Detecting anemia earlier in children using a smartphone

Researchers at UCL and University of Ghana have successfully predicted whether children have anemia using only a set of smartphone images.

The study, published in PLOS ONE, brought together researchers and clinicians at UCL Engineering, UCLH and Korle Bu Teaching Hospital, Ghana, to investigate a new non-invasive diagnostic technique using smartphone photographs of the eye and face.

The advance could make anemia screening more widely available for children in Ghana (and other low- and middle-income countries) where there are high rates of the condition due to iron deficiency, as the screening tool is much cheaper than existing options and delivers results in one sitting.

The paper builds on previous successful research undertaken by the same team exploring use of an app—neoSCB—to detect jaundice in newborn babies.

Anemia is a condition causing a reduced concentration of hemoglobin in the blood, which means oxygen is not transported efficiently around the body.

It affects two billion people globally and can have a significant impact on developmental outcomes in children, increasing their susceptibility to infectious diseases and impairing their cognitive development.

The most common cause of anemia globally is iron deficiency, but other conditions such as blood loss, malaria and sickle-cell disease also contribute.

First author, Ph.D. candidate Thomas Wemyss (UCL Medical Physics & Biomedical Engineering) said, "Smartphones are globally popular, but research using smartphone imaging to diagnose diseases shows a general trend of experiencing difficulty when transferring results to different groups of people.

"We are excited to see these promising results in a group which is often underrepresented in research into smartphone diagnostics. An affordable and reliable technique to screen for anemia using a smartphone could drive long-term improvements in quality of life for a large amount of people."

Traditionally, diagnosis of anemia requires blood samples to be taken, which can be costly for patients and health care systems. It can create inequalities related to the expense of traveling to hospital for a blood test. Often families need to make two trips, to have a blood sample taken and then to collect their results, due to samples being transported between the clinic and the laboratory for analysis.

In the 1980s a handheld device, the HemoCue, was developed to provide more immediate results, but this carries significant upfront and ongoing costs, as well as still needing a finger-prick blood sample.

The researchers knew that hemoglobin has a very characteristic color due to the way it absorbs light, so aimed to develop a procedure to take smartphone photographs and use them to predict whether anemia is present.

They analyzed photos taken from 43 children aged under four who were recruited to take part in the study in 2018. The images were of three regions where minimal skin pigmentation occurs in the body (the white of the eye, the lower lip and the lower eyelid).

The team found that when these were evaluated together to predict blood hemoglobin concentration, they were able to successfully detect all cases of individuals with the most severe classification of anemia, and to detect milder anemia at rates which are likely to be clinically useful.

Principal investigator Dr. Terence Leung (UCL Medical Physics & Biomedical Engineering) said, "Since 2018, we've been working with University of Ghana on affordable ways to improve health care using smartphones. Following our success in screening neonatal jaundice, we are so excited to see that the smartphone imaging technique can also apply to anemia screening in young children and infants."

Senior author Dr. Judith Meek (UCLH) added, "Anemia is a significant problem for infants, especially in low- and middle-income countries, and we hope this sort of technology will lead to earlier detection and treatment in the near future."

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Novel cutpoints for diagnosing cardiac hypertrophy in adolescents and young adults

The three-decade-old international cutpoint for diagnosing children and adolescents with an enlarged heart misclassifies normal heart size as cardiac damage in adolescents, a paper published in the American Journal of Physiology-Heart and Circulatory Physiology concludes. The study was conducted in collaboration between the University of Bristol in the U.K. and the University of Eastern Finland.


An enlarged heart, often described as left ventricular hypertrophy, is a sign of early cardiac damage which has been linked to long-term cardiovascular diseases and death in adults. In children and adolescents, left ventricular hypertrophy is often recognized as a consequence of elevated blood pressure and metabolic disorders.


Echocardiography can be used to assess left ventricular hypertrophy. The most accurate echocardiography measurement is left ventricular mass indexed for muscle mass. This requires a dual energy-X-ray absorptiometry scan of muscle mass which is often not available due to cost. Other indices for left ventricular mass such as height and body surface area are useful although less accurate.

The most widely used cutpoint for diagnosing left ventricular hypertrophy in children and adolescents was established over 30 years ago and the average age of the children participating in that study was about 12 years. The established cutpoint identified left ventricular mass indexed for height greater than 38.6g/m2.7 as left ventricular hypertrophy in a pediatric population. The 38.6g/m2.7 is the 95th percentile value, meaning that 95% of children remain below this value, and it corresponded to 3.4g/kg of left ventricular mass indexed for muscle mass.

Among adults, the established cut point for diagnosing left ventricular hypertrophy is 51g/m2.7. Until now, there have been no large enough studies to define an accurate cutpoint for diagnosing left ventricular hypertrophy during late adolescence and young adulthood. The current pediatric cutpoint is significantly low for mid- and late-adolescents and the adults' cut point is quite high, both leading to the misclassification of adolescents with normal cardiac mass as abnormal.

The current study was conducted among 868 adolescents who were 17 years old and followed up for 7 years until young adulthood at age 24 years. All 868 adolescents had dual-energy X-ray absorptiometry body composition measurements and echocardiography measurements at baseline and follow-up.

The results revealed that during growth from age 17 years to 24 years, muscle mass and left ventricular mass increased significantly in both males and females, although more in males. However, when left ventricular mass was indexed for total body muscle mass, it removed the difference in the cardiac mass between the males and females by young adulthood.

The researchers also observed that estimating left ventricular mass by height2.7 or 3 had the best agreement with left ventricular mass divided by muscle mass. The left ventricular mass indexed for muscle mass 95th percentile cutpoint for males and females was 4.3g/kg and 4.6g/kg respectively at age 17 years. At 24 years of age, the 95th percentile cutpoints were 4.7g/kg and 4.6g/kg for males and females, respectively.

Correspondingly, the 95th percentile cutpoint for left ventricular mass indexed for height reflecting left ventricular hypertrophy in males and females was 49.5g/m2.7and 46.8g/m2.7 respectively at age 17 years. At 24 years of age, the 95th percentile cutpoints were 57.1g/m2.7 and 50.2g/m2.7 for males and females, respectively.

"These new cutpoints for the young population are higher than the pediatric cutpoint and lower than the adult cutpoint, except among 24 year old males. Thus, an extra 10–20g/m2.7 left ventricular mass indexed for height in comparison to the currently used pediatric cutpoint may be normal in adolescents and young adults, depending on sex.

"Therefore, pediatricians, cardiologists, physiologists, researchers, and caregivers are encouraged to familiarize themselves with the new cutpoints in order to accurately stratify adolescents and young adults at risk of an enlarged heart and premature cardiac damage," says Andrew Agbaje, a physician and clinical epidemiologist at the University of Eastern Finland.

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Sublingual Immunotherapy Appears Viable in Treating Peanut Allergies in Kids

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Peanut sublingual immunotherapy (SLIT) achieved clinically significant desensitization to peanut allergens in the majority of children in an open-label, prospective study.

Among 47 kids who completed therapy and the 48-month double-blind, placebo-controlled food challenge, 70% achieved clinically significant desensitization (successfully consumed dose [SCD] >800 mg), and 36% achieved full desensitization (SCD 5,000 mg), reported Edwin H. Kim, MD, MS, of the University of North Carolina School of Medicine in Chapel Hill, and co-authors.

The mean SCD of peanut protein during the food challenge increased from 48.4 mg at baseline to 2,723 mg after 48 months (P<0.0001), and desensitization lasted more than 17 weeks following treatment discontinuation, they noted in the Journal of Allergy and Clinical Immunology

opens in a new tab or window.As of 2021, it has been estimated

opens in a new tab or window that about 4.6 million adults in the U.S. have some form of peanut allergy, with 800,000 having developed the allergy during adulthood. Approximately 200,000 people in the U.S.opens in a new tab or window are sent to the emergency department following a food-related allergic reaction each year.

"The typical approach of strict allergen avoidance has been shown to greatly reduce the frequency of allergic reactions; however, over time most patients experience accidental ingestions with unpredictable and sometimes severe symptoms," Kim and team wrote. "Furthermore, strict allergen avoidance has led to the unintended consequence of a significant decrease in quality of life driven by factors such as anxiety, social isolation, restricted daily activities, and financial burden. Immunotherapy has been the best studied approach to treatment with numerous positive studies of oral immunotherapy (OIT) leading to the recent regulatory approval of the first product for peanut OIT."

In the study, peanut skin prick testing for the per-protocol population was significantly decreased by 12 months of treatment and remained this way over the course of treatment, from a mean wheal size of 16.5 mm at baseline to 9.1 mm after 48 months (P<0.0001).

Peanut-specific immunoglobulin E levels had significantly decreased by 24 months and through the duration of treatment, from a mean baseline level of 213.0 kU_A/L to 60.7 kU_A/L after 48 months (P<0.0001), following an initial increase from baseline to 6 months. Peanut-specific immunoglobulin G4, however, increased from an average of 0.8 mg/L at baseline to an average of 20.6 mg/L after 48 months (P<0.0001).

Mean percentage of CD63+ basophils decreased from baseline at both the 10 ng/mL dilution, which was significant throughout the 48 months, and the 1 ng/mL dilution, which was significant at the 24- and 48-month time points.

T_H2 cytokine levels after peanut stimulation also decreased over time, with average IL-4, IL-5, IL-13, and IFN-gamma levels significantly reduced over 48 months.

"With the goal of peanut allergy treatment increasingly focused on protection from accidental ingestions of peanut, our data for peanut SLIT supports a treatment response in the majority of patients that importantly appears to be able to withstand lapses in therapy of up to several weeks," Kim and colleagues wrote.

"When considering that tolerance does not appear likely with food immunotherapy and that treatment is likely to be required long-term if not indefinitely, these results demonstrating the feasibility and safety of keeping up the daily peanut SLIT regimen for multiple years take on particular importance," they added.

For this study, 54 peanut-allergic children ages 1 to 11 years (mean age 7.1, 63% boys, 90.7% white) were treated with open-label 4-mg peanut SLIT for 48 months, and 47 completed therapy. At baseline, 70.4% of children reported atopic dermatitis, 59.3% reported allergic rhinitis, 40.7% reported asthma, and 27.8% reported other food allergies. Dosing compliance was high, with 97.6% of doses administered.

Desensitization after SLIT was assessed by a 5,000-mg double-blind, placebo-controlled food challenge. A randomly assigned avoidance period between 1-17 weeks was followed by a food challenge. Skin prick testing, immunoglobulins, basophil activation testing, TH1, TH2, and IL-10 cytokines were measured longitudinally. Safety was assessed through patient-reported diaries.

Symptoms were reported after 4% of home-administered doses. Lip swelling and oropharyngeal itching were the most common symptoms, occurring with 3.7% of doses. Belly pain, vomiting, diarrhea, and skin symptoms were reported with 0.1% of doses. Three participants withdrew as the result of abdominal reactions or food aversion. While 0.14% of the administered doses required the use of antihistamines, epinephrine was not given at any point during the course of the study.

Kim and team noted that there was no blinding of the treatment or avoidance phases of the study, which was a limitation. Children can also "spontaneously outgrow" a peanut allergy, though the authors said this was unlikely in their cohort.

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Tablet-based game can assess pediatric visual motor skills in autism

 A tablet-based game is feasible for assessing visual motor skills in neurotypical children and those with autism spectrum disorder, according to a study published online Feb. 3 in npj Digital Medicine.

       Sam Perochon, from Duke University in Durham, North Carolina, and colleagues examined the use of a bubble-popping game administered on a tablet as an assessment of visual-motor abilities in young children. Participants included 233 children aged 1.5 to 10 years: 147 neurotypical and 86 diagnosed with autism spectrum disorder, 32 of whom had co-occurring attention-deficit/hyperactivity disorder (autistic+ADHD). Game-based touch features were compared across autistic, autistic+ADHD, and neurotypical participants.

   The researchers found that younger children with autism (aged 1.5 to 3 years) popped the bubbles at a lower rate, and their ability to touch the center of the bubble was less accurate than that of neurotypical children. In addition, their finger lingered for a longer period when they popped a bubble and there was more variability in their performance. For older children (3 to 10 years), greater motor impairment was seen in association with the presence of co-occurring ADHD, reflected by lower accuracy and more variability in performance. There were correlations seen for several motor features with fine motor and cognitive abilities.

"This simple yet informative tool has the potential of being deployed at scale to enhance detection and assessment of early autism signs and obtain objective and quantitative measures of toddler and school age children's visual motor skills," the authors write.

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Congenital heart defects in children

                                                            

Symptoms

Serious congenital heart defects usually are noticed soon after birth or during the first few months of life. Signs and symptoms could include:

• Pale gray or blue lips, tongue or fingernails (cyanosis)
• Rapid breathing
• Swelling in the legs, belly or areas around the eyes
• Shortness of breath during feedings, leading to poor weight gain

Less-serious congenital heart defects may not be diagnosed until later in childhood. Signs and symptoms of congenital heart defects in older children may include:

• Easily becoming short of breath during exercise or activity
• Easily tiring during exercise or activity
• Fainting during exercise or activity
• Swelling in the hands, ankles or feet

causes

• To understand the causes of congenital heart defects, it may be helpful to know how the heart typically works.

• The heart is divided into four chambers, two on the right and two on the left. To pump blood throughout the body, the heart uses its left and right sides for different tasks.

  The right side of the heart moves blood to the lungs through the lung (pulmonary) arteries. In the lungs, blood picks up oxygen then returns to the heart's left side through the pulmonary veins. The left side of the heart then pumps the blood through the body's main artery (aorta) and out to the rest of the body.

  How congenital heart defects develop

  During the first six weeks of pregnancy, the baby's heart begins to form and starts beating. The major blood vessels that run to and from the heart also begin to develop during this critical time.

  It's at this point in a baby's development that congenital heart defects may begin to develop. Researchers aren't sure exactly what causes most of these defects, but they think genetics, certain medical conditions, some medications, and environmental or lifestyle factors, such as smoking, may play a role.

  There are many different types of congenital heart defects. They fall into the general categories described below.

  Altered connections in the heart or blood vessels

  Altered connections allow blood to flow where it usually wouldn't. Holes in the walls between heart chambers are one example of this type of congenital heart defect.

  An altered connection can cause oxygen-poor blood to mix with oxygen-rich blood. This lowers the amount of oxygen sent through the body. The change in blood flow forces the heart and lungs to work harder.

  Types of altered connections in the heart or blood vessels include:

  • Atrial septal defect is a hole between the upper heart chambers (atria).
  • Ventricular septal defect is a hole in the wall between the right and left lower heart chambers (ventricles).
  • Patent ductus arteriosus (PAY-tunt DUK-tus ahr-teer-e-O-sus) is a connection between the lung artery and the body's main artery (aorta). It's open while a baby is growing in the womb, and typically closes a few hours after birth. But in some babies, it stays open, causing incorrect blood flow between the two arteries.
  • Total or partial anomalous pulmonary venous connection occurs when all or some of the blood vessels from the lungs (pulmonary veins) attach to a wrong area or areas of the heart.

  Congenital heart valve problems

  Heart valves are like doorways between the heart chambers and the blood vessels. Heart valves open and close to keep blood moving in the proper direction. If the heart valves can't open and close correctly, blood can't flow smoothly.

  Heart valve problems include valves that are narrowed and don't open completely (stenosis) or valves that don't close completely (regurgitation).

  Examples of congenital heart valve problems include:

  • Aortic stenosis (stuh-NO-sis). A baby may be born with an aortic valve that has one or two valve flaps (cusps) instead of three. This creates a small, narrowed opening for blood to pass through. The heart must work harder to pump blood through the valve. Eventually, this leads to enlarging of the heart and thickening of the heart muscle.
  • Pulmonary stenosis. A defect on or near the pulmonary valve narrows the pulmonary valve opening and slows the blood flow.
  • Ebstein anomaly. The tricuspid valve — which is located between the right upper heart chamber (atrium) and the right lower chamber (ventricle) — is malformed and often leaks.

  Combination of congenital heart defects

  Some infants are born with several congenital heart defects that affect the structure and function of the heart. Very complex heart problems may cause significant changes in blood flow or undeveloped heart chambers.

  For example, tetralogy of Fallot (teh-TRAL-uh-jee of fuh-LOW) is a combination of four congenital heart defects:

  • A hole in the wall between the heart's lower chambers (ventricles)
  • A narrowed passage between the right ventricle and pulmonary artery
  • A shift in the connection of the aorta to the heart
  • Thickened muscle in the right ventricle

  Other examples of complex congenital heart defects are:

  • Pulmonary atresia. The valve that lets blood out of the heart to go to the lungs (pulmonary valve) isn't formed correctly. Blood can't travel its usual route to get oxygen from the lungs.
  • Tricuspid atresia. The tricuspid valve isn't formed. Instead, there's solid tissue between the right upper heart chamber (atrium) and the right lower chamber (ventricle). This congenital heart defect restricts blood flow and causes the right ventricle to be underdeveloped.
  • Transposition of the great arteries. In this serious, rare congenital heart defect, the two main arteries leaving the heart are reversed (transposed). There are two types. Complete transposition of the great arteries is typically noticed during pregnancy or soon after birth. Levo-transposition of the great arteries (L-TGA) is less common. Symptoms may not be noticed right away.
  • Hypoplastic left heart syndrome. A major part of the heart fails to develop properly. In hypoplastic left heart syndrome, the left side of the heart hasn't developed enough to effectively pump enough blood to the body.

  Risk factors

  Most congenital heart defects result from changes that occur early as the baby's heart is developing before birth. The exact cause of most congenital heart defects is unknown, but some risk factors have been identified. Risk factors for congenital heart defects include:

  • Rubella (German measles). Having rubella during pregnancy can cause problems in a baby's heart development. A blood test done before pregnancy can determine if you're immune to rubella. A vaccine is available for those who aren't immune.
  • Diabetes. Careful control of blood sugar before and during pregnancy can reduce the risk of congenital heart defects in the baby. Diabetes that develops during pregnancy (gestational diabetes) generally doesn't increase a baby's risk of heart defects.

  • Medications. Certain medications taken during pregnancy may cause birth defects, including congenital heart defects. Give your health care provider a complete list of medications you take before trying to become pregnant.

    Medications known to increase the risk of congenital heart defects include thalidomide (Thalomid), angiotensin-converting enzyme (ACE) inhibitors, statins, the acne medication isotretinoin (Myorisan, Zenatane, others), some epilepsy drugs and certain anxiety drugs.

  • Drinking alcohol during pregnancy. Drinking alcohol during pregnancy increases the risk of congenital heart defects.
  • Smoking. If you smoke, quit. Smoking during pregnancy increases the risk of a congenital heart defect in the baby.
  • Family history and genetics. Congenital heart defects sometimes run in families (are inherited) and may be associated with a genetic syndrome. Many children with an extra 21st chromosome (Down syndrome) have congenital heart defects. A missing piece (deletion) of genetic material on chromosome 22 also causes heart defects.

  Complications

  Potential complications of a congenital heart defect include:

  • Congestive heart failure. This serious complication may develop in babies who have a significant heart defect. Signs of congestive heart failure include rapid breathing, often with gasping breaths, and poor weight gain.
  • Heart infections. Congenital heart defects can increase the risk of infection of the heart tissue (endocarditis), which can lead to new heart valve problems.
  • Irregular heart rhythms (arrhythmias). A congenital heart defect or scarring from heart surgery may cause changes in the heart's rhythm.
  • Slower growth and development (developmental delays). Children with more-serious congenital heart defects often develop and grow more slowly than do children who don't have heart defects. They may be smaller than other children of the same age. If the nervous system has been affected, a child may learn to walk and talk later than other children.
  • Stroke. Although uncommon, some children with congenital heart defects are at increased risk of stroke due to blood clots traveling through a hole in the heart and on to the brain.
  • Mental health disorders. Some children with congenital heart defects may develop anxiety or stress because of developmental delays, activity restrictions or learning difficulties. Talk to your child's provider if you're concerned about your child's mental health.

  Prevention

  Because the exact cause of most congenital heart defects is unknown, it may not be possible to prevent these conditions. If you have a high risk of giving birth to a child with a congenital heart defect, genetic testing and screening may be done during pregnancy.

  There are some steps you can take to help reduce your child's overall risk of birth defects such as:

  • Get proper prenatal care. Regular checkups with a health care provider during pregnancy can help keep mom and baby healthy.
  • Take a multivitamin with folic acid. Taking 400 micrograms of folic acid daily has been shown to reduce birth defects in the brain and spinal cord. It may help reduce the risk of heart defects as well.
  • Don't drink or smoke. These lifestyle habits can harm a baby's health. Also avoid secondhand smoke.
  • Get a rubella (German measles) vaccine. A rubella infection during pregnancy may affect a baby's heart development. Get vaccinated before trying to get pregnant.
  • Control blood sugar. If you have diabetes, good control of your blood sugar can reduce the risk of congenital heart defects.
  • Manage chronic health conditions. If you have other health conditions, including phenylketonuria, talk to your health care provider about the best way to treat and manage them.
  • Avoid harmful substances. During pregnancy, have someone else do any painting and cleaning with strong-smelling products.
  • Check with your provider before taking any medications. Some medications can cause birth defects. Tell your provider about all the medications you take, including those bought without a prescription.

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Nutrient-enriched diets improve health of premature, underweight babies post-discharge

While smaller premature babies are given around-the-clock nutritional care in the Neonatal Intensive Care Unit (NICU), there has been debate among researchers on whether or not regular breastmilk or standard formula alone is enough nutrition for these babies to develop optimally after being discharged from the hospital.

Now, a meta-analysis—or detailed analysis of previous studies—conducted by researchers at the University of Missouri and University of Oxford, UK, suggests that adding nutritional fortification to human breastmilk or using a nutrient-enriched formula for those who are formula-fed, improves the size, weight and physical health of premature babies, as well as possibly improving their cognitive development.

Jan Sherman, a professor in the MU Sinclair School of Nursing, collaborated with Alan Lucas, a professor at University of Oxford, UK, to analyze more than 27 randomized trials that involved more 2,000 premature babies around the world, including in North America, Europe, Asia, and Africa. After comparing the physical and neurodevelopmental health outcomes, the researchers found that small premature babies who were given a nutrient-enriched diet after being discharged from the NICU weighed more, had larger heads and brains, and stronger bones. Although the research is incomplete, some evidence suggests that improving growth in these babies may also benefit cognitive development.

“This new research-based review can help providers decide on the best nutritional care for premature babies after they are discharged from the NICU,” Lucas said. “Breast feeding is the preferred way of feeding these babies, but whether they are breast or formula fed, we hope that this review will also help providers to appraise optimal levels of nutrients used for this important group of babies. It has also been questioned whether such nutrient-enriched diets would put these babies at potential risk of cardiovascular disease. However, the studies reviewed did not support this concern.”

Lucas has been researching nutrition in premature babies for 45 years, and Sherman, a Neonatal Nurse Practitioner (NNP) as well as an expert in statistical analysis, has seen the health issues babies born prematurely face first hand while working in NICUs for nearly 40 years.

“Every baby deserves the best possible care we can provide, and every parent wants the best outcome for their baby, so providing optimal nutrition is very important to us,” Sherman said. “The dietary choices that providers make for these infants is very important given that early nutrition is crucial for positive health outcomes later on in life.”

“Post-discharge nutrition in preterm infants” was recently published in NeoReviews, a journal published by the American Academy of Pediatrics. 

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