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Adams-Chapman I, Heyne RJ, DeMauro SB, Duncan AF, Hintz SR, Pappas A, Vohr BR, McDonald SA, Das A, Newman JE, Higgins RD. Neurodevelopmental Impairment Among Extremely Preterm Infants in the Neonatal Research Network. Pediatrics 2018; 141:e20173091. [PMID: 29666163 PMCID: PMC5914487 DOI: 10.1542/peds.2017-3091] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Evaluate the spectrum of neurodevelopmental outcome in a contemporary cohort of extremely preterm infants. We hypothesize that the rate of severe neurodevelopmental impairment (NDI) decreases over time. METHODS Retrospective analysis of neurodevelopmental outcome of preterm infants ≤27 weeks' gestational age (GA) from a Neonatal Research Network center that completed neurodevelopmental follow-up assessments between April 1, 2011, and January 1, 2015. The Bayley Scales of Infant Development-III (BSID III) and a standardized neurosensory examination were performed between 18 and 26 months' adjusted age. Outcome measures were neurologic examination diagnoses, BSID III cognitive and motor scores, sensory impairment, and the composite outcome of NDI, based on the BSID III cognitive score (analyzed by using a cutoff of <85 or <70), BSID III motor score of <70, moderate or severe cerebral palsy (CP), bilateral blindness, and hearing impairment. RESULTS Two thousand one hundred and thirteen infants with a mean GA of 25.0 ± 1.0 weeks and mean birth weight of 760 ± 154 g were evaluated. The 11% lost to follow-up were less likely to have private insurance, late-onset sepsis, or severe intraventricular hemorrhage. Neurologic examination results were normal in 59%, suspect abnormal in 19%, and definitely abnormal in 22%. Severe CP decreased 43% whereas mild CP increased 13% during the study. The rate of moderate to severe NDI decreased from 21% to 16% when using the BSID III cognitive cutoff of <70 (P = .07) or from 34% to 31% when using the BSID III cognitive cutoff of <85 (P = .67). CONCLUSIONS Extremely preterm children are at risk for NDI. Over time, the rate of moderate to severe NDI did not differ, but the rates of severe CP decreased, and mild CP increased.
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Affiliation(s)
- Ira Adams-Chapman
- Department of Pediatrics, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia;
| | - Roy J Heyne
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sara B DeMauro
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea F Duncan
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Betty R Vohr
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
| | - Scott A McDonald
- Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Rockville, Maryland; and
| | - Jamie E Newman
- Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Rosemary D Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Pereira A, Lopes S, Magalhães P, Sampaio A, Chaleta E, Rosário P. How Executive Functions Are Evaluated in Children and Adolescents with Cerebral Palsy? A Systematic Review. Front Psychol 2018; 9:21. [PMID: 29467685 PMCID: PMC5808176 DOI: 10.3389/fpsyg.2018.00021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/09/2018] [Indexed: 11/18/2022] Open
Abstract
Aims: The aim of the present study was to examine how executive functions are assessed in children and adolescents with Cerebral Palsy. Method: A systematic literature review was conducted using four bibliographic databases (WebScience, Scopus, PubMed, and Psycinfo), and only studies that evaluated at least one executive function were selected. Both the research and reporting of results were based on Cochrane's recommendations and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Results: The instrument most frequently used was the D-KEFS. All studies point to the existence of impairments in the executive functions among children and adolescents with Cerebral Palsy with an impact on several cognitive and life domains. Interpretation: There is a need to further systematize the research protocols to study the executive functions and their assessment in the intervention context. Findings of this review presented a diversity of tests (e.g., D-KEFS) or tasks (e.g., The inhibitory ability task) used with children with Cerebral Palsy. However, no information was given about adaptations performed to the test/task to meet Cerebral Palsy's specificities. Future research could consider including this information, which is key both to researchers and practitioners. The results of this study have important implications and suggestions for future avenues and guidelines for research and practice.
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Affiliation(s)
- Armanda Pereira
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Sílvia Lopes
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Paula Magalhães
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Adriana Sampaio
- Neuropsychophysiology Lab, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Elisa Chaleta
- Department of Psychology, CIEP, School of Social Science, University of Évora, Évora, Portugal
| | - Pedro Rosário
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, Braga, Portugal
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Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy? Dev Med Child Neurol 2018; 60:147-154. [PMID: 29105760 DOI: 10.1111/dmcn.13602] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Robert Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, PA, USA
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Bernardo J, Friedman H, Minich N, Taylor HG, Wilson-Costello D, Hack M. Cognitive and motor function of neurologically impaired extremely low birth weight children. Paediatr Child Health 2015; 20:e33-7. [PMID: 26435676 DOI: 10.1093/pch/20.6.e33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rates of neurological impairment among extremely low birth weight children (ELBW [<1 kg]) have decreased since 2000; however, their functioning is unexamined. OBJECTIVE To compare motor and cognitive functioning of ELBW children with neurological impairment, including cerebral palsy and severe hypotonia/hypertonia, between two periods: 1990 to 1999 (n=83) and 2000 to 2005 (n=34). METHODS Measures of function at 20 months corrected age included the Mental and Psychomotor Developmental Indexes of the Bayley Scales of Infant Development and the Gross Motor Functional Classification System as primary outcomes and individual motor function items as secondary outcomes. RESULTS Analysis failed to reveal significant differences for the primary outcomes, although during 2000 to 2005, sitting significantly improved in children with neurological impairment (P=0.003). CONCLUSION Decreases in rates of neurological impairment among ELBW children have been accompanied by a suggestion of improved motor function, although cognitive function has not changed.
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Affiliation(s)
- Janine Bernardo
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Harriet Friedman
- Department of Pediatrics, University Hospitals of Cleveland Case Medical Center, Cleveland, Ohio, USA
| | - Nori Minich
- Department of Pediatrics, University Hospitals of Cleveland Case Medical Center, Cleveland, Ohio, USA
| | - H Gerry Taylor
- Department of Pediatrics, University Hospitals of Cleveland Case Medical Center, Cleveland, Ohio, USA
| | - Deanne Wilson-Costello
- Department of Pediatrics, University Hospitals of Cleveland Case Medical Center, Cleveland, Ohio, USA
| | - Maureen Hack
- Department of Pediatrics, University Hospitals of Cleveland Case Medical Center, Cleveland, Ohio, USA
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Parikh NA, Kennedy KA, Lasky RE, Tyson JE. Neurodevelopmental Outcomes of Extremely Preterm Infants Randomized to Stress Dose Hydrocortisone. PLoS One 2015; 10:e0137051. [PMID: 26376074 PMCID: PMC4573756 DOI: 10.1371/journal.pone.0137051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/11/2015] [Indexed: 12/17/2022] Open
Abstract
Objective To compare the effects of stress dose hydrocortisone therapy with placebo on survival without neurodevelopmental impairments in high-risk preterm infants. Study Design We recruited 64 extremely low birth weight (birth weight ≤1000g) infants between the ages of 10 and 21 postnatal days who were ventilator-dependent and at high-risk for bronchopulmonary dysplasia. Infants were randomized to a tapering 7-day course of stress dose hydrocortisone or saline placebo. The primary outcome at follow-up was a composite of death, cognitive or language delay, cerebral palsy, severe hearing loss, or bilateral blindness at a corrected age of 18–22 months. Secondary outcomes included continued use of respiratory therapies and somatic growth. Results Fifty-seven infants had adequate data for the primary outcome. Of the 28 infants randomized to hydrocortisone, 19 (68%) died or survived with impairment compared with 22 of the 29 infants (76%) assigned to placebo (relative risk: 0.83; 95% CI, 0.61 to 1.14). The rates of death for those in the hydrocortisone and placebo groups were 31% and 41%, respectively (P = 0.42). Randomization to hydrocortisone also did not significantly affect the frequency of supplemental oxygen use, positive airway pressure support, or need for respiratory medications. Conclusions In high-risk extremely low birth weight infants, stress dose hydrocortisone therapy after 10 days of age had no statistically significant effect on the incidence of death or neurodevelopmental impairment at 18–22 months. These results may inform the design and conduct of future clinical trials. Trial Registration ClinicalTrials.gov NCT00167544
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Affiliation(s)
- Nehal A. Parikh
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, United States of America
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH, United States of America
- * E-mail:
| | - Kathleen A. Kennedy
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX, United States of America
| | - Robert E. Lasky
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX, United States of America
| | - Jon E. Tyson
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX, United States of America
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Duncan AF, Bann C, Boatman C, Hintz SR, Vaucher YE, Vohr BR, Yolton K, Heyne RJ. Do currently recommended Bayley-III cutoffs overestimate motor impairment in infants born <27 weeks gestation? J Perinatol 2015; 35:516-21. [PMID: 25634519 PMCID: PMC4531094 DOI: 10.1038/jp.2014.243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/14/2014] [Accepted: 11/20/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether a Bayley-III motor composite score of 85 may overestimate moderate-severe motor impairment by analyzing Bayley-III motor components and developing cut-point scores for each. STUDY DESIGN Retrospective study of 1183 children born <27 weeks gestation at NICHD Neonatal Research Network centers and evaluated at 18-22 months corrected age. Gross Motor Function Classification System determined gross motor impairment. Statistical analyses included linear and logistic regression and sensitivity/specificity. RESULTS Bayley-III motor composite scores were strong indicators of gross/fine motor impairment. A motor composite cut-point of 73 markedly improved the specificity for identifying gross and/or fine motor impairment (94% compared with a specificity of 76% for the proposed new cut-point of 85). A Fine Motor Scaled Score <3 differentiated mild from moderate-severe fine motor impairment. CONCLUSIONS This study indicates that a Bayley-III motor composite score of 85 may overestimate impairment. Further studies are needed employing term controls and longer follow-up.
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Affiliation(s)
- Andrea F. Duncan
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Carla Bann
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC, USA
| | | | - Susan R. Hintz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yvonne E. Vaucher
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Betty R. Vohr
- Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, RI, USA
| | - Kimberly Yolton
- Department of Pediatrics, Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Roy J. Heyne
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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Soleimani F, Zaheri F, Abdi F. Long-term neurodevelopmental outcomes after preterm birth. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e17965. [PMID: 25068052 PMCID: PMC4102985 DOI: 10.5812/ircmj.17965] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/13/2014] [Accepted: 04/05/2014] [Indexed: 11/16/2022]
Abstract
CONTEXT All over the the world, preterm birth is a major cause of death and important neurodevelopmental disorders. Approximately 9.6% (12.9 million) births worldwide are preterm. EVIDENCE ACQUISITION In this review, databases such as PubMed, EMBASE, ISI, Scopus, Google Scholar and Iranian databases including Iranmedex, and SID were researched to review relevant literature. A comprehensive search was performed using combinations of various keywords. RESULTS Cerebral palsy especially spastic diplegia, intellectual disability, visual (retinopathy of prematurity) and hearing impairments are the main neurodevelopmental disorders associated with prematurity. CONCLUSIONS The increased survival of preterm infants was not associated with lower complications. There is now increasing evidence of sustained adverse outcomes into school age and adolescence, for preterm infants.
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Affiliation(s)
- Farin Soleimani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Farzaneh Zaheri
- Department of Midwifery, Kurdistan University of Medical Sciences, Sanandaj, IR Iran
| | - Fatemeh Abdi
- Students Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Fatemeh Abdi, Students Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-09122018795, E-mail:
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Abstract
Survival of extremely preterm infants has improved since 2000. Neurodevelopmental impairment rates remain high at the limits of viability. Although improved survival and neurodevelopmental impairment rates are associated with higher gestational age and more recent year of birth, significant variability in findings among geographic areas and networks is evident, and seems related to differences in population, management style, regional protocols, definitions, and outcome assessments. Outcome studies during adolescence and young adult age are needed to determine the long-term impact of extremely preterm birth.
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Affiliation(s)
- Betty R Vohr
- Neonatal Follow-up Program, Women and Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA.
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Spittle AJ, Spencer-Smith MM, Eeles AL, Lee KJ, Lorefice LE, Anderson PJ, Doyle LW. Does the Bayley-III Motor Scale at 2 years predict motor outcome at 4 years in very preterm children? Dev Med Child Neurol 2013; 55:448-52. [PMID: 23216518 DOI: 10.1111/dmcn.12049] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2012] [Indexed: 11/29/2022]
Abstract
AIM To assess the predictive validity of the Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III) for later motor outcome. METHOD Ninety-six infants (49 males, 47 females) born at less than 30 weeks' gestation admitted to two tertiary hospitals in Melbourne, Australia, were assessed with the Bayley-III Motor Scale at 2 years' corrected age and were classified as suspect or definite motor impairment if they scored less than -1 or -2 standard deviations respectively, relative to the test mean. At 4 years' corrected age, children completed Movement Assessment Battery for Children - Second Edition (MABC-2); for the total motor score, cut-offs of not more than the 15th were used to classify motor development and cut-offs of not more than the 15th centile were classified as having a significant movement difficulty. RESULTS Of the 96 children assessed at both ages, at 2 years 9% had suspect and 4% had definite motor impairment; however, by 4 years, rates had increased to 22% and 19% respectively. The specificity of the Bayley-III for motor impairments for later motor outcome was excellent (ranging from 94 to 100% for cerebral palsy [CP] and 97 to 100% for motor impairment), although the sensitivity was low (ranging from 67 to 83% for CP and 18 to 37% for motor impairment); many children with later impairment were not identified by the Bayley-III. INTERPRETATION The Bayley-III Motor Scale at 2 years underestimates later rates of motor impairment, particularly in the absence of CP at 4 years on the MABC-2 total motor score in children born at less than 30 weeks' gestational age.
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Affiliation(s)
- Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
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Ballot DE, Potterton J, Chirwa T, Hilburn N, Cooper PA. Developmental outcome of very low birth weight infants in a developing country. BMC Pediatr 2012; 12:11. [PMID: 22296705 PMCID: PMC3293066 DOI: 10.1186/1471-2431-12-11] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 02/01/2012] [Indexed: 11/15/2022] Open
Abstract
Background Advances in neonatal care allow survival of extremely premature infants, who are at risk of handicap. Neurodevelopmental follow up of these infants is an essential part of ongoing evaluation of neonatal care. The neonatal care in resource limited developing countries is very different to that in first world settings. Follow up data from developing countries is essential; it is not appropriate to extrapolate data from units in developed countries. This study provides follow up data on a population of very low birth weight (VLBW) infants in Johannesburg, South Africa. Methods The study sample included all VLBW infants born between 01/06/2006 and 28/02/2007 and discharged from the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Bayley Scales of Infant and Toddler Development Version 111 (BSID) 111 were done to assess development. Regression analysis was done to determine factors associated with poor outcome. Results 178 infants were discharged, 26 were not available for follow up, 9 of the remaining 152 (5.9%) died before an assessment was done; 106 of the remaining 143 (74.1%) had a BSID 111 assessment. These 106 patients form the study sample; mean birth weight and mean gestational age was 1182 grams (SD: 197.78) and 30.81 weeks (SD: 2.67) respectively. The BSID (111) was done at a median age of 16.48 months. The mean cognitive subscale was 88.6 (95% CI: 85.69 - 91.59), 9 (8.5%) were < 70, mean language subscale was 87.71 (95% CI: 84.85 - 90.56), 10 (9.4%) < 70, and mean motor subscale was 90.05 (95% CI: 87.0 - 93.11), 8 (7.6%) < 70. Approximately one third of infants were identified as being at risk (score between 70 and 85) on each subscale. Cerebral palsy was diagnosed in 4 (3.7%) of babies. Factors associated with poor outcome included cystic periventricular leukomalacia (PVL), resuscitation at birth, maternal parity, prolonged hospitalisation and duration of supplemental oxygen. PVL was associated with poor outcome on all three subscales. Birth weight and gestational age were not predictive of neurodevelopmental outcome. Conclusion Although the neurodevelopmental outcome of this group of VLBW infants was within the normal range, with a low incidence of cerebral palsy, these results may reflect the low survival of babies with a birth weight below 900 grams. In addition, mean subscale scores were low and one third of the babies were identified as "at risk", indicating that this group of babies warrants long-term follow up into school going age.
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Affiliation(s)
- Daynia E Ballot
- Department of Paediatrics and Child Health, University of the Witwatersrand, PO Wits 2050, South Africa.
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Aisen ML, Kerkovich D, Mast J, Mulroy S, Wren TAL, Kay RM, Rethlefsen SA. Cerebral palsy: clinical care and neurological rehabilitation. Lancet Neurol 2011; 10:844-52. [PMID: 21849165 DOI: 10.1016/s1474-4422(11)70176-4] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cerebral palsy (CP) is defined as motor impairment that limits activity, and is attributed to non-progressive disturbances during brain development in fetuses or infants. The motor disorders of CP are frequently accompanied by impaired cognition, communication, and sensory perception, behavioural abnormalities, seizure disorders, or a combination of these features. CP is thought to affect three to four individuals per 1000 of the general population. The incidence, prevalence, and most common causes of CP have varied over time because of changes in prenatal and paediatric care. Medical management of children and adults involves care from primary-care physicians with input from specialists in neurology, orthopaedics, and rehabilitation medicine. Physicians should also work in conjunction with rehabilitation therapists, educators, nurses, social care providers, and schoolteachers. The focus of rehabilitation treatment has recently shifted to neurological rehabilitation in response to increasing evidence for neuroplasticity. This approach aims to improve development and function by capitalising on the innate capacity of the brain to change and adapt throughout the patient's life. As the life expectancy of individuals with CP approaches that of the general population, therapies must be developed that address the needs of adults ageing with disability.
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Affiliation(s)
- Mindy Lipson Aisen
- Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA.
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Placencia FX, McCullough LB. The History of Ethical Decision Making in Neonatal Intensive Care. J Intensive Care Med 2011; 26:368-84. [DOI: 10.1177/0885066610393315] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neonatal ethics has focused on 2 questions: is withholding potentially live-saving treatment from neonates ethically justified? and if so, who has the authority to decide? This article details how these questions developed and provides a description of the possible answers. In the first section, we review a selection of seminal articles by noted authors in the fields of ethics, medicine, and law. The second section provides a detailed account of the development of the Baby Doe Regulations and the impact they had on neonatal ethics, with particular attention to the emergence of the Best Interest Standard as a guideline for decision making. In the last section, we review the landmark position statements by the American Academy of Pediatric (AAP), and the focus on evidence-based decision making. We conclude that forgoing life-saving treatment is ethically justified. However, this requires a rigorous evidence-based process and is limited by the Best Interest Standard. The second question is more difficult to answer, but we feel that in light of legal limitations, physicians acting as both the infant advocate and a proxy for the state, decide what falls in the range of acceptable treatment options, with the parents free to choose within that range.
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Affiliation(s)
- Frank X. Placencia
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, and Texas Children’s Hospital, Houston, TX, USA
| | - Laurence B. McCullough
- Dalton Tomlin Chair in Medical Ethics and Health Policy, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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KOERTE INGA, PELAVIN PAULA, KIRMESS BERIT, FUCHS TERESA, BERWECK STEFFEN, LAUBENDER RUEDIGERPAUL, BORGGRAEFE INGO, SCHROEDER SEBASTIAN, DANEK ADRIAN, RUMMENY CLAUDIA, REISER MAXIMILIAN, KUBICKI MAREK, SHENTON MARTHAE, ERTL-WAGNER BIRGIT, HEINEN FLORIAN. Anisotropy of transcallosal motor fibres indicates functional impairment in children with periventricular leukomalacia. Dev Med Child Neurol 2011; 53:179-86. [PMID: 21121906 PMCID: PMC3057566 DOI: 10.1111/j.1469-8749.2010.03840.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM In children with bilateral spastic cerebral palsy (CP), periventricular leukomalacia (PVL) is commonly identified on magnetic resonance imaging. We characterized this white matter condition by examining callosal microstructure, interhemispheric inhibitory competence (IIC), and mirror movements. METHOD We examined seven children (age range 11y 9mo-17y 9mo, median age 15y 10mo, four females, three males) with bilateral spastic CP/PVL (Gross Motor Function Classification System level I or II, Manual Ability Classification System level I) and 12 age-matched controls (age range 11y 7mo-17y 1mo, median age 15y 6mo, seven females, five males). Fractional anisotropy of the transcallosal motor fibres (TCMF) and the corticospinal tract (CST) of both sides were calculated. The parameters of IIC (transcranial magnetic stimulation) and mirror movements were measured using a standardized clinical examination and a computer-based hand motor test. RESULTS Fractional anisotropy was lower in children with bilateral spastic CP/PVL regarding the TCMF, but not the left or right CST. Resting motor threshold was elevated in children with bilateral spastic CP/PVL whereas measures of IIC tended to be lower. Mirror movements were markedly elevated in bilateral spastic CP/PVL. INTERPRETATION This study provides new information on different aspects of motor function in children with bilateral spastic CP/PVL. Decreased fractional anisotropy of TCMF is consistent with impairment of hand motor function in children with bilateral spastic CP/PVL. The previously overlooked microstructure of the TCMF may serve as a potential indicator for hand motor function in patients with bilateral spastic CP/PVL.
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Affiliation(s)
- INGA KOERTE
- Institute of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - PAULA PELAVIN
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - BERIT KIRMESS
- Pediatric Neurology and Developmental Medicine, Dr von Hauners Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - TERESA FUCHS
- Pediatric Neurology and Developmental Medicine, Dr von Hauners Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - STEFFEN BERWECK
- Pediatric Neurology and Developmental Medicine, Dr von Hauners Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - RUEDIGER PAUL LAUBENDER
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany
| | - INGO BORGGRAEFE
- Pediatric Neurology and Developmental Medicine, Dr von Hauners Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - SEBASTIAN SCHROEDER
- Pediatric Neurology and Developmental Medicine, Dr von Hauners Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - ADRIAN DANEK
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - CLAUDIA RUMMENY
- Institute of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - MAXIMILIAN REISER
- Institute of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - MAREK KUBICKI
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - MARTHA E SHENTON
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, Brockton, MA, USA
| | - BIRGIT ERTL-WAGNER
- Institute of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - FLORIAN HEINEN
- Pediatric Neurology and Developmental Medicine, Dr von Hauners Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
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