P08.03 Separation and divorce after the diagnosis of child’s brain tumor

BACKGROUND

The diagnosis of a child’s brain tumor is a terrible situation for every member of the family. Numerous are the case of separations and divorces in Italy after a diagnosis of a child’s cancer. In particular, it happens with parents of children affected with brain tumor, being the most frequent solid tumor and the first cause of a tumor child’s death. The crisis related to the discovery of a tumor consists of four phases: shock, reaction, processing and re-orientation. It can happen that the diagnosis, experienced as a traumatic experience, can unite the family members as well as separate them. If there is already a process of family disintegration, a trauma can be a cause for breakup. The aim of our study was to investigate the possible correlation between brain tumor diagnosis in children and parental separations/divorces.

MATERIAL AND METHODS

We considered 427 patients afferent from 2012 to 2018 to the Neuro-Oncology Unit of the Meyer Children’s Hospital. Brain tumors are the 55–60% of all the tumors of our hospital, with an extra-regionality greater than 65%. The data analysis was conducted through information obtained directly from the families during follow-up visits or by telephone interviews.

RESULTS

Consistent with literature data in our series, the most frequent brain tumors were low-grade gliomas medulloblastomas, high-grade gliomas, ependymomas, midline diffuse gliomas, craniopharyngiomas, germ cell tumors and other rare pediatric tumors. The population was divided in 16 females and 18 males from different Italian regions: 65% from Central Italy, 23% from the South and Islands, 12% from the North. Data analysis showed 34 cases of separation and/or divorce, equal to 7% of our whole population, during treatment and more frequently at the end of treatment or after death. The median age of the 34 patients at the diagnosis of brain tumor was 9.5 years (range 1–19 years), with a higher percentage of cases of separations (41%) for parents of patients aged 10 years-14 years; 7 were the cases of separation and/or divorce when the diagnosis of brain tumor was made around 12–48 months after the child birth.

CONCLUSION

The diagnosis of a child’s brain tumor can generate stress in the family leading to different reactions, such as conflicts between parents or a real family crisis. The results of our study suggest a possible correlation between the diagnosis of a child’s brain tumor and the cases of separation and/or divorce. High risk medulloblastomas and high-grade gliomas that are likely to have a shorter path due to the unfavorable prognosis of the disease, appear to be the pathologies more often related to situations of family disputes. However, further investigations are necessary to verify the trend emerged from our study respect to the normal population.

P04.08 The role of SCN1A in glioblastomas and mixed neuronal glial tumors of pediatric age

BACKGROUND

Low and high grade gliomas, are the most common pediatric central nervous system (CNS) tumors and they show an extremely broad range of clinical behavior. Pediatric glioma is distinct from its adult counterpart with different genetic/epigenetic profile and biological features. Recently, several studies have shown the involvement of voltage-gated Na+ channels (VGSC) in different types of cancer, including gliomas. VGSC are multimeric transmembrane complexes, responsible for membrane depolarization in excitable cells playing an important role also in cell proliferation, migration, apoptosis and differentiation. VGSC are therapeutic targets in cardiovascular and neurological disorders and, in cancers, they could be a novel target for the development of promising anticancer therapy

MATERIAL AND METHODS

Firstly, we explored the genetic background of 9 pediatric glioblastomas (1–9 pGBMs), through whole-exome sequencing (WES) using HiSeq1000 platform (Illumina) with paired-end approach. On the basis of our results, we extended our study in another group of 16 epileptogenic mixed neuronal-glial tumors of pediatric age, (WHO grade I and II), through an amplicon approach (TSCA) using MiniSeq System platform (Illumina)

RESULTS

We identified variants in SCN1A gene in 3/9 pGBMs: case 3 had c.5782C>G in tumor and blood; case 5 showed c.2278G>T and two mosaic variants (c.5933C>T, 22% and c.4942C>T, 14%); case 6 showed c.667G>T variant only in tumor, and not in other non tumoral tissues (blood, urine and buccal swab). No variants in SCN1A were identified in a group of 16 pediatric mixed gliomas

CONCLUSION

In this study, we explore the genetic background of two groups of pediatric neuroepithelial brain tumors, through Next generation sequencing approach. We identified only in pGBMs variants in SCN1A gene that encoded for VGSCs and is involved in a spectrum of early-onset epileptic encephalopathies. None of our mutated patients showed history of epilepsy. Now, it is not clear the significance of these variants in pGBMs but interestingly, these variants are present in pGBM and not in mixed gliomas. Further studies on a big cohort of patients are needed to establish if they could play a role in pGBMs aggressiveness, migration and progression. Moreover, VGSCs could be a pharmacological target in pGBMs treatment

Strategy for promoting greater responsiveness in adolescent parent/infant relationships: report of a pilot study

A small pilot study tested an interaction coaching procedure designed to increase the level of responsiveness in adolescent parent/infant interaction behavior with 12 teenage parents and their infants. There was a significant increase in the level of responsiveness and parental self-esteem scores after the intervention compared with those before the intervention. Although the sample size was small, the results are encouraging and suggest further development of the intervention, Interaction Coaching for Adolescent Parents and their Infants (ICAP).

Behavioral and psychophysiologic assessment of the preterm infant

Cardiorespiratory activity was recorded during attentional responsivity on the Brazelton scale in term and preterm infants. Preterm infants showed less heart rate deceleration, less heart rate variance and less power in the ECG spectrum at frequencies associated with respiratory sinus arrhythmia and oscillations in blood pressure: A lower threshold for attentional stimulation in the preterm infant may trigger a CNS mechanism that protects the infant from stimulus overload. Study of the coordination between behavioral and physiological reactivity provides an understanding of the role of the CNS in mediating information processing.

An instrument for the measurement of infant-adult synchrony

The Dyadic Mini Code (DMC) is designed to measure levels of synchrony in early infant-adult interaction. Based on important components of synchronous interaction reported in the literature, the instrument consists of six items, a total score, and a summary rating. Videotapes of 38 term and preterm mother-infant pairs were studied to establish reliability and validity of the tool. Interrater reliability was determined using Cohen's kappa and percent of agreement; kappa was .86 for the total score and ranged from .63 to .92 for each of the six items. A discrimination index, applied to each item, indicated that four items are good predictors of the final rating and two require further testing. Dyadic Mini Code summary ratings compared to mean coherence values computed from Monadic Phase Scale (Tronick, Als, & Brazelton, 1980) scores on the same data yielded moderate concurrent validity; point bi-serial analysis, rpb = .488, p less than .01; and chi 2 = 4.878, df = 1, Fisher's exact test (1-tail) = p less than .05. Construct validity was demonstrated by finding that the instrument discriminated between preterm and term dyads according to expected differences, chi 2 = 4.071, df = 1, Fisher's exact test (1-tail) = p less than .05. Further refinement of the DMC is indicated.

Home care of the high-risk newborn

When a newborn at high risk because of prematurity is discharged from the hospital, the family involved faces a time of crisis. Because parents experience increased stress during the transition to home care, both the parents and their infant are vulnerable to the effects of the added stress on the family's health and well-being. Community nursing intervention is a necessary component of care for the family of a high-risk newborn. Nursing strategies that address specific counseling and teaching needs of the family of a high-risk newborn are presented.

Rhythmic patterning in mother-newborn interaction

Face-to-face, dyadic interaction in term and preterm mother-newborn pairs was examined for a rhythmic pattern at 40 weeks gestational age. Three-minute interaction episodes for each mother-infant pair were recorded on videotape and scored with a dyadic code graded along a dimension of disengagement-engagement. Spectral analysis was used to analyze the data for rhythmicity. A reliable rhythmic structure was found in all dyadic interactions. No significant difference was evident between term and preterm dyads. The findings provide quantitative evidence of rhythmic patterning in dyadic interaction from birth for term pairs and as early as 40 weeks gestation for preterm pairs, which is much earlier than previously reported in the literature. The Dyadic Interaction Code, a new tool for studying the interaction process over time, is described, and a recently reported method of analysis (spectral analysis) for interaction data is applied to mother-newborn behavioral data.