Auditory brainstem response latencies of infants and maternal eposure to environmental toxic product

OBJECTIVE: To explore the effects of pesticide exposure on the auditory system, specifically on hearing status based on auditory brainstem responses. METHODS: A cohort of pregnant women was identified in several communities in a rural area from April 2002 to February 2003 and followed up until delivery. Mother-infant dyads were assessed for exposure to pesticides. Maternal and fetal exposures to environmental toxic products were determined by measuring levels in maternal hair and blood, and infant cord blood, hair, and meconium, respectively. Hearing status was measured using otoacoustic emissions (OAE) and confirmed by diagnostic auditory brainstem responses (ABR) measured at 80, 60, and 40 decibels. Waves I, III, V were identified and absolute latencies measured, including inter-peak latencies from waves 11III, I-V, and III-V. Pesticide exposure was then correlated with latencies of Waves I, III, V, and interpeak latencies of waves I-III, IIV, and III-V. Hearing loss and pesticide exposures were correlated with Griffiths Mental Development Scores (GMDS). RESULTS: Significant delays in the ABR wave latencies were noted in the group with exposure to pesticides. Propoxur was the most common toxic product detected in infants and meconium the best substrate for its detection. There was a 1.4% risk of hearing loss with exposure to propoxur (RR=0.52 (0.12-2.30), p = 0.06), a 6.25% risk with cypermethrin exposure (RR= 4.53 (0.61133.64), P = 0.10) and 6.25% risk with pretilachlor exposure (3.13 (0.44-22.30), p = 0.07). Griffith's Mental Developmental Scale scores (GMDS- hearing and speech subscale and general quotient scores) were not significantly different between exposed and unexposed groups. However, three infants with positive exposures and hearing loss had below average, or low to average scores using this scale. CONCLUSION: Maternal exposure to environmental toxic products may affect the auditory pathway in infants at birth. Pregnant women should limit their exposure to such toxic products in order to avoid neurodevelopmental effects particularly on hearing because this is very important in the critical stage of language and speech development.

Validation of the pictorial pediatric symptom checklist - Filipino version for the psychosocial screening of children in a low-income urban community

RATIONALE. The timely identification of children with psycho social problems is very important in facilitating early intervention. Detection of these children in the community setting requires the development of an easy-to-use screening tool that can be used by community health workers. OBJECTIVE. To develop a valid and reliable screening tool that can be easily used by community health workers for the detection of psycho social problems in Filipino children. Specifically, 1) To develop a Filipino version of the Pictorial Pediatric Symptom Checklist (PPSC) for use by community health workers; and 2) To culturally validate the PPSC-Filipino version in a low-income urban community. METHODS. This study consisted of three phases: Phase 1 (Exploratory Study) consisted of focus group discussions and key informant interviews for content validation. Phase 2 (Questionnaire Development) involved refinement of the Filipino translation of the PPSC. In Phase 3 (Actual Survey), the PPSC was administered by health workers to 127 primary caregivers of children aged 4 to 7 years residing in a low-income community in Pandacan, Manila. Data gathered were subjected to reliability testing and factor analysis for construct validation. Chi-square analyses were done to determine the association of sociodemographic factors to overall PPSC results. RESULTS. Construct and content validity were confirmed. The Filipino PPSC showed high internal consistency (Cronbachs alpha 0.89). Factor analysis resulted in three new domains: 1) Attention & Externalizing Problems, 2) Internalizing Problems, and 3) School & Learning Problems. Among the 127 children screened, 24 (18.9%) were positive for psychosocial problems. Externalizing behaviors (fighting, rule-breaking, teasing) dominated among those who screened positive. The child age and number of siblings were the factors significantly associated with the overall PPSC results. CONCLUSIONS. The Pictorial Pediatric Symptom Checklist-Filipino Version is a valid and reliable tool in screening for psychosocial problems in children aged 4 to 7 years old residing in a low-income urban community. Administration by community health workers is feasible and its use in the community setting is particularly relevant since many cases of psychosocial disorders remain undetected.

A five-year review of referrals to the developmental pediatrics section of a major tertiary hospital

Developmental disabilities involve a delay in development based on that expected for a given age level or stage of development.1 These impairments which originate before age 18 are expected to continue indefinitely and constitute a substantial impairment that may create a burden to the family and society. In a developing country like the Philippines, it is a public health problem that remains largely undetected and neglected. Local attempts to organize more systematic diagnostic services are needed.Objectives. To review the referrals made to the Section of Developmental Pediatrics for evaluation and to describe the demographic and clinical patterns of the more common developmental disabilities identified.Methods. This was a retrospective study based on the clinical census of patients seen over a five-year period from January 2004 to December 2008 by the Section of Developmental Pediatrics.Results. Referrals made to the Section of Developmental Pediatrics were usually seen during the first decade of life, were mostly males and were usually referred for developmental delay. The three most common developmental disabilities identified were mental retardation or global developmental delay, autistic spectrum disorders and cerebral palsy.