The relationship between early concentrations of 25 blood proteins and cerebral white matter injury in preterm newborns: the ELGAN study.

OBJECTIVE: To evaluate whether concentrations of inflammation-related proteins are elevated in the blood of preterm newborns who develop cerebral white matter damage. STUDY DESIGN: We measured 25 proteins in blood collected on days 1, 7, and 14 from 939 infants born before the 28th week of gestation. Brain ultrasound scans were read by at least two sonologists, who agreed on the presence or absence of lesions. A protein concentration was considered elevated if it was in the highest quartile for gestational age and the day on which the specimen was collected. RESULTS: In time-oriented models, elevated concentrations of vascular endothelial growth factor receptor 1, serum amyloid A, and macrophage inflammatory protein 1ß on day 1 and interleukin-8 on day 7 were associated with increased risk of ventriculomegaly. Elevated concentrations of macrophage inflammatory protein 1ß on day 1 and intercellular adhesion molecule 1 on day 7 were associated with increased risk of an echolucent lesion. Infants with elevated concentrations of inflammation-related proteins on two separate days were at significantly increased risk for ventriculomegaly, but at only modestly increased risk for an echolucent lesion. CONCLUSIONS: Concentrations of inflammation-related proteins in the circulation in the first days after preterm birth provide information about the risk of sonographic white matter damage. The inflammatory process might begin in utero.

PaCO2 and neurodevelopment in extremely low birth weight infants.

OBJECTIVE: To determine the relationship between PaCO2 in the first 4 days of life and neurodevelopment at 18 to 22 months. STUDY DESIGN: Stepwise regression and exhaustive CHAID (Chi-squared Automatic Interaction Detector) analyses were done for neurodevelopmental impairment (NDI), mental developmental index (MDI), and psychomotor developmental index (PDI) using clinical variables in combination with the maximum (max), time-weighted average (avg), and max-minimum (max-min) PaCO2 in 400 infants of 401 to 1000 g birth weight (BW). RESULTS: By regression, NDI predictors were male sex, non-Caucasian race, premature prolonged rupture of membranes (PPROM), lower BW, IVH 3 to 4, and lower 1-minute Apgar score. For lower MDI, predictors were male sex, non-Caucasian race, PPROM, IVH 3 to 4, sepsis, and higher max-min PaCO2. For lower PDI, predictors were male sex, PPROM, lower BW, IVH 3 to 4, sepsis, and higher avg PaCO2. By CHAID, the most important predictor of NDI was sex. For MDI, sex was most important followed by max-min PaCO2 >42 mm Hg in boys. For PDI, IVH was most important, followed by max-min PaCO2 >42 mm Hg for grade < or = 2 IVH. CONCLUSIONS: Extreme fluctuations in PaCO2 and higher max PaCO2 are associated with worse neurodevelopmental outcomes and may indicate either a greater severity of illness or contribution of PaCO2 to pathophysiology of adverse neurodevelopment.

[Iron biochemical screening and development in infants from 6 to 24 month, by socioeconomic background, Cordoba Argentina]. / Hierro hemático y desarrollo, en niños de 6 a 24 meses de edad, según su origen social, Córdoba Argentina.

AIMS: To correlate the iron biochemical screening with cognitive and motor development, related to social background, in 6 to 24 month infants. METHODS: a population - based study of 276 children. The iron deficiency was determine by the modified criterion of Hillman (1996), combining three different screenings tests: serum ferritin, hemoglobin and erythrocyte protoporphyrin. To analyse development we used Bayley II Scale. RESULTS AND CONCLUSIONS: the anaemia was significative different (p< 0,05) between social levels, 36% in children with low socioeconomic background, 8% for the high one and iron deficiency without anaemia 42% in the total population. The motor development was homogeneous by social groups, showed 1% significative delay, 8% light delay. But the mental development shows significative differences (p<0,05) in both light and significative delay, been the must affected children with low socioeconomic background.

Hierro hemático y desarrollo en niños de 6 a 24 meses de edad, según su origen social, Córdoba, Argentina / Iron biochemical screening and development, in infants from 6 to 24 month, by socioeconomic background, Cordoba Argentina

Objetivo: Correlacionar parámetros bioquímicos de hierro y desarrollo psicomotríz, en relación al origen social, en niños de 6 a 24 meses de Córdoba, Argentina. Material y Métodos: En 276 niños se determino el estado nutricional del hierro con el criterio de Hillman, combinando ferritina, hemoglobina y protoporfirina eritrocitaria, para desarrollo Escala de Bayley 11, y variables socioeconómicas. Resultados y Conclusiones: La anemia presento diferencias (p<0.05) entre los niveles soci21es, la depleción fue 42 % en la población total. El desarrollo motor fue homogéneo en los grupos sociales; mientras que el mental presento diferencias ( p< 0.05) en retraso leve y significativo, siendo los mas afectados los niños del nivel bajo. En desarrollo y parámetros bioquímicos, el 19 % de los niños con anemia y depleción, presentaron retraso motor leve, mientras que en desarrollo mental, el retraso leve y significativo afecto en doble proporción a los niños con depleción y anemia en comparación con los niños normales.

Aims: To correlate the iron biochemical screening with cognitive and motor development, related to social background, in 6 to 24 month infants. Methods: a population - based study of 276 children. The iron deficiency was determine by the modified criterion of Hillman ( 1996), combining three different screenings tests: serum ferritin, hemoglobin and erythrocyte protoporphyrin. To analyse development we used Bayley 11 Scale. Results and conclusions: the anaemia was significative different (p< 0,05) between social levels, 36% in children with low socioeconomic background, 8% for the high one and iron deficiency without anaemia 42% in the total population. The motor development was homogeneous by social groups, showed 1 % significative delay, 8% light delay. But the mental development shows significative differences (p<0,05) in both light and significative delay, been the must affected children with low socioeconomic background.

Hierro hemático y desarrollo en niños de 6 a 24 meses de edad, según su origen social, Córdoba, Argentina / Iron biochemical screening and development, in infants from 6 to 24 month, by socioeconomic background, Cordoba Argentina

Objetivo: Correlacionar parámetros bioquímicos de hierro y desarrollo psicomotríz, en relación al origen social, en niños de 6 a 24 meses de Córdoba, Argentina. Material y Métodos: En 276 niños se determino el estado nutricional del hierro con el criterio de Hillman, combinando ferritina, hemoglobina y protoporfirina eritrocitaria, para desarrollo Escala de Bayley 11, y variables socioeconómicas. Resultados y Conclusiones: La anemia presento diferencias (p<0.05) entre los niveles soci21es, la depleción fue 42 % en la población total. El desarrollo motor fue homogéneo en los grupos sociales; mientras que el mental presento diferencias ( p< 0.05) en retraso leve y significativo, siendo los mas afectados los niños del nivel bajo. En desarrollo y parámetros bioquímicos, el 19 % de los niños con anemia y depleción, presentaron retraso motor leve, mientras que en desarrollo mental, el retraso leve y significativo afecto en doble proporción a los niños con depleción y anemia en comparación con los niños normales.(AU)

Aims: To correlate the iron biochemical screening with cognitive and motor development, related to social background, in 6 to 24 month infants. Methods: a population - based study of 276 children. The iron deficiency was determine by the modified criterion of Hillman ( 1996), combining three different screenings tests: serum ferritin, hemoglobin and erythrocyte protoporphyrin. To analyse development we used Bayley 11 Scale. Results and conclusions: the anaemia was significative different (p< 0,05) between social levels, 36% in children with low socioeconomic background, 8% for the high one and iron deficiency without anaemia 42% in the total population. The motor development was homogeneous by social groups, showed 1 % significative delay, 8% light delay. But the mental development shows significative differences (p<0,05) in both light and significative delay, been the must affected children with low socioeconomic background.(AU)

Long-term neurobehavioral outcomes in children with neuroblastoma and opsoclonus-myoclonus-ataxia syndrome: relationship to MRI findings and anti-neuronal antibodies.

OBJECTIVES: Opsoclonus-myoclonus-ataxia (OMA) syndrome affects 2% to 3% of patients with neuroblastoma. This study examined relationships between long-term neurobehavioral outcomes and potential biologic markers of OMA, including chronic changes on magnetic resonance imaging (MRI) brain scanning and prevalence of late antineuronal antibodies. STUDY DESIGN: Children with neuroblastoma and OMA were identified through medical record review of patients treated at the University of California at San Francisco Medical Center from 1979 to 1999. Eleven patients with a mean follow-up time of 7.6 years underwent standard neurologic, neurocognitive, developmental/behavioral, and academic assessments. Consenting patients underwent MRI brain scanning and a blood draw. Sera were analyzed for the presence of antineuronal immunoreactivity. RESULTS: Two (18%) patients had no observed neurologic abnormalities, 7 (64%) demonstrated mild deficits, and 2 (18%) had severe neurologic deficits. However, on neurocognitive, behavioral, and academic assessments, 6 (55%) children performed within the average range, 1 (9%) was moderately below average and 4 (36%) had severe cognitive and behavioral deficiencies. Brain MRI in 5 of 5 patients was notable for cerebellar atrophy without supratentorial involvement. Antineuronal activity was detected in sera of 0 of 10 children at follow-up. CONCLUSIONS: Certain patients with neuroblastoma associated OMA may achieve average-range neurobehavioral function in spite of residual neurologic abnormalities, with suggestion of continued improvement over time. Late cerebellar atrophy appears to be a common finding regardless of neurologic outcome, whereas antineuronal immune reactivity does not appear to be a long-term feature of OMA.

Health needs of a place of safety for children in Kingston metropolitan (Glenhope Hospital)

This cross-sectional study was based on determining the health needs of children at a place of safety in Kingston metropolitan namely Glenhope Nursery. The level of care being provided for the children at the institution as well as the children's physical, mental and social health status were determined. The institution suffered from overcrowding and shortage of caregivers and was inadequate in meeting some of the children's needs. The most important need of the children as perceived by the caregivers (83 percent) was "someone to talk to". All the caregivers (n=18) stated that of the needs that were not adequately addressed by the institution the physical need was most outstanding. The high prevalence of common illness (skin infection, ear, nose and throat infection and upper respiratory infection) indicate that overcrowding was a contributing factor. The Denver II Development Screening Test showed that 88 percent of the children had a language development problem and that a significant amount of the children had personal - social and motor developmental problems. Anthropometry revealed that there was a moderately high level of malnutrition. The dietary survey showed that the diet was deficient in some nutrients while excessive in others. Because of the small population of caregivers and childern whatever significant association was made could not be considered as being final.(AU)

Disturbances of brain maturation and neurodevelopment during chronic renal failure in infancy.

Fifteen infants with moderate to severe congenital renal disease were prospectively studied by serial renal, neurodevelopmental, neurophysiologic, and anthropometric assessments. The observation period ranged from 3 to 25 months (mean = 10.9). Eight patients maintained a Mental Development Index (MDI) above the 16th percentile (greater than -1 SD) and comprised group 1. Of the remaining seven patients (group 2), three had an MDI less than 16th percentile when first studied and four had serial decreases of the MDI to less than 16th percentile. Although motor development was more delayed in group 2 at study entry, there were no significant changes of motor performance levels for either group during the study period. Group 2 patients had smaller length (p less than 0.05) and head circumference (p less than 0.05) standard deviation scores in comparison with group 1, and they had higher serum creatinine values (mean = 3.8 vs 1.3 mg/dl, respectively; p less than 0.01). By spectral electroencephalography, the expected progressive increase of the frequency of cerebral cortical background activity with age was demonstrated in group 1 but was not seen in group 2 (multivariate analysis of variance p less than 0.03). This increase of faster-frequency activity was primarily manifested in the left cerebral hemisphere of group 1 patients (p less than 0.01), a finding that was also absent in group 2. The frequent occurrence of neurodevelopmental abnormalities in infants with renal failure is possibly a consequence of impaired dominant hemispheric maturation in the first several years of life, which is clinically manifested as deterioration of cognitive function.