Neurodevelopmental long-term outcome in children with hydrocephalus requiring neonatal surgical treatment

PURPOSE

To assess long-term neurodevelopmental outcome in children with hydrocephalus requiring neurosurgical treatment during the neonatal period.

METHODS

This prospective longitudinal population-based study included 43 children with neonatal shunted hydrocephalus. The 43 children were prospectively reviewed in the presence of their parents at the outpatient clinic. Cognitive and motor outcomes were assessed respectively using different Wechsler scales according to age and Gross Motor Function Classification System (GMFCS). Postoperative MRI was routinely performed.

RESULTS

The mean gestational age at birth of the 43 consecutive children with neonatal hydrocephalus (sex ratio M/F: 1.39) was 34.5±5.4 weeks of gestation. At mean follow-up of 10.4±4 years, mean total IQ was 73±27.7, with equivalent results in mean verbal and mean performance IQ. Of the 33 children with IQ evaluation, 18 presented an IQ≥85 (41.9%). Efficiency in walking without a mobility device (GMFCS≤2) was obtained in 37 children (86%). Only severity of postoperative ventricular dilation was significantly associated with unfavorable outcome (Evans index>0.37; odds ratio: 0.16, P=0.03).

CONCLUSION

This information could be provided to those families concerned who often experience anxiety when multi-disciplinary management of neonatal hydrocephalus is required.

Addition of sorbitol to a milk substitute for veal calves. II. Effects on plasma, liver and muscle lipids

Two homologous groups of preruminant male calves (10 control and 9 sorbitol) of the Friesian X Holstein crossbreed were used to study the effects of sorbitol on lipid metabolism. Between 1 and 8 weeks of age they received two diets (IC, IS) with high levels of protein and fat (23% of DM), and then between 8 and 19 weeks two diets (FC, FS) containing lower levels of protein and fat (21% of DM). Diets IC and FC contained no sorbitol, while in the IS and FS diets it accounted for 0.8% of DM. Blood samples were taken at 2, 3, 4, 7, 12 and 19 weeks of age and at the following times: 2 h before (T-2), and then 1/2 (T1/2), 2 (T2), 3 (T3), 5 (T5) and 7 (T7) hours after ingestion of the morning meal. At slaughter (19 weeks), samples of liver and of rectus abdominis muscle were taken from the carcasses. The addition of sorbitol to the replacer milks had no effect on plasma levels of nonesterified fatty acids or triglycerides. However at weeks 2, 7 and 12, the levels of free and esterified cholesterol decreased significantly by a mean of 60 and 15% respectively. Sorbitol intake significantly reduced muscle levels of triglycerides (6.8 mg/g of fresh tissue vs 18.6 mg/g), free cholesterol (0.41 mg/g vs 0.66) and total lipids (13.6 mg/g vs 26.1). Lipid composition of liver was not modified by sorbitol ingestion. An histological study confirmed that the diets caused no serious lesions. Generally, the results were more dispersed in the control group than in the sorbitol group.