scholarly journals Long-Term Outcomes of Perinatal Hypoxia and Asphyxia at an Early School Age

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 988
Author(s):  
Renata Dzikienė ◽  
Saulius Lukoševičius ◽  
Jūratė Laurynaitienė ◽  
Vitalija Marmienė ◽  
Irena Nedzelskienė ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Perinatal Asphyxia ◽  
Control Group ◽  
Case Group ◽  
School Age ◽  
Long Term Outcomes ◽  
Early School ◽  
Related Quality ◽  
Early School Age

Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: The case group children were 8–9-year-old children (n = 32) who were born at full term and experienced hypoxia or asphyxia at birth, where therapeutic hypothermia (TH) was not applied. The control group consisted of 8–9-year-old children (n = 16) born without hypoxia. A structured neurological examination was performed at an early school age. The neuromotor function was assessed using the Gross Motor Function Classification System (GMFCS). Health-related quality-of-life was assessed using the Health Utilities Index (HUI) questionnaire. Intellectual abilities were assessed using the Wechsler Intelligence Scale for Children (WISC). Results: The case group, compared with controls, had significantly (p = 0.002) lower mean [SD] full-scale IQ (87(16.86) vs. 107(12.15)), verbal-scale IQ (89(17.45) vs. 105(11.55)), verbal comprehension index (89(17.36) vs. 105(10.74)), working memory index (89(15.68) vs. 104(11.84)), performance IQ (87(16.51) vs. 108(15.48)) and perceptual organization index (85(15.71) vs. 105 (15.93)). We did not find any significant differences in the incidence of disorders of neurological examination, movement abilities and health-related quality of life at an early school age between the case and the control group children. Conclusion: In children who experienced perinatal asphyxia but did not have cerebral paralysis (CP), where therapeutic hypothermia was not applied, cognitive assessment scores at an early school age were significantly lower compared to those in the group of healthy children, and were at a low average level.

scholarly journals Effect of iron supplementation during pregnancy on the behaviour of children at early school age: long-term follow-up of a randomised controlled trial

2008 ◽  
Vol 99 (5) ◽  
pp. 1133-1139 ◽  
Author(s):  
Annie G. Parsons ◽  
Shao J. Zhou ◽  
Nicola J. Spurrier ◽  
Maria Makrides
Keyword(s):  
Placebo Group ◽  
Controlled Trial ◽  
Child Behaviour ◽  
School Age ◽  
Long Term Effects ◽  
Early School ◽  
Early School Age ◽  
In Pregnancy

Although routine Fe supplementation in pregnancy is a common practice, its clinical benefits or risks are uncertain. Children born to mothers in the Fe group in a trial of Fe supplementation in pregnancy have been found to have a significantly higher risk of abnormal behaviour at 4 years of age than those born to mothers in the placebo group. The objective of the present study therefore was to determine whether Fe supplementation in pregnancy influences child behaviour at early school age. The study was a follow-up of children at 6–8 years of age after women (n 430) were randomly allocated to receive a daily Fe supplement (20 mg) or placebo from 20 weeks gestation until delivery. The supplement reduced the incidence of Fe-deficiency anaemia at delivery from 9 % to 1 %. Child behaviour and temperament were assessed using the Strengths and Difficulties Questionnaire and the Short Temperament Scale for Children. Of the children, 264 (61 %) participated in the follow-up. Mean behaviour and temperament scores and the proportion of parent-rated and teacher-rated abnormal total difficulties scores did not differ between the Fe and placebo groups. However, the incidence of children with an abnormal teacher-rated peer problems subscale score was higher in the Fe group (eleven of 112 subjects; 8 %) than in the placebo group (three of 113 subjects; 2 %); the relative risk was 3·70 (95 % CI 1·06, 12·91; P = 0·026). We conclude that prenatal Fe supplementation had no consistent effect on child behaviour at early school age in this study population. Further investigation regarding the long-term effects of this common practice is warranted.

scholarly journals Toward a new understanding of legacy of early attachments for future antisocial trajectories: Evidence from two longitudinal studies

2012 ◽  
Vol 24 (3) ◽  
pp. 783-806 ◽  
Author(s):  
Grazyna Kochanska ◽  
Sanghag Kim
Keyword(s):  
Causal Chain ◽  
School Age ◽  
Infant Attachment ◽  
Child Study ◽  
Proposed Model ◽  
Early School ◽  
Early School Age ◽  
Early Parent ◽  
Parent Child

AbstractEarly parent–child attachment has been extensively explored as a contributor to children's future adaptive or antisocial outcomes, but the specific developmental mechanisms remain to be fully understood. We examined long-term indirect developmental sequelae of early security in two longitudinal community samples followed from infancy to early school age: the Family Study (102 mothers, fathers, and infants) and the Parent–Child Study (112 mothers and infants). Constructs at multiple levels (child characteristics, parent–child security, parental discipline, and child antisocial outcomes) were assessed using a range of methods (extensive behavioral observations in a variety of settings, informants' ratings). Both studies supported the proposed model of infant attachment as a potent catalyst that moderates future developmental socialization trajectories, despite having few long-term main effects. In insecure dyads, a pattern of coercion emerged between children who were anger prone as toddlers and their parents, resulting in parents' increased power-assertive discipline. Power assertion in turn predicted children's rule-breaking conduct and a compromised capacity to delay in laboratory paradigms, as well as oppositional, disruptive, callous, and aggressive behavior rated by parents and teachers at early school age. This causal chain was absent in secure dyads, where child anger proneness was unrelated to power assertion, and power assertion was unrelated to antisocial outcomes. Early insecurity appeared to act as a catalyst for the parent–child dyad embarking on a mutually adversarial path toward antisocial outcomes, whereas security defused such a maladaptive dynamic. The possible mechanisms of those effects were proposed.

scholarly journals Symbolization in the Structure of Abilities in Children of Preschool and School Age

2015 ◽  
Vol 11 (2) ◽  
pp. 48-56 ◽  
Author(s):  
A.N. Veraksa ◽  
V.A. Yakupova ◽  
M.N. Martynenko
Keyword(s):  
Effective Means ◽  
First Grade ◽  
Preschool Age ◽  
Educational Activity ◽  
Control Group ◽  
School Age ◽  
Learning Content ◽  
Early School ◽  
Mental Abilities ◽  
Early School Age

This research explores the role of symbolization in educational activity in children of late preschool and early school age. The aim of the research was to compare the efficiency of using sign and symbolic means (i.e. schemes and models) in the learning of some new content in preschool and early school age. The study involved 46 children of late preschool age from one of the Moscow kindergartens, 20 girls and 26 boys (M = 78 months); and 25 first grade students of one of the Moscow schools, 16 girls and 9 boys (M = 101 months). The study consisted of the following stages: carrying out tests of mental abilities and dividing the subjects into two sub¬groups within each age group (that is, two subgroups of preschool children and two subgroups of school chil¬dren) with equal levels of development of the explored abilities; conducting developmental lessons aimed at making the children familiar with phenomena characterizing phase transitions in states of aggregation of mat¬ter — with the help of symbolic means (in the experimental group) or sign means (in the control group); carrying out a posttest, that is, measuring the level of development of the concepts of aggregate states in all sub¬groups. The outcomes of the research indicated that symbolization may actually be an effective means of con¬structing learning content both in preschool and in early school age.

Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence

2020 ◽  
Vol 48 (4) ◽  
pp. 329-334
Author(s):  
Soo Jin Han ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Subeen Hong ◽  
Jeong Won Oh ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Control Group ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Monochorionic Twin ◽  
Increased Risk ◽  
Study Population

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

scholarly journals Long-Term Outcome after Asphyxia and Therapeutic Hypothermia in Late Preterm Infants: A Pilot Study

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 994
Author(s):  
Hanne Lademann ◽  
Karl Abshagen ◽  
Anna Janning ◽  
Jan Däbritz ◽  
Dirk Olbertz
Keyword(s):  
Pilot Study ◽  
Preterm Infants ◽  
Perinatal Asphyxia ◽  
Psychomotor Development ◽  
Long Term Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Developmental Index ◽  
Mental Developmental Index

Therapeutic hypothermia (THT) is the recommended treatment for neuroprotection in (near) term newborns that experience perinatal asphyxia with hypoxic-ischemic encephalopathy. The benefit of THT in preterm newborns is unknown. This pilot study aims to investigate long-term outcomes of late preterm asphyctic infants with and without THT compared to term infants. The single-center, retrospective analysis examined medical charts of infants with perinatal asphyxia born between 2008 and 2015. Long-term outcome was assessed using the Bayley Scales of Infant Development 2 at the age of (corrected) 24 months. Term (n = 31) and preterm (n = 8) infants with THT showed no differences regarding their long-term outcomes of psychomotor development (Psychomotor Developmental Index 101 ± 16 vs. 105 ± 11, p = 0.570), whereas preterm infants had a better mental outcome (Mental Developmental Index 105 ± 13 vs. 93 ± 18, p = 0.048). Preterm infants with and without (n = 69) THT showed a similar mental and psychomotor development (Mental Developmental Index 105 ± 13 vs. 96 ± 20, p = 0.527; Psychomotor Developmental Index 105 ± 11 vs. 105 ± 15, p = 0.927). The study highlights the importance of studying THT in asphyctic preterm infants. However, this study shows limitations and should not be used as a basis for decision-making in the clinical context. Results of a multicenter trial of THT for preterm infants (ID No.: CN-01540535) have to be awaited.

scholarly journals Combined low-dose everolimus and low-dose tacrolimus after Alemtuzumab induction therapy: a randomized prospective trial in lung transplantation

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alberto Benazzo ◽  
Ara Cho ◽  
Anna Nechay ◽  
Stefan Schwarz ◽  
Florian Frommlet ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Lung Transplantation ◽  
Kidney Function ◽  
Induction Therapy ◽  
Low Dose ◽  
Prospective Trial ◽  
Control Group ◽  
Long Term Outcomes ◽  
Maintenance Immunosuppression

Abstract Background Long-term outcomes of lung transplantation are severely affected by comorbidities and development of chronic rejection. Among the comorbidities, kidney insufficiency is one of the most frequent and it is mainly caused by the cumulative effect of calcineurin inhibitors (CNIs). Currently, the most used immunosuppression protocols worldwide include induction therapy and a triple-drug maintenance immunosuppression, with one calcineurin inhibitor, one anti-proliferative drug, and steroids. Our center has pioneered the use of alemtuzumab as induction therapy, showing promising results in terms of short- and long-term outcomes. The use of alemtuzumab followed by a low-dose double drug maintenance immunosuppression, in fact, led to better kidney function along with excellent results in terms of acute rejection, chronic lung allograft dysfunction, and survival (Benazzo et al., PLoS One 14(1):e0210443, 2019). The hypothesis driving the proposed clinical trial is that de novo introduction of low-dose everolimus early after transplantation could further improve kidney function via a further reduction of tacrolimus. Based on evidences from kidney transplantation, moreover, alemtuzumab induction therapy followed by a low-dose everolimus and low-dose tacrolimus may have a permissive action on regulatory immune cells thus stimulating allograft acceptance. Methods A randomized prospective clinical trial has been set up to answer the research hypothesis. One hundred ten patients will be randomized in two groups. Treatment group will receive the new maintenance immunosuppression protocol based on low-dose tacrolimus and low-dose everolimus and the control group will receive our standard immunosuppression protocol. Both groups will receive alemtuzumab induction therapy. The primary endpoint of the study is to analyze the effect of the new low-dose immunosuppression protocol on kidney function in terms of eGFR change. The study will have a duration of 24 months from the time of randomization. Immunomodulatory status of the patients will be assessed with flow cytometry and gene expression analysis. Discussion For the first time in the field of lung transplantation, this trial proposes the combined use of significantly reduced tacrolimus and everolimus after alemtuzumab induction. The new protocol may have a twofold advantage: (1) further reduction of nephrotoxic tacrolimus and (2) permissive influence on regulatory cells development with further reduction of rejection episodes. Trial registration EUDRACT Nr 2018-001680-24. Registered on 15 May 2018

Sign in / Sign up

Export Citation Format

Share Document