[Prospective study on prognosis of infants with neonatal subependymal cysts].

OBJECTIVES: It is confirmed that most neonatal subependymal cysts (SEC) are closely correlated with intrauterine infection and the short-term prognosis of SEC is not very good. Little information about the long-term prognosis of SEC is available. The purpose of the present study was to explore the short-term and long-term prognosis of neonatal SEC cases via a 6-year follow up. METHODS: Seventy SEC neonates detected by cranial ultrasound between October 1993 and October 1994 were enrolled into SEC group and 70 healthy neonates into control group. Serum antibodies (IgG and IgM) to cytomegalovirus (CMV), toxoplasma and rubella virus and PCR for these pathogens (except for rubella virus) were measured in the two groups. CMV-PCR was also performed for urine specimens. Cranial sonography assessment, physical growth evaluation, Bayley developmental scale or Wyeth developmental scale, brain-stem auditory evoked potential (BAEP) and vision examination were undertaken at 3, 6, 12 months and 6 years in the two groups. RESULTS: The positive rate of CMV-IgM and blood CMV-PCR in SEC group was significantly higher than those of control group (19.1% vs. 5.7%, 12.9% vs. 2.9%). The positive rate of urine CMV-PCR in SEC group was also significantly higher (40% vs 17.1%). No significant difference could be found in the positive rate of PCR for toxoplasma and rubella-IgM between the two groups. The weight and height of infants with SEC were obviously lower than those in control group during the first year after birth. The parameters of the physical development in SEC infants reached the similar level as controls till 6 years old. However, the index of mental development below 80 was more often seen in infants with SEC comparing to that in control group during the whole six years. There were no abnormal findings either in BAEP or vision examination in the two groups. CONCLUSION: Infants with SEC may show a transient retardation of physical growth after birth, while their mental developmental retardation might last for longer time. It is suggested that cranial ultrasound examination should be performed in all neonates for the detection of SEC, and a longer follow-up should be done for infants with SEC.

[Effect of toxoplasma infection during pregnancy to the development of fetus and infant].

OBJECTIVE: To investigate the effect of Toxoplasma (Tox) infection during pregnancy to the development of fetus and infant. METHODS: Enzyme linked immunoadsorbent assay (ELISA) was employed to detect Tox-IgM in peripheral blood of 3,908 pregnant women. To Tox-IgM positive cases, the umbilical blood of their neonates were sampled to detect Tox-IgM and abortion tissues were sampled to detect Tox-DNA with polymerase chain reaction. Infection group included 95 cases whose Tox-IgM or DNA were positive, and control group consisted of 119 cases without infection. Different supervision methods were used to periodically observe the intelligence development of infants 3 and 12 months after birth in these two groups. After initial intervention, verbal intelligence quotients (VIQs), performance intelligence quotients (PIQs) and full scale intelligence quotients (FSIQs) were assessed when the infants were 1 and 4 years old of these two groups. RESULTS: The incidences of abortion, stillbirth, pre-term delivery, FGR and malformation in infection group were 12 cases (12.6%), 5 cases (5.3%), 4 cases (4.2%), 4 cases (4.2%) and 3 cases (3.2%), while the incidences of these abnormalities in control group were 3 cases (2.7%), 1 cases (0.9%), 2 cases (1.8%), 2 cases (1.8%) and 1 cases (0.9%). Comparing with these two groups, there was significant difference (P < 0.01). Relative risk (RR) of these 5 abnormalities was 4.7, 5.9, 2.3, 2.3 and 3.6 respectively. Mental development index (MDI) and psychomotor development index (PDI) of infants in infection group were 93 +/- 13 and 101 +/- 16. They were significantly lower than that of control group, which were 107 +/- 17 and 111 +/- 13. There was significant difference between these two groups (P < 0.05). After intervention in 1 and 4 years, their VIQs, PIQs and FSIQs were apparently improved (P < 0.05). CONCLUSION: Congenital Tox infection is closely correlated with abnormal pregnancy outcomes and infantile mental retardation. Early intervention can improve intelligence development.

The trends of changes in children's blood lead levels since the introduction of lead free gasoline in Shanghai.

OBJECTIVE: To describe trends of changes in blood lead levels in children aged 1 - 6 years during the time period before and after introducing lead free gasoline in Shanghai 1997 and 1999. METHODS: Blood lead levels of 1 969 children aged 1 - 6 years were determined by a sampling survey in five districts of Shanghai in August and September, 1997. Blood lead levels of the same population were re-determined by the same method from April to June in 1998 and from August to September in 1999. Filter paper blood lead test was carried out monthly using the filter paper blood lead proficiency testing program of Centers for Disease Control in the United States. The results from blood lead samples were under acceptable ranges during the study. RESULTS: The geometric means of blood lead levels were 83 microgram/L in 1997, 80 microgram/L in 1998 and 76 microgram/L in 1999, respectively. The prevalence rates of childhood lead poisoning (blood lead level was equal or more than 100 microgram/L) were 37.8% in 1997, 25.7% in 1998 and 24.8% in 1999. The amounts of decrease on average blood lead levels in the five districts between 1997 and 1999 were 10 microgram/L, 11 microgram/L, 6 microgram/L, 4 microgram/L and 2 microgram/L, respectively. CONCLUSION: Lead poisoning is a preventable disease. The average levels of lead in young children in Shanghai decreased significantly after the introduction of lead free gasoline to Shanghai. Lead emissions from vehicles running on leaded gasoline was one of the important contributors to increase the children's blood lead levels in Shanghai. Lead poisoning is not evenly distributed among children in Shanghai, resulting in the different levels of decline.