The impact of the environment on neurodevelopmental disorders in early childhood

Abstract Objectives: To review the literature about the environmental impact on children's mental, behavior, and neurodevelopmental disorders. Sources of data: A nonsystematic review of papers published on MEDLINE-PubMed was carried out using the terms environment and mental health or psychiatric disorders or neurodevelopmental disorders. Summary of findings: Psychopathology emerges at different developmental times as the outcome of complex interactions between nature and nurture and may impact each person in different ways throughout childhood and determine adult outcomes. Mental health is intertwined with physical health and is strongly influenced by cultural, social and economic factors. The worldwide prevalence of psychiatric disorders in children and adolescents is 13.4%, and the most frequent are anxiety, disruptive behavior disorders, attention deficit hyperactivity disorder and depression. Neurodevelopment begins at the embryonic stage and continues through adulthood with genetic differences, environmental exposure, and developmental timing acting synergistically and contingently. Early life experiences have been linked to a dysregulation of the neuroendocrine-immune circuitry which results in alterations of the brain during sensitive periods. Also, the environment may trigger modifications on the epigenome of the differentiating cell, leading to changes in the structure and function of the organs. Over 200 million children under 5 years are not fulfilling their developmental potential due to the exposure to multiple risk factors, including poverty, malnutrition and unsafe home environments. Conclusions: Continued support for the promotion of a protective environment that comprises effective parent-child interactions is key in minimizing the effects of neurodevelopmental disorders throughout the lifetime.

Chin tremor in full-term neonate after hypoxia / Tremor de mento em recém-nascido no termo após hipóxia neonatal

CONTEXT: Newborns may present a range of motor phenomena that are not epileptic in nature. Chin tremor is an unusual movement disorder that typically starts in early childhood and may be precipitated by stress and emotion. Its pathophysiology has not been fully elucidated. CASE REPORT: We describe a full-term newborn that, immediately after neonatal anoxia, presented body and chin tremors that were unresponsive to anti-epileptic drugs. Subsequent neurological evaluation revealed signs of pyramidal tract damage and chin tremor triggered by percussion and crying. We discuss the hypothesis that the anatomopathological abnormality may lie at the level of the higher cortical centers or midbrain. CONCLUSIONS: Further studies are needed in order to gain greater comprehension of neonatal tremors. Recognition of the various etiological possibilities and consequent management of treatable causes is essential for care optimization.

CONTEXTO: O recém-nascido está sujeito a uma gama de fenômenos motores de natureza não epiléptica. O tremor do mento é um distúrbio do movimento incomum que tem início habitual na infância e pode ser precipitado por estresse e emoção. Sua fisiopatologia não foi completamente elucidada. RELATO DE CASO: Descrevemos um recém-nascido no termo, que, após anóxia neonatal, apresentou tremor de corpo e mento não responsivo ao uso de drogas antiepilépticas. A avaliação neurológica posterior revelou sinais de lesão do trato piramidal e tremor de mento desencadeado por choro e percussão. Discutimos a hipótese de que as alterações anatomopatológicas estejam localizadas no mesencéfalo ou centros corticais superiores. CONCLUSÕES: São necessários novos estudos para maior compreensão dos tremores em recém-nascidos. O reconhecimento das diversas possibilidades etiológicas e o decorrente manejo das causas tratáveis são essenciais para a otimização do atendimento.

Perfil de pacientes com disrafismos espinhais atendidos em ambulatório de pediatria geral / Profile of patients with spinal dysraphism from an outpatient clinic

Objetivo: Descrever o perfil clínico dos pacientes portadores de disrafismos espinhais atendidos no ambulatório de Pediatria Geral do Hospital São Paulo - Universidade Federal de São Paulo. Método: Estudo retrospectivo de 61 pacientes com diagnóstico de disrafismo atendidos no período de 1997 a 2007. Resultados: Dentre os 61 pacientes, 32 (52,5%) eram do sexo masculino, e a idade de início no serviço apresentou mediana de 3 meses. O número médio de consultas por paciente foi de 1 a cada 2,5 meses. Em relação ao último atendimento, 33 (54,0%) pacientes encontravam-se eutróficos, 56 (91,8%) estavam com a vacinação em dia, 47 (77,0%) apresentavam alimentação adequada e desenvolvimento neuropsicomotor de acordo com o esperado foi verificado em 25 (40,9%). Os diagnósticos mais prevalentes foram: meningomielocele em 57 (93,4%) doentes;...

Objectives: To describe the clinical profile of patients with spinal dysraphism enrolled in a pediatric outpatient clinic in the Federal University of São Paulo. Methods: A retrospective data gthering was conducted in the patients files classified under the diagnosis of spinal dysraphism from the period of 1997 to 2007. Results: In a 61 sample, 32 (52.5%) were male. Initial age of follow up had a three months median. Appointments were schedule in average every 2.5 months. Also, regarding the last appointment: 33 (54.0%) were eutrophic, vaccination was due in 56 cases (91.8%), adequate dietetic behavior was founded in 47 (77.0%) and development delay in 25 (40.9%) patients. The most prevalent diagnosis was myelomeningocele 57 (93.4%) patients; followed by hydrocephalus 48 (78.6%); recurrent urinary tract infection 29 (47.5%); neurogenic bladder dysfunction 28 (45.9%); orthopedic deformities 25 (40.9%) and constipation 16 (26.2%)...