OCT angiography documented reperfusion of translocated autologous full thickness RPE-choroid graft for complicated neovascular age-related macular degeneration.

PurposeThe purpose of this study is to investigate the reperfusion of translocated retinal pigment epithelium (RPE)-choroid graft in the treatment of patients with neovascular age-related macular degeneration (nAMD), using OCT angiography (OCTA), a novel non-invasive, high-resolution imaging modality.Patients and methodsEighteen eyes of 18 consecutive patients suffering from complicated nAMD underwent RPE-choroid patch graft translocation surgery using a peripheral retinotomy and flap-over technique. We analyzed functional and anatomical outcome using visual acuity, Spectral Domain OCT and OCTA.ResultsWith a mean follow-up of 11 months, out of 18 patients, 15 gained vision, 1 remained stable, and 2 lost vision. Overall, the visual acuity improved with a mean of 30 letters. Perfusion of the graft tissue was confirmed in all patients. Two patients developed signs of a recurrent neovascular membrane during follow-up. No cases of proliferative vitreoretinopathy occurred in this series.ConclusionsOCTA images show signs of perfusion in all grafts. Encouraging functional results and low risk of severe complications suggest that RPE-choroid graft translocation is a valid option in patients with complicated nAMD.

[Revised guideline 'prevention of cot death']. / Herziene richtlijn 'preventie wiegendood'.

There are new insights into the pathogenesis of cot death ('sudden infant death syndrome'; SIDS). Based on these new insights, the Dutch Paediatric Association and the Dutch Child and Youth Health Care Physicians have drawn up a new guideline 'Prevention of cot death', which replaces the consensus statement of 1996. The 2 major differences from the old guideline are that co-sleeping of young infants in the same bed with the parents is now actively discouraged under the age of 4 months, and that the supine sleeping position is recommended from birth on. The recommendation that lying on one side can be used during the first 2 weeks of life has now been withdrawn.

[More cot deaths in child care settings than during the same hours at home: 10-year statistics]. / Meer wiegendood tijdens kinderopvang dan in dezelfde uren thuis: 10-jaarscijfers.

OBJECTIVE: To determine whether the incidence of sudden infant death syndrome (SIDS) in child care settings (child care centres or child minders) is different from that in the home setting, and to search for any differences in the prevalence of SIDS risk factors in both settings. DESIGN: Descriptive and comparative. METHOD: All SIDS cases (< 2 years), that occurred between September 1996-August 2006 and known to the 'Landelijke Werkgroep Wiegendood' (the National Cot Death Study Group) of the Dutch Paediatric Association were analysed. The percentage of children involved in child care and the mean duration of their participation in child care, was calculated from national surveys carried out in well-baby clinics. RESULTS: In the 10 years of the study, 216 cases of SIDS became known to the Cot Death Study Group. In the first year of life, the number was 75% of the number registered by Statistics Netherlands. 28 of these infants died from SIDS between the ages of 3-6 months and on Monday-Friday between 8:00 am-5:00 pm: the usual hours of opening of child care facilities. Based on the uptake of child care during this period, 15% of this mortality was expected to have occurred in a child care setting and 85% at home. In reality, 61% (17/28) of the deaths occurred at a child care facility and 39% (11/28) at home. The relative risk was 8.8 (95% CI: 4.1-19.0). This high incidence of SIDS in a child care setting did not appear to be due to a higher prevalence of known risk factors for SIDS at child care facilities i.e. sleeping position (prone or side), passive smoking, heat congestion, or use of a quilt or pillow. CONCLUSION: For infants aged 3-6 months, the relative risk ofSIDS during child care appeared to be increased 8.8 times (95% CI: 4.1-19.0) when compared with home settings in The Netherlands in September 1996-August 2006.

Two cases of acute macular neuroretinopathy.

PURPOSE: To report chorioretinal vasoconstriction as a potential pathogenic mechanism in acute macular neuroretinopathy (AMNR). To describe a time lag between the onset of functional deficits and that of fundoscopically visible lesions and illustrate the superior value of infrared (IR) compared to red-free or white light imaging in AMNR. METHODS: Two young female patients (30 and 19 years old) with AMNR are described. Both underwent detailed clinical examination with additional imaging using IR, blue, and red-free light. Functional evaluation with pattern and multifocal electroretinography, Goldmann manual, and automated Humphrey visual fields (VFs) was also performed. RESULTS: The first patient was diagnosed with AMNR after a caesarian section during and after which she received treatment with vasoconstrictive drugs. She was followed up for 28 months, after which time she still suffered from bilateral U-shaped paracentral scotomata associated with macular lesions. The second patient complained of central scotomata prior to the onset of any visible fundoscopic lesions, following a bout of flu. VFs confirmed a central scotoma and pattern electroretinography was consistent with loss of macular function. Bilateral petaloid lesions became visible after 3 days when function began to improve. In both patients IR imaging was superior to standard red-free and white light in identifying macular lesions. CONCLUSIONS: Vasoconstriction in the chorioretina may be pathogenic in AMNR. Functional complaints precede fundus lesions in AMNR. And, IR light is superior to red-free or white light imaging in detecting typical fundus lesions in AMNR both early and late in the course of the disease.

Behavioral and physiological adaptation to repeated chair restraint in rhesus macaques.

Physical restraint is a commonly used procedure when working closely with nonhuman primates. Nonhuman primates show rapid behavioral changes when learning the restraint procedure, and these changes have been taken to reflect behavioral and physiological habituation to the procedure. This study examined the behavioral and adrenocortical responses to repeated physical restraint in a large sample of adult male rhesus monkeys. Subjects showed a decline in behavioral agitation and cortisol concentrations across seven consecutive days of restraint. The changes in adrenocortical responsiveness were also coincident with an increased sensitivity to dexamethasone and a change in early morning basal cortisol secretion. The subjects were restrained for a single session 6 months later, and while the reduction in behavioral agitation was still present, the majority of changes in adrenocortical responsiveness were no longer present. These data show that behavior is not necessarily an indicator of underlying physiological processes and that the reduction of hypothalamic-pituitary-adrenal (HPA) activity with repeated restraint is due to physiological adaptation to high glucocorticoid concentrations and not to psychological habituation to the restraint procedures.

Sudden infant death syndrome in child care settings in the Netherlands.

BACKGROUND: In the Netherlands, there is a very low incidence of sudden infant death syndrome (SIDS) due to effective preventive campaigns. METHODS: During the period September 1996 to August 2002, nationwide 161 deaths from SIDS (about 85% of all cases of SIDS during that time) were investigated by the Cot Death Committee of the Dutch Paediatric Association. RESULTS AND DISCUSSION: Over 10% of cases of SIDS took place during some type of child care. From a national survey carried out in 2000/01 information was available on the child care attendance of 2000 Dutch infants aged 3-6 months. Based on the hours usually spent in child care by these infants, the number of similarly aged infants that died from SIDS while attending child care was 4.2 times higher than expected. Remarkably, the prevalence of known risk factors for SIDS, such as sleeping position and parental smoking, was favourable in the SIDS cases in child care settings. The adherence of child care facilities to the safe sleeping recommendations is high in the Netherlands, and no explanation as to why child care settings may be associated with an increased risk of SIDS is apparent. The possibility of other explanations, such as stress and change in routine care, is hypothesised.

Paroxysmal phenomena in the first two years of life.

The prevalence of paroxysmal phenomena in the first two years of life was assessed in 1854 children of Dutch-speaking mothers of a population-based birth cohort. At each visit to the Child Health Clinic (CHC), mothers were asked whether they had noted sudden change of consciousness, involuntary movements, deviation of the eyes or apnoea, and if so, whether these appeared to be related to feeding. Paroxysmal episodes occurred in a quarter of the children: in 8 per cent only in relation to feeding, in 19 per cent also not related to feeding. The latter children were more frequently admitted to hospital and had more disabilities at age two years. No connection with epilepsy in the family or with congenital anomalies could be demonstrated. Special attention should be paid by the CHC team to children with paroxysmal phenomena not associated with feeding.

Growth in length and weight from birth to 2 years of a representative sample of Netherlands children (born in 1988-89) related to socioeconomic status and other background characteristics.

Of nearly 1900 live-born singletons, born from April 1988 to October 1989 inclusive, nine measurements of length and weight have been taken between the ages of 1 and 24 months. In the first part of the study, differences in attained length and weight at 1 and 2 years of age are analysed according to socioeconomic status (SES). Multiple regression analyses are used to investigate the association of SES and other background characteristics with length and weight. The second part focuses on the analysis of differences in linear length and weight gain in the first 2 years of life, using a two-step regression technique. At 1 and 2 years of age, differences in attained length and weight and in length and weight gain according to SES are small and not significant, except for the children of Mediterranean parents in the low-SES group, who are significantly heavier than children of all other groups and gain significantly more in weight compared to children of Dutch parents in the low-SES group. Of all the factors studied it appears that parental height, birthweight, parity and ethnic descent of the parents are associated with attained length and weight at 1 and 2 years of age. Of these factors, ethnic descent, however, is not associated with length gain. A small but statistically significant catch-up growth is found in children of mothers who smoked during pregnancy.

Coordinate diurnal regulation of hepatic acyl-coenzyme A: cholesterol acyltransferase and cellular levels of esterified cholesterol.

Hepatic ACAT, HMG-CoA reductase and both cellular free and esterified cholesterol were measured at 3 h intervals over a 24 h period in the rat. ACAT exhibited a characteristic low amplitude diurnal rhythm with maximum activity at the mid-light phase that was significantly higher than the minimum activity observed at the mid-dark phase. The cellular esterified cholesterol concentration showed a diurnal rhythm that closely paralleled the rhythm of ACAT activity. The cellular free cholesterol concentration was not significantly altered during the 24 h cycle. In rats fed cholesterol, the diurnal rhythm of ACAT was still maintained despite the increase in ACAT activity during the entire 24 h cycle suggesting that the ACAT rhythm is the result of changes in the level of ACAT protein expression. The results also indicate that the diurnal rhythms of ACAT and HMG-CoA reductase are generated by a process independent of the LDL receptor rhythm. All three rhythms are also independent of changes in the level of free cholesterol in the cell.

[Use of health care services by children in the first 2 years of life in The Netherlands]. / Gebruik van gezondheidszorgvoorzieningen voor kinderen in de eerste 2 levensjaren in Nederland.

OBJECTIVE: To assess consumption of medical care for infants and toddlers provided by general practitioners and specialists, and of hospital admissions for young children. DESIGN: Descriptive. SETTING: Dutch Child Health Clinics (CHC). METHOD: An aselect cohort of newborns of 1988/89 of the Social Medical Survey of children attending Child health Clinics (SMOCC) were followed for two years; at maximally 8 CHC visits data were collected on the preceding interval. RESULTS: Health problems as observed in the CHCs like hearing disorders, strabismus, congenital hip dysplasia and growth disturbances were present as a cause for consultation of a GP or specialist in one out of six. Over 95% of the children went to consult their GP, 30% to a paediatrician, 20% to another specialist. Twelve per cent of the children was admitted to hospital, 10% of these more than once. Accidents caused 10% of all visits to a doctor in primary or secondary health care. Children with any form of disability at the age of two (6%) made use of the health care system as indicated in this study about three times more frequently than the non-disabled children. CONCLUSION: Nearly every child under two visited a GP, many a specialist. Timely recognition of specific health problems at the CHC prevents delay in treatment, and limits the harm in development as well as the costs.

Otitis media, respiratory tract infections and hearing loss in pre-term and low birthweight infants.

In 1983, 1338 liveborn infants with a gestational age of less than 32 weeks and/or a birthweight of less than 1500 g, were enrolled in a national follow-up study in The Netherlands. At the age of 5 years, 966 children were alive. Of these, 927 (96%) were assessed on a home visit 2-6 weeks after their fifth birthday by three specially trained paediatricians. An assessment of ENT morbidity was made and compared with ENT morbidity in full-term children of the same age group. Markedly preterm birth or very low birthweight does not seem to be a risk factor for developing middle ear disease in childhood, however, the rate of ENT problems seems to be higher than in the general population of Dutch pre-school children.

Sex difference in disability and handicap at five years of age in children born at very short gestation.

OBJECTIVE: The objective of this study was to examine the relationship between sex and disabilities or handicaps at 5 years of age in infants born at less than 32 weeks gestation. DESIGN: From the nationwide collaborative survey starting in 1983, including perinatal data obtained during routine perinatal care and follow-up assessments by the attending pediatricians, data from 1008 infants fulfilling the criteria were used. At age 5 years, a detailed assessment was performed by three specially trained pediatricians in 96% surviving infants (n = 648), of which 345 were boys. Each child was categorized as disabled or handicapped, using World Health Organization definitions. RESULTS: The prevalence of handicaps was three times greater in boys than in girls (21% vs 7%, odds ratio 3.2). Adjustment for gestational age and birth weight (logistic regression analysis) did not change this (odds ratio 3.5). Further adjustment by including perinatal variables such as idiopathic respiratory distress syndrome did not alter the odds ratios. The male excess in handicaps was not related to lower mortality, and therefore was not a mere consequence of a higher survival rate. The excess in handicaps was found in all assessed areas. CONCLUSIONS: Infants' sex seems to be an important determinant of handicaps. The perinatal variables used in the present study do not explain the difference in handicaps. These findings emphasize the need to include the sex distribution of a study population more systematically in analyses in future studies concerning long-term outcome of very preterm birth or low birth weight.

[Birth weight percentiles of premature infants needs to be updated]. / Percentielgrenzen voor geboortegewicht van vroeggeborenen moeten worden herzien.

OBJECTIVE: To analyse whether the conventional so-called Kloosterman charts for birthweight of preterm infants based on data from 1931-1965 are still valid. DESIGN: Descriptive investigation. LOCATION: The Netherlands. METHOD: Data were obtained from the 'project of the premature and small for gestational age' (POPS) survey in 1983. The population consisted of 855 Caucasian infants born after a pregnancy of 24-31 weeks. RESULTS: In nearly all gestational age categories the percentages of small-for-gestational age infants were higher than the 10% they should have been by definition; the percentages of large-for-gestational age infants were much lower than 10%. After exclusion of elective births the percentages remained different. CONCLUSION: These shifts in the birthweight distribution are probably the result of changes in obstetrics. The birthweight percentiles for preterm births will have to be updated.

[The significance of convulsion-like signs in the first 2 years of life]. / De betekenis van convulsieachtige verschijnselen in de eerste twee levensjaren.

OBJECTIVE: Assessment of the prevalence of convulsion-like symptoms in 1854 children of Dutch-speaking mothers of a population-based birth cohort. METHOD: At each child health clinic (CHC) visit mothers were asked whether they had noted any of the following signs: loss of consciousness, involuntary movements, eye rotation movements and apnoea, and if so, whether these appeared to be related to feeding. Registration was done by the CHC physician during eight consultations. RESULTS: Convulsion-like symptoms occurred in a quarter of the children: in 8% exclusively in relation to feeding, almost without exception in the first three months of life, in 19% also without relation to feeding, continuing until the second birthday. The latter children were more frequently admitted into hospital, even for non-neurological problems, than the former or than children without any such signs. They also have more disabilities at the age of two years. No connection with epilepsy in the family or with congenital anomalies could be demonstrated. CONCLUSION: Convulsion-like symptoms were observed in a quarter of children up to the age of two years. Special attention should be paid by the CHC team to children with signs not connected with feeding.

Comparison of mortality and rates of cerebral palsy in two populations of very low birthweight infants.

Comparisons of mortality and rates of cerebral palsy in different populations can be confusing. This is illustrated by comparing two populations of very low birthweight infants born in the 1980s, one from the Netherlands, the other from the UK (Oxford region). Although a number of biases were controlled for while comparing two large geographically defined populations, by assessing the survivors at similar ages and describing their health status in a standard way, some problems in interpretation of outcome remained. Differences in registration practice of live births at early gestational ages, as well as differences in withholding or withdrawing treatment, which occurred in about half of the cases of neonatal death in the Netherlands and in about one third of those in the Oxford region, may have influenced the incidence of registered live births, neonatal mortality, and the rate of cerebral palsy.

[Relationship between socioeconomic status and differences in health care utilization in pregnancy, delivery and puerperium]. / Verband tussen sociaal-economische status en verschillen in gebruik van zorg bij zwangerschap, bevalling en kraamperiode.

OBJECTIVE: Description of differences in pre-, peri- and postnatal care, according to socio-economic status (SES). SETTING: Geographically defined areas of 21 child health clinics (CHC) in several parts of the Netherlands. DESIGN: Retrospective cohort study. MATERIALS AND METHOD: Of all women who delivered a live-born child in the period April 1988-October 1989 and who were residents of the districts of the CHCs (n = 2119), data were recorded during the home visit post partum by the district nurses. Complete data were available of 2060 (97.2%) mothers. The care provided was defined as prenatal care and attendance at delivery (midwife, general practitioner, obstetrician and combinations), place and mode of delivery, and place of lying-in period. The indicator for SES was the educational level of the mother. In multivariate analyses, age, parity, degree of urbanisation of residential area, distance between home and hospital, ethnicity, height, smoking, health problems during pregnancy, obstetrical history, preterm birth and low birth weight were included in order to correct for possible confounding effects of these factors. RESULTS: Compared to the higher SES group, there was an increased risk in the lower SES group for a delivery in hospital (OR 1.60; 95% CI 1.16-2.20); the probability of having a complete lying-in period at home decreased according to the SES level (low SES: OR 0.47; 95% CI 0.34-0.65). Differences in mode of delivery (notably caesarean section) were very small and not significant. CONCLUSIONS: In the Netherlands there are socio-economic differences in perinatal care and the place of the lying-in period. Women of higher SES delivered more often at home and more often had their lying-in period at home, irrespective of other factors. Preferences of the mothers with respect to place of confinement were not taken into account in this study.

Prediction of height achievement at five years of age in children born very preterm or with very low birth weight: continuation of catch-up growth after two years of age.

To predict height at five years in a cohort of 565 very preterm and/or very low-birth-weight children, hypothesized growth determinants were subjected to discriminant analysis. Many neonatal parameters were not significantly associated with short stature at five years of age. A correct classification of stature (smaller/larger than the 10th percentile at five years of age) could be obtained in 85% of children, using the following variables: height at two years of age; total (or mid) parental height; parental level of education; length at one year of age; hypertension during pregnancy; sex; weight at two years of age; length percentile at one year of age. However, when compared to actual longitudinal data, the false-positive rate was 37%. The survey also demonstrated the continuing catch-up growth in very preterm and very low-birth-weight infants after two years of age.