Neonatal cerebral lesions predict 2-year neurodevelopmental impairment in children treated with laser surgery for twin-twin transfusion syndrome.

OBJECTIVE: The objective of this study is to assess whether postnatally detected cerebral abnormalities are predictive of neurodevelopmental impairment (NDI) in survivors of twin-twin transfusion syndrome (TTTS) that underwent laser surgery. MATERIALS AND METHODS: Ninety-nine children treated for TTTS had neurodevelopmental assessment at age 2-years (±6 weeks). 'High-risk survivors' had cerebral imaging in the neonatal period. 'High-risk survivors' were defined as (1) delivered at <32 weeks; or (2) cerebral imaging clinically indicated. NDI was a composite outcome of: Battelle Developmental Inventory 2nd edition (BDI-2) score <70, cerebral palsy, blindness, and/or deafness. Multilevel logistic regression with robust standard errors was used to evaluate associations between cerebral lesions and NDI. RESULTS: Fifty-six children were 'high-risk survivors' and had neonatal cerebral imaging. Ten twins (18%) had at least one cerebral lesion, including grade 1-2 intraventricular hemorrhage (8), cystic periventricular leukomalacia (2), ventriculomegaly (1), and bilateral subependymal cyst (1). The risk of NDI in the 'high-risk survivors' was 7% (4/56) compared with 0% (0/43) in the remaining group. Among 'high-risk survivors', cerebral lesions were a significant risk factor for NDI (OR = 19.28, p < .001). CONCLUSIONS: Among 'high-risk survivors' of TTTS treated with laser surgery, cerebral lesions identified on neonatal imaging were associated with NDI at 2-years.

Reducing anxiety in the pediatric emergency department: a comparative trial.

BACKGROUND: Anxiety among patients in a pediatric emergency department (PED) can be significant, but often goes unaddressed. OBJECTIVE: Our aim was to determine whether exposure to Child Life (CL) or hospital clowning (HC) can reduce anxiety in children presenting to a PED. METHODS: Patients were randomized to CL, HC, or control and assessed upon entry to examination room (T1), before physician arrival (T2), and during physician examination (T3), using the modified Yale Preoperative Anxiety Scale (m-YPAS). CL and HC interventions occurred for 5 to 10 min before physician entry. Effects were analyzed using mixed analysis of variance. RESULTS: m-YPAS scores ranged from 23 to 59, with a higher score indicating increased anxiety. Mixed analysis of variance on the study sample (n = 113) showed a significant interaction between groups (CL, HC, control) and time (p = 0.02). Additional analyses indicated effect of group only at T2 (CL: mean = 23.8; 95% confidence interval [CI] 23.2-24.5; HC: mean 25.2; 95% CI 24.2-26.2; control: mean = 26.1; 95% CI 24.2-27.9; p = .02). Subanalysis of patients with T1 m-YPAS score ≥ 28 (n = 56) showed a significant interaction between group and time (p = 0.01). Additional analysis showed effect of group only at T2 (CL: mean 24.4; 95% CI 23.3-25.6; HC: mean 27.0; 95% CI 25.2-28.7; control: mean 29.2; 95% CI 25.6-32.7; p = 0.003). CONCLUSIONS: CL services can reduce state anxiety for patients presenting to a PED with heightened anxiety at baseline. This reduction occurred immediately after CL intervention, but was not observed in patients exposed to HC or during physician examination.

Declarative and nondeclarative memory in schizophrenia: What is impaired? What is spared?

The study's aim was to assess a broad range of declarative and nondeclarative memory functions in schizophrenia to identify areas of impairment versus relative preservation. Participants included 40 schizophrenia outpatients and 30 demographically comparable community residents. All participants were administered a battery assessing declarative memory (verbal learning, working memory, semantic memory, remote memory, verbal retention) and nondeclarative memory (procedural learning, priming). To control for order effects, the battery was divided into three parts of approximately equal length with order of administration counterbalanced across study participants. The results showed persons with schizophrenia to be significantly impaired relative to community residents in verbal learning, working memory, semantic memory, remote memory, and priming. In contrast, the two groups were comparable in verbal retention and procedural learning. In the schizophrenia group, priming ability best discriminated past year's vocational status. In sum, the findings indicate a specific pattern of impairment and preservation of memory functioning in schizophrenia. Skill (procedural) learning and retention of learned, declarative verbal information across a delay appear intact, while all other areas measured appear impaired.