Maternal perinatal depression and infant sleep problems at 1 year of age: Subjective and actigraphy data from a population-based birth cohort study.

This study used data from 2,222 mothers and infants participating in a population-based birth cohort to verify whether maternal depression in the perinatal period was associated with poor infant sleep. Mothers who scored ≥13 points on the Edinburgh Postnatal Depression Scale at 16-24 weeks of gestation and/or 3 months after delivery were considered perinatally depressed. The main outcome variable was poor infant sleep at 12 months of age, defined as >3 night wakings, nocturnal wakefulness >1 hr or total sleep duration <9 hr. Infant sleep data were obtained with the Brief Infant Sleep Questionnaire (BISQ) and 24-hr actigraphy monitoring. Prevalence of perinatal depression in the sample was 22.3% (95% confidence interval [CI], 20.5-24.0). After Poisson regression, infants of depressed mothers showed an adjusted relative risk (RR) of 1.44 (95% CI, 1.00-2.08; p = .04) for >3 night wakings with questionnaire-derived data. When actigraphy data were analysed, no association was found between perinatal depression and poor infant sleep (adjusted RR, 1.20; 95% CI, 0.82-1.74; p = .35). In conclusion, although mothers in the depressed group were more likely to report more night wakings, objective data from actigraphy did not replicate this finding. Dysfunctional cognition, maternal behavioural factors and sleep impairment associated with perinatal depression may affect the mother's impression of her infant's sleep.

The influence of maternal anxiety and depression symptoms on fNIRS brain responses to emotional faces in 5- and 7-month-old infants.

Greater relative right (versus left) frontal cortical activation to emotional faces as measured with alpha power in the electroencephalogram (EEG), has been considered a promising neural marker of increased vulnerability to psychopathology and emotional disorders. We set out to explore multichannel fNIRS as a tool to investigate infants' frontal asymmetry responses (hypothesizing greater right versus left frontal cortex activation) to emotional faces as influenced by maternal anxiety and depression symptoms during the postnatal period. We also explored activation differences in fronto-temporal regions associated with facial emotion processing. Ninety-one typically developing 5- and 7-month-old infants were shown photographs of women portraying happy, fearful and angry expressions. Hemodynamic brain responses were analyzed over two frontopolar and seven bilateral cortical regions subdivided into frontal, temporal and parietal areas, defined by age-appropriate MRI templates. Infants of mothers reporting higher negative affect had greater oxyhemoglobin (oxyHb) activation across all emotions over the left inferior frontal gyrus, a region implicated in emotional communication. Follow-up analyses indicated that associations were driven by maternal depression, but not anxiety symptoms. Overall, we found no support for greater right versus left frontal cortex activation in association with maternal negative affect. Findings point to the potential utility of fNIRS as a method for identifying altered neural substrates associated with exposure to maternal depression in infancy.

Validation of the Inventaire du Milieu Familial Questionnaire (French version of the Infant/Toddler HOME) into the Brazilian Portuguese language / Validação do questionário Inventaire du Milieu Familial (versão francesa do Infant Toddler Home) para a língua portuguesa

Abstract Objective: To validate the Brazilian Portuguese version of the Family Environment Assessment questionnaire (Inventaire du Milieu Familial). Methods: The validation process was carried out in two stages. First, translation and back-translation were performed, and in the second phase, the questionnaire was applied in 72 families of children between 0 and 24 months for the validation process. The tool consists of the following domains: mother's communication ability; behavior; organization of the physical and temporal environment; collection/quantity of toys; maternal attitude of constant attention toward her baby; diversification of stimuli; baby's behavior. The following was performed for the scale validation: 1 - content analysis (judgment); 2 - construct analysis (factorial analysis - Kaiser-Meyer-Olkin, Bartlett, and Pearson's correlation tests); 3 - criterion analysis (calculation of Cronbach's alpha coefficient, intraclass correlations, and split-half correlations). Results: The mean age of the children was 9 ± 6.7 months, and of these, 35 (48.6%) were males. Most correlations between items and domains were significant. In the factorial analysis of the scale, Kaiser-Meyer-Olkin values were 0.76, Bartlett's test showed a p-value < 0.001, and correlation between items and domains showed a p-value < 0.01. Regarding the validity, Cronbach's alpha was 0.92 (95% CI: 0.89-0.94). The intraclass correlation among the evaluators was 0.97 (0.96-0.98) and split-half correlations, r: 0.60, with p < 0.01. Conclusions: The Portuguese version of the Inventaire du Milieu Familial showed good to excellent performance regarding the assessed psychometric properties.

Resumo Objetivo: Validar a versão em português do Questionário de Avaliação do Ambiente Familiar (Inventaire du Milieu Familial). Métodos: O processo de validação foi feito em duas etapas. Primeiramente, realizou-se a tradução e retrotradução e, na segunda fase, o questionário foi aplicado em 72 famílias de crianças entre zero e 24 meses para o processo de validação. O instrumento é formado pelos seguintes domínios: Capacidade de comunicação da mãe; Comportamento; Organização do ambiente físico e temporal; Acervo/quantidade de brinquedos; Implicação da mãe com seu bebê; Diversificação de estímulos; Comportamento do bebê. Para a validação da escala foi realizada: 1- análise de conteúdo (julgamento); 2- análise de construto (análise fatorial - testes Kaiser-Meyer-Olkin, Bartlett e correlação de Pearson); 3- análise de critério (cálculo do coeficiente alfa de cronbach, correlações intraclasse e correlações split-half). Resultados: A média de idade das crianças foi 9 ± 6,7 meses e, dessas, 35 (48,6%) eram do sexo masculino. A maioria das correlações entre os itens e os domínios foi significativa. Na análise fatorial da escala, os valores de Kaiser-Meyer-Olkin foram 0,76, teste de Bartlett com p < 0,001 e correlação entre os itens e domínios p < 0,01. Em relação à validade, o alfa de Cronbach foi de 0,92 (IC 95% 0,89-0,94). A correlação intraclasse entre os avaliadores foi de 0,97 (0,96-0,98) e correlações split-half r: 0,60 p < 0,01. Conclusões: A versão portuguesa do Inventaire du Milieu Familial apresentou um bom à excelente desempenho nas propriedades psicométricas avaliadas.

Validation of the Brazilian version of the Pediatric Obstructive Sleep Apnea Screening Tool questionnaire / Validação da versão brasileira do questionário Pediatric Obstructive Sleep Apnea Screening Tool

Abstract Objective: To validate the Pediatric Obstructive Sleep Apnea Screening tool for use in Brazil. Materials and methods: The Brazilian version of this questionnaire, originally validated and tested in the United States, was developed as follows: (a) translation; (b) back-translation; (c) completion of the final version; (d) pre-testing. The questionnaire was applied prior to polysomnography to children aged 3-9 years from October 2015 to October 2016, and its psychometric properties (i.e., validity and reliability) were evaluated. The accuracy was assessed from comparisons between polysomnographic results and corresponding questionnaire scores. Results: Sixty patients were enrolled, and based on polysomnographic findings, 48% patients had normal apnea-hypopnea index, while the remaining 52% met the criteria for obstructive sleep apnea. Minimum O2 saturation level was significantly lower among obstructive sleep apnea children (p = 0.021). Satisfactory concordance was found between individual apnea-hypopnea index and questionnaire scores. Bland-Altman plot-derived bias was 0.1 for the difference between measures, with 5.34 (95% CI: 4.14-6.55) and −5.19 (95%CI: −6.39 to −3.98) for the upper and lower agreement range. Internal consistency derived from Cronbach's alpha was 0.84 (95%CI: 0.78-0.90). Conclusion: The questionnaire was translated to and validated into Brazilian-Portuguese version, and showed good reliability and concordance with apnea-hypopnea index. This questionnaire offers a reliable screening option for sleep-disordered breathing in children.

Resumo Objetivo: Validar o questionário Pediatric Obstructive Sleep Apnea Screening Tool para o seu uso no Brasil. Materiais e métodos: A versão brasileira desse questionário, originalmente validado e testado nos Estados Unidos, foi desenvolvida a partir das seguintes etapas: a) tradução; b) retrotradução; c) conclusão da versão final; d) pré-teste. O questionário foi aplicado previamente ao início da polissonografia em crianças de 3 a 9 anos incluídas no estudo de outubro de 2015 a outubro de 2016. As propriedades psicométricas avaliadas foram validade e confiabilidade. A acurácia foi avaliada pela comparação entre os resultados da polissonografia com o escore do questionário. Resultados: Foram incluídos no estudo 60 pacientes. Conforme a polissonografia, 48% dos pacientes apresentaram índices de apneia e hipopneia normais e 51% apresentaram resultados alterados. A SpO2 mínima foi significativamente menor (p = 0,021) nas crianças com diagnóstico de síndrome de apneia obstrutiva do sono. O índice de apneia e hipopneia apresentou concordância satisfatória com os resultados do questionário. O viés médio de Bland-Altman foi de 0,1 para a diferença entre as medidas, com um limite superior de 5,34 (IC95%4,14 a 6,55) e um limite inferior de -5,19 (IC95%-6,39 a -3,98). A consistência interna do questionário avaliada pelo α de Cronbach foi de 0,84 (IC95%0,78 a 0,90). Conclusão: O questionário foi traduzido e validado adequadamente para a versão em português brasileiro, apresentando boa confiabilidade e concordância com o índice de apneia e hipopneia. Esse questionário oferece uma opção confiável de triagem de distúrbios respiratórios do sono em crianças.

Validation of the Brazilian version of the Pediatric Obstructive Sleep Apnea Screening Tool questionnaire.

OBJECTIVE: To validate the Pediatric Obstructive Sleep Apnea Screening tool for use in Brazil. MATERIALS AND METHODS: The Brazilian version of this questionnaire, originally validated and tested in the United States, was developed as follows: (a) translation; (b) back-translation; (c) completion of the final version; (d) pre-testing. The questionnaire was applied prior to polysomnography to children aged 3-9 years from October 2015 to October 2016, and its psychometric properties (i.e., validity and reliability) were evaluated. The accuracy was assessed from comparisons between polysomnographic results and corresponding questionnaire scores. RESULTS: Sixty patients were enrolled, and based on polysomnographic findings, 48% patients had normal apnea-hypopnea index, while the remaining 52% met the criteria for obstructive sleep apnea. Minimum O2 saturation level was significantly lower among obstructive sleep apnea children (p=0.021). Satisfactory concordance was found between individual apnea-hypopnea index and questionnaire scores. Bland-Altman plot-derived bias was 0.1 for the difference between measures, with 5.34 (95% CI: 4.14-6.55) and -5.19 (95%CI: -6.39 to -3.98) for the upper and lower agreement range. Internal consistency derived from Cronbach's alpha was 0.84 (95%CI: 0.78-0.90). CONCLUSION: The questionnaire was translated to and validated into Brazilian-Portuguese version, and showed good reliability and concordance with apnea-hypopnea index. This questionnaire offers a reliable screening option for sleep-disordered breathing in children.

Validation of the Inventaire du Milieu Familial Questionnaire (French version of the Infant/Toddler HOME) into the Brazilian Portuguese language.

OBJECTIVE: To validate the Brazilian Portuguese version of the Family Environment Assessment questionnaire (Inventaire du Milieu Familial). METHODS: The validation process was carried out in two stages. First, translation and back-translation were performed, and in the second phase, the questionnaire was applied in 72 families of children between 0 and 24 months for the validation process. The tool consists of the following domains: mother's communication ability; behavior; organization of the physical and temporal environment; collection/quantity of toys; maternal attitude of constant attention toward her baby; diversification of stimuli; baby's behavior. The following was performed for the scale validation: 1 - content analysis (judgment); 2 - construct analysis (factorial analysis - Kaiser-Meyer-Olkin, Bartlett, and Pearson's correlation tests); 3 - criterion analysis (calculation of Cronbach's alpha coefficient, intraclass correlations, and split-half correlations). RESULTS: The mean age of the children was 9±6.7 months, and of these, 35 (48.6%) were males. Most correlations between items and domains were significant. In the factorial analysis of the scale, Kaiser-Meyer-Olkin values were 0.76, Bartlett's test showed a p-value<0.001, and correlation between items and domains showed a p-value<0.01. Regarding the validity, Cronbach's alpha was 0.92 (95% CI: 0.89-0.94). The intraclass correlation among the evaluators was 0.97 (0.96-0.98) and split-half correlations, r: 0.60, with p<0.01. CONCLUSIONS: The Portuguese version of the Inventaire du Milieu Familial showed good to excellent performance regarding the assessed psychometric properties.

Evaluation of sleep organization in patients with attention deficit hyperactivity disorder (ADHD) and ADHD as a comorbidity of epilepsy.

OBJECTIVE/BACKGROUND: Epilepsy or attention deficit hyperactivity disorder (ADHD) can influence sleep organization in different ways. The aim of this study was to evaluate sleep organization in children and adolescents with ADHD and epilepsy, and to analyze the influence of methylphenidate. METHODS: This was an observational, cross-sectional study of children and adolescents with epilepsy, who were seizure free for at least three months, and were also diagnosed with ADHD. They were selected from the epilepsy and child neurology outpatient clinic of a university hospital in Brazil. After sample size calculation, patients were consecutively included into four different groups, with 21 patients each: epilepsy + ADHD using methylphenidate, epilepsy + ADHD not using methylphenidate, only ADHD, and a healthy control group. All participants were evaluated with the Sleep Disturbance Scale for Children (SDSC) and monitored with actigraphy for five nights/days. RESULTS: Actigraphic analysis showed a higher number of night awakenings in the epilepsy + ADHD groups; they were most prominent in the group without methylphenidate (p = 0.001). Parental reports demonstrated a higher risk for sleep disturbances in the epilepsy + ADHD without methylphenidate and the ADHD groups (p < 0.001). CONCLUSION: Primary ADHD as a comorbidity of epilepsy impairs sleep organization in children, and the use of short-acting methylphenidate seems to improve it. Both objective (actigraphic) and subjective (SDSC) measures showed significant sleep alterations between primary ADHD and ADHD as a comorbidity of epilepsy; this was most prominent in the group without methylphenidate.

Behavioral and neural correlates of emotional development: typically developing infants and infants of depressed and/or anxious mothers / Bases neurais e comportamentais do desenvolvimento emocional: lactentes com desenvolvimento típico e lactentes filhos de mães deprimidas e/ou ansiosas

ABSTRACT Objectives: To describe the main findings of studies of behavioral and neural correlates regarding the development of facial emotion processing during the first year of life in typically developing infants and infants of depressed and/or anxious mothers. Sources: Comprehensive, non-systematic review of the literature on studies about individual differences in facial emotion processing by newborns and infants over the first year of life. Summary of the findings: Maternal stress related to depression and anxiety has been associated to atypical emotional processing and attentional behaviors in the offspring. Recent neurophysiological studies using electroencephalogram and event-related potentials have begun to shed light on the possible mechanisms underlying such behaviors. Conclusions: Infants of depressed and/or anxious mothers have increased risk for several adverse outcomes across the lifespan. Further neurobehavioral investigations and the promotion of clinical and developmental research integration might eventually contribute to refining screening tools, improving treatment, and enabling primary prevention interventions for children at risk.

RESUMO Objetivos: Descrever os principais achados de estudos de correlação entre o comportamento e as bases neurais em relação ao processamento de emoções faciais durante o primeiro ano de vida de lactentes com desenvolvimento típico e lactentes de mães deprimidas e/ou ansiosas. Fontes: Análise abrangente e não sistemática da literatura de estudos sobre diferenças individuais no processamento de emoções faciais de neonatos e lactentes ao longo do primeiro ano de vida. Resumo dos achados: O estresse materno relacionado à depressão e ansiedade tem sido associado a alterações no processamento emocional e na alocação da atenção da prole. Estudos neurofisiológicos recentes utilizando electroencefalograma e potenciais relacionados a eventos começam a esclarecer os possíveis mecanismos inerentes a esses comportamentos. Conclusões: Lactentes filhos de mães deprimidas e/ou ansiosas têm maior risco de problemas de saúde física e mental durante toda vida. O avanço de estudos neurocomportamentais e a promoção de integração entre a pesquisa clínica e de desenvolvimento poderão contribuir para refinar as ferramentas de triagem, melhorar o tratamento e permitir intervenções de prevenção primária para crianças em risco.

Short Sleep Duration in the First Years of Life and Obesity/Overweight at Age 4 Years: A Birth Cohort Study.

OBJECTIVE: To investigate whether short sleep duration from the first year of life influenced weight at an early age. STUDY DESIGN: During 2004, children born in Pelotas, Brazil, were enrolled in a cohort study. Sleeping habits during the previous 2 weeks were assessed, and the children were weighed and measured at 1-, 2-, and 4-year follow-ups. Overweight and obesity at 4 years were defined according to World Health Organization z-scores for body mass index for age. Short sleep duration was defined as fewer than 10 hours of sleep per night at any follow-up. RESULTS: Out of the 4263 live births, 4231 were recruited. The prevalence of short sleep duration at any follow-up from 1-4 years of age was 10.1%. At 4 years of age, 201 children were obese (5.3%), and 302 (8%) were overweight. Among short sleepers, the prevalence ratio for overweight/obesity after adjusting for maternal and children's characteristics was 1.32 (1.03; 1.70). CONCLUSIONS: Children who slept for fewer than 10 hours per night at any follow-up from 1-4 years of age were more likely to be overweight or obese at 4 years of age, despite their sociodemographic and sleep characteristics.

Education in children's sleep hygiene: which approaches are effective? A systematic review, / Educação em higiene do sono na infância: quais abordagens são efetivas? Uma revisão sistemática da literatura,

Aim: To analyze the interventions aimed at the practice of sleep hygiene, as well as their applicability and effectiveness in the clinical scenario, so that they may be used by pediatricians and family physicians for parental advice. Source of data: A search of the PubMed database was performed using the following descriptors: sleep hygiene OR sleep education AND children or school-aged. In the LILACS and SciELO databases, the descriptors in Portuguese were: higiene E sono, educação E sono, educação E sono E crianças, e higiene E sono E infância, with no limitations of the publication period. Summary of the findings: In total, ten articles were reviewed, in which the main objectives were to analyze the effectiveness of behavioral approaches and sleep hygiene techniques on children's sleep quality and parents' quality of life. The techniques used were one or more of the following: positive routines; controlled comforting and gradual extinction or sleep remodeling; as well as written diaries to monitor children's sleep patterns. All of the approaches yielded positive results. Conclusions: Although behavioral approaches to pediatric sleep hygiene are easy to apply and adhere to, there have been very few studies evaluating the effectiveness of the available techniques. This review demonstrated that these methods are effective in providing sleep hygiene for children, thus reflecting on parents' improved quality of life. It is of utmost importance that pediatricians and family physicians are aware of such methods in order to adequately advise patients and their families. .

Objetivo: Avaliar as intervenções visando práticas de higiene do sono em crianças, sua aplicabilidade e efetividade na prática clínica, para que as mesmas possam ser utilizadas na orientação dos pais pelos pediatras e médicos de família. Fonte dos dados: Foi realizada busca na base de dados da Pubmed utilizando os descritores sleep hygiene OR sleep education AND child or school-aged, e nas bases Lilacs e Scielo, com as seguintes palavras-chave: higiene E sono, educação E sono, educação E sono E crianças, e higiene E sono E infância, não tendo sido limitado o período de busca. Síntese dos dados: Foram revisados 10 artigos cujos objetivos eram analisar efetividade de abordagens comportamentais e de técnicas de higiene do sono sobre a qualidade do sono das crianças e na qualidade de vida dos pais. Foram utilizadas uma ou mais das seguintes técnicas: rotinas positivas, checagem mínima com extinçcão sistemática e extinção gradativa ou remodelamento do sono, bem como diários do padrão de sono. Todas as abordagens apresentaram resultados positivos. Conclusões: Apesar de a abordagem comportamental no manejo do sono na faixa etária pediátrica ser de simples execuçcão e adesão, existem poucos estudos na literatura que avaliaram sua efetividade. Os estudos revisados evidenciaram que estas medidas são efetivas na higiene e refletem em melhoria na qualidade de vida dos pais. É de fundamental importância os pediatras e médicos de família conhecerem estas abordagens, para que possam oferecer orientacções adequadas a seus pacientes. .

Education in children's sleep hygiene: which approaches are effective? A systematic review.

AIM: To analyze the interventions aimed at the practice of sleep hygiene, as well as their applicability and effectiveness in the clinical scenario, so that they may be used by pediatricians and family physicians for parental advice. SOURCE OF DATA: A search of the PubMed database was performed using the following descriptors: sleep hygiene OR sleep education AND children or school-aged. In the LILACS and SciELO databases, the descriptors in Portuguese were: higiene E sono, educação E sono, educação E sono E crianças, e higiene E sono E infância, with no limitations of the publication period. SUMMARY OF THE FINDINGS: In total, ten articles were reviewed, in which the main objectives were to analyze the effectiveness of behavioral approaches and sleep hygiene techniques on children's sleep quality and parents' quality of life. The techniques used were one or more of the following: positive routines; controlled comforting and gradual extinction or sleep remodeling; as well as written diaries to monitor children's sleep patterns. All of the approaches yielded positive results. CONCLUSIONS: Although behavioral approaches to pediatric sleep hygiene are easy to apply and adhere to, there have been very few studies evaluating the effectiveness of the available techniques. This review demonstrated that these methods are effective in providing sleep hygiene for children, thus reflecting on parents' improved quality of life. It is of utmost importance that pediatricians and family physicians are aware of such methods in order to adequately advise patients and their families.

The impact of epilepsy on sleep architecture during childhood.

PURPOSE: The effect of etiology on the relationship between epilepsy and sleep during childhood has not been studied in detail. The aim of this study was to evaluate differences in sleep structure in drug-resistant epilepsies with different underlying causes. METHODS: We studied 31 patients with drug-resistant epilepsies with or without a structural lesion (lesional and nonlesional) and compared their sleep architecture with that of normal controls and with that of a group of children with benign epilepsy with rolandic spikes (BERS). Subjects underwent a single-night polysomnographic recording. Sleep recordings were scored according to the American Academy of Sleep Medicine (AASM) and cyclic alternating pattern (CAP) criteria. KEY FINDINGS: Compared to normal controls, patients with drug-resistant epilepsy showed a significant reduction of time in bed, total sleep time, rapid eye movement (REM) sleep, sleep stage N3, and sleep efficiency, and a significant increase in wake after sleep onset. The lesional subgroup showed a reduction in total sleep time and sleep latency and an increase in REM latency and wake after sleep onset. No significant differences, however, were found comparing the lesional and nonlesional subgroups. When compared to BERS, patients with drug-resistant epilepsy showed a significant reduction in sleep stage N3, REM sleep, and sleep efficiency. Regarding CAP analysis, when compared to controls, the drug-resistant group had an increased A1% and a decreased A2%, with a decrease of A1 index in N3 and a global decrease of A2 and A3 indexes. The lesional subgroup showed a slight increase of A1% with a decrease of A1 index in N3 and a global decrease of A2 and A3 indexes. Drug-resistant epilepsy, compared to benign epilepsy showed an increase of CAP rate in N2 and of A1 index in N1 and N2 but not in N3; A2 and A3 indexes were similar in both, but patients with drug-resistant epilepsy showed a significant reduction of A3 index in N1. SIGNIFICANCE: Our findings suggest that the presence of structural cerebral abnormalities may play an important role in disrupting sleep architecture.

Avaliação da arquitetura do sono em crianças com epilepsia refratária / Evaluation of sleep architecture in children with refractory epilepsy

INTRODUÇÃO: Há um interesse crescente nas relações entre sono e epilepsia incentivado pela compreensão de que existem interações potencialmente relevantes nas duas direções. Embora o papel do sono na hipersincronização e a crescente preocupação na geração de crises sejam bem conhecidos, o grau no qual o sono pode facilitar ou induzir a um fenômeno epileptogênico, nas epilepsias lesionais, permanece indefinido. As epilepsias lesionais parecem apresentar um mecanismo particular de epileptogenicidade e o esclarecimento do papel da macro e microarquitetura do sono pode auxiliar na antecipação e monitorização de fenômenos epilépticos relacionados ao sono, conforme a etiologia da epilepsia. OBJETIVO: revisar e discutir as relações entre sono e epilepsia na infância e adolescência relacionando as alterações estruturais do sono à etiologia da epilepsia. MÉTODOS: revi-são bibliográfica utilizando o banco de dados Medline, abrangendo os estudos publicados nos últimos quinze anos, com as palavras-chave (unitermos) sono e epilepsia. CONCLUSÕES: epilepsia refratária durante a infância parece influenciar a organização do sono principalmente naqueles pacientes com etiologia lesional. A definição do tipo de epilepsia pode ser importante na antecipação dos distúrbios de sono nesta população.

ABSTRACT INTRODUCTION: There has been a growing interest in the relations between sleep and epilepsy, kindled by the realization that there are many potentially relevant two-way interactions. Even though the hyper-synchronizing role of sleep and its attending increase in the probability of seizure generation are well known, the degree to which sleep may facilitate or induce epileptogenic phenomena in lesional epilepsies remains unclear. The lesional epilepsies seems to have intrinsic epileptogenic properties and the knowledge about sleep macro and microarchiteture could help clinician to anticipate and monitor sleep-related epileptic phenomena according to the etiology of the epilepsy OBJECTIVE: Discuss the relationship between sleep and epilepsy in childhood and adolescence. METHODS: Literature review in journals indexed through Medline, from the last 15 years. CONCLUSION: Refractory epilepsy during childhood influences sleep organization mainly in patients with lesional etiology. The definition of the type of epilepsy is important to anticipate sleep disorders in this population.

Status cognitivo-comportamental de prematuros de baixo peso ao nascimento em idade pré-escolar que vivem em país em desenvolvimento / Cognitive and behavioral status of low birth weight preterm children raised in a developing country at preschool age

OBJETIVO: Avaliar o desenvolvimento cognitivo e comportamental em idade pré-escolar de crianças prematuras com baixo peso ao nascimento que vivem em um país em desenvolvimento. MÉTODOS: Estudo transversal prospectivo de 80 recém-nascidos de um hospital universitário no sul do Brasil. A avaliação neuropsicológica aos 4-5 anos de idade incluiu a Escala de Inteligência de Wechsler para a Idade Pré-Escolar e Primária (WPPSI), a Escala de Conners para Pais Revisada (CPRS-R), o teste de Denver e exames neurológicos. As informações de desenvolvimento neuropsicomotor inicial e perinatal foram coletadas a partir do banco de dados durante o acompanhamento. Os resultados foram relacionados com o peso ao nascimento, o sexo e a idade gestacional. RESULTADOS: Os escores da WPPSI foram: quociente de inteligência (QI) total 88,00±16,96, QI verbal 89,72±16,72 e QI executivo 88,12±15,71 para o grupo com menos de 1.500 gramas; e QI total 91,11±14,73, QI verbal 93,36±12,65 e QI executivo 90,20±16,06 para o grupo entre 1.500 e 2.500 gramas. Os melhores escores foram obtidos em testes que avaliaram a capacidade de abstração e simbolização, completar figuras e percepção comum, nos quais apenas 5 e 6,3 por cento das crianças apresentaram resultados anormais, respectivamente. Os menores escores foram obtidos em testes que avaliam a coordenação visual-motora e a flexibilidade-velocidade de raciocínio, nos quais 27,5 e 16,3 por cento das crianças tiveram resultados anormais, respectivamente. No total, 32,5 por cento das crianças tiveram resultados anormais em testes aritméticos. Comportamentos relacionados com transtorno do déficit de atenção com hiperatividade (TDAH) foram observados em 48 por cento da amostra. Os baixos resultados na Escala Mental de Bayley e o resultado anormal no teste de Denver apresentaram correlação significativa com o TDAH (p = 0,017 e p = 0,004). Os resultados anormais na Escala Mental de Bayley (p < 0.001), teste de Denver (p < 0,001)...

OBJECTIVE: To assess cognitive and behavioral development at preschool age of children born preterm and with low birth weight and raised in a developing country. METHODS: Prospective cross-sectional study of 80 neonates born in a university hospital in southern Brazil. Neuropsychological assessment at age 4-5 years included the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Conners' Parent Rating Scale-Revised, Denver test and neurological examination. Perinatal and early neuropsychomotor development information was collected from the database during follow-up. Results were related to birth weight, sex and gestational age. RESULTS: WPPSI scores were: total IQ 88.00±16.96, verbal IQ 89.72±16.72, and executive IQ 88.12±15.71 for the group with less than 1,500 grams; and total IQ 91.11±14.73, verbal IQ 93.36±12.65, and executive IQ 90.20±16.06 for the group between 1,500 and 2,500 grams. The best scores were obtained in tests that evaluated capacity of abstraction and symbolization, picture completion and common perception, in which only 5 percent and 6.3 percent of the children had abnormal results, respectively. The lowest scores were obtained in tests that evaluated visual-motor coordination and flexibility-speed of reasoning, in which 27.5 percent and 16.3 percent of the children had abnormal results, respectively. A total of 32.5 percent had abnormal results in the arithmetic tests. Behaviors related to attention deficit/hyperactivity disorder (ADHD) were observed in 48 percent of the sample. Low score in the Bayley Mental Scale and abnormal result in the Denver test were significantly correlated to ADHD (p = 0.017 and p = 0.004). Abnormal results in the Bayley Mental Scale (p < 0.001), Denver test (p < 0.001) and neurological examination (p = 0.002) were associated with lower IQ. CONCLUSIONS: The results revealed an increased incidence of behavioral and cognitive disorders at preschool age.

Cognitive and behavioral status of low birth weight preterm children raised in a developing country at preschool age.

OBJECTIVE: To assess cognitive and behavioral development at preschool age of children born preterm and with low birth weight and raised in a developing country. METHODS: Prospective cross-sectional study of 80 neonates born in a university hospital in southern Brazil. Neuropsychological assessment at age 4-5 years included the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Conners' Parent Rating Scale-Revised, Denver test and neurological examination. Perinatal and early neuropsychomotor development information was collected from the database during follow-up. Results were related to birth weight, sex and gestational age. RESULTS: WPPSI scores were: total intelligence quotient (IQ) 88.00+/-16.96, verbal IQ 89.72+/-16.72, and executive IQ 88.12+/-15.71 for the group with less than 1,500 grams; and total IQ 91.11+/-14.73, verbal IQ 93.36+/-12.65, and executive IQ 90.20+/-16.06 for the group between 1,500 and 2,500 grams. The best scores were obtained in tests that evaluated capacity of abstraction and symbolization, picture completion and common perception, in which only 5% and 6.3% of the children had abnormal results, respectively. The lowest scores were obtained in tests that evaluated visual-motor coordination and flexibility-speed of reasoning, in which 27.5% and 16.3% of the children had abnormal results, respectively. A total of 32.5% had abnormal results in the arithmetic tests. Behaviors related to attention deficit/hyperactivity disorder (ADHD) were observed in 48% of the sample. Low score in the Bayley Mental Scale and abnormal result in the Denver test were significantly correlated to ADHD (p = 0.017 and p = 0.004). Abnormal results in the Bayley Mental Scale (p < 0.001), Denver test (p < 0.001) and neurological examination (p = 0.002) were associated with lower IQ. CONCLUSIONS: The results revealed an increased incidence of behavioral and cognitive disorders at preschool age.

The incidence of sudden death syndrome in a cohort of infants.

OBJECTIVES: To quantify the incidence of sudden infant death syndrome in the town of Passo Fundo, in Rio Grande do Sul, Brazil, and to describe the profile of the deaths observed. METHODS: A population-based cohort study of the live births from February 2003 to January 2004 to parents resident in the urban area. Infants were excluded if they had been hospitalized since birth, were in the process of being adopted or had died before data collection. 2,411 children were included from the total of 2,634 live births and 2,285 (94.8%) of these were followed-up. Data were obtained from the Live Births Information System (Sistema de Informações Sobre Nascidos Vivos), death registers, records of the Committee on Infant Mortality and from interviews with the social mother during home visits. Data collection instruments were adapted from previously validated forms. Data were analyzed on Epi-Info with descriptive statistics. RESULTS: Ten deaths were registered (0.4%). Four deaths of unknown causes could be included in sudden infant death syndrome category III. These deaths took place at home, between 4 and 6 months of age. The children slept on their sides, sharing a bed with adults, and had soft mattresses, pillows and diapers on the surface. They were the children of young mothers, smokers, with incomplete prenatal care and previous births from underprivileged economic classes. The incidence of suspicion of this syndrome was 1.75/1,000. CONCLUSION: The incidence rate of suspected sudden infant death syndrome in Passo Fundo is comparable with the highest international coefficients, which suggests the need for vigilance and risk prevention measures.

The incidence of sudden death syndrome in a cohort of infants

OBJECTIVES: To quantify the incidence of sudden infant death syndrome in the town of Passo Fundo, in Rio Grande do Sul, Brazil, and to describe the profile of the deaths observed. METHODS: A population-based cohort study of the live births from February 2003 to January 2004 to parents resident in the urban area. Infants were excluded if they had been hospitalized since birth, were in the process of being adopted or had died before data collection. 2,411 children were included from the total of 2,634 live births and 2,285 (94.8%) of these were followed-up. Data were obtained from the Live Births Information System (Sistema de Informações Sobre Nascidos Vivos), death registers, records of the Committee on Infant Mortality and from interviews with the social mother during home visits. Data collection instruments were adapted from previously validated forms. Data were analyzed on Epi-Info with descriptive statistics. RESULTS: Ten deaths were registered (0.4%). Four deaths of unknown causes could be included in sudden infant death syndrome category III. These deaths took place at home, between 4 and 6 months of age.The children slept on their sides, sharing a bed with adults, and had soft mattresses, pillows and diapers on the surface. They were the children of young mothers, smokers, with incomplete prenatal care and previous births from underprivileged economic classes. The incidence of suspicion of this syndrome was 1.75/ 1000. CONCLUSION: The incidence rate of suspected sudden infant death syndrome in Passo Fundo is comparable with the highest international coefficients, which suggests the need for vigilance and risk prevention measures.

Clinical correlates of periodic breathing in neonatal polysomnography.

OBJECTIVE: Periodic breathing is a respiratory pattern typical of preterm infants, but its clinical significance has not been clarified yet. The present study was designed to investigate whether the presence of periodic breathing is specifically associated to low post-conceptional ages, preterm birth, or common clinical disorders related to preterm birth. METHODS: The study included 271 consecutive infants submitted to neonatal polysomnography, of whom 138 were born before 37 complete gestational weeks (preterm) and 133 were full-term. The main outcome measure was periodic breathing. A multivariate analysis was performed to test the specific impact of preterm birth, respiratory distress syndrome and hypoxic-ischemic encephalopathy on the occurrence of periodic breathing, with adjustment for potential confounding factors such as the post-conceptional age by the time of the polysomnography. RESULTS: Periodic breathing was twice more frequent in infants born before term (83/138 [60%]) than in full-term babies (41/133 [31%], chi2 = 22.3, P < 0.0001). The presence of periodic breathing was not significantly associated to either hypoxic-ischemic encephalopathy or respiratory distress syndrome. After a multivariate analysis, only preterm birth remained in the regression model as a specific risk factor for periodic breathing (adjusted odds ratio=5.62, P < 0.0001). CONCLUSIONS: Periodic breathing is a respiratory pattern independently associated with preterm birth, and this association cannot be imputed to the coexistence of either respiratory distress syndrome or hypoxic-ischemic encephalopathy among preterm infants. SIGNIFICANCE: The finding of periodic breathing in neonatal polysomnography correlates with preterm birth but not with its associated clinical disorders.

[Use of psychoactive and antiepileptic drugs: guidelines for pediatricians]. / Orientações ao pediatra sobre o manejo das drogas psicoativas e antiepilépticas.

OBJECTIVE: To review the guidelines for the use of psychoactive and antiepileptic drugs in childhood and adolescence. SOURCES OF DATA: Literature review. SUMMARY OF THE FINDINGS: The clinical indications, dosage and side effects of psychoactive and antiepileptic drugs are presented. The use of psychoactive drugs is increasing due to the release of new drugs and to the better understanding of emotional disorders in children and adolescents. CONCLUSIONS: The use of antiepileptic and psychoactive drugs in childhood requires extensive knowledge concerning pharmacokinetics and deleterious side effects. An adequate choice of drugs is essential to ensure a successful treatment.