Spotlight on middle childhood: Rejuvenating the 'forgotten years'.

Middle childhood, from six to 12 years of age, is often known as the 'forgotten years' of development because most research is focused on early childhood development or adolescent growth. However, middle childhood is rich in potential for cognitive, social, emotional and physical advancements. During this period, the brain is actively undergoing synaptic pruning and, as such, is constantly becoming more refined, a process that is heavily dependent on a child's environment. This discovery opens the door to optimizing the experiences a child needs to provide themselves with a strong foundation for adulthood. The present article reviews the neurological changes that occur in middle childhood, their impact on overall development and how to implement this knowledge to augment a child's capabilities.

La période intermédiaire de l'enfance, de six à 12 ans, est souvent connue comme « les années oubliées ¼ du développement, car une bonne partie de la recherche est axée sur le développement de la petite enfance ou la croissance à l'adolescence. Cependant, cette période est riche en potentiel sur le plan du progrès cognitif, social, affectif et physique. Le cerveau subit activement un élagage synaptique et devient donc de plus en plus raffiné, un processus qui dépend lourdement de l'environnement de l'enfant. Cette découverte ouvre la porte à l'optimisation des expériences que vit l'enfant afin d'établir des assises solides pour l'âge adulte. Le présent article aborde les changements neurologiques qui se produisent pendant la période intermédiaire de l'enfance, leurs répercussions sur le développement global et la mise en œuvre de ces connaissances pour accroître les capacités de l'enfant.

Are we making a real difference? Update on 'hidden mortality' in the management of congenital diaphragmatic hernia.

Reports of improved survival rates for cases of congenital diaphragmatic hernia (CDH) patients have prevailed in the literature over the past 10 years. These improvements have been attributed to advances in medical management in the postnatal period. However, further inquiries into the true survival of CDH patients through population-based studies have revealed that the reported increase in survival outcomes, which are often single institution-based reports, are confounded by case selection bias which fails to consider those CDH patients who do not reach the referral centers. This apparent discrepancy between population-based and institution-based statistics raises the question of 'hidden mortality' and the role it plays in both research and clinical medicine. In this review we will examine the reported survival outcomes of CDH from both institution- and population-based perspectives and explore the presence and implications of hidden mortality on research methodology and clinical practice.

Absolute vs relative improvements in congenital diaphragmatic hernia survival: what happened to "hidden mortality".

PURPOSE: The aim of this study is to determine if there has been a true, absolute, or apparent relative increase in congenital diaphragmatic hernia (CDH) survival for the last 2 decades. METHOD: All neonatal Bochdalek CDH patients admitted to an Ontario pediatric surgical hospital during the period when significant improvements in CDH survival was reported (from January 1, 1992, to December 31, 1999) were analyzed. Patient characteristics were assessed for CDH population homogeneity and differences between institutional and vital statistics-based population survival outcomes. SAS 9.1 (SAS Institute, Cary, NC) was used for analysis. RESULT: Of 198 cohorts, demographic parameters including birth weight, gestational age, Apgar scores, sex, and associated congenital anomalies did not change significantly. Preoperative survival was 149 (75.2%) of 198, whereas postoperative survival was 133 (89.3%) of 149, and overall institutional survival was 133 (67.2%) of 198. Comparison of institution and population-based mortality (n = 65 vs 96) during the period yielded 32% of CDH deaths unaccounted for by institutions. Yearly analysis of hidden mortality consistently showed a significantly lower mortality in institution-based reporting than population. CONCLUSION: A hidden mortality exists for institutionally reported CDH survival rates. Careful interpretation of research findings and more comprehensive population-based tools are needed for reliable counseling and evaluation of current and future treatments.