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1.
Nat Commun ; 12(1): 4216, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34244490

RESUMO

The formation of large-scale brain networks, and their continual refinement, represent crucial developmental processes that can drive individual differences in cognition and which are associated with multiple neurodevelopmental conditions. But how does this organization arise, and what mechanisms drive diversity in organization? We use generative network modeling to provide a computational framework for understanding neurodevelopmental diversity. Within this framework macroscopic brain organization, complete with spatial embedding of its organization, is an emergent property of a generative wiring equation that optimizes its connectivity by renegotiating its biological costs and topological values continuously over time. The rules that govern these iterative wiring properties are controlled by a set of tightly framed parameters, with subtle differences in these parameters steering network growth towards different neurodiverse outcomes. Regional expression of genes associated with the simulations converge on biological processes and cellular components predominantly involved in synaptic signaling, neuronal projection, catabolic intracellular processes and protein transport. Together, this provides a unifying computational framework for conceptualizing the mechanisms and diversity in neurodevelopment, capable of integrating different levels of analysis-from genes to cognition.


Assuntos
Encéfalo/crescimento & desenvolvimento , Cognição/fisiologia , Modelos Neurológicos , Rede Nervosa/crescimento & desenvolvimento , Neurogênese/fisiologia , Adolescente , Encéfalo/diagnóstico por imagem , Criança , Desenvolvimento Infantil/fisiologia , Estudos de Coortes , Simulação por Computador , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Rede Nervosa/diagnóstico por imagem
2.
Adv Child Dev Behav ; 61: 317-334, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34266569

RESUMO

Since the proliferation of television sets into households began over half a century ago there has been widespread interest in the impact that viewing has on young children's development. Such interest has grown with the increasing availability of smart phones and tablets. In this review we examine the literature documenting human social learning and how this learning is impacted when the instructing agent appears on a screen instead of face-to-face. We then explore the shifting nature of screen-based media, with a focus on the increasingly socio-normative manner information is portrayed. We discuss how the changing nature of screen technology might be altering how children interpret what they see, and raise the possibility that this may render prevailing evidence as historical documentation, rather than setting out established developmental milestones that transcend the period in which they were documented. We contend that recognizing the significance of historically changing contexts in developmental psychology is timely when the COVID-19 climate is pushing data collection on-line for many labs, often using tasks that were developed primarily for face-to-face contexts.


Assuntos
Desenvolvimento Infantil , Psicologia do Desenvolvimento , Tempo de Tela , Aprendizado Social , COVID-19/epidemiologia , COVID-19/psicologia , Criança , Humanos , Televisão
3.
Artigo em Inglês | MEDLINE | ID: mdl-34203109

RESUMO

Adequate child nutrition is critical to child development, yet child malnutrition is prevalent in crisis settings. However, the intersection of malnutrition and disasters is sparse. This study reviews existing evidence on nutrition responses and outcomes for infants and young children during times of crisis. The scoping review was conducted via two approaches: a systematic search and a purposive search. For the systematic search, two key online databases, PubMed and Science Direct, were utilized. In total, data from 32 studies were extracted and included in the data extraction form. Additionally, seven guidelines and policy documents were included, based on relevance to this study. Overall, the existing evidence demonstrates the negative impacts of crises on nutritional status, diet intake, anthropometric failure, and long-term child development. On the other hand, crisis-related interventions positively affected nutrition-related knowledge and practices. Further studies should be carried out to explore the sustainability of the interventions and the success of existing guidelines. Since this study focuses only on nutrition among children under three, further studies should likewise consider an extended age range from three to five years.


Assuntos
Transtornos da Nutrição Infantil , Desnutrição , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Humanos , Lactente , Estado Nutricional
4.
Artigo em Inglês | MEDLINE | ID: mdl-34204030

RESUMO

BACKGROUND: The early childhood years provide an important window of opportunity to build strong foundations for future development. One impediment to global progress is a lack of population-based measurement tools to provide reliable estimates of developmental status. We aimed to field test and validate a newly created tool for this purpose. METHODS: We assessed attainment of 121 Infant and Young Child Development (IYCD) items in 269 children aged 0-3 from Pakistan, Malawi and Brazil alongside socioeconomic status (SES), maternal educational, Family Care Indicators and anthropometry. Children born premature, malnourished or with neurodevelopmental problems were excluded. We assessed inter-rater and test-retest reliability as well as understandability of items. Each item was analyzed using logistic regression taking SES, anthropometry, gender and FCI as covariates. Consensus choice of final items depended on developmental trajectory, age of attainment, invariance, reliability and acceptability between countries. RESULTS: The IYCD has 100 developmental items (40 gross/fine motor, 30 expressive/receptive language/cognitive, 20 socio-emotional and 10 behavior). Items were acceptable, performed well in cognitive testing, had good developmental trajectories and high reliability across countries. Development for Age (DAZ) scores showed very good known-groups validity. CONCLUSIONS: The IYCD is a simple-to-use caregiver report tool enabling population level assessment of child development for children aged 0-3 years which performs well across three countries on three continents to provide reliable estimates of young children's developmental status.


Assuntos
Desenvolvimento Infantil , Brasil , Criança , Pré-Escolar , Humanos , Lactente , Malaui , Paquistão , Reprodutibilidade dos Testes
5.
Artigo em Inglês | MEDLINE | ID: mdl-34204071

RESUMO

Delays in early child development are among the aspects underlying the persistent developmental gaps between regions and social strata. This study seeks to examine the relationship between the home environment and early child development in less-developed rural areas by drawing on data from 445 children from villages in Guizhou province in southwest China. A demographic questionnaire, the Home Observation Measurement of the Environment (HOME), and the Bayley Scales of Infant Development, version III (BSID-III), were used to measure the child's demographic characteristics, home environment, and early development outcomes, respectively. Our data show that the sample children suffer a delay in various dimensions of child development and a deficit in the HOME scale. The results from a hierarchical regression model suggest that the availability of learning material at home, caregivers' responsiveness and organization sub-scales are significantly positively correlated with the early development of sample children, after controlling for general socioeconomic status, health, and nutrition, and this correlation differs by gender. These results imply that the provision of learning material to households, promoting caregivers' responsiveness and organization in less-developed rural areas could improve early child development among deprived children.


Assuntos
Desenvolvimento Infantil , População Rural , Cuidadores , Criança , China , Características da Família , Humanos , Lactente
6.
Emerg Med Clin North Am ; 39(3): 589-603, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215404

RESUMO

Emergency medicine clinicians are mandated reporters, legally, which obligates clinicians to report any behavior suspicious for child maltreatment to local authorities. Pediatric patients often present to the emergency department with concern for physical injury and other pervasive complaints. In some cases, these injuries are nonaccidental. To appropriately advocate and protect children from further physical and emotional trauma, it is important for clinicians to recognize the signs and symptoms of child maltreatment and sexual abuse.


Assuntos
Maus-Tratos Infantis/diagnóstico , Cuidadores , Criança , Desenvolvimento Infantil , Serviços de Proteção Infantil , Diagnóstico Diferencial , Diagnóstico por Imagem , Medicina Legal , Humanos , Notificação de Abuso , Anamnese , Síndrome de Munchausen Causada por Terceiro/diagnóstico , Exame Físico , Profilaxia Pós-Exposição , Encaminhamento e Consulta , Doenças Sexualmente Transmissíveis/prevenção & controle , Tempo para o Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-34205660

RESUMO

Moderate to late preterm infants are at risk of developing problems later in life. To support attachment and infants' development, high quality parent-infant interaction is important. Parent-infant interaction is known to improve through intervention programs but since no such intervention program is addressed directly to moderate to late preterm infants, a tailor-made intervention was developed. The aim was to describe the rationale, development, framework and practical provision of a new early collaborative intervention program. This study has a descriptive design and the intervention is described using the Template for Intervention Description and Replication. During an intervention-session, the preterm infant's cues are made visible to the parents as they perform an everyday care-taking procedure. Instant feedback is delivered to give the parents the opportunity to notice, interpret and respond to cues immediately. The infant's response to the parent's action is discussed in a dialogue to instantly guide parents´ awareness of the preterm infant's subtle cues. This study describes a new early collaborative intervention, developed to support interaction between parents and their moderate to late preterm infants starting in the neonatal intensive care unit. Clinical studies evaluating parental experiences as well as the effects of the early intervention are ongoing, ClinicalTrials.gov NCT02034617.


Assuntos
Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Desenvolvimento Infantil , Intervenção Educacional Precoce , Humanos , Lactente , Recém-Nascido
8.
Artigo em Inglês | MEDLINE | ID: mdl-34205787

RESUMO

Developmental problems in extremely preterm (EP) infants and the associated longitudinal burden for their families are major health issues worldwide. Approaches to social-emotional support such as family-integrating Creative Music Therapy (CMT) are warranted. We aimed: (1) to explore parental perspectives on the use of CMT with EP infants in the neonatal hospitalization period and (2) to examine the possible longitudinal influence of CMT. A qualitative design was used to examine the perspective of six families from various backgrounds. Semi-structured interviews were carried out when the infants reached school age. We used an inductive-deductive thematic analysis to identify three main themes, each with three sub-themes: (1) the positive impact of CMT on the infants, the parents, and bonding; (2) the attitude toward CMT, from being open-minded to recommending it as complementary therapy; and (3) the experience of overall healthy infant development despite unique developmental delay issues. The findings elucidate the positive and formative impact of CMT on both infants and parents in the stressful NICU setting and beyond. CMT may empower positive transformation in the parents through individualized early nurturing musical interactions, capacity building, and positive reinforcement. Further research may help to identify and implement potentially modifiable factors for improving health care in this vulnerable group through early family-integrating, resource-based approaches such as CMT.


Assuntos
Musicoterapia , Música , Criança , Desenvolvimento Infantil , Seguimentos , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Pesquisa Qualitativa
9.
Soins Pediatr Pueric ; 42(321): 23-29, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34266555

RESUMO

Prematurity puts children born too early at risk of developmental problems. New care strategies, of which the Newborn Individualized Developmental Care Assessment Program is a part, make it possible to reduce this risk and to accompany the baby in its development by optimising its skills. This specific work, which is based on verified scientific data, can be continued at home by the mother and child protection nurse in a long-term project.


Assuntos
Doenças do Prematuro , Neonatologia , Criança , Desenvolvimento Infantil , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Mães
10.
Codas ; 33(6): e20200254, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34190813

RESUMO

PURPOSE: To investigate the association of sociodemographic, obstetrical and psychosocial factors with fine and gross motor developmental delay in preterm and term infants, in the age group of three months and one day to twelve months and twenty-nine days. METHODS: The term and preterm infants were evaluated by the Denver II Test for fine and gross motor skills, investigated in three phases: 165 infants in phase 1 (3 months and 1 day to 4 months and 29 days), 130 infants in stage 2 (8 months and 1 day to 9 months and 29 days) and 102 infants in phase 3 (11 months and 1 day to 12 months and 29 days). Sociodemographic, obstetrical and psychosocial data were obtained through an initial interview with family members and the psychic risk assessment through the Child Development Risk Indicators and PREAUT protocols. Statistical analysis was performed using the logistic regression model. RESULTS: Significant factors in the association with fine and gross motor delay were: maternal gestational and obstetric history (planned pregnancy, type of delivery, number of prenatal consultations, use of medication and gestational intercurrence), features and biological risks of the baby (gender, mechanical ventilation, feeding difficulty), sociodemographic factors (career and level of maternal schooling, number of children and people in the house) and psychosocial issues concerning to the family routine participation and presence of psychic risk. CONCLUSION: There was a significant association between motor development delay of the infants, environmental and biological variables, with emphasis on psychic risk.


Assuntos
Desenvolvimento Infantil , Recém-Nascido Prematuro , Criança , Escolaridade , Feminino , Humanos , Lactente , Recém-Nascido , Destreza Motora , Gravidez , Medição de Risco , Fatores de Risco
11.
Rev Saude Publica ; 55: 32, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34190898

RESUMO

OBJECTIVE: To investigate the association between child care attendance since birth and development in two-years-old Brazilian children. METHODS: The study used longitudinal data from the 2015 Pelotas Birth Cohort. The childhood development (cognitive, fine and gross motor skills, and language) at two-years-old children was assessed using INTER-NDA (INTERGROWTH-21st Neurodevelopment Assessment). The child care attendance was measured at ages one and two years and categorized as: a) never attended child care; b) attended some child care (one or two years); and c) always attended child care (one and two years). Demographic, socioeconomic, health, and child stimulation variables were considered as confounders. Crude and adjusted analyses of child care attendance and development were carried out using linear regression. RESULTS: Out of the 3,870 infants included in the analyses, around 1/3 attended center-based child care. In crude analyses, attending center-based child care was associated with positive developmental outcomes, except in motor domains. In adjusted analyses, compared to those children that have never attended child care, children who did attend presented higher scores for cognitive development (always in child care: ß: 2.44, 95%CI: 0.83-4.05; some child care: ß: 1.35, 95%CI: 0.17-2.53). CONCLUSIONS: This study suggests that center-based child care may help improve child cognitive development in the Brazilian context. Furthermore, the association was higher for early and continued attendance. Considering the low prevalence of children in external care, it is recommended to improve child care opportunities in early childhood.


Assuntos
Cuidado da Criança , Desenvolvimento Infantil , Brasil/epidemiologia , Criança , Saúde da Criança , Pré-Escolar , Estudos de Coortes , Humanos , Lactente
12.
Ecotoxicol Environ Saf ; 220: 112391, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34090107

RESUMO

BACKGROUND: Exposure to heavy metals has been considered harmful and can cause cognitive deficits in preschool children. OBJECTIVE: To investigate the possible mediation effect of neurotransmitters on the relationship of heavy metal exposure with neurobehaviour. METHODS: The levels of blood heavy metals and neurotransmitters, along with the neurobehavioural scores, were determined in preschool children. Multiple linear regression was used to assess the relationship between heavy metals, neurotransmitters, and neurobehavioural scores. Furthermore, the mediating role of neurotransmitters was investigated. RESULTS: An interquartile range (IQR) increase in lead (6.10 µg/L) was associated with a decrease of 8.52%, 30.06%, and 20.10% for Glutamic acid (Glu), Glycine (Gly), and gamma-aminobutyric acid (GABA), respectively. An IQR increase in arsenic (19.37 µg/L) was associated with an increase of 6.32% and 2.09% for Gly and GABA, respectively. Further, an IQR increase in zinc (15.58 µg/L) was associated with an increase of 1.44% for Ser, whereas the IQR increase was associated with a decrease of 2.14%, 2.24%, and 1.89% for Glu, Gly, and GABA, respectively. An IQR increase in selenium (38.75 µg/L) was associated with an increase of 1.88% for GABA. Moreover, both Glu and Gly decreased by 2.87% for an IQR increase in manganese (16.92 µg/L). An IQR increase in mercury (15.22 µg/L) was associated with a decrease of 2.43% for Ser, but the IQR increase was associated with an increase of 4.99% and 3.09% for Gly and GABA, respectively. It was found that Glu and Serine (Ser) have a significant linear relationship with conduct score and impulsivity-hyperactivity index, and that there was a significant linear relationship between Ser and the learning disability index. GABA and conduct score and attention-deficit hyperactivity disorder (ADHD) index have a significant linear relationship. There is a significant linear relationship between Gly and conduct, anxiety, ADHD, and impulsivity-hyperactivity index. The results of the mediating effect analysis indicated that Ser, Glu, Gly, and GABA have a specific mediating effect between blood heavy metals and neurobehaviour. CONCLUSION: We showed the mediating effect of neurotransmitters. The current study may provide valuable information regarding the prevention and management of metal-related neurological disorders in preschool children.


Assuntos
Doenças do Sistema Nervoso Central/induzido quimicamente , Poluentes Ambientais/toxicidade , Metais Pesados/toxicidade , Neurotransmissores/metabolismo , Desenvolvimento Infantil/efeitos dos fármacos , Pré-Escolar , Estudos Transversais , Humanos , Masculino
13.
Andes Pediatr ; 92(2): 174-181, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34106155

RESUMO

The implications of closing educational establishments during the COVID-19 pandemic and the dis cussion about the opening of them, invite and require us to consider, from different positions and responsibilities, the changes that we must make as a society at the educational level. In this article, a group of health professionals collects information and reflects on the repercussions of returning or not to school activities, in terms of physical and emotional health and academic education. Based on what is known to be protective factors and possible threats to return, it is possible to conclude that each local reality must make its own informed decision, with the participation of all its members, seeking the common good, which favors students, protects teachers, and privileges the role of the educational system in socio-emotional learning. School is a space for containing the emotions and adaptation needs that students and their families have experienced in these uncertain times. We all have a level of responsibility in building a new civilization around these issues that link education, physical and mental health, social collaboration, and individual responsibility. Differences in people's living conditions and unequal opportunities have become more visible than before (others are still hidden) and create an opportunity for changes that we must face together.


Assuntos
Desempenho Acadêmico , Saúde do Adolescente , COVID-19/prevenção & controle , Saúde da Criança , Educação à Distância , Saúde Mental , Pandemias/prevenção & controle , Desempenho Acadêmico/psicologia , Adolescente , COVID-19/epidemiologia , COVID-19/psicologia , Criança , Desenvolvimento Infantil , Proteção da Criança , Chile/epidemiologia , Tomada de Decisões , Política de Saúde , Disparidades nos Níveis de Saúde , Humanos , Distanciamento Físico , Fatores de Proteção , Fatores de Risco , Instituições Acadêmicas , Condições Sociais , Meio Social , Responsabilidade Social
14.
Nat Commun ; 12(1): 3598, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127657

RESUMO

Effective curiosity-driven learning requires recognizing that the value of evidence for testing hypotheses depends on what other hypotheses are under consideration. Do we intuitively represent the discriminability of hypotheses? Here we show children alternative hypotheses for the contents of a box and then shake the box (or allow children to shake it themselves) so they can hear the sound of the contents. We find that children are able to compare the evidence they hear with imagined evidence they do not hear but might have heard under alternative hypotheses. Children (N = 160; mean: 5 years and 4 months) prefer easier discriminations (Experiments 1-3) and explore longer given harder ones (Experiments 4-7). Across 16 contrasts, children's exploration time quantitatively tracks the discriminability of heard evidence from an unheard alternative. The results are consistent with the idea that children have an "intuitive psychophysics": children represent their own perceptual abilities and explore longer when hypotheses are harder to distinguish.


Assuntos
Desenvolvimento Infantil , Comportamento Exploratório , Aprendizagem , Criança , Pré-Escolar , Humanos , Modelos Teóricos , Psicofísica
15.
Dtsch Arztebl Int ; 118(18): 313-319, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-34140080

RESUMO

BACKGROUND: In Germany, the 12-month prevalence of methamphetamine use among persons aged 15 to 34 is 1.9%. An increasing number of newborns are being born after a prenatal methamphetamine exposure (PME). In 2014, in the German state of Saxony, approximately four out of 1000 newborns were affected. METHODS: This systematic review (Prospero registration number CRD42017060536) includes publications that were published between January 1990 and November 2019. The purpose was to determine the effects of PME on the peri- and neonatal condition of the affected children and on their further long-term development. Observational studies with a control group were included in the review and examined for their methodological quality. RESULTS: 31 publications, which dealt with two prospective and six retrospective cohort studies, were included in the review. The studies involved a total of 4446 mother-child pairs with PME, compared with 43 778 pairs without PME. A metaanalysis revealed that PME was associated with, among other findings, lower birth weight (SMD = -0.348; 95% confidence interval [-0.777; 0.081]), shorter body length (SMD= -0.198 [-0.348; -0.047]), and smaller head circumference (SMD= -0.479 [-1.047; 0.089]). Some differences between the groups with and without PME persist into the toddler years. Moreover, children with PME much more commonly display psychological and neurocognitive abnormalities, which are more severe in children growing up in problematic surroundings (discord, violence, poverty, low educational level of the parent or caregiver). A limitation of this review is that not all studies employed an objective or quantitative measure of methamphet - amine use. CONCLUSION: The documented effects of PME on child development necessitate early treatment of the affected expectant mothers, children, and families. Emphasis should be placed on structured and interdisciplinary preventive measures for methamphetamine use.


Assuntos
Metanfetamina , Efeitos Tardios da Exposição Pré-Natal , Desenvolvimento Infantil , Feminino , Alemanha/epidemiologia , Humanos , Recém-Nascido , Metanfetamina/efeitos adversos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos
16.
J Pediatr Health Care ; 35(4): 377-386, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34078570

RESUMO

The COVID-19 pandemic impacts daily lives of families globally. Sequelae are not limited to physical consequences of medical complications but extend into social, emotional, spiritual, and psychological health. Interventions including mask-wearing and physical distancing are intended to prevent viral spread, but have unintended negative effects on mental health and child development. Although it is too early to know the full impact, practicing pediatric clinicians are well-positioned to help young people recover and thrive despite challenges presented. This article will review the impact of COVID-19 on child mental health and give practical interventions to foster resilience in youth and their families.


Assuntos
COVID-19/psicologia , Desenvolvimento Infantil , Saúde da Família , Saúde Mental , Resiliência Psicológica , Criança , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2
17.
J Pediatr Orthop ; 41(Suppl 1): S14-S19, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096532

RESUMO

INTRODUCTION: The transition from pediatric to adolescent fractures can lead to uncertainty on what level of surgical correction is warranted as remodeling is limited in these older patients. DISCUSSION: Adolescent diaphyseal radial shaft fractures present several unique challenges; the radial bow must be restored to preserve forearm rotation and there are several clinical scenarios where plating, even in the skeletally immature child, is strongly recommended and will have more reliable results over flexible intramedullary nails. In addition, judging how much angulation, rotation, and displacement will remodel in the older child can be a challenging decision, even for experienced pediatric orthopaedists. CONCLUSION: This overview discusses parameters for acceptable alignment in these fractures, when surgical fixation should be considered, and circumstances where plating should be considered over flexible nails.


Assuntos
Antebraço , Fixação Interna de Fraturas , Fixação Intramedular de Fraturas , Seleção de Pacientes , Fraturas do Rádio/cirurgia , Rádio (Anatomia) , Adolescente , Fatores Etários , Pinos Ortopédicos , Placas Ósseas , Criança , Desenvolvimento Infantil , Feminino , Antebraço/crescimento & desenvolvimento , Antebraço/fisiopatologia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Rádio (Anatomia)/crescimento & desenvolvimento , Rádio (Anatomia)/cirurgia
18.
J Pediatr Orthop ; 41(Suppl 1): S20-S23, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096533

RESUMO

BACKGROUND: Fractures of the proximal humerus in skeletally immature patients are rare, and even rarer still in individuals approaching skeletal maturity. Concepts regarding remodeling potential, amount of deformity and functional demands can guide our treatment decision making, but criteria are poorly defined. The purpose of this manuscript is to discuss the issues and the best available evidence. METHODS: A search of the English literature was carried out using PubMed to identify papers on the topic of proximal humerus fractures in skeletally immature individuals. RESULTS: The literature available on the topic of pediatric proximal humerus fractures is limited, especially regarding fractures in patients approaching skeletal maturity. Certainly, as the remodeling potential decreases and the amount of deformity and functional demand increase, the need for operative treatment increases. The exact tolerances and criteria have not been established. A variety of surgical techniques exist, and have been shown to be helpful. CONCLUSIONS: Operative treatment may be necessary in individuals approaching skeletal maturity. Concepts discussed in this paper regarding remodeling, amount of deformity and functional demand may help the surgeon to make appropriate treatment decisions. Future prospective comparative studies which are pending will hopefully shed further light on this matter.


Assuntos
Fixação de Fratura , Úmero , Fraturas do Ombro/cirurgia , Adolescente , Remodelação Óssea , Criança , Desenvolvimento Infantil , Fixação de Fratura/efeitos adversos , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Deformidades Adquiridas da Mão/etiologia , Deformidades Adquiridas da Mão/prevenção & controle , Humanos , Úmero/crescimento & desenvolvimento , Úmero/cirurgia , Seleção de Pacientes , Fraturas Salter-Harris/cirurgia
19.
J Pediatr Orthop ; 41(Suppl 1): S87-S89, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096544

RESUMO

BACKGROUND: Children with neuromuscular disorders regularly seek care from pediatric orthopaedic surgeons. These conditions can have a significant impact on the growth and development of children and their function and well-being as adults. Questions exist about the long-term outcomes of musculoskeletal interventions performed during childhood. METHODS: A search of recent literature pertaining to the musculoskeletal and functional consequences of cerebral palsy, spina bifida, Duchenne muscular dystrophy, and spinal muscle atrophy was performed. Information from those articles was combined with the experience of the authors and their institutions. RESULTS: Neuromuscular conditions can result in limb and spine deformities that lead to impaired physical function. Orthopaedic interventions during childhood can improve function and well-being and can be durable into adulthood. Unfortunately, many individuals with these conditions transition to adult health care that lacks the informed, collaborative multidisciplinary care they received as children. This can lead to unmet health care needs and a shortage of long-term natural history and outcome studies that would inform the care of children today. CONCLUSIONS: Adults with childhood-onset neuromuscular conditions need, and deserve, dedicated health care systems that include the best aspects of the care they received as children. Pediatric orthopaedic surgeons have a role in promoting the development of such systems and a responsibility to learn from their adult patients. LEVEL OF EVIDENCE: Expert Opinion.


Assuntos
Continuidade da Assistência ao Paciente , Efeitos Adversos de Longa Duração , Doenças Neuromusculares/cirurgia , Procedimentos Ortopédicos , Adulto , Criança , Desenvolvimento Infantil , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/terapia , Doenças Neuromusculares/diagnóstico , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Desempenho Físico Funcional
20.
Nat Commun ; 12(1): 3270, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075035

RESUMO

Little is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5-29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2-20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9-10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results.


Assuntos
Desenvolvimento Infantil , Malformações do Sistema Nervoso/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Infecção por Zika virus/complicações , Adolescente , Adulto , Pré-Escolar , Feminino , Guiana Francesa/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Malformações do Sistema Nervoso/etiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/etiologia , Medição de Risco/estatística & dados numéricos , Adulto Jovem , Zika virus/isolamento & purificação , Infecção por Zika virus/congênito , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/virologia
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