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1.
PLoS One ; 15(9): e0236289, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881866

RESUMO

OBJECTIVE: To validate and test a German version of the revised Parent Report of Children's Abilities questionnaire (PARCA-R). METHODS: Multicentre cross-sectional study. Parents of infants born <32 gestational weeks, completed the PARCA-R within three weeks before the follow-up assessment of their child at age two years. Infants were assessed using the Mental Development Index (MDI) of the Bayley Scales of Infant Development 2nd edition (BSID-II). Pearson correlation between the Parent Report Composite (PRC) of the PARCA-R and MDI was tested. The optimal PRC cut-off for predicting moderate-to-severe mental delay, defined as MDI<70, was identified through the receiver operating characteristic (ROC) curve. RESULTS: PARCA-R and BSID-II data were collected from 154 consecutive infants [51% girls, mean (SD) gestational age 29.0 (2.0) weeks, birth weight 1174 (345) grams] at 23.2 (1.6) months of corrected age. The PRC score [70.5 (31.1)] correlated with the MDI [92.2 (17.3); R = 0.54; p < 0.0001]. The optimal PRC cut-off for identifying mental delay was 44 with 0.81 (0.54-0.96) sensitivity (95%-CI), 0.81 (0.74-0.87) specificity, area under the ROC curve of 0.840 (0.729-0.952). CONCLUSION: The German version of the PARCA-R had good validity with the BSID-II and PCR scores < 44 proved optimal discriminatory power for the identification of mental delay at two years of corrected age.


Assuntos
Desenvolvimento Infantil , Recém-Nascido Prematuro , Transtornos do Neurodesenvolvimento/diagnóstico , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Inquéritos e Questionários , Suíça/epidemiologia
2.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32943536

RESUMO

OBJECTIVES: To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO). METHODS: ELBW infants ≤1000 g and gestational age ≤26 weeks with maximal oxygen ≥60% on either day 1 or day 3 were labeled as "early HRF" and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race. RESULTS: Among 7639 ELBW infants born ≤26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8-3.3), birth weight ≥720 g (aOR: 2.3, 95% CI: 1.7-3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1-2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6-3.6). CONCLUSIONS: Early HRF in infants ≤26 weeks' gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.


Assuntos
Broncodilatadores/uso terapêutico , Hipóxia/complicações , Lactente Extremamente Prematuro , Transtornos do Neurodesenvolvimento/epidemiologia , Óxido Nítrico Sintase Tipo II/uso terapêutico , Insuficiência Respiratória/mortalidade , Administração por Inalação , Afro-Americanos , Índice de Apgar , Peso ao Nascer , Broncodilatadores/administração & dosagem , Feminino , Ruptura Prematura de Membranas Fetais , Mortalidade Hospitalar , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Incidência , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/tratamento farmacológico , Transtornos do Neurodesenvolvimento/etnologia , Óxido Nítrico Sintase Tipo II/administração & dosagem , Alta do Paciente , Gravidez , Pontuação de Propensão , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/etnologia , Insuficiência Respiratória/etiologia , Fatores de Risco , Fatores Sexuais , Esteroides/uso terapêutico
3.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32788267

RESUMO

CONTEXT: The International Liaison Committee on Resuscitation Neonatal Life Support Task Force reviewed evidence for the duration of cardiopulmonary resuscitation (CPR) for newborns immediately after birth. OBJECTIVE: To summarize evidence for ongoing CPR on the outcomes of survival, neurodevelopment, and the composite of survival without moderate or severe neurodevelopmental impairment (NDI). DATA SOURCES: Medline, Embase, Evidence-Based Medicine Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scientific Electronic Library Online were searched between inception and February 29, 2020. STUDY SELECTION: Two independent reviewers selected studies of newborns with at least 10 minutes of asystole, bradycardia, or pulseless electrical activity for which CPR is indicated. DATA EXTRACTION: Two independent reviewers extracted data and appraised the risk of bias. RESULTS: In 16 eligible studies, researchers reported outcomes of 579 newborns born between 1982 and 2017. Within individual studies, 2% to 100% of infants survived to last follow-up (hospital discharge through 12 years). Summarized across studies, 237 of 579 (40.9%) newborns survived to last follow-up. In 13 studies, researchers reported neurodevelopmental outcomes of 277 newborns. Of these, 30 of 277 (10.8%) survived without moderate or severe impairment, and 240 of 277 (87%) met the composite outcome of death or NDI (191 died and 49 survived with moderate or severe impairment). LIMITATIONS: There was very low certainty of evidence because of risk of bias and inconsistency. CONCLUSIONS: Infants with ongoing CPR at 10 minutes after birth are at high risk for mortality and neurodisability, but survival without moderate or severe NDI is possible. One specified duration of CPR is unlikely to uniformly predict survival or survival without neuroimpairment.


Assuntos
Bradicardia/terapia , Reanimação Cardiopulmonar/estatística & dados numéricos , Desenvolvimento Infantil , Parada Cardíaca/terapia , Transtornos do Neurodesenvolvimento/epidemiologia , Comitês Consultivos , Viés , Frequência Cardíaca , Humanos , Recém-Nascido , Transtornos do Neurodesenvolvimento/mortalidade , Sobreviventes/estatística & dados numéricos , Fatores de Tempo
4.
PLoS One ; 15(8): e0237251, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764798

RESUMO

BACKGROUND: Children's exposure to family and domestic violence (FDV) is a global public health concern and is considered one of the most common and severe stressors children can experience. While it is acknowledged that children who are exposed to FDV have poorer general health, there is a lack of data on the outcomes of children exposed to FDV. The use of longitudinal data has been suggested as a way to gain an understanding of the impact on children's long-term outcomes. METHODS: Our cohort study used deidentified individual-level linked administrative data of children born 1987-2010, in Western Australia, who were exposed to FDV in the prenatal period (12 months prior to birth) to five years of age (early years). RESULTS: Children exposed to FDV are more likely to be hospitalised than non-exposed children. Children exposed to FDV in both the prenatal and early childhood period had a threefold increased odds of mental health hospitalisation. We found a significant increase in odds of pregnancy-related hospitalisation in FDV exposed children. When stratified by Aboriginal status, Aboriginal children had a higher proportion of hospitalisations than non-Aboriginal children. CONCLUSION: Exposed children have an increased likelihood for hospitalisation than non-exposed children. Within the exposed cohort differences were apparent between Aboriginal and non-Aboriginal children. Aboriginal children had greater odds for hospitalisation in most of the diagnostic groups compared to their non-Aboriginal counterparts. Our findings represent an important advance in the literature with respect to the burden of disease of children exposed to FDV.


Assuntos
Saúde da Criança , Violência Doméstica , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Saúde Mental , Transtornos do Neurodesenvolvimento/epidemiologia , Grupo com Ancestrais Oceânicos , Gravidez , Austrália Ocidental/epidemiologia
5.
Clin Neuropsychol ; 34(7-8): 1380-1394, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32847476

RESUMO

Objective: To describe the challenges related to COVID-19 affecting pediatric neuropsychologists practicing in inpatient brain injury rehabilitation settings, and offer solutions focused on face-to-face care and telehealth.Methods: A group of pediatric neuropsychologists from 12 pediatric rehabilitation units in North America and 2 in South America have met regularly since COVID-19 stay-at-home orders were initiated in many parts of the world. This group discussed challenges to clinical care and collaboratively problem-solvedsolutions.Results: Three primary challenges to usual care were identified, these include difficulty providing 1) neurobehavioral and cognitive assessments; 2) psychoeducation for caregivers and rapport building; and 3) return to academic instruction and home. Solutions during the pandemic for the first two areas focus on the varying service provision models that include 1) face-to-face care with personal protective equipment (PPE) and social distancing and 2) provision of care via remote methods, with a focus on telehealth. During the pandemic,neuropsychologists generally combine components of both the face-to-face and remote care models. Solutions to the final challenge focus on issues specific to returning to academic instruction and home after an inpatient stay.Conclusions: By considering components of in-person and telehealth models of patient care during the pandemic, neuropsychologists successfully serve patients within the rehabilitation setting, as well as the patient's family who may be limited in their ability to be physically present due to childcare, illness, work-related demands, or hospital restrictions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Transtornos do Neurodesenvolvimento/reabilitação , Neuropsicologia/tendências , Pandemias , Pneumonia Viral/terapia , Telemedicina/tendências , Criança , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/psicologia , Testes Neuropsicológicos , Neuropsicologia/métodos , Pneumonia Viral/epidemiologia , Telemedicina/métodos
6.
Clin Neuropsychol ; 34(7-8): 1367-1379, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32787508

RESUMO

Objective: As the coronavirus pandemic extends across the globe, the impacts have been felt across domains of industry. Neuropsychology services are no exception. Methods for neuropsychological assessments, which typically require an in-person visit, must be modified in order to adhere to social distancing and isolation standards enacted in an effort to slow the pandemic. How can providers continue to meet the needs of patients referred for neuropsychology evaluations, while respecting federal and state guidelines for safety and ethical mandates? We offer a novel, tiered model of care, successfully implemented in response to mandated social distancing, in a large, pediatric neuropsychology program.Method: We describe the considerations and challenges to be addressed in transitioning a large neuropsychology department to a new model of care, including triaging referrals, developing -or rediscovering - types of services to meet the needs of a virtual patient population, and helping patients, parents, and providers to adjust to these new models.Conclusions: Lessons learned as a function of rapid changes in care models have implications for the field of neuropsychology as a whole as well as for future flexibility in meeting the needs of pediatric patients and their families.


Assuntos
Infecções por Coronavirus/terapia , Transtornos do Neurodesenvolvimento/terapia , Testes Neuropsicológicos , Neuropsicologia/tendências , Telemedicina/tendências , Criança , Infecções por Coronavirus/epidemiologia , Humanos , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/psicologia , Neuropsicologia/métodos , Pais/psicologia , Telemedicina/métodos
7.
BMJ Open ; 10(7): e038004, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699166

RESUMO

INTRODUCTION: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, China starting in December 2019. Yet the clinical features and long-term outcomes of neonates with SARS-CoV-2 exposure are lacking. The purpose of this study is to describe the clinical course and prognosis of the neonates exposed to SARS-CoV-2. METHODS AND ANALYSIS: This is a multicentre observational study conducted at the designated children and maternal and child hospitals in the mainland of China. Neonates exposed to SARS-CoV-2 infection will be recruited. The data to be collected via case report forms include demographic details, clinical features, laboratory and imaging results, as well as outcomes. Primary outcomes are the mortality of neonates with COVID-19 and SARS-CoV-2 infection of neonates born to mothers with COVID-19. Secondary outcomes are the birth weight, premature delivery and neurological development of neonates exposed to SARS-CoV-2. The neurological development is assessed by the Chinese standardised Denver Developmental Screening Test at the corrected age of 6 months. ETHICS AND DISSEMINATION: This study has been approved by the Children's Hospital of Fudan University ethics committee (No. (2020)31). The study findings will be disseminated in peer-reviewed journals and presented at national and international conferences in order to improve the understanding of the clinical course among neonates exposed to SARS-CoV-2 and to provide evidence-based treatment and prevention strategies for this group. TRIAL REGISTRATION NUMBER: NCT04279899.


Assuntos
Desenvolvimento Infantil , Infecções por Coronavirus/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Feminino , Maternidades , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Gravidez , Estudos Prospectivos , Índice de Gravidade de Doença
8.
Medicine (Baltimore) ; 99(28): e21194, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664163

RESUMO

The purpose of this study was to investigate the prevalence of neurodevelopmental delay among deformational plagiocephaly (DP) children, and to confirm relationship between neurodevelopmental delay and severity of DP.This study is retrospective study. Five hundred thirteen children who visited for abnormal head shape through outpatient department were recruited. To identify the children with neurodevelopmental delay among the 513 children with DP, Denver Development Screening Test (DDST) was performed in 38 children who suspected of neurodevelopmental delay. Cranial vault asymmetry (CVA) was measured by using caliper, and cranial vault asymmetry index (CVAI) was calculated. Thirty eight children with DP who conducted DDST were divided into 2 groups according to the degree of CVA; group 1 included 21 children with CVA under 10 mm, and group 2 included 17 children with CVA over 10 mm.There was a significant difference in number of neurodevelopmental delay between group 1 (n = 7) and group 2 (n = 14) (P < .05). Mean grade of DP, CVA, and CVAI (1.76 ±â€Š0.44, 5.90 ±â€Š2.21 mm, 4.20 ±â€Š1.51%) in group 1 was smaller than that in group 2 (3.41 ±â€Š0.8, 12.71 ±â€Š3.22 mm, 8.83 ±â€Š2.18%), respectively (P < .05).Our results found that the frequency of developmental delay was significantly increased in children with CVA more than 10 mm. Doctors who take care of children with DP had better keep developmental delays in mild.


Assuntos
Transtornos do Neurodesenvolvimento/epidemiologia , Plagiocefalia não Sinostótica/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Plagiocefalia não Sinostótica/patologia , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
Public Health Rep ; 135(5): 599-610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645279

RESUMO

OBJECTIVE: We estimated the caseload of providers, practices, and clinics for psychosocial services (including psychotherapy) to Medicaid-insured children to improve the understanding of the current supply of such services and to inform opportunities to increase their accessibility. METHODS: We used 2012-2013 Medicaid claims data and data from the 2013 National Plan and Provider Enumeration System to identify and locate therapists, psychiatrists, and mental health centers along with primary, rehabilitative, and developmental care providers in the United States who provided psychosocial services to Medicaid-insured children. We estimated the per-provider, per-location, and state-level caseloads of providers offering these services to Medicaid-insured children in 34 states with sufficiently complete data to perform this analysis, by using the most recent year of Medicaid claims data available for each state. We measured caseload by calculating the number of psychosocial visits delivered by each provider in the selected year. We compared caseloads across states, urbanicity, provider specialty (eg, psychiatry, psychology, primary care), and practice setting (eg, mental health center, single practitioner). RESULTS: We identified 63 314 providers, practices, or centers in the Medicaid claims data that provided psychosocial services to Medicaid-insured children in either 2012 or 2013. The median provider-level per-year caseload was <25 children and <250 visits across all provider types. Providers with a mental health center-related taxonomy accounted for >40% of visits for >30% of patients. Fewer than 10% of providers and locations accounted for >50% of patients and visits. CONCLUSIONS: Psychosocial services are concentrated in a few locations, thereby reducing geographic accessibility of providers. Providers should be incentivized to offer care in more locations and to accept more Medicaid-insured patients.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Transtornos do Neurodesenvolvimento/terapia , Atenção Primária à Saúde/estatística & dados numéricos , Reabilitação Psiquiátrica/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Estados Unidos/epidemiologia
10.
Chemosphere ; 255: 126920, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32387734

RESUMO

The pathological traits or diseases susceptibility caused by maternal exposure to environmental adverse insults (infection, malnutrition, environmental toxicants) could be transmitted across generations. It remains uncertain, however, whether the neurodevelopmental disturbances of offspring induced by maternal exposure to PM2.5 during early life can be inherited by subsequent generations without further exposure. In the current study, using transgenerational animal models, we found that F1 female showed poorer performance in Morris Water Maze (MWM), and the deficits in spatial learning and memory similarly presented in F2-F3 female. The transgenerationally-transmitted neurobehavioral disorders were mediated both via maternal and paternal lineage. Since the epigenetic modifications have been reported to be involved in the disturbed neurodevelopment induced by maternal exposure to detrimental environmental factors during early life, we further explored the possible epigenetic mechanism of the transgenerational effects. Intriguingly, the results displayed the significant increase in expression of Dnmt3a in F1 female offspring. And the hypermethylation of Bdnf promoter Ⅳ and downregulated expression of Bdnf in hippocampus were stably transmitted across the generations until the third generation. There was another interesting finding that the transgenerational effects were sex-specific and only emerged in female offspring. Together, our study indicated for the first time that maternal exposure to PM2.5 during early life could detrimentally affect neurobehaviors in multiple generations, and the declined expression of Bdnf induced by hypermethylation of Bdnf promoter Ⅳ mediated by Dnmts might be the potential molecular mechanism.


Assuntos
Exposição Materna/estatística & dados numéricos , Material Particulado/toxicidade , Animais , Metilação de DNA , Epigênese Genética , Feminino , Humanos , Masculino , Exposição Materna/efeitos adversos , Transtornos do Neurodesenvolvimento/epidemiologia , Fenótipo , Gravidez
11.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32393605

RESUMO

BACKGROUND AND OBJECTIVES: Emergency department (ED) visits for children seeking mental health care have increased. Few studies have examined national patterns and characteristics of EDs that these children present to. In data from the National Pediatric Readiness Project, it is reported that less than half of EDs are prepared to treat children. Our objective is to describe the trends in pediatric mental health visits to US EDs, with a focus on low-volume, nonmetropolitan EDs, which have been shown to be less prepared to provide pediatric emergency care. METHODS: Using 2007 to 2016 Nationwide Emergency Department Sample databases, we assessed the number of ED visits made by children (5-17 years) with a mental health disorder using descriptive statistics. ED characteristics included pediatric volume, children's ED classification, and location. RESULTS: Pediatric ED visits have been stable; however, visits for deliberate self-harm increased 329%, and visits for all mental health disorders rose 60%. Visits for children with a substance use disorder rose 159%, whereas alcohol-related disorders fell 39%. These increased visits occurred among EDs of all pediatric volumes, regardless of children's ED classification. Visits to low-pediatric-volume and nonmetropolitan areas rose 53% and 41%, respectively. CONCLUSIONS: Although the total number of pediatric ED visits has remained stable, visits among children with mental health disorders have risen, particularly among youth presenting for deliberate self-harm and substance abuse. The majority of these visits occur at nonchildren's EDs in both metropolitan and nonurban settings, which have been shown to be less prepared to provide higher-level pediatric emergency care.


Assuntos
Serviços Médicos de Emergência/tendências , Serviço Hospitalar de Emergência/tendências , Saúde Mental/tendências , Transtornos do Neurodesenvolvimento/terapia , Medicina de Emergência Pediátrica/tendências , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais/tendências , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia , Medicina de Emergência Pediátrica/métodos , Estados Unidos/epidemiologia
12.
J Pediatr ; 221: 39-46.e5, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446491

RESUMO

OBJECTIVE: To evaluate the hypothesis that early-onset sepsis increases risk of death or neurodevelopmental impairment (NDI) among preterm infants; and that among infants without early-onset sepsis, prolonged early antibiotics alters risk of death/NDI. STUDY DESIGN: Retrospective cohort study of infants born at the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers (2006-2014) at 22-26 weeks of gestation and birth weight 401-1000 g. Early-onset sepsis defined as growth of a pathogen from blood or cerebrospinal fluid culture ≤72 hours after birth. Prolonged early antibiotics was defined as antibiotics initiated ≤72 hours and continued ≥5 days without culture-confirmed infection, necrotizing enterocolitis, or spontaneous perforation. Primary outcome was death before follow-up or NDI assessed at 18-26 months corrected age. Poisson regression was used to estimate adjusted relative risk (aRR) and CI for early-onset sepsis outcomes. A propensity score for receiving prolonged antibiotics was derived from early clinical factors and used to match infants (1:1) with and without prolonged antibiotic exposure. Log binomial models were used to estimate aRR for outcomes in matched infants. RESULTS: Among 6565 infants, those with early-onset sepsis had higher aRR (95% CI) for death/NDI compared with infants managed with prolonged antibiotics (1.18 [1.06-1.32]) and to infants without prolonged antibiotics (1.23 [1.10-1.37]). Propensity score matching was achieved for 4362 infants. No significant difference in death/NDI (1.04 [0.98-1.11]) was observed with or without prolonged antibiotics among the matched cohort. CONCLUSIONS: Early-onset sepsis was associated with increased risk of death/NDI among extremely preterm infants. Among matched infants without culture-confirmed infection, prolonged early antibiotic administration was not associated with death/NDI.


Assuntos
Antibacterianos/administração & dosagem , Sepse/tratamento farmacológico , Sepse/mortalidade , Idade de Início , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente Extremamente Prematuro , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/etiologia , Estudos Retrospectivos , Medição de Risco , Sepse/complicações , Taxa de Sobrevida , Fatores de Tempo
13.
J Clin Psychiatry ; 81(2)2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32237297

RESUMO

Many observational studies have found an association between antidepressant drug prescription during pregnancy and neurodevelopmental disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability. The results of such studies cannot be considered conclusive because of the possible presence of inadequately measured, unmeasured, and unknown confounds. In this context, maternal anemia before or at but not after 30 weeks of gestation was recently associated with an increased risk of all 3 of these neurodevelopmental disorders. Additionally, meta-analysis has shown that maternal anemia during pregnancy is associated with other adverse gestational outcomes, as well. Given that anemia is common during pregnancy, and that iron deficiency during pregnancy can compromise neurodevelopment in the offspring, it is clear that maternal anemia during pregnancy should be included as a confound that is adjusted for in analyses in studies of psychotropic drugs in pregnancy. However, many studies that significantly associated gestational exposure to antidepressants with adverse pregnancy outcomes did not adjust for maternal anemia during pregnancy. This issue is not merely academic because studies with such "significant" findings discourage depressed pregnant women from accepting antidepressants; therefore, women and their unborn children may risk experiencing the known harms associated with untreated depression during pregnancy. Additionally, such "significant" findings may provoke unjustified guilt in women who do use antidepressants during pregnancy, especially if the pregnancy is associated with an adverse outcome. Whereas this is not an endorsement of the unquestioning use of antidepressants during pregnancy, it does imply that those who argue against medication use during pregnancy should re-examine the science on which their views are based.


Assuntos
Anemia/complicações , Antidepressivos/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Transtornos do Neurodesenvolvimento/etiologia , Complicações Hematológicas na Gravidez/sangue , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adolescente , Adulto , Anemia/epidemiologia , Criança , Transtorno Depressivo/epidemiologia , Feminino , Idade Gestacional , Humanos , Masculino , Transtornos do Neurodesenvolvimento/induzido quimicamente , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Complicações Hematológicas na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto Jovem
14.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32276969

RESUMO

OBJECTIVES: Children born very preterm (VPT) are at an increased risk of developing mental health (MH) disorders. Our aim for this study was to assess rates of MH disorders in children born VPT and term at 13 years of age and stability of MH disorders between ages 7 and 13 years by using a diagnostic measure. METHODS: Participants were from the Victorian Infant Brain Study longitudinal cohort and included 125 children born VPT (<30 weeks' gestational age and/or <1250 g) and 49 children born term (≥37 weeks' gestational age) and their families. Participants were followed-up at both 7 and 13 years, and the Development and Well-Being Assessment was administered to assess for MH disorders. RESULTS: Compared with term peers, 13-year-olds born VPT were more likely to meet criteria for any MH disorder (odds ratio 5.9; 95% confidence interval 1.71-20.03). Anxiety was the most common disorder in both groups (VPT = 14%; term = 4%), whereas attention-deficit/hyperactivity disorder carried the greatest differential elevated risk (odds ratio 5.6; 95% confidence interval 0.71-43.80). Overall rates of MH disorders remained stable between 7 and 13 years, although at an individual level, many participants shifted in or out of diagnostic categories over time. CONCLUSIONS: Children born VPT show higher rates of MH disorders than their term peers, with changing trajectories over time. Findings highlight the importance of early identification and ongoing assessment to support those with MH disorders in this population.


Assuntos
Lactente Extremamente Prematuro/psicologia , Doenças do Prematuro/psicologia , Saúde Mental/tendências , Transtornos do Neurodesenvolvimento/psicologia , Adolescente , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/epidemiologia , Estudos Longitudinais , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia
15.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32341177

RESUMO

OBJECTIVES: To determine if in utero selective serotonin reuptake inhibitor (SSRI) or selective serotonin norepinephrine inhibitor (SNRI) exposure is associated with developmental vulnerability in kindergarten among children whose mothers were diagnosed with prenatal mood or anxiety disorder. METHODS: Linkable administrative data were used to create a population-based cohort of 266 479 mother-child dyads of children born in Manitoba, Canada, between 1996 and 2014, with follow-up through 2015. The sample was restricted to mothers who had a mood or anxiety disorder diagnosis between 90 days before conception (N = 13 818). Exposed women had ≥2 SSRI or SNRI dispensations during pregnancy (n = 2055); unexposed mothers did not have a dispensation of an SSRI or SNRI during pregnancy (n = 10 017). The Early Development Instrument (EDI) was used to assess developmental health in kindergarten children. The EDI is a 104-component kindergarten teacher-administered questionnaire, encompassing 5 developmental domains. RESULTS: Of the 3048 children included in the study who met inclusion criteria and had an EDI, 21.43% of children in the exposed group were assessed as vulnerable on 2 or more domains versus 16.16% of children in the unexposed group (adjusted odds ratio = 1.43; 95% confidence interval 1.08-1.90). Children in the exposed group also had a significant risk of being vulnerable in language and/or cognition (adjusted odds ratio = 1.40; 95% confidence interval 1.03-1.90). CONCLUSIONS: Exposure to SSRIs or SNRIs during pregnancy was associated with an increased risk of developmental vulnerability and an increased risk of deficits in language and/or cognition. Replication of results is necessary before clinical implications can be reached.


Assuntos
Antidepressivos/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Transtornos do Neurodesenvolvimento/induzido quimicamente , Complicações na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Adulto , Pré-Escolar , Estudos de Coortes , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Manitoba/epidemiologia , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Inibidores de Captação de Serotonina/efeitos adversos , Adulto Jovem
16.
Brain ; 143(4): 1099-1105, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32168371

RESUMO

A large fraction of rare and severe neurodevelopmental disorders are caused by sporadic de novo variants. Epidemiological disease estimates are not available for the vast majority of these de novo monogenic neurodevelopmental disorders because of phenotypic heterogeneity and the absence of large-scale genomic screens. Yet, knowledge of disease incidence is important for clinicians and researchers to guide health policy planning. Here, we adjusted a statistical method based on genetic data to predict, for the first time, the incidences of 101 known de novo variant-associated neurodevelopmental disorders as well as 3106 putative monogenic disorders. Two corroboration analyses supported the validity of the calculated estimates. First, greater predicted gene-disorder incidences positively correlated with larger numbers of pathogenic variants collected from patient variant databases (Kendall's τ = 0.093, P-value = 6.9 × 10-6). Second, for six of seven (86%) de novo variant associated monogenic disorders for which epidemiological estimates were available (SCN1A, SLC2A1, SALL1, TBX5, KCNQ2, and CDKL5), the predicted incidence estimates matched the reported estimates. We conclude that in the absence of epidemiological data, our catalogue of 3207 incidence estimates for disorders caused by de novo variants can guide patient advocacy groups, clinicians, researchers, and policymakers in strategic decision-making.


Assuntos
Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/genética , Doenças Raras/epidemiologia , Doenças Raras/genética , Variação Genética , Humanos , Incidência
17.
BJOG ; 127(9): 1129-1137, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32124520

RESUMO

OBJECTIVE: To compare the long-term effects of tocolysis with nifedipine or atosiban on child outcome at age 2.5-5.5 years. DESIGN: The APOSTEL III trial was a multicentre randomised controlled trial that compared tocolysis with nifedipine or atosiban in 503 women with threatened preterm birth. Neonatal outcomes did not differ between both treatment arms, except for a higher incidence of intubation in the atosiban group. METHODS: Parents were asked to complete four questionnaires regarding neurodevelopment, executive function, behaviour problems and general health. MAIN OUTCOME MEASURES: The main long-term outcome measure was a composite of abnormal development at the age of 2.5-5.5 years. RESULTS: Of the 426 women eligible for follow-up, 196 (46%) parents returned the questionnaires for 115 children in the nifedipine group and 110 children in the atosiban group. Abnormal development occurred in 32 children (30%) in the nifedipine group and in 38 children (38%) in the atosiban group (OR 0.74, 95% CI 0.41-1.34). The separate outcomes for neurodevelopment, executive function, behaviour, and general health showed no significant differences between the groups. Sensitivity analysis for all children of the APOSTEL III trial, including a comparison of deceased children, resulted in a higher rate of healthy survival in the nifedipine group (64 versus 54%), but there was no significant difference in the overall mortality rate (5.4 versus 2.7%). There were no significant subgroup effects. CONCLUSION: Outcomes on broad child neurodevelopment, executive function, behaviour and general health were comparable in both groups. Neither nifedipine nor atosiban can be considered as the preferred treatment for women with threatened preterm birth. TWEETABLE ABSTRACT: Nifedipine- and atosiban-exposed children had comparable long-term outcomes, including neurodevelopment, executive function and behaviour.


Assuntos
Nifedipino/uso terapêutico , Tocolíticos/uso terapêutico , Vasotocina/análogos & derivados , Transtornos do Comportamento Infantil/epidemiologia , Pré-Escolar , Função Executiva , Feminino , Seguimentos , Nível de Saúde , Humanos , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Nascimento Prematuro/prevenção & controle , Inquéritos e Questionários , Tocólise , Vasotocina/uso terapêutico
18.
Nord J Psychiatry ; 74(6): 453-460, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32186228

RESUMO

Purpose: The aim of the present study was to investigate the prevalence of specific learning disorder (SLD), comorbid disorders, and risk factors in primary school children for the first time in two-stage design in Turkey.Materials and methods: Participants were 1041 pupils in 28 primary schools and aged from 7 to 11. The Mathematics, Reading, Writing Assessment Scale (MOYA) teacher and parent forms were used in the screening stage and parents and teachers of each child completed MOYA. Ninety-five children were screen positive and eighty-three of these children participated in the interview. SLD diagnoses were based on DSM V criteria. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was used for the comorbid psychiatric disorders.Results and conclusions: The prevalence rate of the SLD was 6.6%, impairment in reading was 4%, in mathematics was 3.6%, and in written expression was 1.8%. About 62.75% of children with SLD had one or more comorbid diagnoses. ADHD was the most common comorbid mental disorder in SLD (54.9%). SLD prevalence was higher among males. The prevalence of SLD in primary school children in Turkey is consistent with previous studies.


Assuntos
Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/psicologia , Instituições Acadêmicas/tendências , Transtorno de Aprendizagem Específico/epidemiologia , Transtorno de Aprendizagem Específico/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/psicologia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Prevalência , Transtorno de Aprendizagem Específico/diagnóstico , Turquia/epidemiologia
19.
Soc Psychiatry Psychiatr Epidemiol ; 55(6): 673-683, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32055892

RESUMO

PURPOSE: Urbanization is linked to increased health risks, including mental health. However, the large majority of this research has been conducted in high-income countries, and little is known about effects in low-and-middle-income countries (LMIC) where urbanization is occurring most frequently and most rapidly. Within global mental health, children and adolescents are a critical but understudied population. The present study assessed relations between urbanization factors, and child mental health in Vietnam, a Southeast Asian LMIC. METHODS: Most studies investigating urbanization and mental health have used geographically based dichotomous urban vs. rural variables. Because of significant limitations with this approach, the present study assessed parent-reported urbanization factors (e.g., pollution, crime). In Sub-study #1 (cross-sectional), 1314 parents from 10 Vietnam provinces completed the Urbanization Factors Questionnaire, Child Behavior Checklist (mental health), and Brief Impairment Scale (life functioning). In Sub-study #2 (longitudinal), 256 parents from one highly urban and one highly rural province completed the same measures, at three timepoints across 12 months. RESULTS: Cross-sectional canonical correlations identified relatively small (e.g., R2 = 0.08) but significant relations between urbanization factors, and child functioning. Parallel analyses using a geographically defined urban vs. rural variable did not produce significant results. The large majority of longitudinal relations between the different urbanization factors and child functioning were non-significant. CONCLUSIONS: This study, among the first to assess urbanization as a multi-dimensional continuous construct in relation to child psychopathology, highlights the value of the use of an urbanization factors approach. A new "urbanization factors differentials" theory is proposed to suggest how effects of urbanization factors might result in global health disparities.


Assuntos
Saúde Global , Disparidades nos Níveis de Saúde , Transtornos do Neurodesenvolvimento/epidemiologia , Urbanização , Adolescente , Criança , Saúde da Criança , Estudos Transversais , Família , Feminino , Humanos , Masculino , Saúde Mental , Pais , Pobreza/psicologia , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Vietnã/epidemiologia
20.
Behav Ther ; 51(1): 27-41, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32005338

RESUMO

Sleep problems are common in school-age children and linked to numerous negative outcomes. Sleep disturbances are particularly common in children with mental health disorders, such as attention-deficit/hyperactivity disorder, depression, and anxiety. Despite frequent use of nonpharmacological pediatric sleep interventions to treat common sleep problems, there is a paucity of research on whether these interventions are effective. Further, it is unclear whether by targeting sleep, these interventions lead to broader improvements in the domains of functioning that are commonly affected by poor sleep. The present review includes 20 studies that evaluated nonpharmacological sleep treatments for school-aged youth, including 5 studies specifically focused on youth with externalizing or internalizing problems. Multimodal approaches consisting of psychoeducation and sleep hygiene in combination with other components were effective at treating insomnia and general sleep problems in typically developing samples. The addition of behavioral parent training to sleep interventions was effective for youth with externalizing problems, whereas incorporating cognitive strategies into sleep interventions for youth with internalizing problems was found to be ineffective. A variety of secondary outcomes were examined, with the strongest support emerging for improvement in anxiety and behavioral problems. Implications for clinical practice and future research directions are discussed.


Assuntos
Saúde Mental , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/terapia , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/terapia , Sono/fisiologia , Adolescente , Criança , Comorbidade , Feminino , Humanos , Masculino , Transtornos do Neurodesenvolvimento/psicologia , Transtornos do Sono-Vigília/psicologia , Resultado do Tratamento
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