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Shiono A, Bonno M, Toyoda H, Ogawa M, Tanaka S, Hirayama M. Autonomic Nervous System in Preterm Very Low Birth Weight Neonates with Intraventricular Hemorrhage. Am J Perinatol 2024; 41:e577-e583. [PMID: 35977712 DOI: 10.1055/a-1926-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Heart rate variability (HRV) indicates cardiac autonomic nerve activity and is influenced by brain damage during the neonatal period. We aimed to determine whether a correlation exists between the HRV of extremely preterm neonates and neurodevelopmental test scores. STUDY DESIGN Electrocardiogram data of neonates were assessed and HRV patterns in extremely preterm neonates with severe intraventricular hemorrhage (IVH; n = 6) and those with no/mild IVH (n = 28) were compared. We analyzed the relationship between HRV and neurodevelopmental outcomes at 18 months (n = 21) and 3 years (n = 23) in extremely preterm neonates. RESULTS HRV was significantly associated with IVH severity in extremely preterm neonates (p < 0.05). Neonates with severe IVH exhibited increased HR and decreased mean R-to-R interval (NN) compared with neonates with no/mild IVH. HRV parameters significantly decreased in the severe IVH group, but not in the no/mild IVH group, suggesting that both sympathetic and parasympathetic activities decreased in neonates with severe IVH. Additionally, decreased HR and increased NN were significantly related to impaired neurodevelopmental outcomes in the no/mild IVH group at corrected ages of 18 months and 3 years, respectively (all p < 0.05). CONCLUSION HRV was significantly associated with IVH severity and neurodevelopmental outcome in extremely preterm neonates. HRV can distinguish extremely preterm neonates who subsequently had severe IVH from those who had no/low-grade IVH. HRV may identify extremely preterm neonates needing adjuvant neuroprotective interventions. These findings warrant further investigation in a larger population of extremely preterm neonates. KEY POINTS · HRV was associated with IVH severity.. · HRV can predict subsequent severe IVH in extremely preterm neonates.. · HRV are predictive of neurodevelopmental outcomes in extremely premature neonates with low-grade IVH..
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Affiliation(s)
- Ai Shiono
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Motoki Bonno
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Hidemi Toyoda
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masahiro Ogawa
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Shigeki Tanaka
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
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Ogata R, Watanabe K, Chong PF, Okamoto J, Sakemi Y, Nakashima T, Ohno T, Nomiyama H, Sonoda Y, Ichimiya Y, Inoue H, Ochiai M, Yamashita H, Sakai Y, Ohga S. Divergent neurodevelopmental profiles of very-low-birth-weight infants. Pediatr Res 2024; 95:233-240. [PMID: 37626120 DOI: 10.1038/s41390-023-02778-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Advanced perinatal medicine has decreased the mortality rate of preterm infants. Long-term neurodevelopmental outcomes of very-low-birth-weight infants (VLBWIs) remain to be investigated. METHODS Participants were 124 VLBWIs who had in-hospital birth from 2007 to 2015. Perinatal information, developmental or intelligence quotient (DQ/IQ), and neurological comorbidities at ages 3 and 6 years were analyzed. RESULTS Fifty-eight (47%) VLBWIs received neurodevelopmental assessments at ages 3 and 6 years. Among them, 15 (26%) showed DQ/IQ <75 at age 6 years. From age 3 to 6 years, 21 (36%) patients showed a decrease (≤-10), while 5 (9%) showed an increase (≥+10) in DQ/IQ scores. Eight (17%) with autism spectrum disorder or attention-deficit hyperactivity disorder (ASD/ADHD) showed split courses of DQ/IQ, including two with ≤-10 and one with +31 to their scores. On the other hand, all 7 VLBWIs with cerebral palsy showed DQ ≤35 at these ages. Magnetic resonance imaging detected severe brain lesions in 7 (47%) of those with DQ <75 and 1 (18%) with ASD/ADHD. CONCLUSIONS VLBWIs show a broad spectrum of neurodevelopmental outcomes after 6 years. These divergent profiles also indicate that different risks contribute to the development of ASD/ADHD from those of cerebral palsy and epilepsy in VLBWIs. IMPACT Very-low-birth-weight infants (VLBWIs) show divergent neurodevelopmental outcomes from age 3 to 6 years. A deep longitudinal study depicts the dynamic change in neurodevelopmental profiles of VLBWIs from age 3 to 6 years. Perinatal brain injury is associated with developmental delay, cerebral palsy and epilepsy, but not with ASD or ADHD at age 6 years.
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Affiliation(s)
- Reina Ogata
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Kyoko Watanabe
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan.
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Jun Okamoto
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Yoshihiro Sakemi
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Toshinori Nakashima
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Takuro Ohno
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Hiroyuki Nomiyama
- Department of Radiology, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Hironori Yamashita
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
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Effectiveness of Dance/Movement Therapy Intervention for Children with Intellectual Disability at an Early Childhood Special Education Preschool. AMERICAN JOURNAL OF DANCE THERAPY 2022. [DOI: 10.1007/s10465-022-09356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Zhang MH, Blair MP, Ham SA, Rodriguez SH. Two-Year Outcomes Comparing Anti-VEGF Injections to Laser for ROP Using a Commercial Claims Database. Ophthalmic Surg Lasers Imaging Retina 2020; 51:486-493. [DOI: 10.3928/23258160-20200831-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/08/2020] [Indexed: 01/09/2023]
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Sacchi C, Marino C, Nosarti C, Vieno A, Visentin S, Simonelli A. Association of Intrauterine Growth Restriction and Small for Gestational Age Status With Childhood Cognitive Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatr 2020; 174:772-781. [PMID: 32453414 PMCID: PMC7251506 DOI: 10.1001/jamapediatrics.2020.1097] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE The magnitude of the association of intrauterine growth restriction (IUGR) and small for gestational age (SGA) status with cognitive outcomes in preterm and term-born children has not been established. OBJECTIVE To examine cognitive outcomes of preterm and term-born children who had IUGR and were SGA compared with children who were appropriate for gestational age (AGA) during the first 12 years of life. DATA SOURCES For this systematic review and meta-analysis, the Scopus, PubMed, Web of Science, Science Direct, PsycInfo, and ERIC databases were searched for English-language, peer-reviewed literature published between January 1, 2000, and February 20, 2020. The following Medical Subject Heading terms for IUGR and SGA and cognitive outcomes were used: intrauterine growth restriction, intrauterine growth retardation, small for gestational age AND neurodevelopment, neurodevelopmental outcome, developmental outcomes, and cognitive development. STUDY SELECTION Inclusion criteria were assessment of cognitive outcomes (full-scale IQ or a cognitive subscale), inclusion of an AGA group as comparison group, and inclusion of gestational age at birth and completion of cognitive assessment up to 12 years of age. DATA EXTRACTION AND SYNTHESIS The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. Data were double screened for full-text articles, and a subset were independently coded by 2 authors. Standardized mean differences (SMDs) and odd ratios from individual studies were pooled by applying random-effects models. MAIN OUTCOMES AND MEASURES Cognitive outcomes, defined as mental, cognitive, or IQ scores, estimated with standardized practitioner-based cognitive tests or as borderline intellectual impairment (BII), defined as mental, cognitive, or IQ scores at least 1 SD below the mean cognitive score. RESULTS In this study of 89 samples from 60 studies including 52 822 children, children who had IUGR and were SGA had significantly poorer cognitive outcomes (eg, cognitive scores and BII) than children with AGA in childhood. For cognitive scores, associations are consistent for preterm (SMD, -0.27; 95% CI, -0.38 to -0.17) and term-born children (SMD, -0.39; 95% CI, -0.50 to -0.28), with higher effect sizes reported for term-born IUGR and AGA group comparisons (SMD, -0.58; 95% CI, -0.82 to -0.35). Analyses on BII revealed a significantly increased risk in the preterm children who had IUGR and were SGA (odds ratio, 1.57; 95% CI, 1.40-1.77) compared with the children with AGA. CONCLUSIONS AND RELEVANCE Growth vulnerabilities assessed antenatally (IUGR) and at the time of birth (SGA) are significantly associated with lower childhood cognitive outcomes in preterm and term-born children compared with children with AGA. These findings highlight the need to develop interventions that boost cognitive functions in these high-risk groups.
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Affiliation(s)
- Chiara Sacchi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Claudia Marino
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Chiara Nosarti
- Centre for the Developing Brain, King's College London School of Bioengineering & Imaging Sciences, London, United Kingdom,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alessio Vieno
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Silvia Visentin
- Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
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Association of perinatal factors of epilepsy in very low birth weight infants, using a nationwide database in Japan. J Perinatol 2019; 39:1472-1479. [PMID: 31527650 PMCID: PMC6892414 DOI: 10.1038/s41372-019-0494-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 07/27/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine clinical features of very low birth weight infants (VLBWIs) who had developed epilepsy by age 3 years. STUDY DESIGN Multicenter cohort study using the Neonatal Research Network of Japan database. We analyzed clinical variables of 8431 VLBWIs who had recorded data of neurological sequelae at age 3 years. Logistic regression identified the association between variables and development of epilepsy. RESULT One hundred and forty-three (1.7%) infants developed epilepsy, 683 (8.1%) showed cerebral palsy (CP), and 1114 (13.2%) had psychomotor delay. Epilepsy was associated with history of sepsis [adjusted odds ratio (AOR) 3.23], severe intraventricular hemorrhage (IVH; AOR 5.13), and cystic periventricular leukomalacia (PVL; AOR 12.7). Severe IVH and cystic PVL were also frequently associated with CP and psychomotor delay. CONCLUSION Severe IVH and cystic PVL are strongly associated with development of epilepsy, as well as other neurological sequelae, and are potential critical therapeutic targets.
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Kidowaki S, Morimoto M, Yamada K, Sakai K, Zuiki M, Maeda H, Yamashita S, Morita T, Hasegawa T, Chiyonobu T, Tokuda S, Hosoi H. Longitudinal change in white matter in preterm infants without magnetic resonance imaging abnormalities: Assessment of serial diffusion tensor imaging and their relationship to neurodevelopmental outcomes. Brain Dev 2017; 39:40-47. [PMID: 27543266 DOI: 10.1016/j.braindev.2016.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/01/2016] [Accepted: 07/28/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE We used diffusion tensor imaging (DTI) to evaluate longitudinal changes in fractional anisotropy (FA) of white matter tracts in preterm infants without abnormal magnetic resonance imaging (MRI) findings. Imaging was conducted at term equivalent age (TEA) and 1year of corrected age. Furthermore, we assessed correlations between FA and neurodevelopmental outcomes at 3years of corrected age to investigate brain prematurity of preterm infants without MRI abnormalities. METHODS Preterm infants underwent serial MRI at TEA and 1year of corrected age. Of these, 13 infants entered a retrospective study, undergoing neurodevelopmental assessment at 3years of corrected age. These infants were divided into two groups depending on gestational age (GA): <26weeks and ⩾26weeks. DTI-based tractography was performed to obtain the FA of the motor tract, sensory tract, superior cerebellar peduncle, middle cerebellar peduncle, and corpus callosum. FA was compared between two groups, and correlations between FA and neurodevelopmental outcomes were assessed. RESULTS FA of the splenium at TEA was significantly different between the two groups divided according to GA. However, this difference was no longer observed at 1year of corrected age. There was no correlation between FA of the splenium at TEA and neurodevelopmental assessment scores at 3years of corrected age. CONCLUSIONS At TEA, FA of the splenium was lower in younger GA infants without MRI abnormalities, but this may not affect subsequent neurodevelopmental outcomes.
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Affiliation(s)
- Satoshi Kidowaki
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masafumi Morimoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Sakai
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masashi Zuiki
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hiroshi Maeda
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoshi Yamashita
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Takashi Morita
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tatsuji Hasegawa
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tomohiro Chiyonobu
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Sachiko Tokuda
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Kawabe K, Kondo S, Matsumoto M, Seo K, Ochi M, Oka Y, Horiuchi F, Ueno SI. Developmental quotient to estimate intelligence in autism spectrum disorder. Pediatr Int 2016; 58:963-966. [PMID: 26933939 DOI: 10.1111/ped.12969] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autism spectrum disorders (ASD) are characterized by persistent deficits in social communication and social interaction across contexts, and are associated with restricted patterns of behavior. The developmental quotient (DQ) is based on the developmental age and chronological age of children. This study investigated the utility of the DQ to estimate cognitive ability in young children with ASD. METHODS The DQ and intelligence quotient (IQ) were assessed using the Kyoto Scale of Psychological Development 2001 (KSPD) and Wechsler Intelligence Scale for Children-III (WISC-III), respectively. The correlation between the DQ and IQ was then analyzed among children with ASD. RESULTS We enrolled 18 children with ASD (16 boys, two girls; age, 63.6 ± 9.4 months; age range, 45-83 months). Overall, Cognitive-Adaptive and Language-Social DQ scores were significantly correlated with IQ score in the full scale, verbal, and performance domains. Full-scale IQ and overall DQ had a linear correlation (y = -22.747 + 1.177x, R2 = 0.677, R = 0.823). CONCLUSIONS The DQ scores obtained using the KSPD were a reasonable estimate of cognitive ability in children with ASD. The KSPD may be a useful alternative to the WISC-III for young children with ASD and could facilitate earlier assessment.
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Affiliation(s)
- Kentaro Kawabe
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan. .,Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan.
| | - Shizuka Kondo
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Miki Matsumoto
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Kanae Seo
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Marina Ochi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan.,Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Yasunori Oka
- Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan.,Center for Sleep Medicine, Ehime University Hospital, Toon City, Ehime, Japan
| | - Fumie Horiuchi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan.,Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Shu-Ichi Ueno
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
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Fruscio R, de Haan J, Van Calsteren K, Verheecke M, Mhallem M, Amant F. Ovarian cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 41:108-117. [PMID: 28029502 DOI: 10.1016/j.bpobgyn.2016.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
Abstract
Although the occurrence of ovarian masses in pregnancy is relatively common, the majority of them is functional and resolve spontaneously; nevertheless, ovarian cancer is the fifth most common malignancy diagnosed in pregnancy. If malignancy is suspected, treatment should be decided on the basis of gestational age, stage of the disease and patient preferences. In early stage, ovarian cancer surgery may be planned preferably after 16 weeks of pregnancy, and chemotherapy can be administered from the second trimester if indicated as in non-pregnant patients. In advanced-stage disease, when complete cytoreduction is not achievable, neoadjuvant chemotherapy could be administered even in pregnancy. Chemotherapy should be a combination of carboplatin and paclitaxel in epithelial ovarian cancer patients and a combination of cisplatin, vinblastin and bleomycin in non-epithelial ovarian cancer. The outcome of patients with ovarian cancer diagnosed in pregnancy is similar to non-pregnant patients, and stage of the disease is the most important prognostic factor.
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Affiliation(s)
- Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy.
| | - Jorine de Haan
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Magali Verheecke
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Division of Gynecologic Oncology, University Hospitals Leuven, Belgium
| | - Mina Mhallem
- Department of Obstetrics and Gynaecology, Cliniques Universitaires St. Luc, UCL, Brussels, Belgium
| | - Frederic Amant
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Division of Gynecologic Oncology, University Hospitals Leuven, Belgium; Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
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Aoki S, Hashimoto K, Ikeda N, Takekoh M, Fujiwara T, Morisaki N, Mezawa H, Tachibana Y, Ohya Y. Comparison of the Kyoto Scale of Psychological Development 2001 with the parent-rated Kinder Infant Development Scale (KIDS). Brain Dev 2016; 38:481-90. [PMID: 26612486 DOI: 10.1016/j.braindev.2015.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of the study was to extend our understanding of the Kyoto Scale of Psychological Development (KSPD) by comparison with a parent-rated scale, the Kinder Infant Development Scale (KIDS). METHODS The participants of this study were 229 children aged 0-4, who were referred to the Developmental Evaluation Center of the National Center for Child Health and Development, due to a suspected developmental disorder/delay. The participants were divided into subgroups, depending on age and overall DQ. For each group separately, correlation analyses were conducted between the Developmental Quotient (DQ) of each KSPD domain and DQ of each KIDS subscale. RESULTS For high DQ group, in all ages, the KSPD Postural-Motor (P-M) domain DQ demonstrated a high correlation with the KIDS Physical-Motor DQ, and at young ages, it was also found to be moderately or strongly associated with the KIDS Manipulation DQ. For high DQ group, the KSPD Cognitive-Adaptive (C-A) domain DQ was most consistently related to the KIDS Manipulation DQ, and was also moderately correlated with the KIDS Physical-Motor DQ, Receptive Language DQ, Social Relationship with Adults DQ, Discipline DQ, and Feeding DQ, depending on age. For high DQ group, the KSPD Language-Social (L-S) DQ most consistently showed a moderate or high correlation with the KIDS Receptive Language DQ and the Manipulation DQ, and also related to Physical-Motor DQ, Expressive Language DQ, Language Conception DQ, Social Relationship with Adults DQ, and Social Relationship with Children DQ for some age groups. The low DQ group demonstrated stronger relationships on many of the pairs of the DQ of a KSPD subdomain and the DQ of a KIDS subscale, regardless of the type of subdomains and subscales. CONCLUSIONS For high DQ group, the KSPD P-M domain was consistently related to parent-reported physical/motor development, the C-A domain primarily reflected a child's fine motor skills and his/her ability to understand and follow verbal instructions provided by adults, while the L-S domain was associated with parent-reported language ability. For low DQ group, the effect of global delay increased overall correlations between each domain and subscale. Further studies are necessary to replicate the findings in a larger sample including typical children.
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Affiliation(s)
- Sayaka Aoki
- Division of Rehabilitation Medicine and Developmental Evaluation Center, National Center for Child Health and Development, Japan
| | - Keiji Hashimoto
- Division of Rehabilitation Medicine and Developmental Evaluation Center, National Center for Child Health and Development, Japan.
| | - Natsuha Ikeda
- Division of Rehabilitation Medicine and Developmental Evaluation Center, National Center for Child Health and Development, Japan
| | - Makoto Takekoh
- Division of Rehabilitation Medicine and Developmental Evaluation Center, National Center for Child Health and Development, Japan
| | - Takeo Fujiwara
- Department of Social Medicine, National Center for Child Health and Development, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Japan
| | - Hidetoshi Mezawa
- Division of Rehabilitation Medicine and Developmental Evaluation Center, National Center for Child Health and Development, Japan; Division of Allergy, National Center for Child Health and Development, Japan
| | - Yoshiyuki Tachibana
- Division of Maternal-Child Psychiatry, National Center for Child Health and Development, Japan
| | - Yukihiro Ohya
- Division of Allergy, National Center for Child Health and Development, Japan
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Kato T, Mandai T, Iwatani S, Koda T, Nagasaka M, Fujita K, Kurokawa D, Yamana K, Nishida K, Taniguchi-Ikeda M, Tanimura K, Deguchi M, Yamada H, Iijima K, Morioka I. Extremely preterm infants small for gestational age are at risk for motor impairment at 3 years corrected age. Brain Dev 2016; 38:188-95. [PMID: 26265090 DOI: 10.1016/j.braindev.2015.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/09/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few studies have targeted psychomotor development and associated perinatal risk factors in Japanese very low birth weight (VLBW) infants who are severely small for gestational age (SGA). DESIGN/SUBJECTS A single-center study was conducted in 104 Japanese VLBW infants who were born preterm, due to maternal, umbilical cord, or placental abnormalities, between 2000 and 2007. Psychomotor development as a developmental quotient (DQ) was assessed using the Kyoto Scale of Psychological Development at 3 years corrected age. Severely SGA was defined as birth weight or length below -2 standard deviation values of the mean values at the same gestation. VLBW infants were divided into 2 subgroups based on gestational age at birth: ⩾28 weeks (n=64) and <28 weeks (n=40). DQs of infants with severe SGA were compared with those of infants who were appropriate for gestational age (AGA). Factors associated with developmental disabilities in VLBW infants with severe SGA (n=23) were determined. RESULTS In the group born at ⩾28 weeks gestation, infants with severe SGA had normal DQ values and did not significantly differ from those with AGA. However, in the group born at <28 weeks gestation, severe SGA infants had significantly lower postural-motor DQ values than AGA infants. Gestational age <28 weeks was an independent factor for low postural-motor DQ, regardless of the cause of severe SGA or pregnancy termination. CONCLUSIONS Extremely preterm newborns with severe SGA are at risk of motor developmental disability at age 3 years.
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Affiliation(s)
- Takeshi Kato
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsurue Mandai
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sota Iwatani
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsubasa Koda
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Miwako Nagasaka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kaori Fujita
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Kurokawa
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiji Yamana
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kosuke Nishida
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masashi Deguchi
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
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Abstract
On one hand, advances in neonatal care and rescue technology allow for the healthy survival or prolonged survival time of critically ill newborns who, in the past, would have been non-viable. On the other hand, many of the surviving critically ill infants have serious long-term disabilities. If an infant eventually cannot survive or is likely to suffer severe disability after surviving, ethical issues in the treatment process are inevitable, and this problem arises not only in developed countries but is also becoming increasingly prominent in developing countries. In addition, ethical concerns cannot be avoided in medical research. This review article introduces basic ethical guidelines that should be followed in clinical practice, including respecting the autonomy of the parents, giving priority to the best interests of the infant, the principle of doing no harm, and consent and the right to be informed. Furthermore, the major ethical concerns in neonatal intensive care units (NICUs) in China are briefly introduced.
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Affiliation(s)
- Jing Liu
- a Department of Neonatology and NICU of Bayi Children's Hospital and
| | - Xin-Xin Chen
- a Department of Neonatology and NICU of Bayi Children's Hospital and
| | - Xin-Ling Wang
- b Department of Information , Beijing Military General Hospital , Beijing , China
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Guzmán C ML, Guzmán C SF, Guzmán ME, Marín F, Remolcois E, Gallardo A, Rozas N, Urra E, Rojas F. [Developmental disorders in children and adolescents of the Los Ríos region, Valdivia, Chile, 2006-2008]. REVISTA CHILENA DE PEDIATRIA 2015; 86:345-350. [PMID: 26593887 DOI: 10.1016/j.rchipe.2015.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/24/2015] [Accepted: 04/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To study possible findings of factors in the antenatal, perinatal or postnatal period, in the mother or the child that may have an influence on the appearance of a developmental disorder. PATIENTS AND METHOD A Data Base of Clinical Histories from every patient with a developmental disorder (F80-F90 ICD10) was created. The patients attended the Child Psychiatric Unit at Hospital Regional of Valdivia, Chile, from August 2006 to December 2008. Total: 493 patientes (48.7% of the total of patients consulting); CONTROL GROUP 32 healthy patients. STATISTICAL METHOD odds ratio (95% confidence). RESULTS The main risk factors for developing a developmental disorder (P<.005, 25% frequency in the consulting population) are: prematurity, male sex, mother with low education, early hospitalizations, and medical illnesses (all with a significant odds ratio). Also, having a mother with psychiatric illness doubles the risk of having a developmental disorder. CONCLUSION It requires an interdisciplinary collaborative work between neonatologists, obstetricians, child psychiatrists and the primary care to detect early children at risk.
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Affiliation(s)
- Maria L Guzmán C
- Servicio de Psiquiatría, Unidad de Psiquiatría Infantil, Hospital Regional Valdivia, Valdivia, Chile.
| | - Sergio F Guzmán C
- Servicio de Ginecología y Obstetricia, Hospital Regional Valdivia , Valdivia, Chile
| | - Maria E Guzmán
- Unidad de Psicología Clínica Infantil, Servicio de Psiquiatría, Hospital Regional Valdivia, Valdivia, Chile
| | - Fransisco Marín
- Escuela de Salud Pública, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Elisabeth Remolcois
- Instituto de Neurociencias, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Andrés Gallardo
- Instituto de Neurociencias, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Néstor Rozas
- Instituto de Neurociencias, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Edmundo Urra
- Instituto de Neurociencias, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Fabián Rojas
- Instituto de Neurociencias, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
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Tanaka Y, Uchida H, Kawashima H, Sato K, Takazawa S, Deie K, Masuko T, Kanno K, Shimizu M. Influence of surgical intervention on neurodevelopmental outcome in infants with focal intestinal perforation. Pediatr Int 2015; 57:687-9. [PMID: 25676146 DOI: 10.1111/ped.12599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/27/2014] [Accepted: 01/29/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intestinal perforation is known to correlate with neurodevelopmental outcome in very low-birthweight (VLBW) infants, and its two major causes are necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP). Infants with FIP are reported to have better neurodevelopmental outcome than infants with NEC, but outcome has not been compared with that in infants without diseases that require surgery. The aim of this study was to compare neurodevelopmental outcomes between FIP survivors and infants without diseases that require surgery. METHODS Records of VLBW infants with FIP and infants without surgical diseases were retrospectively analyzed. Neurodevelopmental outcome was compared between eight infants with FIP and 24 case-matched control infants without surgical diseases using the Kyoto Scale of Psychological Development. Control group members were individually matched with FIP survivors for sex, gestational age, birthweight, and intraventricular hemorrhage (IVH) grade. Those with an episode of sepsis or severe IVH (grade 3-4) that occurred irrespective of FIP were excluded. RESULTS Three FIP survivors and 12 infants without surgical diseases were classified as neurodevelopmentally normal (37.5% vs 50%, P = 0.69) at a corrected age of 18 months-3 years. All neurodevelopmentally normal FIP survivors were born at a gestational age ≥ 26 weeks. CONCLUSION Excluding the influence of sepsis or severe IVH, no significant difference was found in neurodevelopmental outcome between FIP survivors and infants without surgical diseases. None of the FIP infants born before 26 weeks of gestation, however, had normal neurodevelopment, suggesting that longer gestation might be needed to overcome the stress associated with FIP.
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Affiliation(s)
- Yujiro Tanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kaori Sato
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
- Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Shinya Takazawa
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
- Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
- Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Takayuki Masuko
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Keiichi Kanno
- Department of Neonatology, Saitama Children's Medical Center, Saitama, Japan
| | - Masaki Shimizu
- Department of Neonatology, Saitama Children's Medical Center, Saitama, Japan
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Kihara H, Nakamura T. Early standard development assessment characteristics in very low birth weight infants later classified with autism spectrum disorder. Early Hum Dev 2015; 91:357-9. [PMID: 25912387 DOI: 10.1016/j.earlhumdev.2015.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/16/2015] [Accepted: 03/30/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of autism spectrum disorder (ASD) symptoms is high among very low birth weight infants (VLBWIs). Early diagnosis of ASD is crucial, because early intervention for ASD is effective. OBJECTIVE To evaluate early standard development assessment characteristics in VLBWIs later classified with ASD. METHODS Thirty-five VLBWIs later diagnosed with ASD were compared with 169 children with typical development who were admitted to the neonatal intensive care unit at Nagano Children's Hospital between 2001 and 2005. We retrospectively evaluated developmental quotient (DQ) using the Kyoto Scale of Psychological Development (KSPD) at 6 and 18months post-term age (PTA) and 3year chronological age. RESULTS KSPD DQ was significantly lower in ASD infants than in typical development infants at all ages. Postural-motor DQs of ASD infants at 18months PTA and 3year chronological age showed some increase compared to that at 6months PTA. CONCLUSION Early recognition of ASD using standardized development assessment tools in VLBWIs might be possible.
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Affiliation(s)
- Hideki Kihara
- Department of Rehabilitation, Nagano Children's Hospital, Nagano, Japan
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Gnanendran L, Bajuk B, Oei J, Lui K, Abdel-Latif ME. Neurodevelopmental outcomes of preterm singletons, twins and higher-order gestations: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2015; 100:F106-14. [PMID: 25359876 DOI: 10.1136/archdischild-2013-305677] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the neurodevelopmental outcomes of multiple (twins, triplets, quads) compared with singleton extremely preterm infants <29 weeks gestation. DESIGN Population-based retrospective cohort study. SETTING A network of 10 neonatal intensive care units in a geographically defined area of New South Wales and the Australian Capital territory. PATIENTS 1473 infants <29 weeks gestation born between 1 January 1998 and 31 December 2004. INTERVENTION At 2-3 years of corrected age, a neurodevelopmental assessment was conducted using either the Griffiths Mental Developmental Scales or the Bayley Scales of Infant Development II. MAIN OUTCOME MEASURE Moderate-severe functional disability was defined as developmental delay (Griffiths Mental Developmental Scales General Quotient or Bayley Scales of Infant Development-II Mental Development Index >2 SDs below the mean), moderate cerebral palsy (unable to walk without aids), sensorineural or conductive deafness (requiring amplification) or bilateral blindness (visual acuity <6/60 in the better eye). RESULTS Of the 1081 singletons and 392 multiples followed-up, singletons demonstrated higher rates of systemic infections, steroid treatment for chronic lung disease and birth weight <10th percentile. Moderate-severe functional disability did not differ significantly between singletons and multiples (15.8% vs 17.6%, OR 1.14; 95% CI 0.84 to 1.54; p=0.464). Further subgroup analysis of twins, higher-order gestations, 1st-born multiples, 2nd or higher-born multiples, same and unlike gender multiples, did not demonstrate statistically higher rates of functional disability compared with singletons. CONCLUSIONS Premature infants from multiple gestation pregnancies appear to have comparable neurodevelopmental outcomes to singletons.
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Affiliation(s)
- Lokiny Gnanendran
- Department of Medicine, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Barbara Bajuk
- Neonatal Intensive Care Units' Data Collection, NSW Pregnancy and Newborn Services Network, New South Wales, Australia
| | - Julee Oei
- Department of Newborn Care, Royal Hospital for Women, New South Wales, Australia School of Women's and Children's Health, University of New South Wales, New South Wales, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, New South Wales, Australia School of Women's and Children's Health, University of New South Wales, New South Wales, Australia
| | - Mohamed E Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Garran, Australian Capital Territory, Australia School of Clinical Medicine, Australian National University, Australian Capital Territory, Australia
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17
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Ochiai M, Kinjo T, Takahata Y, Iwayama M, Abe T, Ihara K, Ohga S, Fukushima K, Kato K, Taguchi T, Hara T. Survival and neurodevelopmental outcome of preterm infants born at 22-24 weeks of gestational age. Neonatology 2014; 105:79-84. [PMID: 24296364 DOI: 10.1159/000355818] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/13/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The limits of viability in extremely premature infants are challenging for any neonatologists in developed countries. The neurological development and growth of extremely preterm infants have come to be the emerging issue following the management in the neonatal intensive care unit. OBJECTIVE To assess potential associations between changes in practice and survival/neurodevelopmental outcome, and clinical outcomes of extremely preterm infants born at the limit of viability studied in a tertiary center. STUDY DESIGN A retrospective study enrolled 51 infants who had no congenital disorders, and were born at 22-24 weeks of gestational age (GA) in 2000-2009 in our institution. Clinical variables and interventions were studied with regard to one-year survival and developmental quotient (DQ) at 3 years of age. RESULTS The one-year survival rate of 24 preterm infants born in 2005-2009 (79%) was higher than that of the 27 infants born in 2000-2004 (52%, p = 0.04). Infants born after 2005 underwent less tocolysis (54 vs. 94%, p < 0.01) and more frequently antenatal steroid therapy (32 vs. 6%, p = 0.01) than those born before 2004. The post-2005 survivors (n = 19) received more frequently indomethacin therapy (89 vs. 50%, p = 0.03) and early parenteral nutrition (95 vs. 36%, p < 0.01) than the pre-2004 survivors (n = 14). There were no differences in the proportion of infants who attained a DQ of >50 at 3 years of age between pre-2004 (9/13, 69%) and post-2005 groups (10/17, 59%). Multivariate analysis indicated that extremely premature birth at GA <24 weeks was the sole critical factor for a DQ of >50 in survivors. CONCLUSIONS The perinatal care after 2005 improved the overall survival rate, but not the neurological outcome of preterm survivors at the limit of viability. Neurodevelopmental impairments were associated with extremely premature birth at GA <24 weeks.
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Affiliation(s)
- Masayuki Ochiai
- Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan
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Zagouri F, Psaltopoulou T, Dimitrakakis C, Bartsch R, Dimopoulos MA. Challenges in managing breast cancer during pregnancy. J Thorac Dis 2013; 5 Suppl 1:S62-7. [PMID: 23819029 DOI: 10.3978/j.issn.2072-1439.2013.05.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/28/2013] [Indexed: 12/13/2022]
Abstract
Pregnancy-associated breast cancer (PABC) is defined as breast cancer occurring anytime during gestation, lactation or within one year after delivery. The optimal management of pregnant women with breast cancer is challenging and not well established; the main concern is the effect of the drugs on the developing fetus and long-term complications after in utero exposure to anti-cancer drugs. Surgical resection is the mainstay of treatment for early breast cancer diagnosed during pregnancy. Modified radical mastectomy is standard of care in first trimester, whereas breast-conserving surgery (lumpectomy with lymph node dissection) can be performed preferably in the second and third trimester. Of note, breast-conserving surgery is not contraindicated per se during the first trimester, but owing to the potential impact of delaying radiotherapy. Radiation therapy is not favored during pregnancy. Moreover, tamoxifen is contraindicated during pregnancy; the agent has been associated with birth defects in up to 20% of exposures. Chemotherapy is generally contraindicated during the first trimester because of the possible damage to organogenesis. Anthracyclines-based regimens are the most widely used is breast cancer treatment and were been shown to be associated with favourable safety profile when administered during pregnancy. As for taxanes, more limited data is available. The use of trastuzumab is contraindicated during pregnancy, given the apparent risk of oligo- and/or anhydramnios as well as the unknown long-term sequelae on the fetus. It is obvious that, diagnosis of breast cancer during pregnancy adds complexity to cancer treatment recommendations. In all cases, a multidisciplinary therapeutic approach among obstetricians, gynaecologists, surgical oncologists, radiation oncologists, medical oncologists, pediatricians and hematologists is clearly warranted.
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, Athens, Greece; ; Comprehensive Cancer Center Vienna, Department of Medicine I/Division of Oncology, Medical University of Vienna, Austria
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Bilder DA, Pinborough-Zimmerman J, Bakian AV, Miller JS, Dorius JT, Nangle B, McMahon WM. Prenatal and perinatal factors associated with intellectual disability. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 118:156-176. [PMID: 23464612 DOI: 10.1352/1944-7558-118.2.156] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Prenatal and perinatal risk factors associated with intellectual disability (ID) were studied in 8-year-old Utah children from a 1994 birth cohort (N = 26,108) using broad ascertainment methods and birth records following the most current recording guidelines. Risk factor analyses were performed inclusive and exclusive of children with a known or suspected underlying genetic disorder. Risk factors identified were poly/oligohydramnios, advanced paternal/maternal age, prematurity, fetal distress, premature rupture of membranes, primary/repeat cesarean sections, low birth weight, assisted ventilation greater than 30 min, small-for-gestational age, low Apgar scores, and congenital infection. Although several risk factors lost significance once children with underlying genetic disorders were excluded, socioeconomic variables were among those that maintained a prominent association with increased ID risk.
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Affiliation(s)
- Deborah A Bilder
- University of Utah School of Medicine, Psychiatry, Salt Lake City, UT, USA
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20
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Neurodevelopmental Outcome Among Multiples and Singletons: A Regional Neonatal Intensive Care Unit's Experience in Turkey. Twin Res Hum Genet 2013; 16:614-8. [DOI: 10.1017/thg.2012.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: The aim of this study was to compare the neurodevelopmental outcome at 12–18 months’ corrected age between multiples and singleton preterm infants. Methods: We designed a prospective study of preterm infants (≤32 weeks gestation) born and hospitalized in the neonatal intensive care unit between November 2008 and November 2009, whose assessments were performed at 12–18 months’ corrected age. Neurodevelopmental impairment was defined as the presence of any one of the following: moderate or severe cerebral palsy, severe bilateral hearing loss or bilateral blindness, mental developmental index score, or psychomotor developmental index score less than 70. Results were compared for both multiples and singleton infants. Results: One hundred and fifty-nine multiples and 211 singleton infants were assessed at 12–18 months’ corrected age. The neurodevelopmental outcome including all parameters at 12–18 months’ corrected age in multiples was not significantly different from singleton preterm infants. Conclusions: Multiple gestation in preterm infants is not associated with an increased risk of neurodevelopmental impairment at 12–18 months’ corrected age compared with singleton preterm infants. For further information, long term and high participation in neurodevelopmental follow-up and evaluation at pre-school age will be needed.
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Tatsuta N, Suzuki K, Sugawara T, Nakai K, Hosokawa T, Satoh H. Comparison of Kyoto Scale of Psychological Development and Bayley Scales of Infant Development second edition among Japanese Infants. ACTA ACUST UNITED AC 2013. [DOI: 10.6033/specialeducation.2.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yamasaki C, Uchiyama A, Nakanishi H, Masumoto K, Aoyagi H, Washio Y, Totsu S, Imai K, Kusuda S. Hydrocortisone and long-term outcomes in very-low-birthweight infants. Pediatr Int 2012; 54:465-70. [PMID: 22375549 DOI: 10.1111/j.1442-200x.2012.03601.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The long-term effects of hydrocortisone (HDC) used for very-low-birthweight (VLBW) infants with chronic lung disease (CLD) are not fully understood. The aim of this study was to examine the short-term clinical effects and long-term impact of a physiological replacement dose of HDC on acute deterioration of CLD in VLBW infants. METHODS This prospective case-control study included 110 of the 174 VLBW infants admitted to our facility between 2003 and 2006 who were followed up to a corrected age of 18 months. Infant deaths and infants with congenital deformities were excluded from the study. The infants were classified into the following three groups: infants with CLD and treated with HDC (1-2 mg/kg/dose) due to progressive deterioration in oxygenation (CLD treatment group; n = 24); infants with CLD but not treated with HDC (CLD untreated group; n = 40); and infants without CLD (non-CLD group; n = 46). RESULTS The fraction of inspired oxygen (F(I) O(2) ) in the CLD treatment group improved significantly after treatment (P < 0.01). There were no significant differences among the three groups in terms of growth and neurodevelopmental quotient at the corrected age of 18 months following adjustment for birthweight, sex, and presence of light-for-date infants. There were also no significant intergroup differences in all three areas of developmental quotient. CONCLUSIONS Physiological doses of HDC replacement are effective in treating acute deterioration in oxygenation in VLBW infants with CLD. Furthermore, this treatment modality did not adversely affect the growth and development of infants at the corrected age of 18 months.
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Affiliation(s)
- Chika Yamasaki
- Department of Neonatology, Maternal, and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
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Language development in Japanese children who receive cochlear implant and/or hearing aid. Int J Pediatr Otorhinolaryngol 2012; 76:433-8. [PMID: 22281374 DOI: 10.1016/j.ijporl.2011.12.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/27/2011] [Accepted: 12/27/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to investigate a wide variety of factors that influence auditory, speech, and language development following pediatric cochlear implantation (CI). STUDY DESIGN Prospective collection of language tested data in profound hearing-impaired children. HYPOTHESIS Pediatric CI can potentially be effective to development of practical communication skills and early implantation is more effective. METHODS We proposed a set of language tests (assessment package of the language development for Japanese hearing-impaired children; ALADJIN) consisting of communication skills testing (test for question-answer interaction development; TQAID), comprehensive (Peabody Picture Vocabulary Test-Revised; PVT-R and Standardized Comprehension Test for Abstract Words; SCTAW) and productive vocabulary (Word Fluency Test; WFT), and comprehensive and productive syntax (Syntactic processing Test for Aphasia; STA). Of 638 hearing-impaired children recruited for this study, 282 (44.2%) with >70 dB hearing impairment had undergone CI. After excluding children with low birth weight (<1800 g), those with >11 points on the Pervasive Developmental Disorder ASJ Rating Scale for the test of autistic tendency, and those <2 SD on Raven's Colored Progressive Matrices for the test of non-verbal intelligence, 190 children were subjected to this set of language tests. RESULTS Sixty children (31.6%) were unilateral CI-only users, 128 (67.4%) were CI-hearing aid (HA) users, and 2 (1.1%) were bilateral CI users. Hearing loss level of CI users was significantly (p<0.01) worse than that of HA-only users. However, the threshold level, maximum speech discrimination score, and speech intelligibility rating in CI users were significantly (p<0.01) better than those in HA-only users. The scores for PVT-R (p<0.01), SCTAW, and WFT in CI users were better than those in HA-only users. STA and TQAID scores in CI-HA users were significantly (p<0.05) better than those in unilateral CI-only users. The high correlation (r=0.52) has been found between the age of CI and maximum speech discrimination score. The scores of speech and language tests in the implanted children before 24 months of age have been better than those in the implanted children after 24 months of age. CONCLUSIONS We could indicate that CI was effective for language development in Japanese hearing-impaired children and early CI was more effective for productive vocabulary and syntax.
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Abstract
Breast cancer staging and treatment are possible during pregnancy, and should be defined in a multidisciplinary setting. Tumour biology, tumour stage, and gestational stage at diagnosis determine the appropriate approach. Surgery for breast cancer is possible during all trimesters of pregnancy. Radiotherapy is possible during pregnancy but, dependent on the fetal dose received, can result in poor fetal outcomes. The decision to give radiotherapy should be made on an individual basis. Evidence increasingly supports administration of chemotherapy from 14 weeks' gestation onwards. New breast cancer treatments might be applicable to pregnant patients, but tamoxifen and trastuzumab are contraindicated during pregnancy. Cancer treatment during pregnancy will decrease the need for early delivery and thus prematurity, which is a major concern in management of breast cancer in pregnancy.
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Affiliation(s)
- Frédéric Amant
- Multidisciplinary Breast Cancer Center, Leuven Cancer Institute, Katholieke Universiteit Leuven, Belgium.
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