Can Children With Perinatal Stroke Use a Simple Brain Computer Interface?

Background and Purpose: Perinatal stroke is the leading cause of hemiparetic cerebral palsy resulting in lifelong disability for millions of people worldwide. Options for motor rehabilitation are limited, especially for the most severely affected children. Brain computer interfaces (BCIs) sample brain activity to allow users to control external devices. Functional electrical stimulation enhances motor recovery after stroke, and BCI-activated functional electrical stimulation was recently shown to improve upper extremity function in adult stroke. We aimed to determine the ability of children with perinatal stroke to operate a simple BCI. Methods: Twenty-one children with magnetic resonance imaging­confirmed perinatal stroke (57% male, mean [SD] 13.5 [2.6] years, range 9­18) were compared with 24 typically developing controls (71% male, mean age [SD] 13.7 [3.7] years, range 6­18). Participants trained on a simple EEG-based BCI over 2 sessions (10 trials each) utilizing 2 different mental imagery strategies: (1) motor imagery (imagine opening and closing of hands) and (2) goal oriented (imagine effector object moving toward target) to complete 2 tasks: (1) drive a remote controlled car to a target and (2) move a computer cursor to a target. Primary outcome was Cohen Kappa with a score >0.40 suggesting BCI competence. Results: BCI performance was comparable between stroke and control participants. Mean scores were 0.39 (0.18) for stroke versus 0.42 (0.18) for controls (t[42]=0.478, P=0.94). No difference in performance between venous (M=0.45, SD=0.29) and arterial (M=0.34, SD=0.22) stroke (t[82]=1.89, P=0.090) was observed. No effect of task or strategy was observed in the stroke participants. Over 90% of stroke participants demonstrated competency on at least one of the 4 task-strategy combinations. Conclusions: Children with perinatal stroke can achieve proficiency in basic tasks using simple BCI systems. Future directions include exploration of BCI-functional electrical stimulation systems for rehabilitation for children with hemiparesis and other forms of cerebral palsy.

Caracterización de las enfermedades valvulares congénitas en la edad pediátrica / Characterization the pediatric patients with diagnostic of illnesses congenital valvulares

Introducción: Las valvulopatías congénitas son un grupo de entidades en las cuales la principal alteración anatomofuncional está en las válvulas cardiacas. Objetivo: Caracterizar los pacientes pediátricos nacidos vivos con diagnósticos de valvulopatías congénitas. Métodos: Se realizó una investigación descriptiva retrospectiva a partir de los registros de valvulopatías congénitas del Servicio de Cardiología del Hospital Pediátrico Universitario José Luis Miranda en Santa Clara, Cuba, en el periodo de 2005 a 2016. La población estuvo conformada por los 147 niños nacidos vivos con diagnóstico de valvulopatías congénitas. Se empleó un muestreo no probabilístico intencional por criterios y la muestra quedó conformada por 143. La recogida de la información se realizó a través de la revisión documental de las historias clínicas. Resultados: La tasa de incidencia de la valvulopatías congénitas fue de 1,5 x 1 000 nacidos vivos, predominó la estenosis pulmonar que agrupó el 70,6 por ciento de los diagnosticados. Se encontró predominio del sexo masculino con 50,3 por ciento, se determinó que 45,5 por ciento de los casos se diagnosticaron antes de los 29 días de nacido, período que incluye un diagnóstico prenatal. Conclusiones: El desarrollo del diagnóstico prenatal de las cardiopatías congénitas ha posibilitado la disminución de la incidencia de las malformaciones más complejas. El conocimiento de las enfermedades congénitas del corazón contribuye a operar de forma segura y con resolución anatómica completa a muchos de estos niños en el período prenatal o cuando son lactantes pequeños, para evitar el deterioro global de estos cuando la cardiopatía no está resuelta(AU)

Introduction: The congenital valvulopatías is a group of entities in which the main alteration anatomofuncional is in the heart valves. Objective: To characterize the pediatric patients with diagnostic of born congenital valvulopatías. Methods: He/she was carried out a retrospective descriptive investigation starting from the registrations of congenital valvulopatías of the service of Cardiology of the Hospital Pediatric University student José Luis Miranda in the period of 2005 at the 2016. The population was conformed by the 147 alive born children with diagnostic of congenital valvulopatías, a sampling was not used intentional probabilístico by approaches, being conformed the sample by 143. The collection of the information was carried out through the documental revision of the clinical histories. Results: The rate of incidence of the congenital valvulopatías was of 1,5 x 1000 born alive, the lung estenosis prevailed containing to 70,6 percent of those diagnosed he/she was prevalence of the masculine sex in 50,3 percent, it was determined that 45,5 percent of the cases was diagnosed before the 29 days where a prenatal diagnosis is included. Conclusions: The development of the prenatal diagnosis of the congenital cardiopatías has facilitated the decrease of the incidence of the most complex malformations. The knowledge of the congenital illnesses of the heart contributes to operate in a sure way and with complete anatomical resolution to many of these children in the prenatal period or when they are small nurslings, to avoid the global deterioration of these when the cardiopatía is not resolved(AU)

[Adrenal haemorrhage in neonates: risk factors and diagnostic and clinical procedure]. / Wylew do nadnerczy u noworodków: czynniki ryzyka i postepowanie diagnostyczno-kliniczne.

UNLABELLED: Prenatal and neonatal adrenal haemorrhage is being increasingly frequently reported. We present a group of 13 neonates with adrenal haemorrhage, hospitalised in the Department of Paediatrics and Endocrinology of Warsaw Medical University from 2003 to 2007. THE AIM: of this study was to analyse: the perinatal history, haemorrhage predisposing factors, its size, localization and progress estimated by ultrasonography, as well as clinical, biochemical and hormonal findings indicating adrenal insufficiency. MATERIAL AND METHODS: the study group comprised 13 neonates hospitalised in the Department of Paediatrics and Endocrinology, Warsaw Medical University, from 2003 to 2007, due to adrenal haemorrhage diagnosed by ultrasonography in the first week of life. RESULTS: all neonates were born at term, there was a male predominance. Twelve neonates had risk factors such as: birth trauma, intrauterine infection, perinatal asphyxia. No risk factors were found only in 1 neonate. One neonate had bilateral adrenal haemorrhage, others were unilateral - predominantly right-sided. In the study group clinical presentation was asymptomatic in 3 neonates, 1 of the patients had anaemia, 9 persistent jaundice, 2 bluish discoloration of the scrotum. Only one patient with bilateral adrenal haemorrhage showed sings of adrenal insufficiency and supplementation with glyco- and mineralcorticoids was necessary. Complete resolution of adrenal haemorrhage was reported after an average time of 3.5 months of observation. CONCLUSIONS: 1. Adrenal haemorrhage in neonates rarely leads to development of adrenal insufficiency. 2. In neonates with bilateral adrenal haemorrhage an extended hormonal diagnosis is required. 3. All patients require a systematic clinical and sonographic follow-up. Unilateral haemorrhage should be differentiated from neuroblastoma. 4. Scrotal haematoma may be a symptom of adrenal haemorrhage.

Utility of early single photon emission computed tomography (SPECT) in neonatal gelastic epilepsy associated with hypothalamic hamartoma.

Gelastic epilepsy, or laughing seizures, is a rare seizure manifestation often associated with hypothalamic hamartoma. This seizure type is well described in older children and adults, but has only rarely been reported in neonates, oftentimes recognized in retrospect when the children are older. We report a child diagnosed at 3 months of age with a large hypothalamic mass after evaluation for spells occurring since birth. The spells were characterized by bursts of hyperpnea, followed by repeated "cooing" respirations, giggling, and smiling. These spells were recognized soon after birth in the delivery room, and occurred at 15-20 minute intervals. They did not interrupt feeding and occurred during sleep. On referral to our center, the patient was noted to be thriving, with normal medical and neurologic examinations except for his spells. The laboratory evaluation was normal, as were endocrine and ophthalmologic evaluations. Neuroimaging was performed, with magnetic resonance imaging demonstrating a large 2.8-cm isodense, nonenhancing hypothalamic mass. Electroencephalogram was abnormal, demonstrating bi-frontal sharp and spike-wave discharges. Video-EEG did not demonstrate ictal discharges associated with the patient's spells. Single photon emission computed tomography (SPECT) demonstrated dramatic ictal uptake in the area of the tumor, with normalization during the interictal phase. Partial excision of hamartomatous tissue has minimally improved the spells. In conclusion, this patient manifested an unusual, early presentation of a rare seizure type. SPECT scanning confirmed the intrinsic epileptogenesis of the hamartoma, further justifying a surgical approach to such patients. Early surgical intervention is probably indicated in an attempt to minimize or prevent the cognitive and behavioral sequelae commonly seen with this seizure type.

Ultrasound in screening for neonatal adrenal hemorrhage.

Neonatal adrenal hemorrhage is common. Relatively large size and extensive vascularity of the gland results in its vulnerability to trauma and traumatic asphyxial injuries. The reported incidence from necropsies is 1.7 per 1000 births. Ultrasound scans were performed on each of 8374 consecutive newborns delivered throughout 48 months ending December 31, 1993, in the Department of Obstetrics and Gynaecology. During our screening, 16 cases of adrenal hemorrhage (10 males and 6 females) were noted at an incidence of 1.9 per 1000. All of the cases of adrenal hemorrhages remained intracapsular with spontaneous resolution. Thirteen cases were right sided, two cases were left sided, and one case was bilateral. None required surgical exploration. Neonatal treatment included further phototherapy in 12 cases, blood transfusions in five cases, and antibiotics in three cases. Signs of transient adrenocortical insufficiency were observed in one child.

Linear areas of echogenicity in the thalami and basal ganglia of neonates: an expanded association. Work in progress.

A retrospective review of 2,320 neonatal cranial sonograms obtained in 1,324 patients identified 25 patients with areas of echogenicity in their thalami and basal ganglia that were of a linear or branching linear distribution. Four of these patients had cytomegalovirus infection. Other major diagnoses encountered included Down syndrome, trisomy 13 syndrome, neonatal asphyxia, non-immune hydrops, and fetal alcohol syndrome. Results of the study suggest a broader etiologic basis for linear areas of echogenicity in the basal ganglia and thalami of children than has previously been reported. These patients warrant complete screening for possible in utero infection and perhaps also chromosomal analysis.

Intra-uterine tachycardia associated with multicystic encephalomalacia (MCE).

Multiple cystic brain lesions in neonates have been described as a result of a variety of causes. All events described thus far in association with multicystic encephalomalacia (MCE) seem to point to hypoxic-ischaemic injury as the common factor for this particular form of central nervous system damage. We describe a neonate in whom repeated, prolonged episodes of intrauterine tachycardia had been documented. Congestive heart failure and fetal hydrops were present at birth and MCE at the age of 13 wk. The obvious relationship between this child's intrauterine tachycardia and his MCE points to the fact that any fetus with prolonged tachycardia should be considered at risk of severe brain damage.

Symmetric bithalamic and striatal hemorrhage following perinatal hypoxia in a term infant.

A full-term infant who demonstrated a prolonged period of obtundation following asphyxia at birth was found on cranial computed tomography (CT) to have hemorrhage limited exclusively to symmetric bithalamic and striatal areas. This pattern of discrete, symmetric nuclear hemorrhage has not so far been reported as a complication of birth asphyxia. It differs from the germinal matrix hemorrhage on one hand in having a later time of onset (between the 4th and 10th day of life). It is also distinct from the more common supratentorial parenchymal hemorrhages in full-term infants owing to its topography, consequent interruption of the thalamocortical arousal mechanisms, and prolonged period of obtundation.

Barium peritonitis. Experience of five pediatric cases.

Barium peritonitis secondary to perforation of the gut is an infrequent complication of radiological G-I tract examinations. It is thought to imply a high mortality rate. However, this conception seems to be based on data obtained during the early 1950's. More recent case reports and small series indicate a more favourable prognosis depending on effective antibiotics and successful maintenance of severely ill patients. The scant information concerning the fate of pediatric cases warranted presentation of the experience of 5 patients, who all survived. Our approach to treatment and the suggested use of barium studies, in particular barium enema, in obscure abdominal emergency cases are offered.

[Urgent X-ray examinations of new-born babies II. Duodenum-colon (author's transl)]. / Dringliche Röntgenuntersuchungen Neugeborener. II. Duodenum-Colon.

This paper describes those examinations of new-born babies most often indicated as being urgent in cases of mechanical obstruction of the duodenum and small and large intestines. The initial examination is in all cases an abdominal radiograph, which indicates the next diagnostic procedure. Once a direct or indirect picture of an obstruction in the duodenum or small intestine has been attempted, an irrigoscopy without fluoroscopy is indicated for further clarification of these changes. Even in cases of invagination, fluoroscopy becomes unnecessary with careful air insufflation. If the initial clinical condition is questionable or the abdominal general radiograph unclear, a contrast medium enema is to be recommended as an alternative method.

Infants of diabetic mothers: radiographic manifestations.

The radiographic findings of a series of infants of diabetic mothers and a review of the literature are presented to illustrate the wide spectrum of abnormalities that may be seen with this condition. Congenital anomalies of the spine and skeletal, genitourinary, and cardiovascular systems and visceral situs inversus are significantly more frequent among infants of diabetic mothers than normal. The most specific anomaly is sacral agenesis. Renal vein thrombosis and adrenal hemorrhage are also more common and may be diagnosed by sonography. Over one-half of the cases of the small left colon are associated with maternal diabetes and may be diagnosed and treated with a contrast enema. The incidence of the respiratory distress syndrome is higher in infants of diabetic mothers than other premature infants, and the disease may occur in the presence of reliable indicators of lung maturity. Other common causes of dyspnea include cardiomyopathy, congenital heart disease, wet lung syndrome, hyperviscosity syndrome, and persistence of fetal circulation. Echocardiography is the most valuable adjunct in differentiating cardiac from pulmonary problems.

Barium enema in suspected necrotising enterocolitis: is it ever indicated?

Three infants with suspected, and subsequently proven, necrotising enterocolitis (NEC) had contrast medium enemas early in the course of their disease to assist diagnosis. There were no adverse effects from the enemas. All patients had evidence of persistent spasm of segments of the colon and contour speculation, probably representing superficial mucosal ulceration. It is suggested that when early or mild forms of NEC present diagnostic problems, a carefully performed contrast enema may be of diagnostic value. Absence of deep transmucosal necrosis in such cases definitely decreases the risk of perforation during the examination.

[Neonatal small left colon syndrome (author's transl)]. / Síndrome del colon izquierdo pequeño.

Two cases of neonatal intestinal obstruction, with clinical, radiological and evolutive characteristics typical of the "neonatal small left colon syndrome", are described. Some etiological aspects are commented upon as well as differential diagnosis, which must be done with a certain number of diseases that produce intestinal obstruction in the newborn. Authors consider of great interest the high incidence of this syndrome in children born to diabetic mothers, diagnostic value of barium enema and the usually benign clinical course with very simple therapeutic procedures.

[Neonatal small left colon syndrome (author's transl)]. / Neonatal small left colon syndrome.

The article reports on the newborn of a diabetic mother. Intestinal obstruction (subileus) occurred in the infant as a result of a neonatal small left colon syndrome. Diagnosis was established by radiological examination. Contrast enema with Gastrografin resulted in a permanent curative effect. Follow-up studies showed normalisation of the colonic lumen demonstrating the functional character of the disturbance. The etiology of the syndrome has not yet been clarified. It appears to be of differential diagnostic importance to make a clear distinction between this syndrome and Hirschsprung's disease (congenital megacolon) in newborn, because this involves a different therapy.

Ileo-ileal intussusception in the newborn. Report of a radiologically diagnosed case.

Ileo-Ileal intussusception was demonstrated preoperatively in a newborn infant by gastrografin enema with deliberate reflux of the contrast material into the small bowel. An intraluminal filling defect and stretching of the mucosal folds were demonstrated. The indications and proper use of contrast enemas are discussed.

Milk bolus obstruction in the neonate.

Seventeen cases of neonatal intestinal obstruction due to inspissated milk curds were seen at this hospital in the 9 years 1964-1972. The obstruction started on the 2nd to 10th day of life. Half the babies passed blood from the rectum and in most the x-rays were diagnostic. All survived, 14 after operation and 3 after medical treatment with a Gastrografin enema. Incomplete absorption of solids, particularly the fat from cows' milk feeds, is suggested as the cause.