The physical and developmental outcomes of children whose mothers are substance abusers: Analysis of associated factors and the impact of early intervention.

Background/objectives: Maternal illicit drug use is associated with negative physical and developmental outcomes for their born children. We aim to find out the incidence of different developmental problems in a cohort of Chinese children born to drug-abusing mothers, compare the physical health and developmental outcomes of the subjects recruited in the Integrated Program to the Comprehensive Child Development Service (CCDS), and to study the potential factors on their associations. Methods: A retrospective longitudinal cohort study with frequent clinical assessments of the children's physical and developmental outcomes in a HKSAR's regional hospital from birth until 5 years old. 123 Children in Integrated Program were compared with 214 children in CCDS between 1 January 2008 and 28 February 2019. Cox regression analysis was performed to determine the possible factors associated with the developmental outcomes. Results: Developmental delay was detected in 129 children (38.9%). CCDS group has significantly higher incidence of cognitive delay (p = < 0.001), language delay (p = < 0.001), motor delay (p = < 0.001), social delay (p = 0.002), and global delay (p = 0.002). On Cox multivariable regression analysis, integrated program (HRadj 0.53, 95% C. I. 0.34-0.84), social support (HRadj 0.45, 95% C.I. 0.25-0.80), and maternal abstinence from drug use up to 2-year post-delivery (HRadj 0.62, 95% C.I. 0.40-0.95) were significant protective factors, while male gender (HRadj 1.73, 95% C.I. 1.18-2.54) was a significant risk factor. Conclusion: CCDS achieves early engagement of drug-abusing expectant mothers during pregnancy, and an early integrated program with multidisciplinary collaboration was an independent factor in improving the developmental outcomes of these vulnerable children.

Routine Screening Ultrasound in Children With Cleft Palate and/or Lip: A Single Center Experience.

The aim of this study is to evaluate the incidence of associated congenital anomalies that is picked up by screening ultrasound of the heart, urinary system, and central nervous system (CNS) of children with cleft palate and/or lip deformities in a single regional center. A total of 225 children with cleft deformities were recruited in the study in 2009 to 2013, 91% of them underwent screening echocardiogram and of these, 98% of them were normal findings that do not require further follow-up ultrasound or treatment. Total 85% of the children underwent screening ultrasound of the urinary system and CNS, and of these, 99% were reported to have normal findings. Medium term follow-up of these children did not reveal any significant structural anomalies in the heart, brain, and urinary system that might have missed in the initial ultrasound screening. The authors suggest that in resource-limited settings, routine ultrasound screening of the heart, the CNS, and the urinary system may not be required in asymptomatic and nonsyndromic infants with cleft deformities and in those with "lip-only" cleft deformity.

Norovirus as cause of benign convulsion associated with gastro-enteritis.

AIM: Rotavirus and norovirus gastro-enteritis (GE) are common in children. Complications, except severe dehydration, are rare. Rotavirus was known to cause seizures and even GE encephalopathy, but these complications are less described in norovirus infection. The objective of this study is to compare the demographic features, clinical manifestations including the incidence of afebrile seizure, and the outcomes in children with rotavirus and norovirus infections. METHODS: This is a retrospective review of children between age 1 month and 6 years admitted to the paediatric department of a regional hospital in Hong Kong with rotavirus and norovirus infections over a period of 3 years from 1 June 2006 to 31 May 2009. Their demographic data, clinical features, laboratory results and outcomes were compared and analysed. RESULTS: Two hundred and thirty-two children with rotavirus and 173 children with norovirus GE were admitted within the study period. Afebrile seizure commonly occurred in norovirus infection (8.67% vs. 1.29%, P < 0.001). Children with rotavirus infection had higher temperature and more diarrhoea episodes, while more blood-stained stool was noted in the norovirus group. Rotavirus-infected patients stayed longer in hospital. All of them had full recovery without any complication. Among the 18 patients who developed afebrile convulsions, 17 of them had neuroimaging performed, which was normal. Fourteen of them had electroencephalogram (EEG) performed, demonstrating normal or non-specific findings. None of them developed subsequent seizure attack after the GE episode. CONCLUSIONS: Norovirus is more commonly associated with benign convulsion in GE than rotavirus. We need to identify the presence of virus, in particular norovirus, in children with GE and afebrile generalised tonic-clonic seizure. Further neuro-investigations may not be necessary once the aetiology is established. Prognosis is excellent in this group of children and prophylactic anticonvulsant is not needed.