[The use and benefit of the 'children with special health care needs screener' in the paediatric school entrance examinations 2004/2005 in Cologne]. / Einsatz und Nutzen des "Children with Special Health Care Needs-Screener" im Rahmen der Schuleingangsuntersuchung 2004/2005 in Köln.

The aim of this study was to provide an assessment of the usefulness of the questionnaire "Children with Special Health Care Needs Screener" (CSHCN Screener) as a screening instrument to identify children with special needs in the context of paediatric school entrance examinations (SEE).In a retrospective cross-sectional study of the years 2004 and 2005 in Cologne, Germany, the sum variables were derived from the results of the SEE in accordance to the 7 questions of the CSHCN Screener. The correlations of the SEE sum variables and the CSHCN Screener results were analysed and tested for correlations with sociodemographic factors.Of the 18 402 children of the cohorts 2004/2005, corresponding SEE findings and results of the CSHCN Screener were available for 13 076 children. The prevalence of children with special needs was only 6% according to the results of the CSHCN Screener. According to the SEE, however, 26% of the children showed diseases or developmental problems. Out of this group, only one in 8 children was identified by the CSHCN Screener (sensitivity 13%). The sensitivity of the screener was also 13% for children who had been diagnosed to be in need of special support by school physicians. In the case of girls and of children with migration family backgrounds, the sensitivity of the screener was even lower. The CSHCN Screener also could not detect the higher rate of special needs determined by school physicians in children from areas with high quotas of state family support payments.The results of the CSHCN Screener are not convincing, due to his low sensitivity. This is true with regard to its use as a diagnostic tool for the individual child at the beginning of school age as well for its use as an instrument to assess an increased need for support in cohorts of school entry students.

Analysis of the musculoskeletal system in children and adolescents receiving anticonvulsant monotherapy with valproic acid or carbamazepine.

OBJECTIVE: To examine bone development in children and adolescents who have uncomplicated idiopathic epilepsy and had received monotherapy with carbamazepine or valproic acid for at least 1 year. METHODS: Thirty-nine patients from 6 to 19 years of age (18 girls) were studied. Total bone mineral content (BMC) and trabecular volumetric bone mineral density were measured at the distal radius using peripheral quantitative computed tomography. Maximum isometric grip force was determined with a standard dynamometer. Alkaline phosphatase activity and deoxypyridinoline (a marker of bone resorption) were assessed in serum and urine, respectively. RESULTS: Trabecular volumetric bone mineral density was significantly decreased in the entire group (z score mean +/- standard deviation: -0.62 +/- 1.04) and in the subgroup using valproic acid (-0.75 +/- 1.18). In the carbamazepine subgroup, there was a similar but nonsignificant trend (-0.50 +/- 0.90). Total BMC and isometric maximum grip force were normal in the entire study population (0.10 +/- 1.22) and in the 2 subgroups. The relationship between BMC and grip force was similar between patients and healthy participants. Urinary levels of deoxypyridinoline were significantly elevated above normal in the whole study population (1.35 +/- 2.00) and in both the valproic acid and the carbamazepine subgroups. CONCLUSIONS: Bone turnover can be increased, but bone mass is adequate in children and adolescents who have uncomplicated idiopathic epilepsy and who receive monotherapy with carbamazepine or valproic acid.

Analysis of cancellous bone turnover by multiple slice analysis at distal radius: a study using peripheral quantitative computed tomography.

We compared the results of peripheral quantitative computed tomography (pQCT) measurements (XCT-900; Stratec) at the 4% site of the distal radius (section 1; slice thickness of 2 mm) and in two proximally adjacent sections (sections 2 and 3). The study population consisted of 138 ambulatory patients (age 16.4 +/- 5.6 yr; mean +/- SD; 71 female) who were referred to a pediatric densitometry unit. Total volumetric bone mineral density (BMD) increased, whereas the area of the radial cross-section decreased in a proximal direction. There was a decrease in bone mineral content between sections 1 and 3, which was more pronounced in subjects under age 16. Cancellous BMD significantly decreased from section 1 to 3 only under the age of 16. In 12 patients under age 17 who suffered from increased bone fragility, cancellous BMD decreased about 2.5 times more between sections 1 and 3 than in age-matched patients who received anticonvulsant therapy but had a normal neurologic and musculoskeletal status (-21.4% +/- 16.9 vs -8.1% +/- 6.3; p = 0.02). This suggests that in the bone fragility group, trabeculae were removed faster during longitudinal growth of the radius. In conclusion, multiple slice analysis may provide information on the dynamic turnover of metaphyseal trabeculae during growth.

Severe intra-uterine growth retardation: obstetrical management and follow up studies in children born between 1970 and 1985.

Peri- and postnatal data of 263 children with severe intra-uterine growth retardation (IUGR) born between 1970-75 (n = 145) and between 1976-85 (n = 118) are presented. The incidence of premature delivery in IUGR patients rose from 15% (1970-75) to 34% (1976-85). The rate of perinatal asphyxia in premature children with IUGR decreased from 64% during 1970-75 to 45% during 1976-85. Perinatal mortality in preterm SFD babies was higher in 1976-85 (20%) than in 1970-75 (14%), due to an 8-fold higher incidence of very low birth weight (less than or equal to 1000 g) SFD babies. Without this high-risk group perinatal mortality ranged between 2 and 3% in both groups. The incidence of deliveries by Cesarean section increased from 19 to 45% while vaginal deliveries decreased from 73 to 52% during 1976-85 compared with the 1970-75 age group. Follow up studies were carried out in 63 patients (1970-75) and in 41 patients (1976-85). Deficits of body height and weight persisted in one third of the patients, being severe in 10-20%. Infantile developmental milestones were retarded in 22-32%. Neurologic sequelae mostly of a mild degree were seen in 29% (1970-75) and 37% (1976-85). Psychologic testing showed abnormalities in 38% of the older age group, using the Göttinger Formreproduktionstest and in 21% of the younger age group, where the Denver Developmental Screening Test was performed. EEG investigations demonstrated unspecific abnormalities of a mild to moderate degree in one third of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hearing screening using acoustically evoked brain stem potentials in newborn infants and infants]. / Hörscreening mittels akustisch evozierter Hirnstammpotentiale bei Neugeborenen und Säuglingen.

Reported failure rates of hearing screening using the conventional brainstem auditory evoked response (BAER) audiometry range from 5% to 60% with about 30% of the babies having normal hearing sensitivity on follow-up. Testing an automated infant screener using advanced evoked response technology the results of this new system are compared to a conventional evoked response system operated by skilled personal. 50 neonates (100 ears) were tested at a gestational age of 40-42 weeks. Normal results were obtained in all 25 neonates (50 ears) of the control group using both testing procedures. Out of 25 neonates (50 ears) at risk for congenital, peri- or postnatal hearing disorder abnormal results were seen with either one or both methods in 8 patients. In 4 out of 100 investigated ears (4%) results of the BAER infant screener were false positive and in 2 cases (2%) false negative. The possibilities and limits of this hearing screener are evaluated and its validity for newborn-screening compared to known follow-up studies are discussed.

[Hearing screening in neonates and infants using brain stem evoked acoustic potentials]. / Hörscreening bei Neugeborenen und Säuglingen mittels Ableitung akustisch-evozierter Hirnstammpotentiale.

Reported failure rates of screening using the conventional brainstem auditory response (BAER), audiometry range from 5% to 60% with about 30% of the babies having normal hearing sensitivity on follow-up. The results of testing by an automated infant screener using advanced evoked response technology are compared with those of a conventional evoked response system operated by skilled personnel. 50 newborn were tested at a gestational age of 40-42 weeks. Normal results were obtained in all 25 newborn (50 ears) of the control group using both testing procedures. Out of 25 newborn (50 ears) at risk for congenital perinatal or postnatal hearing disorder, abnormal results for either screening or conventional BAER recording were seen in 6 ears with both methods.

[Reye syndrome]. / Reye-Syndrom.

Clinical course, laboratory findings and histopathological features of Reye's syndrome as described. Etiological and pathogenetic aspects are still under discussion although a viral infection preceding Reye's syndrome is a very common finding. Preceding Influenza B, Influenza A and varicella infections were most often seen in the United States. A genetic disposition seems to exists in some cases. Exogenic factors of pathogenetic relevances are aflatoxin, emulging agents, insecticides, paracetamol, acetylsalicylic acid and valproate. In the United States and Great Britain the incidence of Reye's syndrome is about ten times higher than in other European countries, as demonstrated by reports from Spain, Denmark and France. Results of an inquiry in Western Germany on Reye's syndrome between 1983 and 1985 are presented. 99 major pediatric hospitals were included into the study. Clinical data were obtained from 85 hospitals. The incidence of Reye's syndrome in Western Germany during 1983-1985 was 0.04-0.05 cases per 100,000 children under 18 years. 15 cases of Reye's syndrome were reported, i.e. an average of 5 cases per year. 8 children died. 3 patients had been treated with acetylsalicylic acid and 2 patients with paracetamol shortly before the onset of the disease.

[Child development following severe intrauterine growth retardation--results of follow-up studies]. / Die kindliche Entwicklung nach schwerer intrauteriner Wachstumsretardierung--Ergebnisse von Follow-up-Studien.

94 prenatally severely dystrophic newborn (year of birth: 1970 to 1982) of the Department of Gynaecology of the University of Cologne were catamnestically investigated when they 2 to 12 years of age; follow-up examinations were performed by paediatricians, neurologists, EEG specialists and by test psychology. In more than one-half of the children followed up in this manner delays in early childhood development were seen; there were no conspicuous differences between the two groups (classified according to years of birth). On comparing the age brackets 1970-1975 and 1976-1982 about one-third of the children in both groups presented at follow-up clearly evident signs of retarded growth. In 32% of the children born between 1970 and 1975 mostly mild neurological deficits or slight impairments of nerve function were observed, whereas in the 1976-1982 group this figure was 26%. The incidence of cerebral pareses was 7% and 9%, respectively. Disturbances of fine motor response were most frequently seen. Mild to moderate EEG changes occurred in both patient groups at about the same rate of incidence (34% and 32% respectively); one child in each group presented with definitely pathological electroencephalographic findings. Pathological test psychology results were seen in 38% (1970-1975) and 21% (1976-1982) of the followed-up children; the tests employed were the Göttingen form reproduction test in children born between 1970 and 1975 and the Denver development test in the younger children born between 1976 and 1982.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and prognostic aspects of congenital hydrocephalus]. / Klinische und prognostische Aspekte des konnatalen Hydrocephalus.

Clinical data of 24 patients with congenital hydrocephalus are presented. 13 children died within the first 7 months of life; the average period of survival was 2 months. Associated malformations of the CNS or other organs, severely raised intracranial pressure in utero, and postnatal complications involving the CNS indicated a poor prognosis. The follow-up of the 11 surviving children showed severe neurologic sequelae and drug resistent epilepsy in 2 of them. Three others had neural tube defects and associated paraplegia. The 6 remaining children had mild or moderate cerebral palsy or were moderately mentally retarded. If possible, birth should not be induced before 36 weeks of gestation, and the hydrocephalus should be shunted soon after birth. Satisfactory results can be obtained in about one half of surviving patients by early shunting of congenital hydrocephalus.

[Radiologic diagnosis of intracranial aneurysms and arteriovenous malformations in a pediatric patient group]. / Radiologische Diagnostik der intrakraniellen Aneurysmen und arteriovenösen Missbildungen eines pädiatrischen Krankengutes.

This is a description of the radiologic procedure and its importance for the diagnosis of intracranial aneurysms (19 personal cases) and arteriovenous malformations (27 personal cases) in the pre-adult age-group. The value of each method is discussed and the results are compared with those of other authors in order to reveal particular features of this group of patients.

[Correlation of electrophysiologic findings in neural muscular atrophy]. / Korrelation elektrophysiologischer Befunde bei neuralen Muskelatrophien.

In a collective of 22 patients (18 adults, 4 children) with the clinical diagnosis of peroneal muscular atrophy the correlation of various neurophysiological parameters was examined. These included electromyography, motor and sensory nerve conduction velocity, visual (VEP), acoustic (AEP) and somatosensory (SEP) evoked potentials and conventional EEG. In all cases we found a high correlation between the findings of nerve conduction velocities and somatosensory evoked responses. Acoustic evoked potentials were examined in 18 cases and showed 10 pathological findings; visual evoked responses were also examined in 18 cases and produced 5 pathological findings. If nerve conduction velocity measurements are possible, SEP examinations are superfluous as they do not provide additional information. On the other hand, VEP and AEP testing is warrented in all cases to document the impairment of central nervous pathways.

[Follow-up study of former prenatally dystrophic newborn infants now 6 to 12 years old]. / Nachuntersuchungsergebnisse ehemaliger pränatal dystropher Neugeborener im Alter von 6-12 Jahren.

58 small-for-date (SFD) aged 6 to 12 years, born between 1970 and 1975 were followed-up. Retardation of motor skills and speech during early infancy was found in 20-30%. At 6 to 12 years of age one third still had deficits in body weight und height. Neurological abnormalities in 17 children were usually mild, most often affecting fine motor function. Significant impairment of visuomotor perception on psychological testing was seen in 21 children, and EEG abnormalities in 20 cases. The results in neurological, psychological and EEG investigations for 23 children (group I) were normal. 24 patients (group II) showed one or two abnormal findings. In 9 children (group III) results of all three examinations were abnormal. The follow-up results were influenced by socioeconomic factors. Small-for-date babies showed on the whole encouraging results on follow-up during later childhood, with 40% of the children being normal, and mostly mild abnormalities in the remaining patients. Prognosis may be further improved by preterm delivery, i.e. early termination of intrauterine growth retardation.

Intracranial arteriovenous malformations and aneurysms in childhood and adolescence.

Clinical data of 19 arteriovenous malformations (AVM) and 15 aneurysms (AN) are presented. Combined clinical, neurophysiological and neuroradiological follow-up studies have been carried out on the surviving patients (14 AVM and 10 AN). Two patients with multiple AN had coarctation of the aorta. Three AVM of the Vein of Galen showed typical symptoms within the 1st year of life, all other lesions became evident later than 5 years of age. In the acute phase of the disease clinical history and neurological deficits of AVM and AN tend to be very similar. Subarachnoid hemorrhage with or without intracranial hematoma is the most frequent initial symptom. A CT scan is valuable as a first orientating investigation but morphology and operability of the vascular lesion is only demonstrated by angiography. The prognosis of AVM and AN is promising as soon as the first critical period has been survived. AVM patients show significantly less severe residual neurological and psychiatric defects than AN cases. EEG-follow-up studies and CT scans are helpful for controlling residual functional and morphological cerebral damage in survivors.

Early diagnosis of herpes simplex encephalitis in childhood. Clinical, neurophysiological and neuroradiological studies.

In the initial phase of HSE the clinical symptomatology is more variable and insidious in babies and young children than in older children and adults. Combined clinical, neurophysiological and neuroradiological studies have been carried out in 12 children with proven HSE. Ten patients had the first EEGs taken during the acute phase of the illness and all showed large amplitude irregular slow activity, sharp waves and often spikes with variable distribution; in 7 cases periodic phenomena were recognisable. At a later stage localised low amplitude EEG activities were found in children with focal neurological symptoms. Areas of low attenuation were seen in the CT scans of the 7 children who had this investigation done at an early stage of their illness. Such low density regions persisted at follow-up and eventually cerebral atrophy with irregular features became obvious. Prompt EEG investigations combined with CT scans provide an early diagnostic clue for treatment. Follow-up EEG studies (including VEP) and CT scans may help assess the severity of residual cerebral damage in the survivors.