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1.
Medicina (Kaunas) ; 57(9)2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34577911

RESUMO

Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: The case group children were 8-9-year-old children (n = 32) who were born at full term and experienced hypoxia or asphyxia at birth, where therapeutic hypothermia (TH) was not applied. The control group consisted of 8-9-year-old children (n = 16) born without hypoxia. A structured neurological examination was performed at an early school age. The neuromotor function was assessed using the Gross Motor Function Classification System (GMFCS). Health-related quality-of-life was assessed using the Health Utilities Index (HUI) questionnaire. Intellectual abilities were assessed using the Wechsler Intelligence Scale for Children (WISC). Results: The case group, compared with controls, had significantly (p = 0.002) lower mean [SD] full-scale IQ (87(16.86) vs. 107(12.15)), verbal-scale IQ (89(17.45) vs. 105(11.55)), verbal comprehension index (89(17.36) vs. 105(10.74)), working memory index (89(15.68) vs. 104(11.84)), performance IQ (87(16.51) vs. 108(15.48)) and perceptual organization index (85(15.71) vs. 105(15.93)). We did not find any significant differences in the incidence of disorders of neurological examination, movement abilities and health-related quality of life at an early school age between the case and the control group children. Conclusion: In children who experienced perinatal asphyxia but did not have cerebral paralysis (CP), where therapeutic hypothermia was not applied, cognitive assessment scores at an early school age were significantly lower compared to those in the group of healthy children, and were at a low average level.


Assuntos
Asfixia Neonatal , Asfixia , Asfixia Neonatal/epidemiologia , Criança , Feminino , Humanos , Hipóxia/etiologia , Recém-Nascido , Gravidez , Qualidade de Vida , Instituições Acadêmicas
2.
Medicina (Kaunas) ; 55(4)2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30925739

RESUMO

Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750⁻<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. At CA 12 months, there was no difference in neurodevelopment in both groups.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Nutrição Parenteral/métodos , Estatura , Peso Corporal , Feminino , Seguimentos , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Lituânia , Masculino , Destreza Motora , Estudos Prospectivos , Estatísticas não Paramétricas
3.
Medicina (Kaunas) ; 50(2): 100-10, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25172604

RESUMO

BACKGROUND AND OBJECTIVE: The aim of the study was to determine the correlation of hypoxic-ischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year. MATERIALS AND METHODS: In total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated. RESULTS: The HI injury groups detected during USG significantly correlated with the mental development groups (r=0.3; P=0.01) and the neurological evaluation groups (r=0.3; P<0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quadriparesis and severe mental development impairment in 1-year-old subjects: sensitivity - 100%, specificity - 93-100%, positive predictive value (PPV) - 60-100%, and NPV - 100%. In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P≤0.05), and mean resistive index (RI) values were significantly lower (P<0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development. CONCLUSIONS: Hypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year.


Assuntos
Asfixia Neonatal/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Asfixia Neonatal/complicações , Encéfalo/irrigação sanguínea , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Ecocardiografia Doppler , Feminino , Hemodinâmica , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Recém-Nascido , Lituânia , Masculino , Prognóstico , Quadriplegia/diagnóstico por imagem , Quadriplegia/etiologia , Sensibilidade e Especificidade
4.
Medicina (Kaunas) ; 49(1): 42-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23652717

RESUMO

UNLABELLED: The aim of this article was to review the studies on diagnostic and prognostic value of radiological investigations (cranial sonography, Doppler ultrasonography, and magnetic resonance imaging) in the detection of hypoxic-ischemic brain injuries in full-term newborns. MATERIALS AND METHODS: A systematic search of studies on the diagnostic and prognostic possibilities of radiological investigations for the detection of hypoxic-ischemic injuries in full-term newborns was performed. RESULTS: A total of 13 prospective and 4 retrospective studies that analyzed the incidence of hypoxic-ischemic cerebral injuries, determined by means of cranial sonography, Doppler sonography, and magnetic resonance imaging, and associations with the stages of hypoxic-ischemic encephalopathy and long-term neurodevelopmental outcomes were included in this systematic review. CONCLUSIONS: Magnetic resonance imaging detects lesions in 75%-100% of cases. Magnetic resonance imaging performed at the age of 7-11 days demonstrated a high sensitivity (100%) and negative predictive value (100%) to predict unfavorable outcomes at 4 years of age. In newborns with hypoxic-ischemic encephalopathy, substantial cerebral hemodynamic alterations are detected after birth. The sensitivity and negative predictive value of cerebral blood flow velocities (peak systolic flow velocity, end-diastolic flow velocity) changes at 12±2 hours of age to predict the severity of hypoxic-ischemic encephalopathy and unfavorable outcomes at 18 months of age were found to be high (90% and 94%, respectively). A low resistive index (<0.56) at the age of 1-3 days had a specificity of 95% to predict unfavorable outcomes at 3 years of age. The data on the diagnostic and prognostic potential of cranial sonography are limited scarce and contrary.


Assuntos
Encéfalo/patologia , Hipóxia-Isquemia Encefálica/diagnóstico , Adolescente , Velocidade do Fluxo Sanguíneo , Encéfalo/irrigação sanguínea , Encéfalo/ultraestrutura , Circulação Cerebrovascular , Criança , Pré-Escolar , Hemodinâmica , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/patologia , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Ultrassonografia Doppler Transcraniana , Adulto Jovem
5.
Nutrients ; 14(18)2022 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-36145055

RESUMO

Optimal nutrient intake ensuring better neurodevelopment for very low birth weight (VLBW) infants remains unknown. The aim of this study was to assess the relationship between early (first 28 days) nutritional intake, first year growth, and neurodevelopment. In total, 120 VLBW infants were included into the study. A group of 95 infants completed follow-up to 12 months of corrected gestational age (CGA). Nutrient intake was assessed, and weight, length, and head circumference (HC) were measured weekly until discharge and at 3, 6, 9, and 12 months of CGA. Neurodevelopment was assessed at 12 months of CGA. Two groups-extremely preterm (EP) and very/moderately preterm (VP)-were compared. Growth before discharge was slower in the EP group than the VP group. At 12 months, there was no difference in anthropometric characteristics or neurodevelopmental scores between the groups. Higher carbohydrate intake during the first 28 days was the single significant predictor for better cognitive scores only in the EP group (ßs = 0.60, p = 0.017). Other nutrients and growth before discharge were not significant for cognitive and motor scores in either group in multivariable models, whereas post-discharge HC growth was associated with both cognitive and motor scores in the VP group. Monitoring intake of all nutrients and both pre-discharge and post-discharge growth is essential for gaining knowledge about individualized nutrition for optimal neurodevelopment.


Assuntos
Assistência ao Convalescente , Recém-Nascido Prematuro , Carboidratos , Ingestão de Alimentos , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Alta do Paciente
6.
Medicina (Kaunas) ; 47(6): 313-9, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21968883

RESUMO

UNLABELLED: Disorders of executive functioning have recently been reported in patients with juvenile myoclonic epilepsy (JME); however, data on other syndromes of generalized idiopathic epilepsy (IGE) other than JME, especially in adolescence, are scarce. The aim of this study was to explore specific executive functions in a group of adolescents with IGE of short duration and to evaluate the possible factors that might influence these functions. MATERIAL AND METHODS: Neuropsychological investigation of executive functions (the Verbal Fluency Test, the Five-Point Test, the Trail-Making Test, and the Stroop test) was performed in 59 patients aged 14-17 years and meeting the diagnostic criteria for IGE, and in the group of 59 age-matched controls without any history of epilepsy. RESULTS: The IGE group subjects scored worse than the controls in most of the executive function tests: phonemic (P=0.008) and semantic (P=0.001) word fluency, figural fluency (P=0.008), visual search and sequencing of numbers (P=0.001), and alternate number-letter sequencing (P=0.018). None of the test scores differed between the new-onset and the established IGE groups, or between the groups of cases with and without myoclonias. No relationship between executive functioning and gender, age, duration or activity of epilepsy, chronic use of treatment, or epileptiform discharges on electroencephalography was found. CONCLUSIONS: Executive dysfunction was present in adolescents with JME and other syndromes of IGE, manifesting with generalized tonic-clonic seizures without myoclonias, despite short duration and benign course of epilepsy.


Assuntos
Epilepsia Generalizada/fisiopatologia , Epilepsia Generalizada/psicologia , Função Executiva , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Testes Neuropsicológicos
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