ABSTRACT
OBJECTIVES: To study the association between antenatal corticosteroids treatment and childhood mental disorders in infants born at different gestational ages, and to investigate the effect of different administration timing. STUDY DESIGN: This population-based cohort study used data from the Taiwan National Health Insurance Research Database. All singleton live births born between 2004 and 2010 were enrolled and followed up for at least 6 years. The primary outcome was any childhood mental disorder. Secondary outcomes included 7 specific subgroups of mental disorders. RESULTS: A total of 1 163 443 singleton infants were included in the analysis, and 16 847 (1.45%) infants were exposed to antenatal corticosteroid treatment. Children exposed to antenatal corticosteroids were found to have a higher risk of developing childhood mental disorders in the entire cohort (hazard ratio [HR], 1.13; 95% CI, 1.08-1.18), the term group (HR, 1.11; 95% CI, 1.05-1.16), and the late-preterm group (HR, 1.15; 95% CI, 1.06-1.25). The administration of corticosteroids in the early stage of pregnancy (<28 weeks of gestation) significantly increased the risk of childhood mental disorders (HR, 1.22; 95% CI, 1.14-1.31). CONCLUSIONS: Exposure to antenatal corticosteroid treatment increases the cumulative risk of childhood mental disorders and attention deficit hyperactivity disorders, both in term and late preterm infants. The administration of corticosteroids in the early stage of pregnancy tends to increase the risk of mental disorders.
Subject(s)
Mental Disorders , Premature Birth , Child , Infant, Newborn , Infant , Pregnancy , Humans , Female , Infant, Premature , Cohort Studies , Adrenal Cortex Hormones/adverse effects , Premature Birth/epidemiology , Gestational Age , Mental Disorders/epidemiologyABSTRACT
The development and establishment of the normal sleep patterns are very important processes in the final anatomical and physiological architecture of the central nervous system. The relationship between sleep disturbances during childhood with neurodevelopmental disorders is complex and potentially synergistic. Sleep patterns are present since the fetal period but their structure and physiology is modified according with the maturation of the central nervous system. Sleep disorders and their relationship with attention deficit hyperactivity disorders(ADHD), autism spectrum disorders(ASD) and other neurodevelopmental disorders (TDN) are not well understood yet, but significant progresses have been made in understanding associations and potential etiological correlations. We reviewed sleep disturbances in NDT, in ADHD and in ASD. A greater understanding of the pleiotropic functions of the genes involved in sleepwake cycle disorders and deviations from neurological developme nt could lead to new diagnostic and therapeut ic strategies in an early stage in order to improve the quality of life of the patient, relatives and caregivers.
El sueño es uno de los actos fisiológicos más importantes para la estructuración funcional y anatómica de áreas del sistema nervioso central. Las alteraciones del sueño durante la infancia y su relación con trastornos del neurodesarrollo es compleja y sumam ente interesante, donde destaca la multiplicidad de causas de estos trastornos. Bajo esta premisa se realiza una revisión sobre las alteraciones del sueño en los trastornos del neurodesarrollo (TND), por déficit de atención e hiperactividad (TDAH) y del espectro autista (TEA). El sueño está presente desde la etapa fetal y va modificando su expresión en sintonía con la madurez del sistema nervioso central. Los trastornos del sueño y su relación con TDAH, TEA y otros TND son complejos, pero existen avances sobre la etiología de los mismos. Una mayor compresión de las funciones pleiotrópicas de los genes implicados en los trastornos del ciclo vigilia-sueño y en las desviaciones del desarrollo neurológico podría conducir a nuevas estrategias diagnósticas y terapéuticas de manera precoz con el fin de mejorar la calidad de vida del paciente, familiares y cuidadores.
Subject(s)
Attention Deficit Disorder with Hyperactivity/complications , Autism Spectrum Disorder/complications , Sleep Wake Disorders/complications , Attention Deficit Disorder with Hyperactivity/genetics , Autism Spectrum Disorder/genetics , Child, Preschool , Circadian Rhythm , Humans , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/geneticsABSTRACT
El sueño es uno de los actos fisiológicos más importantes para la estructuración funcional y anatómica de áreas del sistema nervioso central. Las alteraciones del sueño durante la infancia y su relación con trastornos del neurodesarrollo es compleja y sumam ente interesante, donde destaca la multiplicidad de causas de estos trastornos. Bajo esta premisa se realiza una revisión sobre las alteraciones del sueño en los trastornos del neurodesarrollo (TND), por déficit de atención e hiperactividad (TDAH) y del espectro autista (TEA). El sueño está presente desde la etapa fetal y va modificando su expresión en sintonía con la madurez del sistema nervioso central. Los trastornos del sueño y su relación con TDAH, TEA y otros TND son complejos, pero existen avances sobre la etiología de los mismos. Una mayor compresión de las funciones pleiotrópicas de los genes implicados en los trastornos del ciclo vigilia-sueño y en las desviaciones del desarrollo neurológico podría conducir a nuevas estrategias diagnósticas y terapéuticas de manera precoz con el fin de mejorar la calidad de vida del paciente, familiares y cuidadores.
The development and establishment of the normal sleep patterns are very important processes in the final anatomical and physiological architecture of the central nervous system. The relationship between sleep disturbances during childhood with neurodevelopmental disorders is complex and potentially synergistic. Sleep patterns are present since the fetal period but their structure and physiology is modified according with the maturation of the central nervous system. Sleep disorders and their relationship with attention deficit hyperactivity disorders(ADHD), autism spectrum disorders(ASD) and other neurodevelopmental disorders (TDN) are not well understood yet, but significant progresses have been made in understanding associations and potential etiological correlations. We reviewed sleep disturbances in NDT, in ADHD and in ASD. A greater understanding of the pleiotropic functions of the genes involved in sleep-wake cycle disorders and deviations from neurological developme nt could lead to new diagnostic and therapeut ic strategies in an early stage in order to improve the quality of life of the patient, relatives and caregivers.
Subject(s)
Humans , Child, Preschool , Attention Deficit Disorder with Hyperactivity/complications , Sleep Wake Disorders/complications , Autism Spectrum Disorder/complications , Attention Deficit Disorder with Hyperactivity/genetics , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/genetics , Circadian Rhythm , Autism Spectrum Disorder/geneticsABSTRACT
The frontal lobe, the most human part of the brain (Goldberg), has been intensely studied, particularly in the last decades. This region is crucial for the control of behavior, cognition, planning, and working memory. Both behavior and higher cognitive abilities depend importantly on the arousal level, and on the autonomic responses that anticipate and accompany behaviors. In this review we will discuss the role played by the medial prefrontal cortex in controlling the level of vigilance and the autonomic and endocrine responses that are crucial for normal behavior. We will also discuss how dysfunctions of the medial prefrontal cortex resulting in the loss of the cortical control over arousal (both behavioral and vegetative) can help to explain the behavioral alterations observed in patients with posttraumatic stress, schizophrenia, attentional deficit and hyperactivity disorder and antisocial and aggressive behavior. Additionally we will discuss how studies in rats may give us valuable information about of the mechanisms by which the medial prefrontal cortex is capable of controlling the arousal state, autonomic and emotional responses in humans.
El lóbulo frontal, la parte más humana del cerebro, como lo propone E. Goldberg, ha llamado intensamente la atención de los investigadores en las últimas décadas. Esta región es clave en el control de la conducta, la personalidad, la memoria de trabajo, y en funciones cognitivas superiores. Sin embargo, tanto la conducta como las habilidades cognitivas superiores dependen de manera importante del estado de alerta, y de las respuestas autonómicas y emocionales asociadas. En esta revisión discutiremos acerca del papel que la corteza prefrontal medial juega en el control del alerta, y cómo alteraciones en la actividad de la corteza prefrontal medial, al afectar dicho control cortical, pueden explicar las alteraciones conductuales observadas en pacientes con estrés postraumático, esquizofrenia, déficit atencional y conductas antisociales y agresivas. Adicionalmente discutiremos cómo los estudios en la rata pueden darnos valiosa información sobre los mecanismos por los cuales la corteza prefrontal medial es capaz de manejar el alerta, el control autonómico y el control emocional.