Prognostic value of cranial ultrasonography in comparison with magnetic resonance imaging in children with cerebral palsy: a population-based study.

The aim of this population-based study was to evaluate the characteristics of cerebral palsy (CP) in relation to the predominant pattern of the Magnetic Resonance Imaging Classification System (MRICS) that was analogously applied to the neonatal/early infant cranial ultrasound (CUS). The study included children born during the 2004-2007 period from the Croatian part (C28 RCP-HR) of the Surveillance of Cerebral Palsy in Europe (SCPE) CP register. Motor functions, accompanying impairments and brain MRI were evaluated in 227 children, 185 of which also had CUS. Concerning CP types, 56% of children had bilateral spastic, 34% unilateral spastic, 9% dyskinetic and 1% ataxic CP type. Gross Motor Function Classification System (GMFCS) revealed that 62.05% had mild (GMFCS I-III) and 37.85% had severe motor impairment (GMFCS IV-V). CUS showed white matter injury in 60%, gray matter injury in 12%, maldevelopments in 8%, miscellaneous changes in 14%, while 6% were normal; MRI showed significant agreement (κ=0.675, p<0.001). Neuroimaging findings of maldevelopments and predominant gray matter injury were associated with more severe CP, but 7% of children with CP had normal MRI. As we found very good agreement between CUS and MRI findings, CUS is recommended in children at an increased risk of CP if MRI is not available.

Family history and cord blood eosinophil count as predictors for atopic manifestations.

OBJECTIVES: The aim of our study was to investigate the correlation between several clinical parameters and the appearance of atopic manifestations (atopic eczema, food allergy, wheezing bronchitis, allergic rhinoconjunctivitis) in the first four years of life. METHODS: A total of 139 unselected full-term newborns were included in a prospective follow up from birth to age 4. Cord blood total immunoglobulin E (cIgE) and cord blood absolute eosinophil count (cEo), positive family history of allergy, maternal smoking during pregnancy, mode of delivery, and duration of exclusive and overall breastfeeding were evaluated as predictors for appearance of atopic manifestations. RESULTS: We found that children with a positive family history of both mother and father are 19.03 times more likely to develop atopic manifestations and those with a positive family history of only mothers are 12.55 times more likely to develop atopy compared with children with a negative family history. Neonates with cord blood eosinophilia had 5.30 times higher chances for developing atopic manifestations. No statistically significant associations were found between cIgE (p = 0.099), mode of delivery (p = 0.379), maternal smoking (p = 0.661), exclusive (p = 0.867) and overall breastfeeding duration (p = 0.675) and the presence of atopic manifestations up to age 4. CONCLUSIONS: A positive medical history, especially of mothers and cEo, seem to be predictive in screening for the onset of allergic diseases.

TIBIAL TUBERCLE AVULSION FRACTURE IN A MALE ADOLESCENT.

Tibial tuberosity fractures are rare in childhood, most frequently due to excessive quadriceps muscle contraction. On performing long jump, a 15-year-old boy sustained tibial tuberosity avulsion fracture type II according to Watson-Jones. The patient was treated operatively with fragment repositioning and screw fixation. Ten months after the injury and rehabilitation, he resumed his sports activities with full range knee motion.

Timing of head circumference measurement in newborns.

AIM: The objective of this study is to compare head circumferences (HCs) measured on the day of delivery and on the third day after delivery. METHOD: A total of 499 children born in the maternity department were recruited for the study. HC was measured in centimeters immediately after birth and on the third day after delivery. RESULTS: There are statistically significant differences between HC at the time of birth and on the third day. Presentation and method of delivery were significantly associated with differences in HC. For presentation, we found that breech newborns more commonly have smaller HC on day 3 measurements (P = .001). For method of delivery, we found that cesarean sections also were more commonly associated with having smaller HC on day 3 measurement (P = .02). CONCLUSION: Measuring HC on the third day is more clinically valuable because much of the effects of molding and birth injuries will have subsided in most newborns.

Language development in preschool children born after asymmetrical intrauterine growth retardation.

BACKGROUND: After intrauterine growth retardation, many minor neurodevelopmental disorders may occur, especially in the motor skills domain, language and speech development, and cognitive functions. AIM: The assessment of language development and impact of postnatal head growth in preschool children born with asymmetrical intrauterine growth retardation. METHODS: Examinees were born at term with birth weight below the 10th percentile for gestational age, parity and gender. Mean age at the time of study was six years and four months. The control group was matched according to chronological and gestational age, gender and maternal education with mean age six years and five months. There were 50 children with intrauterine growth retardation and 50 controls, 28 girls and 22 boys in each group. For the assessment of language development Reynell Developmental Language Scale, the Naming test and Mottier test were performed. RESULTS: There were statistically significant differences (p < 0.05) in language comprehension, total expressive language (vocabulary, structure, content), naming skills and non-words repetition. Statistically significant positive correlations were found between relative growth of the head [(Actual head circumference - head circumference at birth)/(Body weight - birth weight)] and language outcome. Children with neonatal complications had lower results (p < 0.05) in language comprehension and total expressive language. CONCLUSION: Intrauterine growth retardation has a negative impact on language development which is evident in preschool years. Slow postnatal head growth is correlated with poorer language outcome. Neonatal complications were negatively correlated with language comprehension and total expressive language.