RESUMO
Attention problems hinder many children in their cognitive and social emotional development. Children at risk for developmental problems, like preterm born infants, are specifically known for attention difficulties. Early identification of attention difficulties is important for application of appropriate stimulation in trying to reduce further problems. Specifically designed instruments with good psychometric characteristics are needed to show difficulties in attention, that may contribute to early identification. The Utrecht Tasks of Attention in Toddlers using Eye tracking (UTATE) is an instrument to measure orienting, alerting and executive attention capacities in young children. Reliability and validity of the UTATE are specifically addressed in three studies, reported in this paper. A sample of 95 term born children assessed at 18 months of age was used that provided data for both the second and third study reported here. In addition, three other small samples were used, of which the first consisted of 12 children at 18 months with test-retest data available that are reported in the first study. Two other samples that were used in the third study, consisted of 14 children measured at 12 months, and 15 children examined at 24 months. The UTATE resulted in reliable information on eye movements and some first support for construct and predictive validity was found. Low scores on the UTATE at 18 months were found to be related to slower cognitive development as measured with the Bayley-III-NL at 24 months. Furthermore, a first indication that the UTATE is able to detect some age differences in attention was found. It is concluded that the UTATE can be used to study attention capacities in toddlers that underlie cognitive functioning and development, but further research is necessary.
RESUMO
BACKGROUND: To gain insight into factors that might affect results of future case-control studies, we performed an analysis of children with sepsis and purpura admitted to the paediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital (Rotterdam, The Netherlands). METHODS: Between 1988 and 2006, all 287 children consecutively admitted with sepsis and purpura were included in various sepsis studies. Data regarding age, gender, ethnicity, serogroup of Neisseria meningitidis, severity, therapy, and survival were collected prospectively. These data were pooled into one database and analyzed retrospectively. RESULTS: The case fatality rate (CFR) from sepsis and purpura was 15.7%. During the study period, survival improved significantly. Younger age was significantly associated with more severe disease and a higher CFR. Children under the median age of 3.0 years had an increased risk of case fatality (odds ratio 4.3, 95% confidence interval 2.1 to 9.2; p < 0.001). Gender was not associated with CFR. However, males did have higher Paediatric Risk of Mortality scores, fewer PICU-free days, and more presence of shock. The course of sepsis and purpura was not related to ethnic origin. A causative organism was isolated in 84.3% of cases. N. meningitidis was the major organism (97.5%). Although N. meningitidis serogroup B was observed more often in younger children, serogroups were not associated with severity or survival. During the study period, the use of inotropic agents and corticosteroids changed substantially (less dopamine and more dobutamine, norepinephrine, and corticosteroids). CONCLUSION: Age and gender are determinants of severity of paediatric sepsis and purpura. Survival rates have improved during the last two decades.
