Moderately and Late Preterm Infants: Short- and Long-Term Outcomes From a Registry-Based Cohort.

Background: While most studies on the association of preterm birth and cerebral palsy (CP) have focused on very preterm infants, lately, attention has been paid to moderately preterm [32 to <34 weeks gestational age (GA)] and late preterm infants (34 to <37 weeks GA). Methods: In order to report on the outcomes of a cohort of moderately and late preterm infants, derived from a population-based CP Registry, a comparative analysis of data on 95 moderately preterm infants and 96 late preterm infants out of 1,016 with CP, was performed. Results: Moderately preterm neonates with CP were more likely to have a history of N-ICU admission (p = 0.001) and require respiratory support (p < 0.001) than late preterm neonates. Birth weight was significantly related to early neonatal outcome with children with lower birth weight being more likely to have a history of N-ICU admission [moderately preterm infants (p = 0.006)/late preterm infants (p < 0.001)], to require ventilator support [moderately preterm infants (p = 0.025)/late preterm infants (p = 0.014)] and not to have neonatal seizures [moderately preterm infants (p = 0.044)/late preterm infants (p = 0.263)]. In both subgroups, the majority of children had bilateral spastic CP with moderately preterm infants being more likely to have bilateral spastic CP and less likely to have ataxic CP as compared to late preterm infants (p = 0.006). The prevailing imaging findings were white matter lesions in both subgroups, with statistically significant difference between moderately preterm infants who required ventilator support and mainly presented with this type of lesion vs. those who did not and presented with gray matter lesions, maldevelopments or miscellaneous findings. Gross motor function was also assessed in both subgroups without significant difference. Among late preterm infants, those who needed N-ICU admission and ventilator support as neonates achieved worse fine motor outcomes than those who did not. Conclusions: Low birth weight is associated with early neonatal problems in both moderately and late preterm infants with CP. The majority of children had bilateral spastic CP and white matter lesions in neuroimaging. GMFCS levels were comparable in both subgroups while BFMF was worse in late preterm infants with a history of N-ICU admission and ventilator support.

Oxidative stress in ageing and disease development studied by FT-IR spectroscopy.

FT-IR spectroscopy was used to investigate the effect of oxidative stress and to approach the mechanism on cancer bone demineralization, aortic valve mineralization and heterotopic ossification on disease development. The FT-IR spectra obtained from paediatric, adult bone and ex vivo irradiated adult healthy bone with a dose of 20Gy were compared with those of healthy bone. The increase of band intensity changes of vasCH2,vsCH2 in the region 3000-2850cm-1 depended on aging, the disease progression and the dose of irradiation. The bands at 3080cm-1 and 1744cm-1, which originate from olefinic terminal bond (v=CH) and ester carbonyl group (vROCO), respectively, indicate the influence of oxidative stress on lipid degradation and peroxidation, respectively. The new bands at about 1690cm-1 and 1516cm-1 denote the presence of ß-sheet conformation of the proteins due to the diseases, confirming the increasing amount of lipophilic environment and fibril formation. Comparison of the FT-IR spectra of calcified aortic valve and hip heterotopic ossification with that of normal bones showed that in the bone-like formation the peroxide anion free radicals play an important role in the disease.

Anticonvulsant drug-induced rickets and multiple slipped epiphyses in a child treated non-operatively: a case report.

The clinical and radiographic presentation of a child with spastic tetraplegia, anticonvulsant drug-induced rickets, borderline hypothyroidism and multiple slipped epiphyses is described. While the metabolic abnormalities were being treated, the parents denied surgical treatment and have been non-compliant with bracing of the wrist, ankle and knee deformities. By two years of medical treatment, rickets had resolved and the growth plates of the lower limbs' joints had closed. Non weight-bearing, gentle physiotherapy and bracing led to good results in the hip, ankle and wrist joints and to unacceptable residual valgus angular and rotational deformity of the right knee. Severely handicapped paediatric patients with metabolic bone disorders, non-compliant with bracing and with co-existent soft tissue contractures, are probably not good candidates for conservative treatment of severe angular limb deformities. However, non-operative treatment of minimal or moderate slippage of the proximal femoral epiphysis (as well as other major epiphyses) can lead to good results.

Perthes' disease associated with osteogenesis imperfecta.

Primary hip disorders, such as congenital hip dislocation, have rarely been reported in children with osteogenesis impefecta (OI). Protrusio acetabuli and coxa vara secondary to severe osteopenia and recurrent fractures are common. Perthes' disease in association with osteogenesis imperfecta has not been reported previously. Epiphyseal and growth plate changes may occur in the more severe forms of OI. There was no evidence of growth plate disruption or severe osteopenia in our case. Approximately two-thirds of OI patients have a tendency to bleed easily but the association of clotting and bleeding disorders with Perthes' disease has yet to be clarified.