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1.
Medicine (Baltimore) ; 99(33): e21669, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872032

RESUMO

BACKGROUND: Whether regional anesthesia (RA) offers better long-term neurodevelopment outcomes compared to general anesthesia (GA) to infants undergoing inguinal herniorrhaphy is still under heated debate. The aim of this meta-analysis is to compare the long-term neurodevelopment impact of RA with GA on infants undergoing inguinal herniorrhaphy. METHODS: A systematic search of MEDLINE, EMBASE, PubMed, the Cochrane Central Register of Controlled Trials, clinicaltrials.gov and controlledtrials.com will be performed. Published eligible randomized controlled trials (RCTs) or quasi-RCTs (including abstracts) through May 20, 2020 with language limit of English will be enrolled in the meta-analysis. Two reviewers will independently conduct the procedures of study selection, data extraction, methodological quality assessment, and risk of bias assessment. The primary outcome is long-term neurodevelopmental state (at 2- and 5-year follow-up) as reflected in the Bayley and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) scales of infants development following surgeries. The secondary outcomes consist of satisfactory intraoperative infants immobility, duration of surgery, any anesthetic failure, the supplement of postoperative analgesia, postoperative apnea, and postoperative bradycardia. The pooled weighted mean differences (WMDs) or odds ratios (ORs) of each outcome measurement and relative 95% confident intervals (CIs) will be calculated. EndNote X8 (Clarivate Analytics) software will be applied to manage all citations. The Cochrane Review Manager version 5.3 software (RevMan 5.3) will be employed for statistical analysis. DISCUSSION: This study will summarize scientific and practical evidence and provide evidence-based individualized decision-making guidance on anesthesia regimen for inguinal herniorrhaphy in infants. REGISTRATION: This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 17 June 2020 (registration number INPLASY202060064).


Assuntos
Anestesia por Condução/efeitos adversos , Anestesia Geral/efeitos adversos , Cognição/efeitos dos fármacos , Herniorrafia/métodos , Desenvolvimento Infantil , Pré-Escolar , Hérnia Inguinal/cirurgia , Humanos , Lactente , Recém-Nascido , Metanálise como Assunto , Revisões Sistemáticas como Assunto
3.
Plast Reconstr Surg ; 146(2): 205e-216e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740598

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe normal ear anatomy and development, and evaluate the patient's ears for differences in shape, size, prominence, and symmetry. 2. Identify common congenital ear deformities, including prominent ear, macrotia, Stahl ear, cryptotia, constricted ear, and lobule anomalies. 3. Describe both early nonoperative management and operative techniques for correction of these ear deformities. 4. Be aware of advantages and disadvantages of common and emerging techniques for correction of pediatric ear deformities. SUMMARY: Whereas severe ear malformations such as microtia/anotia are rare, other ear deformities, such as prominent ear, Stahl ear, and cryptotia, are common. Although these ear deformities result in minimal physiologic morbidity, their psychological and cosmetic impact can be significant. Identifying these common deformities and understanding how they differ from normal ear anatomy is critical to their management. In cases where a deformity is identified in neonatal life, ear molding may obviate the need for surgery. Although various surgical techniques have been described for correction of common ear deformities, the surgeon should follow a careful stepwise approach to address the auricular deformity or deformities present. By using such an approach, complications may be minimized and predictable aesthetic outcomes achieved.


Assuntos
Orelha Externa/anormalidades , Estética , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fatores Etários , Criança , Desenvolvimento Infantil , Pré-Escolar , Orelha Externa/crescimento & desenvolvimento , Orelha Externa/cirurgia , Humanos , Lactente , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Tempo para o Tratamento , Adesivos Teciduais , Resultado do Tratamento
5.
Lancet Psychiatry ; 7(9): 775-787, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828167

RESUMO

BACKGROUND: Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal. METHODS: 40 village clusters in Pakistan were randomly allocated using a computerised randomisation sequence to receive a group-based, psychosocial intervention and enhanced usual care for 36 months, or enhanced usual care alone. Pregnant women (≥18 years) were screened for moderate or severe symptoms of depression (patient health questionnaire-9 [PHQ-9] score ≥10) and were recruited into the trial (570 participants), and a cohort without depression (PHQ-9 score <10) was also enrolled (584 participants). Including the non-depressed dyads enabled us to determine how much of the excess risk due to maternal depression exposure the intervention could mitigate. Research teams responsible for identifying, obtaining consent, and recruiting trial participants were blind to the allocation status throughout the duration of the study, and principal investigators, site coordinators, statisticians, and members of the trial steering committee were also blinded to the allocation status until the analysis of 6-month data for the intervention. Primary outcomes were maternal depression symptoms and remission (PHQ-9 score <10) and child socioemotional skills (strengths and difficulties questionnaire [SDQ-TD]) at 36-months postnatal. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02658994. FINDINGS: From Oct 15, 2014 to Feb 25, 2016 46 village clusters were assessed for eligibility, of which 40 (including 1910 mothers were enrolled. After exclusions, 288 women were randomly assigned to the enhanced usual care group and 284 to the intervention group, and 1159 women were included in a group without prenatal depression. At 36-months postnatal, complete data were available from 889 mother-child dyads: 206 (72·5%) in the intervention group, 216 (75·3%) in the enhanced usual care group, and 467 (80·0%) women who did not have prenatal-depression. We did not observe significant outcome differences between the intervention group and the enhanced usual care group for the primary outcomes. The standardised mean difference of PHQ-9 total score was -0·13 (95% CI -0·33 to 0·07), relative risk of patient health questionnaire-9 remission was 1·00 (95% CI 0·88 to 1·14), and the SDQ-TD treatment estimate was -0·10 (95% CI -1·39 to 1·19). INTERPRETATION: Reduced symptom severity and high remission rates were seen across both the intervention and enhanced usual care groups, possibly masking any effects of the intervention. A multi-year, psychosocial intervention can be task-shifted via peers but might be susceptible to reductions in fidelity and dosage over time (which were not among the outcomes of this trial). Early intervention efforts might need to rely on multiple models (eg, collaborative care), be of greater intensity, and potentially targeted at mothers who are at high risk for depression to reduce the intergenerational transmission of psychopathology from mothers to children. FUNDING: National Institutes of Health.


Assuntos
Desenvolvimento Infantil , Depressão Pós-Parto/terapia , Relações Mãe-Filho , Mães/psicologia , Grupo Associado , Psicoterapia de Grupo/métodos , Adolescente , Adulto , Comportamento Infantil , Pré-Escolar , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Feminino , Humanos , Paquistão , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
7.
Pediatrics ; 146(Suppl 1): S9-S12, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737226

RESUMO

The "Baby Doe" case of the early 1980s was marked by considerable controversy, primarily regarding the legal response of the federal government to the case at the time. In the decades that followed, the decision-making for children with trisomy 21, like Baby Doe, has been substantially reevaluated. The data, the assumptions about quality of life that were based on those data, and the ethical principles underpinning the decision-making in the Baby Doe case have all evolved significantly over time. The present strategies for decision-making for children with trisomy 13 and 18 appear to be following a similar pattern. The data, quality-of-life assumptions based on those data, and even the ethical principles underlying the decision-making for these children are currently being reexamined. Children with trisomy 13 and 18 are, in this regard, the next Baby Doe(s).


Assuntos
Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Síndrome da Trissomia do Cromossomo 13/terapia , Síndrome da Trissomía do Cromossomo 18/terapia , Desenvolvimento Infantil , Atresia Esofágica , Humanos , Recém-Nascido , Estimativa de Kaplan-Meier , Pais , Qualidade de Vida , Síndrome da Trissomia do Cromossomo 13/mortalidade , Síndrome da Trissomía do Cromossomo 18/mortalidade , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
8.
Pediatrics ; 146(Suppl 1): S25-S32, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737229

RESUMO

In this article, I examine the role of minors' competence for medical decision-making in modern American law. The doctrine of parental consent remains the default legal and bioethical framework for health care decisions on behalf of children, complemented by a complex array of exceptions. Some of those exceptions vest decisional authority in the minors themselves. Yet, in American law, judgments of minors' competence do not typically trigger shifts in decision-making authority from adults to minors. Rather, minors' decisional capacity becomes relevant only after legislatures or courts determine that the default of parental discretion does not achieve important policy goals or protect implicated constitutional rights in a particular health care context and that those goals can best be achieved or rights best protected by authorizing capable minors to choose for themselves. It is at that point that psychological and neuroscientific evidence plays an important role in informing the legal inquiry as to whether minors whose health is at issue are legally competent to decide.


Assuntos
Tomada de Decisão Clínica , Competência Mental/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança/legislação & jurisprudência , Educação Infantil , Bem-Estar da Criança/legislação & jurisprudência , Direitos Civis , Tomada de Decisão Clínica/ética , Família , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Competência Mental/normas , Menores de Idade/psicologia , Relações Pais-Filho , Consentimento dos Pais/ética , Patient Self-Determination Act , Autonomia Pessoal , Procurador/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
9.
Medicine (Baltimore) ; 99(30): e21082, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791681

RESUMO

INTRODUCTION: Cerebral palsy is the most common motor disability of childhood. Spastic cerebral palsy accounts for 60% to 70% of cases. Research has shown that acupuncture can improve the quality of life of children with cerebral palsy, but the mechanism of action remains unclear. This study aims to determine the effectiveness of acupuncture for treatment of children with spastic cerebral palsy and to assess the value of multimodal magnetic resonance imaging (MRI) and ambulatory electroencephalogram (EEG) for evaluation of treatment effect. METHODS AND ANALYSIS: This randomized controlled trial will enroll a total of 72 children with CP from 2 hospitals-Jiangsu Province Hospital of Chinese Medicine and Nanjing State Hospital of Pediatric-with 36 participants from each hospital. Patients will be randomly assigned (1:1 ratio) to receive "Tonifying Kidney and Invigorating Brain" acupuncture treatment plus standardized physical rehabilitation treatment (treatment group) or only standardized physical rehabilitation (control group). All participants will receive 3 treatment sessions per week for 3 consecutive months; they will then be followed up for another 3 months. The primary outcome measures will include multimodal magnetic resonance imaging (MRI), ambulatory electroencephalogram (EEG), and Gesell Developmental Diagnostic Schedules. The secondary outcome measures will include Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure (GMFM), Functional Independence Measure (WeeFIM), and Modified Ashworth Scale score. Outcome measures (including primary and secondary outcome measures) were collected at the baseline, 3 months and 6 months prior to the intervention.Ethics and dissemination PATIENTS CONSENT:: Obtained. ETHICS APPROVAL: The central independent ethics committee of Jiangsu Province Hospital of Traditional Chinese Medicine approved the protocol (2017NL-115-02). SAFETY CONSIDERATIONS: Routine blood tests and liver and kidney function tests will be conducted to exclude patients with severe heart, liver, or kidney diseases. The same examinations will be performed again at the end of the study to detect any possible side effects. Possible acupuncture-related adverse events (e.g., fainting, needle stick injury, local infection, subcutaneous hematoma, and low-grade fever) will be documented. Serious adverse events will be reported to the principal investigator immediately. All unexpected and unintended responses, even those not necessarily related to the acupuncture intervention, will be documented as adverse events. CASE DROPOUT MANAGEMENT: Participants have a right to withdraw from the study at any time if they feel uncomfortable upon receiving the treatments or being diagnosed with serious complications or diseases. They will then be referred to the preferred department for further treatment and management. If cases of dropout, the researcher need to contact the participant to reason the problem out, collect and record all the necessary assessments on the last visit as well as the date of last visit. All data available until the date of withdrawal will be stored for further statistical analysis. DISCUSSION: This research is being conducted to assess the value of acupuncture as an intervention for rehabilitation of children with spastic cerebral palsy and also to evaluate the usefulness of multimodal MRI and ambulatory EEG for identifying changes in brain function. TRIAL REGISTRATION: This trial is registered with Chinese Clinical Trials Register, ChiCTR 1900024546 (registered 15 July 2019; retrospective registration, http://www.chictr.org.cn/showproj.aspx?proj=35763).


Assuntos
Acupuntura , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/terapia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/reabilitação , Criança , Desenvolvimento Infantil , Eletroencefalografia , Humanos , Rim , Imagem por Ressonância Magnética , Destreza Motora , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(7): 706-710, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32669165

RESUMO

OBJECTIVE: To study the level of neuropsychological development in late preterm infants and early term infants at the age of 1 year. METHODS: A total of 1 257 children with a corrected age of 1 year were enrolled as subjects. According to gestational age at birth, they were divided into an early preterm group (28-33+6 weeks), a late preterm group (34-36+6 weeks), an early term group (37-38+6 weeks), and a full-term group (39-41+6 weeks). Gesell Developmental Schedules were used to assess the neuropsychological development of the children, and the groups were compared in terms of neuropsychological development at the age of 1 year. RESULTS: There were significant differences in the developmental quotients of the five functional areas (adaptability, gross motor, fine motor, language and social ability) between the four groups at the age of 1 year (P<0.05), and the full-term infants had the highest development quotients, followed by the early term infants, the late preterm infants, and the early preterm infants (P<0.05). The full-term infants had the lowest rate of developmental delay in each functional area, while the early preterm infants had the highest rate (P<0.05). Compared with the full-term infants, the early term infants had a higher risk of developmental delay in adaptability (OR=1.796, P<0.05), and the late preterm infants had a higher risk of developmental delay in adaptability (OR=2.651, P<0.05) and fine motor (OR=2.679, P<0.05), while the early preterm infants had a higher risk of developmental delay in adaptability (OR=4.069, P<0.05), fine motor (OR=3.710, P<0.05), and social ability (OR=3.515, P<0.05). CONCLUSIONS: The risk of neuropsychological developmental delay decreases with the increase in gestational age in children at the age of 1 year, with a dose-response effect. There are varying degrees of developmental delay in early term infants and late preterm infants, and health care follow-up for early term infants and late preterm infants should be taken seriously.


Assuntos
Recém-Nascido Prematuro , Nascimento Prematuro , Desenvolvimento Infantil , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez
11.
Public Health ; 185: 290-297, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32712460

RESUMO

OBJECTIVES: Malnutrition is one of the leading causes of death among children younger than five years. In this study, we aimed to formulate a ready-to-use supplementary food (RUSF), based on local food products, and investigate its efficacy on growth indicators in children with mild to moderate malnutrition. STUDY DESIGN: This is a randomized controlled clinical trial. METHODS: This study was performed in six health centers in Shahr-e-Rey, Tehran, Iran, between April and October 2017. One hundred children, aged 24-59 months, with mild to moderate malnutrition (weight-for-height Z-score [WHZ] between -3 and -1) were randomly assigned to two groups to receive either 1-3 sachets of RUSF or normal diet for 8 weeks. All mothers and caregivers received nutrition education. Growth indicators including weight and height, WHZ, and body mass index (BMI), along with clinical outcomes, were assessed. RESULTS: Children who received RUSF had a significant increase in weight (1.44 ± 0.38 vs 0.7 ± 0.32 kg, respectively, P < 0.001), and BMI (1.2 ± 0.47 vs 0.35 ± 0.33 kg/m2, respectively, P < 0.001) compared with the control group. There was a greater daily weight gain during the first 4 weeks (P < 0.001) and throughout the study (P = 0.013) in the RUSF group. Daily height gain was considerably higher in the RUSF group during the first 4 weeks (P = 0.027). Children in the RUSF group had more improvement in WHZ (1.18 ± 0.41 vs 0.41 ± 0.31, P < 0.001) after supplementation. Besides, 92% of the RUSF and 12% of the control group reached to WHZ > -1 at the end of the study (P < 0.001). There was lower prevalence of diarrhea (12% vs 28.6%, respectively, P = 0.01) and marginally lower fever (16% vs 36.7%, respectively, P = 0.05) in the intervention than in the control group. CONCLUSIONS: A newly developed RUSF improved growth indicators and clinical outcomes in children with mild to moderate malnutrition. CLINICAL TRIAL REGISTRY NUMBER: IRCT2017021315536N6 (registered at www.irct.ir).


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Suplementos Nutricionais , Alimentos Formulados , Desnutrição/dietoterapia , Índice de Massa Corporal , Peso Corporal , Desenvolvimento Infantil , Pré-Escolar , Dieta , Feminino , Humanos , Irã (Geográfico) , Masculino , Ganho de Peso
13.
PLoS One ; 15(7): e0235287, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667931

RESUMO

OBJECTIVE: Noise in the neonatal intensive care unit can be detrimental to the health of the hospitalized infant. Means of reducing that noise include staff training, warning lights, and ear coverings, all of which have had limited success. Single family rooms, while an improvement, also expose the hospitalized infant to the same device alarms and mechanical noises found in open bay units. METHODS: We evaluated a non-contact incubator-based active noise control device (Neoasis™, Invictus Medical, San Antonio, Texas) in a simulated neonatal intensive care unit (NICU) setting to determine whether it could effectively reduce the noise exposure of infants within an incubator. In the NICU simulation center, we generated a series of clinically appropriate sound sequences with bedside medical devices such as a patient monitor and fluid infusion devices, hospital air handling systems, and device mechanical sounds. A microphone-equipped infant mannequin was oriented within an incubator. Measurements were made with the microphones with the Neoasis™ deactivated and activated. RESULTS: The active noise control device decreased sound pressure levels for certain alarm sounds by as much as 14.4 dB (a 5.2-fold reduction in sound pressure) at the alarm tone's primary frequency. Frequencies below the 2 kHz octave band were more effectively attenuated than frequencies at or above the 2 kHz octave band. Background noise levels below 40 dBA were essentially not impacted by the active noise control device. CONCLUSIONS: The active noise control device further reduces noise inside infant incubators. Device safety and potential health benefits of the quieter environment should be verified in a clinical setting.


Assuntos
Desenvolvimento Infantil/fisiologia , Incubadoras para Lactentes , Recém-Nascido Prematuro/fisiologia , Unidades de Terapia Intensiva Neonatal , Ruído/efeitos adversos , Segurança de Equipamentos , Humanos , Saúde do Lactente , Recém-Nascido , Manequins , Texas
14.
Public Health ; 185: 246-253, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32688100

RESUMO

OBJECTIVES: During recent decades, China has experienced a rapid growth in economy and also in prevalence of childhood obesity. Given the great importance of adolescence overweight/obesity for future health and given the relative lack of longitudinal studies on adolescent obesity in developing countries, particularly in China, in this study, we aimed to explore the potential growth trajectories of overweight/obesity among Chinese adolescents and to further examine socio-economic status predictors and health consequences of these growth trajectories. STUDY DESIGN: This study is a longitudinal study. METHODS: The data were from four waves of panel data from the China Family Panel Studies (CFPS 2010, 2012, 2014, and 2016). For the present study, children aged 10 to 12 years from the baseline 2010 sample were selected (N = 1685), among whom 1388 were reinterviewed in 2012, 1172 in 2014, and 941 in 2016. We retained a final sample of 800 who had at least three waves of body mass index (BMI) data (i.e. final N = 800). Generalized growth mixture modeling was used as the major analytical strategy. RESULTS: We found three different types of overweight/obesity developmental trajectories for these Chinese adolescents, namely a stably normal class, a decreased risk class, and a chronically overweight/obese class. Moreover, we found that higher family income was associated with a lower probability of getting into the chronically overweight/obese class for urban adolescents but with a higher probability of getting into the same class for rural adolescents. Lastly, the adolescents classified in the chronically overweight/obese group reported significantly lower levels of self-rated health. CONCLUSIONS: There were heterogeneous growth trajectories of adolescent overweight/obesity in China. Sustained overweight/obesity during adolescence was predicted by lower family income in urban China but by higher family income in rural China. More targeted and regionalized interventions for childhood overweight/obesity in China should be considered.


Assuntos
Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Desenvolvimento do Adolescente , Índice de Massa Corporal , Trajetória do Peso do Corpo , Criança , Desenvolvimento Infantil , China/epidemiologia , Status Econômico , Feminino , Humanos , Renda , Estudos Longitudinais , Masculino , Pobreza , População Rural , Classe Social , Fatores Socioeconômicos
15.
PLoS One ; 15(7): e0235311, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628734

RESUMO

OBJECTIVE: This study aimed to define the prevalence and predictors of non-right-handedness and its link to long-term neurodevelopmental outcome and early neuroimaging in a cohort of children born extremely preterm (<28 weeks gestation). METHODS: 179 children born extremely preterm admitted to the Neonatal Intensive Care Unit of our tertiary centre from 2006-2013 were included in a prospective longitudinal cohort study. Collected data included perinatal data, demographic characteristics, neurodevelopmental outcome measured by the Bayley Scales of Infant and Toddler Development at 2 years and the Movement Assessment Battery for Children at 5 years, and handedness measured at school age (4-8 years). Magnetic resonance imaging performed at term-equivalent age was used to study overt brain injury. Diffusion tensor imaging scans were analysed using tract-based spatial statistics to assess white matter microstructure in relation to handedness and neurodevelopmental outcome. RESULTS: The prevalence of non-right-handedness in our cohort was 22.9%, compared to 12% in the general population. Weaker fine motor skills at 2 years and paternal non-right-handedness were significantly associated with non-right-handedness. Both overt brain injury and fractional anisotropy of white matter structures on diffusion tensor images were not related to handedness. Fractional anisotropy measurements showed significant associations with neurodevelopmental outcome. CONCLUSIONS: Our data show that non-right-handedness in children born extremely preterm occurs almost twice as frequently as in the general population. In the studied population, non-right-handedness is associated with weaker fine motor skills and paternal non-right-handedness, but not with overt brain injury or microstructural brain development on early magnetic resonance imaging.


Assuntos
Encéfalo/crescimento & desenvolvimento , Desenvolvimento Infantil/fisiologia , Imagem de Tensor de Difusão/estatística & dados numéricos , Lateralidade Funcional/fisiologia , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Criança , Pré-Escolar , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Estudos Prospectivos
16.
PLoS One ; 15(7): e0236107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649702

RESUMO

BACKGROUND AND OBJECTIVES: Globally, studies have shown associations between maternal stimulation and early child development. Yet, little is known about the prevalence of paternal and other caregivers' stimulation practices, particularly in low- and- middle-income countries (LMICs). METHODS: Data from the Multiple Indicators Cluster Survey (MICS) and the Demographic and Health Survey (DHS) were combined across 62 LMICs (2010-2018). The sample included 205,150 mothers of children aged 3 and 4 years. High levels of stimulation were defined as caregiver engagement in at least 4 out of 6 possible activities with the child. The proportion of mothers, fathers, and other caregivers providing high levels of stimulation was calculated by country, region, and for the whole sample. Socioeconomic disparities within and between countries were estimated. RESULTS: On average, 39.8% (95% CI 37.4 to 42.2) of mothers, 11.9% (95% CI 10.1 to 13.8) of fathers, and 20.7% (95% CI 18.4 to 23.0) of other adult caregivers provided high levels of stimulation. Stimulation varied by region, country income group, and Human Development Index (HDI), with higher levels of maternal and paternal-but not other caregivers'-stimulation in high-income and high-HDI countries. Within countries, stimulation levels were, on average, lower in the poorest relative to the richest households, and some but not all countries exhibited differences by child sex (i.e., boys vs. girls) or area (i.e., urban vs. rural). CONCLUSIONS: Results suggest a need for intervention efforts that focus on increasing caregiver stimulation in LMICs, particularly for fathers and in low-income contexts.


Assuntos
Cuidadores/psicologia , Desenvolvimento Infantil , Países em Desenvolvimento/estatística & dados numéricos , Pai/psicologia , Mães/psicologia , Pré-Escolar , Relações Pai-Filho , Feminino , Humanos , Masculino , Relações Mãe-Filho , Inquéritos e Questionários
17.
S Afr Med J ; 110(4): 308-312, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657743

RESUMO

BACKGROUND: Neonatal hypoxic ischaemic encephalopathy (NHIE) is an important cause of long-term handicap in survivors. There is limited information on the burden of handicap from NHIE in sub-Saharan Africa. OBJECTIVES: To determine the developmental outcomes in survivors of NHIE in South Africa (SA). METHODS: In this prospective observational study, the developmental outcomes in 84 infants who had survived hypoxic ischaemic encephalopathy (the NHIE group) were compared with those in 64 unaffected infants (the control group). The Bayley Scales of Infant Development version III were used for assessment of developmental outcomes. RESULTS: Significant differences were found between the developmental outcomes of the two groups, with a significantly lower composite language score and higher proportions with language, motor and cognitive developmental delays in the NHIE group than in the control group. Cerebral palsy (CP) was present in 13 of the infants with NHIE (15.5%) and none in the control group (p<0.001). CP was associated with developmental delay, and also with the severity of NHIE. Therapeutic hypothermia (TH) was administered in 58.3% of the study group, but although it was associated with lower rates of CP and developmental delay than in the group without TH, the only significant difference was for delay on the language subscale. CONCLUSIONS: Survivors of NHIE in SA are at risk of poor developmental outcomes.


Assuntos
Paralisia Cerebral/epidemiologia , Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Hipóxia-Isquemia Encefálica/epidemiologia , Transtornos do Desenvolvimento da Linguagem/epidemiologia , Estudos de Casos e Controles , Paralisia Cerebral/fisiopatologia , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Humanos , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Doenças do Recém-Nascido , Transtornos do Desenvolvimento da Linguagem/fisiopatologia , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , África do Sul/epidemiologia
18.
BMJ Open ; 10(7): e038004, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699166

RESUMO

INTRODUCTION: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, China starting in December 2019. Yet the clinical features and long-term outcomes of neonates with SARS-CoV-2 exposure are lacking. The purpose of this study is to describe the clinical course and prognosis of the neonates exposed to SARS-CoV-2. METHODS AND ANALYSIS: This is a multicentre observational study conducted at the designated children and maternal and child hospitals in the mainland of China. Neonates exposed to SARS-CoV-2 infection will be recruited. The data to be collected via case report forms include demographic details, clinical features, laboratory and imaging results, as well as outcomes. Primary outcomes are the mortality of neonates with COVID-19 and SARS-CoV-2 infection of neonates born to mothers with COVID-19. Secondary outcomes are the birth weight, premature delivery and neurological development of neonates exposed to SARS-CoV-2. The neurological development is assessed by the Chinese standardised Denver Developmental Screening Test at the corrected age of 6 months. ETHICS AND DISSEMINATION: This study has been approved by the Children's Hospital of Fudan University ethics committee (No. (2020)31). The study findings will be disseminated in peer-reviewed journals and presented at national and international conferences in order to improve the understanding of the clinical course among neonates exposed to SARS-CoV-2 and to provide evidence-based treatment and prevention strategies for this group. TRIAL REGISTRATION NUMBER: NCT04279899.


Assuntos
Desenvolvimento Infantil , Infecções por Coronavirus/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Feminino , Maternidades , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Gravidez , Estudos Prospectivos , Índice de Gravidade de Doença
19.
Rev Saude Publica ; 54: 48, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491093

RESUMO

OBJECTIVE To identify the Brazilian cohorts that started either in the prenatal period or at birth, to describe their characteristics and the explored variables, and to map the cohorts with potential for studies on early determinants on health and the risk of falling ill on later stages of the life cycle. METHODS A scoping review was carried out. The articles were searched in the electronic databases PubMed and Virtual Health Library (VHL). The descriptors used were [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND (Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. The inclusion criteria were Brazilian cohorts that started the baseline in the prenatal period or at birth and with at least two follow-ups with the participants. In order to meet the concept of LCE, we excluded those cohorts whose follow-ups were restricted to the first year of life, as well as those that did not address biological, behavioral and psychosocial aspects, and cohorts with data collection of a single stage of the life cycle. RESULTS The search step identified 5,010 articles. Eighteen cohorts were selected for descriptive synthesis. The median number of baseline participants was 2,000 individuals and the median age at the last follow-up was 9 years. Sample loss at the last follow-up ranged from 9.2 to 87.5%. Most cohorts monitored two phases of the life cycle (the perinatal period and childhood). The Southern region had the highest number of cohorts. The main variables collected were sociodemographic and environmental aspects of the family, morbidity aspects, nutritional practices and lifestyle. CONCLUSIONS We recommend the continuity of these cohorts, the approach to different social contexts and the performance of follow-ups with participants in different phases of the life cycle for the strengthening and expansion of life course epidemiology analyses in Brazil.


Assuntos
Desenvolvimento Infantil/fisiologia , Estudos de Coortes , Estágios do Ciclo de Vida/fisiologia , Fatores Etários , Brasil , Criança , Pré-Escolar , Projetos de Pesquisa Epidemiológica , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez
20.
J Psychiatr Res ; 128: 1-4, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32474140

RESUMO

Prenatal COVID-19 infection is anticipated by the U.S. Centers for Disease Control to affect fetal development similarly to other common respiratory coronaviruses through effects of the maternal inflammatory response on the fetus and placenta. Plasma choline levels were measured at 16 weeks gestation in 43 mothers who had contracted common respiratory viruses during the first 6-16 weeks of pregnancy and 53 mothers who had not. When their infants reached 3 months of age, mothers completed the Infant Behavior Questionnaire-Revised (IBQ-R), which assesses their infants' level of activity (Surgency), their fearfulness and sadness (Negativity), and their ability to maintain attention and bond to their parents and caretakers (Regulation). Infants of mothers who had contracted a moderately severe respiratory virus infection and had higher gestational choline serum levels (≥7.5 mM consistent with U.S. Food and Drug Administration dietary recommendations) had significantly increased development of their ability to maintain attention and to bond with their parents (Regulation), compared to infants whose mothers had contracted an infection but had lower choline levels (<7.5 mM). For infants of mothers with choline levels ≥7.5 µM, there was no effect of viral infection on infant IBQ-R Regulation, compared to infants of mothers who were not infected. Higher choline levels obtained through diet or supplements may protect fetal development and support infant early behavioral development even if the mother contracts a viral infection in early gestation when the brain is first being formed.


Assuntos
Betacoronavirus/patogenicidade , Encéfalo , Desenvolvimento Infantil , Colina , Desenvolvimento Fetal , Comportamento do Lactente , Complicações Infecciosas na Gravidez , Adulto , Atenção , Encéfalo/efeitos dos fármacos , Encéfalo/crescimento & desenvolvimento , Desenvolvimento Infantil/efeitos dos fármacos , Desenvolvimento Infantil/fisiologia , Colina/administração & dosagem , Colina/sangue , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Suplementos Nutricionais , Feminino , Desenvolvimento Fetal/efeitos dos fármacos , Desenvolvimento Fetal/fisiologia , Idade Gestacional , Humanos , Lactente , Comportamento do Lactente/fisiologia , Comportamento do Lactente/psicologia , Masculino , Nootrópicos/administração & dosagem , Nootrópicos/sangue , Apego ao Objeto , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos
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