bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of iodine supplementation during pregnancy on child growth and development at school age
Authors: O'Donnell Karen J , Abdul Rakeman Murdon , Zhi‐Hong Dou , Xue‐Yi Cao , Yong Mei Zeng , DeLong Nancy , Brenner Gerald , Tai Ma , Dong Wang , Robert DeLong G
Published: July 2010

Growth and development of 207 children (49% males; mean age 5.4 years [SD 0.2], range 4 to 7.3 years whose mothers received iodine during pregnancy, and children who received iodine first in their 2nd year, were examined in 1996; 192 children(49% males; mean age 6.5 years[SD 0.2], range 5.8 to 6.9 years) whose mothers received iodine while pregnant were seen in 1998. Children were from the southern part of China's Xinjiang Province which has the lowest levels of iodine in water and soil ever recorded. Head circumference but not height was improved for those who received iodine during pregnancy (compared with those receiving iodine at age 2) and for those supplemented before the end of the 2nd trimester (relative to those supplemented during the 3rd trimester). Iodine before the 3rd trimester predicted higher psychomotor test scores for children relative to those provided iodine later in pregnancy or at 2 years. Results from the test for cognitive development resulted in trend only differences between those children supplemented during pregnancy versus later. The results address the question of when maternal iodine supplements should begin in public health programs world wide. Findings may be relevant to the treatment of maternal and newborn thyroid deficiency in industrialized countries, particularly for those infants delivered before the end of the second trimester.
Effect of auditory, tactile, visual, and vestibular intervention on length of stay, alertness, and feeding progression in preterm infants
Authors: White‐Traut Rosemary C , Nelson Michael N , Silvestri Jean M , Vasan Ushanalini , Littau Susan , Meleedy‐Rey Patricia , Gouguang Gu , Patel Minu
Published: July 2010

This study determined whether an auditory, tactile, visual, and vestibular intervention (ATVV) reduced the length of hospitalization of 37 preterm infants by increasing the proportion of alert behavioral states, thereby improving their feeding progression. Participants comprised 12 infants born between 23 and 26 weeks’gestation with normal head ultrasounds and 25 CNS‐injured infants born between 23 and 31 weeks’gestation. Infants were randomly assigned to the control group (11 males, five females) or study group (seven males, 14 females) at 32 weeks’postconceptional age. ATVV intervention was administered to the study group for 15 minutes, twice daily, 5 days per week, from 33 weeks of age until discharge. The study group demonstrated increased alertness during the first 5 minutes of intervention, which was significantly correlated to length of stay (p<0.05). The proportion of nippled (teat) intake increased significantly faster for the study group (p=0.0001). Infants in the study group were discharged at a mean of 36.54 weeks, 1.6 weeks earlier than control infants (p<0.05). ATVV intervention facilitated increased alertness, faster transition to complete nipple feeding, and decreased length of hospitalization.
Pathological long‐bone fractures in residents with cerebral palsy in a long‐term care facility in South Africa
Authors: Bischof F , Basu D , Pettifor J M
Published: July 2010

A high incidence of long‐bone fractures has been observed in children and young adults with quadriplegic cerebral palsy in residential care. This study aimed to determine factors that contribute to these fractures and to institute preventive treatment. Twenty individuals (12 males, eight females) of a cohort of 88 residents with spastic quadriplegia in residential care in Gauteng, South Africa who had sustained fractures were compared with a random sample of age‐matched control participants (10 males, 10 females) from the same facility. Participants ranged in age from 6 to 29 years (median 17.5 years). The majority of fractures were in the upper extremities. There was radiological and biochemical evidence of rickets and osteomalacia in both groups. However, the severity of the disease was more pronounced in the group with fractures. There was a significant relation (p=0.002) between the number of fractures and the use of anticonvulsant therapy (ACT). Three months of vitamin D administration (calciferol 5000iu/day) resulted in a marked clinical improvement. There were no fractures during this period in either group. In addition, the mean serum calcium (Ca) and phosphate (Pi)levels increased (Ca from 2.17 to 2.35 mmol/L and Pi from 1.13 to 1.66 mmol/L) and mean total alkaline phosphatase level decreased (from 1123 to 423U/L). We concluded that vitamin D deficiency was the major factor contributing to the occurrence of fractures in this population. Unless sunlight exposure can be guaranteed, vitamin D supplementation should be considered for children and adults in residential care, especially if they are on ACT, even in areas with year‐round sunshine.
Benign intracranial hypertension associated with arteriovenous malformation
Authors: Vorstman E B A , Niemann D B , Molyneux A J , Pike M G
Published: July 2010

This is a report of a 9‐year‐old female with a clinical presentation of benign intracranial hypertension (BIH) who was found to have an unruptured pial arteriovenous malformation (AVM) with a significant fistula. The AVM was completely embolized using a recently developed liquid embolic system, Onyx, after which gradual clinical improvement followed. A few cases of BIH associated with AVM have been described in adults and adolescents. Possible causal relation is discussed.
Neuropsychological effects of hyperbaric oxygen therapy in cerebral palsy
Authors: Hardy Paule , Collet Jean‐Paul , Goldberg Joanne , Vanasse Michel , Lambert Jean , Marois Pierre , Amar Maxime , Montgomery David L , Lecomte Jacqueline M , Johnston Karen M , Lassonde Maryse
Published: July 2010

We conducted a double‐blind placebo study to investigate the claim that hyperbaric oxygen treatment (HBO2) improves the cognitive status of children with cerebral palsy (CP). Of 111 children diagnosed with CP (aged 4 to 12 years), only 75 were suitable for neuropsychological testing, assessing attention, working memory, processing speed, and psychosocial functioning. The children received 40 sessions of HBO2 or sham treatment over a 2‐month period. Children in the active treatment group were exposed for 1 hour to 100% oxygen at 1.75 atmospheres absolute (ATA), whereas those in the sham group received only air at 1.3 ATA. Children in both groups showed better self‐control and significant improvements in auditory attention and visual working memory compared with the baseline. However, no statistical difference was found between the two treatments. Furthermore, the sham group improved significantly on eight dimensions of the Conners’Parent Rating Scale, whereas the active treatment group improved only on one dimension. Most of these positive changes persisted for 3 months. No improvements were observed in either group for verbal span, visual attention, or processing speed.
Maturation of finger‐synchronization skills
Authors: Milling‐Smith Oliver , Eunson Paul , Walsh E Geoffrey
Published: July 2010

The ability to move two fingers at the same time was measured in young and older adults. This study measured the accuracy with which 45 normally developing children (23 boys, 22 girls; mean ages 8.4 and 8.3 years respectively) and 49 young adults (25 males, 24 females; mean ages 19.8 and 20.5 years respectively) could synchronize movements of two fingers when making or breaking contact with circular metal discs. A portable electronic instrument displayed the timings. To measure‘in‐phase’skills, attempts were made to contact both discs simultaneously with the two index fingers or to break both contacts; asynchrony was only a few milliseconds and differences between children and adults were insignificant. To measure‘antiphase’skills, attempts were made with the index and middle fingers to make contact simultaneously with one disc while breaking contact with the other; asynchrony was larger. Usually one contact was made and later the other was broken; for a while both fingers touched (overlap). Rarely one contact was broken before the other was made; for a while neither finger touched (gap). Boys’periods of overlap were longer than those of men and women; on both sides these differences were highly significant statistically (p<0. 0001). Boys’errors on the right side were also significantly greater than those of girls. On both sides, mean errors of girls were higher than those of men and women: three of the four sets of data reached statistical significance. While boys’performance improved with age, that of girls was static. Children achieved an essentially adult level of control for in‐phase skills but with antiphase skills the children, and especially the boys, had clearly poorer performances.
Care of adolescents with severe learning disability from tuberous sclerosis
Authors: Ferguson Anne P , McKinlay Ian A , Hunt Ann
Published: July 2010

A postal study was completed by 138 members of the Tuberous Sclerosis Association for individuals with severe learning disabilities from tuberous sclerosis complex (TSC) (78 males, median 20 years of age; 60 females median 19 years 6 months of age) to investigate the abilities and care needs of these adolescents and young adults. Results were compared with a Salford community survey of young people with severe learning disability (SLD) from a variety of causes (42 males, median 17 years; 29 females, median 17 years 8 months of age). Those with SLD associated with TSC had a higher level of verbal disability and were more dependent for managing toileting and bathing. The young people with TSC were less able to interact socially, showing autistic behaviour. Sexually, they were less aware and less active. Only 20 were thought by their parents to have received sex education.
Tics and psychiatric comorbidity in children and adolescents
Authors: Gadow Kenneth D , Nolan Edith E , Sprafkin Joyce , Schwartz Joseph
Published: July 2010

This study examined comorbid psychiatric symptoms in a large, community‐based sample of children and adolescents. The study sample comprised a total of 3006 school children: 413 preschool (3 to 5 years; 237 males, 176 females; mean age 4 years 2 months, SD 8 months), 1520 elementary school (5 to 12 years; 787 males, 733 females; mean age 8 years 2 months, SD 1 year 11 months), and 1073 secondary school children (12 to 18 years; 573 males, 500 females; mean age 14 years 4 months, SD 1 year 10 months), all of whom were attending regular education programs. Children were evaluated with a teacher‐completed DSM‐IV‐referenced rating scale. The sample was divided into four groups: attention‐deficit‐hyperactivity disorder with tics (ADHD+tics), ADHD without tics (ADHD), tics without ADHD (T), and a comparison group i.e. neither ADHD nor tics (Non). The percentage of children with tic behaviors varied with age: preschool children (22.3%), elementary school children (7.8%), and adolescents (3.4%). Tic behaviors were more common in males than females, regardless of comorbid ADHD symptoms. For many psychiatric symptoms, screening prevalence rates were highest for the ADHD groups (ADHD+tics ADHDTNon). However, obsessive‐compulsive and simple and social phobia symptoms were more common in the groups with tic behavior. Findings for a community‐based sample show many similarities with studies of clinically referred samples suggesting that teacher‐completed ratings of DSM‐IV symptoms may be a useful methodology for investigating the phenomenology of tic disorders.
Children with ADHD and motor dysfunction compared with children with ADHD only
Authors: Tervo Raymond C , Azuma Scott , Fogas Bruce , Fiechtner Helen
Published: July 2010

The purpose of this study was to identify group differences in children with attention‐deficit‐hyperactivity disorder and motor dysfunction (ADHD‐MD) and ADHD only, and to evaluate the medication responsiveness of ADHD‐MD. Sixty‐three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo‐controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.05 mg/kg, twice daily) and placebo. Forty‐nine trials were completed. Nineteen were children with ADHD‐MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD‐MD were more likely to have severe ADHD‐combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.
Prognosis of haemorrhagic stroke in childhood: a long‐term follow‐up study
Authors: Blom Ingrid , De Schryver Els L L M , Kappelle L Jaap , Rinkel Gabriël J E , PhD Aag Jennekens‐Schinkel , Peters A C Boudewyn
Published: July 2010

Little is known about long‐term physical sequelae, cognitive functioning, and quality of life of children who have had a haemorrhagic stroke. Fifty‐six patients (29 females, 27 males) under 16 years of age at time of the bleeding were studied. Mean age at time of bleeding was 7.7 years (range 1 month to 15.9 years). The primary site and cause of the bleeding at baseline were determined. Occurrences of death, rebleedings, and seizures during follow‐up were recorded. Patients who survived were invited for a follow‐up examination including physical check‐up, general screening of cognition, and an inventory of subjective health perception. Thirteen children died directly as a result of the haemorrhage; nine experienced a recurrent bleeding, which was fatal in three; six children developed epileptic seizures. At follow‐up 36 of 56 patients were still alive. Mean follow‐up time was 10.3 years (range 1.3 to 19.9 years) and mean age was 18.6 years (range 1.8 to 34.1 years). There was no patient lost to follow‐up. Five patients declined to visit the hospital. In 15 out of 31 patients who could be examined, no physical impairment was observed, 11 had a hemiparesis of varying severity, and three had symptoms of cerebellar ataxia. One child had persisting tetraparesis and one persisting paraparesis. Signs of cognitive deficits were found in 15 patients. Of the children who survive haemorrhagic stroke, the physical and functional prognosis is relatively good, as almost all children were independent at follow‐up. However, only a quarter of the surviving children had no physical or cognitive deficit after a mean follow‐up period of 10 years. The majority had low self‐esteem as well as emotional, behavioural, and health problems.
Fatigue in adults with cerebral palsy in Norway compared with the general population
Authors: Jahnsen Reidun , Villien Lisbeth , Stanghelle Johan K , Holm Inger
Published: July 2010

Fatigue is commonly reported among adults with cerebral palsy (CP) and in the general population. The aim of this study was to examine the prevalence of perceived fatigue in adults with CP compared with the general Norwegian population. A multidimensional questionnaire, containing among other instruments the Fatigue Questionnaire, was sent to persons with CP aged 18 years or older with no intellectual disabilities documented in their medical records. Results were compared with recently published results of a study of fatigue in the general population in Norway. There were 406 respondents (209 males, 197 females; mean age 34 years, SD 11 years; age range 18 to 72 years). Distribution of the different types of CP coincided with international epidemiological studies on CP. Adults with CP reported significantly more physical, but not more mental fatigue, than the general population. The strongest predictors associated with fatigue were bodily pain, deterioration of functional skills, limitations in emotional and physical role function, and low life satisfaction. Fatigue was not significantly associated with type of CP but was most prevalent in persons with a self‐reported moderate grade of CP. Results of the present study indicate that physical fatigue is a pronounced problem in adults with CP, which has an impact on the preservation of functional skills and life satisfaction. Fatigue and factors related to fatigue should be addressed specifically in follow‐up programmes for persons with CP.
Corpus callosum and posterior fossa development in monozygotic females: a morphometric MRI study of Turner syndrome
Authors: Fryer Susannah L , Kwon Hower , Eliez Stephan , Reiss Allan L
Published: July 2010

Previous neuroimaging research in Turner syndrome (TS) has indicated parietal lobe anomalies, while anomalies in other brain loci have been less well‐substantiated. This study focused on potential cerebellar abnormalities and possible disruptions of interhemispheric (parietal) callosal connections in individuals with TS. Twenty‐seven female children and adolescents with TS (mean age 13 years, SD 4 years 2 months) and 27 age‐matched female control individuals (mean age 13 years 2 months, SD 4 years 1 month) underwent MRI. Age range of all participants was 7 to 20 years. Morphometric analyses of midline brain structures were conducted using standardized, reliable methods. When compared with control participants, females with TS showed reduced areas of the genu of the corpus callosum, the pons, and vermis lobules VI–VII, and an increased area of the fourth ventricle. No group difference in intracranial area measurements was observed. The reduced area of the genu in TS may reflect compromised connectivity between inferior parietal regions. Further, cerebellar vermis hypoplasia associated with TS agrees with literature that suggests the posterior fossa as a region prone to structural alterations in the face of early developmental insult.
Prevalence of hearing loss in Rett syndrome
Authors: Pillion Joseph P , Rawool Vishakha W , Bibat Genila , Naidu Sakkubai
Published: July 2010

This study examined the auditory status of females with Rett syndrome (RS) using auditory brainstem response (ABR) testing and measures of acoustic admittance. Prevalence of hearing impairment in 81 female patients (age range 1 year 3 months to 39 years 8 months; mean age 8 years 7 months, SD 6 years 4 months) was evaluated with ABR measurements. If the ABR latencies at 20dB nHL exceeded those of the normative group, a slight hearing loss was diagnosed. For ABR thresholds in the range 30 to 40dB nHL, a mild hearing loss was determined; moderate hearing loss was diagnosed for ABR thresholds in the range 50 to 60dB nHL. Bilateral hearing loss was found in 16 (19.3%) patients and unilateral hearing loss in 13 (16%) patients. Bilateral hearing loss of moderate degree was found in one patient. No patient was found with severe hearing loss (ABR threshold of 70dB nHL and above) in either ear. Slight hearing loss was found in 10.5% of ears (17 of 162), mild hearing loss in 14.2% of ears(23 of 162), and moderate hearing loss in 3.1% of ears (5 of 162). In 72.2% of ears (117 of 162), findings indicated the presence of normal peripheral auditory sensitivity. Prevalence of sensorineural hearing loss was 17.3% (28 of 162). Evidence of conductive involvement (conductive and mixed hearing loss) was observed in 9.9% of ears (16 of 162). In this cross‐sectional study, the prevalence of hearing loss was increased in older RS participants and in those with seizures requiring the use of anticonvulsants. Neither the type of hearing loss nor the presence of preserved speech seemed to be correlated with the type of mutation in methyl‐CpG‐binding protein 2 (MeCP2) gene that is associated with RS.
Whole‐body cooling after perinatal asphyxia: a pilot study in term neonates
Authors: Debillon Thierry , Daoud Patrick , Durand Philippe , Cantagrel Sylvain , Jouvet Philippe , Saizou Carole , Zupan Véronique
Published: July 2010

In order to test the practicability and safety of whole‐body cooling in term neonates with moderate‐to‐severe hypoxic‐ischaemic encephalopathy (HIE) and to report outcomes, a prospective pilot study was carried out in 25 term infants (median postmenstrual age 38 weeks, range 36 to 41 weeks; 20 males, five females). Whole‐body cooling, to a target core temperature of 33 to 34C, started within 6 hours of birth and was maintained for 72 hours. Of the 25 newborn infants (19 Sarnat II and six Sarnat III, 18 outborn), 18 survived, including 13 (72%) with normal cerebral signal by MRI. Temperature instability occurred during cooling in 15 infants, but neither severe haemodynamic instability nor renal failure was seen. Thrombocytopenia developed in 12 infants, including seven with biological disseminated intravascular coagulation. One patient had hypoxaemia with right‐to‐left shunting through the ductus arteriosus, and seven had limited meningeal or subdural bleeding. Whole‐body cooling is feasible in term neonates, with no life‐threatening adverse events. Improvements are needed to obtain stable hypothermia for 72 hours.
Effect of asphyxia on non‐protein‐bound iron and lipid peroxidation in newborn infants
Authors: Yu Tao , Qing Kui Liao , Ming Qian Zhong
Published: July 2010

The effect of asphyxia on iron metabolism and lipid peroxidation in newborn infants with hypoxic‐ischemic encephalopathy (HIE) was investigated. Non‐protein‐bound iron (NPBI) and lipid peroxidation (thiobarbituric‐acid‐reactive species; TBARS) in plasma and hematological iron indices were measured in 15 healthy newborn infants (mean gestational age 39 04 weeks, SD 1); 15 asphyxiated infants without neurological abnormalities (AS‐HIE; mean gestational age 38.8 weeks, SD 0.9); and 15 asphyxiated infants with neurological abnormalities (AS+HIE; mean gestational age 39.75 weeks, SD 1.4). Follow‐up was performed at the age of 5 months. It was found that the detectable rates of NPBI in 10 of 15 of the AS‐HIE group and 13 of 15 of the AS+HIE group were significantly higher than that of the control group (5 of 15; both p0.01). Plasma levels of TBARS in the control (9.20μmol/L, SD 1.9) and AS‐HIE infants (10.13μmol/L, SD 2.7) were significantly lower than those of the AS+HIE group (13.42μmol/L, SD 2.8). Serum iron, total iron binding capacity, and transferrin saturation in the AS+HIE group was higher than the corresponding values of the control and AS‐HIE groups, although no statistical difference was found among them. At 5 months of age, all control and AS‐HIE infants were neurologically normal, whether or not their NPBI was detectable. Of the 12 AS+HIE infants, four (all of whom had detectable NPBI) were neurologically impaired. The average Gross Development Quotient of AS+HIE infants was significantly lower than that of the control or AS‐HIE groups (p<0.01). Results showed that asphyxia could affect iron metabolism and lead to a significant increase in NPBI and lipid peroxidation in newborn infants with HIE, indicating that iron delocalization induced by asphyxia plays a role in the brain injury of asphyxiated infants.
Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: developmental aspects in children and adolescents
Authors: Banaschewski Tobias , Woerner Wolfgang , Rothenberger Aribert
Published: July 2010

Although premonitory sensory phenomena (PSP) and suppressibility of tics (SPT) are important in Tourette syndrome not only when behavioural therapeutic approaches in children are considered, there is a lack of developmental information on these phenomena. Therefore, a cross‐sectional survey of these factors in children and adolescents was carried out. Rates of PSP and SPT were gathered using a questionnaire for the assessment of Tourette syndrome. The 254 outpatients (212 males, 42 females) with Tourette syndrome investigated had an age range of 8 to 19 years, normal intelligence, and diagnosis according to DSM‐IV‐TR/ICD‐10. To test for developmental effects, the total group was stratified into three age groups (8 to 10, 11 to 14, and 15 to 19 years). Data were statistically evaluated using ?2 tests. Of the 254 participants, 37% reported PSP, while 64% were able to suppress their tics. Only a subgroup of 119 patients gave unequivocal answers to both questions and only 60% of these experienced both PSP and SPT. Statistically significant stepwise increases were found at two different age levels. One was around 10 years (PSP‘Yes’or‘No’and SPT), the other around age 14 (PSP‘Yes’). There was no influence of tic duration and age at tic onset on PSP/SPT. The reported data suggest that PSP is experienced rarely in younger children with Tourette syndrome and is not a necessary prerequisite for SPT. Increasing PSP with age merely seems to reflect cognitive development rather than intrinsic aspects of Tourette syndrome. In children under 10 years of age, SPT might require more awareness of tics than in older age groups. Developmental aspects of PSP and SPT should be taken into consideration when studies of cognitive behavioural treatment for children and adolescents with Tourette syndrome are planned.
Botulinum toxin with and without casting in ambulant children with spastic diplegia: a clinical and functional assessment
Authors: Bottos M , Giannini S , Benedetti M G
Published: July 2010

This study compared clinical and functional outcomes after treatment with botulinum toxin A (BTX‐A) and BTX‐A with casting in children with dynamic equinus foot. Ten children (seven males, three females; mean age 6 years 4 months, SD 2 years 7 months; range 4 to 11 years) with mild spastic diplegia and independent walking were divided into two groups: group 1, BTX‐A and group 2, BTX‐A plus casting. BTX‐A was injected in the triceps surae bilaterally at multiple sites while the children were sedated with mask anaesthesia. Dysport® toxin was used, 15 to 20 IU/kg in each muscle. Immediately after injection an ankle‐foot orthosis was applied to children in group 1 and a cast to children in group 2. Clinical assessment using the Ash worth scale, Gross Motor Function Measure (GMFM), range of movement measurement, and gait analysis was performed before treatment and 1, 4, and 12 months after treatment. Spasticity decreased significantly at 1‐month examination in both groups (p=0.002), at 4–month examinations (Wilcoxon test p=0.003), and 12 month (p=0.052) examinations in group 2. GMFM highlighted a significant improvement in group 2 at the 4–month examination (p=0.052 for standing, p=0.007 for walking). Gait analysis showed a significant increase in the walking speed in group 2 (p=0.04). No change was detected in ankle kinematics and kinetics or in muscular activity during the gait cycle. We confirmed that BTX‐A reduces spasticity and improves functional performance in standing and walking; association with casting provides more marked and enduring results.
Effects of a topical anesthetic on non‐socially maintained self‐injurious behavior
Authors: Kern Lee , MA Deborah Bailin , Mauk Joyce E
Published: July 2010

In the present study we hypothesized that the self‐injurious behavior (SIB) of a 12‐year‐old male diagnosed as having autism and severe mental retardation was maintained by automatic reinforcement. Further, we hypothesized SIB served a sensory reinforcement function related to sensation at the skin surface. The participant engaged in high rates of SIB in the form of self‐slapping. A functional analysis resulted in undifferentiated findings. Additional observations indicated that SIB occurred only to exposed skin surfaces. To test for a sensory function, we applied a topical anesthetic to the participant's skin. SIB was reduced by 20 to 60% after application of the dermal anesthetic. These results support an automatic reinforcement hypothesis. Implications for treatment are discussed.
Factors associated with microcephaly at school age in a very‐low‐birthweight population
Authors: Chiriboga Claudia A , K Karl C , Durkin Maureen , Kuhn Louise , Sanocka Ulana , Bellinger David
Published: July 2010

The neonatal predictors of microcephaly, defined as a head circumference <5th centile in children born preterm, has not been systematically assessed. Children were drawn from the Developmental Epidemiology Network (DEN) cohort of very low‐birth weight children (VLBW: 500–1500g) born from 1991 to 1993 at three sites in the USA. Neurological assessments were carried out among 198 singleton children (mean age 6 years 8 months, SD 0.5 years). Ninety‐six children (48.5%) were male. Microcephaly was observed in 30 children (15%) and, using multivariate analysis, it was found to be associated with gestational age <26 weeks and bronchopulmonary dysplasia (BPD). Sonography‐defined white‐matter damage (WMD, i.e. echolucency or echodensities) was not associated with increased odds of microcephaly, while occurrence of intraventricular hemorrhage (IVH) was in univariate but not multivariate analysis. In analyses that excluded children with IVH/WMD, odds of microcephaly increased in dose‐related fashion according to number of days on ventilator: >5 days, OR=4.5; 95%CI=1.4 to 15; >10 days, OR=5.7; 95%CI=1.7 to 19; >15 days OR=8.3; 95% CI=2.3 to 29.2. Among children without BPD, microcephaly was not associated with differences in IQ, while IQ scores among children with BPD or any ventilation were disproportionately lower among those with microcephaly. In multivariate analyses predicting IQ at age 7 years, microcephaly was found to modify the association between neonatal lung disease and IQ.
Cognitive status of young adults with spina bifida
Authors: Barf HA , Verhoef M , PhD A Jennekens‐Schinkel , M M W , J R H , H A J
Published: July 2010

The cognitive status of 168 Dutch young adults (103 females, 65 males; mean age 20 years 9 months, age range 16 to 25 years) with spina bifida (SB) was examined. The main purpose was to establish the effect of the type of SB (occulta or aperta) and the effect of hydrocephalus (HC) within the group with SB aperta (AHC+). Results indicated, on average, a lower cognitive status of persons with AHC+ (n=111) than of persons with SB occulta (n=37) and of persons with SB aperta without HC (AHC‐; n=20). Almost half the young adults with AHC+ had cognitive impairments of some sort. These included more domain specific impairments (70%) as well as a more general cognitive deficit (30%). Cognitive status of persons with SB occulta and of those with AHC‐ was similar to that in the healthy population. The presence of associated pathology, rather than SB per se, has a negative effect on cognitive status.
Sensorimotor recovery in children after traumatic brain injury: analyses of gait, gross motor, and fine motor skills
Authors: Kuhtz‐Buschbeck Johann P , Hoppe Birgit , Gölge Mukaddes , Dreesmann Mona , MD Ute Damm‐Stünitz , Ritz Annegret
Published: July 2010

The recovery of gait, gross motor proficiency, and hand function was examined in 23 children (13 males, 10 females; age 4 years 7 months to 15 years 10 months) with traumatic brain injury (TBI) over five months of in patient rehabilitation. We used gait analysis, the Gross Motor Function Measure, the Developmental Hand Function Test, and the Purdue Pegboard test. Brain injury had been severe (initial Glasgow Coma Scale GCS <8) in 17 children and moderate (GCS 8–10) in six children. Compared with healthy control children of the same age and sex, repeated gait analyses in ambulatory children with brain injury showed significant reductions of velocity, stride length and cadence, and impaired balance. Spatiotemporal gait variables were correlated with Gross Motor Function Measure scores. Hand function tests revealed deficits in fine motor skills, speed, and coordination. Degree of impairment increased with trauma severity. Despite significant improvements, differences in gait velocity, stride length, and hand function of children with brain injuries and controls were still present about 8 months after TBI. Hand motor skills improved less than gait. Young age at injury was not associated with better recovery.
Ultrasound‐guided botulinum toxin injection technique for the iliopsoas muscle
Authors: Westhoff Bettina , Seller Konrad , Wild Alexander , Jaeger Marcus , Krauspe Ruediger
Published: July 2010

Intramuscular botulinum toxin A injections are beneficial for the treatment of functional shortening of the iliopsoas muscle, but it is difficult to achieve precise needle positioning and injection. As a solution to this we present an ultrasound‐guided injection technique for the iliopsoas muscle using an anterior approach from the groin. The procedure was performed 26 times in 13 patients (seven males, six females; mean age 11 years, SD 9 years 8 months; age range 4 to 31 years), 10 times bilaterally. Indications were functional iliopsoas shortening due to cerebral palsy (17 hips), hereditary spastic paraplegia (four hips), and Perthes disease (five hips). In all cases the iliopsoas muscle was identified easily by ultrasound; the placement of the injection needle and injection into the site of interest were observed during real time. No complications were encountered.
Hand function in children with hemiplegic cerebral palsy: prospective follow‐up and functional outcome in adolescence
Authors: Fedrizzi Ermellina , Pagliano Emanuela , Andreucci Elena
Published: July 2010

The aim of this prospective study was to determine the outcome of affected hand impairment and disability in a group of 31 children (16 males, 15 females) with hemiplegic cerebral palsy who were referred consecutively to our rehabilitation service and followed from a mean age of 2 years and 7 months to a mean age of 12 years and 9 months. The hand function assessment protocol consisted of video‐recorded procedures: one to assess grip and the other to assess the extent of spontaneous use of the affected hand. Assessments at outset and at latest follow‐up showed that the series as a whole had greater hand impairment in spontaneous manipulation than in gripping tasks. Comparison of hand function before age 4 years with the latest assessment over age 11 years revealed a nonsignificant improvement in grip, whereas spontaneous hand use remained stable. All but one of the children who had good grip and hand use scores at first assessment maintained them over time unless they were not treated for hand dysfunction. Among the children with low scores at outset, the improvement over time was more marked in grip than spontaneous hand use and occurred mainly in the early years. These results suggest that to evaluate the real disability of the affected hand in children with hemiplegia, grip assessment is insufficient and that an instrument assessing spontaneous hand use in bilateral manipulation is required. Furthermore, intensive treatment focused on hand function should be planned in the early years for children with more severe hand impairment, whereas regular follow‐up is sufficient for less affected children.
Community integration among adults with spinal cord injuries sustained as children or adolescents
Authors: Anderson Caroline J , Krajci Katherine A , Vogel Lawrence C
Published: July 2010

The purpose of this study was to determine factors associated with community integration of adults who sustained spinal cord injuries as children or adolescents. Outcome measures included the Craig Handicap Assessment and Reporting Technique and measures of independent living. Independent variables include demographic factors, level of injury, functional independence as measured by the Functional Independence Measure, and perceived health as measured by Short Form‐12 physical and mental component scores. Data were analyzed by multiple regression analyses for each of the outcome measures. Two‐hundred and sixteen adults (150 males and 66 females) were interviewed. Mean age at interview was 29 years (range 24 to 27 years) and mean age at injury was 14 years (range 0 to 18 years). Results showed that the five factors most strongly associated with community integration were education level, employment, income, functional independence, and health status. Factors that were not associated with community integration included sex, age at injury, duration, and level of injury.
Behavioural phenotype in foetal alcohol syndrome and foetal alcohol effects
Authors: Steinhausen Hans‐Christoph , Winkler Christa
Published: July 2010

A sample of 12 children (seven males, five females; mean age 6 years 7 months, SD 2 years 6 months, range 2 years 4 months to 12 years 1 month) with moderate‐to‐severe foetal alcohol syndrome (FAS) and another sample of 26 children (12 males, 14 females; mean age of 6 years 2 months SD 2 years 10 months, range 2 years 6 months to 12 years 8 months) with mild FAS or foetal alcohol effects (FAE) as well as a sample of 15 age‐ and sex‐matched control children with unspecific intellectual disability were compared using the Developmental Behaviour Checklist (DBC). There were significant differences (p=0.01) between the groups on five of six subscales of the DBC with controls scoring lower on the disruptive, self‐absorbed, anxiety, antisocial behaviour, and communication disturbance scales. The DBC profiles of the two foetal alcohol exposed groups did not differ from each other. It is concluded that quantitative behaviour measurement provides insights into specific behavioural phenotypes of FAS/FAE.
Why parents of children with neurodevelopmental disabilities requiring gastrostomy feeding need more support
Authors: Craig Gillian M , Scambler Graham , Spitz Lewis
Published: July 2010

This was a qualitative research study of parental perceptions of gastrostomy feeding before surgery using an in‐depth interview in the parental home to examine the factors parents consider when gastrostomy feeding is recommended and to identify the need for support. Participants were a subgroup of families taking part in a larger research study evaluating gastrostomy placement in children with severe neurodevelopmental disabilities at a major paediatric centre in the UK between 1998 and 2000. Parents of 22 children (13 males, nine females; mean age 4 years 8 months [SD 3 years 6 months]; age range 1 year 1 month to 13 years 3 months) were interviewed. Categories of disability were: cerebral palsy (n=10), a syndrome of chromosomal or genetic origin (n=10), and unconfirmed diagnoses (n=2). Thirteen children were recommended for a gastrostomy and seven were recommended for a gastrostomy with an antireflux procedure. Four families were undecided about surgery at the time of the interview, two of whom went ahead with the procedure some time later. Parental accounts of oral and tube feeding were both contradictory and ambivalent. Concerns about the loss of oral feeding, which was regarded as having a range of psychosocial effects for the child and family, were raised. Both oral and tube feeding have multiple meanings for parents and signify more than obtaining an adequate nutritional intake. The need for additional information about the risks and benefits of gastrostomy and how tube feeding fits into the context of everyday life were dominant themes. The biomedical emphasis on health and weight‐gains may fail to reflect parental concerns about tube and oral feeding. There is a need for greater practical and emotional support for families feeding children with severe disabilities.
Long‐term outcome of neurosurgical untethering on neurosegmental motor and ambulation levels
Authors: Schoenmakers MAGC , Gooskens RHJM , Gulmans VAM , Hanlo PW , Vandertop WP , Uiterwaal CSPM , Helders PJM
Published: July 2010

The aim of this study was to determine the long‐term outcome of neurosurgical untethering on neurosegmental motor level and ambulation level in children with tethered spinal cord syndrome. Forty‐four children were operated on (17 males, 27 females; mean age at operation 6 years 2 months, SD 5 years). Sixteen patients had myelomeningocele, nine had lipomyelomeningocele, and 19 had other types of spinal dysraphism. Motor level and ambulation level were assessed pre‐ and three times postsurgery (mean duration of follow‐up 7 years 1 month, SD 1 year 8 months). Deterioration of motor level was seen in five of 44 patients, 36 of 44 remained stable, while improvement was seen in three of 44 patients. Deterioration of ambulation level was seen in five of 44 patients, and remained stable in 26 of 44. Thirteen of 44 children were too young to ambulate at time of operation (<2 years 6 months). Late deterioration of motor or ambulation level was only seen in (lipo)myelomeningocele patients. Deterioration of ambulatory status was strongly associated with obesity and retethering. Revision of the initial tethered cord release was perfor Med in nine of 44 patients, mainly in those with lipomyelomeningocele.
Psychological factors in pregnancy and mixed‐handedness in the offspring
Authors: Obel Carsten , Hedegaard Morten , Brink Tine , Secher Niels Jørgen , Olsen Jørn
Published: July 2010

Animal studies suggest that psychological factors may interfere with the development of brain asymmetry during gestation. We evaluated whether psychological exposure in pregnancy was associated with mixed‐handedness in the offspring. In a follow‐up design study, 824 Danish‐speaking women with singleton pregnancies provided information on psychological distress and the occurrence of life events in the early second and third trimesters of pregnancy. Handedness of the children was based on maternal reports when the children were 3 years of age. Among the 419 males and 405 females, 7% and 5% respectively were mixed‐handed whereas mixed‐handedness was found in 3% of the parents. Psychological distress in the third trimester as well as higher levels of stressful life events were related to a higher prevalence of mixed‐handedness in the offspring. About 16% of the women reported more than one life event in the third trimester of pregnancy and among the offspring of these women 11% were mixed‐handed (odds ratio=2.3; 95% confidence interval 1.2 to 4.4). Women who at the same time reported a high level of distress and stressful life events, had a three‐ to four‐fold higher prevalence of mixed‐handedness in their offspring.
Predictive value of EEG in neonates with periventricular leukomalacia
Authors: Vermeulen R J , M R L , Lafeber H N , J B M , Van M S
Published: July 2010

The aim of this study was to evaluate whether EEG (i.e. positive Rolandic sharp waves) can be used to predict neurodevelopment in newborn infants with periventricular leukomalacia and compare the predictive value with that of MRI. A sequential cohort of neonates (n=45; 33 males, 12 females; mean gestational age 31.2 weeks, SD 2.7, range 27 to 37.8 weeks; mean birthweight 1592g, SD 601g) with periventricular hyperechogenicities on cranial ultrasound was recruited for this study. EEGs were analyzed for positive Rolandic sharp waves. Neurodevelopment was evaluated at the ages of 12 and 18 months. In the whole group the probability of a poor outcome was 24% and the probability of any impairment was 33%. If the number of positive Rolandic sharp waves was no more than 0.1 per minute, the probability of a poor outcome was reduced to 9% (95% confidence interval [95% CI] 2 to 27%) and the probability of any impairment was reduced to 13% (95% CI 4 to 32%). In all infants with more than 0.1 positive Rolandic sharp waves per minute the probability of a poor outcome was 41% (95% CI 23 to 61%) and of any impairment was 55% (95% CI 34 to 73%). In these infants MRI identified infants with a poor outcome with a sensitivity of 1.00 (95% CI 0.70 to 1.00) and a specificity of 0.92 (95% CI 0.67 to 0.99), and infants with any impairment with a sensitivity of 0.83 (95% CI 0.55 to 0.95) and a specificity of 1.00 (95% CI 0.72 to 1.00). Results suggest that if an EEG of an infant with periventricular leukomalacia contains no more than 0.1 positive Rolandic sharp waves per minute the probability of a normal or mildly delayed development is high (0.91, 95% CI 0.73 to 0.98). MRI enhances the accuracy of the outcome prediction slightly; however, owing to a wide confidence interval, this advantage is negligible. However, if the frequency of the positive Rolandic sharp waves exceeds 0.1 per minute, MRI can significantly enhance the precision of the prediction of outcome.
Everyday functioning in young children with cerebral palsy: functional skills, caregiver assistance, and modifications of the environment
Authors: Østensjø Sigrid , Brogren Eva , K Nina
Published: July 2010

Everyday functioning is described in 95 children with cerebral palsy (CP; 55 males and 40 females; mean age 58 months, SD 18 months, range 25 to 87 months) using the three scales of the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills, Caregiver Assistance, and Modifications of the Environment. Types of CP in the children were hemiplegia, (n=19), spastic/ataxic diplegia, (n=44), spastic quadriplegia, (n=16), dyskinetic, (n=9), and mixed (n=7). Symptoms were grouped by severity according to the Gross Motor Function Classification System (GMFCS): 23% were classified at level I, 21% at level II, 10% at level III, 23% at level IV, and 23% level V. A large variability in functioning in mobility, self‐care, and social function was seen because of the heterogeneity of children with CP. Limitations in achievement of activities, need for assistance, and use of assistive devices increased progressively with GMFCS level. Furthermore, these children differed to a great extent from the normative sample of the PEDI. Stepwise regression analysis showed that the GMFCS was a good predictor of everyday functioning with age and learning problems as significantly contributing factors, particularly in self‐care and social function. In conclusion, the three scales of the PEDI represent different but strongly related aspects of everyday functioning in young children with CP.
Autism: known and unknown
Authors: COLEMAN MARY
Published: July 2010

Autism appears to be melting the edges of the pediatric interface between neurology and psychiatry as they become blended back into one medical discipline. This process is being facilitated by major technological advances ‐ in particular, the decoding of the human genome and the development of functional imaging. This is a brief review of what is known about autism today and what might happen in the future.
Clinical validation of the Paediatric Pain Profile
Authors: Hunt Anne , Goldman Ann , Seers Kate , Crichton Nicola , Moffat Vivien , Oulton Kate
Published: July 2010

The Paediatric Pain Profile (PPP) is a 20–item behaviour rating scale designed to assess pain in children with severe neurological disability. We assessed the validity and reliability of the scale in 140 children (76 females, mean age 9 years 11 months, SD 4 years 7 months; range 1 to 18 years), unable to communicate through speech or augmentative communication. Parents used the PPP to rate retrospectively their child's behaviour when‘at their best’and when in pain. To assess interrater reliability, two raters concurrently observed and individually rated each child's behaviour. To assess construct validity and responsiveness of the scale, behaviour of 41 children was rated before and for four hours after administration of an‘as required’analgesic. Behaviour of 30 children was rated before surgery and for five days after. Children had significantly higher scores when reported to have pain than‘at their best’and scores increased in line with global evaluations of pain. Internal consistency ranged from 0.75 to 0.89 (Cronbach's alpha) and interrater reliability from 0.74 to 0.89 (intraclass correlation). Sensitivity (1.00) and specificity (0.91) were optimized at a cut‐off of 14/60. PPP score was significantly greater before administration of the analgesic than after (paired‐sample t‐tests, p < 0.001). Though there was no significant difference in mean pre‐ and postoperative scores, highest PPP score occurred in the first 24 hours after surgery in 14 (47%) children. Results suggest that the PPP is reliable and valid and has potential for use both clinically and in intervention research.