Impact of the environmental layout of the neonatal intensive care unit on clinical outcomes and neurological development in very/extremely preterm infants / 中国当代儿科杂志

OBJECTIVES@#To investigate the impact of the environmental layout of the neonatal intensive care unit (NICU) on clinical outcomes and neurological development in very/extremely preterm infants.@*METHODS@#A total of 304 very/extremely preterm infants admitted to Children's Hospital of Chongqing Medical University between January 2021 and June 2022 within 24 hours after birth were included in this retrospective cohort study. Based on different environmental layouts in the NICU, the infants were divided into two groups: centralized layout group (n=157) and decentralized layout group (n=147). The clinical outcomes and Test of Infant Motor Performance (TIMP) scores at corrected gestational age between 34 to 51+6 weeks were compared between the two groups.@*RESULTS@#The decentralized layout group had lower incidence rates of bronchopulmonary dysplasia (44.9% vs 62.4%, P<0.05) and intracranial hemorrhage (17.7% vs 28.0%, P<0.05) than the centralized layout group. The cure rate was higher in the decentralized layout group compared to the centralized layout group (68.7% vs 56.7%, P<0.05). The decentralized layout group had higher TIMP scores than the centralized layout group at corrected gestational age between 34 to 51+6 weeks (P<0.05).@*CONCLUSIONS@#The decentralized layout of the NICU exhibits positive effects on the clinical outcomes and early neurological development compared to the centralized layout in very/extremely preterm infants.

Effects of assisted reproductive technology on physique and autistic behavior of children： a 3-year longitudinal follow-up study / 四川精神卫生

BackgroundAssisted reproductive technology is increasingly mature and widely used in clinic. As more and more newborns are born with assisted reproductive technology， the health problems of these newborns also need more attention. ObjectiveTo investigate the effects of assisted reproductive technology on newborn physique and autistic behavior， and to raise the attention of autistic behavior of assisted reproductive children. MethodsFrom the medical record information system， 588 assisted reproduction newborns （assisted reproduction group） born in the obstetrics department of Chaohu Hospital of Anhui Medical University from August 2018 to August 2019 were selected as the study objects. From the medical records information system， 600 newborns born naturally in the obstetrics department in the same period of time were selected as the control group. The basic information of all newborns was collected， including the mother's age and years of education， sex， gestational age， birth weight and birth length， and they were assessed by the Clancy Autism Behavior Scale （CABS） at 3 years of follow-up. ResultsThe educational years of mothers in assisted reproduction group were longer than those in control group ［（12.04±1.96） years vs. （11.34±2.90） years， t=-4.887， P<0.01］， gestational age and birth weight of assisted reproduction group were lower than those of control group ［（38.68±2.56） weeks vs. （39.53±2.91） weeks， t=5.315， P<0.01； （3 273.27±720.39） g vs. （3 158.29±701.74） g， t=2.792， P<0.05］. There was no significant difference in birth length between the two groups ［（49.97±5.94） cm vs. （50.07±6.08） cm， t=-0.287， P>0.05］. At the age of three， the weight and height of the assisted reproduction group were both lower than those of the control group ［（16.16±2.53）kg vs.（16.96±1.67）kg， t=6.393， P<0.01， （95.81±4.50）cm vs.（97.47±7.49）cm， t=4.626， P<0.01］. Respectively， 6 （1.00%） and 15 （2.55%） children with autism were detected in the control group and assisted reproduction group， and the difference was statistically significant （χ2=4.113， P<0.05）. ConclusionAssisted reproductive technology may affect the physical and neurological development of children. ［Funded by Outstanding Young Talents Support Program of Anhui Education Department （number， gxyqZD2022022）］

The effects of enhanced breastfeeding management on the neurodevelopmental outcomes of preterm infants in neonatal intensive care unit / 中国新生儿科杂志

Objective:To study the effects of enhanced breastfeeding management on the neurodevelopmental outcomes of preterm infants in neonatal intensive care unit (NICU).Methods:From January to December 2020, preterm infants with gestational age (GA) ≥32 weeks admitted to NICU of our hospital were randomly assigned into the enhance group and the control group. Breast-feeding education using WeChat and routinely playing recorded mother's sound to the infants were carried out in the enhance group, while conventional management was carried out in the control group. Breastfeeding status was followed up regularly in both groups. Mental development index (MDI) and psychomotor development index (PDI) at 6-month of corrected GA were measured using Infant Intelligence Development Scale.Results:A total of 109 cases were included in the enhance group and 118 cases in the control group. The breast-feeding rates in the enhance group were significantly higher than the control group at discharge, 3-month and 6-month of corrected GA [88.1% (96/109) vs. 61.0% (72/118), 90.8% (99/109) vs. 67.8% (80/118), 88.1% (96/109) vs. 61.9% (73/118)] ( P<0.05). MDI and PDI at 6-month of corrected GA in the enhance group were significantly higher than the control group [(106.2±10.7) vs. (101.9±11.4), (103.4±13.7) vs. (99.5±11.6)] ( P<0.05). Conclusions:Enhanced breast-feeding management is helpful improving the breast-feeding rate of preterm infants in NICU and beneficial to the neurodevelopment of preterm infants.

Comparison in physical and neurological development between two types of children born small for gesta-tional age / 国际儿科学杂志

Almost 3% of newborns are diagnosed as small for gestational age(SGA)worldwide.Born SGA is one of the important causes of perinatal morbidity and mortality,and is also associated with metabolic diseases in adulthood.Low birth weight by itself is insufficient to characterize growth restriction,as it does not include information about the neonate’s body proportionality.Depending on the origin,timing and severity of in-sult,small for gestational age infants are classified into two types:proportionate or symmetric growth restriction (SGR)and disproportionate or asymmetric growth restriction(AGR).There may be differences in physical and neurological development of these two types.This study compares three classification indexes,and to find differ-ences in postnatal growth of these two types.

Hipotiroidismo congénito: un diagnóstico que no debemos olvidar / Congenital hypothyroidism: a diagnosis not to forget

Summary: Congenital hypothyroidism (CH) is the most common cause of preventable mental retardation. Since 1994, Chile has a national plan for mass screening all newborns to diagnose the disease. Currently, the CH incidence is approximately 1:3163 newborn (NB). Approximately, 10 percent of these cannot be identified by screening programs, so the clinical suspicion is fundamental in the diagnosis. The most frequently clinical features observed in neonates or young infants are the presence of a posterior fontanelle greater than 5 mm, umbilical hernia and dry skin. It is important to determine the etiology of CH, but the etiological study should not delay the start of treatment. Early treatment determines a better prognosis of neurological development. A review of the CH screening program, pathophysiology, clinical presentation, and aspects of the study and treatment are presented in this study.

El hipotiroidismo congénito (HTC) es la causa más frecuente de discapacidad intelectual prevenible. Desde el año 1994 existe en Chile un plan nacional de tamizaje masivo a todos los recién nacidos para el diagnóstico de la enfermedad. Actualmente, la incidencia de HTC es de aproximadamente 1:3 163 recién nacidos (RN). Hasta un 10 por ciento de éstos puede no ser identificado por los programas de tamizaje, por lo que es importante la sospecha clínica del diagnóstico. Las características clínicas más frecuentemente observadas en RN o lactantes pequeños son la presencia de una fontanela posterior mayor de 5 mm, hernia umbilical y piel seca. Es importante determinar la etiología del HTC, pero el estudio etiológico no debe retrasar el inicio del tratamiento. El inicio precoz de éste determina un mejor pronóstico de desarrollo neurológico. Se presenta una revisión del programa de tamizaje de HTC, su fisiopatología, presentación clínica, y aspectos del estudio y tratamiento.

O retardo mental na distrofia muscular de Duchenne / Mental retardation in Duchenne muscular dystrophy

OBJETIVO: Fazer um levantamento da literatura médica destinada ao estudo das disfunções cognitivas nos pacientes com distrofia muscular de Duchenne, através da descrição dos marcos do desenvolvimento neuropsicomotor e dos testes psicométricos para quantificação da inteligência. FONTES DOS DADOS: Revisão não sistemática sobre os aspectos da cognição na distrofia muscular de Duchenne nas principais bases médicas científicas: MEDLINE, LILACS, Biblioteca Cochrane e SciELO. SÍNTESE DOS DADOS: Os pacientes com distrofia muscular de Duchenne apresentaram atraso para marcha e desenvolvimento da linguagem, os quais se correlacionaram a menores pontuações nos testes de inteligência no futuro. Há marcante disfunção nos subtestes das habilidades verbais. CONCLUSÕES: A média do coeficiente de inteligência encontra-se com um desvio padrão abaixo da média populacional. Quanto maior a disfunção cognitiva, piores serão os aspectos relacionados à morbidade e mortalidade na doença.

OBJECTIVE: To survey the medical literature directed to the study of cognitive dysfunction in patients with Duchenne muscular dystrophy through description of the milestones of neurological development and psychometric tests for quantifying intelligence. SOURCES: Non-systematic review of aspects of cognition in Duchenne muscular dystrophy in the major medical scientific bases: MEDLINE, LILACS, SciELO and Cochrane Library. SUMMARY OF THE FINDINGS: Patients with Duchenne muscular dystrophy exhibited delay in walking and language development, which correlated with lower scores on future intelligence tests. There is marked impairment in the verbal subtests. CONCLUSIONS: Average IQ has standard deviation below the average of the population. The greater the cognitive impairment, the worse aspects related to morbidity and mortality in the disease will be.

Alteraciones del desarrollo neurológico en niños nacidos de madres con VIH

El desarrollo neurológico es una parte fundamental en el sano crecimiento de un niño; sin embargo, existen factores que pueden detener su desarrollo y causar deterioro, entre ellos factores infecciosos y socioculturales. Los niños que nacen de una madre infectada con el virus de inmunodeficiencia humana (VIH) en algunos casos adquieren la infección y, en otros, logran escapar de ella. Independientemente de su condición de infectados. Existe un subgrupo de niños que adicionalmente tiene exposición farmacológica in útero a los potentes antirretrovirales usados por las madres infectadas durante la gestación. Se sabe que los niños infectados por el VIH tienen una amplia variedad de trastornos cognoscitivos y motores y, en la medida en que progresa la inmunodeficiencia, el riesgo de tener infecciones oportunistas a nivel cerebral aumenta. Está demostrado que aun los niños no infectados, pero nacidos de madres infectadas, no están exentos de presentar alteraciones cognoscitivas y motoras. Los diferentes problemas neurológicos que enfrentan los niños nacidos de madres infectadas por el VIH, no sólo se explican por la existencia de infecciones en el niño o la madre, sino por la presencia de factores adversos de tipo sociocultural, los cuales pueden afectar el desarrollo cerebral en grados diversos. Ante esta situación es importante que el médico reconozca en forma temprana las alteraciones neurológicas que se presentan, con el propósito de proporcionar un manejo oportuno e incluso para poder prevenir su evolución.

Neurological development is a fundamental part of a child's healthy growth, however, there are factors that can stop his development or that can cause deterioration, amongst them infectious and socio-cultural factors. In some cases, children that are born from a mother infected with the Human Immunodeficiency Virus (HIV) acquire the infection and in others they can escape it. Apart from the condition of their infection status, there is a subgroup of children that additionally have in uterus pharmacological exposure to antiretrovirals, used by their mothers during gestation. It is well known that children infected with HIV have a vast variety of cognitive and motor disturbances, and that as the immunodeficiency progresses, they have a risk of opportunistic infections at cerebral level. It has been demonstrated that even children without infection, but born from infected mothers are not exempt from presenting cognitive and motor disturbances. The different neurological problems that children born from HIV+ mothers present are not only explained by the child's or mother's infection, but by the presence of adverse factors, socio-cultural ones, that can affect cerebral development on different levels. Due to this situation it is important to recognize neurological alterations as early as possible with the aim of providing a timely management and even to prevent them.

Síndrome de Pfeiffer tipo 2 con expresividad variable

Introducción. Objetivo: presentar un caso clínico de síndrome de Pfeiffer, de 5 años de edad, con cráneo en trébol, proptosis ocular severa, y aparentemente sin retardo mental Caso clínico. Niño de 5 años de edad, producto de segunda gesta, embarazo normoevolutivo de término; padres de 19 años de edad al momento de nacer el propositus, sin antecedentes teratogénicos, ni consanguinidad o de otro padecimiento similar en miembros de la familia. A la exploración física: cráneo en trébol, frente amplia y prominente, proptosis ocular (antecedente de salida del globo ocular derecho en dos ocasiones), aplanamiento medio facial, pabellones auriculares con hélix de configuraciones en cruz horizontal, primer dedo de manos y pies anchos de su falange distal, sindactilia parcial en manos y pies. El cariotipo en linfocitos de sangre periférica mostró un complemento cromosómico normal 46, XY. Radiológicamente se observó cráneo en trébol, con múltiples impresiones digitales. Conclusión. El caso presentado aquí corresponde clínica y radiológicamente a un síndrome de Pfeiffer tipo 2, sin complicaciones viscerales y con desarrollo neurológico de acuerdo a su edad cronológica.

Introduction. Since 1964, about 30 cases of Pfeiffer syndrome type 2 have been informed; this variant is characterized by cloverleaf skull, prominent forehead, severe ocular proptosis, severe central nervous system damage, elbow synostosis, and early death. Case report. A 5 years old male withouth antecedents of consanguinity, teratogenic exposure of his parents (of 19 years of age at the time of the bird of patient), or familial malformation, was admitted. On physical examination a cloverleaf skull, wide forehead, ocular proptosis (in 2 previous occasions the right eye exited), mid facial flattening, horizontal cross configuration of ear helix, widening of the first finger of hand and feet, and partial syndactyly of hands and feet were observed. A normal 46 XY cariotype, and a normal neural development were found. Discussion. We present a case of Pfeiffer syndrome type 2 without visceral complications and normal neurologic development.

Influence of Preterm Premature Rupture of Membranes on Neurological Development of Preterm Infants / 实用儿科临床杂志

Objective To investigate the influence of preterm premature rupture of membranes (PPROM) on neurological development of preterm infants.Methods The preterm infants were classified into 2 groups( PPROM group and control group).The neonatal behavioral neurological assessment (NBNA) and CDCC of infants in two groups were measured and compared after retrieved:gestational age 40 weeks,3 months and 6 months.Results Psycho-moter developmental index(PDI) of PPROM group after retrieved gestational age 3,6 months was significantly lower than that of control group(Pa