[Handicaps and the perinatal period. II. Perinatal pathology and severe deficiencies]

Causes of severe to profound deafness in Omani paediatric population

The study includes a retrospective analysis of causes of deafness in 1400 Omani children who were detected to be suffering from severe to profound levels of hearing impairment. A standard form was used to collect various details from the otolaryngologists all over the country. The time period included is from 1986 to 2000. The rate of consanguineous marriage in the parents of the affected children was 70%, and 67.8% of these children had a sibling suffering from hearing impairment. There has been a rapid evolution of the antenatal, perinatal and neonatal care delivery in Oman during last couple of decades. The Omani paediatric population has been well covered (>90%) under the vaccination protocols including rubella. It has helped in reducing the share of infectious diseases towards the hearing impairment. The study is an attempt to identify various causes of the identifiable causes of severe to profound hearing impairment in Omani paediatric population which is the first attempt of this kind in this country. Relevant literature has been reviewed.

Handicap neuro-sensoriel grave de l’enfant grand prématuré

OBJECTIVE

Advances in perinatal care have resulted in a sharply increasing survival rate among very preterm infants. However, there is some concern about the later neurodevelopmental outcome of those infants who survive. In this paper, we review the prevalence estimates of motor (cerebral palsy), sensorineural and cognitive impairments and their recent time-trends in very preterm infants.

METHOD

A review of studies describing neurodevelopmental outcome of very preterm infants in Europe, Australia and America North.

RESULTS

The gestational age-specific prevalences of cerebral palsy (CP) were 72-86 for extremely preterm children (<28 weeks), 32-60 for very preterm (28-31 weeks) and 5-6 for moderate preterm (32-36 weeks), and 1.3-1.5 for term children per 1000. The live birth prevalence for CP remained unchanged in extremely and very preterm infants since 1990. The prevalence estimates of moderate and severe cognitive impairments are 15 to 25% in very preterm children. Less than 4% of very preterm infants develop severe hearing or visual loss.

CONCLUSION

This review indicates that very preterm infants have high risk of disability. Most studies have been conducted between 1985 and 1995. Thus, these results should be interpreted with caution before generalisation to recent cohorts.

[Neuro-intellectual prognosis at school age for 62 children born with a gestational age of under 32 weeks]

AIM

The aim of this study was to detail the incidence of cerebral palsy in children born before 32 weeks of gestation and to evaluate the scholastic and intellectual performance in non-handicapped children.

POPULATION AND METHODS

The population included 63 survivors hospitalized in 1984-85 (gestational age: 30.06 +/- 1.21 weeks; birth weight: 1386 +/- 267 g; inborn 60%; male: 38.7%; small for gestational age: 4.8%; hyaline membrane disease: 32%; European: 98.4%). Neurodevelopmental assessment was performed by pediatricians and psychologists using Wisc-R, visual screening by Monoyer scale, hearing by audiometry realized by oto-rhinolaryngologists.

RESULTS

There were 62 survivors (one child dead by sudden infant death syndrome). Fifty children evaluated at a mean age of 9.3 +/- 0.7 years and written data available for another eight. Twelve children presented with cerebral palsy. Risk factors were ultrasound abnormalities of parenchymal brain and male gender. In children without cerebral palsy, we observed 12 visual and two hearing impairment. Three were in special education, 32 were in an age-appropriate level, nine with one year below. Neonatal events were not associated with the Wisc-R results except for ultrasound abnormalities of parenchymal brain. Wisc-R was strongly correlated with familial economic and education level.

CONCLUSION

School performances in non-handicapped children born before 32 weeks is satisfying. Intellectual performance is mainly correlated with familial economic and education level.