{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T23:04:44Z","timestamp":1782428684841,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T00:00:00Z","timestamp":1703289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To develop robust multivariable prediction models for non\u2010response to (1) submandibular botulinum neurotoxin A (BoNT\u2010A) injections and (2) concurrent submandibular and parotid (four\u2010gland) injections, to guide treatment decisions for drooling in children with neurodevelopmental disabilities, including cerebral palsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a retrospective cohort study including 262 children (155 males\/107 females, median age 7\u2009years 11\u2009months [IQR 5\u2009years 1\u2009month], range 4\u2009years 0\u2009months \u2013 17\u2009years 11\u2009months) receiving submandibular injections and 74 children (52 males\/22 females, median age 7\u2009years 7\u2009months [IQR 4\u2009years 3\u2009months], range 4\u2009years 9\u2009months \u2013 18\u2009years 8\u2009months) receiving four\u2010gland injections. Multivariable logistic regression analyses were used to estimate associations between candidate predictors and non\u2010response 8\u2009weeks after injection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety\u2010six children (37%) were non\u2010responders to submandibular injections, for which developmental age was the strongest predictor (adjusted odds ratio [aOR] 2.13; 95% confidence interval [CI] 1.02\u20134.45 for developmental age\u2009&lt;4\u2009years or 4\u20136\u2009years with IQ &lt;70). Other characteristics that showed a trend towards an increased risk of non\u2010response were diagnosis, sex, and head position. Thirty\u2010four children (46%) were non\u2010responders to four\u2010gland injections, for which tongue protrusion (aOR 3.10; 95% CI 1.14\u20138.43) seemed most predictive, whereas multiple preceding submandibular injections (aOR 0.34; 95% CI 0.10\u20131.16) showed a trend towards being protective. Predictors were, however, unstable across different definitions of non\u2010response and both models (i.e. submandibular and four\u2010gland) had insufficient discriminative ability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Potential predictors of non\u2010response to BoNT\u2010A injections were identified. Nevertheless, the developed prediction models seemed inadequate for guidance of treatment decisions.<\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Developmental age seemed most predictive of non\u2010response to submandibular botulinum neurotoxin A injections.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Non\u2010response to concurrent submandibular and parotid injections was best predicted by tongue protrusion and number of previous injections.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Multivariable prediction models including these clinical characteristics were unable to discriminate well.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Predictors differed when non\u2010response was defined using alternative outcome measures.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.15837","type":"journal-article","created":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T12:29:59Z","timestamp":1703334599000},"page":"919-930","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predicting non\u2010response to intraglandular botulinum neurotoxin A injections for drooling in children with neurodevelopmental disabilities"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0561-4768","authenticated-orcid":false,"given":"Lynn B.","family":"Orri\u00ebns","sequence":"first","affiliation":[{"name":"Department of Paediatric Neurology, Division of Paediatrics Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-3450","authenticated-orcid":false,"given":"Karen","family":"van Hulst","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7860-7791","authenticated-orcid":false,"given":"Mich\u00e8l A. A. P.","family":"Willemsen","sequence":"additional","affiliation":[{"name":"Department of Paediatric Neurology, Division of Paediatrics Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2935-5599","authenticated-orcid":false,"given":"Frank J. 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