精神运动发育迟缓患儿的早期综合干预疗效观察

目的:探讨精神运动发育迟缓患儿的早期综合干预治疗的效果.方法:对69例精神运动发育迟缓患儿分为治疗组(综合康复干预组)36例和对照组33例;对照组以运动疗法、高压氧、脑循环治疗、脑细胞营养药等进行早期综合干预治疗,治疗组在对照治疗的基础上加认知训练;在干预前及干预6个月后用上海Gesell发育量表对发育商进行评估.结果:干预后治疗组五个能区发育商均较对照组明显提高(P＜0.01).结论:早期系统综合干预治疗,能有效地提高精神运动发育迟缓患儿五个能区的整体发育水平.     

小组训练对语言发育迟缓儿童社交能力的影响

目的:观察小组训练对语言发育迟缓儿童社交能力的影响.方法:选取康复中心2007年1月-6月间就诊的语言发育迟缓患儿75例,观察组32例根据其语言发育评估水平进行分组,同一水平者每两人一组,以组为单位进行语言训练;对照组43例进行一对一语言训练.6个月后应用Gesell测试量表中的语言和个人社交发育商进行疗效对比.结果:观察组12例患儿显效,14例患儿有效,6例无效,总有效率81.3%;对照组13例患儿显效,17例患儿有效,13例无效,总有效率69.6%;二组进行有效率的卡方检验有正著差异(P>0.01).结论:小组训练可以改善语言发育迟缓儿童的社交能力,值得临床推广.     

引导式教育理念对脑瘫儿童康复护理效果的影响

目的探讨引导式教育理念对改善脑瘫儿童康复护理效果的影响。方法将2013-12—2014-12间收治的74例脑瘫患儿按随机数字表法分为2组,各37例。对照组患儿接受常规康复护理。观察组同时应用引导式教育理念。统计2组患儿治疗前后粗大运动功能测试量表(Gross Motor Function Measure,GMFM)各能区功能评分和Gesell发育评分。观察2组护理效果。结果观察组患儿GMFM评分A-E区得分及Gesell发育评分均优于对照组,2组比较,差异有统计学意义(P0.05)。结论引导式教育理念的应用对改善脑瘫儿童康复护理效果有积极影响,有利于促进患儿运动功能良好康复,提高治疗有效率。     

语言发育迟缓儿童社会适应能力与心智发育水平的关系研究

目的了解语言发育迟缓儿童社会适应能力发展状况及其与心智发育水平的关系。方法采用婴儿-初中生社会生活能力量表、0~6岁小儿神经心理发育检查表对133例语言发育迟缓儿童进行调查。结果语言发育迟缓儿童的社会适应能力总体水平以边缘及轻度缺陷为主(占66.17%),心智发育也是以边缘(37例)和轻度缺陷(77例)为主(85.71%);不同程度心智发育水平儿童的社会适应能力评分比较,差异有统计学意义(P0.01);心智发育水平与社会适应总体及5项能力(除外集体生活能力)存在显著相关(P0.05,P0.01)。结论语言发育迟缓儿童不仅在语言方面出现落后,智能和社会适应能力也受到影响,其社会适应能力与心智发育水平存在密切关系,对儿童进行智能干预将有助于提高其社会适应能力,同时提高社会适应能力也将会促进儿童智能水平的发展。     

早期持续家庭康复护理对早产儿智能发育的影响

目的探讨早期持续家庭康复护理对早产儿智能发育的影响。方法将60例住院治疗好转出院的早产儿按随机数字表法分为对照组和干预组各30例。对照组出院后按照《婴儿科学健身法》光碟及《挖掘儿童潜能始于零岁》中的0~3岁教育大纲在家里进行康复训练;干预组在住院期间对患儿家长进行婴儿抚触、水疗、音乐疗法等康复技能培训,出院后根据患儿月龄及实际发育水平进行家庭康复训练。采用格塞尔(Gesell)发育量表评估早产儿智能发育水平。结果两组大运动行为、精细动作、适应行为、语言行为和个人-社会交往行为评分随着患儿年龄的增长而提高,干预组各项指标评分显著高于对照组(均P0.05)。结论对早产儿实施早期持续家庭康复护理有利于促进其智能发育,改善和提高儿童素质。     

情景演示在脑性瘫痪患儿康复训练中的应用

目的探讨情景演示在脑性瘫痪(脑瘫)患儿康复训练中的应用效果的影响。方法将60例脑瘫患儿按照参加康复训练的时间分为对照组和观察组各30例。两组均给予相应的功能训练、作业治疗、理疗等。对照组(脱落1例)进行常规训练和健康教育,观察组将情景演示应用于康复训练。干预前及干预3个月后应用Gesell发展量表进行效果评价。结果干预后两组动作能、应物能、应人能、言语能积分显著高于干预前,且干预后观察组显著高于对照组(均P0.05)。结论将情景演示应用于脑瘫患儿康复训练,能激发患儿康复训练兴趣,提高患儿家长协助患儿康复训练的能力,对康复效果产生积极的影响。     

情景演示在脑性瘫痪患儿康复训练中的应用

目的 探讨情景演示在脑性瘫痪（脑瘫）患儿康复训练中的应用效果的影响.方法 将60例脑瘫患儿按照参加康复训练的时间分为对照组和观察组各30例.两组均给予相应的功能训练、作业治疗、理疗等.对照组（脱落1例）进行常规训练和健康教育,观察组将情景演示应用于康复训练.干预前及干预3个月后应用Gesell发展量表进行效果评价.结果 干预后两组动作能、应物能、应人能、言语能积分显著高于干预前,且干预后观察组显著高于对照组（均P＜0.05）.结论 将情景演示应用于脑瘫患儿康复训练,能激发患儿康复训练兴趣,提高患儿家长协助患儿康复训练的能力,对康复效果产生积极的影响.     

脑认知功能评价儿童脑积水三脑室底造瘘术后疗效的价值

目的探讨用脑认知功能评价儿童脑积水三脑室底造瘘术后疗效的价值。方法2007年6月～2012年6月,对20例行三脑室底造瘘术的脑积水患儿于手术前和术后2、6个月进行智能评测（采用Gesell发育诊断量表,包括适应行为、大运动行为、精细运动行为、语言行为和个人-社会行为）及脑室额角宽度测量,进行术后疗效评价。结果术后2、6个月与术前相比智能测定有统计学差异（P〈0．01）,分别有8／20和15／20患儿DQ恢复正常。术后脑室大小较术前差异无显著性（P〉0．05）。结论脑发育的改善及脑认知功能的恢复对儿童脑积水三脑室底造瘘术后疗效的评价有重要意义。     

对脑瘫患儿实施社区引导式康复训练的实践

目的提高脑瘫患儿康复训练效果。方法成立由儿科康复治疗师、社区护士和家长组成的社区引导式康复训练指导小组,培训社区护士和家长考试合格后即对86例脑瘫患儿进行社区引导式康复训练,包括异常姿势控制训练、语言功能训练、运动功能训练及认知功能训练。结果训练后患儿的Gesell测评发育障碍程度及运动功能、语言交流、异常姿势矫正、认知功能实现目标评分显著优于训练前(均P<0.01)。结论社区引导式康复训练能促进患儿康复。     

Practice of community-based conductive rehabilitation training in children with cerebral palsy

目的 提高脑瘫患儿康复训练效果.方法 成立由儿科康复治疗师、社区护士和家长组成的社区引导式康复训练指导小组,培训社区护士和家长考试合格后即对86例脑瘫患儿进行社区引导式康复训练,包括异常姿势控制训练、语言功能训练、运动功能训练及认知功能训练.结果 训练后患儿的Gesell测评发育障碍程度厦运动功能、语言交流、异常姿势矫正、认知功能实现目标评分显著优于训练前(均P＜0.01).结论 社区引导式康复训练能促进患儿康复.     

Growth and development in patients operated on for islet cell dysplasia

Neonatal hypoglycemia caused by islet cell dysplasia (ICD), sometimes called nesidioblastosis, may lead to psychomotor retardation and neurologic dysfunction in up to 50% of patients who are not given early aggressive treatment. In 1979, we adopted a more aggressive protocol for treating this condition that consists of the following steps: immediate insertion of a silastic central venous line for reliable venous access; continuous intravenous infusion of glucose and glucagon to maintain euglycemia; oral diazoxide; and near total pancreatectomy if the first steps fail to overcome the hypoglycemia or the patient cannot be weaned off intravenous therapy. Twelve consecutive patients who underwent pancreatectomy for control of hypoglycemia between 1979 and 1984 were recalled and evaluated for growth delay, neurologic dysfunction, and psychomotor retardation using the Revised Yale Developmental Schedules, the Peabody Picture Vocabulary, and the Draw a Man Test. Follow-up ages ranged from 1.2 to 6.0 years with a median of 3.6 years. No significant growth abnormalities were identified. No patient exhibited focal neurologic dysfunction, although some demonstrated soft neurologic signs, which did not appear to be related to their earlier hypoglycemia. Psychomotor function for the group as a whole was normal, with a mean developmental quotient (DQ) of 99.2. The DQ was average for five patients and above average for four; no patient had a DQ in the frankly subnormal range. Psychomotor development correlated better with the family's socioeconomic and educational status than with the neonatal hypoglycemia. These children are developmentally and neurologically normal despite severe neonatal hypoglycemia. Continued follow-up will be necessary to detect any late sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of Psychoeducational Outcomes After Pediatric Liver Transplant

Outcomes research in pediatric liver transplant (LT) has focused on mortality and morbidity but there is a need to also evaluate functional outcomes. Standardized cognitive testing was administered to a cohort of children with infantile chronic liver disease who were transplanted at the University of Alberta during their preschool years. Thirty children had comprehensive assessments with the Bayley Scales of Infant Development or Wechsler testing. Patient variables potentially associated with cognitive delay were analyzed with multiple regression analysis. The mean DQ/IQ score (developmental quotient/intelligence quotient) was 81 ± 17. Delay (DQ/IQ score < 70), and borderline delay (DQ/IQ 70–84) were each present in 27% of the cohort, with only 46% demonstrating normal cognition. Regression analysis demonstrated that the decreased IQ was associated with pretransplant growth retardation and elevated calcineurin inhibitor levels. Performance IQ had strong correlation with pretransplant growth retardation and elevated serum ammonia, R²= 45%, compared to verbal IQ that was associated was elevated calcineurin inhibitor levels, R²= 23%. Children post-LT are at high risk for cognitive delay or borderline delay. This is the first study to demonstrate the association calcineurin inhibitors with impaired IQ and also the unique finding of different variables predictive of impaired verbal intelligence quotient (VIQ) versus performance intelligence quotient (PIQ).     

Neurodevelopmental predictors of short-term outcome in very-low-birth-weight infants

Having previously confirmed a lower developmental quotient (DQ) in very-low-birth-weight infants identified by physiotherapists as being at risk, a retrospective analysis was undertaken to ascertain which of the neurodevelopmental tests were of value in predicting subsequent poor outcome. At 3 months corrected age, 9 tests differentiated normal from at-risk infants, and infants with abnormal test results were assessed as having a 56% (mean) risk of subsequent DQ less than 100. At the 6-month assessment, 7 neurodevelopmental tests differentiated normal from at-risk infants; infants with abnormal test results had a 73% (mean) risk of subsequent DQ less than 100. At 12 months, 3 tests differentiated normal from at-risk infants; infants with abnormal test results had a 79% (mean) risk of DQ less than 100. We believe the identification of predictive tests may assist doctors and developmental therapists in assessing need for intervention and response to treatment in high-risk infants. However, it must be noted that the tests studied relate to DQ at 1 year; we are not yet in a position to comment on the relationship between 1 year DQ and subsequent neurodevelopmental outcome.     

Neurodevelopmental outcome related to cerebral risk factors in children after neonatal arterial switch operation

BACKGROUND: Neurodevelopmental outcome after neonatal arterial switch operation for complete transposition of the great arteries is an important topic needing prospective assessment. METHODS: A group of 33 unselected children (3.0 to 4.6 years) operated on as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass and a control group of 32 age-matched healthy children (3.0 to 4.8 years) underwent evaluation of socioeconomic and clinical neurological status and a standardized test comprising all areas of child development. Results of patients were related to those of the control group, to population norms, and to preoperative, perioperative, and postoperative cerebral risk factors. RESULTS: Clinical neurological status was normal in 26 patients (78.8%) and reduced in 7 (21.2%). Complete developmental score and the subscores for motor function, visual perception, learning and memory, cognitive function, language, and socioemotional functions were not different compared to population norms. Compared to the patients, the children of the control group scored higher on tests of complete development, cognition, and language, but also on socioeconomic status. Complete developmental score and the scores for motor, cognitive, and language functions were weakly inversely related to the duration of circulatory arrest, but not to the duration of bypass. Cerebral risk factors such as serum levels of the neuron-specific enolase, perinatal acidosis, perinatal asphyxia, peri- and postoperative cardiocirculatory insufficiency, or clinical seizures were not correlated to the test results. CONCLUSIONS: Neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with neurological impairment, but not with reduced development as assessed by formal testing of motor, cognitive, language, and behavioral functions. Perioperative serum level of the neuron-specific enolase is not a valid marker for later developmental impairment.     

Growth,development and nutritional status in Japanese children under 2 years on continuous ambulatory peritoneal dialysis

We examined the growth, development and nutritional status over a period of 10 years of 15 young children (<2 years old) on continuous ambulatory peritoneal dialysis (CAPD). There were 6 males and 9 females with a mean age of 12.5 months, mean weight of 6.3 kg, mean height of 66.2 cm at the start of CAPD and a mean duration of therapy of 2.6 years. Height, weight, head circumference, development quotient (DQ), blood chemistry and dietary intake were assessed over a period of 10 years. The patients' mean height standard deviation score (SDS) did not change significantly (from –2.51 to –2.74) during CAPD therapy. The mean growth velocity index (GVI) during CAPD was 76.5% and correlated positively with energy intake but not with protein intake. The mean DQ was low (67.0%) at the start of CAPD and 69.3% at the end of CAPD. DQ did not correlate with energy intake, GVI, head circumference SDS or with the weight/height ratio; however, 2 patients with low DO (<60%) had a low energy intakes. Although most patients had a low DQ, the IQ at 5–6 years of age was normal in all patients except 1 without cerebral disease. Our study showed minimal growth (SDS) and mental developmental (IQ) delays during CAPD therapy, but an adequate nutritional intake must be assured to obtain the above results.     

Unwarranted clinical variation in the care of children and young people hospitalised for injury: a population-based cohort study

IntroductionInjury is a leading cause of death and disability among children and young people. Recovery may be negatively affected by unwarranted clinical variation such as representation to an emergency department (ED), readmission to a hospital, and mortality. The aim of this study was to examine unwarranted clinical variation across providers of care of children and young people who were hospitalised for injury in New South Wales (NSW).Materials and MethodsRetrospective population-based cohort study using linked ED, hospital, and mortality data of all children and young people aged ≤25 years who were injured and hospitalised during 1 January 2010–30 June 2014 in NSW. Unwarranted clinical variation across providers was examined using three indicators. That is, for each hospital that treated ≥100 cases per year, risk standardised ratios were calculated with 95% and 99.8% confidence limits using the number of observed and expected events of (1) representations to ED within 72 h, (2) unplanned readmissions to hospital within 28 days, and (3) all-cause mortality within 30 days.ResultsThere were 189,990 injury-related hospitalisations of children and young people. Of these, 4.4% represented to an ED, 8.7% were readmitted to hospital, and 0.2% died. Of the 45 public hospitals that treated ≥100 cases per year, higher than expected rates of ED representations, hospital readmissions, and mortality were observed in eleven, six, and two hospitals, respectively.ConclusionThe rates of ED representations, hospital readmissions, and mortality among children and young people hospitalised for injury in NSW were similar to the rates reported in other countries. However, unwarranted clinical variation across public hospitals was observed for all three indicators. These findings suggest that by improving routine follow-up support services post-discharge for children and young people and their families, it may be possible to reduce unwarranted clinical variation and improve health outcomes.     

Delayed treatment of type 3 supracondylar humerus fractures in children

A retrospective review of 158 type 3 supracondylar humerus fractures was undertaken to determine whether any correlation exists between an increased time from injury to surgery and four unfavorable results: a longer operative time, an increase in hospital stay, an increase in the need to open the fracture, or an increase in unsatisfactory outcomes. The average age of the patients was 5.0 years. Five children had nerve injury on initial examination, and no arm was poorly perfused. The average time from injury to evaluation in the emergency department was 9.8 hours and the average time from the emergency department to surgery was 11.5 hours. The average total time from injury to surgical treatment was 21.3 hours. The patients were in the hospital between 1 to 6 days. The average operative time was 53 minutes. Thirty patients had unsatisfactory results, defined as a pin infection, more than 15 degrees loss of motion in any plane, loss of normal carrying angle, neuropraxia, or retained hardware. There was no correlation between an increase in time to surgical intervention and longer operative time or need to open the fracture site, nor was there an indication that the delay to surgical treatment resulted in a longer hospital stay or an increase in unsatisfactory results.     

Effects of cardiac surgery on intellectual in and children

Intellectual function was evaluated by Gesell's developmental quotient (DQ) and Binet's intelligence quotient (IQ) in 161 infants and children (61 ventricular septal defects, 49 tetralogies of Fallot, 15 transpositions of the great arteries, seven atrial septal defects, five complete atrioventricular canals, five double outlet right ventricles and 19 shunt cases; average age 3.6 years) before and after cardiac surgery. There were no significant differences in preoperative DQs and IQs among the patient groups. Although average DQ scores in 21 infants with hypothermic (13–24 °C) total circulatory arrest (36–70 min) were not significantly different from the preoperative values, 13 patients with an arrest time >50 min showed a significant decrease in DQ scores. The postoperative DQ and IQ scores in patients without circulatory arrest or in shunt cases were not significantly impaired after surgery. It was concluded that cardiac surgery did not impair intellectual function in infants and children, although cerebral dysfunction might occur if circulatory arrest was >50 min.