Search PubMed⌕ Search

Biomedical subjects

J H Ellenberg

Publications and source records attributed to J H Ellenberg.

At least 55 records · Page 3Linked to original sources
PubMed1985

Antecedents of cerebral palsy. I. Univariate analysis of risks.

A large prospective study investigated prenatal and perinatal antecedents of chronic motor dysfunction (cerebral palsy [CP]), evaluating approximately 400 characteristics of the mothers, pregnancies, or deliveries. In addition to confirming some, but not all, of the classic risk factors for CP, this study observed relatively large increases in the CP rate in association with maternal mental retardation, seizure disorders, hyperthyroidism, or with the administration of thyroid hormone and estrogen in pregnancy. Some risk factors were predictive of CP only insofar as they were associated with low birth weight or low Apgar scores. Among factors not significantly related to CP rate were maternal age, parity, socioeconomic status, smoking history, maternal diabetes, first trimester vaginal bleeding, kidney or bladder infection, moderate hypertension, long cord, use of anesthetic agents, or use of oxytoxics for initiation or augmentation of labor. Duration of labor, whether precipitate or prolonged, was not a risk factor for CP.

Anti-Bacterial Agents↗
PubMed1985

Incidence of clinical infections in a defined population of pregnant women.

The incidence of clinical maternal infections was determined in a prospective study of 44,016 pregnant women at 12 university hospitals. Viral and bacterial infections were the most frequently reported. Overall, the highest incidence of infections was for vaginitis, influenza/"flu"-like disease, and infections of the kidney, ureter, bladder; parasitic and fungal infections occurred at low rates. Most women experienced only one infection during pregnancy (89.7%); however, some had two different infections (8.5%), and a few had three or more (1.7%). The analysis of the effects of some of the maternal infections on the pregnant women and their children have been published, and further studies are in progress.

Black or African American↗
PubMed1984

Obstetric complications as risk factors for cerebral palsy or seizure disorders.

In a prospective study, late obstetric complications were common, one or more occurring in 62% of 51,285 pregnancies. We examined these complications as risk factors for cerebral palsy (CP) or nonfebrile seizure disorders. Certain complications were associated with an increased rate of CP, but in babies over 2,500 g, the observed rate of CP did not exceed 2% following any condition evaluated. For most conditions, the CP rate was highest in the small subgroup of children who had five-minute Apgar scores of 3 or less. Most babies over 2,500 g born after each complication achieved five-minute Apgar scores of 7 or higher, and for them the risk of CP was not significantly greater than in children whose births were uncomplicated. Neither the complications considered nor Apgar scores were important antecedents of nonfebrile seizure disorders in children free of CP.

Apgar Score↗
PubMed1984

Age at onset of seizures in young children.

Age at onset of seizures in young children and its relationship to factors such as prior neurological status and neurological outcome were examined. Of 52,360 children, 39,270 of whom were followed for the full 7 years, a total of 2,635 experienced one or more seizures between birth and 7 years of age. The incidence of nonfebrile convulsions was highest in the first year of life, especially in the first month. Children with neonatal seizures who later developed nonfebrile seizures did so early, two-thirds by 6 months and three-quarters by 1 year of age. Children with neurological or developmental abnormality assessed in the first year of life did not have their first seizure earlier than children without abnormality. Neurological abnormality in the first year of life before any seizure, and the presence of minor motor seizures, were associated with an increased rate of mental retardation and cerebral palsy at age 7, but early age at onset appeared to have little prognostic value regarding intellectual function, cerebral palsy, and epilepsy.

Age Factors↗
PubMed1984

The risk of recurrence of nonfebrile seizures in children.

In a prospective study, the risk of recurrence after a first postneonatal nonfebrile seizure was 61% by age 7 years. The risk of recurrence for nonsymptomatic seizures was considerably higher than for seizures attributed to immediate precipitating factors. Focal motor seizures were more likely than generalized motor seizures to recur. Children who had prior neonatal seizures were at greater risk for nonfebrile recurrence than children with no prior seizure. Family history and neurodevelopmental status were not significantly related to recurrence risk. Almost 90% of recurrences took place within 1 year, and 96% within 2 years.

Child↗
PubMed1983

Seizures following childhood immunizations.

In 1.4% of children who experienced a seizure during the first seven years of life, the seizure followed within two weeks of an immunization procedure. We report 40 postimmunization seizures in 39 children enrolled in the Collaborative Perinatal Project. Ten seizures followed diphtheria-pertussis-tetanus (DPT) immunization, and 10 followed measles immunization. All but one of the seizures were associated with fever, often high. Thirty-seven seizures lasted less than 30 minutes. More than half of the children had a personal or immediate-family history of febrile seizures. One of the children had a right focal seizure lasting six hours after DPT immunization and had a significant speech deficit on long-term follow-up. No child developed epilepsy, and results in all children with brief seizures were normal on neurologic and cognitive examination at 7 years of age. Both in clinical presentation and generally benign outcome, these immunization-related seizures closely resemble febrile seizures, which are common in early childhood.

Child↗
PubMed1982

Maternal seizure disorder, outcome of pregnancy, and neurologic abnormalities in the children.

Among 45,000 pregnant women, 21.4 per 1000 (2.1%) reported at least one seizure before or during pregnancy. During the study pregnancy, 4.4 per 1000 had a noneclamptic seizure, and another 4.5 per 1000 had one in the 5 years preceding the study. Stillbirth, microcephaly, mental retardation, and nonfebrile seizure disorders occurred with heightened frequency in the offspring of women with seizure disorders; low birthweight, neonatal seizures, and first-year deaths were not more common. Approximately 80% of the women with seizure disorders had infants with none of the unfavorable outcomes studied. The observational nature of this and other clinical studies on this topic makes it difficult to evaluate the role of medical therapy in the outcome.

Anticonvulsants↗
PubMed1982

Children who "outgrew' cerebral palsy.

A diagnosis of cerebral palsy was made for 229 one-year-old children enrolled in a large longitudinal study. Of these children, 118 were free of motor handicap at the age of 7 years. Mild early cerebral palsy, and the monoparetic, ataxic/dyskinetic, and diplegic forms of the disorder, resolved with high frequency. Normalization of motor signs was observed more frequently in black than in white children. However, 13% of white children and 25% of black children whose motor signs resolved were mentally retarded (IQ below 70) at 7 years of age. Nonfebrile seizures, abnormalities in speech articulation and extraocular movements, and certain abnormalities of behavior were more frequent among children who "outgrew" cerebral palsy than in the general population of the study.

Age Factors↗
PubMed1981

Early recognition of infants at high risk for cerebral palsy: examination at age four months.

More than 32,000 children in a prenatally-defined cohort were examined four months after birth, and were re-examined at the age of seven years to determine the presence of cerebral palsy. Observations from the examination at four months were investigated as predictors of cerebral palsy, and the most reliable individual sign was increased muscle tone in neck, arms, legs or trunk. On completion of the physical examination at four months, the neurological status of each infant was assessed. Of the children considered to be normal, one in 1000 had cerebral palsy by the age of seven years, compared with one in 100 of those thought to be suspect. Of the children who had been definitely neurologically abnormal at four months, one in seven had disabling cerebral palsy by early school-age. The predictive power of abnormal physical findings increased with the number of abnormal findings with failure to meet motor milestones. Four-month-old infants who passed all milestone measures had a very low rate of later cerebral palsy, even if they had had abnormal physical findings. Examination of four-month-old infants permits the clinician to recognize children at widely different levels of risk of chronic motor handicap.

Body Height↗
PubMed1981

Apgar scores as predictors of chronic neurologic disability.

Apgar scores were recorded at one and five minutes for approximately 49,000 infants, and at ten, 15, and 20 minutes for babies who did not achieve a score of 8 or higher at five minutes. These children were followed to the age of 7 years. Low Apgar scores were risk factors for cerebral palsy, but 55% of children with later cerebral palsy had Apgar scores of 7 to 10 at one minute, and 73% scored 7 to 10 at five minutes. Of 99 children who had Apgar scores of 0 to 3 at ten, 15, or 20 minutes and survived, 12 (12%) had later cerebral palsy; 11 of the 12 were also mentally retarded (in ten, IQ less than 50) and half had seizure disorders. Eight children who survived after having very low late Apgar scores and who did not have cerebral palsy had lesser but significant disabilities. Of the children who had Apgar scores of 0 to 3 at ten minutes or later and survived, 80% were free of major handicap at early school age.

Apgar Score↗
PubMed1980

Sample selection and the natural history of disease. Studies of febrile seizures.

We have compared published reports on the frequency of unfavorable sequelae in a common disorder of childhood, febrile seizures, as ascertained from hospital clinics or referral units, with the frequency as reported from population-based studies. Studies on defined populations, in which the attempt was made to recognize and follow up all affected persons regardless of medical care sought for the condition, are in close agreement and indicate relatively low rates of unfavorable sequelae. Clinic-based studies of febrile seizures have reported disparate results, including high frequencies of adverse outcomes. A possible explanation is that patients in clinic-based studies may not be representative of persons with the disorder in the general population.

Adolescent↗
PubMed1980

Statistical considerations for a medical data base.

Some of the special statistical problems associated with the design and analysis of observational studies arising from medical data bases are reviewed. Particular attention is given to the adequacy of the collected data to provide information from which to draw valid statistical inferences.

Clinical Trials as Topic↗
PubMed1979

Birth weight and gestational age in children with cerebral palsy or seizure disorders.

Birth weight and gestational age of single-born children with cerebral palsy (CP) and those with seizure disorders were compared with norms for 40,000 single-born children in the same prospectively identified population. Low birth-weight and short gestation were important risk factors for CP, but these characteristics were uncommon, and the majority of children with CP were of normal birth weight and term gestational age. Preterm children with CP by age 7 years tended to have been even smaller at birth than was appropriate for their short gestions. Among term infants with later CP, the birth weights of the majority were appropriate for dates, but a subgroup were noticeably small for dates at term. Low birth weight, preterm birth, and smallness for dates at term were not significantly related to the risk of seizure disorders in children free of CP.

Birth Weight↗
PubMed1979

Neonatal signs as predictors of cerebral palsy.

Signs of neonatal neurologic dysfunction, recorded in approximately 40,000 infants, were evaluated prospectively for their ability to predict later motor handicap. Tenfold to 33-fold increases in risk of cerebral palsy (CP) were observed in surviving children with any one of the following characteristics: birth weight less than 2,000 gm, head circumference more than 3 SD above or below the mean, five minute Apgar score of 3 or less, diminished activity or diminished cry lasting for more than one day, thermal instability, need for gavage feeding, hypotonia or hypertonia, single or multiple apneic episodes, or hematocrit less than 40%. Of worse portent, with relative risks exceeding 50, were neonatal seizures or Apgar scores of 3 or less at ten minutes or later. These characteristics were also markers of considerable risk of early death. For 0.5% of surviving infants, an overall impression of abnormality of brain function during the nursery period was recorded by the attending physician; there was a 99-fold increase in CP among these children.

Apgar Score↗
PubMed1978

Febrile seizures and later intellectual performance.

The relationship of febrile seizures to later intellectual and academic performance was examined in a sibling-control study. Amont 431 sibling pairs tested at the age of 7 years, the mean full scale IQ on the Vechsler Intelligence Scales for Children was not different for children who had febrile seizures as compared with siblings who were seizure-free. Neither recurrent seizures nor those lasting 30 minutes or longer were associated with IQ deficit. Poor academic achievement, defined as Wide Range Achievement Test performance more than one grade level below school placement in children with IQs of 90 or above, was equally frequent in index cases and control patients. Febrile seizures were not associated with a decrement in IQ or early academic performance, as judged by comparison of affected children with their siblings.

Achievement↗