Longitudinal stability of visual evoked potentials in children and adolescents with hydrocephalus.

There were two purposes for this study: to determine the within-subject changes of visual evoked potentials (VEPs) over time, and to evaluate the usefulness of baseline VEP testing in the early diagnosis of increased intracranial pressure (ICP). Twenty children with hydrocephalus between the ages of 4 and 18 years (18 males, 2 females) were evaluated monthly for up to four months. Flash-evoked VEP tests were done in a standardized manner using a Cadwell Quantum 84 evoked potential stimulation and recording instrument. One participant had abnormal VEPs found during a previous episode of shunt malfunction. For all of the other VEP tests, the latency of the N2 response was in the range of adult normal values. For 15 participants with multiple evaluations there were non-significant differences in N2 latency from one session to the next. This study's results provide evidence that within-subject VEP measurements in children with hydrocephalus appear to be relatively stable over limited periods. However, considerable differences were found when comparing VEPs between participants. Further research may provide additional evidence that periodic, routine VEP testing is an effective way to monitor individuals who have shunted hydrocephalus in order to detect increased ICP before the appearance of obvious symptoms.

Weight gain: a possible factor in deciding timing for inguinal hernia repair in premature infants.

A retrospective study was done to determine whether improved weight gain follows inguinal hernia repair in the premature infant and whether the presence of an inguinal hernia is associated with comparatively poorer weight gain prior to repair. Demographic and growth data from 28 premature infants who had undergone hernia repair were compared with corresponding data from 25 matched "control" premature patients. The two groups' weight for age Z scores for both time periods (i.e., before and after hernia repair) were then determined and analyzed. The differences found in Z scores between these two groups indicated that premature infants who have inguinal hernias seem to grow better after the hernia repair as compared with before the surgery. Despite issues related to group matching, the results of this study indicate that weight gain may be an additional factor to consider in determining the appropriate time to do surgical correction of a premature infant's inguinal hernia.

Use of incremental weight charts with follow-up of high-risk infants.

A retrospective descriptive study was done to determine the potential usefulness of using incremental weight charts in the management of infants followed in a high-risk infant follow-up clinic. For this study, 135 charts were reviewed and 42 were subjected to data collection and analysis by using commercially available weight velocity charts. The incremental weight charts that were produced demonstrated that most of the infants studied had growth velocities well within the normal range; however, infants who had a history of bronchopulmonary dysplasia had a tendency to have weight velocities below the 5th percentile. Also observed was a correlation for infants born with a very low birth weight (< 1000 gm) to have somewhat lower, although usually normal, percentiles for later weight velocity. Analysis and comparison of these incremental charts with standard growth charts for these infants demonstrated that incremental weight charts appear to be superior to standard charts in graphically demonstrating changes in weight over time.

Comparison of a computer tutorial with other methods for teaching well-newborn care.

Research using a computer-assisted instructional program developed for teaching well-newborn care is described. Third-year medical students were randomly assigned during their week-long nursery rotation into three groups to study the acceptability and effectiveness of using the computer-assisted instructional lessons. Group A, the control group, was not required to complete any additional educational task. Group B was assigned specific reading material. Group C completed the microcomputer-based tutorial. (The term tutorial is often used interchangeably to describe the computer-assisted instructional program.) Both groups B and C improved dramatically on a posttest in comparison with group A. There was no statistically significant difference between groups B and C on the improvement from pretest to posttest scores. However, significantly less time was spent by group C completing the tutorial compared with the total time spent reading by group B. The results of this study provide further illustration of the feasibility and effectiveness of using a computer-assisted instructional program for medical student education.

Evaluation of changes made to an infant home apnea monitoring program in response to findings from a national consensus panel.

A comparison was made of two different management methods that were developed to help follow high-risk infants on home apnea or bradycardia monitors. With the first method (group 1), used before 1986, decisions were based partly on home pneumogram results. The second method (group 2), based partly on suggestions about monitoring from a national consensus panel, mainly uses clinical history to assist with making decisions. Comparisons were made between the two groups of infants in a retrospective clinical analysis. The infants in group 2, on the average, had significantly fewer days on a monitor than group 1 (174 vs 324) and had much fewer pneumogram tests (0.3 vs 1.6). Several advantages in using a specific monitoring follow-up procedure were noted, including the benefits to the parents from using a consistent plan for management.

Relationship of head circumference to measures of school performance.

To study the possible relationship of head circumference (HC) to learning problems in children, a retrospective study was done, using records from 360 subjects who had been evaluated between the years 1976 and 1981. The data selected from the records included standardized academic test results, e.g., IQ scores and school achievement test results, as well as determinations of visual motor abilities. Statistical analyses demonstrated a positive correlation between full scale IQ (FSIQ) and HC (p less than 0.005). The incidence of specific learning disabilities based on significant academic and achievement discrepancies was 54% in those with HC greater than 2 S.D., 39% for normocephalic, and 23% for those with HC less than 2 S.D. Comparison of HC with results from the Wide Range Achievement Test (WRAT) demonstrated a tendency for those children with HC greater than 2 S.D. to have lower arithmetic scores when compared to results of children with normocephaly. Scores for spelling and reading ability did not demonstrate this tendency. The results of this study were found to be somewhat incongruous to those of previous studies of similar children. Further studies using large unselected populations are needed to better define the risks to learning that may be related to the extremes of head circumference.