Hemoglobin status associated with performance IQ but not verbal IQ in Chinese preschool children

Background: Despite the body of literature that links anemia with poorer cognition in children and the evidence that the severity of the effects of anemia on children's cognition vary in different populations, few studies have investigated the effects of anemia on the cognitive development of Chinese children. Methods: This longitudinal cohort included 171 children from a developing region of China. Hemoglobin (Hb) and iron levels were taken when the children were 4 years old. At age 6, the children's cognition was tested with the Chinese Wechsler Preschool and Primary Scale of Intelligence. Psychosocial information was also used in analyses. Results: Results showed that the children who had low Hb levels had significantly lower scores in performance IQ (PIQ), but not verbal IQ. Although blood Fe levels were not shown to moderate the link between Hb levels and IQ, we found children who performed the best on IQ tests exhibited low iron levels concurrent with high Hb levels, whereas the group who performed the worst exhibited high iron but low Hb levels. We also found that psychosocial adversity did not differ significantly between children who had normal or low Hb levels, although the effect of Hb on PIQ became only suggestive after controlling for psychosocial adversity, therefore the correlation is not causal but only a suggestive association. Conclusion: Our findings are in agreement with literature on the negative effects of anemia on children's cognition and point to the possibility that the portions of the brain associated with PIQ components are particularly affected by low Hb during crucial periods of development.     

The correlation of deficits in IQ with midface and digit hypoplasia in children exposed in utero to anticonvulsant drugs

OBJECTIVE: Children exposed during pregnancy to the anticonvulsant drugs phenytoin, phenobarbital, and carbamazepine as monotherapy and polytherapy have an increased frequency of midface and digit hypoplasia. Some children also have cognitive dysfunction. The hypothesis tested is that the anticonvulsant drug-exposed child with midface and digit hypoplasia is more likely to have cognitive dysfunction. METHODS: Children exposed to anticonvulsant drugs (n = 80) were recruited for a follow-up evaluation, which included testing cognitive function and a physical examination for head size, height, and the presence of midface and digit hypoplasia. Microcephaly, midface and digit hypoplasia, and major malformations were correlated with full scale (FSI), performance (PIQ) and verbal (VIQ) intelligence. RESULTS: The presence of the 3 anticonvulsant-exposed children with microcephaly had a deficit of 23.7 IQ points in FSI in comparison with the other children with a normal head size. Either midface or digit hypoplasia, after excluding the persons with microcephaly and with the Bonferroni correction, correlated significantly with deficits in VIQ (-12.7), PIQ (-10) and FSI (-12.8) IQ points ( P = .0061). There was no decrease in IQ in association with major malformations. CONCLUSION: The presence of midface and digit hypoplasia in a child exposed to anticonvulsant drugs in pregnancy is an indication for a systematic developmental evaluation.     

急性肾损伤患儿的营养支持

急性肾损伤是危重患儿常见的多器官功能障碍之一,常发生在危重疾病的严重分解代谢期,代谢紊乱又使肾损伤进一步加重。营养支持对于改善预后至关重要。伴有急性肾损伤的危重患儿存在特殊的营养需求,需要提供肠内或肠外营养支持。应反复评估此类患儿营养需求的变化,以寻求个体化营养支持以及与肾脏替代治疗的精细整合。     

Long-term development of intelligence (IQ) and EEG in 34 children with phenylketonuria treated early

In 34 children with phenylketonuria (PKU) treated early the prognostic value of the age on institution of the diet (within the first 3 months of life) and of the quality of dietary treatment was determined in two different ways: 1) following intelligence closely (IQ) and (2) evaluating the EEG development up to their 12th (n=34) and 15th (n=18) years of life as appropriate. In general, IQ scores were found to be normal from the 4th–15th years of life. In our group of patients there was no effect on the IQ of the timing of diet onset. Children with strict dietary control showed a significantly higher IQ than those with loose control. One hundred and fifty-four EEGs (10/20 system, awake with eyes closed) were recorded at intervals of 2 years and conventionally evaluated. The development of alpha-activity was found to be normal. Beta-activity was enhanced. Abnormal EEG findings like general slowing and generalized paroxysmal activity (GPA) with or without spikes were more frequent in children with PKU than in controls, with the exception of focal abnormalities. EEG abnormalities increased with advancing age independently of IQ development and showed no relation to either the age at the onset nor the quality of dietary treatment.Abbreviations PKU phenylketonuria - PHE phenylalanine - GPA generalized paroxysmal activity - IDC index of dietary control     

伴中央颞区棘波的儿童良性癫(痫)治疗前后脑电图与认知功能的对比分析

目的 通过研究伴中央颞区棘波的儿童良性癫(痫)(benign childhood epilepsy with centro-tem-poral spikes,BECT)患儿的脑电图放电指数、智力测试得分及事件相关电位P300潜伏期,分析治疗前后脑电图放电指数与认知功能的改变.方法 选取60例BECT患儿,治疗前后均监测视频脑电图、智力测试及P300,并比较三者结果之间的差异.结果 (1)BECT患儿通过左乙拉西坦、拉莫三嗪治疗后VEEG放电较治疗前明显减少,差异具有统计学意义(P＜0.05).(2)治疗3个月、6个月P300潜伏期与治疗前比较,差异具有统计学意义(P＜0.05).(3)治疗3个月言语智商、总智商无明显改善,而操作智商提高,言语智商与总智商差异无统计学意义(均P＞0.05),治疗6个月所有患儿的言语智商、操作智商及总智商均升高,差异具有统计学意义(均P ＜0.05).(4)脑电图放电指数与P300相关性分析结果(r=0.175),与智力测试的相关性分析结果(r =0.044),呈负相关.结论 BECT患儿均存在智力受损,脑电图放电越频繁,P300潜伏期延长,智力受损害越严重.左乙拉西坦、拉莫三嗪治疗后智力均有所改善,治疗时间越长,智力改善越明显.     

Multifocal epilepsy in children is associated with increased long-distance functional connectivity: An explorative EEG-fMRI study

Objective

Multifocal epileptic activity is an unfavourable feature of a number of epileptic syndromes (Lennox-Gastaut syndrome, West syndrome, severe focal epilepsies) which suggests an overall vulnerability of the brain to pathological synchronization. However, the mechanisms of multifocal activity are insufficiently understood. This explorative study investigates whether pathological connectivity within brain areas of the default mode network as well as thalamus, brainstem and retrosplenial cortex may predispose individuals to multifocal epileptic activity.

Cognitive outcome at 24 months is more predictive than at 18 months for IQ at 8-9 years in extremely low birth weight children

Background

It is unclear whether developmental assessment later or earlier in childhood is the better predictor of intelligence at 8 years of age. This is an important distinction as many clinical trials assess their final outcomes only in early childhood, assuming the results are valid for later childhood cognitive functioning.

Aims

To compare the ability of developmental assessment at 18 months with 24 months in predicting general intellectual functioning at 8–9 years of age in extremely low birth weight (ELBW, birthweight < 1000 g) children.

Study design

Cohort study.

Subjects

58 ELBW survivors born during 1997 at the Royal Women's Hospital, Melbourne, Australia.

Outcome measures

Cognitive assessments at each of 18 months, 24 months (Mental Developmental Index [MDI]) and 8–9 years (Full Scale IQ) of age, corrected for prematurity were compared by regression analysis and by the κ statistic (agreement beyond chance).

Results

Both the 18-month and the 24-month MDI were significantly predictive of Full Scale IQ at 8–9 years, but more so for the 24-month MDI, with 38% of variance explained compared with 34% of variance explained by the 18-month MDI. The 24-month MDI, expressed as categories of severe, moderate, mild or no developmental delay, was more predictive of categories of severe, moderate, mild or no intellectual impairment at 8–9 years (weighted κ = 0.43, P < 0.001) than was the 18-month MDI (weighted κ = 0.35, P = 0.001).

Conclusions

Cognitive assessment at 24 months is superior to cognitive assessment at 18 months in predicting IQ and intellectual impairment at 8–9 years of age in ELBW children.     

儿童食物不耐受的研究进展

近年来食物不耐受逐渐成为人们关注的焦点.食物不耐受是不同于食物过敏的另一种复杂的变态反应性疾病,可引起全身多系统疾病.因其症状隐匿且无特异性,故临床诊断较为困难.通过食物特异性IgG抗体的检测,忌食或少食不耐受食物,可有效地改善患者的症状,有助于控制及预防疾病.该文就食物不耐受的发病机制、发病情况、与儿童头痛的关系、诊断技术及营养调整等方面作一概述.     

中国大陆学习困难儿童韦氏智力测验对照研究的Meta分析

目的 评估中国学习困难和正常儿童韦氏儿童智力量表(WISC)测量的差异。方法 检索PubMed、MD Consult、中图公司免费外文期刊整合库（cnpLINKer）、中国知网和万方生物医学期刊数据库,检索时间均从建库至2012年5月。获得中国学习困难和正常儿童WISC测量的对照研究,WISC中文版本为北京师范大学版（WISC-CR）或湖南医科大学版（C-WISC）。提取总智商（FIQ）、言语智商（VIQ）和操作智商（PIQ）。应用RevMan 5.0软件进行Meta分析,根据异质性结果选择相应的效应模型分析,并进行亚组分析。结果 23篇文献进入Meta分析,研究实施地均为中国大陆;10篇文献采用WISC-CR,13篇文献采用C-WISC;12篇文献研究现场为医院门诊或儿童保健门诊,对照组基本为来院智力检测的正常儿童;13篇文献研究现场为学校,对照组来自同校或同班同学。①FIQ、VIQ和PIQ异质性检验提示具显著异质性,均采用随机效应模型分析。Meta分析结果显示,FIQ、VIQ和PIQ的WMD分别为-16.23（95％CI:-18.20~-14.25）、-18.90(95%CI:-21.04~-16.77)和-11.92(95%CI:-13.90~-9.94);学习困难组均显著低于对照组（P均<0.000 01）。②对纳入文献的依据诊断方法、研究现场、WISC版本行异质性原因分析,结果显示不能消除异质性。③对VIQ和PIQ各分项进行亚组分析,结果显示VIQ的6个分项（常识、类同、算数、词汇、理解、数字广度）和PIQ的5个分项（填图、排列、积木、拼图、译码）的文献间均具显著异质性,采用随机效应模型分析。Meta分析结果显示,学习困难组VIQ和PIQ各分项得分均显著低于对照组（P均<0.001）。结论 中国大陆学习困难儿童FIQ、VIQ和PIQ低于正常儿童,VIQ的延迟发展更明显。VIQ和PIQ各分项中以常识、类同、积木和译码的延迟发展更明显。     

儿童急性白血病长期持续化疗后智力与心理行为的调查分析

目的了解儿童急性白血病长期持续化疗对智力与心理行为的影响。方法27例急性白血病患儿,经长期化疗,已获得3年以上生存。27例均进行智商测定选用儿童联合型瑞文测试(CRT);心理行为测定:13例12岁以上患儿采用90项自觉症状自评量表(SCL-90),14例12岁以下患儿采用心理健康诊断测试(MHT)。所得结果与我国常模相比较。结果27例患儿平均智商为107,与正常儿童相比较,无显著的统计学差异(P>0·05);13例患儿SCL-90量表总均分为1·58,各因子分均值在1·39~1·79之间,其中人际关系、强迫症状,敌对、偏执得分最高;14例心理健康诊断测试(MHT)无一例患儿全量表标准分≥65,说明白血病患儿总体焦虑程度不高。学习焦虑达(85·71%),说明学习焦虑程度较高。其次是自责倾向(21·43%)、过敏倾向(21·43%)、孤独倾向(7·14%)、身体症状(7·14%)。结论儿童急性白血病长期持续化疗对智力无明显影响,但存在一定程度的心理行为的影响,尤其在人际关系、学习焦虑方面,提示我们需要加强白血病患儿的心理支持。     

Training of attention and memory deficits in children with acquired brain injury

This pilot study concerns cognitive rehabilitation of children with acquired brain injury (ABI). Aim: The aim is threefold; to determine (1) whether the Amsterdam Memory and Attention Training for Children (AMAT‐C) programme for children with ABI can be integrated in the child’s school, (2) whether supervision in the school‐setting maintains the child’s motivation throughout the training programme and (3) whether positive changes in memory, attention and executive functions are found with this implementation of the training method. Methods: Seven children with memory and/or attention deficits after ABI were trained with AMAT‐C. Measures used were programme evaluation questions, neuropsychological tests and a questionnaire concerning executive functions. Results: Overall, children, parents and trainers were satisfied with the programme and the children were motivated throughout the programme. The children showed significant improvements in neuropsychological subtests, primarily in tests of learning and memory. No overall change in executive functions was noted. Conclusion: Provision of AMAT‐C training and supervision at the child’s school appears to ensure (1) satisfaction with the programme, (2) sustaining of motivation and (3) improvements in learning and memory.     

Thyroid dysfunction associated with increased low-density lipoprotein cholesterol in epileptic children treated with carbamazepine monotherapy: A causal relationship?

OBJECTIVE: Lipid abnormalities and thyroid dysfunction have been reported in patients treated with antiepileptic drugs. The aim of this study was to evaluate prospectively the association between thyroid and lipid profile in children treated with carbamazepine (CBZ) monotherapy. MATERIALS AND METHODS: Thyroid function was evaluated in 18 epileptic children, previously reported with CBZ-induced changes in serum lipid profile, before and at 6, 12 and 24 months of CBZ monotherapy. RESULTS: All children had normal thyroid function before the initiation of CBZ treatment. During CBZ therapy thyroid dysfunction, with increased thyrotropin (TSH) and decreased thyroxine (T4), free thyroxine (FT4) and triiodothyronine (T3) was found, while, significant association was revealed between serum low-density lipoprotein cholesterol (LDL-C) and TSH levels at 6 (r=0.469; p=0.043) and 12 (r=0.730; p=0.001) months of treatment. CONCLUSION: Lipid abnormalities may be associated with thyroid hormone disturbance in children treated with CBZ monotherapy. Since thyroid dysfunction and hypercholesterolemia are both associated with a higher atherosclerotic risk special attention and further studies are needed in epileptic patients treated with CBZ monotherapy.     

Nutritional assessment of peripheral blood stem cell transplantation in children

Peripheral blood stem cell transplantation (PBSCT) has many advantages for patients because hematopoiesis and general condition return to normal more rapidly than they do following bone marrow transplantation. Thus, the authors hypothesize that the nutritional condition of patients also returns to normal more rapidly after PBSCT. The duration of insufficient nutrition was investigated in children undergoing PBSCT. The subjects of this study were 8 patients with malignant diseases. The factors measured were body weight, body fat, cholesterol, albumin, pre-albumin, and retinol-binding protein. These parameters were measured a day before transplantation, and then once a week for 4 weeks after transplantation. All parameters were recovered until day 28 from the lowest level in transplantation. In this study, all parameters returned to normal comparatively early. PBSCT causes little damage to patients' nutrition.