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Comparatively lower body mass index (BMI) has been reported in patients with adolescent idiopathic scoliosis (AIS)-a feature which may be an unrecognised symptom, or an organic consequence of the condition. The primary aim of this systematic review is to investigate the relationship between low BMI and AIS. A secondary aim is to investigate the effect of low BMI on outcomes of postsurgical correction in this patient group. The Cochrane Library, PubMed, SCOPUS, Web of Science and Ovid MEDLINE databases were searched up to December 2016 for relevant studies that reported prevalence of low preoperative BMI in patients with AIS and/or compared BMI between patients with AIS and healthy controls, as well as those that examined the relationship between low BMI and postoperative outcomes. Forty-five eligible studies were identified from the search strategy. Mean differences (MDs) were used with 95% confidence intervals (CI) in a random effects model to compare BMI in patients with AIS and controls in a pooled analysis of data from nine eligible studies (n = 3747 patients). In the meta-analysis, BMI of patients in the AIS group was significantly lower than those in the control group (MD -1.19, 95% CI -1.78 to -0.60). Low BMI in AIS can impact postoperative outcomes, including increased risk of ileus. This review demonstrates that patients with AIS are significantly more likely to have a low BMI compared to the general population. We advocate that closer attention be paid to AIS patients with low BMI both pre- and postsurgical correction.

Background: Posterior spinal instrumentation and fusion for correction of adolescent idiopathic scoliosis (AIS) typically requires lengthy operating time and may be associated with significant blood loss and subsequent transfusion. This study aimed to identify factors predictive of duration of surgery, intraoperative blood loss and transfusion requirements in an Irish AIS cohort., Methods: A retrospective review of 77 consecutive patients with AIS who underwent single-stage posterior spinal instrumentation and fusion over a two-year period at two Dublin tertiary hospitals was performed. Data were collected prospectively and parameters under analysis included pre- and postoperative radiographic measurements, intraoperative blood loss, surgical duration, blood products required, laboratory blood values and perioperative complications., Results: Mean preoperative primary curve Cobb angle was 62.3°; mean surgical duration was 5.6 h. The perioperative allogeneic red blood cell transfusion rate was 42.8 % with a median requirement of 1 unit. Larger curve magnitudes were positively correlated with longer fusion segments, increased operative time and greater estimated intraoperative blood loss. Preoperative Cobb angles greater than 70° [Relative Risk (RR) 4.42, p = 0.003] and estimated intraoperative blood loss greater than 1400 ml (RR 3.01, p = 0.037) were independent predictors of red blood cell transfusion risk., Conclusion: Larger preoperative curve magnitudes in AIS increase operative time and intraoperative blood loss; preoperative Cobb angles greater than 70(o) and intraoperative blood loss greater than 1400 ml are predictive of red blood cell transfusion requirement in this patient group.

Background: Surgical procedures to correct larger curve magnitudes >70° in patients with adolescent idiopathic scoliosis (AIS) are still common; despite their increased complexity, limited research has assessed the effect of preoperative curve severity on outcomes., Aim: This study aimed to examine the impact of preoperative curves >70° vs. those ≤70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF)., Methods: Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to preoperative function was reported. Preoperative curves >70° vs. ≤70° were analysed in relation to surgical duration, estimated blood loss, perioperative complications, length of hospitalisation, return to function and cost of surgical treatment per patient., Results: Severe preoperative curves >70°, identified in 21 patients (27.3 %), were associated with significantly longer surgical duration (median 6.5 vs. 5 h, p = 0.001) and increased blood loss (median 1250 vs. 1000 ml, p = 0.005)-these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, CI 1.4-2.7, p = 0.004). Curves >70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 vs. €28,620, p < 0.0001)., Conclusion: Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70° vs. those ≤70°. Surgical correction for curves >70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.

Purpose: Abnormal anthropometry including comparably lower weight and body mass index (BMI) in the adolescent idiopathic scoliosis (AIS) population is increasingly recognised, however, no study has examined postoperative weight loss or its clinical relevance in these relatively thin patients. This study aimed to assess perioperative nutritional status as well as clinically severe involuntary weight loss and its impact on outcomes in patients with AIS undergoing posterior spinal fusion (PSF). A further objective was to compare preoperative anthropometric measurements of the current AIS cohort with healthy controls., Methods: Seventy-seven consecutive and eligible patients with AIS who underwent PSF were prospectively followed up from hospital admission (January 2010-April 2012). Pre- and postoperative anthropometric measurements were collected (weight, height, BMI), and clinically severe unintentional weight loss computed, defined as loss of >10% body weight from admission to hospital discharge. The effect of weight loss >10% was analysed in relation to radiographic, nutritional and perioperative complication data, and length of hospitalisation. A case-controlled study was then performed to establish potential differences in weight, height and BMI of this AIS cohort with healthy age- and gender-matched controls derived from the National Teens' Food Survey (2005-2006). Anthropometric values were standardised by conversion to age- and gender-specific Z-scores; 'undernutrition' was defined as BMI Z-scores <-2., Results: Mean age of the cohort was 15 years (SD 1.89); 93.5 % of subjects were female. Clinically severe postoperative weight loss >10%, identified in 22 patients (30.6%), was associated with a significantly increased superficial wound infection incidence (13.6 vs. 2%, P = 0.047), as well as lower serum albumin at hospital discharge (25 vs. 28 g/L, P < 0.05). A high prevalence of postoperative undernutrition was observed-over one quarter of patients had a BMI Z-score <-2 at hospital discharge (26.4%); serum albumin, total protein and haemoglobin levels were below normal limits in 98, 66 and 91% of patients, respectively. Significantly lower weight (52 vs. 59.8 kg, P < 0.0001), corrected height (162 vs. 166.3 cm, P < 0.0001) and BMI (19.72 vs. 21.6 kg/m(2), P < 0.0001) measurements were identified in this AIS cohort, in comparison with those recorded in The National Teens' Survey., Conclusions: This study demonstrated that clinically severe postoperative weight loss >10%, identified in almost one-third of this AIS cohort, was associated with significantly increased wound infection incidence. Early detection and prevention of severe postoperative weight loss in patients with AIS who undergo spinal fusion may be beneficial in reducing wound infection risk. This study confirms a body of literature indicating the significantly lower weight and BMI in patients with AIS compared with healthy controls.

Study Design: Prospective study., Objective: To assess the timing and predictors of return to short-term functional activity in patients with adolescent idiopathic scoliosis (AIS) after posterior spinal fusion (PSF)., Summary of Background Data: Few studies have examined the timing and rate of return to short-term functional activity in patients with AIS after PSF. No study has yet evaluated the timing and factors that predict a delayed return to school/college--a topic relevant to patients who have had or anticipate having spinal fusion, and their treating surgeons., Methods: Seventy-seven eligible subjects with AIS who underwent PSF and correction (January 2010 to April 2012) were followed up until return to the functional outcomes under analysis. Timing of return to school/college and physical activity, as per the patients' preoperative level or better, was assessed. Binary logistic regression analysis was used to determine predictors of delayed return to school/college full-time (>16 wk) and unrestricted physical activity (>32 wk) relative to sociodemographic, anthropometric, radiographical, clinical, and surgical factors. In the present study, a "delayed" return to all the functional outcomes recorded was defined as "greater than the 75th percentile" of the continuous distribution., Results: Mean follow-up was 12.8 months (SD, 5.7). Mean age was 15.04 years (SD, 1.89). The median time to return to school/college full-time (n = 75) was 10 weeks; the majority returned by 16 weeks (77.3%). Preoperative curves greater than 70° (relative risk, 3.38; P = 0.008), postoperative weight loss greater than 5 kg (relative risk, 3.02; P = 0.012), and minor perioperative respiratory complication incidence (relative risk, 2.89; P = 0.024) independently predicted delayed return to school/college full-time. By 24 and 52 weeks, 51.4% and 88.5% of subjects, respectively, returned to unrestricted physical activity. At final follow-up, nonreturn to unrestricted physical activity was identified in only 3 subjects (4.3%) because of chronic back pain., Conclusion: The majority of patients with AIS can expect to return to school/college full-time by 16 weeks and unrestricted physical activity by 52 weeks after PSF. Preoperative curves greater than 70°, postoperative weight loss greater than 5 kg, and minor perioperative respiratory complication incidence independently predicted a delayed return to school/college full-time. These findings add to the current knowledge base regarding actual versus anticipated timing of return to short-term functional outcomes in this population., Level of Evidence: 3.

Study Design: Retrospective cohort study., Objective: To determine the association between low preoperative body mass index (BMI) and outcome of spinal fusion in adolescent idiopathic scoliosis (AIS)., Summary of Background Data: Several studies report a lower weight and BMI in untreated subjects with AIS than nonscoliotic age-matched controls. However, very little is known about the clinical impact of low BMI on pre- or postsurgical parameters in this patient group., Methods: Seventy-seven eligible patients with AIS who underwent 1-stage posterior spinal fusion and correction at 2 tertiary centers (January 2010-April 2012) were included. Preoperative weight, corrected height, and BMI values were converted to z scores using the British 1990 growth reference data. Relationships between anthropometric indices and comorbidities, laboratory blood data, radiographical outcomes, length of hospital stay, and perioperative complications were examined, and the independent factors associated with low BMI (z score < -1) evaluated using binary logistic regression analysis., Results: In this AIS cohort (mean age, 15.04 yr; n = 72 females), 21 subjects (27.3%) had a low preoperative BMI; of these, 5 cases (6.5%) were considered severely thin. Lower BMI and weight z scores correlated with a greater percent correction of thoracic curves (rs = -0.287 and rs = -0.257, respectively, P < 0.05). In both the univariate and multivariate regression analysis, low BMI was significantly associated with preoperative asthma incidence (adjusted odds ratio 5.33, P = 0.023) and prolonged prothrombin time (adjusted odds ratio 4.53, P = 0.027), in addition to postoperative ileus development (adjusted odds ratio 11.96, P = 0.019). Preoperative Cobb angle, estimated intraoperative blood loss and length of hospital stay did not significantly differ between the BMI groups., Conclusion: Significantly increased preoperative coagulation abnormality and asthma incidence as well as a greater percent correction of thoracic curves were associated with low BMI in this series. It was also found that postoperative ileus was independently associated with low BMI., Level of Evidence: 3.

There is a need to comprehensively examine why mothers in Ireland discontinue breastfeeding early and to explore the factors influencing duration of breastfeeding during the first 6 months postpartum. Findings from this study provide valuable direction for future strategies and interventions aimed at increasing breastfeeding duration rates in Ireland.

This prospective Irish observational study examined maternal and infant nutritional supplement use. From an initial sample of 539 mothers recruited from the Coombe Women and Infants University Hospital in Dublin (during 2004-2006), 450 eligible mothers were followed up at 6 weeks and 6 months postpartum. Only 200 women (44.4%) complied with peri-conceptional folic acid at the recommended time with strong social patterning associated with its uptake. Almost 10% of the sample (n = 44) consumed a combined multivitamin and mineral supplement during pregnancy. A vitamin D-containing supplement was provided to only 5 (1.1%) and 15 (3.3%) infants at 6 weeks and 6 months, respectively. A national guideline that advises on adequate and safe use of both vitamin and multivitamin supplements during pregnancy with particular reference to vitamin A and D is warranted. Given the re-emergence of rickets in Ireland, and the reported morbidities associated with vitamin D insufficiency, promoting and monitoring compliance with 200 IU [5 microg] daily vitamin D supplements to all infants particularly those from higher risk groups from birth to 1 year, should be a public health priority.

Background/objectives: To examine the prevalence and combined occurrence of peri-conceptional folic acid (FA) supplement use, smoking and alcohol consumption during pregnancy in a sample of women in Dublin, and determine the factors associated with these health behaviours., Subjects/methods: A prospective observational study (2004-2006) involving the recruitment of 491 pregnant women from antenatal clinics in a Dublin maternity hospital, with postpartum follow-up of 450 eligible mothers. Data on FA use, maternal smoking and alcohol consumption patterns during pregnancy were collected from the antenatal patient-administered questionnaire, which was completed by participants, and returned to the investigator on the day of recruitment., Results: The median gestational age of women at recruitment was 36 weeks. A combined 24.2% of mothers commenced FA at the recommended time, avoided alcohol consumption and smoking during pregnancy. In all, 35.3% of mothers reported to consuming alcohol, 20.9% smoked during pregnancy and 44.4% commenced FA at the recommended time. Mothers <25 years were more likely to have not taken FA at the recommended time (adjusted odds ratio (aOR): 4.0, 95% confidence interval (CI): 1.64-9.77) and were more likely to have smoked during pregnancy (aOR: 3.56, 95% CI: 1.32-9.57). Irish nationality positively predicted both alcohol consumption (aOR: 4.37, 95% CI: 1.88-10.15) and smoking (aOR: 10.92, 95% CI: 1.35-87.98) during pregnancy., Conclusions: Educational efforts are still necessary to convince women of Irish nationality, in particular, of the adverse effects of smoking and alcohol consumption on fetal outcome. Women <25 years should be specifically targeted in smoking cessation and FA promotional campaigns., (© 2011 Macmillan Publishers Limited All rights reserved)

The WHO (2001) recommends exclusive breast-feeding and delaying the introduction of solid foods to an infant's diet until 6 months postpartum. However, in many countries, this recommendation is followed by few mothers, and earlier weaning onto solids is a commonly reported global practice. Therefore, this prospective, observational study aimed to assess compliance with the WHO recommendation and examine weaning practices, including the timing of weaning of infants, and to investigate the factors that predict weaning at ≤ 12 weeks. From an initial sample of 539 pregnant women recruited from the Coombe Women and Infants University Hospital, Dublin, 401 eligible mothers were followed up at 6 weeks and 6 months postpartum. Quantitative data were obtained on mothers' weaning practices using semi-structured questionnaires and a short dietary history of the infant's usual diet at 6 months. Only one mother (0.2%) complied with the WHO recommendation to exclusively breastfeed up to 6 months. Ninety-one (22.6%) infants were prematurely weaned onto solids at ≤ 12 weeks with predictive factors after adjustment, including mothers' antenatal reporting that infants should be weaned onto solids at ≤ 12 weeks, formula feeding at 12 weeks and mothers' reporting of the maternal grandmother as the principal source of advice on infant feeding. Mothers who weaned their infants at ≤ 12 weeks were more likely to engage in other sub-optimal weaning practices, including the addition of non-recommended condiments to their infants' foods. Provision of professional advice and exploring antenatal maternal misperceptions are potential areas for targeted interventions to improve compliance with the recommended weaning practices.

Objective: To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and 'any' breast-feeding at 6 weeks in a sample of Irish-national mothers., Design: This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum., Setting: Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin., Subjects: In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study., Results: Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47% and 79.6%, respectively. Factors that were significantly (P = 0.000) associated with both breast-feeding initiation and 'any' breast-feeding at 6 weeks included mothers who were >or=35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation., Conclusions: Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.

Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering 'any' breast milk to their infants at 6 weeks. Mothers' positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and 'any' breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers' attitudes and beliefs pertaining to breast-feeding. These results suggest that the 'cultural' barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve.