[Psychomotor and cognitive development of children born after intracytoplasmic sperm injection]. / Psychomotorický a kognitivní vývoj detí narozených po mimotelním oplodnení metodou intracytoplazmatické injekce spermie.

OBJECTIVE: To analyse data on psychomotor and cognitive development of children born after intracytoplasmic sperm injection (ICSI). DESIGN: Open cross-section clinical study. SETTING: Institute for the Care of Mother and Child, Prague and Department of Paediatrics, Charles University, 2nd Medical School and University Hospital Motol, Prague. METHODS: In 133 children (75 boys and 58 girls) psychological examination was made at the age range 11 months - 8.5 years in the years 2004-2006. All children were born after intracytoplasmic sperm injection (ICSI). Psychomotor development of children aged from 11 months to 3.5 years was assessed using the Bayley Scales (BSID-II). In older children, Global Intelligence McCarthy Test was used. RESULTS: In our sample of ICSI-children, no significantly higher incidence of children delayed in mental (cognitive) as well as in motor development has been found as compared with the population norms. However, the results indicate a significantly lower average value of the Psychomotor Developmental Index (PDI) in the group of younger children as compared with the given norm (92.3 +/- 13.9 versus 100 +/- 15; p<0.01). In the group of older children, lower average value of the General Cognitive Index (GCI), as compared with corrected population norm has been found (105.1 +/- 14.7 versus 110 +/- 16; p<0.05). In the group of twins, a significantly higher number of mild developmental disorders was ascertained on the contrary in the group of singletons (64.7% versus 333%; p<0.01) in our older children conceived by ICSI. CONCLUSION: The results indicate only mild lowering of some performances in our ICSI-children: in motor domain in younger children, and in cognitive domain in older children. Children from multiple pregnancies are at greater developmental risk than singletons.

[Parental attitudes and socio-emotional development in children born after ICSI]. / Rodicovské postoje a socioemocní vývoj detí pocatých po ICSI.

OBJECTIVE: To analyze parental attitudes and socio-emotional development of children conceived by ICSI. DESIGN: Open cross-sectional study. SETTING: Department of Clinical Psychology, Thomayer University Hospital, Prague and Department of Paediatrics, Charles University, 2nd Medical School, University Hospital-Motol, Prague. METHODS: 133 children (75 boys, 58 girls) conceived by ICSI, age ranged from 11 months to 8.5 years were psychologically assessed between the years 2004-2006. Children's behavior was evaluated by 4 rating scales during the assessment. Parents answered questionnaires concerning children's temperament, behavioral problems (TBC) and the parental attitudes questionnaire (PARQ). RESULTS: Children's behavior during the psychological assessment was rated mostly as very good or good, although the children were often less communicative. Most of the children have mixed or easy temperament, a difficult type of temperament didn't report any of the parents. Most of the parents didn't describe significant behavioral problems in their children, in particular there were very few externalizing difficulties (opposition, aggression), but in 29.5% of the sample, there were found some social or emotional difficulties. We found surprisingly high frequency of milder forms of autism spectrum disorders and another social problems (social and other anxiety disorders) in the sample, other psychopathology was rare. Parental attitudes had a tendency to grater involvement with the child and high affection in relation with him. CONCLUSION: Socio-emotional development of ICSI children is good, although some have specific social difficulties, externalising problems were present only exceptionally. Parental attitudes toward ICSI children are positive, there is slight tendency to higher emotional involvement with the child.

[Children born after intracytoplasmic sperm injection (ICSI): factors of infertility, pregnancy complications, neonatal period and neonatal characteristics]. / Deti narozené po intracytoplazmatické injekci spermie: faktory neplodnosti, prubeh tehotenství a porodu, perinatální období.

OBJECTIVE: To analyze the type of infertility, pregnancy and neonatal outcome in children conceived after intracytoplasmic sperm injection (ICSI children). DESIGN: Prospective open cross-sectional clinical study. SETTING: University hospital and private IVF unit. METHODS: Type of infertility, pregnancy complications, neonatal period and neonatal characteristics were evaluated in 135 newborns conceived after ICSI from singleton and twin pregnancies and compared to general population. RESULTS: The percentage of twins was significantly higher after ICSI compared to general population (31% versus 1.7%; p<0.001) as well as the percentage of caesarean section deliveries (31% versus 17.8%; p<0.001). Some complication in neonatal period was found in 21.5% ICSI newborns (18 out of 42 twins and 12 out of 93 singletons; p< 0.001). Some complication during the course of pregnancy was found in 50.9% ICSI children. CONCLUSIONS: no differences in gestational age, birth weight and birth length were found when ICSI and spontaneously conceined (sc) singletons and ICSI and SC twins were compared. However, complications during the course of pregnancy and in the neonatal period were more frequent in ICSI conceived children.

[Birth defects, medical outcome and somatic development in children conceived after intracytoplasmic sperm injection (ICSI)]. / Vrozené vývojové vady, zdravotní stav a somatický vývoj detí narozených po intracytoplazmatické injekci spermie.

OBJECTIVE: To analyze the incidence of birth defects, medical outcome and somatic development in children conceived after intracytoplasmic sperm injection (ICSI). DESIGN: Prospective open cross-sectional clinical study. SETTING: University hospital and private IVF unit. METHODS: 135 Czech children (59 girls, 76 boys) from singleton and twin pregnancies conceived after ICSI (age 03-9.5 years; median 5.9) were assessed during the period 2004-2006. The incidence of birth defects, medical outcome and somatic development were evaluated and compared with data of general population and/or with control group matched for sex and age. RESULTS: Birth defects were found in 133% of ICSI children (compared to 4.6% in children after spontaneous conception; p<0.001). The general health of ICSI children did not differ significantly compared to general population. ICSI children required more surgery or hospitalization compared to general population data. There is high rate (69.6%) among ICSI children in the care of various specialised clinics. Body height and weight in ICSI children is in normal range and corresponds to their growth potential. Head circumference in ICSI children is larger compared to reference data (0.43 SD; p<0.001). CONCLUSIONS: No clinically important differences in somatic development between ICSI and general population of Czech children were found. Birth defects were more frequent in ICSI children. The overall general health in ICSI children seems satisfactory but ICSI children were more likely to need health care compared to general population.

[Psychological condition of children from pregnancies after assisted reproduction in the third year of life]. / Psychický stav detí z tehotenství po asistované reprodukci ve tretím roce zivota.

OBJECTIVE: To analyse psychological development of children born after assisted reproductive technology. DESIGN: Psychological analysis of the child's development related to the technology of assisted reproduction, length of pregnancy and multiple birth was performed and compared with the control group. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Out of the total number of 123 children born after assisted reproductive technology during the 1st half of the year 1998 in the Center ISCARE IVF, psychological development was evaluated in 109 children (88.6%). Ninety four children from this sample were assessed using mental, motor and behavior scales of the Bayley Scales of Infant Development II. RESULTS: Mental and motor development of infants born after intracytoplasmatic injection (ICSI) and after in-vitro-fertilisation (IVF) was not significantly different. Fullterm singletons born after assisted reproductive technology did not differ from control fullterm children. There was a developmental delay in both fullterm and preterm children from multiple pregnancies in comparison to control children. No child had serious impairment of psychic functions (developmental index <50). There were no significant differences in behavior records between children born after assisted reproductive technology and control children, but some parents had problems in educational care of their children born after assisted reproductive technology. CONCLUSION: From children born after assisted reproductive technology, those from multiple pregnancies may be at risk for later psychological development. The occurrence of educational problems in assisted reproductive families indicates a need of accessible professional care in this field.

[Further development of neonates with severe pneumopathy]. / Dalsí vývoj novorozencu s tezkou formou pneumopatie.

OBJECTIVE: To assess the risk and the degree of possible unfavourable development in neonates with bronchopulmonal dysplasia and with congenital diaphragmatic hernia. DESIGN: Longitudinal monitoring of the mental, motoric and neurological development until the age of 2 years. Comparison of the findings with the result of polygraphic examination carried out at the expected time of birth. METHODS: The following children were monitored: a) 38 children with bronchopulmonal dysplasia born between the 24th and 33rd post-conception weeks; b) 18 children with congenital diaphragmatic hernia, of whom 3 children were born between the 34th and 36th post-conception weeks, while the remaining 15 children were born on the expected date. All children underwent polygraphic examinations (EEG - 8 channels, respiration, EKG, EOG and EMG) between the 38th and 42nd post-conception weeks. During the 1st and the 2nd years, their psychomotoric development and neurological status were repeatedly evaluated according to Bayley and Vlach, respectively. RESULTS: Up until the 2nd year of life, approximately 2/3 of the children in both monitored groups were developing favourably or satisfactorily. However, the development of the remaining 1/3 was not favourable: The children were mentally or motorically retarded and/or cerebral palsy developed in them. The polygraphic examination in the neonatal period predicted the favourable or unfavourable development of the monitored children with high probability. CONCLUSION: The study showed that in accordance with the data stated in the literature, the development of neural functions is seriously affected in a relatively high percentage of neonates with severe pneumopathy. Neonatal polygraphy can contribute to timely determination of the prognosis for these children. Children with serious neonatal pneumopathies need to be provided with dispensary care on a long-term basis, and professional consultancy and intervention programmes need to be ensured for them.

[Effect of early nutrition on growth parameters and psychomotor development of children of very low birth weight]. / Vliv casné výzivy na rustové parametry a psychomotorický vývoj u detí s velmi nízkou porodní hmotností.

OBJECTIVE: The aim of the study was to evaluate influence of early nutrition on growth parameters and psychomotor development of children with very low birth weight (VLBW). DESIGN: A prospective clinical study. SETTING: Institute for Care of Mother and Child, Prague. METHODS: Thirty nine children of birth weight 1,000-1,499 were followed up to one year of their corrected age in a prospective study. The group was divided in two groups according to type of nutrition: 17 children (group A) were fed with milk of own mother - "preterm milk", 22 children (group B) were orally fed with mature milk from the Bank of mother milk - "term milk", which was fortified with BMF preparation (Nutricia, Netherlands). Both groups were comparable in basic anthropometric parameters (weight, lenght, circumference of head and thotax) and in psychosocial characteristics of their mothers. Growths parameters were monitored in weekly intervals for approximatelly eight weeks. In the period between 11th and 15th month of corrected age, the children were evaluated by a clinical psychologist on a blind basis in mental a motor development by using Bayley Scales of Infant Development (BSID-II). Statistical analysis was performed by chi-square test and t-test. RESULTS: No statistically significant differences between the two groups in evaluating the growth parameters were observed. The psychological examination demonstrated statistically significant differences in the motor development. The psychomotor developmental index (PVI) proved to be 84.4 +/- 14.6 in the group A and 94.3 +/- 12.5 in the group B (t-test = 2.28, p<0.05). There was not any statistically significent difference in metal development between the two groups. The mean mentel developmental index (MVI) was 98.2 +/- 10.2 in the A group and 101.0 +/- 13.3 in the group B. CONCLUSION: Result of the study indicate favorable effect of fortification of breast milk in VLBW newborns, especially in view of the observed favorable influence of fortfication on motor development of the children.

[Psychomotor development of children with signs of intrapartum hypoxia and monitored by intrapartum fetal pulse oxymetry]. / Psychomotoricky vývoj detí ohrozených intrapartální hypoxií a monitorovaných intrapartálním fetálním pulzním oxymetrem.

OBJECTIVE: The following questions were investigated: 1) the psychomotor development in newborns with pathological cardiotocographic recording (CTG), having been born spontaneously due to a normal oxygen saturation monitored by intrapartum pulse oxymetry (IFPO)(group I), 2) possible difference in development of children in group I in comparison with those with pathological CTG without IFPO monitoring delivered by cesarean section (group II), 3) possible differences in children in these two groups with signs of intrapartum hypoxia (groups I and II, respectively) from children delivered spontaneously during physiological delivery without signs of hypoxia (group III). DESIGN: A prospective clinical study SETTING: Institute for the Care of Mother and Child METHODS: There have been 88 children born in the years 2000-2001 from singleton pregnancies in gestational ages > 36 weeks. Three groups of children were established: 1) in the group I (IFPO, n=32) there were children born spontaneously having pathological CTG detected by cardiotocograph HP50A and simultaneously monitored by intrapartum fetal pulse oxymeter NELLCOR Puritan Benett A400 with the NELLCOR FE 14 sensor with normal values of oxygen saturation. The children of group II (CTG-SC, n=25) were born by cesarean section due to acute intrapartum fetal hypoxia (IH) indicated by CTG recording without IFPO. The group III (physiological, n=31) was formed by children from physiological deliveries without signs of IH. All children underwent psychological examination at the average age of 21.8 months by the Bayley Scales of Infant Development (BSID-II). The statistical analysis of data was performed according to the variables using t-test or chi-square test, respectively. RESULTS: Group I (IFPO) did not differ significantly from group II (CTG-SC) in any area of psychological evaluation. The prevention of cesarean section due to IFPO method in the group I therefore prevented a significant increase of psychological morbidity in children of this early age. In spite of that the children of the group I (IFPO) reached the lowest evaluation and differed significantly from the most favorably evaluated group III (physiological) in motor development, behavior, and in a total number of deviations. Group II (CTG-SC) was evaluated significantly worse in comparison with group III (physiological) only in behavior items. On the other hand the occurrence of children of above-average mental development in the groups I and II were the same as in group III. The results indicate complex character of the problem. CONCLUSION: The prevention of CS due to IFPO prevented a development of psychological morbidity in children. The increased occurrence of deviations in psychomotor development of children with signs of acute IH (groups I and II) in comparison with children of group III (physiological) will be analyzed in detail in relation to further data.

[Psychologic aspects in perinatal medicine 1980-2000: I. Pregnancy]. / Psychologické aspekty v perinatální medicíne v letech 1980-2000: I. tehotenství.

OBJECTIVE: A retrospective view of fulfillment of prognosis concerning psychosocial influence on the development of conceptus within the framework of the "Healthy Physical, Mental and Social Development of the New Generation" (11) as a background work for a new project called "Evaluation of the Development, Present State and Conditions to Provide Healthy Physical, Mental and Social Development of the New Generation until 2010" (No. 7346-3). TYPE OF THE STUDY: A retrospective analysis of the period 1980-2000, dealing with psychosocial problems in relation to pregnancy in this country. NAME AND ADDRESS OF THE INSTITUTION: Institute of the Care for Mother and Child, Podolské nábrezí 157, 147 00, Praha 4. CONCLUSION: In the beginning of eighties, the perinatal studies paid for the first time attention to psychosocial risk factors and their close relationship to the biological risk factors. For example, smoking and obesity in women occurred at significantly higher rates in dysfunctional families as well as artificial abortions, perinatal losses etc. In the nineties epidemiological studies in this area were originated. New problem areas, which emerged, concerned mainly pregnant women with HIV/AIDS infection, drug-dependent women and those after artificial fertilization. In addition to medial questions, social and psychological questions had also to be solved. An old and new theme is a psychoprophylactic preparation for delivery, which underwent significant changes, particularly in connection with presence of the father during delivery. Moreover, it should not be neglected to investigate to influence of the methods of examination on the psychical conditions of the pregnant women for their possible negative effects, as in for example the case of examination of amniotic fluid sampled by amniocentesis for genetic indication and a "long" period of waiting for the results. In contrast, other factors may exert a positive effect, as is for example the case with sonographic examination of the conceptus, when the women can observe the conceptus and its movements on the screen.

[Psychological aspects in perinatal medicine 1980-2000: III. The postnatal period]. / Psychologické aspekty v perinatální medicíne v letech 1980-2000: III. poporodní období.

OBJECTIVE: Analysis of the problems concerning postnatal period in the Czech Republic over the last 20 years from psychological point of view. The analysis is included in the basic materials for the elaboration of prognosis in the given area for the project called "Evaluation of the evolution, present state and conditions to secure healthy physical, mental and social development of the new generation until the year 2010" (Grant No. 7346-3). DESIGN: A retrospective analysis of the problems concerned of the postnatal period from the viewpoint of the psychologist in the Czech Republic in the period of 1980 to 2000. SETTINGS: Institute for the Care of Mother and Child, Prague. CONCLUSIONS: In the postnatal period great changes have occurred over the last 20 years especially in connection with introduction of a joint care of the mother and the newborn by so called "rooming-in" system. This kind of system, which favorably influences the relations between mother and child as well as the breast-feeding, is mostly accepted favorably by the women. In the Czech Republic, low attention has been paid so far to postnatal psychical disorder in the women, especially to so called post partum or postnatal depression, which occurs in 10 to 15% of puerperas and exerts unfavorable effect on the formed relationship between the mother and child. It should be useful to contact these women in time and offer them a sufficient psychosocial support. The psychosocial care of the newborns at risk and their parents in our society requires to keep up with the advanced western countries, as well as the care of parents whose newborn dies.

Screening of perinatal risk factors leading to deviations of physical development and/or mental retardation of the child and their prevention.

We tried to demonstrate some results obtained from the analysis of one selective and one countrywide follow-up study the mode of detection of risk pregnancies and of risk factors that could be the cause of physical and mental congenital defects; the search for optimal form of screening and prevention in these cases; and verification of the effectivity of these measures.