Factors affecting head growth and intellectual function in children of drug addicts.

The effect of maternal heroin and methadone use on head growth and neurodevelopmental performance was studied in preschool children of untreated heroin addicts (n = 25), women receiving methadone therapy (n = 26), and a drug-free comparison group (n = 41) who had been followed from birth. The mean birth head circumference of both groups of drug-exposed infants was significantly below that of the comparison group; however, the only factors determined by multiple regression analysis as associated with head size at birth were maternal nutritional status and birth weight. By preschool age, head size did not differ significantly among groups. The factors associated with postnatal head growth were birth weight, intrapartum risk score, and race. Data show an increased incidence of low-average and mildly retarded intellectual performance in the drug-exposed children. Regression analyses demonstrated that amount of prenatal care, prenatal risk score, and home environment were most predictive of intellectual performance and that the degree of maternal narcotic use was not a significant factor.

Optic nerve manifestations of human congenital cytomegalovirus infection.

A Latin American male and a white female infant who had a cytomegalovirus infection on the first day of life had unilateral optic nerve hypoplasia. A white male infant who had cytomegalovirus isolated at 5 weeks of age had a unilateral partial coloboma of the optic nerve. A 4-month-old black infant with cytomegalovirus infection diagnosed at 2 days of age had a unilateral complete coloboma of the optic nerve associated with microphthalmia. Optic nerve involvement was an important manifestation of this disease.

Cerebellar hemorrhage in the term neonate: developmental and neurologic outcome.

To elucidate the effects of cerebellar hemorrhage on the term neonate, neurodevelopmental assessments were conducted at a mean age of 32 months on six children. In addition to cerebellar hemorrhage, ventriculomegaly was present on each subject's initial computed tomographic scan. All were managed without surgical evacuation. Two patients required shunts for progressive ventriculomegaly. Five patients had follow-up computed tomography indicating mild atrophy of the superior anterior vermis of the cerebellum; however, none had abnormal ventricular size or abnormalities of the cerebrum. On detailed examination conducted between the ages of 18 and 48 months, five had hypotonia, truncal ataxia, and intention tremor; two had nystagmus. Only one patient walked independently. Intellectual performance of four patients was within the retarded range and two had mildly delayed development. Two patients had markedly disordered expressive language. These data suggest that term neonates surviving cerebellar hemorrhage have neurologic deficits related to the site of hemorrhage, and cognitive deficits related to more generalized cerebral insult.

Neurodevelopmental status of low birth weight infants with bronchopulmonary dysplasia requiring prolonged oxygen supplementation.

Fifty infants weighing 1,500 g or less at birth with a diagnosis of bronchopulmonary dysplasia (BPD) were followed to a mean age of 25 months to determine their clinical course and short-term neurodevelopmental outcome after discharge from the Neonatal Intensive Care Unit, and to identify possible predictive factors for outcome. Because study participation was voluntary, the subjects may not have represented the total population of BPD survivors. Occurrences of abnormalities were high: 11 hearing impaired, 10 legally blind, 14 cerebral palsy, and 23 abnormal development scores. Twenty-one subjects had feeding problems and weight was below the fifth percentile in 26. Home-oxygen therapy was required by 50 per cent of the subjects. Although severity of illness, duration of oxygen therapy and feeding problems were greater among those sent home on oxygen, their neurodevelopmental status did not differ from that of infants breathing room air by discharge. Factors associated with neurodevelopmental outcome were intracranial hemorrhage, pulmonary air leak, and length of hospital stay.

Visually impaired infants in the 1980s. A survey of etiologic factors and additional handicapping conditions in a school population.

To identify etiologic factors and ophthalmologic diagnoses related to visual impairment in young infants, a survey was carried out within the 22 school districts providing educational services to all visually impaired infants, birth to 3 years of age, in Harris County, Texas. Review of 102 records revealed that 51 percent had impaired vision associated with prenatal factors, and 31 percent were associated with perinatal events. The most frequent ophthalmologic diagnoses were lesions of the optic nerve, optic pathway, and visual centers of the brain (cortical blindness). A majority of the infants had multiple handicaps: 17 percent had hearing loss, 48 percent had cerebral palsy, 46 percent had seizures, and 78 percent had severe developmental delay. The high incidence of multiple handicaps and significant medical problems indicates the necessity for interface between physicians and educators who serve the visually impaired infant.

A review of newborn medicine in America: European past and guiding ideology.

The beginnings of newborn medicine and its rapid advance in America since the early twentieth century are reviewed through presentation of ideas that have influenced the givers of care. Newly born infants attained patient status at the end of the 19th century when Budin gave them hospital charts and Ballantyne designed the blueprint for continuity of maternal-infant care. These achievements gave impetus to the task of preserving infant life. In 1915, the United States established a birth registration area permitting calculation of infant mortality rates. These rates became the guide and yardstick for measuring progress in newborn care. Since 1915 infant mortality has decreased tenfold as survival increased successively in the postnatal infant, the neonate, and recently in the premature. Pediatricians began to supervise newborn nurseries after World War I. During depression years, national efforts were expended for the premature. After World War II, pediatricians moved close to birth, assessing and treating in the delivery room. Special care and intensive care nurseries sprang up in the 1960s. In the past 25 years, improvements in ventilation and life support systems have enhanced survival of compromised and immature infants. Today, newborn medicine is spectacularly successful in lowering neonatal mortality but is beset by costs, ethics, legal concerns, and the burden of survival morbidity. Controversy such as exists today is not new to newborn medicine; it has been its constant companion throughout history.

Follow-up of methadone-treated and untreated narcotic-dependent women and their infants: health, developmental, and social implications.

This study compares the first year's health, neurodevelopmental status, and environment of infants of drug-dependent mothers attending methadone programs during pregnancy with those of drug-dependent mothers not enrolled in treatment programs (untreated). Both groups were also compared with drug-free controls. During pregnancy, the use of heroin and other psychoactive drugs was common among patients using methadone. Neonatal abstinence syndrome was of longest duration in the methadone group. Infants of both drug groups were smaller at birth, had more neonatal infections, and were viewed as more difficult to care for after nursery discharge than were those of drug-free mothers. On follow-up, mean developmental scores were within the normal range for all groups. The untreated drug-dependent group was more hypertonic than the methadone group, and a high rate of transient or minor motor disturbances and poor attention span was found in both drug groups. The behavior of methadone-treated women during pregnancy and the postnatal period closely resembled that of drug-free controls, and contrasted with untreated drug-dependent women. Methadone-treated women had a high degree of compliance with antepartum care, and 80% continued in the role of parent through the first year. Further investigation will determine whether the consistency of parenting will continue and whether it will enhance the development of their children.

Fetal and postnatal growth of children born to narcotic-dependent women.

We studied the effect of heroin and methadone on birth length and 3-year stature of children of untreated heroin addicts (n = 22), women receiving methadone maintenance therapy (95% were polydrug users) (n = 21), and a drug-free comparison group (n = 28), after adjustment for biologic, demographic, and health variables. The mean birth lengths of both groups of drug-exposed infants were significantly below that of a comparison group; however, group means were similar after adjustment for sex, race, prenatal care, pregnancy weight gain, obstetrical risk, maternal education, and smoking. At 3 years of age the mean height was comparable for all groups. When adjusted for birth length, parental height, and smoking, the methadone group was significantly shorter than children exposed to heroin in utero, and the comparison group assumed an intermediate position. These data indicate that the effect of heroin and methadone on intrauterine growth cannot be differentiated from that of associated factors, and that postnatal growth of children exposed to narcotics during pregnancy is no more impaired than that of a high-risk comparison group. Children of all three groups deserve continued observation and efforts to improve their environment in order that their full potential might be achieved.

The effects of methadone on maternal-fetal interactions in the rat.

Female Sprague-Dawley rats received methadone (25 mg/kg/day) by gavage throughout gestation. Water-gavaged rats served as controls. Fetuses were delivered by cesarean section when parturition was imminent. Our results indicate that methadone may interfere with fetal development and maternal-fetal interactions to some degree. The observed alterations were as follows: fetal growth retardation, an interference with the triggering of parturition once normal delivery size is attained and possible positional malformations.

The very low birth weight infant after discharge from intensive care: anticipatory health care and developmental course.

Despite intensive research, the data available on the long-term effects of prematurity on development of the child have not led to clearcut conclusions, particularly when the investigations are based on infant or perinatal factors alone. Previous research does indicate that the infant is "at risk" through school age and that the parents' perception of the child and the harmony between the child and his environment are powerful determinants of outcome. The implications for medical care, however, are clear. The developing low birth weight infant is best served by close medical supervision, particularly during the turbulent early years. Health care should be planned to include ongoing developmental assessment and screening at least through school entrance so that emerging vulnerabilities or deficits may be addressed as early as possible, thus impeding developmental progress minimally. An optimal care plan includes active partnership with the parents in detection of weaknesses, reinforcement of strengths, and formulation of recommendations for behavioral and educational management. For the physician this will require clinical acumen, an understanding of the child within the context of his environment, an attitude of supportive realism and a long view.

Survival of low-birth-weight infants with neonatal intraventricular hemorrhage. Outcome in the preschool years.

Twenty-nine low-birth-weight infants who survived neonatal intraventricular hemorrhage (IVH) were followed up prospectively and were last examined at a mean age of 3 1/2 years. The mean gestational age (+/- SD) of the group was 28.9 weeks (+/- 2.4 weeks), and the mean birth weight (+/- SD) was 1,167 g (+/- 292 g). Ten patients (34%) had normal neurologic outcome, and four (14%) had minimal abnormalities. Nine children (31%) were categorized as moderately abnormal, and six (21%) had severe abnormalities on neurologic examination. Intellectual performance was normal for 14 patients (48%), mildly delayed for seven (24%), and in the retarded range for eight (28%). Twelve children (41%), at 3 years of age, had handicapping conditions severe enough to warrant admission to special education programs in the public school. The grade of IVH was related significantly to neurologic outcome; both grade of hemorrhage and birth weight were correlated significantly with need for special education. Intellectual performance was related not only to grade of hemorrhage and birth weight, but also to paternal social class.

Prospective study of congenital cytomegalovirus infection.

The overall incidence of neonates with urinary cytomegalovirus (CMV) excretion was 0.9% of 954 tested. The incidence was twice as high in the lower as in the upper socioeconomic group (SEG). Mothers of infants with CMV infection in the lower SEG reported a greater number of chronic and gestational medical problems and showed a lower mean age than mothers of CMV-infected infants in the upper SEG. The mean age of mothers of CMV-infected infants was not significantly different from the respective control group in either upper or lower SEG. There was no impairment of immune responses in nine prospective or in two referred cases. Although eight of nine prospective cases might have been considered asymptomatic at birth, careful evaluation in the neonatal period showed significant growth inhibition in five, specific clinical changes in seven, and nonspecific clinical changes in all of the nine infants. Thus, "asymptomatic" neonates may demonstrate effects of the infection during the neonatal period.

Symptomatic congenital cytomegalovirus. Disorders of language, learning, and hearing.

Seventeen patients with symptomatic congenital cytomegalovirus (CMV) were studied longitudinally, with emphasis given to disorders of language, learning, and hearing. At a mean age of 5.5 years (range, 1 go 10 years), nine children (53%) performed in the retarded range. Eleven (65%) experienced sensorineural hearing loss, in three of whom it was progressive. Developmental verbal dyspraxia was documented in two children and suspected in a third. Disabilities in several areas of the learning process exhibited by four children with normal intelligence and hearing loss. Although the effects of congenital CMV were diverse, all of the children had developmental disorders that necessitated special education. Such patients require longitudinal follow-up that includes more than tests of intelligence and hearing. All areas of development must be evaluated to appreciate the full effect of CMV encephalitis in utero.

Long-term sequelae of group B streptococcal meningitis in infants.

The long-term outcome and admission features predictive of outcome were determined for 61 patients with group B streptococcal meningitis treated between 1974 and 1979. Infection was rapidly fatal in 13 patients (21%). Among the 48 survivors, 38 (79%) 3 years of age or older were available for comprehensive evaluation. Excluding five who had died before age 3 years, the mean age at evaluation was 6.0 years (range 3.3 to 9.0 years). Among survivors, 11 (29%) had severe neurologic sequelae, eight (21%) had mild to moderate deficits, and 19 (50%) were functioning normally. Analysis of predictive features revealed a significant risk of death or severe impairment among infants who at hospital admission were comatose or semicomatose, had decreased perfusion, total peripheral WBC less than 5,000/mm3, absolute neutrophil count less than 1000/mm3, and CSF protein greater than 300 mg/dl (P less than or equal to 0.05). These data indicate that, although mortality from group B streptococcal meningitis has declined, approximately half of the survivors of acute infection have some degree of morbidity when evaluated at ages permitting the detection of language delay and borderline or mild mental retardation.