Propranolol for severe post-head injury action tremor.

Two children developed persistent, incapacitating, upper extremity tremor following severe head injury from bicycle-automobile collision accidents. Both responded well to treatment with the beta blocking agent, propranolol, improving motor control in school and self-care tasks.

Clinical recovery from Schilder disease.

A 7-year-old girl presented with progressive dementia. 99-mTechnetium pertechnetate brain imaging and flow, cerebral angiograms, and a pneumoencephalogram revealed a large, bilateral frontal lesion that crossed the corpus callosum. At surgery, the consistency of affected brain tissue was soft. The histologic diagnosis was Schilder disease. Postoperatively, prednisone therapy was initiated because of clinical evidence of increased intracranial pressure, including funduscopic change. Within 4 months, the prednisone was discontinued, and the child completed the school year at the top of her class. Three years later she continued to function as a superior student, without demonstrable clinical neurologic abnormality.

Transient hyperammonemia in the preterm infant: neurologic aspects.

Two preterm infants had serum ammonia levels of 2400 and 2800 micrograms per deciliter and profound neurologic depression with seizures and coma. Both responded to treatment by exchange transfusion and peritoneal dialysis. All previously reported survivors of transient hyperammonemia of the preterm infant have had normal neurologic and developmental examinations on follow-up.

Herpes simplex: a possible cause of brain-stem encephalitis.

Herpes simplex virus was isolated from the tracheal aspirate of a 10-year-old boy presenting with acute onset of multiple cranial nerve palsies and a mild right hemiparesis. There was also an elevated herpes complement-fixation titer with decrease in the following weeks infection by herpes virus have been debated, we propose that this represents a case of brain-stem encephalitis due to herpes simplex infection. The importance of early diagnosis and evaluation of therapy are emphasized by this case in which the patient recovered completely.

A note on interdisciplinary research in developmental/behavioral pediatrics/psychology.

In sum, we have offered a few observations about the practice of interdisciplinary research. Now, in addition to our rather specific suggestions, we want to add a few general comments about the interactions of professionals who are actually involved in interdisciplinary research. Collaboration between physicians and psychologists can be enriching, stimulating, and rewarding. But it can also be problematic, because the former do not have much exposure to research and the latter do not have much exposure to clinical issues. Bringing these skills together may require many hours of discussion and reading each other's publications. Overall, physicians need to improve their research skills. Reading statistics texts, taking courses, handling data sets, reviewing other researchers' statistical designs are all reasonable strategies. Psychologists also need to expand their knowledge base. Reading the clinical literature is a start, but this ought to be supplemented by consistent exposure to the clinical milieu. The physician, who has access to the clinical milieu, needs to be sensitive to the question of exposure. Our final comments about collaboration are perhaps the most sensitive ones. The maintenance of a solid physician and psychologist research collaboration requires thoughtfulness, understanding, tact, and nurturance. Consider the status and responsibilities of the physician. He or she often outranks the psychologist, has access to the subject population, daily confronts ethical issues surrounding patient diagnoses, and controls communication of information to child and family. A sense of being in charge develops. Consequently, the psychologist may be perceived as being an adjunct to the research, responsible for day-to-day operations and committing ideas to paper.(ABSTRACT TRUNCATED AT 250 WORDS)

Computed tomography in child abuse and cerebral contusion.

Cerebral contusion is considered to be the lesion leading to neurological sequelae of mental retardation and cerebral palsy in abused children. This has been difficult to document other than at autopsy or craniotomy by previously available techniques. Acute contusion or hemorrhage presumably secondary to contusion is readily documented by computed tomography (CT). We are reporting the cases of four children with alleged or suspected abuse and CT evidence of cerebral contusion. The contusion has been found both with and without external evidence of head injury.

Considerations in evaluating changes in outcome for infants weighing less than 1,501 grams.

Neonatal mortality for 285 infants and developmental outcome for 158 infants with birth weights of 751 to 1,500 gm, born in the Capital Regional Perinatal Center between July 1975 and December 1979, were compared with the findings in 1952, in 1965 to 1967, and in 1968 to 1970. In the 1,001- to 1,500-gm group, mortality decreased and there was an 18% incidence of major neuropsychiatric disability compared to the 48% found in 1952 when the same examination techniques and diagnostic criteria were used. More 751- to 1,000-gm infants survive now also, but 40% have a major handicap. There is a high incidence of preconceptional, prenatal, perinatal, and postnatal abnormalities in this group of very low-birth-weight infants, but the incidence is significantly higher in those with major disabilities. The infants who die and those who have subsequent major neuropsychiatric abnormalities require the sophisticated techniques of neonatal intensive care, whereas these procedures are not needed or are used only briefly for the infants who are normal. In upper New York State, the demographic shifts in race, age, parity, education, and induced abortions account for 13% of the drop in neonatal mortality in the 1,001- to 1,500-gm group. These demographic as well as social and medical care changes must be taken into account in any evaluation of the decreasing mortality and morbidity that has occurred. Improvements in prenatal, obstetric, and neonatal care appear to be doing for the 751- to 1,000-gm group now what the then high-level care in 1952 did for the 1,001- to 1,500-gm group, when mortality decreased but only half of those who survived were normal.

Development of a scoring system for the Milani-Comparetti and Gidoni method of assessing neurologic abnormality in infancy.

This article reports the results of using a scoring system designed for the Milani-Comparetti and Gidoni method of neurologic examination of infants. The system was used in the assessment of 999 infants from the neonatal intensive care units affiliated with the Medical College of Wisconsin. The sample included all neonates who spent more than five days in the units from 1975 to 1978. Full assessments were conducted at 6 months and at 15 to 16 months corrected gestational age; additional assessments were scheduled by the physical therapists. For data analyses, the scores from the Milani-Comparetti and Gidoni method were summed; infants were subdivided into normal, transiently abnormal, and abnormal on the basis of the summed scores. Abnormal infants were further categorized on the basis of all information available. Several data analyses were performed to test the contribution of each item in separating normal, transiently abnormal, and abnormal infants and in distinguishing one type of abnormality from another. We conclude that the scoring system is useful in quantifying the degree of abnormality, in separating normality from abnormality, and in distinguishing among types of abnormality.

Construction of an Infant Neurological International Battery (Infanib) for the assessment of neurological integrity in infancy.

In this article, we describe the construction of an instrument for the assessment of the neurological integrity of infants. In a follow-up program for infants from the neonatal intensive care unit, 365 evaluations of 308 infants were made by using a 32-item battery with items from four methods. Factor analyses were used for data analyses, which yielded a 20-item instrument with five factors. We named the instrument the Infant Neurological International Battery (Infanib). The Infanib has sufficient reliability for clinical and research purposes. We have formed scoring sheets, which permit clinical use of the instrument. Cut points are recommended for the separation of infants with normal, transiently abnormal, and abnormal neurologic development. The quantified scoring system enables comparison of infants on item scores, subscores (factor scores), and total scores. It also permits entry of these scores in the computer so that more complex descriptions are possible of the relationship of the neurological assessment of infants both to earlier (eg, birth) and later variables (eg, cerebral palsy, cognitive function, and school performance).

Neurologic development of the high-risk infant.

Excellent methods of examining infants neurologically have been described and used in studies with follow-up to preschool or early school years. Few children discharged from NICUs returned with major neurologic abnormalities that were not noted on the infancy examinations, unless there had been an intervening event such as meningitis, head injury, or a difficult seizure disorder. Approximately 20 per cent of infants who were discharged from NICUs had lesser neurologic abnormalities on the infancy examinations, and these were transient. These children are at risk for lesser neurologic sequelae in the preschool years and school years, specifically hyperactivity, emotional immaturity, and a variety of learning disorders. There has been a tendency in follow-up studies of children from the NICU to fucus on the severe neurologic sequelae, but the bulk of the sequelae will become obvious when the school system requires compliance for behavior, rewards advancement in learning skills, and draws attention to deficits in complex coordination. For the teachers and parents of these children, these are frustrating years. In our follow-up study of school-age children, while not markedly abnormal, were not normal either. They demanded patience and extra attention that often wore thin by the time the child reached age six or seven. Early recognition of problem children by health care professionals may increase understanding and aid in early identification of children who need special services for behavior modification, remedial reading, and other school-related skills. It should also encourage much needed family support and counseling.

The construction of a scored neonatal neurological examination for assessment of neurological integrity in full-term neonates.

We describe the construction of a scored form for the neurological examination of the full-term neonate. Extensive data analyses were obtained from a large sample of neonatal neurological examinations performed by one examiner (MSP). Examinations were used from neonates with ages less than or equal to 48 hours (n = 727) and 72 hours to 1 week (n = 510) with gestational ages greater than or equal to 37 weeks. Forty-four items from several neonatal assessments were used in these neurological examinations. Further subdivision yielded a total of 65 items. Correlations were obtained for the 65 items. We factored the matrix of these correlations, using several solutions of factor analysis. Thirty-two items were thus grouped and pruned into seven dimensions (factors) to provide a scorable neonatal neurological examination (Neoneuro) with an internal consistency or reliability of 0.80. From the total scores, cut points are recommended for categories of normality/abnormality: normal, mildly abnormal, moderately abnormal, and severely abnormal. This scoring system is well-based both theoretically and psychometrically. The quantified computer-compatible scoring system permits evaluation of individual neonates, as well as comparison of samples of neonates on item scores, subscores (factor scores), and total scores. Such quantification will permit documentation of the natural history of specific abnormalities and the evaluation of various therapies.

Neurology of hard times. Economic depression as related to neurologic illness in children.

Many children and their families have experienced "hard times" because of the current economic conditions. Five cases are presented in which neurologic illness in children was related to changes in the family's economic circumstances. Pediatricians are encouraged to look carefully at the impact of changing economic conditions upon child health.

Follow-up of families of neonates in whom life support was withdrawn.

Grieving patterns and psychosocial functioning were studied in 20 families who had participated in a decision-making conference regarding withdrawal of support of their newborn in the neonatal intensive care unit and for whom the life support had been withdrawn. Prolonged grieving was reported by one father and pathologic grieving by one grandmother. In the majority of families, grieving patterns and psychosocial functioning were similar to those of other families whose newborns have died.

Decisions to withdraw life support in the neonatal intensive care unit.

Neonatal intensive care units may choose to selectively withdraw support in some neonates with severe brain damage. We offer suggestions for criteria for such withdrawal, and a review of 20 cases in which such a decision-making process occurred in our neonatal intensive care unit.