脑瘫高危因素与脑瘫患儿智商相关性研究

目的　探讨脑瘫患儿高危因素、临床分型与智力低下的关系。方法　我科 1997年 1月至 2 0 0 0年 12月共收治32 9名脑瘫患儿 ,经过询问病史、体格检查、智力测验及必要的实验室检查 ,排除贫血、营养不良、头小畸形、癫痫、视听觉障碍等影响智力的因素后 ,脑瘫单独伴有智力低下者 10 2名 ,这 10 2名患者按高危因素、临床分型、父母文化程度分别分组。数据输入计算机用spss10 .0统计软件对上述几种因素与智力低下的关系进行分析。结果　在不同高危因素中其大运动能 ,DQ差异显著 ,(P <0 .0 5 ) ,窒息组的大运动能低于早产组 (P <0 .0 1) ,高胆红素血症组DQ低于其他高危因素组 (P <0 .0 5 )。脑瘫伴智力低下者 ,其发育商的 5个行为领域均明显下降 ,(P <0 .0 5 ) ,手足徐动型、痉挛型脑瘫的精细动作 ,认知、语言、社交行为明显降低 (P <0 .0 5 ) ,混合型脑瘫智测的 5个行为领域均明显下降 (P<0 .0 1) ,母亲的文化程度与患儿的语言能区相关(P <0 .0 5 )。结论　不同的高危因素及临床类型可导致相同程度的智力残疾。     

Serum immunoreactivity to S-100 in children with cerebral palsy and delayed development and in their healthy parents

The passive immunization of pregnant female rats to S-100 protein often leads to ultra-structural abnormalities in the brain glial structures of the offspring of these rats and induces signs of delayed development in the fetal brain. Additionally passive immunization of pregnant animals with certain antigens induces permanent Ag-specific changes in the immune response of their offspring. The purpose of this study was to investigate serum immunoreactiviy (SIR) to S-100 in cerebral-palsied and developmentally-delayed children as well as in their healthy parents and to evaluate its significance related to radiologic findings of brain MRI and single photon emission computed tomography (SPECT). The subjects were children with cerebral palsy and delayed development that had abnormal findings on brain MRI or Brain SPECT. SIR to S-100 protein was measured by ELISA method in the patients, their healthy parents, 20 normal adult controls and 22 normally developed children. The SIR to S-100 protein was significantly higher in the cerebral-palsied and developmentally-delayed children when compared to that of the normal control group children. Increased SIRs were detected in healthy mothers but not in their fathers. There was no difference of SIR between the cerebral-palsied and developmentally-delayed children or any significant difference of SIRs according to the findings of the brain MRI or to developmental quotients. But, the SIRs to S-100 protein were higher in the group of more abnormal findings on brain SPECT.     

Methylenetetrahydrofolate reductase gene polymorphisms and cerebral palsy in Chinese infants

Genetic polymorphisms of methylenetetrahydrofolate reductase (MTHFR) have been suggested as being associated with cerebral palsy (CP) but the evidence is uncertain. The purpose of this study was to investigate whether MTHFR gene polymorphisms contribute to the development of CP in Chinese infants. For this study, 169 health controls and 159 infants with CP including 43 cases also suffering from mental retardation (MR) were recruited. Genomic DNA was prepared from venous blood and all five single nucleotide polymorphisms in MTHFR (rs4846049, rs1476413, rs1801131, rs1801133 and rs9651118) were genotyped using TaqMan technology. There were no significant differences in allele or genotype frequencies between the CP patients and controls at any of the five genetic polymorphisms. Subgroup analysis found statistically significant difference in allele and genotype frequencies between cases with both CP and MR (CP + MR) compared with both CP-only cases and controls at rs4846049, rs1476413 and rs1801131. The frequencies of the T alleles of rs4846049, rs1476413 and the G allele of rs1801131 were greater in the CP + MR patients than in the CP-only patients and controls. This study provides the first evidence pointing to a MTHFR gene polymorphism as a potential risk factor for CP combined with MR.     

新生儿硬肿症的高危因素分析

１９８５－１９９３年我院儿科收治新生儿硬肿症１１９例，存活６５例，自动出院９例，死亡４５例．经统计学分析认为该病发病的高危因素依次为：环境温度低、体温低、出生体重低、围产期异常、早产、感染。经存活组与死亡组对比分析认为该病死亡的高危因素依次为：呼吸衰竭（主要是肺出血引起）、ＤＩＣ、硬肿面积大、心脏损害、颅内出血、重要脏器先天畸形、肾损害、休克、低钠血症、酸中毒。     

早产儿视网膜病发病情况及高危因素的探讨

目的 探讨早产儿视网病（retinopathy of prematurity，ROP）的发病率、高危因素及防治措施。方法对194例早产儿生后72h内及生后4w开始定期检查眼底，发现ROP者密切随访至生后1年。结果72h内早期眼底检查眼底异常包括视乳头水肿、视网膜水肿、视网膜血管改变及出血等。生4w后检出ROP患儿12例（6．2％），高危因素分别为低出生体重，小孕周、长期或高浓度吸氧。结论建议出生体重小于2000g和／或孕周小于35w的早产儿，在生后第3w或胎龄达34w时常规行首次眼底检查，以早期发现ROP并给予及时治疗。     

Diffusion tensor tractography can predict hemiparesis in infants with high risk factors

Diffusion tensor tractography (DTT) is known to be useful in detecting white matter lesions. In the current study, we report on two hemiparetic patients with risk factors who showed abnormalities of the corticospinal tract (CST) on diffusion tensor tractography (DTT) prior to the manifestation of hemiparesis. Two hemiparetic patients with risk factors (preterm, low birth weight) and six age-matched normal control subjects were enrolled to this study. Diffusion tensor imaging (DTI) was performed at the age of 43 weeks (patient 1) and 33 weeks (patient 2) using 1.5-T with a Synergy-L Sensitivity Encoding (SENSE) head coil. We measured fractional anisotropy (FA), apparent diffusion coefficients (ADCs), and fiber counts of the CST. There were no definite asymmetric findings on physical examination and conventional brain MRI. By contrast, DTT showed a unilateral CST disruption at the periventricular white matter, low FA values, and low CST fiber counts compared with those of the unaffected CST and controls. These patients were diagnosed with hemiparetic cerebral palsy when we re-evaluated these patients at the age of 6 years (patient 1) and 3 years of age (patient 2), respectively. In these two patients, DTT revealed abnormalities of the CST prior to the manifestation of hemiparesis. Therefore, it seems that DTT would be a useful modality in detecting CST abnormalities in advance of clinical manifestation in infants with high risk factors.     

早产儿血清NSE、IL-6水平测定对筛查脑性瘫痪高危儿意义的研究

目的探讨早产儿脐血及静脉血IL-6和NSE的水平与脑损伤的关系以及用以辅助筛查出脑瘫高危儿人群的价值.方法选胎龄≤35w和/或出生体重＜2000g的早产儿脐血32例,静脉血30例,足月儿脐血、静脉血对照各20例,检测血清IL-6、NSE水平.两组均随访至3岁(死亡及诊断为脑瘫者终止).采用SAS6.12统计软件进行成组设计t检验或秩和检验.并以ROC曲线分析筛查值.结果1.早产儿脐血、静脉血组IL-6、NSE水平较各自对照组平均水平明显增高(P＜0.05).2.脑瘫组IL-6水平、脐血及静脉血NSE水平均显著高于非脑瘫组(P=0.0140、0.0255及0.0095).结论IL-6、NSE水平与围产期脑损伤有关,以脐血IL-6≥305.03pg/ml,NSE≥8.1175μg/l作为筛查脑瘫高危儿标准时具有较好的灵敏度与特异度.     

羊水过少对围产儿影响因素的分析

目的 探讨羊水过少对母婴的影响。方法 采用回顾分析方法，对羊水过少组80例及同期羊水正常组3173例进行对比分析。结果 羊水越少，羊水粪染率及胎儿窘迫发生率越高；羊水过少组新生儿窒息率明显高于对照组。结论 羊水过少确诊后适时以剖宫产结束分娩为宜。     

Prospective evaluation of a risk scoring system for cervical neoplasia in primary care.

BACKGROUND. Against a background of concern over the costs of the cervical screening programme in the United Kingdom, increased precision in targeting groups at high risk of having an abnormal cervical smear offers a means of increasing efficiency. Previous papers have described the development of a risk scoring system and its feasibility and reliability in primary care. AIM. A study was carried out to assess the validity of the scoring system by testing its predictive ability on a prospective data set. METHOD. Consecutive attenders for cervical smear tests at seven practices and three clinics were recruited for the study. The women completed a questionnaire from which their risk scores could be calculated. The scores were compared with cytology and histology results. Various performance statistics were obtained. RESULTS. In terms of cervical intraepithelial neoplasia (CIN) 2 or 3, there was an 11 fold increased risk among the low risk group (scores of four or five) compared with the very low risk group (scores of three or less). The system enabled the identification of 75% (95% confidence interval 62% to 84%) of cases of CIN 2 or 3 among the 21% of the 3629 women with known histology who had a score of four or five. CONCLUSION. Given the ease with which risk status can be ascertained (a risk score could not be calculated for only 23 of 3661 women) and the magnitude of difference in risk, the risk scoring system appears to have potential for assisting the targeting of screening resources. Studies of risk perception and behaviour, and ultimately a randomized controlled trial, are required to assess the effectiveness and cost effectiveness of risk targeting.     

Risk factors for atopic dermatitis in infants at high risk of allergy: the PIAMA study

BACKGROUND: It has been suggested that the period immediately after birth is a sensitive period for the development of atopic disease. OBJECTIVE: We investigated whether birth characteristics and environmental factors are associated with the development of atopic dermatitis in the first year of life. METHODS: Seventy-six children with and 228 without atopic dermatitis, all children of mothers with respiratory allergy or asthma (PIAMA birth cohort study) were included in the study. Atopic dermatitis was defined as a positive history of an itchy skin condition with at least two of the following characteristics: visible dermatitis, history of outer arms/leg involvement, or general dry skin. Multiple logistic regression analysis was performed to study the independent effects of various risk factors. RESULTS: A birth weight >/=4000 g compared to 3000-4000 g was a significant risk factor for atopic dermatitis (odds ratio (OR)=2.4; 95% CI: 1.1-5.1) as was day care attendance (OR=2.9; 95% CI: 1.5-5.9). Exclusive breastfeeding in the first 3 months was negatively associated with atopic dermatitis (OR=0.6; 95% CI: 0.3-1.2), especially with visible dermatitis (OR=0.4; 95% CI: 0.2-1.0). Gender, gestational age, the presence of siblings or pets, and parental smoking were not significantly associated with atopic dermatitis. CONCLUSION: This study shows that a high birth weight and day care attendance increase the risk of atopic dermatitis in the first year of life, while exclusive breastfeeding is a protective factor when dermatitis is found on inspection.     

Intestinal microbiota in infants at high risk for allergy: Effects of prebiotics and role in eczema development

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A sleep disturbance in high risk for SIDS infants

A developmentally immature sleep pattern has been identified in infants with a recent history of an unexplained life-threatening episode of sleep apnoea who are considered at risk for SIDS. In these infants there is a persistence of Sleep Onset REM Periods (SOREMPS) after prolonged wakefulness when compared to controls matched for age, sex, birthweight and race. This sleep characteristic has not been previously reported.     

The applicability of magnetic resonance imaging classification system (MRICS) for cerebral palsy and its association with perinatal factors and related disabilities in a Croatian population-based sample

AimTo investigate the association of cerebral palsy motor disorders, perinatal factors, and related disabilities with brain magnetic resonance imaging classification score (MRICS)-based groups in a population-based sample.MethodsThe study enrolled children with cerebral palsy born from 2003 to 2015 treated at Split University Hospital who underwent brain MRI scanning. Perinatal data (plurality, birth weight, gestational age, and Apgar score) were collected from hospital records. Motor disorders of cerebral palsy (gross and fine motor function) and the related disabilities (intellectual status, speech and eating ability, epilepsy, vision and hearing status) were evaluated with neurological status assessment. Neuroimaging findings were presented as MRICS-based groups.ResultsOf 115 enrolled children, an abnormal finding on brain MRI was confirmed in 95%, including white matter injury (66%), maldevelopments (13.9%), gray matter injury (9.6%), and miscellaneous findings (6.1%). Gross and fine motor function were not significantly associated with MRICS-based group. All related disabilities and perinatal factors, except Apgar score, were significantly associated with MRICS-based group.ConclusionBrain MRICS-based groups were associated with perinatal risk factors and related disabilities of cerebral palsy, but not with common motor disorders. MRI classification score is a reliable diagnostic tool, which strongly correlates with perinatal factors and related disabilities of cerebral palsy.

Cerebral palsy (CP) represents a group of conditions characterized by permanent and non-progressive motor disorders, which present as difficulties in motion, balance, and posture. CP has a range of etiologic pathways and associated disabilities. CP patients commonly suffer from intellectual, speech, vision, or hearing impairment or epilepsy, which makes the patient care complex and patient-specific. CP incidence is 1-3/1000, with a slightly decreasing trend in recent years (1). Several investigations suggested a different incidence rate and distributions of CP types, associated with socioeconomic factors and improvement in perinatal and natal care (2).Of four main CP types (spastic, athetoid, ataxic, and mixed), spastic is the most common, accounting for up to 80% of the cases (3,4). The spastic type is related to motor cortex damage, athetoid to basal ganglia damage, ataxic to cerebellum damage, and mixed to combination damage. The affected limb is associated with the location of a specific brain injury. Neuroimaging represents a standard diagnostic tool in CP. Brain magnetic resonance imaging (MRI) findings are abnormal in a high percent of CP patients (5,6). MRI can detect anatomic abnormalities and help better understand the etiology and pathogenesis of CP. Based on the investigations in the last decades, MRI interpretation significantly progressed with the introduction of an MRI classification score (MRICS) by Surveillance of Cerebral Palsy in Europe (SCPE) in 2017. The score is designed to unify the MRI interpretation by specialists dealing with CP patients (7). MRI findings were divided into five groups based on the chronological order of brain damage appearance (A. Maldevelopments; B. Predominant white matter injury; C. Predominant gray matter injury; D. Miscellaneous; E. Normal). Some groups were subdivided depending on the extent of the lesion. So far, the applicability of the proposed MRICS has not been widely investigated (8).To our knowledge, the incidence, and clinical and MRI characteristics of CP in southern Croatia have not been investigated so far. In general, CP research involving other Croatian regions is lacking (9,10). MRICS applicability is yet to be proven. Therefore, this study aimed to associate CP motor disorders, perinatal factors, and related disabilities of CP with MRICS-based groups in order to assess score applicability in a population-based sample in southern Croatia.     

The effects of physical therapy on cerebral palsy. A controlled trial in infants with spastic diplegia

Legislatively mandated programs for early intervention on behalf of handicapped infants often stipulate the inclusion of physical therapy as a major component of treatment for cerebral palsy. To evaluate the effects of physical therapy, we randomly assigned 48 infants (12 to 19 months of age) with mild to severe spastic diplegia to receive either 12 months of physical therapy (Group A) or 6 months of physical therapy preceded by 6 months of infant stimulation (Group B). The infant-stimulation program included motor, sensory, language, and cognitive activities of increasing complexity. Masked outcome assessment was performed after both 6 and 12 months of therapy to evaluate motor quotient, motor ability, and mental quotient. After six months, the infants in Group A had a lower mean motor quotient than those in Group B (49.1 vs. 58.1, P = 0.02) and were less likely to walk (12 vs. 35 percent, P = 0.07). These differences persisted after 12 months of therapy (47.9 vs. 63.3, P less than 0.01, and 36 vs. 73 percent, P = 0.01, respectively). We noted no significant differences between the groups in the incidence of contractures or the need for bracing or orthopedic surgery. Group A also had a lower mean mental quotient than Group B after six months of therapy (65.6 vs. 75.5, P = 0.05). The routine use of physical therapy in infants with spastic diplegia offered no short-term advantage over infant stimulation. Because of the limited scope of the trial, our conclusions favoring infant stimulation are preliminary. The results suggest that further study of the effects of both physical therapy and infant stimulation is indicated.     

Long-term neuropsychological outcome of high risk infants with intracranial hemorrhage.

Evaluated long-term neuropsychological outcome of 20 high risk infants with intracranial hemorrhage (ICH) during the neonatal period who appeared free of significant impairment through 30 months of age. This group was compared with a matched sample of 20 high risk infants without intracranial hemorrhage and a group of 70 children with no history of perinatal or chronic health problems. A comprehensive neuropsychological evaluation at age 5 revealed that the two high risk groups tended to perform at a lower level than the control group across most measures. However, the ICH group performed at a significantly lower level than the control group on measures of perceptual-motor skills and intermodal memory abilities while the high risk group without ICH did not. The implications of differences in level and pattern of performance are discussed along with the implications of the current findings for long-term functioning of high risk infants with ICH.     

Parental and perinatal factors influencing the development of handedness in captive chimpanzees

It has been proposed that human right handedness is determined by genetic factors associated with the emergence of language, whereas non-human primate handedness is determined by random, non-genetic factors. These different mechanisms account for differences in the distribution of handedness between human and non-human primates. Here we report evidence that genetic factors play a role in the determination of handedness in chimpanzees. We further report that differential rearing has no influence on the expression of handedness in related individuals. Contrary to many theories of the origin of handedness, these results indicate that genetic factors have a significant influence on handedness in chimpanzees.