Etiology of childhood hypothyroidism

This study prospective without any selection bias included 80 of the 152 hypothyroid infants and children seen over the past six years. The clinical diagnosis was confirmed by TSH and thyroid hormone (T3, T4) studies. Scanning for thyroid with TC99m pertechnetate was carried out in all except seven older children with grade II and III goiters where 131I uptake studies were done. Serum thyroglobulin (RIA) was estimated and antithyroglobulin and antimicrosomal antibodies were tested. Based on thyroid 131I scan or 131I uptake, 52.5% had no demonstrable thyroid tissue except one with hypoplasia (Group I, n = 42), 25% had ectopic thyroid (Group II, n = 20), and 22.5% had normal or enlarged thyroid gland (Group III, n = 18). One hypothyroid patient of Group III had thyroiditis with high antibody titre and one was proved to have iodine deficiency). The mean age at time of diagnosis was lowest in Group I (age in months--30.3 +/- 36.2; 60.6 +/- 53.9; 106.2 +/- 69.3 in Groups I, II and III respectively. The intergroup differences in age were significant. The mean serum Tg levels increased progressively from Groups I to III. In the present series thyroid dysgenesis led to hypothyroidism in 77.5%, with athyreosis in 52.5% and ectopia in 25%. Dyshormonogenesis was noted in 20% and thyroiditis in 1.5%.     

Children of Epileptic and Psychotic Mothers*

Abstract A comparison study of maternal characteristics in a sample of mentally retarded children and in paired non-retarded children from epileptic and psychotic mothers matched. for sex, age and living area was done. Thirty-two children of epileptic mothers and 42 children of psychotic mothers were classified into three and two groups according to the presence of mental retardation, respectively. The frequency of maternal epileptic seizure during pregnancy was significantly higher in the mentally retarded offspring group than in the other two groups. Almost all seizures of the mothers of children with mental retardation were taken for a type of generalized motor seizures. Generalized motor seizures during pregnancy and maternal lower mental condition would be a risk factor of mental retardation in the offspring. An impressive difference between the groups of offsprings of psychotic mothers was observed during the offspring's infancy. About 71 per cent in the group of children with mental retardation was brought up by their mostly psychotic mothers during infancy. Many of the children without mental retardation were raised in foster home care. These facts would imply that some behaviour in the children with mental retardation could be related to postnatal environmental abnormal factors.     

Clinical manifestations in selective IgA deficiency in childhood. A follow-up report

Clinical manifestations in 40 children with selective IgA deficiency were studied during a follow-up period of 2-10 years. The patients were divided into two groups: group I consisted of 25 children with "sporadic" IgA deficiency and group II of 15 children with "familial" IgA deficiency. Respiratory tract infections including otitis media were frequent in both groups. Concomitant IgG2-IgG4 deficiency was found in two patients in group I. Longitudinal serum IgG levels were elevated significantly in both groups. Atopic complaints were observed in 10 children of the "sporadic" group, but only in two of the "familial" group. However, elevated serum IgE levels were more often found in group II. Two children of group I were mentally retarded and chromosomal examination showed abnormalities in both. Anti-IgA antibodies were detected in one child in group I and three children in group II. These three patients had an IgA deficient mother with class-specific anti-IgA antibodies. Concomitant IgG4-IgE deficiency was found in all four.     

Clinical Manifestations in Selective IgA Deficiency in Childhood; A Follow-up Report

ABSTRACT. Clinical manifestations in 40 children with selective IgA deficiency were studied during a follow-up period of 2-10 years. The patients were divided into two groups: group I consisted of 25 children with "sporadic" IgA deficiency and group II of 15 children with "familial" IgA deficiency. Respiratory tract infections including otitis media were frequent in both groups. Concomitant IgG,-IgG, deficiency was found in two patients in group I. Longitudinal serum IgG levels were elevated significantly in both groups. Atopic complaints were observed in 10 children of the "sporadic" group, but only in two of the "familial" group. However, elevated serum IgE levels were more often found in group II. Two children of group I were mentally retarded and chromosomal examination showed abnormalities in both. Anti-IgA antibodies were detected in one child in group I and three children in group II. These three patients had an IgA deficient mother with class-specific anti-IgA antibodies. Concomitant IgG₄-IgE deficiency was found in all four.     

Normal ranges of continuous pH monitoring in the proximal esophagus

BACKGROUND: To determine normal ranges of gastroesophageal reflux (GER) in the proximal esophagus, measured with continuous pH monitoring. Normal ranges in the distal esophagus have been published. Because esophageal pH monitoring is frequently performed in children with atypical manifestations such as chronic respiratory disease, and because one of the possible pathophysiologic mechanisms may be (micro-)aspiration, it may be relevant to establish normal ranges in the proximal esophagus. METHODS: Twenty-four-hour pH monitoring was performed in 200 children with suspected GER disease. The mean age of the patients was 4.5 months (range, 0.5-17.0 months). After initial analysis, patients were divided into three groups according to the reflux index (RI) in the distal esophagus, because it could be speculated that the amount of reflux reaching the proximal esophagus depends on the amount of reflux in the distal esophagus: Group I (n: 120) children had a distal RI of less than 5% and were considered normal, group II (n:50) had a distal RI of 5% to 10% and was considered to have intermediate disease, and group III (n:30) had a distal RI of more than 10% and was regarded as pathologic. The following parameters are calculated: the RI, the total number of reflux episodes, the number of reflux episodes lasting more than 5 minutes, the duration of the longest reflux episode, and the acid clearance time (ACT). RESULTS: The median RI in the distal esophagus was 3.8 +/- 0.34 (standard error of the mean [SEM]), and in the proximal esophagus, the RI was 1.2 +/- 0.23. In group I patients, the RI in the proximal esophagus was 0.5% +/- 0.09%, in group II the RI increased significantly to 2.75% +/- 0.34% (P [group I compared with group II] < 0.01), and in group III the RI was 6.15% +/- 0.96% (P [II-III] < 0.01). The number of acid reflux episodes in group I was 17.0 +/- 2.27, in group II the number increased to 62.5 +/- 8.18 (P [I-II] < 0.01), and in group III it reached 102.0 +/- 23.9 (P [II-III] < 0.05). Also the duration of the longest reflux episodes and the number of reflux episodes lasting more than 5 minutes increased from group I to group II, and from group II to group III. The ACT was shorter in the proximal esophagus (group I 0.3 +/- 0.06 minutes; group II 0.48 +/- 0.07 minutes, P [I-II] = not significant [NS]; group III 0.56 +/- 0.17 minutes P [II-III] = NS) than in the distal esophagus (group I 0.49 +/- 0.03 minutes, P [proximal ACT compared with distal ACT] < 0.05; Group II 0.76 +/- 0.05 minutes, P [proximal-distal] < 0.01; Group III 0.89 +/- 0.09 minutes, P [proximal-distal] = NS) suggesting more effective esophageal clearance in the proximal esophagus. CONCLUSIONS: Protection of the proximal esophagus from acid reflux is significantly related to the incidence and duration of reflux measured in the distal esophagus. These normal ranges in the upper esophagus will be helpful in the interpretation of upper esophageal pH monitoring data.     

Efficacy of pollen immunotherapy in seasonal allergic rhinitis

BACKGROUND: The efficacy of subcutaneous pollen immunotherapy has been documented in published double-blind, placebo-controlled studies related to treatment of seasonal allergic rhinitis. In the present study, subjective (symptom scores) and objective (nasal peak inspiratory flow, nasal smear, nasal biopsy) parameters were used to study the efficacy of pollen immunotherapy. METHODS: Forty-eight patients (32 male), mean +/- SE age 13.6 +/- 2.8 years allergic to grass-pollen participated in the present study. Patients were divided into three groups: group I, 24 patients who did not receive pollen immunotherapy; group II, 12 patients who received the build-up phase of pollen immunotherapy; and group III, 12 patients who had just finished pollen immunotherapy. With regard to objective and subjective parameters these three groups were compared. RESULTS: When group I was compared to groups II and III, the patients who had not received any immunotherapy were found to have a high daytime nasal symptoms score (P < 0.01), high daytime eye symptoms score(P < 0.01) and high night-time symptoms score (P < 0.01). In objective parameters, it was found that group I had low nasal peak inspiratory flow (P < 0.05), and a high eosinophil count in nasal smears (P < 0.05) and peripheral blood (P < 0.05). It was also demonstrated that there was an increased eosinophil infiltration (P < 0.01) and mast cell infiltration (P < 0.05) in nasal biopsy in group I. There was no significant difference between group II and group III according to these results (P > 0.05). CONCLUSIONS: Immunotherapy leads to a better clinical and histopathological prognosis in children with seasonal allergic rhinitis.     

Cortisol and cytokine responses after surgery in different age groups of pediatric patients

We investigated the cortisol and cytokine responses to surgical stress in the different age groups of pediatric patients. This study included 19 neonates (0-6 days old, group I), 19 infants (1-11 months old, group II), and 20 pre-school children (1-5 years old, group III), undergoing major thoracic and abdominal surgery. We obtained blood samples preoperatively and 0, 3, 6, 12, and 24 h postoperatively to measure the plasma levels of C-reactive protein (CRP), cortisol, interleukin (IL)-6, and IL-10. The plasma CRP level in each group reached a peak value on postoperative day 2; however, the peak value was significantly lower in group I than in groups II or III (I vs II, III; p=0.0134, p=0.0017, respectively). The plasma cortisol level in each group reached a peak value just after surgery; however, the peak value was also significantly lower in group I than in groups II or III (I vs II, III; p<0.001, p=0.0104, respectively). The plasma IL-6 level in each group reached a peak level hours postoperatively; however, the peak values in groups I and II were higher than in group III (I, II vs III; p=0.003, p=0.0458, respectively). The plasma IL-10 level in each group reached a peak value just after surgery and did not differ among the three groups. The endocrine and cytokine responses to the surgical stress vary among the different age groups of pediatric patients.     

Lactose absorption and malabsorption in healthy Italian children: do the quantity of malabsorbed sugar and the small bowel transit time play roles in symptom production?

Using breath hydrogen analysis after an oral lactose load (2 g/kg; maximum 50 g), we investigated the prevalence of lactose malabsorption in 61 healthy Italian children aged 6-13 years. We also examined the relationship between symptoms and small bowel transit time and the degree of sugar malabsorption. Three of 61 subjects produced no H2 after both lactose and lactulose load and thus were eliminated at the outset. Lactose malabsorption was defined as excretion of greater than 20 ppm H2. Lactose intolerance was classified as mild (colicky pain, flatulence, abdominal distension, borborygmi) or severe (diarrhea). The frequency of lactose malabsorption in the children aged 6-8 years (group I) was 25%; in the children aged 8-11 years (group II), it was 35%, and in the children aged 11-13 years (group III) 56%. The differences in frequency between the first and the third groups were significant (p = 0.05). Three of 20 (15%) in group I, two of 20 (10%) in group II, and three of 18 (17%) in group III were classified not only as lactose malabsorbing, but also as lactose intolerant, with symptoms during and after the test. We found no difference in the small bowel transit times or in the quantities of malabsorbed lactose in symptomatic and asymptomatic malabsorbing subjects. Other factors that may play a role in symptom production are discussed.     

Efficacy and safety of rectal thiopental sedation in outpatient echocardiographic examination of children

The efficacy and safety of rectal thiopental administration in sedation for paediatric echocardiographic examination were prospectively investigated in infants with known or suspected congenital heart disease in an outpatient manner. A total of 1150 patients (546F, 604M) were studied; 264 were 7 d to 6 mo old (group I), 572 were 6 mo to 2-y-old (group II), and 314 were 2 to 6-y-old (group III). Thiopental sodium dissolved in 10 ml of water in a syringe to which a 6-F feeding catheter was attached was administered prior to echocardiographic examination to patients in groups I, II and III with doses of 50, 35 and 25 mg/kg, respectively in an emergency care environment. Length of time to achieve sedation (induction time), duration of sedation, length of time to return to normal activity (recovery time), whether sedation was successful and side effects were recorded. In the overall study population, sedation was successful in 1094 (95.1%) of the patients, the induction time was 16.34 +/- 3.69 min, the duration of sedation was 35.07 +/- 7.04 min, the recovery time was 63.25 +/- 10.17 min and the overall side-effect prevalence was 2%. Sedation was significantly more successful, the induction time was significantly shorter, the recovery time was significantly longer and side effects significantly more prominent in groups I and II compared to group III. Conclusion: Rectally administered thiopental is a safe and efficacious agent for sedation of infants and young children with known or suspected congenital heart disease who are undergoing echocardiography in an outpatient cardiology clinic, provided that it is used in an emergency care setting considering the risk of respiratory depression even though the prevalence of this side effect is significantly low.     

The relation between the secretion of growth hormone (GH), somatomedin C/IGF I (IGF I) and steroids before and after the onset of puberty in patients of small stature

Somatomedin C/IGF I, dehydroepiandrosterone sulfate (DHAS), testosterone (T) or estradiol (E2) have been measured in 154 patients of a previous study in which growth hormone (GH) responses to classical pharmacologic stimuli and spontaneous growth hormone secretion during sleep were compared in short children before and at the beginning of puberty. Five groups were identified: Group I, normal growth hormone secreting children; group II, completely growth hormone deficient; group III, partially growth hormone deficient; group IV, with normal sleep secretion and low responses to stimuli; group V, with the reverse situation. The somatomedin C/IGF I levels were widely dispersed. In group I, the mean +/- SEM levels of somatomedin C/IGF I were 0.77 +/- 0.047 U/ml before puberty and 1.36 +/- 0.142 U/ml in early pubertal patients, with a relation to age (r = 0.52, p less than 0.001). The difference between prepubertal and pubertal patients was significant. In groups II to V, there was no pubertal rise of somatomedin C/IGF I. In group II, the mean IGF I level was 0.48 +/- 0.05 U/ml, significantly lower than in prepubertal patients of group I. In groups III, IV and V, it was 0.7 +/- 0.069 U/ml, 0.8 +/- 0.059 U/ml, and 0.73 +/- 0.059 U/ml respectively, not different from prepubertal patients of group I, but significantly lower than in early pubertal patients of the same group. In prepubertal patients, somatomedin C/IGF I was slightly but highly significantly correlated to growth hormone sleep secretion (r = 0.27, p less than 0.001) and to dehydroepiandrosterone sulfate (r = 0.36, p less than 0.001), but growth hormone and dehydroepiandrosterone sulfate were not correlated with each other.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lead poisoning in children. Apropos of 129 cases

One hundred and twenty nine children with chronic lead poisoning were followed from August 1985 to July 1989. Old lead paint was recognized as the contaminant source at home. Pica of paint flakes was the main mode of intoxication. Children were classified according to the Center for Disease Control 1985 as follows: class IV (39 cases), class III (45 cases), class II (30 cases), class I (15 cases). Nineteen of those in class IV had blood lead levels above 700 micrograms/l and received BAL + EDTA followed by EDTA alone for a mean of 4.6 +/- 3.5 courses. With this treatment, blood lead level decreases were 50 +/- 17%. Nine of these class IV children had an evaluation at last 3 months after the last chelation course: 5 became class I or II, and 2 class III with a negative provocative test. The remaining 20 children in class IV were given a mean of 2.7 +/- 1.4 courses of EDTA. Blood lead levels decreased by 52 +/- 15%; 11 children were evaluable at least 3 months after the last chelation course: 4 became class I, and 7 class II. Thus overall 80% of class IV moved under treatment to class I or II. Among those 45 children in class II, 30 underwent a provocative test and 24 one to three courses of EDTA: 8 were further studied: 3 became class I and 5 class II. Combination of screening, medical treatment and sociocultural approach led to avoid acute effects of severe chronic childhood lead poisoning. The efficacy of such an approach in preventing chronic effects has still to be evaluated.     

Growth and growth hormone secretion after bone marrow transplantation.

This study analyses the growth and the growth hormone secretion of children given various conditioning protocols before bone marrow transplantation (BMT). Twenty nine children (14 boys, 15 girls) given BMT were classified according to their conditioning protocol: total body irradiation (TBI) given as a single exposure of 10 Grays (Gy, group I, 11 cases), or 8 Gy (group II, four cases), 12 Gy given as six fractionated doses (Group III, seven cases), or chemotherapy alone (group IV, seven cases). The arginine-insulin stimulated growth hormone peak, 2-7.5 years after BMT, was > 10 micrograms/l in all patients except four from group I (6.9-8.9 micrograms/l). A second growth hormone secretion evaluation was performed in 10 group I patients because of persistent low growth velocity despite a normal growth hormone peak. There were no significant changes in the mean (SEM) stimulated growth hormone peak (18.4 (2.2) v 20.1 (3.6) micrograms/l) at 3 (0.3) to 5.2 (0.6) years after BMT. The sleep growth hormone peaks and concentrations (n = 6) were normal. The mean cumulative height changes (SD) during the three years after BMT were: -1.4 (0.2) in group I, -0.1 (0.4) in group II, -0.4 (0.2) in group III, and 1.5 (0.5) in group IV; this was significant in groups I and IV. The final heights of two monozygotic twins (BMT donor and recipient) had differed by 17.5 cm, despite them both having normal growth hormone peaks and puberty. Eight patients, treated for congenital immune deficiency syndrome, were growth retarded at the time of BMT. Of these, only those conditioned by chemotherapy alone had significant catch up growth (2(0.6)SD) while those conditioned by a single Gy exposure did not (0(0.4)SD). It is concluded that the total radiation dose is critical for growth evolution, as is the fractionation schedule. For the TBI doses and the interval since BMT studied, there was no correlation between growth hormone peak and the height loss. The rapidity of decreased growth velocity after TBI and the comparison between the monozygotic twins suggest that radiation induced skeletal lesions are partly responsible for the decreased growth.     

Growth and growth hormone secretion after bone marrow transplantation

This study analyses the growth and the growth hormone secretion of children given various conditioning protocols before bone marrow transplantation (BMT). Twenty nine children (14 boys, 15 girls) given BMT were classified according to their conditioning protocol: total body irradiation (TBI) given as a single exposure of 10 Grays (Gy, group I, 11 cases), or 8 Gy (group II, four cases), 12 Gy given as six fractionated doses (Group III, seven cases), or chemotherapy alone (group IV, seven cases). The arginine-insulin stimulated growth hormone peak, 2-7.5 years after BMT, was > 10 micrograms/l in all patients except four from group I (6.9-8.9 micrograms/l). A second growth hormone secretion evaluation was performed in 10 group I patients because of persistent low growth velocity despite a normal growth hormone peak. There were no significant changes in the mean (SEM) stimulated growth hormone peak (18.4 (2.2) v 20.1 (3.6) micrograms/l) at 3 (0.3) to 5.2 (0.6) years after BMT. The sleep growth hormone peaks and concentrations (n = 6) were normal. The mean cumulative height changes (SD) during the three years after BMT were: -1.4 (0.2) in group I, -0.1 (0.4) in group II, -0.4 (0.2) in group III, and 1.5 (0.5) in group IV; this was significant in groups I and IV. The final heights of two monozygotic twins (BMT donor and recipient) had differed by 17.5 cm, despite them both having normal growth hormone peaks and puberty. Eight patients, treated for congenital immune deficiency syndrome, were growth retarded at the time of BMT. Of these, only those conditioned by chemotherapy alone had significant catch up growth (2(0.6)SD) while those conditioned by a single Gy exposure did not (0(0.4)SD). It is concluded that the total radiation dose is critical for growth evolution, as is the fractionation schedule. For the TBI doses and the interval since BMT studied, there was no correlation between growth hormone peak and the height loss. The rapidity of decreased growth velocity after TBI and the comparison between the monozygotic twins suggest that radiation induced skeletal lesions are partly responsible for the decreased growth.     

The status of hemoglobin concentration and hematocrit in Angola children]

Hemoglobin-concentration (Hb) and hematocrit (Ht) were determined in 622 Angolean children between ages of 3 months and 13 years. The children were divided into two groups: group I (n = 530) of low social and economic state, group II (n = 92) children enjoyed good living conditions. 38.9% of all children had a Hb below 6.8mmol/l. 218 of which were part of group I, only 18 were out of group II. An extensive anemia (less than Hb 4.3mmol/l) existed in only 3% of all children. 51.7% of children were below 3 years. Between age groups of 3 months to over 10 years there was a continual rise in Hb of 17.6 +/- 6.6% (boys) and 9.5 +/- 3% (girls). Using the Ht values the percentage of anemic children was only 16.4%. It existed a relationship, especially, clearly observed in group I, between physical development and aemia frequency. Children of group I were more anemic than children of group II.     

Cardioprotective effect of dexrazoxane during treatment with doxorubicin: a study using low-dose dobutamine stress echocardiography

AIM: To assess the late cardioprotective effect of dexrazoxane associated with doxorubicin during treatment of osteosarcoma by means of low-dose dobutamine stress echocardiography (LDDSE) in non-relapsed asymptomatic children and teenagers. PATIENTS AND METHODS: The study population included 58 patients with osteosarcoma divided in three groups, with equivalent age range, gender proportion and body surface area. Group I (21 patients, 14 males, 15 +/- 4 years) was analyzed before chemotherapy and considered the control group; Group II (19 patients, 11 males, 19.7 +/- 4 years) was treated with 348.4 +/- 18 mg/m2 of doxorubicin only and Group III (18 patients, 14 male, 16.8 +/- 5 years) treated with 396.5 +/- 55 mg/m2 of doxorubicin with dexrazoxane in the ratio 10:1. The patients were submitted to LDDSE (maximal dose 5 microg/kg/min). No major side effects were observed. Heart rate, blood pressure, left ventricular diameters, end systolic wall stress (ESWS), and other diastolic and systolic function indexes were assessed at rest conditions and during LDDSE and compared between the three groups. RESULTS: Group III received a doxorubicin dose significantly greater than Group II (P = 0.001). During LDDSE there were no significant changes in the diastolic function indexes in any of the groups, but there was a significant increase of systolic indexes and a decrease of ESWS in Group III compared to group II. There was no significant difference of any systolic functional parameters between Group I and III. Considering the ejection fraction (EF) at rest or at LDDSE, 13 patients (69.4%) in Group II and 5 patients (27.7%) in Group III were considered to have systolic dysfunction. (P = 0.02). CONCLUSION: Myocardial response to LDDSE in patients treated with doxorubicin and dexrazoxane was similar to patients without chemotherapy and better than those treated with doxorubicin only, suggesting less cardiotoxicity.     

MRI follow-up and natural history of avascular necrosis of the femoral head in Kuwaiti children with sickle cell disease

PURPOSE:: To document the MRI progression and the natural history of avascular necrosis of the femoral head (AVNFH) in Arab children with sickle cell disease. PATIENTS AND METHODS: Twenty-three SS and 7 SbetaThal patients (aged 6-17 years) were screened for AVNFH between 1998 and 1999. Eight (26.7%) were identified with varying degrees of AVNFH. Seventeen of the original 30 patients have now been followed for 1 to 4 (mean 2.0 +/- 1.2) years, with repeat MRI of the hips. Spin-echo T1-and T2-weighted images and T2 fat-saturation sequences were obtained using a 1.5-Tesla GE unit with superconductors. AVNFH was graded I (mild), II (moderate), or III (severe). RESULTS: Eleven (64.7%) of the 17 patients had significant progression of their lesions; at the initial study, 9 were normal, 7 were grade I, 1 was grade II, and none was grade III. At the end of the follow-up period, two were normal, seven were grade I, one was grade II, and seven were grade III. Of the nine who were initially normal, two still had no lesions, while four were grade I and three were grade III on follow-up. Of the seven who were classified as grade I initially, four remained at grade I, one moved to grade II, and two became grade III. The one patient who was initially grade II progressed to III. CONCLUSIONS: AVNFH is a common, chronic, and unrelenting complication in children with sickle cell disease, and it is usually progressive.     

Stiffness of the abdominal aorta in obese children

Obesity is pathogenically related to clinical and subclinical disorders that contribute to the development of atherosclerotic plaques and their complications leading to onset of cardiovascular events. Arterial stiffness may be an indicator of early vascular changes signaling the development of vascular disease. The purpose of this study was to assess the stiffness of the abdominal aorta using transthoracic echocardiography in normotensive obese and hypertensive obese pediatric patients and a control group. The study group consisted of 25 healthy children (M/F: 13/12) as a control group (Group I), 25 normotensive obese children (M/F: 13/12) (Group II) and 25 hypertensive obese children (M/F: 14/11) (Group III). The mean ages were 12.1 +/- 1.8, 11.9 +/- 1.5 and 12.4 +/- 1.4 years, respectively. Aortic strain (S), pressure strain elastic modulus (Ep) and normalized Ep (Ep*) measurements were significantly different in the hypertensive obese group, and cholesterol levels and body mass index were higher in this group. These findings may be important in determining the relationship between obesity and cardiovascular risk factors at pediatric age.     

Evaluation of different induction regimens in children with acute lymphocytic leukemia

Four induction regimens-prednisolone and 6- mercaptopurine (group I), prednisolone and vincristine (group II), prednisolone, vincristine & asparaginase (group III) and prednisolone, vincristine and adriamycin followed by cyclophosphamide and 1-asparaginase (group IV)- have been evaluated. Successful induction remission was achieved in 16 (69.6%) in group I, 23 (92.0%) in group II, 36 (94.7%) in group III, 31 (96.8%) in group IV. Relapses were seen in 10 (62.5%), 10 (73.8%), 25 (69.4%) and 9 (29.0%) in the four groups respectively. Relapses seen in group IV were infrequent as compared to children of group I, II & III. Adverse risk factors were similar in all the four groups. Ninety four children (61.3%) had one or more poor prognostic factors at diagnosis. Three of 43(7%) children with no poor prognostic factors died during induction therapy as compared to 18 of 94 (19.1%) children associated, with poor prognostic factors at diagnosis. Higher mortality was seen under two years of age.     

Pune low birth weight study--cognitive abilities and educational performance at twelve years

OBJECTIVE: To assess the intelligence, visuo-motor perception, motor competence and school performance of children with birth weight less than 2000 grams, at the age of 12 years. DESIGN: Prospective cohort study. SETTING: Infants discharged from a Neonatal Special Care Unit of a referral hospital with birth weight less than 2000 g between 1987-89 and followed up in the High Risk Clinic. METHODS: The children were assessed by the Weschler's Intelligence Scale, Bender Gestalt test for visuo-motor perception, Wide Range Achievement Test for specific learning disability, Draw-a-Person screening test for emotional problems and Movement Assessment Battery for motor competence. Academic achievement was also scrutinised. RESULTS: One hundred and eighty children weighing less than 2000 grams at birth and ninety control children were assessed. The mean IQ of the study group was normal (89.5 +/- 16.9), though significantly lower than that of controls (97.2 +/- 14.1; p<0.05). Pre term SGA children had the lowest mean IQ (85.4 +/- 17.7). In the 78 VLBW children, there were 12 (15.4%) mentally retarded children as compared to only 3 (3.3%) amongst controls (p<0.001). There were only 3 (3.8%) 'bright' children among the VLBW group, as compared to 20 (22.2%) in the control group (p<0.001). Visuo-motor perception and motor competence of the study group was poor, and they had writing and mathematics learning disability, especially the preterm SGA and VLBW group. Academic achievement was poor and the incidence of borderline intelligence was 24.4%, which has increased from 13.4% at 6 years. CONCLUSIONS: The intelligence and academic performance of the children weighing less than 2000 grams is significantly lower than that of controls, though within normal limits. They also have poor visuo-motor perception, motor incompetence, reading and mathematics learning disability. The preterm SGA and VLBW children had the poorest cognitive abilities.