Commercial software package “Growth Analyser Viewer Edition” (“GAVE”) aims to document, monitor and analyze growth and development in children and adolescents. Although its clinical and scientific use is widespread, there are no published studies that describe the method and its validation. We were informed that GAVE calculates the weight velocity (kg/year) at age t from the weight difference between t and 448 days earlier or at birth, divided by the time difference. We recently discussed a case of false child abuse diagnosis (Pediatric Condition Falsification), resulting in the separation of the child from its parents, in which GAVE played a negative contributing role. To prevent such inappropriate diagnoses, we analyzed GAVE from a schematic representation of the measured clinical weight curve, with precisely defined weight velocities. In conclusion, the 448 days included for weight velocity predictions by GAVE caused the erroneous outcomes. Until the necessary changes to the software are implemented and validated, we advise against the use of GAVE in infants younger than 1.5 years, if multiple weight changes occur within 448 days, and following a long-lasting weight velocity change. Our analysis suggests to discard all medical software packages that lack public description and proof of validation.

/pdf/limitations-of-weight-velocity-analysis-by-commercial-57f23xw5qu.pdf

Limitations of Weight Velocity Analysis by Commercial Computer Program Growth Analyser Viewer Edition.

https://repub.eur.nl/pub/117612/Repub_117612_O-A.pdf

Weight velocity equations with 14-448 days time separated weights should not be used for infants under 3 years of age.

BACKGROUND The commercial software for hospitals, Weight Velocity for Age Standard Deviation Score (SDSWVA), claims to document the growth and development of children, although published details are unavailable. The statistics-derived parameter SDSWVA includes the weight velocity at age t, WV(t) (weight gained between t and (t-1.23) years, divided by 1.23), and 3 standard weight velocity curves at average age AA, defined as AA=t-1.23/2 years. SDSWVA denotes the number of standard deviations that WV(t) deviates from the 0 SD weight velocity at AA. WV(t) yielded erroneous outcomes when applied to weights of a seriously underweight boy with an allergy to cows' milk who showed strong weight growth after being fed on food free of cows' milk. The SDSWVA software tacitly suggests that it is more accurate than WV(t). CASE REPORT The case of this boy was previously described in this Journal. Using SDSWVA(t,AA) software, his weight growth was analyzed by his third pediatrician, beginning at age 1.5 years. The diagnosis of the mother with Pediatric Condition Falsification was confirmed, adding 6 months to foster care, which totalled 8.5 months. Testing of the SDSWVA software on the boy's weight curve yielded results that were complex, nontransparent, and as erroneous as WV(t), explaining the misdiagnosis by the third pediatrician. CONCLUSIONS SDSWVA software should not be used for children under 3 years and during variable weight behavior. Erroneous performance, unpublished details, and an error identified in their new but untested software make the Dutch Growth Research Foundation unlikely to meet the 2020 European Union regulations for in vitro medical devices.

/pdf/limitations-of-dutch-growth-research-foundation-commercial-h79b48925c.pdf

Limitations of Dutch Growth Research Foundation Commercial Software Weight Velocity for Age Standard Deviation Score.

This chapter identifies four types of situations in which parents and physicians are likely to encounter disagreement. The chapter also points toward avenues toward resolution. The first situation is one in which the parent refuses a measure proffered by a physician. The second is the circumstance in which the parent demands treatment the physician deems inappropriate. The third paradigm involves disagreement among custodial parents regarding the child. Finally, either a parent or a physician can abuse her power to undercut the appropriate authority of the other. Each of these paradigms requires different analysis, pointing to a different approach to solution. The State Intervention Test is useful in identifying the problem and pointing toward a solution. With regard to unreasonable demands for care, the traditional Roman Catholic distinction between ordinary and extraordinary care proves very useful.

Treatment of Disease

BACKGROUND Pediatric condition falsification (PCF) is a rare form of child abuse in which a caregiver fabricates or induces illness in the child. The diagnosis is difficult and controversial and can easily include false positives. CASE REPORT A boy, 3.18 kg birthweight (P25 curve), lost weight between age 56 to120 days. Cow milk allergy was suspected, feeding was changed to elementary formula, and he started catch-up weight growth while remaining significantly underweight. His pediatrician continuously interpreted his low weight as insufficient growth, despite prescribing 3 times the normal caloric intake, concluded that the mother purposely malnourished her son, diagnosed PCF, and the boy was separated from his family (days 502-755 of age). PCF was confirmed by 2 other pediatricians and 3 child protection physicians and was supported by 4 child protection agencies and 6 judges. However, proper analysis of the weight growth (kg/year) from the weight curve showed a normal weight gain. Beyond 120 days of age, weight gain at home was significantly above normal (during 347-489 days: 6.2 versus 3 kg/year of the P50). He reached P25 again at around 516 days. CONCLUSIONS The question "How could so many physicians misjudge weight gain?" has scientific and sociologic aspects. Scientifically, low weight was wrongly interpreted as insufficient weight growth, requiring that physicians learn how to assess weight gain from weight curves. Sociologically, physicians seem to follow a diagnosis made by a colleague without proper evaluation. Arguments provided by the parents against this diagnosis seemed to be neglected. Confirmation bias occurs when any information against PCF is disregarded.

/pdf/pediatric-condition-falsification-misdiagnosed-by-misjudged-wfx1ma35mw.pdf

Pediatric Condition Falsification Misdiagnosed by Misjudged Weight Growth from the Curve of Measured Weights.

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Pediatric Condition Falsification Misdiagnosed by Misjudged Weight Growth from the Curve of Measured Weights.