Responsive Parenting Behaviors and Cognitive Function in Children With Sickle Cell Disease

Developmental delay in infants and toddlers with sickle cell disease: a systematic review

AIM

To summarize developmental delay among infants and toddlers with sickle cell disease (SCD).

METHOD

This systematic review included studies that reported developmental outcomes of children with SCD between 0 months and 48 months of age and followed standards set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Ten studies were included, describing 596 unique developmental assessments. The rate of developmental delay ranged from 17.5% to 50% and increased with age. Cognition was the only domain included in all studies and the most frequently identified delay. One study reported that more severe SCD genotypes predicted worse development, while five studies reported no difference in rates of developmental delay across genotypes.

INTERPRETATION

These findings emphasize the need for standardized screening to identify children with SCD at risk of delay at a young age to facilitate appropriate referrals for therapeutic intervention. Frequent and comprehensive developmental screening is necessary among all SCD genotypes.

A bioética da intervenção como possibilidade de inclusão social de pacientes com doença falciforme em tempos de COVID-19

Este artigo discute a exclusão social vivida pelos indivíduos brasileiros com a doença falciforme, sob a perspectiva da bioética de intervenção. Trata-se de uma enfermidade na qual o afetado herda de seus progenitores o gene responsável pelo formato diferenciado da hemoglobina; ademais, apresenta maior incidência na população negra, uma vez que a alteração do formato da hemoglobina foi resultado da evolução do próprio corpo para evitar a contração da malária no continente africano. Além da exclusão social que a população negra sofre, há, ainda, um maior grau de preconceito advindo dos efeitos da doença. Revela-se que as dificuldades enfrentadas pelos acometidos são agravadas em decorrência da COVID-19. Portanto, a criação de políticas públicas que se alicercem nos parâmetros da bioética da intervenção, cujo foco principal é a vulnerabilidade e os desafios persistentes da sociedade, é proposta como possível ação para minorar as consequências da doença falciforme na população por ela afetada.

Pediatric Neurodevelopmental Delays in Children 0 to 5 Years of Age With Sickle Cell Disease: A Systematic Literature Review

INTRODUCTION

Sickle cell disease (SCD) is the most common abnormal genetic blood disease that affects ∼100,000 Americans. Approximately 20% to 37% of children with sickle cell anemia have silent cerebral infarcts by the age of 14 years old. Neurocognitive deficits are identified in infants and preschool children with SCD. The purpose of this systematic literature review is to provide a comprehensive understanding of the prevalence, severity, and the associated risk factors for neurodevelopmental delays (NDDs) in children with SCD 5 years of age and younger.

METHODS

Systematic search of 6 databases identified 2467 potentially relevant publications and 8 were identified through a manual search. Only 24 articles met the inclusion criteria.

RESULTS

We identified an increased prevalence of NDDs (cognitive, motor, or both). Children experienced deficits with language, attention and behavior, executive functioning, school readiness and/or academic performance, and motor skills (fine and gross motor functioning). Risk factors include silent cerebral infarcts and strokes, SCD genotype (HbSS>HbSC), other biologic, and social factors.

CONCLUSION

NDDs are common in children ages 0 to 5 years old with SCD. There is an opportunity to improve adherence to national guideline recommendations and early detection practices by pediatricians, hematologists, and other health care providers.

Correlates of Cognitive Function in Sickle Cell Disease: A Meta-Analysis

OBJECTIVE

To provide a comprehensive quantitative review of biological, environmental, and behavioral correlates across domains of cognitive function in sickle cell disease (SCD).

METHODS

Forty-seven studies were identified in PubMed, MedLine, and PsycINFO involving 2573 participants with SCD.

RESULTS

Meta-analytic findings across all identified samples indicate that hemoglobin and hematocrit were positively correlated with Full Scale IQ [FSIQ; r = .15, 95% confidence interval (CI) = .10 to .21], language and verbal reasoning (r = .18, 95% CI = .11 to .24), and executive function (r = .10, 95% CI = .01 to .19) with small effects and significant heterogeneity. Transcranial Doppler velocity was negatively associated with visual spatial and perceptual reasoning (r = -.18, 95% CI = -.31 to -.05). Socioeconomic status was positively associated with FSIQ (r = .23, 95% CI = .17 to .28), language and verbal reasoning (r = .28, 95% CI = .09 to .45), visual spatial and perceptual reasoning (r = .26, 95% CI = .09 to .41), and executive function (r = .18, 95% CI = .07 to .28) with small to medium effects. Finally, total behavioral problems were negatively associated with FSIQ (r = -.12, 95% CI = -.21 to -.02) such that participants with lower FSIQ exhibited greater behavioral and emotional problems.

CONCLUSIONS

Findings provide evidence for biological, environmental, and psychosocial corelates across multiple domains of cognitive function in SCD. More research on more specific cognitive domains and psychosocial correlates is needed in addition to assessments of interactional models among risk factors.