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Prevalence of retinal hemorrhages in pediatric patients after inhospital cardiopulmonary resuscitation: A prospective study
Edited by Jeffrey N. Bloom, MD
Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. Chalom EC, Goldsmith DP, Koehler MA, eta].* J Rheumatol 1997;24:2031-4. Chronic uveitis has been reported to occur in 13% to 34% of patients with juvenile rheumatoid arthritis (JRA). Previous studies have indicated that up to 38% of patients with JRA-associated uveitis develop severe visual impairment, with visual loss to 20/200 or worse. The authors of this publication investigated the prevalence and outcome of chronic uveitis in JRA by a retrospective analysis of 760 JRA patients followed in four pediatric rheumatology centers, Uveitis was detected in 9.3% of patients, with 15% in the pauciarticular group. This is among the lowest prevalence rates reported for patients with JRA. The authors attributed this finding to several reasons: their cohort was the largest to be analyzed for the prevalence of uveitis; the patient population was diverse; and all degrees of JRA, from mild to severe, were included in this broad primary, not tertiary, care population. The mean interval from the onset of JRAto the onset of uveitis was 21 months, and 90% of the patients who developed uveitis did so within the first 4 years of diagnosis. Patients with visual complications had a shorter interval from onset of JRA to onset of uveitis than did patients without complications. Although 31% of the children with uveitis developed complications (synechiae, band keratopathy, cataract, or glaucoma), only 11% of the uveitis patients had a visual impairment of 20/50 or less, with 5.6% suffering a visual loss to 20/100 or worse in either eye. The prevalence of uveitis was lower in the antinuclear antibody (ANA)-negative group than in the ANA-positive group. However, if uveitis occurred in ANAnegative children, complications were more common. The authors suggested that the low rate of poor visual outcome may have been the result of more aggressive screening, earlier recognition, and more effective management compared with earlier studies. They concluded that the outcome of children with JRA who developed uveitis was excellent, regardless of ANA status, 95% of the time.--JN Bloom
Prevalence of retinal hemorrhages in pediatric patients after inhospital cardiopulmonary resuscitation: A prospective study. Odom A, Christ E, Kerr N, et al. Pediatrics (electronic article) 1997;99:e3.t Child abuse occurs in 1% of children in the United States every year; 10% of the traumatic injuries suffered by children less than 5 years old are nonaccidental, and 5% to 20% of these nonaccidental injuries are fatal. In some cases, particularlythose involving children with the shaken baby syndrome (SBS), obvious signs of physical injury may not exist. Frequently retinal hemorrhages may be the only presenting sign of child abuse. Complicating the interpretation of the finding of retinal hemorrhages is the belief of some physicians that retinal hemorrhages may be the result of chest compressions given during resuscitative efforts. The authors studied the prevalence of retinal hemorrhages after inpatient cardiopulmonary resuscitation
(CPR) in pediatric patients hospitalized for nontraumatic illnesses in an intensive care unit. Forty-three patients with a mean age of 23 months (range 1 month to 15.8 years; 84% less than age 2 years) survived 45 episodes of inpatient CPR (mean duration 16.4 minutes; range 1 to 60 minutes). Ninety-three percent of patients had an elevated prothrombin time or partial thromboplastin time, while 49% were thrombocytopenic. Dilated fundus examinations were performed within 96 hours of the CPR. Small punctate retinal hemorrhages, uncharacteristic of those found in SBS, were detected in only one child who underwent an open chest cardiac massage and had an extensive coagulopathy. The authors concluded that retinal hemorrhages are rarely found after chest compressions in pediatric patients with nontraumatic illnesses, that those retinal hemorrhages that are detected are different in appearance from those noted in SBS, and that retinal hemorrhages do not occur after chest compressions in children with a normal coagulation profile and platelet count.--JN Bloom
Prediction of early-onset esotropia from components of the infantile squint syndrome. *Schor CM, Fusano RE, Wilson N, et al. Invest Ophthalmol Vis Sci 1997;38:719-40. Purpose:To examine the association between components of the infantile squint syndrome (ISS) and age of onset of esotropia among subjects in the Cooperative Amblyopia Classification Study (CACS). Methods: Fifty subjects were classified retrospectively as having early-onset esotropia (EOE) and 150 subjects were classified as having late-onset esotropia (LOE), depending on whether symptoms of (or treatment for) strabismus occurred before the first birthday or between the first and ninth birthdays, respectively. The authors compared the degree to which latent nystagmus (LN), dissociated vertical deviation (DVD), monocular asymmetry of optokinetic nystagmus (MOKN), monocular asymmetry of smooth pursuit (MSP), and perceived monocular speed bias (MSB) predicted EOE. Results: Slow-phase velocity of MOKN and MSP were faster in response to nasal than to temporal target motion. In contrast, MSB revealed that targets of equal velocity were perceived as moving faster temporallythan nasally. The authors evaluated MOKN, MSP, and MSB as dichotomous and as continuous predictors. Dichotomous analysis showed significant associations between DVD and asymmetries of MOKN in the preferred eye of subjects with EOE. Univariate logistic regression models, based on DVD and LN as well as on continuous measures of MOKN, MSP, and MSB, revealed predictive power for all ISS components except LN. In the preferred eye, MSP asymmetry was the strongest single predictor of EOE; multivariate analysis revealed that prediction of EOE improved with the inclusion of DVD. Conclusions: Multivariate analysis indicated that dichotomous measures of DVD and continuous measures of MSP were independent predictors of E0E in a population of 8- to 40-year-old subjects with strabismus. In the preferred eye, MOKN asymmetry was predictive of E0E in the absence of information about MSP. Predictive values of all ISS components depended heavily on the baseline prevalence of E0E in the target population.-Authors'abstract
*Dr. G.F. Keenan,Children's Hospital of Philadelphia, Section of Rheumatology, 34 St. and Civic Center Blvd., Philadelphia, PA 19104. JAAPOS 1998;2:63-4. Copy~ght © 1998 by theAmerican Assochz#onfor Pediatr~ Ophthalmology arm Strab~rmts. 1091-8Y31/98 SY.O0 + 0 75/3/88203
Journal of AAPOS
tThis peer-reviewed article is from Pediatricselectronic pages (www.pediatrics.erg/). *School of Optometry, University of California at Berkeley, 420 Minor Hall, Berkeley CA 94720-2020.
February 1998 65
Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. Chalom EC, Goldsmith DP, Koehler MA, eta].* J Rheumatol 1997;24:2031-4. Chronic uveitis has been reported to occur in 13% to 34% of patients with juvenile rheumatoid arthritis (JRA). Previous studies have indicated that up to 38% of patients with JRA-associated uveitis develop severe visual impairment, with visual loss to 20/200 or worse. The authors of this publication investigated the prevalence and outcome of chronic uveitis in JRA by a retrospective analysis of 760 JRA patients followed in four pediatric rheumatology centers, Uveitis was detected in 9.3% of patients, with 15% in the pauciarticular group. This is among the lowest prevalence rates reported for patients with JRA. The authors attributed this finding to several reasons: their cohort was the largest to be analyzed for the prevalence of uveitis; the patient population was diverse; and all degrees of JRA, from mild to severe, were included in this broad primary, not tertiary, care population. The mean interval from the onset of JRAto the onset of uveitis was 21 months, and 90% of the patients who developed uveitis did so within the first 4 years of diagnosis. Patients with visual complications had a shorter interval from onset of JRA to onset of uveitis than did patients without complications. Although 31% of the children with uveitis developed complications (synechiae, band keratopathy, cataract, or glaucoma), only 11% of the uveitis patients had a visual impairment of 20/50 or less, with 5.6% suffering a visual loss to 20/100 or worse in either eye. The prevalence of uveitis was lower in the antinuclear antibody (ANA)-negative group than in the ANA-positive group. However, if uveitis occurred in ANAnegative children, complications were more common. The authors suggested that the low rate of poor visual outcome may have been the result of more aggressive screening, earlier recognition, and more effective management compared with earlier studies. They concluded that the outcome of children with JRA who developed uveitis was excellent, regardless of ANA status, 95% of the time.--JN Bloom
Prevalence of retinal hemorrhages in pediatric patients after inhospital cardiopulmonary resuscitation: A prospective study. Odom A, Christ E, Kerr N, et al. Pediatrics (electronic article) 1997;99:e3.t Child abuse occurs in 1% of children in the United States every year; 10% of the traumatic injuries suffered by children less than 5 years old are nonaccidental, and 5% to 20% of these nonaccidental injuries are fatal. In some cases, particularlythose involving children with the shaken baby syndrome (SBS), obvious signs of physical injury may not exist. Frequently retinal hemorrhages may be the only presenting sign of child abuse. Complicating the interpretation of the finding of retinal hemorrhages is the belief of some physicians that retinal hemorrhages may be the result of chest compressions given during resuscitative efforts. The authors studied the prevalence of retinal hemorrhages after inpatient cardiopulmonary resuscitation
(CPR) in pediatric patients hospitalized for nontraumatic illnesses in an intensive care unit. Forty-three patients with a mean age of 23 months (range 1 month to 15.8 years; 84% less than age 2 years) survived 45 episodes of inpatient CPR (mean duration 16.4 minutes; range 1 to 60 minutes). Ninety-three percent of patients had an elevated prothrombin time or partial thromboplastin time, while 49% were thrombocytopenic. Dilated fundus examinations were performed within 96 hours of the CPR. Small punctate retinal hemorrhages, uncharacteristic of those found in SBS, were detected in only one child who underwent an open chest cardiac massage and had an extensive coagulopathy. The authors concluded that retinal hemorrhages are rarely found after chest compressions in pediatric patients with nontraumatic illnesses, that those retinal hemorrhages that are detected are different in appearance from those noted in SBS, and that retinal hemorrhages do not occur after chest compressions in children with a normal coagulation profile and platelet count.--JN Bloom
Prediction of early-onset esotropia from components of the infantile squint syndrome. *Schor CM, Fusano RE, Wilson N, et al. Invest Ophthalmol Vis Sci 1997;38:719-40. Purpose:To examine the association between components of the infantile squint syndrome (ISS) and age of onset of esotropia among subjects in the Cooperative Amblyopia Classification Study (CACS). Methods: Fifty subjects were classified retrospectively as having early-onset esotropia (EOE) and 150 subjects were classified as having late-onset esotropia (LOE), depending on whether symptoms of (or treatment for) strabismus occurred before the first birthday or between the first and ninth birthdays, respectively. The authors compared the degree to which latent nystagmus (LN), dissociated vertical deviation (DVD), monocular asymmetry of optokinetic nystagmus (MOKN), monocular asymmetry of smooth pursuit (MSP), and perceived monocular speed bias (MSB) predicted EOE. Results: Slow-phase velocity of MOKN and MSP were faster in response to nasal than to temporal target motion. In contrast, MSB revealed that targets of equal velocity were perceived as moving faster temporallythan nasally. The authors evaluated MOKN, MSP, and MSB as dichotomous and as continuous predictors. Dichotomous analysis showed significant associations between DVD and asymmetries of MOKN in the preferred eye of subjects with EOE. Univariate logistic regression models, based on DVD and LN as well as on continuous measures of MOKN, MSP, and MSB, revealed predictive power for all ISS components except LN. In the preferred eye, MSP asymmetry was the strongest single predictor of EOE; multivariate analysis revealed that prediction of EOE improved with the inclusion of DVD. Conclusions: Multivariate analysis indicated that dichotomous measures of DVD and continuous measures of MSP were independent predictors of E0E in a population of 8- to 40-year-old subjects with strabismus. In the preferred eye, MOKN asymmetry was predictive of E0E in the absence of information about MSP. Predictive values of all ISS components depended heavily on the baseline prevalence of E0E in the target population.-Authors'abstract
*Dr. G.F. Keenan,Children's Hospital of Philadelphia, Section of Rheumatology, 34 St. and Civic Center Blvd., Philadelphia, PA 19104. JAAPOS 1998;2:63-4. Copy~ght © 1998 by theAmerican Assochz#onfor Pediatr~ Ophthalmology arm Strab~rmts. 1091-8Y31/98 SY.O0 + 0 75/3/88203
Journal of AAPOS
tThis peer-reviewed article is from Pediatricselectronic pages (www.pediatrics.erg/). *School of Optometry, University of California at Berkeley, 420 Minor Hall, Berkeley CA 94720-2020.
February 1998 65