of febrile seizures. RESULTS: The children experienced 851 febrile episodes, and 89 of these included a febrile seizure. Febrile seizure recurrences occurred in 54 of the 231 children (23.4%). There were no significant differences between the groups in the main measure of effect, and the effect estimates were similar, as the rate was 23.4% (46 of 197) in those receiving antipyretic agents and 23.5% (8 of 34) in those receiving placebo (difference, 0.2; 95% confidence interval, -12.8 to 17.6; P = .99). Fever was significantly higher during the episodes with seizure than in those without seizure (39.7 degrees C vs 38.9 degrees C; difference, 0.7 degrees C; 95% confidence interval, -0.9 degrees C to -0.6 degrees C; P < .001), and this phenomenon was independent of the medication given. CONCLUSIONS: Antipyretic agents are ineffective for the prevention of recurrences of febrile seizures and for the lowering of body temperature in patients with a febrile episode that leads to a recurrent febrile seizure.