主动免疫治疗不明原因反复自然流产的子代生长发育追踪

目前将反复自然流产(recurrent spontaneous abortion,RSA)定义为连续二次及二次以上的自然流产,发生率约占总妊娠数的5%,占自然流产数的15%。RSA的发病原因复杂,主要将其发病机制归纳为:遗传因素、生殖道解剖异常、内分泌紊乱、感     

Sudden unexplained death in children with epilepsy: a cohort study with an eighteen-year follow-up

Aim: Sudden unexplained death is a significant cause of mortality in adults with epilepsy. Only a few data exist about this risk in childhood. Methods: Cases of sudden unexplained death in epilepsy (SUDEP) up to the age of 18 y occurring at our hospital between 1984 and 2001 were identified. The incidence rate was calculated on the basis of diagnosed epileptics registered with a statutory disability insurance scheme. Results: Four cases of SUDEP were identified during the 18-y period. The incidence of SUDEP was 4.3 per 10 000 patient-years. All children showed polytherapy-refractory epilepsy, developmental retardation and early-onset epilepsy. Two witnessed cases had shown no previous signs of seizure.

Conclusion: SUDEP is rare in childhood. Children with uncomplicated epilepsy seem not to be at risk.     

Apparent life-threatening events during infancy: a follow-up study of subsequent growth and development

This research was an exploratory follow-up study of 51 infants who had experienced an "apparent life-threatening event" (ALTE) characterized by apnea and subsequent home cardiorespiratory monitoring. The purpose was to (1) describe relationships among perinatal characteristics, birth status, recurrent apnea, and ratings of the home environment, and (2) relate these measures to infant growth and developmental outcomes. The method included home visits and assessments of infant outcomes at 10 to 14 months, followed by retrospective review of obstetric and infant medical records. Perinatal characteristics, birth status, and recurrent apnea were interrelated correlates of both growth and developmental outcomes. The ratings of the home environment (HOME [Home Observation for Measurement of the Environment] Scale) were related to developmental outcomes and to a lesser extent to physical growth status. Hierarchical regression analysis entering gestational age, obstetric and postnatal complications, apnea, and HOME subscale 4 (provision of appropriate play materials) significantly enhanced the predictability of mental and psychomotor development. Future longitudinal research is necessary to explore whether the association between apnea and specific infant outcomes attenuates over time and whether the relationship is direct or mediated by parental perception of infant vulnerability and altered caregiving style.     

Psychomotor development and general movements in offspring of women with epilepsy and anticonvulsant therapy

While the role of antiepileptic drug (AED) therapy in teratogenesis has widely been investigated, there are few prospective studies on later postnatal development in offspring of epileptic women in utero exposed. The aim of this study was a prospective investigation of the psychomotor development in a selected population of infant born to women with epilepsy on AED therapy during pregnancy. PATIENTS AND METHODS: Children were assessed at various times until 30 months of age by general movement (GMs) observation (at 7 days and 4 and 13 weeks), traditional neurologic examination (at 7 days and 4 and 13 weeks, 6, 9 and 12 months) and Brunet-Lezine (B-L) administration (at 30 months). We present the preliminary results of our study conducted on 11 children. RESULTS: Psychomotor delay in children was confirmed by traditional neurological examinations scores at 7 days, 4 weeks, 13 weeks and 6 months and by B-L score at 30 months. Between 9 and 12 months of age, traditional neurologic examination became "silent". GM assessment was found to be a better predictor of psychomotor development. In fact, GM analysis, particularly at 4 weeks, was strongly correlated with the Brunet-Lezine score at 30 months. In conclusion, on the basis of these data we suggest a psychomotor delay in the offspring of epileptic women and that GMs and neurologic evaluation provide complementary information concerning psychomotor development and later outcome of these children.     

Neurodevelopmental follow-up of children of women infected with varicella during pregnancy: a prospective study

BACKGROUND: The fetal varicella syndrome is associated with abnormal central nervous system development, which in many cases is associated with mental retardation. However, the incidence of neurobehavioral deficits in asymptomatic structurally normal children whose mothers had clinically diagnosed varicella-zoster virus infection is unknown. METHODS: Neurobehavioral outcome was evaluated in 84 children born to women infected with varicella during pregnancy and 40 children born to women who were not infected with varicella during pregnancy. Children were 3 to 15 years of age at the time of testing. Clinical features of the fetal varicella syndrome were present in only 1 of the 84 children in the varicella group. These sample sizes provide statistical power of 0.80 (alpha = 0.05) to detect group differences of 0.54 sd (the equivalent of 8.1 IQ points). RESULTS: No differences were found in the test performance of the two groups. In addition, within the varicella sample, no meaningful differences were found relative to infection-related hyperthermia or the timing of infection. CONCLUSIONS: As a group, the children born to women infected with varicella-zoster virus during pregnancy and who do not have structural features characteristic of the fetal varicella syndrome are not neurodevelopmentally different from unexposed, uninfected control children.     

母乳喂养对宫内发育迟缓儿胰岛素敏感性影响的随访研究

目的 探讨宫内发育迟缓（IUGR）儿胰岛素敏感性和血清脂联素水平,随访研究母乳喂养对胰岛素敏感性的影响。方法 选择2014年10月至2018年10月住院的足月IUGR儿为IUGR组（106例）,同期出生足月适于胎龄儿（AGA）为AGA组（90例）,记录出生体重、身长,生后7 d检测血清空腹血糖（FG）、三酰甘油（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、胰岛素（INS）和脂联素水平,计算胰岛素抵抗指数（HOMA-IR）。将IUGR组按照实际喂养方式,分为母乳喂养组（37例）和配方奶喂养组（42例）,于3月龄、6月龄追踪复测上述血清指标和生长指数。结果 与AGA组比较,IUGR组血清胰岛素、HOMA-IR增高,脂联素水平降低,差异均有统计学意义（P < 0.05）。母乳喂养和配方奶喂养组IUGR儿生后7 d、3月龄、6月龄生长指数、血清FG、TG、LDL和HDL水平差异无统计学意义（P > 0.05）。母乳喂养组血清INS、HOMA-IR水平随母乳喂养时间延长而降低,脂联素水平随母乳喂养时间延长而增高（P < 0.05）。结论 IUGR儿生后早期胰岛素敏感性下降,母乳喂养可改善IUGR儿胰岛素敏感性。     

Longitudinal neurological follow-up of a group of HIV-seropositive and HIV-seronegative hemophiliacs: results from the hemophilia growth and development study

BACKGROUND: Boys and young men with hemophilia treated with factor infusions before 1985 had a substantial risk of acquiring the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome. This study was designed to assess the effects of HIV and hemophilia per se on neurological function in a large cohort of subjects with hemophilia, and to investigate the relationships between neurological disease and death during follow-up. METHODS: Three hundred thirty-three boys and young men (207 HIV seropositive and 126 HIV seronegative) were evaluated longitudinally in a multicenter, multidisciplinary study. Neurological history and examination were conducted at baseline and annually for 4 years. The relationship between neurological variables, HIV serostatus, CD4+ cell counts, and vital status at the conclusion of the study was examined using logistic regression models. RESULTS: The risks of nonhemophilia-associated muscle atrophy, behavior change, and gait disturbance increased with time in immune compromised HIV-seropositive subjects compared with HIV seronegative or immunologically stable HIV-seropositive subjects. The risk of behavior change in immune compromised HIV-seropositive hemophiliacs, for example, rose to 60% by year 4 versus 10% to 17% for the other study groups. Forty-five subjects (13.5%), all of whom were HIV seropositive, died by year 4. Subjects who died had had increased risks of hyperreflexia, nonhemophilia-associated muscle atrophy, and behavior change. CONCLUSIONS: These results indicate that immune compromised, HIV-seropositive hemophiliacs have high rates of neurological abnormalities over time and that neurological abnormalities were common among subjects who later died. By contrast, immunologically stable HIV-seropositive subjects did not differ from the HIV-seronegative participants. Hemophilia per se was associated with progressive abnormalities of gait, coordination, and motor function.     

Psychological development in children born with very low birth weight after severe intrauterine growth retardation: a 10-year follow-up study

Children born small for gestational age (SGA) and children having very low birth weight, less than 1500 g, are claimed to be at risk of developmental problems, even when obvious pathology and disability are absent. In this study, sensorimotor and cognitive development of 14 medically healthy, very-low-birth-weight and small-for-gestational-age children were investigated. The children were born at the Karolinska Hospital between 1979 and 1981. At the time of the assessment, the children were aged 8.7-11.2 years. The assessment instruments included the Wechsler Intelligence Scale for Children, a modified version of the Bruininks-Oseretsky Test of Motor Proficiency, as well as selected subtests from the Halstead-Reitan Neuropsychological Battery and from the Southern California Tests of Sensory Integration. Information was also obtained from obstetric, neonatal and pediatric records, which included early developmental assessments. As a control group, 14 children were recruited and matched for age, sex and socio-economic background. The very-low-birth-weight-small-for-gestational-age group scored significantly lower on measures of visuospatial ability, non-verbal reasoning, strategy formation and gross-motor coordination. The group differences were largely attributable to the subnormal performance of eight of the very-low-birth-weight-small-for-gestational-age children. These children, who also tended to be born earliest (less than 33 weeks), had a high incidence of behavioral and educational problems. These findings are consistent with the view that the very preterm infant develops a different neurobehavioral organization than a full-term infant. Developmental deficits may become increasingly evident in the early school years.     

A behavioural teratologic study on offspring of self-poisoned pregnant women.

Ninety-three cases born from women who attempted suicide by taking large doses of chemicals and eight cases who had mothers affected by a chemical poisoning as accident during pregnancy were studied. Data of birth weight and gestational time, congenital anomalies and postnatal disorders were obtained in cases and matched controls (sociological twins). Test examinations were performed in both cases--controls and their mothers in the home of families. The mothers of index children had a lower socioeconomic status and more were unmarried than the Hungarian pregnant population at large. The behaviour of index and control mothers showed some obvious differences. The bivariate analyses indicated some possible teratogenic effect of maternal poisoning, but it was not confirmed by multivariate analysis except lower birth weight. Thus differences between cases and control were explained mainly by the maternal behavioural factors.     

The development of adopted children after institutional care: a follow-up study

BACKGROUND: Research suggests that institutional care has long-lasting effects on children. However, no study has longitudinally studied infants in an institution and their subsequent development at age four. METHODS: Sixty-one adopted children aged four years who had spent their first two years of life in an institution were compared to 39 children reared in their own two-parent families. Cognitive development, security of attachment, shyness, children's emotional understanding and behavioural problems were examined in both groups. Parental health and stress were also assessed. RESULTS: At four years adopted children still had lower scores on cognitive development, were less secure, and less able to understand emotions than family-reared children. Children with a secure attachment type in infancy were found to be less secure at age four, compared with those who were classified in infancy as having an insecure attachment type. Their physical development had recovered, they were less shy, had no behavioural problems and no problems in the relationship with their teacher. CONCLUSIONS: Early residential group care has long-lasting effects on important socio-emotional and cognitive aspects of preschool children's development.     

Mild conductive hearing loss and language development: a one year follow-up study

Thirteen children aged 3 to 5 years with mild conductive hearing losses and histories of otitis media were pair-matched with audiologically normal children on age, sex, socioeconomic status, family intactness, and first language (English). The Test for Auditory Comprehension of Language, the Northwestern Syntax Screening Test, and the Developmental Sentence Scoring Procedure were administered. Phonology errors were tabulated from the spontaneous language sample. The language evaluation was repeated after a 1-year interval. All measures differentiated the groups at highly significant levels on the initial assessment. All tests except the Test for Auditory Comprehension of Language continued to show significant differences a year later. The results support the hypothesis that children who experience recurrent middle ear problems are at risk for persistent language delay.