ABSTRACT
OBJECTIVE: To collect normal data on blood pressure (BP) in healthy children aged 4-8 and to compare measurements of BP made in the same subjects with a sphygmomanometer and a portable automated oscillometric BP monitor (Omron HEM 711 with child cuff). METHODS: Cross-sectional observational study of 764 children. BP measurements were made at school, using both a sphygmomanometer and an Omron HEM 711. Immediately after the BP measurement children were asked to state which device they preferred (if any). RESULTS: Children had no preference for whether the sphygmomanometer or the Omron was used. Bland-Altman plots showed a lack of consistency between the two methods of BP measurement. With systolic BP there was a trend for the Omron to underestimate when low and overestimate when high. CONCLUSIONS: Children were equally distributed in their preference for BP device. There was a wide variation between the two methods of BP measurement, which suggests that comparison of automated BP measurements with normative data obtained by sphygmomanometer is not valid.
Subject(s)
Blood Pressure Determination/instrumentation , Blood Pressure , Blood Pressure Determination/methods , Child , Child, Preschool , Consumer Behavior , Cross-Sectional Studies , Humans , Oscillometry/instrumentation , Reference Values , Reproducibility of Results , SphygmomanometersABSTRACT
The lower leg length velocity (LLLV) of 14 children with a median age of 4.5 yr who were undergoing chemotherapy (CT) for acute lymphoblastic leukaemia (ALL) was studied for a median duration of 56 weeks (range 14-112). Nine children were studied over the first 6 months, six over the first year, four over the full 2-year course and nine children over the 3 months before and after the end of CT. Over the first month of CT, during induction, median LLLV was 0 mm/wk (P5, P95: -1.6, 0.11); during the fourth month of CT, at the end of CNS-directed therapy, there was a significant rise to 0.38 mm/wk (P5, P95: -0.04, 0.81; p = 0.01, WSR). In the children measured following the end of CT, median LLLV rose from 0.46 mm/wk (P5, P95: -0.02, 0.79) in month 23 to 0.84 mm/wk (P5, P95: 0.72, 1.12) (p = 0.03). There was a positive relationship between neutrophil count and LLLV during continuation chemotherapy (r = 0.4, p = 0.0002); median LLLV was 0.2 mm/ wk (P5, P95: -0.15, 0.5) when the neutrophil count was less than 1 x 10(9)/l and 0.65 mm/wk (P5, P95: 0.1, 1.0) (p = 0.01) when the count was above 1 x 10(9)/l. No significant differences in LLLV were observed between children randomised to different UKALLXI regimens. Intensive chemotherapy for ALL adversely affects lower leg growth. Growth was subnormal during the first few weeks of chemotherapy, but was comparable to healthy children during CNS directed and continuation therapy. There was a significant relationship between growth velocity and neutrophil count during continuation chemotherapy. On discontinuation of chemotherapy there was a further acceleration in lower leg length velocity to supranormal levels ("catch-up" growth).
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Growth/drug effects , Leg/growth & development , Precursor Cell Lymphoblastic Leukemia-Lymphoma/physiopathology , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Body Weights and Measures , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Leukocyte Count , Longitudinal Studies , Male , Neutrophils/drug effects , Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Remission Induction , Time FactorsABSTRACT
As the knemometer is increasingly being used to study changes in lower leg length in conditions associated with weight changes it is important to clearly delineate the relationship between these two variables. Lower leg length and weight were measured in 26 children and nine adults including one pregnant woman. There was a weak but positive relationship between lower leg length and weight fluctuation in children. Daily fluctuations in weight as well as lower leg length were higher in women than men; median lower leg length fluctuation: women, 0.16 mm (P5-0, P95-0.7); men, 0.1 mm (P5-0, P95-0.48) p approximately 0.02, Wilcoxon signed-rank test. Median weight fluctuation: women 0.15 kg (P5-0, P95-0.54); men, 0.1 kg (P5-0, P95-0.5) p = 0.94 (Wilcoxon signed-rank test). Sustained weight gain in pregnancy led to a reduction in lower leg length followed by an increase which was coincident with the appearance of dependent oedema. Lower leg length changes are likely to be positively related to changes in weight when the latter are only modest in magnitude. However, greater sustained increases in weight are likely to have an opposite effect on lower leg length due to direct compression of the lower leg. Due consideration of weight is essential in longitudinal studies of lower leg length changes, especially in conditions which are associated with significant changes in weight.
Subject(s)
Body Weight/physiology , Leg/anatomy & histology , Adult , Age Factors , Child , Child, Preschool , Female , Humans , Leg/growth & development , Longitudinal Studies , Male , Pregnancy , Reproducibility of Results , Sex Factors , Time FactorsABSTRACT
The consequences in later life for people whose growth in childhood has been restricted can be profound, often with severe emotional or psychological effects. The author defines the causes of short stature and describes clinical trials being undertaken to evaluate the use of growth hormone in children who do not appear to have growth hormone deficiency.
