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1.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 8-13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31036702

RESUMO

OBJECTIVE: Since therapeutic hypothermia became standard care for neonatal hypoxic-ischaemic encephalopathy (HIE), even fewer infants die or have disability at 18-month assessment than in the clinical trials. However, longer term follow-up of apparently unimpaired children is lacking. We investigated the cognitive, motor and behavioural performances of survivors without cerebral palsy (CP) cooled for HIE, in comparison with matched non-HIE control children at 6-8 years. DESIGN: Case-control study. PARTICIPANTS: 29 case children without CP, cooled in 2008-2010 and 20 age-matched, sex-matched and social class-matched term-born controls. MEASURES: Wechsler Intelligence Scales for Children, Fourth UK Edition, Movement Assessment Battery for Children, Second Edition (MABC-2) and Strengths and Difficulties Questionnaire. RESULTS: Cases compared with controls had significantly lower mean (SD) full-scale IQ (91 [10.37]vs105[13.41]; mean difference (MD): -13.62, 95% CI -20.53 to -6.71) and total MABC-2 scores (7.9 [3.26]vs10.2[2.86]; MD: -2.12, 95% CI -3.93 to -0.3). Mean differences were significant between cases and controls for verbal comprehension (-8.8, 95% CI -14.25 to -3.34), perceptual reasoning (-13.9, 95% CI-20.78 to -7.09), working memory (-8.2, 95% CI-16.29 to -0.17), processing speed (-11.6, 95% CI-20.69 to -2.47), aiming and catching (-1.6, 95% CI-3.26 to -0.10) and manual dexterity (-2.8, 95% CI-4.64 to -0.85). The case group reported significantly higher median (IQR) total (12 [6.5-13.5] vs 6 [2.25-10], p=0.005) and emotional behavioural difficulties (2 [1-4.5] vs 0.5 [0-2.75], p=0.03) and more case children needed extra support in school (34%vs5%, p=0.02) than the control group. CONCLUSIONS: School-age children without CP cooled for HIE still have reduced cognitive and motor performance and more emotional difficulties than their peers, strongly supporting the need for school-age assessments.


Assuntos
Hipotermia Induzida , Hipóxia-Isquemia Encefálica/terapia , Transtornos do Neurodesenvolvimento/diagnóstico , Estudos de Casos e Controles , Criança , Transtornos do Comportamento Infantil/diagnóstico , Compreensão , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Memória de Curto Prazo , Destreza Motora , Testes Neuropsicológicos , Estudos Prospectivos , Desempenho Psicomotor , Reino Unido , Escalas de Wechsler
2.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31515298

RESUMO

OBJECTIVES: To examine screening practices for autism spectrum disorder (ASD), subsequent referrals, and diagnostic outcomes within a large network of primary pediatric care practices. METHODS: Rates of ASD screening with the Modified Checklist for Autism in Toddlers (M-CHAT) at 18- and 24-month well-child visits were examined among 290 primary care providers within 54 pediatric practices between June 2014 and June 2016. Demographic, referral, and diagnostic data were abstracted from the medical records for all children who failed the M-CHAT (ie, score of ≥3) at either or both visits. RESULTS: Rates of M-CHAT screening were 93% at 18 months and 82% at 24 months. Among 23 514 screens, scores of 648 (3%) were ≥3 (386 at 18 months, 262 at 24 months) among 530 unique children who failed 1 or both screenings. Among screen-failed cases, 18% received a diagnosis of ASD and 59% received ≥1 non-ASD neurodevelopmental disorder diagnosis within the follow-up period. Only 31% of children were referred to a specialist for additional evaluation. CONCLUSIONS: High rates of ASD-specific screening do not necessarily translate to increases in subsequent referrals for ASD evaluation or ASD diagnoses. Low rates of referrals and/or lack of follow-through on referrals appear to contribute to delays in children's receipt of ASD diagnoses. Additional education of primary care providers regarding the referral process after a failed ASD screening is warranted.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Lista de Checagem , Pediatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Etários , Transtorno do Espectro Autista/epidemiologia , Pré-Escolar , Humanos , Lactente , Perda de Seguimento , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia
3.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31548334

RESUMO

Pediatricians and other pediatric primary care providers may be consulted when families have concerns that their child is not making expected progress in school. Pediatricians care not only for an increasingly diverse population of children who may have behavioral, psychological, and learning difficulties but also for increasing numbers of children with complex and chronic medical problems that can affect the development of the central nervous system and can present with learning and academic concerns. In many instances, pediatric providers require additional information about the nature of cognitive, psychosocial, and educational difficulties that affect their school-aged patients. Our purpose for this report is to describe the current state of the science regarding educational achievement to inform pediatricians' decisions regarding further evaluation of a child's challenges. In this report, we review commonly available options for psychological evaluation and/or treatment, medical referrals, and/or recommendations for referral for eligibility determinations at school and review strategies for collaborating with families, schools, and specialists to best serve children and families.


Assuntos
Desempenho Acadêmico , Pediatras , Papel do Médico , Criança , Defesa da Criança e do Adolescente , Diagnóstico Diferencial , Diagnóstico Precoce , Educação Especial/legislação & jurisprudência , Humanos , /prevenção & controle , Anamnese , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/terapia , Privacidade/legislação & jurisprudência , Encaminhamento e Consulta , Fatores de Tempo
4.
Int J Mol Sci ; 20(17)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31454888

RESUMO

In this narrative review, we summarize recent pieces of evidence of the role of microbiota alterations in Rett syndrome (RTT). Neurological problems are prominent features of the syndrome, but the pathogenic mechanisms modulating its severity are still poorly understood. Gut microbiota was recently demonstrated to be altered both in animal models and humans with different neurodevelopmental disorders and/or epilepsy. By investigating gut microbiota in RTT cohorts, a less rich microbial community was identified which was associated with alterations of fecal microbial short-chain fatty acids. These changes were positively correlated with severe clinical outcomes. Indeed, microbial metabolites can play a crucial role both locally and systemically, having dynamic effects on host metabolism and gene expression in many organs. Similar alterations were found in patients with autism and down syndrome as well, suggesting a potential common pathway of gut microbiota involvement in neurodevelopmental disorders.


Assuntos
Microbioma Gastrointestinal , Transtornos do Neurodesenvolvimento/etiologia , Síndrome de Rett/etiologia , Animais , Biodiversidade , Disbiose , Humanos , Metagenoma , Metagenômica/métodos , Transtornos do Neurodesenvolvimento/diagnóstico , Fenótipo , Síndrome de Rett/diagnóstico
5.
Codas ; 31(4): e20180177, 2019 Aug 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31460569

RESUMO

PURPOSE: This study aimed to present findings on language, behavior, and neurodevelopment in a girl diagnosed with Angelman Syndrome, evaluated when she was three and eight years old. METHODS: The following evaluation instruments were used: Observation of Communication Behavior, Early Language Milestone (ELM) Scale, and Denver Developmental Screening Test, 2nd edition (DDST-II). RESULTS: In this case report, presence of AS phenotype signals such as wide mouth and wide-spaced teeth, tongue thrusting, strabismus, up slanting palpebral fissures, and sialorrhea are verified. Expressive and receptive deficits were verified in the language assessment, with the absence of orality and loss of comprehension with very similar performances in both evaluations. The ELM and DDST-II tests indicated severe impairment of all abilities evaluated at both three and eight years of age. Performance was quite similar in both evaluations in all areas of child development. Little progress was observed over time despite the great therapeutic and educational investment. CONCLUSION: The presence of a complex scenario such as AS demands high complexity clinical needs, a situation that is worsened due to scarcity of therapeutic resources that could minimize the harmful impacts of AS and culminate in increased quality of life for the AS population and their families.


Assuntos
Síndrome de Angelman/reabilitação , Transtornos do Neurodesenvolvimento/reabilitação , Síndrome de Angelman/diagnóstico , Síndrome de Angelman/psicologia , Criança , Desenvolvimento Infantil , Comunicação , Feminino , Humanos , Desenvolvimento da Linguagem , Testes de Linguagem , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/psicologia , Testes Neuropsicológicos , Desempenho Psicomotor
7.
Acta Clin Croat ; 58(1): 107-112, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363332

RESUMO

Intraventricular hemorrhage (IVH) is usually associated with premature infants; however, it has been estimated to occur in up to 5% of infants born at term and may be associated with different prenatal, perinatal and postnatal risk factors. The present retrospective study included toddlers aged 13-24 months, born at term (≥36 weeks), referred to the Department of Rheumatology, Physical Medicine and Rehabilitation in Zagreb, Croatia, because they had at least two risk factors for neurodevelopmental delay. A total of 63 patients without hemorrhage were control subjects, while 103 case patients were children with IVH. The ordinal logistic regression revealed that neurodevelopmental outcome in term infants was associated with IVH grade (p<0.05). Although more boys than girls suffered from severe IVH (grades III and IV), there were no statistically significant gender differences in the distribution of IVH or in neurodevelopmental outcomes (p>0.05).


Assuntos
Recém-Nascido Prematuro/crescimento & desenvolvimento , Hemorragias Intracranianas/complicações , Transtornos do Neurodesenvolvimento/diagnóstico , Pré-Escolar , Croácia , Feminino , Idade Gestacional , Humanos , Lactente , Doenças do Prematuro/fisiopatologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
8.
Nat Commun ; 10(1): 2619, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31197175

RESUMO

Sleep architecture carries vital information about brain health across the lifespan. In particular, the ability to express distinct vigilance states is a key physiological marker of neurological wellbeing in the newborn infant although systems-level mechanisms remain elusive. Here, we demonstrate that the transition from quiet to active sleep in newborn infants is marked by a substantial reorganization of large-scale cortical activity and functional brain networks. This reorganization is attenuated in preterm infants and predicts visual performance at two years. We find a striking match between these empirical effects and a computational model of large-scale brain states which uncovers fundamental biophysical mechanisms not evident from inspection of the data. Active sleep is defined by reduced energy in a uniform mode of neural activity and increased energy in two more complex anteroposterior modes. Preterm-born infants show a deficit in this sleep-related reorganization of modal energy that carries novel prognostic information.


Assuntos
Encéfalo/fisiologia , Recém-Nascido Prematuro/fisiologia , Modelos Biológicos , Transtornos do Neurodesenvolvimento/diagnóstico , Sono/fisiologia , Eletroencefalografia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Análise Espaço-Temporal
9.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31189616

RESUMO

CONTEXT: Children with orofacial clefts (OFCs) are reported to have worse neurodevelopmental outcomes than unaffected peers, although study methodologies and findings are highly variable and trends in outcomes by age remain unexplored. OBJECTIVE: To examine the strength of the evidence and explore trends in neurodevelopment by age. DATA SOURCES: A systematic review was conducted of studies published from January 1, 1980, through November 3, 2017. STUDY SELECTION: Studies were independently screened by the authors and included in the review if they met predetermined eligibility criteria: (1) children and/or youth (<25 years) with OFCs were studied, and (2) neurodevelopmental or academic outcomes were included. DATA EXTRACTION: The authors independently evaluated study quality and extracted outcome data. RESULTS: Thirty-one studies involving 10 143 patients with OFCs and 2 017 360 controls met eligibility criteria. Although the quality of the studies varied, patients with OFCs consistently performed worse than their peers on neurodevelopmental and academic measures. In infancy, differences were observed on multiple developmental outcomes (eg, cognition, motor skills, and language), and in later childhood and adolescence, differences were manifest on several indicators of academic achievement (eg, use of special education services, grades, and scores on standardized measures). LIMITATIONS: Heterogeneity in study designs, methods, and outcomes prevented statistical pooling and modeling for meta-analysis. CONCLUSIONS: Children with OFCs exhibit neurodevelopmental and academic deficits compared with their unaffected peers. Although the nature of these deficits changes with development, differences are observed from infancy through adolescence. Clinicians should monitor neurodevelopment in children with OFCs and support them appropriately.


Assuntos
Sucesso Acadêmico , Fenda Labial/complicações , Fissura Palatina/complicações , Transtornos do Neurodesenvolvimento/etiologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Fenda Labial/psicologia , Fissura Palatina/psicologia , Feminino , Humanos , Lactente , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia , Adulto Jovem
10.
Eur J Gen Pract ; 25(3): 116-127, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31246106

RESUMO

Background: Although common and often with long-lasting effects, child mental health problems (MHPs) are still under-recognized and under-treated. A better understanding of the factors associated with the identification of MHPs in primary care may improve the recognition of MHPs. Objectives: To review studies on factors associated with the identification of child MHPs in primary care. Methods: Six leading databases were systematically searched until 1 October 2018. Two independent researchers selected articles and extracted data on study characteristics and factors associated with MHP identification. Inclusion criteria were the investigation of factors associated with MHP identification by primary care professionals (PCPs) in children aged 0-18 years. Results: Of the 6215 articles identified, 26 were included. Prevalence rates of PCP-identified MHPs varied between 7 and 30%. PCPs identified 26-60% of children with an increased risk of MHPs as indicated by MHP assessment tools, but associated factors were investigated in relatively few studies. MHPs were more often identified in children with a family composition other than married parents, with worse mental health symptoms, prior MHPs, among boys in elementary school, when contact with PCPs was related to parental psychosocial concerns or routine health check-ups, when PCPs were recently trained in MHPs or when PCPs felt less burdened treating MHPs. Conclusion: MHP identification varied substantially between studies and PCPs and was related to several child, family and practice factors. Future studies should systematically investigate factors associated with MHP identification by PCPs and specifically in children with an increased risk of MHPs according to mental health assessment tools.


Assuntos
Pessoal de Saúde/organização & administração , Transtornos do Neurodesenvolvimento/diagnóstico , Atenção Primária à Saúde/métodos , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Transtornos do Neurodesenvolvimento/epidemiologia , Medição de Risco/métodos , Fatores de Risco
12.
Eur J Pediatr ; 178(7): 1053-1061, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31065842

RESUMO

This study aimed to investigate the accuracy of different grades of brain injuries on serial and term equivalent age (TEA)-cranial ultrasound imaging (cUS) as compared to TEA magnetic resonance imaging (MRI) in extremely preterm infants < 28 weeks, and determine the predictive value of imaging abnormalities on neurodevelopmental outcome at 1 and 3 years. Seventy-five infants were included in the study. Severe TEA-cUS injury had high positive predictive value-PPV (100%) for predicting severe MRI injury compared to mild to moderate TEA-cUS injury or severe injury on worst cranial ultrasound scan. Absence of moderate to severe injury on TEA cUS or worst serial cUS was a good predictor of a normal MRI (negative predictive values > 93%). Severe grade 3 injuries on TEA-US had high predictive values in predicting abnormal neurodevelopment at both 1 and 3 years of age (PPV 100%). All grades of MRI and worst serial cUS injuries poorly predicted abnormal neurodevelopment at 1 and 3 years. Absence of an injury either on a cranial ultrasound or an MRI did not predict a normal outcome. Multiple logistic regression did not show a significant correlation between imaging injury and neurodevelopmental outcomes.Conclusion: This study demonstrates that TEA cUS can reliably identify severe brain abnormalities that would be seen on MRI imaging and positively predict abnormal neurodevelopment at both 1 and 3 years. Although MRI can pick up more subtle abnormalities that may be missed on cUS, their predictive value on neurodevelopmental impairment is poor. Normal cUS and MRI scan may not exclude abnormal neurodevelopment. Routine TEA-MRI scan provides limited benefit in predicting abnormal neurodevelopment in extremely preterm infants. What is Known: • Preterm neonates are at increased risk of white matter and other brain injuries, which may be associated with adverse neurodevelopmental outcome. • MRI is the most accurate method in detecting white matter injuries. What is New: • TEA-cUS can reliably detect severe brain injuries on MRI, but not mild/moderate lesions as well as abnormal neurodevelopment at 1 and 3 years. • TEA-MRI brain injury is poor in predicting abnormal neurodevelopment at 1 and 3 years and normal cUS or MRI brain injury may not guarantee normal neurodevelopment.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Doenças do Prematuro/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Transtornos do Neurodesenvolvimento/diagnóstico , Ultrassonografia/métodos , Lesões Encefálicas/classificação , Lesões Encefálicas/complicações , Pré-Escolar , Feminino , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Valor Preditivo dos Testes , Estudos Retrospectivos
13.
Semin Pediatr Surg ; 28(2): 118-121, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31072460

RESUMO

After a diagnosis of omphalocele during pregnancy, questions regarding long-term prognosis are of primary importance for parents. It is imperative that their questions are answered with substantiated data to promote confident decisions for their children. They frequently express concerns regarding long-term survival, quality of life, need for more operations, feeding issues, motor and cognitive development, cosmesis, and the unique difficulties of giant omphaloceles. The available outcome studies that address these questions are discussed.


Assuntos
Hérnia Umbilical/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/terapia , Criança , Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Dor Crônica/terapia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/terapia , Hérnia Umbilical/diagnóstico , Hérnia Umbilical/fisiopatologia , Hérnia Umbilical/cirurgia , Herniorrafia , Humanos , Lactente , Recém-Nascido , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/etiologia , Transtornos do Neurodesenvolvimento/terapia , Prognóstico , Qualidade de Vida , Resultado do Tratamento
14.
Nord J Psychiatry ; 73(4-5): 244-247, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31074670

RESUMO

Background: Body dysmorphic disorder (BDD) is preoccupation with perceived body defects leading to distress and impairment in social functioning. Most of adolescent BDD literature has been done on patients within the outpatient setting with prior versions of DSM with dearth of information about BDD and comorbid psychiatric conditions among adolescents within the inpatient setting. Aims: This pilot study evaluated the prevalence rate, clinical characteristics in adolescent BDD compared to non-BDD adolescents in a psychiatric in patient setting in addition to their comorbid issues like anxiety, OCD, ADHD and substance abuse. Methods: Forty-five consecutively admitted adolescent patients participated with 17 meeting the DSM 5 criteria for BDD while 28 did not. Patients were asked four questions designed around the DSM-5 criteria for BDD after which they were asked to complete questionnaires like BDDQ child and adolescent version, BDDM, Multiaxial Anxiety Scale for Children, Children's Depression Inventory, Y-BOCS and Vanderbilt ADHD rating scales. Results: Seventeen participants had BDD. Mean age of BDD patients was 13.1 while non-BDD was 12.4. Male patients with BDD were seven (41%) while female BDD patients were 10 (58.8%). Anxiety, depression, OCD and substance use disorders were common comorbid diagnoses. Majority of patients in the BDD group classified their BDD as a severe problem with more BDD, patient's considering suicide because of their BDD. Discussion: BDD is present in adolescents admitted in inpatient psychiatric hospital with more female patients endorsing BDD versus their male counterparts. Patients with BDD are more likely to endorse more comorbid psychiatric issues such as anxiety, OCD, ADHD and substance abuse.


Assuntos
Transtornos Dismórficos Corporais/epidemiologia , Transtornos Dismórficos Corporais/psicologia , Hospitais Psiquiátricos , Pacientes Internados/psicologia , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/psicologia , Adolescente , Transtornos Dismórficos Corporais/diagnóstico , Criança , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Hospitalização/tendências , Humanos , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Projetos Piloto , Prevalência , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários
15.
Psychiatry Res ; 276: 115-123, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31075706

RESUMO

Pediatric obsessive-compulsive disorder (OCD) co-occurs frequently with other mental health conditions, adding to the burden of disease and complexity of treatment. Cognitive behavioral therapy (CBT) is efficacious for both OCD and two of its most common comorbid conditions, anxiety and depression. Therefore, treating OCD may yield secondary benefits for anxiety and depressive symptomatology. This study examined whether anxiety and/or depression symptoms declined over the course of OCD treatment and, if so, whether improvements were secondary to reductions in OCD severity, impairment, and/or global treatment response. The sample consisted of 137 youths who received 12 sessions of manualized CBT and were assessed by independent evaluators. Mixed models analysis indicated that youth-reported anxiety and depression symptoms decreased in a linear fashion over the course of CBT, however these changes were not linked to specific improvements in OCD severity or impairment but to global ratings of treatment response. Results indicate that for youth with OCD, CBT may offer benefit for secondary anxiety and depression symptoms distinct from changes in primary symptoms. Understanding the mechanisms underlying carryover in CBT techniques is important for furthering transdiagnostic and/or treatment-sequencing strategies to address co-occurring anxiety and depression symptoms in pediatric OCD.


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Transtornos do Neurodesenvolvimento/terapia , Transtorno Obsessivo-Compulsivo/terapia , Adolescente , Ansiedade/diagnóstico , Ansiedade/psicologia , Criança , Terapia Cognitivo-Comportamental/tendências , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/psicologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Resultado do Tratamento
16.
J Pediatr Endocrinol Metab ; 32(6): 597-606, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31112508

RESUMO

Background For several decades, transient hypothyroxinemia of prematurity (THOP) has been a topic of debate. The pathophysiology is incompletely understood and consensus on the therapeutic approach is lacking. This study aimed at gaining a better insight into the pathogenesis by studying the trends in thyroid hormone (TH) levels during the first week of life. Methods This single-center prospective observational study analyzed the plasma levels of total thyroxine (T4) and free thyroxine (fT4), total triiodothyronine (T3), thyroid-stimulating hormone (TSH) and T4-binding globulin (TBG) in cord blood and at the end of the first week of life in 120 preterm infants (gestational age [GA] <37 weeks). The change over time was calculated (delta, ∆). The impact of perinatal and subsequently postnatal variables on ∆ was studied by hierarchical multiple regression. The impact of ∆ on the neurodevelopmental outcome at the corrected ages of 9 and 24 months, measured by the Bayley Scales of Infant Development (BSID)-II, was assessed by logistic regression. Results ∆fT4 levels were negatively affected by GA and use of dopamine, whereas only GA was associated with low ∆T3 levels. Negative ∆fT4 levels were present in 75% of the extremely low-for-gestational-age infants, whereas 23.5% had a negative ∆T3 level. There was an increased risk for an abnormal mental developmental score (<85) with decreasing ∆T3 at 9 months, corrected age, but not at 24 months. Conclusions A negative evolution in circulating TH levels is principally an immaturity phenomenon, whereas dopamine can further suppress the hypothalamic-pituitary-thyroid axis. There is at least a temporary negative effect of this evolution on the infants' neurodevelopment.


Assuntos
Biomarcadores/sangue , Doenças do Prematuro/fisiopatologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Transtornos do Neurodesenvolvimento/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Hormônios Tireóideos/sangue , Bélgica/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido Prematuro/sangue , Masculino , Transtornos do Neurodesenvolvimento/sangue , Transtornos do Neurodesenvolvimento/diagnóstico , Prognóstico , Estudos Prospectivos , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/diagnóstico , Testes de Função Tireóidea
17.
Trials ; 20(1): 268, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088531

RESUMO

BACKGROUND: Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children's behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent-child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service. METHODS: This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver's wellbeing and children's general functioning will be reassessed. DISCUSSION: This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03374904 . Registered on 14 December 2017 (retrospectively registered).


Assuntos
Comportamento do Adolescente , Cuidadores/psicologia , Comportamento Infantil , Retroalimentação Psicológica , Pacientes Internados/psicologia , Transtornos do Neurodesenvolvimento/terapia , Pais/psicologia , Gravação em Vídeo , Adolescente , Fatores Etários , Criança , Emoções , Estudos de Viabilidade , Feminino , Humanos , Masculino , Mentalização , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/psicologia , Relações Pais-Filho , Poder Familiar , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Nord J Psychiatry ; 73(2): 132-140, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30964388

RESUMO

AIM: The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey. METHOD: A nation-wide, randomly selected, representative population of 5830 children (6-13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently. RESULTS: Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring. CONCLUSION: This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.


Assuntos
Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia , Adolescente , Criança , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Transtornos do Neurodesenvolvimento/psicologia , Pais/psicologia , Prevalência , Psicopatologia , Distribuição Aleatória , Estudantes/psicologia , Turquia/epidemiologia
19.
Neuropediatrics ; 50(3): 164-169, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30939599

RESUMO

BACKGROUND: Array-based comparative genomic hybridization (aCGH) is a molecular analysis method for identifying chromosomal anomalies or copy number variants (CNVs) correlating with clinical phenotypes. The aim of our study was to identify the most significant clinical variables associated with a positive outcome of aCGH analyses to develop a simple predictive clinical score. METHODS: We conducted a cross-sectional study in a tertiary center comparing the genotype and phenotype of the cases. A score was developed using multivariate logistic regression. The best score cutoff point, sensitivity, specificity, positive and negative predictive values, and area under the curve were calculated with the receiver operating characteristic curve. RESULTS: aCGH identified structural chromosomal alterations responsible for the disorder in 13.7% (95% confidence interval [CI]: 10.9-16.5) of our sample (570 patients analyzed by aCGH). Based on the most frequent phenotypic characteristics among patients with a pathogenic CNV, we have created a checklist with the following items: alteration of the cranial perimeter, stature < percentile (p) 3, weight < p3, presence of brain malformations, ophthalmological malformations, two or more dysmorphic features in the same patient, and autism spectrum disorder diagnosis. Using a score ≥1.5 as the cutoff point for the test, we obtained a sensitivity of 82.4% (95% CI: 73.1-91.8) and a specificity of 54.2% (95% CI: 49.7-58.7). CONCLUSION: All individuals with a score of 1.5 or higher should be genetically screened by aCGH. This approach can improve clinical indications for aCGH in patients with neurodevelopmental disorders, but the scoring system should be validated in an external group.


Assuntos
Lista de Checagem/métodos , Hibridização Genômica Comparativa/métodos , Testes Genéticos/métodos , Transtornos do Neurodesenvolvimento/genética , Sequenciamento Completo do Exoma/métodos , Lista de Checagem/normas , Criança , Pré-Escolar , Hibridização Genômica Comparativa/normas , Estudos Transversais , Feminino , Testes Genéticos/normas , Humanos , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Reprodutibilidade dos Testes , Sequenciamento Completo do Exoma/normas
20.
Eur J Radiol ; 113: 232-237, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927952

RESUMO

OBJECTIVE: Arachnoid cysts (AC) are congenital lesions comprising 1% of all intracranial mass lesions. The aim of this study was to characterize arachnoid cysts and their neurodevelopmental outcome and to compare it with the outcome of children without AC. METHODS: This is a retrospective cohort study of arachnoid cysts detected prenatally by fetal MRI in 29 fetuses compared to a control group of 59 fetuses without arachnoid cyst who were examined by MRI. The cohort was investigated from two different angles: anatomical and developmental. Anatomical analyzation, the cohort was divided into 2 groups by the arachnoid cyst anatomical location: group A (n = 9), which included cases with supratentorial cyst, and group B (n = 20), which included cases with infratentorial cyst. Developmental analyzation, the cohort was divided into 2 groups by the neurodevelopmental outcome: group γ (n = 5) which included cases that were affected by arachnoid cyst presence, and group δ (n = 17) which included cases that had neurodevelopmental outcome within the normal range. Data collected included prenatal history, MRI features, sonographic follow up, and neurodevelopmental outcome. RESULTS: In 22/29 cases we achieved a long-term follow up, by evaluation of children development in a range of ages from 6 months to 6 years. In group A (n = 9), 4 infants had normal outcome, 2 had abnormal outcome, 1 pregnancy was terminated, and 2 cases were not cooperative with the study. In group B (n = 20), 13 infants had normal outcome, 3 had abnormal outcome, and 4 cases were not cooperative with the study. CONCLUSIONS: From all cases with AC detected by fetal MRI, 77.3% had normal neurodevelopmental outcome and 22.7% had abnormal neurodevelopment.


Assuntos
Cistos Aracnóideos/diagnóstico , Doenças Fetais/diagnóstico , Transtornos do Neurodesenvolvimento/diagnóstico , Diagnóstico Pré-Natal/métodos , Adulto , Desenvolvimento Infantil , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Idade Materna , Gravidez , Valores de Referência , Estudos Retrospectivos
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