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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relationships between doppler-sonographic determination of systolic, diastolic flow velocity and pulsation index in the A. cerebri anterior and developmental outcome at 12 month of age were studied by means of multivariate variance and discriminance analysis. The study involves 92 preterm infants, in whom flow measurement were performed in the first 3 days and the second week of life. The influence of additional perinatal risk factors like Apgar score, blood gas values and type of intensive care were taken in consideration: Doppler-sonographic flow parameters were found to be necessary coefficients of statistically significant discriminant functions, which differentiate between infants with normal or delayed psycho-motoric development or cerebral palsy. However, in comparison to the other risk factors their weight for differentiation is low. Parameters of immediate postnatal adaptation like apgar score and blood gas values decide quality of developmental outcome in infants with as well as without ultrasonographically proven neonatal brain damage. In infants with neonatal ventricular hemorrhages only a distinct influence of immaturity was observed additionally.
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PMID:[Prognostic value of Doppler ultrasound blood flow measurements in the anterior cerebral artery of premature infants]. 205 57

The prevalence at school age of cerebral palsy and severe education subnormality in children of low birthweight (less than or equal to 4 lb=1814 g) born to residents in the region served by the South East Thames Regional Health Authority in the early 1970s was compared with that in children of the same birthweight born in 1950-53. The prevalence of one or both of these defects was lower in the 1970s cohort; this was due to both a fall in the incidence of extreme gestational immaturity among children of low birthweight and a reduction in risk of defects to the gestationally immature births that occurred. The decreased risk of these defects in children of low birthweight was approximately counter-balanced by the increased likelihood of their survival; among children of all birthweights the prevalence of these defects attributable to children of very low birthweight changed little.
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PMID:Cerebral palsy and severe educational subnormality in low-birthweight children: a comparison of births in 1951-53 and 1970-73. 612 Nov 91

We assessed the extent to which use of medical record data might improve gestational age estimates compared with reliance on the birth certificate alone. Using population-based data from four northern Californian counties, we constructed an algorithm to select the best gestational age estimate from antenatal assessments recorded in medical records. A total of 172 singletons with moderate or severe congenital cerebral palsy from the California Cerebral Palsy Project were compared with 472 randomly selected controls with regard to discrepancies between the algorithm-derived estimated gestational age (bestgest) and an estimate based solely on the last menstrual period as recorded on birth certificates. Agreement between bestgest and birth certificate estimated gestational age was exact or within one week for at least 60% of both cases and controls in each of the three birthweight strata. In general, the greater the birthweight of the babies, the better the agreement. The mean number of weeks of overestimation by the birth certificate was 0.7 weeks for cases and 1.1 weeks for controls in the lowest birthweight group (< 1500 g). When compared with bestgest, clinical examination of the infant also tended to overestimate gestational age. In the < 1500 g birthweight group, cases were twice as likely as controls to have a bestgest of 'low certainty,' but antenatal estimates of 'high certainty' were obtained for at least a third of very low birthweight babies born during the mid-1980s. More widespread use of early ultrasound in more recent birth cohorts may result in a greater proportion of accurate antenatal estimates. When a distinction between immaturity and intrauterine growth retardation is important to the understanding of the aetiology of the outcome under investigation, the use of antenatal estimates from medical records may substantially improve the certainty of the data.
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PMID:Assessment of gestational age using birth certificate data compared with medical record data. 924 92

The aim of this study was to examine the character of motor dysfunction in individuals with Angelman syndrome (AS). Thirty-three children and adolescents (median age 6 years, range 18 months to 23 years) were consecutively investigated for learning disability, epilepsy, and motor dysfunction to detect suspected AS. Twenty-three individuals (13 males, 10 females; median age 5 years 6 months, range 21 months to 23 years) fulfilled international consensus criteria for AS. Clinical diagnosis was supported by a positive DNA methylation test in eleven participants. Ten participants (seven males, three females; median age six years, range 18 months to 13 years) did not comply with consensus criteria for AS and were regarded as a comparison group. There was no significant difference between the AS and the comparison group regarding age or developmental level. Median developmental quotient level was 26 months (range 8 to 63 months); median gross motor developmental level in participants with AS was 24 months (range 8 to 60 months); median fine motor developmental level was 15 months (range 6 to 60 months). Muscle strength, spasticity, tremor, and coactivation were assessed: distal lower limb spasticity, ataxic like gait, stiff lower limbs, and the presence of coactivation during locomotion were significantly more frequent in participants with AS than in the comparison group (p<0.05). Asymmetry of muscle strength and spasticity were frequent. Neurological abnormalities were insufficient for a diagnosis of cerebral palsy and impeded function less than immaturity in both AS groups. Risk of increasing impairment needs to be anticipated to prevent negative long-term effects of muscle imbalance and motor asymmetries in individuals with AS.
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PMID:Motor impairments, neurological signs, and developmental level in individuals with Angelman syndrome. 1570 39

To delineate the frequency, severity, and characteristics of the brain injury occurring in children surviving extremely premature birth, we reviewed brain magnetic resonance images (MRIs) of children with cerebral palsy whose birthweight was less than 1000 g and whose gestational age was less than 28 weeks. The patients were all enrolled in the state Children's Rehabilitative Services clinic, where cerebral palsy is an automatic qualifying condition. We tabulated the MRI findings with respect to the cerebellum, periventricular white matter, and corpus callosum. The inclusion criteria were met by 157 children; 94 had an MRI. The available scans were reviewed by the authors, and the findings were tabulated. Fifty scans were available for review. There were 4 totally normal scans, 18 scans had normal cerebellar imaging, and 8 scans were felt to have normal cerebral findings. The common cerebral abnormalities included decreased white-matter volume without gliosis (n = 36), periventricular leukomalacia (n = 16), and a thin corpus callosum (n = 18). Cerebellar abnormalities were found in 32. The cerebellar findings included destruction of major portions of the cerebellum (usually the inferior vermis and hemispheres) (n = 23) and focal or unilateral loss of cerebellar tissue (n = 4). The high incidence of injury to the cerebellum has not been previously appreciated. The most common cerebral injury is decreased volume of white matter in the periventricular regions without gliosis. The pattern of cerebellar injury suggests a vascular insult, and the deficient white matter without gliosis suggests immaturity of oligodendrogliocytes with limited response to injury. Both lesions are more or less unique to the age at which the insult occurred and represent an emerging, newly recognized type of cerebral palsy.
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PMID:Magnetic resonance imaging (MRI) findings in children surviving extremely premature delivery and extremely low birthweight with cerebral palsy. 1697 Aug 78

Extremely low birth-weight newborns (<1000g) experience low levels of thyroid hormone that vary inversely with the severity of neonatal illness and the extent of developmental immaturity with levels reaching a nadir at approximate, equals7 days after birth; this phenomenon can persist for several weeks. In the absence of transplacental passage, 30-50% of these neonates cannot generate sufficient quantities of thyroid hormone to meet postnatal demands, placing them at an increased risk for developmental delay and cerebral palsy. Population surveys and interventional trials suggest that a therapeutic opening exists during a 'window of opportunity' corresponding to this period of diminished capacity. Variables to consider before intervention focus on the consideration that supplementation of both the substrate thyroxine and the active hormone triiodothyronine may be necessary in quantities that do not suppress thyroid-stimulating hormone release, yet overcome the persistence of increased conversion to 3,3'5'-triodo-L-thyronine, terminal deiodination, and activity of the sulfation inactivation pathways, as well as the diminished capacity of the newborn to accommodate postnatal physiologic changes. Single daily replacement doses may suppress levels of converting enzymes in the brain, suggesting that physiologic 'mimicry' provided by a constant infusion may be the preferred dosing option. Properly powered clinical trials targeting long-term developmental outcomes are needed to discern whether these interventions will do more than simply elevate blood levels of thyroid hormones to the target values of either the fetus or developing neonate. Identifying the appropriate indications for supplementation may alleviate individual pain and distress due to disability for several hundred extremely low birth-weight neonates each year in the US alone, and save society a pro-rated lifetime cost of nearly $US1 million per child.
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PMID:Neonatal thyroxine supplementation for transient hypothyroxinemia of prematurity : beneficial or detrimental? 1710 19

A common language on CP has been developed for the European registers by the SCPE (Surveillance of Cerebral Palsy in Europe) working group and the common database allows prevalence analyses on a larger basis. CP prevalence increases with lower birthweight and higher immaturity. Increase of survival after preterm birth has first also increased CP rates. But already in the 80s this trend was reversed for LBW infants, and in the 90 s also for VLBW or very immature infants. The outcome with respect to CP in the group of extremely LBW or immature infants remains a matter of specific concern, as prevalence seems to be rather stable on a high level. CP is caused in more than 80% by brain lesions or maldevelopments which can be attributed to different timing periods of the developing brain. Extent and topography determine the clinical subtype of CP and are related also to the presence and severity of associated disabilities. CP, thus, offers a model to study plasticity of the developing brain. Reorganisation following unilateral lesions is mainly interhemispheric and homotopic. In the motor system, it involves the recruitment of ipsilateral tracts; functionality seems to be limited and decreases already towards the end of gestation. There is no clear evidence for substantial reorganisation in the sensory system. The best compensatory potential is described concerning language function following left hemispheric lesions. Language function reorganized to the right hemisphere eventually seems not to be impaired, this occurs, however, on the expense of primary right hemispheric functions.
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PMID:Cerebral palsy update. 1938 53

Prematurity apnea remains a major clinical problem that requires treatment choices which are sometimes difficult. Prematurity apnea occurs in most infants of gestational age at birth less than 33 weeks. It is a developmental disorder which usually reflects a "physiological" immaturity of respiratory control. However, neonatal diseases may be associated and play an additive role, resulting in an increased incidence of apnea. Careful screening should therefore be performed in order to make sure that no other factor than immaturity is involved in the occurrence of apnea. Short apnea (less than 10s, without hypoxemia and bradycardia), due to immaturity, are not clinically relevant. More prolonged apnea, that last for more than 15 or 20s, and / or apnea associated with bradycardia or oxygen desaturation, results in short-term disturbances of cerebral haemodynamics and oxygenation, which may negatively impact on neurodevelopmental outcome. Evaluating the immediate severity of apnea and the risks that apnea may affect long-term outcome remains a challenge. The choice of treatments is based on a few evidences. Caffeine citrate, which reduces the incidence of apnea, has been used for decades. However, a thorough evaluation of risks and benefits of this medication has been performed only recently. Caffeine citrate was found to be safe and resulted in unexpected benefits. In treated infants, compared with controls, indeed, a decreased incidence of the following complications was recorded: bronchopulmonary dysplasia at 36 weeks of conceptional age, patent ductus arteriosus, cerebral palsy at 18 months of age. Nasal CPAP can be used in association with caffeine citrate, when the latter is not effective enough.
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PMID:[Apnea of prematurity: what's new?]. 1994 73

The authors explored associations between blood gas abnormalities in more than 1,000 preterm infants during the first postnatal days and indicators of neonatal brain damage. During 2002-2004, women delivering infants before 28 weeks' gestation at one of 14 participating institutions in 5 US states were asked to enroll in the study. The authors compared infants with blood gas values in the highest or lowest quintile for gestational age and postnatal day (extreme value) on at least 1 of the first 3 postnatal days with the remainder of the subjects, with separate analyses for blood gas abnormalities on multiple days and for partial pressure of oxygen in the alveolar gas of <35. Outcomes analyzed were ventriculomegaly and an echolucent lesion on an ultrasound scan in the neonatal intensive care unit, and cerebral palsy, microcephaly, and a low score on a Bayley Scale of Infant Development at 24 months. Every blood gas derangement (hypoxemia, hyperoxemia, hypocapnia, hypercapnia, and acidosis) was associated with multiple indicators of brain damage. However, for some, the associations were seen with only 1 day of exposure; others were evident with 2 or more days' exposure. Findings suggest that individual blood gas derangements do not increase brain damage risk. Rather, the multiple derangements associated with indicators of brain damage might be indicators of immaturity/vulnerability and illness severity.
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PMID:Early blood gas abnormalities and the preterm brain. 2080 36

As late preterm infants are defined children born in the 340/7- 366/7 gestational age period. Their body mass is usually above 2500, that's why they are often incorrectly rated as mature by both parents and the medical professionals. Infants born in the period 34-37 g.a. are functionally and metabolically immature, they have a difficult postnatal adaptation. This explains the higher morbidity rate and the fourfold higher neonatal mortality in comparison to the babies born in term. The following review examines the reasons for the rising number of births in the period 34-37 g.a. The most common early disturbances of adaptation among the late preterm infants are described: hypothermia, hypoglycemia, respiratory distress syndrome, apnea, jaundice, nutrition disorders. Their therapy demands a long hospital stay and often expensive intensive care. The long-term disabilities among the late preterm infants are not well enough examined, but there is data for a higher cerebral palsy rate, hypotrophy, talking and behavior diversion. In the last 15 years the rate of the late preterm births has increased from 7% up to 10-12% of the total birth count. The indicators for conducting such births should be more precise. The care for the late preterm infant should take into consideration the level of immaturity and the numerous problems of adaptation.
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PMID:[The late preterm infants--time to put our mind]. 2323 34


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