Evaluation of developmental profiles of children with hydrocephalus / Evaluación de perfiles de desarrollo de niños con hidrocefalia

Objective The objective of this study was to compare the developmental characteristics of children with hydrocephalus with those of healthy children. Material and methods A total of 109 children aged between 2 and 46 months were included in the study, 54 patients diagnosed with hydrocephalus and 55 healthy children were evaluated with demographic data forms and Denver Developmental Screening Test II. Results The mean personal–social (p<0.001), fine motor-adaptive (p<0.001), language (p<0.001), and gross motor subscale scores were significantly lower in children with hydrocephalus than in the control group. Personal–social (p=0.002) and gross motor (p=0.029) subscale scores were significantly lower in children with obstructive hydrocephalus than communicating hydrocephalus. There was a significant negative correlation between language scores and ages of the children with hydrocephalus (r=−0.350, p=0.009). It was found that children with obstructive hydrocephalus carry a 6.7 folds higher risk of experiencing problems in terms of personal–social development compared to those with communicating hydrocephalus (p=0.011). Conclusion We found that patients with hydrocephalus were developmentally retarded compared to the healthy control subjects. Retardation was the most prominent in the obstructive group. Our results showed that neurodevelopmental follow-up should be carried-out regularly in pediatric patients with hydrocephalus, and early intervention should be started in necessary cases. (AU)

Objetivo El objetivo de este estudio fue comparar las características del desarrollo de niños con hidrocefalia con las de los niños sanos. Materiales y métodos Se incluyeron en este estudio un total de 109 niños con edades entre dos y 46 meses. Del total, 54 pacientes diagnosticados con hidrocefalia y 55 niños sanos fueron evaluados con formularios de datos geográficos y test screening de desarrollo Denver II. Resultados El promedio de los puntajes de las subescalas: desarrollo personal y social (p<0,001), motricidad fina-adaptativa (p=0,001), lengua (p=0,001) y motricidad gruesa fueron significativamente menores en niños con hidrocefalia que en el grupo control. Los puntajes de las subescalas desarrollo personal y social (p=0,002) y motricidad gruesa (p=0,029) resultaron significativamente menor en niños con hidrocefalia obstructiva que en hidrocefalia comunicante. Hubo una correlación negativa significativa entre los puntajes de lengua y las edades de los niños con hidrocefalia. (r=−0,350, p=0,009). Se encontró que los niños con hidrocefalia obstructiva portaban 6,7 veces un mayor riesgo de experimentar problemas en términos de desarrollo personal-social comparado con aquellos con hidrocefalia comunicante (p=0,011). Conclusión Encontramos que pacientes con hidrocefalia presentaron un retraso madurativo en comparación con los sujetos de control sanos. El retraso madurativo fue lo más prominente en el grupo obstructivo. Nuestros resultados mostraron que debería realizarse un seguimiento de neurodesarrollo regularmente en pacientes pediátricos con hidrocefalia y una intervención temprana debería comenzar en los casos que lo requieran. (AU)

The neurodevelopmental profile of healthy children with premature anterior fontanel closure.

BACKGROUND: We aimed to assess the neurodevelopmental status of healthy children with premature anterior fontanel closure. METHODS: This retrospective observational study was conducted on 40 (20 M, 20 F) children admitted to Mersin University Pediatric Neurology Outpatient Clinic between 2015-2020 with complaints of premature fontanel closure. Patients with dysmorphic features, microcephaly, craniosynostosis, hypoxic-ischemic sequelae, infections, metabolic disorders, intracranial hemorrhage, epilepsy, endocrine problems, additional congenital anomalies, intrauterine growth retardation (IUGR), prematurity, and postmaturity were excluded. The Denver II and Bayley III tests were applied to all patients and controls. RESULTS: The Denver II identified retardations in gross motor skills (p = 0.015) and personal-social skills (p = 0.042) and Bayley III in cognitive (p = 0.030) and motor skills (p = 0.007) in the study group. None of the participants in the study group had neurodevelopmental retardation, according to the Bayley III normal standards. DISCUSSION: Our results suggest that children with premature fontanel closure may develop motor retardation. These children should, therefore, be closely monitored for neurodevelopmental aspects.

Evaluation of developmental profiles of children with hydrocephalus.

OBJECTIVE: The objective of this study was to compare the developmental characteristics of children with hydrocephalus with those of healthy children. MATERIAL AND METHODS: A total of 109 children aged between 2 and 46 months were included in the study, 54 patients diagnosed with hydrocephalus and 55 healthy children were evaluated with demographic data forms and Denver Developmental Screening Test II. RESULTS: The mean personal-social (p<0.001), fine motor-adaptive (p<0.001), language (p<0.001), and gross motor subscale scores were significantly lower in children with hydrocephalus than in the control group. Personal-social (p=0.002) and gross motor (p=0.029) subscale scores were significantly lower in children with obstructive hydrocephalus than communicating hydrocephalus. There was a significant negative correlation between language scores and ages of the children with hydrocephalus (r=-0.350, p=0.009). It was found that children with obstructive hydrocephalus carry a 6.7 folds higher risk of experiencing problems in terms of personal-social development compared to those with communicating hydrocephalus (p=0.011). CONCLUSION: We found that patients with hydrocephalus were developmentally retarded compared to the healthy control subjects. Retardation was the most prominent in the obstructive group. Our results showed that neurodevelopmental follow-up should be carried-out regularly in pediatric patients with hydrocephalus, and early intervention should be started in necessary cases.

Long-term cognitive outcomes of prematurely born infants: A longitudinal follow-up of Denver II, Bayley III and WISC-IV Tests.

BACKGROUND: Prematurity constitutes a risk factor for developmental delay in infancy and childhood. This study aims to: (i) determine long-term cognitive outcomes in prematurely delivered children and compare them with term-delivered children using the WISC-IV and Stroop tests; (ii) examine the relation between Denver II, Bayley III and WISC-IV, Stroop tests. METHODS: The study group consisted of children born prematurely who had been tested with Denver II and Bayley III in their first 2 years, and had been evaluated with WISC-IV and Stroop tests under follow up, 6-10 years later. RESULTS: The study group (n = 60, 25 F, 35 M) was 8.0 ± 2.4 (6-10.7) years old when given WISC-IV and Stroop tests. Gestational age in the study group was 34-37 weeks in 25%, 30-33 weeks in 48.3%, and <29 weeks in 26.7%. On WISC-IV, the verbal comprehension index, perceptual reasoning index, working memory index, and full-scale IQ scores were lower in the study group than the control group (P < 0.05). The study group took longer to complete the Stroop test (P < 0.05). Lower socioeconomic status (P = 0.005) and parental education level (P = 0.000) were associated with lower verbal comprehension index scores. Denver II and Bayley III test results were related to WISC-IV results (P < 0.05) but not to the Stroop test results (P > 0.05). CONCLUSIONS: Our results showed prematurity negatively influences the results of WISC-IV and Stroop tests at school age. Denver II and Bayley III tests applied at age 2 years likely predict WISC-IV results.

Neurodevelopmental risk evaluation of premature closure of the anterior fontanelle.

PURPOSE: To evaluate neurological development of completely healthy children with anterior fontanelle premature closure via Denver Developmental Screening Test II and to compare the results with control group. METHOD AND RESULTS: The records of 140 patients applied to Mersin University Pediatric Neurology Outpatient Clinic between 2011 and 2019 with the complaint of premature closure of the anterior fontanelle were retrospectively reviewed. Patients with microcephaly, craniosynostosis, infection, sequelae of hypoxia-ischemia, metabolic disorders, intracranial hemorrhage, epilepsy, endocrine problems, and dysmorphic features were excluded from the study. Sixty-six completely healthy children with anterior fontanelle premature closure were included in the study. Denver Developmental Screening Test II was performed by the same developmental specialist to the children with premature closure of the anterior fontanelle as well as to the healthy control group. For each child included in the case and the control group, 90% of the values for each development area were calculated and recorded. Then, the results were compared. Denver II Developmental Screening Test (p < 0.001) and gross motor subtest (p < 0.001) results showed statistically significant retardation in the case group compared with the control group. CONCLUSIONS: The study was the first study in the literature on the gross motor development of children with premature closure of anterior fontanelle, and it has been found significantly undeveloped compared with the control group, and it has been concluded that similar patients should be evaluated from this view point in pediatric neurology department.

Corpus callosotomy for treatment of drug-resistant epilepsy: a review of 16 pediatric cases in northern Vietnam.

OBJECTIVE: The aim of this study was to evaluate postoperative seizure outcome in children with drug-resistant epilepsy not eligible for focal resection who underwent corpus callosotomy. METHODS: The study included 16 patients undergoing corpus callosotomy between September 2015 and May 2018. Seizure semiology and frequency, psychomotor status, and video electroencephalography and imaging findings were evaluated for all patients. RESULTS: Of the 16 patients who underwent callosotomy during the study period, 11 underwent complete callosotomy and 5 underwent anterior only. Seizure improvement greater than 75% was achieved in 37.5% of patients, and another 50% of patients had seizure improvement of 50%-75%. No sustained neurological deficits were observed in these patients. There were no significant complications. Duration of postoperative follow-up ranged from 12 to 44 months. CONCLUSIONS: Corpus callosotomy is an effective treatment for selected patients with drug-resistant epilepsy not eligible for focal resection in resource-limited settings. Fostering and developing international epilepsy surgery centers should remain a high priority for the neurosurgical community at large.

Ocular and Systemic Results of Intravitreal Bevacizumab Injection in Retinopathy of Prematurity Treatment.

OBJECTIVES: The aim of this study was to evaluate the effectiveness and safety of an intravitreal bevacizumab injection (IVB) in the treatment of retinopathy of prematurity (ROP). METHODS: The medical records of patients who had received IVB treatment for ROP between January 2014 and October 2018. Anatomical and functional outcomes were evaluated. The Denver II Developmental Screening Test was administered and fluorescein angiography (FA) was performed in some cases. RESULTS: Thirty-eight eyes of 19 infants were included in the study. An IVB injection was administered to 9 infants with aggressive posterior ROP (APROP) disease (Group 1), 6 infants with any stage ROP with plus disease in zone I (Group 2), and 4 infants with stage 2-3 ROP with plus disease in zone II (Group 3). Complete retinal vascularization was observed in 24 eyes of 12 infants who received a single dose of bevacizumab without any additional treatment. Recurrence of the disease was observed in 12 eyes of 6 infants diagnosed with APROP and laser photocoagulation was performed. FA was performed to 5 IVB patients whose parents approved the procedure. The Denver II Developmental Screening Test was administered to all of the participants, and the test outcomes were consistent with the corrected age of the children, though 2 infants demonstrated a developmental delay in gross motor development tasks. Overall, good anatomical and functional results were obtained. CONCLUSION: IVB is an effective and relatively safe treatment modality for infants with ROP; however, prospective studies are required to provide more detailed information about systemic side effects.

Avaliação do desenvolvimento motor infantil em crianças de alto risco / Evaluation of child motor development in high-risk children

Objetivo: avaliar a qualidade de vida e o desenvolvimento de crianças estratificadas como de alto risco. Método: trata-se de um estudo quantitativo, descritivo, exploratório, transversal, no Centro de Atendimento Materno Infantil, com 101 crianças em que se utilizaram para a coleta de dados questionários, analisados e processados no programa Epiinfo, com o uso do teste de Kruskal-Wallis (95% de confiança) e O V de Cramer. Resultados: identificou-se a associação positiva entre o escore de suspeita de atraso no desenvolvimento neuropsicomotor e a escolaridade do responsável (p=0,000), renda familiar (p=0,000), faixa etária (p=0,012), tempo de intervenção ao nascimento (p=0,029) e alimentação (p=0,003). Conclusão: conclui-se que as crianças de alto risco estão relacionadas a diversos fatores que podem gerar atraso no desenvolvimento ou uma baixa qualidade de vida. Ressalta-se, contudo, a necessidade de novos estudos acerca do tema.(AU)

Objective: to assess the quality of life and development of children stratified as high risk. Method: this is a quantitative, descriptive, exploratory, cross-sectional study at the Maternal and Child Care Center, with 101 children who used questionnaires to collect data, analyzed and processed in the Epiinfo program, using the Kruskal-Wallis (95% confidence) and Cramer's OV. Results: a positive association was identified between the score of suspected delay in neuro-psychomotor development and the education level of the guardian (p = 0.000), family income (p = 0.000), age group (p = 0.012), time of intervention at birth (p = 0.029) and food (p = 0.003). Conclusion: it is concluded that highrisk children are related to several factors that can cause developmental delay or a low quality of life. However, there is a need for further studies on the subject.(AU)

Objetivo: evaluar la calidad de vida y el desarrollo de los niños estratificados como de alto riesgo. Método: este es un estudio cuantitativo, descriptivo, exploratorio, transversal en el Centro de Atención Materno Infantil, con 101 niños que utilizaron cuestionarios para recopilar datos, analizados y procesados en el programa Epiinfo, utilizando la prueba de Kruskal-Wallis (95% de confianza) y Cramer's OV. Resultados: se identificó una asociación positiva entre la puntuación de sospecha de retraso en el desarrollo neuropsicomotor y el nivel educativo del tutor (p = 0.000), ingresos familiares (p = 0.000), grupo de edad (p = 0.012), tiempo de intervención al nacer (p = 0.029) y alimentación (p = 0.003). Conclusión: se concluye que los niños de alto riesgo están relacionados con varios factores que pueden causar retraso en el desarrollo o una baja calidad de vida. Sin embargo, se enfatiza la necesidad de más estudios sobre el tema.(AU)

Indicadores de atraso no desenvolvimento em crianças de creche advindas de famílias de baixa renda / Developmental delays among children from day care center of socially disadvantaged families / Indicadores de retraso del desarrollo en niños de guarderías provenientes de famílias de baja renta

Avaliações periódicas precoces de indicadores de desenvolvimento são importantes para a elaboração de programas preventivos. O objetivo deste estudo foi identificar atrasos em indicadores globais de desenvolvimento em 100 crianças (idades entre 16-24 meses, média de 21,84 meses, DP+1,94), matriculadas em creches de um município do Estado de São Paulo. O instrumento de coleta de dados foi o Teste de Triagem de Desenvolvimento de Denver II (Denver II). Na amostra estudada, o domínio de maior prejuízo foi o da linguagem, seguido pelo domínio de cuidado pessoal-social. Os resultados do estudo apontam para a necessidade de incluir na avaliação do desenvolvimento infantil fatores familiares e educacionais comumente associados a atrasos de desenvolvimento. (AU)

Periodic early assessments of child development are important to elaborate prevention programs. The goal of this study was to identify global developmental delays in 100 children (aged 16-24 months, mean age 21.84 months, SD±1.94) who attended day care centers in a town in the São Paulo State. The used instrument was the Denver Developmental Screening Test II (Denver II). In the current sample, greatest deficits were observed in the speech/language domain, followed by the social-emotional development domain. The study results indicate the need of including familial/educational factors into child development's assessments, which are commonly associated with developmental delays. (AU)

Evaluaciones periódicas tempranas de indicadores de desarrollo son importantes para la creación de programas de prevención. El objetivo de este estudio fue identificar retrasos en indicadores globales de desarrollo en 100 niños (de 16 a 24 meses, promedio 21,84 meses, SD±1,94), asistidos en guarderías en una ciudad de São Paulo. El instrumento de recolección de datos fue el teste de Evaluación del desarrollo Denver II (Denver II). En esta muestra, la mayor pérdida fue el dominio de la lengua, seguida del dominio de la atención personal-social. Los resultados del estudio apuntan para la necesidad de incluir en la evaluación del desarrollo infantil factores ambientales familiares y educacionales comunmente asociados a atrasos del desarrollo. (AU)

Assessment of the Relationship between Body Mass Index and Gross Motor Development in Children.

OBJECTIVE: Obesity is a growing epidemic and public health problem in children. The purpose of this study was to determine the effect of body mass index (BMI) on the gross motor development. MATERIALS & METHODS: In this cross-sectional study conducted in 2012-13 in Gorgan, northern Iran, the gross motor development of 90 children 3-5 yr old in three groups of lean, normal and obese/overweight were evaluated by the ages and stages questionnaires (ASQ) and Denver 2 scale. RESULTS: Totally, 90 children were enrolled and their developmental level was assessed with two ASQ and Denver II indices. The mean and standard deviation of the ASQ scores of the children was 53.11± 11.06 and based on Denver index, 9 children (10%) were at developmental delay status, 15 (16.7%) in the caution conditions, and 53 (58.9%) at normal developmental status. The developmental level was lower in obese/overweight group comparing with other groups according to both Denver and ASQ and there was a significant difference between obese/overweight group and normal group based in Denver and ASQ, respectively. There was no significant difference between underweight and normal and obese and underweight groups. CONCLUSION: Overweight and obesity could affect on the gross motor development.

Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration.

BACKGROUND: Neonatal hypernatremic dehydration (NHD) is a dangerous condition that can lead to severe weight loss, renal impairment, and central nervous system complications. We aimed to evaluate the consequences of NHD in infants in their second year of life. MATERIALS AND METHODS: This was a prospective case-control study in Ghaem hospital, Mashhad, Iran. Sixty-five healthy breastfed neonates (serum sodium concentration <150 mmol/L) and 65 hypernatremic (serum sodium concentration ≥150 mmol/L) neonates were followed up from 2008 to 2011. Maternal and neonatal factors were compared between the two groups together with their growth parameters, and developmental milestones (using Denver II developmental assessment scores) were assessed and compared in ages 6, 12, 18, and 24 months, respectively. RESULTS: The weight of infants at 6 months of age was significantly different between the two groups (7,264 ± 1,089 g vs. 7,596 ± 957 g, p = 0.009). Twenty-five percent of infants in the group who had developed NHD had a delay in development at 6 months of age, with corresponding values of 21% at 12 months, 19% at 18 months, and 12% at 24 months of age. Developmental delay was ∼0.3% for the control group at similar ages. The severity of hypernatremia was strongly correlated with poor developmental outcome at 6 months (p = 0.001). Serum sodium concentration of neonates was 153-195 mg/dL in the NHD group. Median peak serum sodium was 158 ± 16 in case group and 141 ± 9 in control group. Serious complications were cerebral edema (five cases), hemorrhage (five cases), and kidney stones (six cases). Hypernatremic dehydration has an adverse effect on child development especially in the first year of life, their prevalence decreases with advanced age. Growth problems are also present during their first year of life. The major signs and symptoms of infants with poor prognosis on admission were poor feeding (8 infants, 61.5%), seizure (3 infants, 23.1%), hyperthermia (1 infant, 7.7%), and lethargy (1 infant, 7.7%). CONCLUSIONS: NHD affects growth parameters and developmental milestones of children. Occasionally the child's weight gain was normalized by the end of first year of life; although developmental delay continued, its severity was reduced, with age.

Adaptation and standardization of a Western tool for assessing child development in non-Western low-income context.

BACKGROUND: Due to lack of culturally relevant assessment tools, little is known about children's developmental profiles in low income settings such as Ethiopia. The objective of this study was to adapt and standardize the Denver II for assessing child development in Jimma Zone, South West Ethiopia. METHODS: Culture-specific test items in Denver II were modified. After translation into two local languages, all test items were piloted and fine-tuned. Using 1597 healthy children 4 days to 70.6 months of age, the 25, 50, 75 and 90 % passing ages were determined for each test item as milestones. Milestones attainment on the adapted version and the Denver II were compared on the 90 % passing age. Reliability of the adapted tool was examined. RESULTS: A total of 36 (28.8 %) test items, mostly from personal social domain, were adapted. Milestones attainment ages on the two versions differed significantly on 42 (34 %) test items. The adapted tool has an excellent inter-rater on 123 (98 %) items and substantial to excellent test-retest reliability on 119 (91 %) items. CONCLUSIONS: A Western developmental assessment tool can be adapted reliably for use in low-income settings. Age differences in attaining milestones indicate a correct estimation of child development requires a population-specific standard.

Triagem do Desenvolvimento Neuropsicomotor de Crianças das Unidades de Educação Infantil do Município de Belém, Pará, Brasil / Psychomotor development screening of children from kindergarten units of Belém, Pará, Brazil

INTRODUCTION: Child development is considered a sequence of changes in behaviour and underlying processes that are influenced by biological and environmental factors. The screening and monitoring of neuropsychomotor development (NPMD) procedures have been shown to be effective in the early identification of different diseases in childhood. OBJECTIVE: relate the condition of the NPMD in children aged 36-48 months attending Early Childhood Education Units (ECEU) in Belém, Pará, Brazil to certain personal characteristics and variables of their ecological environment. METHODS: The following instruments were applied: Questionnaire of the biopsychosocial characteristics of the child, the Instrument for Measuring Urban Poverty Level, and finally, Developmental Screening Denver II Test. RESULT: The study revealed that of the 319 children evaluated, 77.74% had probable delays in development. The variables that were statistically significant were paternal education (0.000**), the child's primary caregiver (0.039*) and pregnancy planning (0.007*). Regarding the instrument of measurement for the level of urban poverty, the scores ranged from 28 to 52 points, and showed a statistically significant relation with the outcome (0.003)* CONCLUSION: The high prevalence of probable developmental delays seen in children of the city's ECEU showed the need to introduce early stimulation programs, encouraging the monitoring of child development through the screening, and, in addition, to alert for the issue of negative interference of socioeconomic factors related to family condition and city they reside in on child growth and development.

INTRODUÇÃO: O desenvolvimento infantil é considerado uma sequência de mudanças no comportamento e processos subjacentes, sendo influenciado por fatores biológicos e ambientais. A triagem e o acompanhamento do desenvolvimento neuropsicomotor (DNPM) têm se revelado como procedimentos eficientes na identificação precoce das diferentes afecções na infância. OBJETIVO: Este estudo teve como objetivo relacionar o estado do desenvolvimento neuropsicomotor de crianças, na faixa etária de 36 a 48 meses, que frequentavam Unidades de Educação Infantil (UEI) do município de Belém, com determinadas características pessoais e variáveis do seu ambiente ecológico. MÉTODO: Foram aplicados os seguintes instrumentos: Questionário das Características Biopsicossociais da Criança, o Instrumento de medição do Nível de Pobreza Urbana, e por fim, o Teste de Triagem do Desenvolvimento Denver II. : O estudo revelou que das 319 crianças avaliadas, 77,74% apresentaram desenvolvimento suspeito de atraso. As variáveis que apresentaram relação estatisticamente significativa foram escolaridade paterna (p < 0,001**), principal cuidador da criança (p=0,039*), planejamento da gravidez (p = 0,007*). Quanto ao instrumento de medição do nível de pobreza urbana, a pontuação variou de 28 a 52 pontos, e apresentou relação estatisticamente significativa com o desfecho (0,003*). CONCLUSÃO: A alta prevalência da condição de suspeita de atraso no desenvolvimento entre as crianças pesquisadas alerta para a influência de fatores socioeconômicos relativos à condição da família e do município em que moram no crescimento e desenvolvimento infantil, e aponta a necessidade de introduzir programas de estimulação precoce.

Assessment of Risk Factors and Prognosis in Asphyxiated Infants.

BACKGROUND: Asphyxia is considered an important cause of morbidity and mortality in neonates. This condition can affect many vital organs including the central nervous system and may eventually lead to death or developmental disorders. OBJECTIVES: Considering the high prevalence of asphyxia and its adverse consequences, the present study was conducted to evaluate the risk factors for birth asphyxia and assess their correlation with prognosis in asphyxiated infants. PATIENTS AND METHODS: This two-year follow-up cohort study was conducted on 260 infants (110 asphyxiated infants and 150 healthy neonates) at Mashhad Ghaem Hospital during 2007 - 2014. Data collection tools consisted of a researcher-designed questionnaire including maternal and neonatal information and clinical/laboratory test results. The subjects were followed-up, using Denver II test for 6, 12, 18, and 24 months (after discharge). For data analysis, t-test was performed, using SPSS version 16.5. P value ≤ 0.05 was considered statistically significant. RESULTS: Of 260 neonates, 199 (76.5%) and 61 (23.5%) cases presented with normal neonatal outcomes and with abnormal neonatal outcomes (developmental delay), respectively. Variables such as the severity of asphyxia (P = 0.000), five-minute Apgar score (P = 0.015), need for ventilation (P = 0.000), and severity of acidosis at birth (P = 0.001) were the major prognostic factors in infants with asphyxia. Additionally, prognosis was significantly poorer in boys and infants with dystocia history (P = 0.000). CONCLUSIONS: Prevalence of risk factors for developmental delay including the severity of asphyxia need for mechanical ventilation, and severity of acidosis at birth, dystocia, and Apgar score were lower in surviving infants; therefore, controlling these risk factors may reduce asphyxia-associated complications.

Evaluating developmental screening in clinical practice.

OBJECTIVE: To demonstrate a method of evaluating accuracy of developmental screening modeled on the evidence-based medical literature. METHOD: A retrospective review was performed on 418 children screened with the Denver II by a trained technician. Two models for analyzing screening data were examined, using predictive values and likelihood ratios (LR+ and LR-). RESULTS: The technician, working at 20% time, screened 44% of eligible children. There were 129/418 (31%) children with Suspect Denver II results, 115/418 who were referred, 81/115 (70%) who were evaluated by Early Intervention, and 64/81 (79%) who qualified for services. The uncorrected positive predictive value for the Denver II alone (44%) was insufficient to meet the preset standard of 60%, but the LR+ of 4.16 indicated a significant contribution of test information to improving predictive value. Combining test results with information from the parent-technician conference to achieve a referral decision resulted in an uncorrected predictive value of 56%, which rose with correction for children referred but not evaluated to 72% (LR+ 10.33). Negative predictive values and likelihood ratios of a negative test and a non-referral decision achieved recommended levels. Parents who expressed concern were significantly more likely to complete recommended evaluation than those who did not (82% vs 58%, p < .01). Results were in the same range as in published studies with other screening tests but showed three areas for improvement: screening more children, more carefully supervising some referral decisions, and getting more children to evaluation. CONCLUSION: Levels of predictive accuracy above 60% can be obtained by combining different types of information about development to make decisions about referral for more complete evaluation. Systematic study of such combinations could lead to improved predictive accuracy of screening programs and support attempts to close the gap between referral and evaluation.

Edad de presentación de los reactivos del Test de Denver II en Niños de 0 a 4 años de edad del Estado de Morelos / Age of presentation of Denver Test items in the first 4 year of life of children from Morelos, Mexico

Uno de los instrumentos más utilizados a nivel internacional en la vigilancia del desarrollo del niño es la segunda versión del Denver Developmental Screening Test (DENVER II), del cual se han hecho evaluaciones y modificaciones en varios países, a partir de la estimación de la edad de presentación de los reactivos, pues constituye la base de su estructura y validez. Objetivo Identificar las edades y secuencias de presentación de los reactivos del Test Denver II en los cuatro primeros años de vida en niños de condición socioeconómica baja de una comunidad del Estado de Morelos, México. Método Se realizaron 2350 evaluaciones a niños de 0 a 48 meses de edad. Mediante un modelo de regresión logística se estimó la edad de presentación de cada reactivo para los percentiles 25, 50, 75 y 90. Se establecieron diferencias con los valores de referencia del instrumento con base en los intervalos de confianza al 95% para el percentil 90. Resultados De los 98 reactivos evaluados, 42 se presentaron con retraso; 23 no mostraron diferencias estadísticas y 33 se lograron antes por los niños del estudio. En las áreas Motor grueso y Personal-social predominaron los retrasos en 19/25 y 11/21 reactivos respectivamente. Por el contrario en Motor Fino-Adaptativo y Lenguaje predominaron los adelantos en 11 de 22 y 16 de 30 reactivos. Conclusiones Existen diferencias en las edades y secuencias de presentación de los reactivos del Test de Denver II en la población estudiada. Se recomienda realizar ajustes antes de implementar su uso en contextos socioculturales específicos.

The Denver Developmental Screening Test (Denver II) is the most used internationally tool for child development surveillance, from which assessments and changes have been made in several countries, from the estimate of the age of presentation of the items, because it constitutes the basis of its structure and validity. Objective To identify the age and sequences acquiring of each item of the Denver-II test during the first four years of life in children of low socioeconomic status from a community of Morelos State, Mexico. Method 2350 assessments were conducted to children from 0 to 48 months of age. A logistic regression model was used to estimate the age of presentation of each item to the centiles 25th, 50th, 75th and 90th. Differences were established with values of reference based on confidence intervals up to 95% for 90th centile. Results Of the 98 items evaluated, 42 were submitted delayed, 23 showed no statistical difference and 33 were acquired in earlier age in children of Morelos. In the Gross Motor and Personal-social areas predominated the delayed with 19/25 and 11/21 items, respectively. By contrast, in Fine Motor-Adaptive and Language predominated the advances, with 11/22 and 16/30 items. Conclusions There are differences in the age and sequence of presentation of the items of the Denver-II test in the population studied. Adjustments are recommended before implementing its use in specific socio-cultural contexts.

Desenvolvimento de crianças nascidas pré-termo avaliado pelo teste de Denver-II: revisão da produção científica brasileira / Development of children born preterm evaluated by the Denver-II test: a review of the Brazilian scientific production

Este artigo objetivou analisar a produção científica sobre o desenvolvimento de crianças brasileiras nascidas pré-termo e de muito baixo peso avaliado por meio do Teste de Denver-II, no período de 2000 a 2009. Realizou-se levantamento bibliográfico de estudos empíricos indexados nas bases de dados Medline, Lilacs e Scielo, por meio da combinação das palavras chave: pré-termo, muito baixo peso, fatores de risco, desenvolvimento, Denver-II. Foram identificados 26 artigos e selecionados oito conforme critérios de inclusão. A maioria dos estudos avaliou crianças pré-termo entre 5 a 24 meses de idade. Os estudos identificaram associação entre as variáveis neonatais e ambientais e o desempenho no Teste de Denver-II. Crianças nascidas pré-termo devem ser acompanhadas ambulatorialmente para prevenir e detectar riscos no desenvolvimento.

This article aims to analyze the scientific literature on the development of children born preterm with very low birth weight assessed by the Denver-II test in the period from 2000 to 2009. A survey of empirical literature indexed in Medline, Lilacs and Scielo was carried out through the combination of the keywords: preterm, very low birth weight, risk factors, development, and Denver-II. Twenty six articles were identified and eight were selected following the inclusion criteria. Most studies evaluated preterm children between 5 and 24 months of age. The studies identified a significant association between neonatal and environmental variables and the performance on Denver-II Test. Children born preterm must be followedup at outpatient Units to prevent and detect risks in development.

Desenvolvimento de crianças nascidas pré-termo avaliado pelo teste de Denver-II: revisão da produção científica brasileira / Development of children born preterm evaluated by the Denver-II test: a review of the Brazilian scientific production

Este artigo objetivou analisar a produção científica sobre o desenvolvimento de crianças brasileiras nascidas pré-termo e de muito baixo peso avaliado por meio do Teste de Denver-II, no período de 2000 a 2009. Realizou-se levantamento bibliográfico de estudos empíricos indexados nas bases de dados Medline, Lilacs e Scielo, por meio da combinação das palavras chave: pré-termo, muito baixo peso, fatores de risco, desenvolvimento, Denver-II. Foram identificados 26 artigos e selecionados oito conforme critérios de inclusão. A maioria dos estudos avaliou crianças pré-termo entre 5 a 24 meses de idade. Os estudos identificaram associação entre as variáveis neonatais e ambientais e o desempenho no Teste de Denver-II. Crianças nascidas pré-termo devem ser acompanhadas ambulatorialmente para prevenir e detectar riscos no desenvolvimento.(AU)

This article aims to analyze the scientific literature on the development of children born preterm with very low birth weight assessed by the Denver-II test in the period from 2000 to 2009. A survey of empirical literature indexed in Medline, Lilacs and Scielo was carried out through the combination of the keywords: preterm, very low birth weight, risk factors, development, and Denver-II. Twenty six articles were identified and eight were selected following the inclusion criteria. Most studies evaluated preterm children between 5 and 24 months of age. The studies identified a significant association between neonatal and environmental variables and the performance on Denver-II Test. Children born preterm must be followedup at outpatient Units to prevent and detect risks in development.(AU)

Desempenho de crianças pré-termo com muito baixo peso e extremo baixo peso segundo o teste Denver-II / The performance of pre-term children with very and extreme low weight according to the Denver-II test

OBJETIVOS: analisar o desempenho de crianças da região metropolitana Belo Horizonte/MG nascidas pré-termo com muito e extremo baixo peso nos itens do teste Denver II. MÉTODOS: as crianças foram selecionadas em um programa de acompanhamento do desenvolvimento de crianças de risco. A amostra incluiu 177 crianças, nas quais o Teste de Denver II foi aplicado nas idades corrigidas de 4, 8, 12, 18 e 24 meses. As respostas foram comparadas (χ2) aos dados da amostra normativa do instrumento. RESULTADOS: crianças pré-termo de muito e extremo baixo peso apresentaram desempenho superior no primeiro ano de vida com desvantagem a partir dos 12 meses em relação à amostra normativa do Denver II. O grupo de extremo baixo peso foi o que apresentou pior desempenho. CONCLUSÕES: houve diferenças no padrão de respostas das crianças examinadas em relação à amostra normativa do Denver II, sendo importante fazer mais estudos acerca da validade do teste para a população brasileira.

OBJECTIVES: to evaluate the performance on the Denver II test of preterm children with very and extreme low weight from the Belo Horizonte/MG metropolitan region. METHODS: the children were selected as part of a program to monitor the development of children at risk. The sample included 177 children, to whom the Denver II Test was applied at corrected ages of 4, 8, 12, 18 and 24 months. The responses were compared (χ2) to data from a normative sample. RESULTS: preterm children with very or extremely low weight showed improved performance in the first year of life, although disadvantages began to emerge after twelve months in relation to the normative Denver II sample. The extremely low weight group performed the worst. CONCLUSIONS: there were differences in the pattern of children's responses compared to those of the normative Denver II sample, and it is important to carry out further studies of the validity of this test for the Brazilian population.

Valor de predição da ultrassonografia cerebral em recém-nascidos pré-termo para alteração de desenvolvimento neuropsicomotor aos 12 meses de idade corrigida / The predictive value of neonatal brain ultrasound in premature babies for impaired neurodevelopment with a correted age of 12 months

OBJETIVO: verificar o valor preditivo da ultrassonografia transfontanelar em recém-nascidos prematuros na determinação das alterações do desenvolvimento neuropsicomotor. MÉTODO: coorte prospectivo. Foram estudados 99 recém-nascidos prematuros com peso de nascimento menor ou igual a 1800 gramas e idade gestacional abaixo de 37 semanas que fizeram ultrassom transfontanelar no período neonatal durante internação em UTI. Para avaliação do desenvolvimento neuropsicomotor utilizou-se o Teste de Denver II. Na análise bivariada utilizou-se o teste do qui-quadrado e na análise multivariada, regressão logística onde foram detectadas associações entre características sócio-econômicas e a variável resposta. Finalmente foi realizada análise para avaliação de valores preditivos positivos e negativos. RESULTADOS: população composta de crianças com 12 meses de idade corrigida, com média de peso de nascimento de 1320 gramas e idade gestacional média de 31 semanas e 3 dias. Alterações ultra-sonográficas estiveram presentes em 49,4 por cento das crianças. Dos testes realizados, 34,3 por cento tiveram resultados desfavoráveis. Dos fatores de risco para alteração de desenvolvimento, alterações ultra-sonográficas cerebrais e renda familiar mostram-se estatisticamente significantes. O valor preditivo positivo dos exames ultra-sonográficos transfontanelares para alterações de desenvolvimento neuropsicomotor, foi de 51,02 por cento e o negativo, 82 por cento. Acrescentando-se a variável renda familiar às alterações ultra-sonográficas transfontanelares, o valor preditivo positivo aumentou para 90 por cento e o negativo reduziu-se para 71,91 por cento. CONCLUSÃO: acredita-se que o acréscimo à análise da variável renda familiar é boa alternativa para aumentar a capacidade de predizer o desenvolvimento de prematuros com alterações ultra-sonográficas transfontanelares