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1.
Arq Neuropsiquiatr ; 70(8): 593-8, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22899030

ABSTRACT

OBJECTIVE: To compare gross motor development of preterm infants (PT) without cerebral palsy with healthy full-term (FT) infants, according to Alberta Infant Motor Scale (AIMS); to compare the age of walking between PT and FT; and whether the age of walking in PT is affected by neonatal variables. METHODS: Prospective study compared monthly 101 PT and 52 FT, from the first visit, until all AIMS items had been observed. RESULTS: Mean scores were similarity in their progression, except from the eighth to tenth months. FT infants were faster in walking attainment than PT. Birth weight and length and duration of neonatal nursery stay were related to walking delay. CONCLUSION: Gross motor development between PT and FT were similar, except from the eighth to tenth months of age. PT walked later than FT infants and predictive variables were birth weight and length, and duration of neonatal intensive unit stay.


Subject(s)
Child Development/physiology , Infant, Low Birth Weight/growth & development , Infant, Premature/growth & development , Term Birth/physiology , Walking/physiology , Age Factors , Female , Gestational Age , Humans , Infant , Infant, Newborn , Intensive Care Units , Length of Stay , Male , Motor Skills/physiology , Perinatal Care , Prospective Studies , Regression Analysis , Socioeconomic Factors
2.
Arq. neuropsiquiatr ; 70(8): 593-598, Aug. 2012. ilus, tab
Article in English | LILACS | ID: lil-645370

ABSTRACT

OBJECTIVE: To compare gross motor development of preterm infants (PT) without cerebral palsy with healthy full-term (FT) infants, according to Alberta Infant Motor Scale (AIMS); to compare the age of walking between PT and FT; and whether the age of walking in PT is affected by neonatal variables. METHODS: Prospective study compared monthly 101 PT and 52 FT, from the first visit, until all AIMS items had been observed. Results: Mean scores were similarity in their progression, except from the eighth to tenth months. FT infants were faster in walking attainment than PT. Birth weight and length and duration of neonatal nursery stay were related to walking delay. CONCLUSION: Gross motor development between PT and FT were similar, except from the eighth to tenth months of age. PT walked later than FT infants and predictive variables were birth weight and length, and duration of neonatal intensive unit stay.


OBJETIVO: Comparar o desenvolvimento motor de lactentes pré-termo sem paralisia cerebral (PT) com lactentes normais nascidos a termo (T), de acordo com Escala Motora Infantil de Alberta (AIMS); comparar idade da marcha entre PT e T e se a idade da marcha em PT é passível de ser afetada. MÉTODOS: Estudo prospectivo com 101 PT e 52 T, seguidos mensalmente até que todos os itens da AIMS tivessem sido observados. Resultados: Os escores médios apresentaram semelhanças entre os grupos, com exceção do oitavo ao décimo meses. Os lactentes T iniciaram marcha antes dos PT. Peso, estatura ao nascimento e tempo de internação na unidade de terapia intensiva neonatal (UTIN) foram preditivos. CONCLUSÃO: O desenvolvimento motor entre PT e T foi semelhante, exceto entre o oitavo e o décimo meses de idade. PT andaram mais tardiamente e variáveis preditivas foram peso, estatura ao nascimento e o tempo de permanência na UTIN.


Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Child Development/physiology , Infant, Low Birth Weight/growth & development , Infant, Premature/growth & development , Term Birth/physiology , Walking/physiology , Age Factors , Gestational Age , Intensive Care Units , Length of Stay , Motor Skills/physiology , Perinatal Care , Prospective Studies , Regression Analysis , Socioeconomic Factors
3.
J Bone Joint Surg Am ; 91(7): 1729-37, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19571096

ABSTRACT

BACKGROUND: The criteria and timing for nerve surgery in infants with obstetric brachial plexopathy remain controversial. Our aim was to develop a new method for early prognostic assessment to assist this decision process. METHODS: Fifty-four patients with unilateral obstetric brachial plexopathy who were ten to sixty days old underwent bilateral motor-nerve-conduction studies of the axillary, musculocutaneous, proximal radial, distal radial, median, and ulnar nerves. The ratio between the amplitude of the compound muscle action potential of the affected limb and that of the healthy side was called the axonal viability index. The patients were followed and classified in three groups according to the clinical outcome. We analyzed the receiver operating characteristic curve of each index to define the best cutoff point to detect patients with a poor recovery. RESULTS: The best cutoff points on the axonal viability index for each nerve (and its sensitivity and specificity) were <10% (88% and 89%, respectively) for the axillary nerve, 0% (88% and 73%) for the musculocutaneous nerve, <20% (82% and 97%) for the proximal radial nerve, <50% (82% and 97%) for the distal radial nerve, and <50% (59% and 97%) for the ulnar nerve. The indices from the proximal radial, distal radial, and ulnar nerves had better specificities compared with the most frequently used clinical criterion: absence of biceps function at three months of age. CONCLUSIONS: The axonal viability index yields an earlier and more specific prognostic estimation of obstetric brachial plexopathy than does the clinical criterion of biceps function, and we believe it may be useful in determining surgical indications in these patients.


Subject(s)
Birth Injuries/diagnosis , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus/physiopathology , Neural Conduction , Action Potentials , Birth Injuries/surgery , Brachial Plexus Neuropathies/surgery , Female , Humans , Infant , Infant, Newborn , Male , Muscle Strength , Patient Selection , Prognosis , ROC Curve , Sensitivity and Specificity , Upper Extremity/innervation
4.
J Hand Surg Am ; 32(7): 999-1004, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17826552

ABSTRACT

PURPOSE: The real utility of needle electromyography (EMG) for evaluation of infants with obstetric brachial plexopathy remains controversial. The objective of this paper is to evaluate how EMG correlates with clinical evaluation of these patients. METHODS: We performed EMG in 41 infants (42 arms) with severe obstetric brachial plexopathy who were from 3 to 12 months of age. We correlated the EMG interference pattern with the clinical assessment of infraspinatus, deltoid, biceps, triceps, and extensor digitorum communis muscles. RESULTS: Motor unit potentials were always present, and abnormal spontaneous activity was not common in proximal muscles. The correlation between EMG interference pattern and clinical assessment was not good, except for extensor digitorum communis. EMG showed higher scores than clinical evaluation for infraspinatus, deltoid, and biceps muscles. Respiratory synkinesis was present in 19 patients, or 45% of the affected arms, and it could involve any muscle innervated from C5 to T1. CONCLUSIONS: Needle EMG fails to estimate or overestimates clinical recovery in proximal muscles in this age group.


Subject(s)
Birth Injuries/physiopathology , Brachial Plexus Neuropathies/physiopathology , Electromyography , Muscle, Skeletal/innervation , Humans , Infant , Muscle, Skeletal/physiopathology , Respiration , Respiratory Muscles/physiopathology
5.
Arq Neuropsiquiatr ; 64(1): 30-4, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16622549

ABSTRACT

We did a case-control study to verify if the birthweight, forceps delivery or perinatal asphyxia have any significant effect on the prognosis of obstetrical brachial plexopathy. Group A was composed of 25 infants who completely recovered at the age of 6 months. Group B was composed of 21 infants who were still not able to remove a blindfold from the face with the affected limb in the sitting position at the age of 12 months. There was no statistical difference of the median birthweight or median first minute Apgar score between the groups. There was also no relation between birthweight higher than 4000 g, first minute Apgar score lower than 6 or forceps delivery with a poor prognosis.


Subject(s)
Apgar Score , Birth Weight , Brachial Plexus Neuropathies/diagnosis , Obstetrical Forceps/adverse effects , Case-Control Studies , Delivery, Obstetric , Gestational Age , Humans , Infant , Infant, Newborn , Obstetrical Forceps/statistics & numerical data , Prognosis , Risk Factors
6.
Arq. neuropsiquiatr ; 64(1): 30-34, mar. 2006. tab, graf
Article in English | LILACS | ID: lil-425267

ABSTRACT

Realizamos um estudo caso-controle para verificar se o peso ao nascimento, parto forceps ou asfixia perinatal apresentam efeito significativo no prognóstico da plexopatia braquial obstétrica. O grupo A foi composto por 25 lactentes que apresentavam recuperação completa aos 6 meses de idade. O grupo B foi composto por 21 lactentes incapazes de remover uma venda do rosto com o membro acometido na posição sentada aos 12 meses de idade. Não houve diferença significativa entre as medianas de peso ao nascimento ou do boletim Apgar do primeiro minuto entre os grupos. Também não foi observada relação entre peso ao nascimento maior que 4000g, boletim Apgar do primeiro minuto menor do que 6 ou parto forceps com um prognóstico desfavorável.


Subject(s)
Humans , Infant , Infant, Newborn , Apgar Score , Birth Weight , Brachial Plexus Neuropathies/diagnosis , Obstetrical Forceps/adverse effects , Case-Control Studies , Delivery, Obstetric , Gestational Age , Obstetrical Forceps/statistics & numerical data , Prognosis , Risk Factors
7.
Arq Neuropsiquiatr ; 63(3A): 588-91, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16172705

ABSTRACT

Botulinum toxin type A was recently introduced for treatment of biceps-triceps muscle cocontraction, which compromises elbow function in children with obstetrical brachial plexopathy. This is our preliminary experience with this new approach. Eight children were treated with 2-3 U/kg of botulinum toxin injected in the triceps (4 patients) and biceps (4 patients) muscle, divided in 2 or 3 sites. All patients submitted to triceps injections showed a long-lasting improvement of active elbow flexion and none required new injections, after a follow-up of 3 to 18 months. Three of the patients submitted to biceps injections showed some improvement of elbow extension, but none developed anti-gravitational strength for elbow extension and the effect lasted only three to five months. One patient showed no response to triceps injections. Our data suggest that botulinum toxin can be useful in some children that have persistent disability secondary to obstetrical brachial plexopathy.


Subject(s)
Birth Injuries/complications , Botulinum Toxins, Type A/administration & dosage , Brachial Plexus Neuropathies/drug therapy , Neuromuscular Agents/administration & dosage , Brachial Plexus Neuropathies/etiology , Child, Preschool , Elbow Joint/drug effects , Electromyography , Female , Follow-Up Studies , Humans , Infant , Male , Muscle Contraction/drug effects , Treatment Outcome
8.
Arq. neuropsiquiatr ; 63(3A): 588-591, set. 2005. ilus, tab
Article in English | LILACS | ID: lil-409038

ABSTRACT

A toxina botulínica do tipo A foi introduzida recentemente para o tratamento das co-contrações entre os músculos biceps e triceps, que comprometem a função do cotovelo nas crianças com plexopatia braquial obstétrica. Apresentamos nossa experiência preliminar com esta abordagem. Oito crianças foram tratadas com 2 - 3 U/kg de toxina botulínica injetada nos músculos triceps (4 pacientes) e biceps (4 pacientes), divididas em 2 ou 3 sítios. Todos os pacientes submetidos a injeções no triceps apresentaram melhora persistente da flexão do cotovelo e nenhum precisou de novas aplicações após seguimento de 3 a 18 meses. Três pacientes submetidos a aplicações no biceps apresentaram melhora na extensão do cotovelo, mas nenhum adquiriu força antigravitacional e o efeito durou apenas 3 a 5 meses. Um paciente não respondeu às injeções. Nossos dados sugerem que a toxina botulínica pode ser útil no tratamento de algumas crianças com seqüelas de plexopatia braquial obstétrica.


Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Birth Injuries/complications , Botulinum Toxins, Type A/administration & dosage , Brachial Plexus Neuropathies/drug therapy , Neuromuscular Agents/administration & dosage , Brachial Plexus Neuropathies/etiology , Electromyography , Elbow Joint/drug effects , Follow-Up Studies , Muscle Contraction/drug effects , Treatment Outcome
9.
Muscle Nerve ; 30(4): 451-5, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15372436

ABSTRACT

Early prognostic assessment of obstetrical brachial plexopathies (OBP) would facilitate rational selection of infants for brachial plexus surgery. We performed bilateral motor nerve conduction studies (MNCS) of axillary, musculocutaneous, radial, median, and ulnar nerves in 33 babies (age 10-60 days) with OBP in order to compare the amplitude of compound muscle action potentials (CMAPs). All babies were followed up until 6 months of age and the outcome was classified according to muscle strength and arm function. A CMAP amplitude reduction of more than 90%, compared to the unaffected side, predicted severe weakness of the corresponding root level (p < 0.01). Our results indicate that MNCS are a useful tool for very early prognostic assessment of OBP.


Subject(s)
Brachial Plexus Neuropathies/diagnosis , Motor Neurons/physiology , Neural Conduction/physiology , Pregnancy Complications/diagnosis , Action Potentials/physiology , Adult , Arm/physiology , Electrodiagnosis , Facial Nerve Diseases/diagnosis , Facial Nerve Diseases/physiopathology , Female , Humans , Infant , Infant, Newborn , Male , Muscle, Skeletal/physiopathology , Neurologic Examination , Pregnancy , Prognosis , Treatment Outcome
10.
J Pediatr (Rio J) ; 80(4): 296-304, 2004.
Article in English | MEDLINE | ID: mdl-15309231

ABSTRACT

OBJECTIVE: To study the relationship among the quality, type, and trajectory of general movements in preterm infants and neonatal cranial ultrasonography findings and neurological outcome. METHOD: Forty preterm newborn infants, with gestational ages under 35 weeks, had their general movements recorded through video-tape during the preterm, term (37th - 42nd postconceptional weeks of age) and post-term (49th - 56th postconceptional weeks of age) periods, and were prospectively followed up to one-year conceptional age. RESULTS: Our results showed that the quality of general movements, particularly in the post-term period (p = 0.009), were related with the presence of severe cerebral lesions in the neonatal cranial ultrasonography and the neurological outcome. While the presence of severe ultrasonography lesions was associated with an adverse neurological outcome (p = 0.01), the finding of normal general movements patterns was associated with a normal neurological outcome, with negative predictive values of 100%, for the preterm, and 80%, for both term and post-term periods. CONCLUSIONS: When concurrently used, these evaluation methods may increase the specificity and sensitivity in detecting the group of preterm infants at high risk for neurological disturbances in long-term follow-up.


Subject(s)
Brain Diseases/diagnosis , Infant, Premature , Movement , Brain Diseases/diagnostic imaging , Brain Diseases/physiopathology , Female , Humans , Infant, Low Birth Weight , Infant, Newborn , Male , Movement/physiology , Neurologic Examination/methods , Prognosis , Prospective Studies , Sensitivity and Specificity , Ultrasonography , Videotape Recording
11.
J. pediatr. (Rio J.) ; 80(4): 296-304, jul.-ago. 2004. tab
Article in English | LILACS | ID: lil-391642

ABSTRACT

OBJETIVO: Estudar a relação entre a qualidade, tipos e trajetória dos movimentos generalizados espontâneos em recém-nascidos pré-termo com os achados da ultra-sonografia de crânio neonatal e com a evolução neurológica. MÉTODO: 40 recém-nascidos pré-termo, com idade gestacional < 35 semanas, tiveram seus movimentos generalizados registrados através de videoteipe durante os períodos pré-termo, a termo (37ª - 42ª semana de idade pós-concepcional) e pós-termo (49ª - 56ª semana de idade pós-concepcional), e foram seguidos prospectivamente até um ano de idade pós-concepcional. RESULTADOS: Nossos resultados mostraram que a qualidade dos movimentos generalizados, particularmente no período pós-termo (p = 0,009), foram relacionados com a presença de lesões cerebrais detectadas à ultra-sonografia e com a evolução neurológica. Enquanto a presença de lesões ultra-sonográficas graves foi associada à evolução neurológica desfavorável (p = 0,01), o achado de padrões de movimentos generalizados espontâneos normais foi associado à normalidade neurológica no seguimento, com valores preditivos negativos de 100 por cento, para o período pré-termo, e 80 por cento para ambos os períodos a termo e pós-termo. CONCLUSÕES: Quando usados conjuntamente, esses métodos podem aumentar a especificidade e a sensibilidade na detecção de um grupo de recém-nascidos pré-termo de alto risco para seqüelas neurológicas, no seguimento a longo prazo.


Subject(s)
Humans , Male , Female , Infant, Newborn , Brain Diseases/diagnosis , Infant, Premature , Movement , Neurologic Examination/methods , Brain Diseases/physiopathology , Infant, Low Birth Weight , Movement/physiology , Prognosis , Prospective Studies , Sensitivity and Specificity , Skull , Videotape Recording
12.
Arq. neuropsiquiatr ; 55(4): 757-61, dez. 1997. tab
Article in English | LILACS | ID: lil-209374

ABSTRACT

Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m.) that experienced at least one febrile seizure (FS) entered a prospective study of intermittent therapy with clobazam. Cases with severe neurological abnormalities, progressive neurological disease, afebrile seizures, sympromatic seizures of other nature, or seizures during a central nervous system infection were excluded. Seizures were of the simple type in 25 patients, complex in 20 and unclassified in 5. The mean follow-up period was 7.9 months (range=1 to 23 m.), and the age at the first seizure varied from 5 to 42 months (mean=16.8 m.). Clobazam was administered orally during the febrile episode according to the child's weight: up to 5 kg, 5 mg/day; from 5 to 10 kg, 10 mg/day; from 11 to 15 kg, 15 mg/day, and over 15 kg, 20 mg/day. There were 219 febrile episodes, with temperature above 37.8 degrees Celsius, in 40 children during the study period. Twelve children never received clobazam and 28 received the drug at least once. Drug efficacy was measured by comparing FS recurrence in the febrile episodes that were treated with clobazam with those in which only antipyretic measures were taken. Ten children (20 percent) experienced a FS during the study period. Of the 171 febrile episodes treated with clobazam there were only 3 recurrences (1.7 percent), while of the 48 episodes treated only with antipyretic measures there were 11 recurrences (22.9 percent), a difference highly significant (p<0.0001). Adverse effects occurred in 10/28 patients (35.7 percent), consisting maily in vomiting, somnolene and hyperactivity. Only one patient had recurrent vomiting which lead to drug interruption. These effects did not necessarily ocurred in every instance the drug was administered, being present in one febrile episode and not in the others. We conclude that clonazepam is safe and efficacious in preventing FS recurrence. It may be an alternative to deazepam in the intermittent treatment of FS recurrence.


Subject(s)
Child , Child, Preschool , Infant , Female , Humans , Anticonvulsants/therapeutic use , Benzodiazepinones/therapeutic use , Seizures, Febrile , Anticonvulsants , Benzodiazepinones , Prospective Studies , Recurrence
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