Long-term neurodevelopmental outcome and brain volume after treatment for hydrops fetalis by in utero intravascular transfusion.

OBJECTIVE: We tested the hypothesis that long-term neurodevelopmental outcomes of successfully treated fetuses with immune hydrops are similar to their unaffected siblings according to a protocol that addresses the underlying pathophysiologic condition. STUDY DESIGN: Sixteen of 18 consecutive hydropic fetuses (89%) who were treated in a dedicated fetal medicine unit between July 1985 and October 1995 survived. The transfusion protocol used a 2-step correction over a 2 to 4 day interval, combined with umbilical venous pressure measurements to avoid over transfusion and bicarbonate administration to assure a posttransfusion UV pH of >7.30. Survivors were evaluated at a mean age of 10 years. Statistical analyses included t-test, Wilcoxon rank-sum test, Fisher's exact test, and Pearson coefficients. RESULTS: Overall, death or major neurologic morbidity occurred in 4 of 18 of the fetuses (22%) who were treated (2/16 of survivors [12.5%]). Among the survivors, the children with immune hydrops had physical, neurologic, and cognitive outcomes statistically similar to their siblings, except for a measure of visual attention. Two of the children (12%) had major neurologic sequelae. Brain volumes were statistically smaller than unrelated control subjects by 8.8%, but these control subjects were not matched for height at testing or gestational age at birth. Both groups had brain volumes within the normal range. CONCLUSION: Intravascular transfusion of fetuses with profoundly anemic immune hydrops results in high survival rates and favorable long-term neuropsychological outcomes.

The child's voice: understanding the contexts of children and families today.

Children and families live and grow in a different social context than 15 years ago. The purpose of this report was to explore contemporary themes for improved contextual understanding of children and families today and their relationship to providing optimal pediatric dental care. Twelve themes were discussed using research studies and clinical expertise from the viewpoints of a pediatric psychologist and pediatrician. It was concluded that enhanced communication and partnership building improves comprehension and compliance with dental treatment. Furthermore, diagnosing the child and family within the immediate local context is central to developing and accomplishing an effective dental treatment plan.

Relations between visual and auditory continuous performance tests in a clinical population: a descriptive study.

Increased interest in auditory continuous performance tests (CPTs) exists despite the absence of a clear understanding about this procedure. The relation between auditory and visual CPTs and associations with IQ, achievement, and memory are evaluated in a referred sample of 634 children, ages 5.5 to 17.9. Age effects are found with CPT performance, regardless of modality. Total number correct or number of commissions correlations across tasks were greater than within-task number correct-number of commissions relations. The mean visual minus auditory correct difference score was 7.01; the mean commission difference score was -.85. Difference scores decreased with age and were not consistently related to other measures. Those with the lowest number correct on both CPTs (<25th percentile) were younger and had weaker short-term auditory memory and verbal learning skills; those falling in the problem quartile on commissions (>75th percentile) were younger and had poorer reading, verbal memory, and verbal learning. Total error scores (omissions + commissions) were inversely related to age. The auditory CPT has clinical utility, but other factors must be considered.