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Call C, Oran A, O'Shea TM, Jensen ET, Frazier JA, Vaidya R, Shenberger J, Gogcu S, Msall ME, Kim S, Jalnapurkar I, Fry RC, Singh R. Health-related quality of life at age 10 years in children born extremely preterm. J Perinatol 2024; 44:835-843. [PMID: 38760579 DOI: 10.1038/s41372-024-01987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To evaluate the association between prenatal maternal health and socioeconomic status (SES) and health-related quality of life (QoL) among 10-year-old children born extremely preterm. DESIGN/ METHODS Retrospective analysis of the Extremely Low Gestational Age Newborns (ELGAN) Study cohort of infants born < 28 weeks gestational age. QoL was assessed at 10 years of age using the Pediatric Quality of Life Inventory. Multivariate regression models were used for analyses. RESULTS Of 1198 participants who survived until 10 years of age, 889 (72.2%) were evaluated. Lower maternal age, lack of college education; receipt of public insurance and Supplemental Nutrition Assistance Program (SNAP) were associated with lower QoL scores. Specific maternal health factors were also associated with lower child QoL scores. CONCLUSIONS Specific, potentially modifiable, maternal health and social factors are associated with lower scores on a measure of parent-reported child QoL across multiple domains for children born extremely preterm.
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Affiliation(s)
- Catherine Call
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
| | - Ali Oran
- Department of Environmental Sciences & Engineering, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jean A Frazier
- Department of Psychiatry and the Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ruben Vaidya
- Department of Pediatrics, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA
| | - Jeffrey Shenberger
- Department of Pediatrics, Connecticut Children's Hospital, Hartford, CT, USA
| | - Semsa Gogcu
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael E Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities University of Chicago, Chicago, IL, USA
| | - Sohye Kim
- Department of Psychiatry and the Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Isha Jalnapurkar
- Department of Psychiatry and the Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rebecca C Fry
- Department of Environmental Sciences & Engineering, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachana Singh
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.
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Sriram S, Jensen E, Msall M, Yi J, Zhabotynsky V, Joseph R, Kuban K, Frazier J, Hooper S, Santos H, Gogcu S, Shenberger J, Fry R, O'Shea T. Retinopathy of prematurity and neurodevelopmental outcome and quality of life at 10 years of age. RESEARCH SQUARE 2024:rs.3.rs-4324566. [PMID: 38766141 PMCID: PMC11100895 DOI: 10.21203/rs.3.rs-4324566/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Objective In a cohort of 10-year-old children born extremely preterm, we evaluated the hypothesis that increasing severity of retinopathy of prematurity (ROP) is associated with increasing frequency of unfavorable neurodevelopmental and quality of life outcomes. Study Design Study participants were classified according to the severity of ROP. At 10 years of age, their neurocognitive abilities, academic achievement, and gross motor function were assessed, and they were evaluated for autism spectrum disorder, anxiety, depression, and quality of life. Results After adjustment for sample attrition and confounders, only the association with lower quality of life persisted. Increasing severity of visual impairment was associated with worse neurodevelopmental outcomes and lower quality of life. Conclusion Among extremely preterm children, severity of visual impairment, but not severity of ROP, was associated with adverse neurodevelopmental outcomes at 10 years of age. Both severe ROP and more severe visual impairment were associated with lower quality of life.
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Affiliation(s)
| | | | | | - Joe Yi
- University of North Carolina School of Medicine
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3
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Jensen ET, Yi J, Jackson W, Singh R, Joseph RM, Kuban KCK, Msall ME, Washburn L, Fry R, South AM, O’Shea TM. Analysis of Neurodevelopment in Children Born Extremely Preterm Treated With Acid Suppressants Before Age 2 Years. JAMA Netw Open 2022; 5:e2241943. [PMID: 36378311 PMCID: PMC9667324 DOI: 10.1001/jamanetworkopen.2022.41943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Children born preterm are at increased risk of adverse neurodevelopmental outcomes and may be particularly vulnerable to the effects of gastric acid suppression during infancy. OBJECTIVE To assess whether early acid suppressant use in infants born extremely preterm is associated with poorer neurodevelopmental outcomes. DESIGN, SETTING, AND PARTICIPANTS The Extremely Low Gestational Age Newborn study was a multicenter, longitudinal cohort study of infants born before 28 weeks' gestational age between March 22, 2002, and August 31, 2004. The current analyses were performed from September 12, 2020, through September 22, 2022. Of the 1506 infants enrolled, 284 died before discharge and 22 died before 24 months of age. An additional 2 died before age 10 years, leaving 1198 (79.5%) eligible for a visit. Of these, 889 (74%) participated in the visit at age 10. At age 10 years, the association of early-life acid suppressant use with neurocognitive, neurodevelopmental, and psychiatric symptomatology was assessed. EXPOSURES Acid suppressant use before 24 months of age was determined from medical records and from questionnaires administered to mothers. MAIN OUTCOMES AND MEASURES Neurodevelopmental assessments at age 10 years included the School-Age Differential Ability Scales-II, the Developmental Neuropsychological Assessment-II, the Autism Diagnostic Observation Schedule-2, the Social Responsiveness Scale-2, and the Child Symptom Inventory-4 for attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. RESULTS Of the 889 participants assessed at age 10 years (mean [SD] age, 9.97 [0.67] years; mean [SD] gestational age at birth, 26.1 [1.3] weeks; 455 [51.2%] male), 368 (41.4%) had received acid suppressants by 24 months of age. Associations were observed between acid suppressant use and decreased full-scale IQ z score (adjusted β, -0.29; 95% CI, -0.45 to -0.12), verbal IQ z score (adjusted β, -0.34; 95% CI, -0.52 to -0.15), nonverbal IQ z score (adjusted β, -0.22; 95% CI to -0.39 to -0.05), working memory z score (adjusted β, -0.26; 95% CI to -0.45, -0.08), autism spectrum disorder (adjusted relative risk, 1.84; 95% CI, 1.15-2.95), and epilepsy (adjusted relative risk, 2.07; 95% CI, 1.31 to 3.35). Results were robust to multiple sensitivity analyses. Use of acid suppressants was not associated with inhibitory control, ADHD, anxiety, or depression. CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that early-life use of acid suppressants in extremely preterm infants may be associated with poorer neurodevelopmental outcomes and add to evidence indicating caution in use of these agents.
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Affiliation(s)
- Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Joe Yi
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Wesley Jackson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Rachana Singh
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Michael E. Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Lisa Washburn
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Rebecca Fry
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Andrew M. South
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
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Vaidya R, Yi JX, O’Shea TM, Jensen ET, Joseph RM, Shenberger J, Gogcu S, Wagner K, Msall ME, Thompson AL, Frazier JA, Fry R, Singh R. Long-Term Outcome of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation. Pediatrics 2022; 150:e2022056445. [PMID: 36200375 PMCID: PMC9647591 DOI: 10.1542/peds.2022-056445] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are complications in preterm infants associated with high morbidity, mortality, impaired growth, and neurodevelopmental (ND) outcomes. Few studies have reported growth or ND outcomes of infants born extremely preterm with NEC/SIP beyond early childhood. Here, we compared anthropometric and ND outcomes, at 10 and 15 years, for children with medical NEC, surgical NEC, SIP, and neither NEC nor SIP. METHODS Participants from the prospective longitudinal extremely low gestational age newborns study were evaluated at ages 10 and 15 years for anthropometrics, neurocognition, attention-deficit/hyperactivity disorder, epilepsy, and gross motor function. RESULTS At age 10 years, 889 children were followed-up (medical NEC = 138, surgical NEC = 33, SIP = 29, no NEC/SIP = 689), and 694 children were followed up-at 15 years. Children with medical NEC had similar weight, BMI, height, and head circumference compared with controls at both 10 and 15 years. At 15 years, children with surgical NEC had lower weight z-score (adjusted β: -0.75, 95% confidence interval [CI]: -1.25 to -0.25), lower BMI z-score (adjusted β: -0.55, 95% CI: -1.09 to -0.01), and lower height z-score (adjusted β: -0.65, 95% CI: -1.16 to -0.14). Children with SIP had lower weight and height z-scores at age 10 years when adjusted for sample attrition, but these differences were not significant when adjusted for confounders. We observed no differences in long-term ND outcomes. CONCLUSIONS Surgical NEC- and SIP-associated growth impairment may persist through late childhood. ND outcomes among school-aged children born extremely preterm with any NEC or SIP are no different from children without NEC/SIP.
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Affiliation(s)
- Ruben Vaidya
- Department of Pediatrics, University of Massachusetts Chan Medical School, Baystate, Springfield, Massachusetts
| | - Joe X. Yi
- Frank Porter Graham Child Development Institute
| | | | | | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey Shenberger
- Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Semsa Gogcu
- Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn Wagner
- Department of Pediatrics, University of Massachusetts Chan Medical School, Baystate, Springfield, Massachusetts
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Michael E. Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago, Chicago, Illinois
| | - Amanda L. Thompson
- Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jean A. Frazier
- Department of Psychiatry, Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Rebecca Fry
- Institute for Environmental Health Solutions
| | - Rachana Singh
- Department of Pediatrics, Tufts Children’s Hospital, Tufts University School of Medicine, Boston, Massachusetts
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5
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Campbell H, Check J, Kuban KCK, Leviton A, Joseph RM, Frazier JA, Douglass LM, Roell K, Allred EN, Fordham LA, Hooper SR, Jara H, Paneth N, Mokrova I, Ru H, Santos HP, Fry RC, O’Shea TM. Neonatal Cranial Ultrasound Findings among Infants Born Extremely Preterm: Associations with Neurodevelopmental Outcomes at 10 Years of Age. J Pediatr 2021; 237:197-205.e4. [PMID: 34090894 PMCID: PMC8478718 DOI: 10.1016/j.jpeds.2021.05.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the association between neonatal cranial ultrasound (CUS) abnormalities among infants born extremely preterm and neurodevelopmental outcomes at 10 years of age. STUDY DESIGN In a multicenter birth cohort of infants born at <28 weeks of gestation, 889 of 1198 survivors were evaluated for neurologic, cognitive, and behavioral outcomes at 10 years of age. Sonographic markers of white matter damage (WMD) included echolucencies in the brain parenchyma and moderate to severe ventricular enlargement. Neonatal CUS findings were classified as intraventricular hemorrhage (IVH) without WMD, IVH with WMD, WMD without IVH, and neither IVH nor WMD. RESULTS WMD without IVH was associated with an increased risk of cognitive impairment (OR 3.5, 95% CI 1.7, 7.4), cerebral palsy (OR 14.3, 95% CI 6.5, 31.5), and epilepsy (OR 6.9; 95% CI 2.9, 16.8). Similar associations were found for WMD accompanied by IVH. Isolated IVH was not significantly associated these outcomes. CONCLUSIONS Among children born extremely preterm, CUS abnormalities, particularly those indicative of WMD, are predictive of neurodevelopmental impairments at 10 years of age. The strongest associations were found with cerebral palsy.
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Affiliation(s)
- Heather Campbell
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Jennifer Check
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Karl C. K. Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA
| | - Alan Leviton
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Robert M Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
| | - Jean A. Frazier
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA
| | - Laurie M. Douglass
- Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA
| | - Kyle Roell
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Elizabeth N. Allred
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Lynn Ansley Fordham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Stephen R. Hooper
- Department of Allied Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Hernan Jara
- Department of Radiology, Boston University Medical Center, Boston, MA
| | - Nigel Paneth
- Michigan State University College of Human Medicine, East Lansing, MI
| | | | - Hongyu Ru
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Hudson P. Santos
- Biobehavioral Laboratory, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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6
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Torres AR, Camayd-Muñoz C, Alvarado MC, Perez B, Pou J, Hereen T, Jonas R, Douglass LM. A Novel Parent Questionnaire for the Detection of Seizures in Children of Spanish-Speaking Families. J Child Neurol 2021; 36:461-467. [PMID: 33336600 DOI: 10.1177/0883073820978001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We developed and validated a Spanish seizure screen for children based on a previously validated English seizure screen that could be administered by a trained research assistant in a 2-step process, approximating the clinical diagnostic process of a pediatric epilepsy specialist. This questionnaire was designed to study seizure prevalence in a research population of children at risk for epilepsy. METHODS Spanish-speaking parents of children 6 months to 17 years old were recruited from the pediatric neurology clinics at Boston Medical Center and interviewed using a computerized questionnaire. A computerized algorithm of parent responses rendered a seizure classification of positive or negative. Blinded to questionnaire results, pediatric neurologists served as the diagnostic gold standard, ranking each patient event using a 4-level scale based on clinical history and examination: (1) not likely, (2) indeterminate, (3) probable, and (4) almost certain where rankings of 3 or 4 lead to a diagnosis of seizure. RESULTS The questionnaire was completed by 163 enrolled parents. The seizure screen demonstrated a 94.2% sensitivity and 93.7% specificity for identifying seizures. The positive predictive value was 87.5%, and the negative predictive value was 97.2%. CONCLUSIONS This pediatric seizure questionnaire was both sensitive and specific for detecting clinically confirmed seizures. This tool may be useful to clinicians and researchers in screening large populations of children, decreasing the time and cost of added neurologic assessments.
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Affiliation(s)
- Alcy R Torres
- 12259Boston University School of Medicine, Boston, MA, USA
| | | | | | - Brandon Perez
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Jonathan Pou
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Timothy Hereen
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Rinat Jonas
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Laurie M Douglass
- 1836Boston Medical Center, One Boston Medical Center Pl, Boston, MA, USA
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7
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Venkatesh KK, Leviton A, Fichorova RN, Joseph RM, Douglass LM, Frazier JA, Kuban K, Santos HP, Fry RC, O'Shea TM. Prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm: a prospective cohort. BJOG 2021; 128:1586-1597. [PMID: 33682301 DOI: 10.1111/1471-0528.16690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the association between prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm (<28 weeks of gestation). DESIGN The Extremely Low Gestational Age Newborn (ELGAN) Study, a prospective cohort. SETTING Ten-year follow-up of extremely preterm infants born at 14 US hospitals between 2002 and 2004. METHODS Prenatal tobacco smoke exposure was defined as a mother's report at enrolment of active (i.e. maternal) and passive smoking during pregnancy. Poisson regression with generalized estimating equations was used. Models adjusted for mother's age, race/ethnicity, education, insurance, pre-pregnancy body mass index, US region, multiple gestation and infant's sex; and in sensitivity analysis, gestational age at delivery and clinical subtype of preterm birth, given their classification as intermediate and non-confounding variables. MAIN OUTCOMES Neurological impairment at 10 years, epilepsy, cerebral palsy and cognitive impairment. RESULTS Of 1200 ELGAN study survivors, 856 were assessed at 10 years of age with neurological outcomes, of whom 14% (118/856) had active tobacco exposure during pregnancy and 24% (207/852) had passive tobacco exposure. Compared with children who were not exposed prenatally to tobacco, children exposed to active tobacco use during pregnancy had a higher risk of epilepsy (14% versus 5%; adjusted relative risk: 1.68, 95% CI 1.45-1.92). This risk remained after adjustment for gestational age at delivery and clinical subtype of preterm birth. Prenatal tobacco smoke exposure was not associated with other assessed neurological outcomes, including cerebral palsy and multiple measures of cognitive impairment. CONCLUSIONS Among children born extremely preterm, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life. TWEETABLE ABSTRACT Among infants born before 28 weeks of gestation, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life.
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Affiliation(s)
- K K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - A Leviton
- Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - R N Fichorova
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R M Joseph
- Department of Anatomy & Neurobiology, Boston University, Boston, MA, USA
| | - L M Douglass
- Department of Pediatrics, Boston University, Boston, MA, USA
| | - J A Frazier
- Department of Psychiatry, University of Massachusetts Medical School, Worchester, MA, USA
| | - Kck Kuban
- Department of Pediatrics, Boston University, Boston, MA, USA
| | - H P Santos
- Biovehavioral Laboratory, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - T M O'Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
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8
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Blackmon K, Waechter R, Landon B, Noël T, Macpherson C, Donald T, Cudjoe N, Evans R, Burgen KS, Jayatilake P, Oyegunle V, Pedraza O, Abdel Baki S, Thesen T, Dlugos D, Chari G, Patel AA, Grossi-Soyster EN, Krystosik AR, LaBeaud AD. Epilepsy surveillance in normocephalic children with and without prenatal Zika virus exposure. PLoS Negl Trop Dis 2020; 14:e0008874. [PMID: 33253174 PMCID: PMC7728266 DOI: 10.1371/journal.pntd.0008874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/10/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Children with Congenital Zika Syndrome and microcephaly are at high risk for epilepsy; however, the risk is unclear in normocephalic children with prenatal Zika virus (ZIKV) exposure [Exposed Children (EC)]. In this prospective cohort study, we performed epilepsy screening in normocephalic EC alongside a parallel group of normocephalic unexposed children [Unexposed Children (UC)]. We compared the incidence rate of epilepsy among EC and UC at one year of life to global incidence rates. Pregnant women were recruited from public health centers during the ZIKV outbreak in Grenada, West Indies and assessed for prior ZIKV infection using a plasmonic-gold platform that measures IgG antibodies in serum. Normocephalic children born to mothers with positive ZIKV results during pregnancy were classified as EC and those born to mothers with negative ZIKV results during and after pregnancy were classified as UC. Epilepsy screening procedures included a pediatric epilepsy screening questionnaire and video electroencephalography (vEEG). vEEG was collected using a multi-channel microEEG® system for a minimum of 20 minutes along with video recording of participant behavior time-locked to the EEG. vEEGs were interpreted independently by two pediatric epileptologists, who were blinded to ZIKV status, via telemedicine platform. Positive screening cases were referred to a local pediatrician for an epilepsy diagnostic evaluation. Epilepsy screens were positive in 2/71 EC (IR: 0.028; 95% CI: 0.003-0.098) and 0/71 UC. In both epilepsy-positive cases, questionnaire responses and interictal vEEGs were consistent with focal, rather than generalized, seizures. Both children met criteria for a clinical diagnosis of epilepsy and good seizure control was achieved with carbamazepine. Our results indicate that epilepsy rates are modestly elevated in EC. Given our small sample size, results should be considered preliminary. They support the use of epilepsy screening procedures in larger epidemiological studies of children with congenital ZIKV exposure, even in the absence of microcephaly, and provide guidance for conducting epilepsy surveillance in resource limited settings.
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Affiliation(s)
- Karen Blackmon
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, Florida, United States of America
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
- * E-mail:
| | - Randall Waechter
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Barbara Landon
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Trevor Noël
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Calum Macpherson
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | | | - Nikita Cudjoe
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Kemi S. Burgen
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Piumi Jayatilake
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Vivian Oyegunle
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Otto Pedraza
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, Florida, United States of America
| | - Samah Abdel Baki
- Biosignal Group Inc., Boston, Massachusetts, United States of America
| | - Thomas Thesen
- New York University School of Medicine, Department of Neurology, New York, New York, United States of America
- Department of Biomedical Sciences, University of Houston College of Medicine, USA
| | - Dennis Dlugos
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Geetha Chari
- SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Archana A. Patel
- Boston Children’s Hospital, Department of Neurology, Boston, Massachusetts, United States of America
| | - Elysse N. Grossi-Soyster
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| | - Amy R. Krystosik
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| | - A. Desiree LaBeaud
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
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9
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Venkatesh KK, Leviton A, Hecht JL, Joseph RM, Douglass LM, Frazier JA, Daniels JL, Fry RC, O’Shea TM, Kuban KC. Histologic chorioamnionitis and risk of neurodevelopmental impairment at age 10 years among extremely preterm infants born before 28 weeks of gestation. Am J Obstet Gynecol 2020; 223:745.e1-745.e10. [PMID: 32387324 DOI: 10.1016/j.ajog.2020.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/03/2020] [Accepted: 05/04/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Extremely preterm infants whose placenta had histologic evidence of chorioamnionitis have early brain dysfunction, but little is known about neurologic development at 10 years of age. OBJECTIVE We investigated the association between histologic chorioamnionitis and neurodevelopmental impairment at 10 years among children born <28 weeks' gestation (extremely preterm). STUDY DESIGN The multicenter Extremely Low Gestational Age Newborns study enrolled extremely preterm newborns from 2002 to 2004 at 14 hospitals in the United States. Chorioamnionitis was defined by histologic stage (early, moderate, and advanced) and grade (mild/moderate and severe) of chorionic plate and umbilical cord inflammation. The children were examined for cerebral palsy at 2 years and for autism spectrum disorder, cognitive impairment (intelligence quotient >2 standard deviations below the mean), and epilepsy at the age of 10 years by blinded evaluators using validated measures. Multivariable logistic regression with generalized estimating equations was used. RESULTS Among 805 placentas, 43% (347/805) had histologic chorioamnionitis by moderate or advanced maternal stage, 36% (286/805) by severe maternal grade, 18% (132/737) by moderate or advanced fetal stage, and 1% (10/737) by severe fetal grade. The frequencies of impairments were 11% (88/767) for cerebral palsy, 7% (56/773) for autism spectrum disorder, 15% (120/788) for cognitive impairment, and 7% (52/763) for epilepsy. After adjustment for maternal age, body mass index, race, insurance status, maternal education, tobacco use, infant sex, and multiple gestations, the adjusted odds ratio for the association between histologic chorioamnionitis and cerebral palsy years was increased with advanced maternal stage (adjusted odds ratio, 2.5; 95% confidence interval, 1.6-3.9), severe maternal grade (adjusted odds ratio, 2.0; 95% confidence interval, 1.2-3.4), moderate fetal stage (adjusted odds ratio, 2.20; 95% confidence interval, 2.1-2.2), and mild or moderate fetal grade (adjusted odds ratio, 1.5; 95% confidence interval, 1.0-2.2). Similarly, the adjusted odds ratio for the association between histologic chorioamnionitis and epilepsy was increased with advanced maternal stage (adjusted odds ratio, 1.5; 95% confidence interval, 1.3-1.6) and severe fetal grade (adjusted odds ratio, 5.9; 95% confidence interval, 1.9-17.8). In addition, the adjusted odds ratio for the association between histologic chorioamnionitis and autism spectrum disorder was increased with mild or moderate fetal grade (adjusted odds ratio, 1.7; 95% confidence interval, 1.0-2.9). Histologic chorioamnionitis was not associated with cognitive impairment. These findings held after adjustment for gestational age at delivery. In contrast to histologic chorioamnionitis, a clinical diagnosis of chorioamnionitis was not associated with neurodevelopmental impairment. CONCLUSION Histologic chorioamnionitis may be associated with some forms of neurodevelopmental impairment at 10 years of life among infants born <28 weeks' gestation.
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Bertolli J, Attell JE, Rose C, Moore CA, Melo F, Staples JE, Kotzky K, Krishna N, Satterfield-Nash A, Pereira IO, Pessoa A, Smith DC, Santelli ACFES, Boyle CA, Peacock G. Functional Outcomes among a Cohort of Children in Northeastern Brazil Meeting Criteria for Follow-Up of Congenital Zika Virus Infection. Am J Trop Med Hyg 2020; 102:955-963. [PMID: 32228785 PMCID: PMC7204564 DOI: 10.4269/ajtmh.19-0961] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Following the large outbreak of Zika virus in the Western Hemisphere, many infants have been born with congenital Zika virus infection. It is important to describe the functional outcomes seen with congenital infections to allow for their recognition and appropriate interventions. We evaluated 120 children conceived during the 2015-2016 Zika virus outbreak in Paraíba, Brazil, who were approximately 24 months old, to assess functional outcomes. All children met either anthropometric criteria or laboratory criteria suggestive of possible congenital Zika virus infection. We collected results of previous medical evaluations, interviewed parents, and performed physical examinations and functional assessments, for example, the Hammersmith Infant Neurological Examination (HINE). We compared patterns of neurologic outcomes and developmental delay at age 24 months by whether children met anthropometric or laboratory criteria, or both. Among children meeting both criteria, 60% (26/43) were multiply affected (had severe motor impairment, severe developmental delay, and suboptimal HINE scores), compared with 5% (3/57) meeting only laboratory criteria and none (0/20) meeting only anthropometric criteria. Of the remaining 91 children, 49% (45) had developmental delay, with more severe delay seen in children meeting both criteria. Although children meeting physical and laboratory criteria for potential congenital Zika virus infection were more severely affected, we did identify several children with notable adverse neurologic outcomes and developmental delay with no physical findings but potential laboratory evidence of Zika virus infection. Given this, all children who were potentially exposed in utero to Zika virus should be monitored in early childhood for deficits to allow for early intervention.
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Affiliation(s)
- Jeanne Bertolli
- Division of Human Development and Disability, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Charles Rose
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Flávio Melo
- Hospital Regional de Guarabira/Governo do Estado da Paraíba, João Pessoa, Brazil
| | | | - Kim Kotzky
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Nevin Krishna
- Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
| | | | | | - André Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Brazil
| | | | | | - Coleen A Boyle
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Georgina Peacock
- Division of Human Development and Disability, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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11
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Greenlaw C, Nuss S, Camayd-Muñoz C, Jonas R, Rollins JV, Cabral H, Douglass LM. Clinical Implementation of a Parent Questionnaire to Identify Seizures in High-Risk Children. J Child Neurol 2020; 35:485-491. [PMID: 32207663 DOI: 10.1177/0883073820911505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study evaluated the effectiveness of a parent-completed questionnaire for detecting seizures in high-risk children. METHODS A 2-part seizure screen for children up to 12 years of age with suspected autism spectrum disorder, developmental delay, or seizure, was implemented in 12 Massachusetts clinics serving populations with high health disparities. Primary care providers and developmental behavioral pediatricians administered part 1, a brief highly sensitive screen. If the result was positive, a research assistant administered part 2, a more detailed screen with higher specificity. Positive part 2 results prompted a specialized assessment by a pediatric neurologist. Screening data were evaluated for detection of seizures or other diagnoses, reason for conducting the screen, and appointment outcomes. Data analysis included chi-squared tests, percentages for categorical variables, and means for numerical data. RESULTS Of 207 administered seizure questionnaires, 78% of children screened positive on part 1. Of those, 94% of families completed part 2 by telephone, and 64 individuals screened positive. The screen helped to detect 15 new seizure diagnoses and 35 other neurologic diagnoses. Average time to first scheduled appointment was 23.8 days. The no-show rate was 7%. CONCLUSIONS The seizure questionnaire effectively identified seizures and other disorders in a diverse population of high-risk children. Broader use of this low-cost screening tool could improve access to care for children with suspected seizures, increase seizure recognition, and help allocate resources more effectively.
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Affiliation(s)
| | - Sarah Nuss
- Division of Pediatric Neurology, Boston Medical Center, Boston, MA, USA
| | | | - Rinat Jonas
- Division of Pediatric Neurology, Boston Medical Center, Boston, MA, USA
| | - Julie Vanier Rollins
- Division of Neonatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Laurie M Douglass
- Boston University School of Medicine, Boston, MA, USA
- Division of Pediatric Neurology, Boston Medical Center, Boston, MA, USA
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12
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Singh R, Douglass LM, O’Shea TM, Stafstrom CE, Allred EN, Engelke S, Shah B, Leviton A, Hereen TC, Kuban KCK. Antecedents of epilepsy and seizures among children born at extremely low gestational age. J Perinatol 2019; 39:774-783. [PMID: 30918341 PMCID: PMC7216413 DOI: 10.1038/s41372-019-0355-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify specific risk factors for epilepsy for individuals born extremely preterm. STUDY DESIGN In a prospective cohort study, at 10-year follow-up, children were classified as having epilepsy or seizures not associated with epilepsy. We evaluated for association of perinatal factors using time-oriented, multinomial logistic regression models. RESULTS Of the 888 children included in the study, 66 had epilepsy and 39 had seizures not associated with epilepsy. Epilepsy was associated with an indicator of low socioeconomic status, maternal gestational fever, early physiologic instability, postnatal exposure to hydrocortisone, cerebral white matter disease and severe bronchopulmonary dysplasia. Seizure without epilepsy was associated with indicators of placental infection and inflammation, and hypoxemia during the first 24 postnatal hours. CONCLUSIONS In children born extremely preterm, epilepsy and seizures not associated with epilepsy have different risk profiles. Though both profiles included indicators of infection and inflammation, the profile of risk factors for epilepsy included multiple indicators of endogenous vulnerability.
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Affiliation(s)
| | - Laurie M. Douglass
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | | | - Carl E. Stafstrom
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth N. Allred
- Neuroepidemiology Unit, Department of Neurology, Boston Children’s Hospital, Boston, MA,Department of Neurology, Harvard Medical School, Boston, MA
| | - Stephen Engelke
- Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC
| | | | - Alan Leviton
- Neuroepidemiology Unit, Department of Neurology, Boston Children’s Hospital, Boston, MA,Department of Neurology, Harvard Medical School, Boston, MA
| | - Timothy C. Hereen
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - Karl C. K. Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center and Boston University School of Medicine, Boston, MA
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13
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Almohammadi AM, Huzaim RM. Level of physicians' awareness of antiepileptic drug adverse effects. Epilepsy Behav 2018; 89:59-62. [PMID: 30384101 DOI: 10.1016/j.yebeh.2018.09.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/18/2018] [Accepted: 09/27/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The study aimed to investigate the level of physicians' awareness regarding the adverse effects of antiepileptic drugs (AEDs) that were reported by their patients and to investigate whether these adverse effects caused by AEDs were documented in patients' files. PRINCIPAL RESULTS One hundred one patients and 21 physicians were recruited; one patient and 2 physicians did not take part in the study. Sixty-two percent of the patients had epileptic seizures for more than 3 years, and 74% of them had generalized seizures. Sodium valproate, carbamazepine, topiramate, vigabatrin, levetiracetam, and lamotrigine were the most frequently used AEDs by patients; whereas, phenytoin, clonazepam, and pregabalin were the least used. Drowsiness came on top on the adverse effects' list, where its occurrence was about twice the weight gain and almost three times as frequent as movement and behavioral adverse effects. CONCLUSION Majority of the adverse effects were not documented in the patients' files. However, physicians were aware of majority of the adverse effects associated with AEDs.
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Affiliation(s)
- Ameen Mosleh Almohammadi
- Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Ruqayah Mohamed Huzaim
- Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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14
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Bangma JT, Kwiatkowski E, Psioda M, Santos HP, Hooper SR, Douglass L, Joseph RM, Frazier JA, Kuban KCK, O'Shea TM, Fry RC. Assessing Positive Child Health among Individuals Born Extremely Preterm. J Pediatr 2018; 202:44-49.e4. [PMID: 30078720 PMCID: PMC6456448 DOI: 10.1016/j.jpeds.2018.06.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the development of a Positive Child Health Index (PCHI) based on 11 adverse outcomes and evaluate the association of PCHI with quality of life (QoL) scores in a preterm cohort. STUDY DESIGN A total of 889 children enrolled in the Extremely Low Gestational Age Newborn (ELGAN) study in 2002-2004 were followed up at 10 years of age. A parent/caregiver completed questionnaires for child QoL, asthma, visual or hearing impairment, gross motor function impairment, epilepsy, attention deficit/hyperactivity disorder, anxiety, and depression. The child was assessed for cognitive impairment, autism, and obesity. PCHI scores were computed and linear regression models were used to evaluate the relationship between QoL categories (psychosocial, physical, emotional, social, school, and total) and the PCHI (dichotomized and coded as a multilevel categorical predictor) and to assess sex differences. RESULTS Among ELGAN children, higher PCHI scores were associated with higher reported QoL scores for all QoL categories. Children with no disorders and a PCHI of 100% had Pediatric Quality of Life Inventory total scores that were 11 points higher than children with 1 or more adverse outcomes (PCHI of <100%). Boys had lower QoL scores for the total, psychosocial, social, and school categories. CONCLUSIONS Positive child health assessed using a quantitative PCHI was associated with QoL across the ELGAN cohort at school age. In the current study, the PCHI encompassed 11 outcomes assessed in ELGANs. Future research could include an enhanced panel of child health outcomes to support the use of PCHI as an indicator of positive child health.
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Affiliation(s)
- Jacqueline T Bangma
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Evan Kwiatkowski
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew Psioda
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hudson P Santos
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Robert M Joseph
- Department of Anatomy and Neuroanatomy, Boston University, Boston, MA
| | - Jean A Frazier
- Department of Psychiatry, University of Massachusetts Medical School/University of Massachusetts Memorial Health Care, Worcester, MA
| | - Karl C K Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA
| | - Thomas M O'Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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15
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Hirschberger RG, Kuban KCK, O'Shea TM, Joseph RM, Heeren T, Douglass LM, Stafstrom CE, Jara H, Frazier JA, Hirtz D, Rollins JV, Paneth N. Co-occurrence and Severity of Neurodevelopmental Burden (Cognitive Impairment, Cerebral Palsy, Autism Spectrum Disorder, and Epilepsy) at Age Ten Years in Children Born Extremely Preterm. Pediatr Neurol 2018; 79:45-52. [PMID: 29310907 PMCID: PMC5803305 DOI: 10.1016/j.pediatrneurol.2017.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study aims to determine the prevalence of neurodevelopmental impairments at age ten years among children born extremely preterm (less than 28 weeks gestational age) and to offer a framework for categorizing neurological limitations. METHODS A multicenter, prospective cohort follow-up study recruited 889 ten-year-old children born from 2002 to 2004. We assessed prevalence of cognitive impairment, measured by intelligent quotient and tests of executive function, cerebral palsy (CP), autism spectrum disorder (ASD), and epilepsy singly and in combination. The three levels of impairment severity were: category I-no major neurodevelopmental impairment; category II-normal cognitive ability with CP, ASD, and/or epilepsy; and category III-children with cognitive impairment. RESULTS A total 214 of 873 children (25%) had cognitive impairment, 93 of 849 children (11%) had CP, 61 of 857 children (7%) had ASD, and 66 of 888 children (7%) had epilepsy. Further, 19% of all children had one diagnosis, 10% had two diagnoses, and 3% had three diagnoses. Decreasing gestational age was associated with increasing number of impairments (P < 0.001). Half the children with cognitive impairment and one third of children with CP, ASD, or epilepsy had a single impairment. Six hundred one (68% [95% CI, 64.5%-70.7%]) children were in category I, 74 (8% [95% CI, 6.6%-10.3%]) were in category II, and 214 (24% [95% CI 21.7%-27.4%]) were in category III. CONCLUSIONS Three quarters of children had normal intellect at age ten years; nearly 70% were free of neurodevelopmental impairment. Forty percent of children with impairments had multiple diagnoses.
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Affiliation(s)
- Rachel G Hirschberger
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
| | - Karl C K Kuban
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | - Robert M Joseph
- Department of Psychology and Neuroanatomy, Boston University, Boston, Massachusetts
| | - Tim Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Laurie M Douglass
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hernan Jara
- Department of Radiology, Boston Medical Center, Boston University, Boston, Massachusetts
| | - Jean A Frazier
- Departments of Psychiatry and Pediatrics, UMASS Medical School/ University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Deborah Hirtz
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | | | - Nigel Paneth
- Department of Epidemiology and Biostatistics and Pediatrics and Human Development, Michigan State University, East Lansing, Michigan
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16
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Satterfield-Nash A, Kotzky K, Allen J, Bertolli J, Moore CA, Pereira IO, Pessoa A, Melo F, Santelli ACFES, Boyle CA, Peacock G. Health and Development at Age 19-24 Months of 19 Children Who Were Born with Microcephaly and Laboratory Evidence of Congenital Zika Virus Infection During the 2015 Zika Virus Outbreak - Brazil, 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:1347-1351. [PMID: 29240727 PMCID: PMC5730218 DOI: 10.15585/mmwr.mm6649a2] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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17
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Douglass LM, Heeren TC, Stafstrom CE, DeBassio W, Allred EN, Leviton A, O’Shea TM, Hirtz D, Rollins J, Kuban K. Cumulative Incidence of Seizures and Epilepsy in Ten-Year-Old Children Born Before 28 Weeks' Gestation. Pediatr Neurol 2017; 73:13-19. [PMID: 28619377 PMCID: PMC5524375 DOI: 10.1016/j.pediatrneurol.2017.05.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/01/2017] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We evaluated the incidence of seizures and epilepsy in the first decade of life among children born extremely premature (less than 28 weeks' gestation). METHOD In a prospective, multicenter, observational study, 889 of 966 eligible children born in 2002 to 2004 were evaluated at two and ten years for neurological morbidity. Complementing questionnaire data to determine a history of seizures, all caregivers were interviewed retrospectively for postneonatal seizures using a validated seizure screen followed by a structured clinical interview by a pediatric epileptologist. A second pediatric epileptologist established an independent diagnosis based on recorded responses of the interview. A third epileptologist determined the final diagnosis when evaluators disagreed (3%). Life table survival methods were used to estimate seizure incidence through ten years. RESULTS By age ten years, 12.2% (95% confidence interval: 9.8, 14.5) of children had experienced one or more seizures, 7.6% (95% confidence interval: 5.7, 9.5) had epilepsy, 3.2% had seizure with fever, and 1.3% had a single, unprovoked seizure. The seizure incidence increased with decreasing gestational age. In more than 75% of children with seizures, onset was after one year of age. Seizure incidence was comparable in both sexes. Two-thirds of those with epilepsy had other neurological disorders. One third of children with epilepsy were not recorded on the medical history questionnaire. SIGNIFICANCE The incidence of epilepsy through age ten years among children born extremely premature is approximately 7- to 14-fold higher than the 0.5% to 1% lifetime incidence reported in the general pediatric population. Seizures in this population are under-recognized, and possibly underdiagnosed, by parents and providers.
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Affiliation(s)
- Laurie M. Douglass
- Department of Pediatrics and Neurology, Boston Medical Center, Boston, MA, USA
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | | | - William DeBassio
- Department of Pediatrics and Neurology, Boston Medical Center, Boston, MA, USA
| | - Elizabeth N. Allred
- Harvard Medical School, Boston, MA, USA,Boston Children’s Hospital, Boston, MA, USA
| | - Alan Leviton
- Harvard Medical School, Boston, MA, USA,Boston Children’s Hospital, Boston, MA, USA
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Deborah Hirtz
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Julie Rollins
- Department of Pediatrics and Neurology, Boston Medical Center, Boston, MA, USA
| | - Karl Kuban
- Department of Pediatrics and Neurology, Boston Medical Center, Boston, MA, USA
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18
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Le Marne FA, McGinness H, Slade R, Cardamone M, Balbir Singh S, Connolly AM, Bye AM. Evaluation of an E-learning resource on approach to the first unprovoked seizure. J Paediatr Child Health 2016; 52:896-900. [PMID: 27650145 DOI: 10.1111/jpc.13277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/26/2016] [Accepted: 04/04/2016] [Indexed: 11/30/2022]
Abstract
AIM To develop and evaluate an online educational package instructing paediatricians and trainees in the diagnosis and management of a first unprovoked seizure in children. METHODS The E-learning content was created following a comprehensive literature review that referenced current international guidelines. Rigorous consultation with local paediatric neurologists, paediatricians and epilepsy nurses was undertaken. A series of learning modules was created and sequenced to reflect steps needed to achieve optimal diagnosis and management in a real-life situation of a child presenting with a paroxysmal event. Paediatric registrars and advanced trainees from the Sydney Children's Hospitals Network were assessed before and after using the E-learning Resource. Measures included general epilepsy knowledge, case-based scenario knowledge; self-rated measures of satisfaction with instruction and confidence regarding clinical approach to the child with first unprovoked seizure; and open ended questions evaluating the usefulness of the E-learning resource. RESULTS Performance on measures of general epilepsy knowledge and on the seizure-related case scenarios improved significantly following completion of the E-learning as did self-rated satisfaction with instruction and confidence across all aspects of managing first seizure. CONCLUSIONS The E-learning resource has been validated as a useful educational resource regarding the first afebrile unprovoked seizure for paediatricians.
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Affiliation(s)
- Fleur A Le Marne
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Hannah McGinness
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Rob Slade
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Michael Cardamone
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Shirleen Balbir Singh
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Anne M Connolly
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Ann Me Bye
- Department of Neurology, Level 4 Emergency Wing, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia. .,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.
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19
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Kuban KCK, Joseph RM, O’Shea TM, Allred EN, Heeren T, Douglass L, Stafstrom CE, Jara H, Frazier JA, Hirtz D, Leviton A. Girls and Boys Born before 28 Weeks Gestation: Risks of Cognitive, Behavioral, and Neurologic Outcomes at Age 10 Years. J Pediatr 2016; 173:69-75.e1. [PMID: 27004675 PMCID: PMC4884461 DOI: 10.1016/j.jpeds.2016.02.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare the prevalence of cognitive, neurologic, and behavioral outcomes at 10 years of age in 428 girls and 446 boys who were born extremely preterm. STUDY DESIGN A total of 889 of 966 eligible children previously enrolled in the multicenter Extremely Low Gestational Age Newborns Study from 2002-2004 were evaluated at 10 years of age. Children underwent a neuropsychological battery and testing for autism spectrum disorder (ASD), and parents reported on their child's behavior, development, and seizures. RESULTS Of the children, 28% of boys and 21% of girls exhibited moderate to severe impairment on summary measures of cognitive abilities. Boys had a higher prevalence of impairment than girls in nearly all measures of cognition, were more than twice as likely to have microcephaly (15% in boys, 8% in girls), and require more often assistive devices to ambulate (6% in boys, 4% in girls). In contrast, boys and girls had comparable risk for a history of seizure (identified in 10% of the cohort) or epilepsy (identified in 7% of the cohort). The boy-to-girl ratio of ASD (9% in boys, 5% in girls) was lower than expected compared with the overall US autism population. CONCLUSIONS In this contemporary cohort of children born extremely premature and evaluated at school age, boys had higher prevalence of cognitive, neurologic, and behavioral deficits than girls. The ratio of boys to girls among those with ASD deserves further study as does the perinatal environmental-genetic interactions that might contribute to male preponderance of deficits in this high-risk sample.
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Affiliation(s)
- Karl C. K. Kuban
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University, Boston, MA
| | - Thomas M. O’Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
| | - Elizabeth N. Allred
- Department of Neurology, Harvard Medical School, Boston, MA, USA,Department of Neurology, Neuroepidemiology Unit, Boston Children’s Hospital, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Laurie Douglass
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Carl E. Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD
| | - Hernan Jara
- Department of Radiology, Boston Medical Center, Boston University, Boston, USA
| | - Jean A. Frazier
- Department of Psychiatry, UMASS Medical School/ University of Massachusetts Memorial Health Care, Worcester, MA, USA
| | - Deborah Hirtz
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Alan Leviton
- Department of Neurology, Harvard Medical School, Boston, MA, USA,Department of Neurology, Neuroepidemiology Unit, Boston Children’s Hospital, Boston, MA, USA
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