ABSTRACT
This was a retrospective review to determine predictors of outcome in term infants with hypoxic ischaemic encephalopathy (HIE) at the University Hospital of the West Indies. Ninety-five neonates fulfilled criteria for entry into the study of these 34 (36%) had a poor outcome. The stage of encephalopathy, seizures on admission, the need for more than one antiepileptic for seizure control and an abnormal neurological examination at hospital discharge were found to be associated with poor outcome. Multiple logistic regression analyses showed that an abnormal neurological examination at discharge was the only independent predictor of poor outcome. Babies who had an abnormal neurological examination at hospital discharge were more likely to have a poor outcome (odds ratio 2.6, confidence interval 0.03-0.4). An abnormal neurological examination at discharge had a positive predictive value of 88% and a negative predictive value of 84% for poor outcome, with a sensitivity and specificity of 60 and 96%, respectively. We recommend that if post-HIE, an infant has an abnormal neurological examination at the time of discharge from hospital, that infant should be followed up and monitored in a specialist neurology clinic and parents counselled about the guarded prognosis for normal neurodevelopmental outcome.
Subject(s)
Anticonvulsants/administration & dosage , Hypoxia-Ischemia, Brain/drug therapy , Neurologic Examination/methods , Seizures/drug therapy , Cephalometry/methods , Child , Electroencephalography/methods , Female , Hospitals, University , Humans , Hypoxia-Ischemia, Brain/classification , Hypoxia-Ischemia, Brain/diagnosis , Hypoxia-Ischemia, Brain/mortality , Infant , Infant, Newborn , Male , Neonatal Screening , Predictive Value of Tests , Prognosis , Retrospective Studies , Seizures/complications , Seizures/diagnosis , Severity of Illness Index , Treatment Outcome , West Indies/epidemiologyABSTRACT
Sleep disorders are highly prevalent during childhood and adolescence. It is known that if left untreated, these problems can have significant impact on daytime function, including learning, memory, attention, and behavior. The approach to the treatment of these disorders (whether with or without pharmacotherapy) is dependent on a thorough evaluation of the sleep complaint and determination of an accurate diagnosis. Many pediatric sleep problems are due to insomnia. There is good evidence that young children with behaviorally based insomnia respond to appropriate behavioral interventions. There is less research evidence of the efficacy of these interventions in children who are either school age or adolescents; however, nonpharmacologic strategies are usually indicated initially in the approach to treatment. The indication for the use of pharmacotherapy in pediatric insomnia is not well understood; however, some general principles are described when medications may be considered. There are specific sleep disorders (other than insomnia) for which pharmacotherapy plus behavioral strategies are warranted. The research regarding pharmacotherapy in pediatric sleep disorders is limited; often, medications are used "off label" based on data extrapolated from adult studies. Clinicians who suggest over-the-counter treatments or prescribe medications for pediatric patients with sleep disorders should have an understanding of the classification of sleep disorders and the role of pharmacotherapy in the treatment of these disorders. In this chapter, the emphasis is on the pharmacologic treatment of sleep disorders in typically developing children and adolescents.
