Characteristics of infants with positional abnormal head shapes and their physiotherapy service at an Australian community health facility

Purpose: There is limited biographic information regarding infants presenting with abnormal head shape in Australia and little discussion of the effect of different cutoff values for diagnosis of plagiocephaly. This study aimed to 1) describe the biographic characteristics of infants with positional abnormal head shapes referred for physiotherapy management; 2) explore their access to physiotherapy services and intervention outcomes; and 3) explore the impact of using different modified Cranial Vault Asymmetry Index (mCVAI) cutoff points in plagiocephaly classification.Patients and methods: This retrospective community health record audit included the total cohort of infants referred over concerns about abnormal head shape to a pediatric physiotherapy service at a community health center in Australia from January 2004 to December 2007 (N=126 valid cases). Data retrieved included: demographic data; birth history; positioning; initial physiotherapy assessment; and factors associated with physiotherapy intervention and outcomes.Results: Of the 126 charts (65 males), 106 infants (84.1%) presented with plagiocephaly, ten (7.9%) with brachycephaly, and ten (7.9%) with combined deformities. Most biographic data from this study were similar to those reported in the literature. The mean age +/- standard deviation (SD) of infants at referral was 11.29 +/- 7.84 weeks, with about 4-weeks wait for assessment. For the plagiocephalic group, there was significant reduction in mCVAI mean value from assessment (- 5.44%+/- 2.95%) to discharge (-4.41%+/- 2.66%) (t([df= 60]) =-5.396; 95% confidence interval [CI]: -1.66%, -0.76%;

A clinical tool to measure plagiocephaly in infants using a flexicurve: a reliability study

Purpose: There has been an increasing incidence of infants presenting with plagiocephaly in the last two decades. A practical, economical, and reliable clinical plagiocephaly measure is essential to assess progression and intervention outcomes. This study investigated the reliability of a modified cranial vault asymmetry index using a flexible curve in infants.Measurement: A flexicurve was molded to the infant's head and its shape maintained as it was placed onto paper to trace the head shape. Using a small modification of Loveday and De Chaplain's procedure to measure a cranial vault asymmetry index, a pair of diagonals were drawn at 30 degrees through the midpoint of the central line to their intersection with the traced head outline. The difference in length of the paired diagonals was divided by the short diameter then multiplied by 100%, yielding the modified cranial vault-asymmetry index.Patients and methods: Infants referred to a community health physiotherapist for assessment due to suspected abnormal head shape were included. To explore intrarater reliability, 34 infants aged 3-14 months were measured twice (T-1/T-1') at the beginning, and 21 of these remeasured twice at the end (T-2/T-2') of their physiotherapy sessions. Test-retest reliability used matchedaverage data (T1/T1') and (T2/T2') from 21 infants. To explore interrater reliability, 18 healthy infants aged 2-6 months were recruited. Each infant was measured once by each rater.Results: For intrarater reliability, the intraclass correlation coefficient with 54 degrees of freedom (ICCdf54) was 0.868 (95% confidence interval [CI] 0.783-0.921); for test-retest reliability, ICCdf20 = 0.958 (95% CI 0.897-0.983); and for interrater reliability, ICCdf17 = 0.874 (95% CI 0.696-0.951).Conclusion: The modified cranial vault asymmetry index using flexicurve in measuring plagiocephaly is a reliable assessment tool. It is economical and efficient for use in clinical settings

Impact of parent practices of infant positioning on head orientation profile and development of positional plagiocephaly in healthy term infants

The influence of infant positioning on the development of head orientation and plagiocephaly is not clear. This study explored the relationship between infant body and head positioning, with the development of asymmetrical head orientation and/or positional plagiocephaly.\ua0Methods: Clinician measurement of head orientation profile and parent-reported infant positioning data were collected for 94 healthy term infants at 3, 6, and 9 weeks of age. Plagiocephaly was measured at 9 weeks with the modified Cranial Vault Asymmetry Index.More severe plagiocephaly was associated with longer supine-sleep-maximum (p = 0.001) and longer supine-lying-total (p = 0.014) at 6 weeks. Prone positioning was not associated with plagiocephaly. Parent-reported head asymmetry during awake and sleep time at 3 weeks identified infants with clinician-measured head asymmetry at 9 weeks. Better symmetry in head turning was associated with more side-lying-total time by 9 weeks (p = 0.013).Our results showed that infant positioning is associated with early head orientation and plagiocephaly development. Early parent-reported asymmetry during awake and sleep time is an important indicator for the need for professional assessment and advice. A Plagiocephaly Prevention Strategy and Plagiocephaly Screening Pathway are provided for clinicians and parents

Nasal high flow in room air for hypoxemic bronchiolitis infants

Background: Bronchiolitis is the most common reason for hospital admission in infants, with one third requiring oxygen therapy due to hypoxemia. It is unknown what proportion of hypoxemic infants with bronchiolitis can be managed with nasal high-flow in room air and their resulting outcomes. Objectives and Settings: To assess the effect of nasal high-flow in room air in a subgroup of infants with bronchiolitis allocated to high-flow therapy in a recent multicenter randomized controlled trial. Patients and Interventions: Infants allocated to the high-flow arm of the trial were initially treated with room air high-flow if saturations were ≥85%. Subsequently, if oxygen saturations did not increase to ≥92%, oxygen was added and FiO2 was titrated to increase the oxygen saturations. In this planned sub-study, infants treated during their entire hospital stay with high-flow room air only were compared to infants receiving either standard-oxygen or high-flow with oxygen. Baseline characteristics, hospital length of stay and length of oxygen therapy were compared. Findings: In the per protocol analysis 64 (10%) of 630 infants commenced on high-flow room air remained in room air only during the entire stay in hospital. These infants on high-flow room air were on average older and presented with moderate hypoxemia at presentation to hospital. Their length of respiratory support and length of stay was also significantly shorter. No pre-enrolment factors could be identified in a multivariable analysis. Conclusions: In a small sub-group of hypoxemic infants with bronchiolitis hypoxemia can be reversed with the application of high-flow in room air only

Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children (Review)

Background - Mycoplasma pneumoniae (M. pneumoniae) is widely recognised as an important cause of community-acquired lower respiratory tract infection (LRTI) in children. Pulmonary manifestations are typically tracheobronchitis or pneumonia but M. pneumoniae is also implicated in wheezing episodes in both asthmatic and non-asthmatic individuals. Although antibiotics are used to treat LRTIs, a review of several major textbooks offers conflicting advice for using antibiotics in the management of M. pneumoniae LRTI in children. Objectives - To determine whether antibiotics are effective in the treatment of childhood LRTI secondary to M. pneumoniae infections acquired in the community. Search methods - We searched CENTRAL (2014, Issue 3), MEDLINE (1966 to July week 4, 2014), EMBASE (1980 to July, 2014), and both WHO ICTRP and ClinicalTrials.gov (13 August 2014). Selection criteria - Randomised controlled trials (RCTs) comparing antibiotics commonly used for treating M. pneumoniae (i.e. macrolide, tetracycline or quinolone classes) versus placebo, or antibiotics from any other class in the treatment of children under 18 years of age with community-acquired LRTI secondary to M. pneumoniae. Data collection and analysis - The review authors independently selected trials for inclusion and assessed methodological quality. We extracted and analysed relevant data separately and resolved disagreements by consensus. Main results - A total of 1912 children were enrolled from seven studies. Data interpretation was limited by the inability to extract data that referred to children with M. pneumoniae. In most studies, clinical response did not differ between children randomised to a macrolide antibiotic and children randomised to a non-macrolide antibiotic. In one controlled study (of children with recurrent respiratory infections, whose acute LRTI was associated with Mycoplasma, Chlamydia or both, by polymerase chain reaction and/or paired sera) 100% of children treated with azithromycin had clinical resolution of their illness compared to 77% not treated with azithromycin at one month. Authors' conclusions - There is insufficient evidence to draw any specific conclusions about the efficacy of antibiotics for this condition in children (although one trial suggests macrolides may be efficacious in some children with LRTI secondary to Mycoplasma). The use of antibiotics has to be balanced with possible adverse events. There is still a need for high quality, double-blinded RCTs to assess the efficacy and safety of antibiotics for LRTI secondary to M. pneumoniae in children

Positional plagiocephaly is associated with sternocleidomastoid muscle activation in healthy term infants

Purpose: To explore the relationship between sternocleidomastoid activation and positional plagiocephaly in healthy full term infants. Methods: Participants were 82 infants from a regionally based-longitudinal study of infant development. Sternocleidomastoid (SCM) activation was assessed using active head-righting responses of body-on-head with and against gravity and head-on-body against gravity at 3, 6 and 9\ua0weeks. Plagiocephaly was assessed using the Modified Cranial Vault Asymmetry Index (mCVAI) at 9\ua0weeks. Results: More severe plagiocephaly was associated with more severe asymmetry in active head-righting responses at all ages (p\ua

Measuring Middle Ear Admittance in Newborns Using 1000 Hz Tympanometry: A Comparison of Methodologies

The present study aimed to compare three measures to estimate middle ear admittance in neonates using 1000 Hz tympanometry. Data were obtained from 36 full-term newborns, aged between 24 and 123 hours, who passed a transient evoked otoacoustic emissions test and assessed using a Madsen Otoflex impedance meter. The results showed that the mean middle ear admittances obtained by compensating for the susceptance and conductance components at a pressure of 200 daPa and -400 daPa (Y-CC200 = 1.00 mmho and YCC-400 = 1.24 mmho, respectively) were significantly greater than that using the traditional baseline compensation method (Y-BC = 0.65 mmho). Although Y-CC400 has attained the highest mean value, it has the lowest test-retest reliability. Hence, the component compensation approach compensated at 200 daPa holds promise as an alternative method for estimating middle ear admittance in neonates. Further research to evaluate its test performance using clinical decision theory is required to determine its clinical significance

High frequency (1000 HZ) tympanometry findings in newborns: Normative data using a component compensated admittance approach

Recently clinicians have started to use a new approach, called the component compensation method, to evaluate middle ear function in newborn babies using high frequency (1000 Hz) tympanometry. The present study aimed to establish tympanometric normative data using this new method. Participants were 157 normal, healthy, full-term newborn babies with chronological age between 1 and 8 days. Normative data showing the 90 % range for tympanometric peak pressure, admittance at 200 daPa, uncompensated peak admittance, component compensated static admittance (YCC) and traditional baseline compensated static admittance (YBC) are provided. The results showed no significant gender and ear asymmetry effects, nor their interactions with any of the test parameters studied. YCC had a significantly higher mean value than YBC (1.02 ±0.46 versus 0.66 ±0.34 mmho). Given that ears with middle ear dysfunction often show severely reduced admittance values, the higher mean admittance result obtained from normal ears using the new method suggests that this method has the potential to better separate normal from abnormal admittance results. Furthermore, this method is mathematically sound since it takes into account the phase difference between admittance quantities when a 1000 Hz probe tone is used

High frequency immittance findings: Newborn versus six-week-old infants

This study aimed to compare the high frequency (1 kHz) tympanometry (HFT) and acoustic reflex (AR) measures obtained from infants at birth and at 6-7 weeks of age. HFT results and AR thresholds using a 2-kHz tone and broadband noise activators were obtained from 42 healthy full-term neonates (15 boys and 27 girls) at both test sessions, separated by six weeks. The results showed that the mean values of HFT test parameters and AR thresholds obtained at 6-7 weeks were generally greater than those obtained at birth. In particular, the differences in mean values of uncompensated admittance at 200 daPa, uncompensated peak admittance, uncompensated peak susceptance, peak-compensated static admittance, and AR thresholds with a 2 kHz tone and broadband noise were found to be statistically significant. The findings from this study suggest the need to have separate sets of normative LIFT and AR data for infants at birth and 6-7 weeks