Neurobehavioral development of preterm and full term children: biomedical and environmental influences.

BACKGROUND: Previous studies indicate that VLBW preterm children obtain significantly lower scores than full-term children in all the NBAS clusters. However the samples studied usually presented additional medical complications. AIMS: The present study aims to compare the results obtained by low-risk preterm and full term children in the NBAS, and relate possible differences to biological and contextual factors. METHOD: Early neurobehavioral development of 150 preterm (PR) children is compared to that of 49 full term children (FT). The children were assessed at the age of 15 days (corrected age for preterm children) with the NBAS. Biological and environmental variables were collected through an extended interview with the mothers as well as medical data. RESULTS: Significant differences were found between preterm and full term children in the following areas: motor, range of state, and regulation of state. Differences were also found in relation to birth weight in these same three areas, following a parallel pattern. These differences between the two groups were not, however, necessarily more favorable for the FT group; the PR group had higher results in the motor and range of state areas, and lower results in the regulation of state area. The mothers' smoking habit had a negative effect on infants' regulation and orientation. CONCLUSIONS: No general maturation delay in this particular sample of preterm children was found.

Complicaciones neurológicas en el postoperatorio inmediato de cirugía cardiaca: todavía un largo camino por recorrer / Acute neurological complications after pediatric cardiac surgery: still a long way to go

Introducción: Existe una creciente preocupación por las complicaciones neurológicas asociadas a las cardiopatías congénitas y a la cirugía cardiaca infantil. Material y métodos: Estudio observacional retrospectivo de casos y controles de las cirugías cardiacas infantiles y su postoperatorio en cuidados intensivos durante un período de 10 años. Se seleccionaron dos controles por cada caso, ajustados por el mismo grado de complejidad quirúrgica. Resultados: Se estudiaron 900 cirugías. Se detectaron 38 complicaciones neurológicas (4,2%), de las cuales 21 (55,3%) implicaban al sistema nervioso periférico y 17 (44,7%) al sistema nervioso central. Las complicaciones del sistema nervioso central (1,9% del total) fueron 8 convulsiones, 4 accidentes cerebrovasculares, 4 encefalopatías hipóxico-isquémicas y un déficit neurológico reversible. Un 35,3% mostró afectación al alta y un 17,6% falleció. Se encontró una diferencia estadísticamente significativa en el tiempo de circulación extracorpórea (p=0,009), el tiempo de isquemia (p=0,12), los días de estancia en cuidados intensivos (p=0,001), días de ventilación mecánica (p=0,004) y días de soporte inotrópico (p=0,001). Conclusiones: La incidencia de complicaciones neurológicas en nuestra serie es similar a la descrita previamente. Las convulsiones son la manifestación clínica más común. Las complicaciones del sistema nervioso central se asocian con un aumento de la morbilidad, una mayor estancia hospitalaria y un mayor consumo de recursos. Es necesario establecer medidas en el pre y post-operatorio, así como durante la cirugía, encaminadas a su prevención y diagnóstico precoz(AU)

Introduction: There has been an increasing concern over the neurological complications associated with congenital heart disease and cardiac surgery. Material and methods: We performed a retrospective, case-control, observational review of the postoperative period in the intensive care unit of patients undergoing cardiac surgery over the past 10 years. We selected 2 control patients for each case, matched for surgical complexity. Results: A total of 900 patients were reviewed. We found 38 neurological complications (4.2%), of which 21 (55.3%) were in the peripheral nervous system and 17 (44.7%) in the central nervous system. The complications involving the central nervous system (1.9% of total) consisted of 8 seizures, 4 cerebrovascular accidents, 4 hypoxic-ischemic encephalopathy events, and 1 reversible neurological deficit. At the time of discharge, 35.3% were symptomatic and 17.6% had died. Patients with neurological complications had a longer bypass time (P=.009), longer aortic cross time (P=.012), longer hospitalization in intensive care (P=.001), longer duration of mechanical ventilation (P=.004) and an increased number of days under inotropic support (P=.001). Conclusions: Our incidence of neurological complications after cardiac surgery is similar to that previously described. Clinical seizures are the most common complication. Central nervous system complications are associated with a higher morbidity and hospitalization time. Units caring for patients with congenital heart disease must implement neurological monitoring during and after cardiac surgery to prevent and to detect these complications earlier(AU)

[Acute neurological complications after pediatric cardiac surgery: still a long way to go]. / Complicaciones neurológicas en el postoperatorio inmediato de cirugía cardiaca: todavía un largo camino por recorrer.

INTRODUCTION: There has been an increasing concern over the neurological complications associated with congenital heart disease and cardiac surgery. MATERIAL AND METHODS: We performed a retrospective, case-control, observational review of the postoperative period in the intensive care unit of patients undergoing cardiac surgery over the past 10 years. We selected 2 control patients for each case, matched for surgical complexity. RESULTS: A total of 900 patients were reviewed. We found 38 neurological complications (4.2%), of which 21 (55.3%) were in the peripheral nervous system and 17 (44.7%) in the central nervous system. The complications involving the central nervous system (1.9% of total) consisted of 8 seizures, 4 cerebrovascular accidents, 4 hypoxic-ischemic encephalopathy events, and 1 reversible neurological deficit. At the time of discharge, 35.3% were symptomatic and 17.6% had died. Patients with neurological complications had a longer bypass time (P=.009), longer aortic cross time (P=.012), longer hospitalization in intensive care (P=.001), longer duration of mechanical ventilation (P=.004) and an increased number of days under inotropic support (P=.001). CONCLUSIONS: Our incidence of neurological complications after cardiac surgery is similar to that previously described. Clinical seizures are the most common complication. Central nervous system complications are associated with a higher morbidity and hospitalization time. Units caring for patients with congenital heart disease must implement neurological monitoring during and after cardiac surgery to prevent and to detect these complications earlier.

Effect of castration and gonadal hormones on insulin-induced drinking.

Female Wistar rats in any of the estrual phases have been shown to drink significantly more water than males (p < 0.05), after a single I.P. insulin injection (5 U/kg b.wt.). Sexual differences in insulin-induced drinking persisted after castration when it was made in adult rats (4.6 +/- 1.2 ml/2 h, males = 8; vs. 13.0 +/- 3.1 ml/2 h, females = 8; p < 0.05). On the other hand, when animals were castrated before puberty or when newborn, sexual differences in insulin-induced drinking disappeared. Hence, insulin-induced drinking seems to be a sex-dependent phenomenon that differentiates just before or during puberty since it is abolished by castration prior to sexual maturation. Sex hormone administration in male and female rats castrated at different ages showed a variety of actions on insulin-induced drinking. A pattern emerged showing that androgenized (testosterone treated) rats drank usually less in response to insulin than estrogen-treated rats (independent of their genetic sex). According to the above results, we can conclude that insulin-induced drinking is a phenomenon sensible to gonadal hormones, both by conditioning the differentiation of some physiological structure or mechanisms that underlay drinking behavior in that paradigm and by a direct action on these or other related mechanisms.