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 15,878 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prematurity and birth defects present parents with a crisis for which they have usually had little preparation and no prior education. Both types of early medical complications may represent a state of suspended animation for most parents. Even large premature infants with good prognoses induce anxiety and symbolize potential death and disability, and children with birth defects may portend years of medical procedures and long-term disability. The fear of serious neurologic impairment or mental retardation presents parents with a long period of ambiguity and chronic anxiety. During this period, they must be helpless observers rather than active participants. Recent research has indicated that the active involvement of parents in the care of their premature infants can be helpful in alleviating the guilt and anxiety related to loss and impairment. Similarly, early physical contact between parents and their severely malformed infant is equally critical. Even if the ultimate complexities of early attachment have yet to be delineated fully, this is a worthwhile practice and useful approach in the nursery. Child mental health professionals have important roles to fulfill in helping staff members deal with increased parental participation and directly managing family members with intense distress related to their infants' fragility. The role of the mental health professional in such consultation may cover five related tasks: 1. Understanding the nature of the biologic issues facing the child and integrating that understanding with an evaluation of the child's neurobehavioral profile. 2. Understanding the family's relationship with the child and their overall level of functioning during an acutely stressful time. 3. Developing an appreciation of the place of the child in his or her family and how the parents understand the nature of the medical problems. 4. Forming a collaborative relationship with the pediatricians and other subspecialists who care for the child so that behavioral and psychological interventions are integrated with the child's biomedical care. 5. Fostering a brief, or sometimes long-term, therapeutic relationship with the family or facilitating the family's finding such a relationship with another clinician. There will never be enough child and adolescent psychiatrists and psychologists to treat all families of medically compromised infants. Knowledge of normative responses has advanced to the point at which basic skills can be used by and transmitted to others who can provide basic services. There is much to be learned about the short- and long-term sequelae of such stressful situations on individuals and family systems with preexisting psychopathology. For such families, child mental health professionals are uniquely suited to play a further role in research and treatment.
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PMID:Child mental health consultation with families of medically compromised infants. 1291 Aug 15

To get a comprehensive picture of prematurity and neonatal death or survival, all factors on the maternal and fetal records that might be pertinent were recorded. This information, having to do with factors such as age, gravida of the mother, blood group incompatibility, period of gestation, weight at birth, type of delivery, medication and anesthesia administered to the mother, is presented in tabular form. In the study of perinatal mortality it was noted that failure to establish normal pulmonary ventilation is the most common cause of death in the neonatal period. Maternal history of relative infertility, that is, previous abortions, stillbirths and premature deliveries, was the most impressive finding in the stillborn series. In the follow-up study of premature infants who survived the neonatal period, 8.5 per cent were found to be severely handicapped. In four cases the handicap was due to congenital anomalies, in two others probably to infection, leaving 12 with complications possibly ascribable to prematurity. Six of these had retrolental fibroplasia as a major handicap. In seven, mental retardation was the presenting problem. Most of the handicapped children had multiple handicaps, which included spasticity, delayed motor development, strabismus, etc. The incidence of the necessity for corrective measures for feet and legs appeared relatively high. In general, survivors compared favorably with the rest of the childhood population. Complications and twinning were associated inordinately often.
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PMID:A five-year study of prematurity. 1330 92

The objective of this study was to compare the outcomes at 5 years of age of SGA and AGA children born < 28 weeks of gestation. The method used was a longitudinal follow-up of a cohort of 37 dyads of SGA and AGA infants matched by gestational age (GA), gender, and date of delivery. Mean GA was 26+/-1.2 weeks, and BW was 638+/-77 g for SGA and 833+/-134 g for AGA (P < 0.0001). The SGA infants remained lighter at 3, 24, and 60 months. Their head circumference was statistically smaller at 3 and 60 months, and their length remained lower but no longer statistically significant. There was no difference after the second year of life between SGA and AGA children in the need for rehospitalization (16% versus 11%) and the incidence of medical problems such as Otitis (38% versus 41%) and asthma (24% versus 30%). SGA exhibited more neurodevelopmental deficits (41% versus 30%) and severe handicaps, including CP, blindness, deafness, and mental retardation (22% versus 14%). Those deficits were seen predominantly in association with microcephaly, which was more prevalent in the SGA group. We conclude that the combination of severe prematurity and intrauterine growth retardation constitutes a serious developmental handicap and predisposes to physical and developmental delays. The presence of microcephaly further aggravates the prognosis.
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PMID:Outcome at 5 years of age of SGA and AGA infants born less than 28 weeks of gestation. 1556 89

We studied the risk factors affecting the functional status of cerebral palsy. A cross-sectional study of 73 children with cerebral palsy was conducted with the Functional Independence Measure for Children (WeeFIM), which assesses functional skills in the domains of self-care, mobility, and cognition. The mean total Functional Independence Measure for Children quotient was 67.5%. The mean subquotients for self-care, mobility, and cognition were 68.3%, 62.7%, and 69.4%, respectively. The risk factors related to the degree of functional dependency were (1) mental retardation (P = .030), (2) epilepsy (P = .005), (3) type of cerebral palsy (P < .001), and (4) severity of cerebral palsy using the Gross Motor Function Classification System (P < .001) (using univariate analysis). However, when using multivariate analysis, only epilepsy (P = .02) and severity status according to the Gross Motor Function Classification System (P < .001) were significantly related. When the etiology was analyzed, only prematurity was significantly associated with better Functional Independence Measure for Children scores using both univariate (P = .022) and multivariate (P = .007) analyses. The functional status of children with cerebral palsy depends on the severity and the presence of epilepsy. Despite impairment, we found that most children with cerebral palsy could achieve functional independence.
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PMID:Cerebral palsy: correlation of risk factors and functional performance using the Functional Independence Measure for Children (WeeFIM). 1565 94

Approximately 10% of newborns are born prematurely. Of these children, more than 10% will sustain neurological injuries leading to significant learning disabilities, cerebral palsy, or mental retardation, with very low birth weight infants having an even higher incidence of brain injury. Whereas intraventricular hemorrhage was the most common form of serious neurological injury a decade ago, periventricular white matter injury (PWMI) is now the most common cause of brain injury in preterm infants. The spectrum of chronic PWMI includes focal cystic necrotic lesions (periventricular leukomalacia; PVL) and diffuse myelination disturbances. Recent neuroimaging studies support that the incidence of PVL is declining, whereas diffuse cerebral white matter injury is emerging as the predominant lesion. Factors that predispose to PVL include prematurity, hypoxia, ischemia, and inflammation. It is believed that injury to oligodendrocyte (OL) progenitors contributes to the pathogenesis of myelination disturbances in PWMI by disrupting the maturation of myelin-myelin-forming oligodendrocytes. Other potential mechanisms of injury include activation of microglia and axonal damage. Chemical mediators that may contribute to white matter injury include reactive oxygen (ROS) and nitrogen species (RNS), glutamate, cytokines, and adenosine. As our understanding of the pathogenesis of PWMI improves, it is anticipated that new strategies for directly preventing brain injury in premature infants will evolve.
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PMID:Emerging concepts in periventricular white matter injury. 1569 97

Cerebral palsy (CP) is a common pediatric disorder occurring in about 2 to 2.5 per 1000 live births. It is a chronic motor disorder resulting from a non-progressive (static) insult to the developing brain. CP is the clinical presentation of a wide variety of cerebral cortical or sub-cortical insults occurring during the first year of life. The commonest cause of CP remains unknown in 50% of the cases; prematurity remains the commonest risk factor. Children with CP suffer from multiple problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. Screening for these conditions should be part of the initial assessment. The child with CP is best cared for with an individualized treatment plan that provides a combination of interventions. This requires the provision of a number of family-centered services that make a difference in the lives of these children and their families. Management of spasticity can be challenging with a wide variety of possible therapeutic interventions. The treatment must be goal oriented, such as to assist with mobility, reduce or prevent contractures, improve positioning and hygiene, and provide comfort. Each member of the child's multidisciplinary team, including the child and both parents, should participate in the serial evaluations and treatment planning.
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PMID:Cerebral palsy: comprehensive review and update. 1676 50

Fifteen years of evidence have established that the cytokine erythropoietin offers promise as a treatment for brain injury. In particular, neonatal brain injury may be reduced or prevented by early treatment with recombinant erythropoietin. Extreme prematurity and perinatal asphyxia are common conditions associated with poor neurodevelopmental outcomes including cerebral palsy, mental retardation, hearing or visual impairment, and attention deficit hyperactivity disorder. When high doses of erythropoietin are administered systemically, a small proportion crosses the blood-brain barrier and can protect against hypoxic-ischemic brain injury. In addition to other protective effects, erythropoietin can specifically protect dopaminergic neurons. Since reduced dopamine neurotransmission contributes to attention deficit hyperactivity disorder, this condition may be amenable to erythropoietin treatment. This review focuses on the potential application of erythropoietin as a neuroprotectant with regard to neurologic complications of extreme prematurity, including attention deficit hyperactivity disorder. Recent concerns that early erythropoietin might exacerbate the pathologic neovascularization associated with retinopathy of prematurity are addressed.
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PMID:Recent trends in erythropoietin-mediated neuroprotection. 1793 39

The case histories of 83 children admitted to the hospital with a diagnosis only of failure to thrive were examined. In twenty-six cases there was evidence of maternal deprivation as a factor. Forty patients were found to have significant organic diseases as a possible or probable cause or contributing influence.Twenty-six were found to have some degree of mental retardation, either documented or suspected, but in nearly all of them there were associated factors presumably responsible, at least in part, for failure to thrive.Several children had birth weight less than 2,500 grams, but no child was thought to grow poorly because of prematurity alone. Congenital anomalies such as cleft palate and other problems leading to feeding difficulties were not unusual.In any case of persistent failure of an infant to gain adequately in weight and length, in which the cause is not evident, the child should be admitted to a hospital to determine response in a new environment. Also an adequate social history should be sought and siblings more closely evaluated; and careful study should be made of the renal, gastro-intestinal, cardiac, pulmonary and central nervous systems, even if there are no symptoms or signs referable to these systems.
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PMID:Failure to thrive-an analysis of 83 cases. 1873 93

Rarely in the history of medicine has an X-linked mental retardation syndrome so thoroughly entered every branch of medicine, at least of pediatrics, but also of internal medicine, on account of its protean manifestations. In such countries as Zambia, malaria, tuberculosis, HIV, and other infections diseases, and many environmental and nutritional disorders still top the list of childhood morbidity and mortality. However, in the more developed nations of the Old and New Worlds, prematurity, birth defects, and genetic conditions constitute the major burden of infant mortality adn chronic childhood handicaps. One of the most pervasive of these is the group of FG syndromes seen in every pediatric clinic and mental health service. Thus, in our experience FGS emerges as the most common yet the least known developmental disabilities condition in our society. FGS imposes a tremendous burden of morbidity, and to some extent also of mortality, on society and families. After successful neonatal adaptation, such recurring problems as otitis, reactive airway disease, and constipation can be routinely treated symptomatically. However, the neurodevelopmental burden represents the greatest challenge that FGS presents for families and to society. Under the best of circumstances, motor and speech development catch up. However, virtually all FGS children, boys and girls, have difficulties in psychologic development, school performance, and ultimate emotional adaptation to adult life and social integration. The many such cases added to those with outright psychiatric disturbances are overwhelming social, psychologic, and psychiatric services and, above all, public and private school systems, which are understaffed, under-funded, beyond formulating individual educational plans, and helpless to deal with the enormous burden of special service needs of these children. It's time that handicapped children receive care according to needs and not according to diagnosis. However, the near absence of information on FGS available to these professionals is a handicap in arriving at a specific diagnosis (allowing state and federal support for special services) and in understanding the prognosis, natural history, and such complications as "autism," seizures, and tethered cord that affect the child's success at home, in school, and out in society. The FGS parent support group has been of enormous help in informing families about all of these "issues," and to this day remains the greatest repository of knowledge on FGS. As they say in baseball, it is time at long last for the professionals "to step up to the plate."
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PMID:The FG syndromes (Online Mendelian Inheritance in Man 305450): perspective in 2008. 1904 30

We undertook a community-based case-control study on persons with active epilepsy residing in Kerala, southern India. Using a standardized questionnaire, we collected information from 362 cases and 362 controls. In the final multivariate model, family history of epilepsy (odds ratio=7.8, 95% confidence interval=3.2-18.8, P=0.000), antecedent history of febrile seizures (7.7, 4.3-14.0, 0.000), birth by complicated delivery (6.8, 2.1-21.8, 0.001), and neonatal seizures (7.8, 1.7-35.4, 008) emerged as strong independent predictors of epilepsy, followed in decreasing order by mental retardation, prematurity, maternal age 30, perinatal distress, and incomplete immunization. There were more similarities than differences in the distribution of risk factors between generalized and localization-related epilepsy syndromes. Our findings suggest interplay between genetic and acquired factors in the pathogenesis of epilepsies, and underscore the need for improvement in obstetric and neonatal care to minimize the epilepsy burden in low-income countries.
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PMID:Risk factors for epilepsy: a population-based case-control study in Kerala, southern India. 1966 Sep 89


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