长沙市学龄儿童睡眠不足对智力结构的影响

目的：探讨小学生睡眠不足对智力发育的影响,为有效干预提供科学理论依据。方法：2009 年 6 月至 2010 年 4 月,在长沙市4 个行政区分层随机抽取4所小学10~11岁5年级小学生316名进行调研,了解其不同程度的睡眠不足在中国韦氏儿童智力量表测验上反映的智力结构特点。结果：收回有效问卷286份,应答率90.5%,其中睡眠时间正常（夜间睡眠时间≥8 h,对照组）106人,睡眠不足180人（夜间睡眠时间<8 h,睡眠不足组）。睡眠不足组各项分测验、言语智商、操作智商和总智商得分均显著低于对照组（P<0.05）,语言理解因子和记忆/注意因子得分亦显著低于对照组（P<0.05）。与对照组比较,中度睡眠不足亚组语言智商、总智商及语言理解因子、记忆/注意因子得分降低（P<0.05）;重度睡眠不足亚组各项得分均降低（P<0.05）。睡眠不足组及中度和重度睡眠不足亚组儿童中智力不平衡者的比例显著高于对照组（P<0.05）。结论：睡眠不足对小学生智力发育有不良影响,尤其是对言语智商发育的影响较大,主要发生于中、重度睡眠不足的小学生。     

Sex differences in cerebral volumes of 8-year-olds born preterm

We investigate sex-associated effects of preterm birth on cerebral gray matter (GM) and white matter (WM) volumes. Preterm children (n=65) and 31 healthy, term control children had usable magnetic resonance imaging (MRI) data acquired at 8 years of age. Both GM and WM volumes were significantly reduced in the preterm group compared with controls. However, only males with preterm birth had significantly reduced WM compared with term males (P=.021), whereas WM volumes were equivalent in the female groups. Lower birth weight was associated with reduced WM in both boys and girls with preterm birth, whereas intraventricular hemorrhage (IVH) was associated with reduced GM in girls only. Positive correlations between GM and cognitive outcome were observed in girls with preterm birth but not boys. We conclude that preterm birth has a significant impact on brain development with increased risk for smaller GM and WM cerebral volumes. Males appear particularly vulnerable to adverse effects of preterm birth on WM development. However, girls with preterm birth show stronger correlations between neuro-anatomical variables and both neonatal risk factors and cognitive outcome, compared with boys. These findings indicate that the sex of the very preterm newborn influences the mechanisms by which the developing brain is affected.     

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。     

Visual search and attention in five-year-old very preterm/very low birth weight children

Introduction

This study aimed to establish visual search performance and attention functioning in very preterm/very low birth weight (VP/VLBW) children using novel and well established measures, and to study their contribution to intellectual functioning.

Methods

Visual search and attention network efficiency were assessed in 108 VP/VLBW children and 72 age matched term controls at 5.5 years corrected age. Visual search performance was investigated with a newly developed paradigm manipulating stimulus density and stimulus organization. Attention functioning was studied using the Attention Network Test (ANT). Intellectual functioning was measured by a short form of the Wechsler Preschool and Primary Scale of Intelligence. Data were analyzed using ANOVAs and multiple regression analyses.

Results

Visual search was less efficient in VP/VLBW children as compared to term controls, as indicated by increased search time (0.31 SD, p = .04) and increased error rate (0.36 SD, p = .02). In addition, VP/VLBW children demonstrated poorer executive attention as indicated by lower accuracy for the executive attention measure of the ANT (0.61 SD, p < .001). No differences were found for the alerting (0.06 SD, p = .68) and orienting attention measures (0.13 SD, p = .42). Visual search time and error rate, and executive attention, collectively, accounted for 14% explained variance in full scale IQ (R² = .14, p < .001).

Discussion

VP/VLBW children were characterized by less efficient visual search ability and reduced executive attention. Visual attention dysfunctions contributed to intelligence, suggesting the opportunity to improve intellectual functioning by using interventions programs that may enhance attention capacities.     

Brain damage in glycogen storage disease type I

OBJECTIVE: To investigate brain morphology and function in patients with glycogen storage disease type I (GSDI). STUDY DESIGN: Nineteen patients (13 females and 6 males, aged 0.9-22.6 years) and 38 sex- and age-matched controls entered the study. Neurological examinations, psychometric tests (IQ, tests of performance and verbal abilities), standard electroencephalogram (EEG), somatosensory (SEPs), visual (VEPs), and brain-stem auditory evoked potentials (BAEPs), and brain magnetic resonance imaging (MRI) were performed. RESULTS: The results of tests of performance ability were lower in patients than in controls (P <.05). The prevalence of abnormal EEG findings (26.3% versus 2.6%), VEPs (38.4% versus 7.7%), SEPs (23.0% versus 0%), and BAEPs abnormalities (15.7% versus 0%) was higher in patients than in controls (P <.05). MRI pattern was altered in 57.1% of patients and was normal in all controls (P <.05). Both results of tests of performance ability and BAEPs abnormalities significantly correlated with the frequency of admissions for hypoglycemia, whereas EEG abnormalities correlated with dietary compliance (P <.05). CONCLUSIONS: Brain damage, probably caused by recurrent severe hypoglycemia, may be present in patients with GSDI.     

Neurodevelopmental outcomes in congenital hypothyroidism: comparison of initial T4 dose and time to reach target T4 and TSH

OBJECTIVES: To compare neurodevelopmental outcomes in severe and moderate congenital hypothyroidism (CH) among 3 different initial L-thyroxine doses and to examine the effect of the time to thyroid function normalization on neurodevelopmental outcomes. STUDY DESIGN: Neurodevelopmental assessments of 31 subjects included the Mullen Scales of Early Learning, Wechsler Preschool and Primary Scale of Intelligence-Revised, Wechsler Intelligence Scale for Children, Wide-Range Achievement Test, and Child Behavioral Checklist. RESULTS: Subjects started on higher initial L-thyroxine doses (50 mug) had full-scale IQ scores 11 points higher than those started on lower (37.5 mug) initial doses. However, verbal IQ, performance IQ, and achievement scores did not differ among the 3 treatment cohorts. Subjects with moderate CH had higher full-scale IQ scores than subjects with severe CH, regardless of the initial treatment dose. Subjects who took longer than 2 weeks to normalize thyroid function had significantly lower cognitive, attention, and achievement scores than those who achieved normal thyroid function at 1 or 2 weeks of therapy. CONCLUSIONS: Initial L-thyroxine dose and faster time to normalization of thyroid function are important to optimal neurodevelopmental outcome. In severe CH, it is important to choose an initial dose at the higher end of the recommended range to achieve these goals.     

Sensory evoked potentials in inhalant (volatile solvent) abuse

Abstract A study was made to determine whether children with a significant history of inhalant abuse but who lack clinical evidence of neurological abnormality have abnormal visual, auditory or somatosensory evoked potentials. Visual, auditory and somatosensory evoked potential studies were obtained from 15 such children aged 9–17 years. Eight of the children had abnormal visual or auditory evoked potentials. Somatosensory evoked potentials were normal in all. It was concluded that evoked potentials may serve as an objective marker of early neurological damage in children who abuse inhalants and demonstrate potential usefulness for counselling and intervention.     

Visual and brainstem auditory evoked potentials in children with headache

Background: Headache is a common problem in the pediatric population. The purpose of the present study was to evaluate visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) in children with headache. Methods: Thirty‐seven children fulfilling the International Headache Society Criteria for a diagnosis of migraine, 35 children with tension‐type headache and 40 healthy children (control group) were enrolled in the study. Results: The mean age of patients and controls was 10.4 years. P100 latency and amplitudes of migraine patients were significantly higher than children with tension‐type headache and control subjects. Children with tension‐type headache also had higher P100 latency and amplitude values than control subjects but there was no statistical difference. BAEP responses were similar between all groups. Conclusion: Measurement of VEP latency and amplitude is a valuable and reliable test for the diagnosis of migraine and can be used safely in childhood.