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Biomedical subjects

Magda Lahorgue Nunes

Publications and source records attributed to Magda Lahorgue Nunes.

At least 19 recordsLinked to original sources
PubMed2006

[Sleeping habits related to sudden infant death syndrome: a population-based study].

This cross-sectional study on sleeping habits with potential risk for sudden infant death syndrome included all live births in Passo Fundo, Rio Grande do Sul, Brazil, in 2003 with data collection from Certificates of Live Birth and interviews, analyzed with descriptive statistics and the chi-squared test. From the 2,634 live births, 2,285 children were selected (86.75%), with 8.4% exclusion and 5.2% losses. Protective habits included 77% of infants with appropriate clothing, 90% loosely wrapped, 69% with thin blankets, 98% sleeping in the parents' bedroom, and 56% in the crib. Potentially risky habits included lateral decubitus (92%), use of a pillow (88%), and feet far from the lower edge of the crib (96%). Among low-income families, bed-sharing with other children was significant (p = 0.00). Thus, in a county with a low prevalence of sudden infant death syndrome, infants are exposed to both protective and risk factors, suggesting that in underprivileged populations in developing countries, other risk factors for this syndrome should be considered.

Beds↗
PubMed2006

Prognostic value of 1H-MRS in neonatal encephalopathy.

The aim of this study was to determine the prognostic value of proton magnetic resonance spectroscopy in neonatal encephalopathy. Studies were carried out in 11 consecutive term newborns with encephalopathy probably caused by hypoxic-ischemic injury. The clinical evaluation included pregnancy data, labor conditions, encephalopathy grade, presence of seizures, and necessity of antiepileptic drug therapy. Polygraphic recordings were obtained in all cases. Interest areas evaluated by spectroscopy were the basal ganglia and thalami. Among the cases, N-acetylaspartate/creatine, choline/creatine, and lactate/creatine ratios were calculated and related to the clinical variables, polygraphic recordings, and 6-month neurodevelopmental outcome. Abnormal follow-up occurred in 5 of 11 patients (45.4%) and was clearly related to an Apgar score <5 at 5 minutes (P = 0.003), encephalopathy grade (P = 0.02), early neonatal seizures (P = 0.02), and antiepileptic therapy (P = 0.01). No relationship was observed between spectroscopy results and polygraphic recordings profile. The lowest mean N-acetylaspartate/creatine ratio was observed in four of five patients with an adverse outcome and, although not statistically significant, demonstrated a clear trend to unfavorable follow-up (t test = 0.06). The choline/creatine ratios could not be related to follow-up in our sample. The most consistently observed abnormality on the spectra was the presence of the lactate peak in four of five patients with unfavorable outcome, with a high relative risk to determine evolution in the sample, relative risk 7.0 (chi2 = 0.01, 95% confidence interval = 1.1-42.9).

Apgar Score↗
PubMed2006

Sleep practices and sudden infant death syndrome: a new proposal for scoring risk factors.

STUDY OBJECTIVES: To evaluate sleep practices regarding maternal, infant, and socioeconomic factors in an infant population and to propose a scoring scale associated with high versus low risk of sudden infant death syndrome. DESIGN: Cross-sectional, population-based study. SETTING: Passo Fundo, Brazil. PARTICIPANTS: 2,285 newborns. INTERVENTIONS: Perinatal information was collected from the city health database, and a questionnaire regarding sleep practices was applied to the de facto mothers. The scale for classification of infant sleep practices in relation to high or low risk of sudden infant death syndrome was based on previous population studies. Cox regression, bivariate, and multivariate analyses were employed. MEASUREMENTS AND RESULTS: Application of the score allowed detection of high-risk sleep practices in 42.4% of infants. The following variables maintained association with high-risk sleep practices: 6 or fewer visits in the antenatal clinic (p < .001), maternal age < or = 20 years (p < .001), smoking during pregnancy (p = .041), disease during the first 2 months of life (p = .038), low birth weight (p = .049), and low socioeconomic status (p < .001); 90% of deceased infants and 75% of suspected sudden infant death syndrome cases were regularly exposed to high-risk sleep practices. CONCLUSIONS: High-risk sleep practices were widely observed in the study population. The significance of this study lies in the future application of this information via public health measures targeted at high-risk populations.

Adult↗
PubMed2006

Clinical assessment of language development in children at age 3 years that were born preterm.

OBJECTIVE: To evaluate the influence of gestational age and birth weight on language development and neurodevelopmental outcome at age 3 years in children born preterm. METHOD: Cross sectional study including 69 children followed in our developmental outpatient clinic. Patients were consecutively included at the time of the 3 years of age appointment and stratified for birth weight (<1500 grams and between 1500-2500 grams). All patients were assessed for receptive and expressive language , Denver II and Bayley II tests and clinical neurological examination. For analysis patients were divided in two groups normal language acquisition (NLA) and delay in language acquisition (DLA). RESULTS: NLA children had higher scores on mental and psychomotor (p=<0.01, p=0.012) indexes of Bayley II. Newborns with less than 1500 grams had lower scores on all Bayley scale at age 36 months (p=0.002, p=0.007 and p<0.001). Multivariate analysis suggests an association between gestational age (p=0.032), abnormal behavior (p<0.001) and delay in language acquisition. Denver test at 12 and 24 months of age was a good predictor of delayed receptive and expressive language at three years of age (p=<0.01 and p=<0.01). CONCLUSION: Children born prematurely with low birth weight had an increased risk of language acquisition delay, and those had also lower cognitive and behavior scores when compared to NLA.

Child, Preschool↗
PubMed2005

The influence of gestational age and birth weight in the clinical assessment of the muscle tone of healthy term and preterm newborns.

OBJECTIVE: To evaluate the influence of gestational age (GA) and birth weight (BW) in the clinical assessment of the muscle tone of healthy term and preterm newborns. METHOD: Cross sectional study. The muscle tone of healthy 42 preterm and 47 term newborns was quantified and measured with a goniometer (an instrument for measuring angles) respectively between 7th-14th day of life and 24-48 hours of life. Newborns were grouped according to GA and BW and evaluated at fixed time intervals by one examiner. Preterm newborns were matched to term at 40 weeks postconceptional age (PCA). RESULTS: The evolution of muscle tone in the preterm occurred gradually, following PCA, independent of birth weight. Preterm newborns had lower scores in all muscle tone indicators when compared to term at the first assessment. Differences were observed among preterm small for GA and adequate to GA for the indicator heel to ear (p<0.001). When compared at 40 weeks PCA, except for posture, all other indicators were significantly different (p< 0.001) among groups. CONCLUSION: Prematurity and intrauterine malnutrition are influential factors in some indicators of the newborn muscle tone state. Muscle tone assessment of preterm infants does not seem to be influenced by birth weight, however evolution is clearly related to postconceptional age. When we compared term newborns AGA and SGA it seems to have a clear influence of the birth weight on some indicators of the muscle tone. The use of devices such as the goniometer allows the performance of a more objective assessment of muscle tone and helps to quantify findings.

Analysis of Variance↗
PubMed2005

The relationship between ictal activity and sleep stages in the newborn EEG.

OBJECTIVE: To verify the relationship of ictal activity and sleep organization (REM/NREM stages) in the neonatal EEG. METHODS: A retrospective study was developed with 41 high-risk newborns, with clinical history suggestive of seizures and ictal activity identified by the EEG. In each EEG, sleep organization and number/duration of sleep stages were determined. Sleep stages (REM, NREM) were scored following behavior and EEG activity. When it was impossible to recognize stages the epoch was classified as unrecognizable sleep stages (UNSS). Ictal activity was classified according to morphology and correlated with sleep epochs. Density of ictal activity was calculated as the duration of the discharge divided by the duration of the sleep epoch. RESULTS: Unrecognizable sleep stages were observed in 21 EEGs (51.2%). Comparing NREM X REM states there was a significant predominance of ictal activity in REM sleep (P = 0.01). Duration of discharges was longer on REM epochs; however, differences were not significant. Considering the type of discharges there was a predominance of monomorphic rhythmic discharges in all sleep epochs. CONCLUSIONS: In this sample, epileptogenic activity occurred more frequently in UNSS, where sleep organization was already disrupted. When it was possible to recognize sleep stages, ictal activity was more frequently during REM sleep. SIGNIFICANCE: This study speculates the relationship between sleep organization and ictal activity and raises the hypothesis that the expression of ictal activity in relation to sleep stages (REM/NREM) may have age-dependent mechanisms in the developing brain.

Action Potentials↗
PubMed2005

Prognostic value of non-reactive burst suppression EEG pattern associated to early neonatal seizures.

UNLABELLED: Seizures are the most frequent neurological event in newborns and clinical data suggest that etiology is the dominant factor in long term outcome. However, there are consistent background EEG abnormalities associated to neonatal seizures that are usually related to unfavorable outcome as the burst-suppression pattern. OBJECTIVE: The objective of this study was to correlate clinical and EEG features associated to long-term outcome of newborns with non-reactive burst-suppression (BS) EEG. METHOD: Newborns included in the study were selected from our database and had conceptional age (at the time of first EEG) >37 weeks, EEG recordings with non-reactive BS available for review and clinical follow up. RESULTS: 12 newborns met inclusion criteria, 50% had seizures in the first day of life. Seizures became refractory to treatment in all of them. In 50% the etiology of seizures was considered cryptogenic, 33% had inborn errors of metabolism and 17% had clinical history and neuroimage suggestive of hypoxic-ischemic encephalopathy. The follow-up showed that 7/12 infants deceased, 3 during the first year of life, and one in the neonatal period. All the survivors had severe developmental delay and multifocal neurological impairment. 92% developed refractory epilepsy, 58% were latter diagnosed with West syndrome. CONCLUSION: The non-reactive BS pattern may appear related to many neonatal neurological disorders and is associated with early and refractory neonatal seizures. It is clearly associated with elevated morbidity and mortality and to the development of post-neonatal epilepsy.

Cross-Sectional Studies↗
PubMed2004

Risk factors for developing epilepsy after neonatal seizures.

The objective of this study was to determine clinical and polysomnographic risk factors that might be early predictors for the development of postnatal epilepsy in a cohort of infants with seizures. The study sample included 158 infants who presented two or more clinically proven seizures. Gestational, perinatal, and polysomnographic data were obtained retrospectively. A questionnaire designed to detect patients with epilepsy in the community was prospectively given to all families, and the positive cases were reassessed for confirmation of epilepsy. Epilepsy rate after neonatal seizures was 22% within 12 months of follow-up and 33.8% within 48 months. Transient electrolytic imbalance and perinatal asphyxia were the most frequent etiologic factors associated with neonatal seizures. More than one seizure type was detected in 17.3% (n = 22) of cases and strongly associated with central nervous system infection (relative risk [RR] = 3.02, 95% confidence interval [CI] = 1.24-7.40, P = 0.02). Focal symptomatic epilepsy (P = 0.01) and syndromes not determined as focal or generalized (P = 0.04) were also associated with central nervous system infection. Abnormal polysomnographic recordings (P = 0.09) and abnormal neurologic examination on discharge (P < 0.01) were correlated with postnatal epilepsy. No differences were observed between premature and term infants concerning outcome. Neonatal seizures were associated with a high incidence of postnatal epilepsy in the cohort, including epileptic syndromes with catastrophic evolution. Abnormal neurologic examination on discharge was a good predictor of an unfavorable outcome and abnormal polysomnographic recording a moderate predictor.

Asphyxia Neonatorum↗
PubMed2003

Developmental characteristics of temporal sharp transients in the EEG of normal preterm and term newborns.

OBJECTIVE: To describe developmental characteristics, morphological aspects and incidence of temporal sharp transients (TST) in normal preterm and term newborns at matched conceptional ages (CA). METHOD: Neonatal EEGs from two groups of normal newborns were evaluated in order to identify and characterize TST. Group I (n=40) consisted of newborns from 34 to 40 weeks of gestational age (GA) that were submitted to a single EEG between 24 and 48 hours of life. Group II consisted of 10 preterm newborns with GA between 30-32 weeks, followed with a weekly EEG until they reached term. Morphology of TST was divided in 3 groups (temporal sawtooth, isolated transients or repetitive transients). TST index, density and total number were calculated in each polysomnography and related to sleep stages and CA. Laterality (right/left) was also evaluated. The groups were compared at 34, 36, 38 and 40 weeks of CA. RESULTS: TST index and density decreased with the increase of CA in both groups (p<0.0001). The temporal sawtooth feature was registered in both groups only at 34 weeks. Although rare, repetitive and isolated TST were the most prevalent morphology between 36 - 40 weeks CA. Significant intragroup difference was observed in the comparison of TST density in REM and transitional sleep in GI. Moreover, isolated TST morphology was significant higher in GI at 34 weeks when compared to the others CA. No intragroup differences were observed on GII. No significant differences between the groups were observed considering TST number, index, density, morphology or laterality, at the matched CA. CONCLUSION: TST are normal features of neonatal EEG, as they are registered in normal newborns. Its incidence varies accordingly to morphology and they tend to disappear following the increase of CA. Temporal sawtooth appears more often in preterm newborns. Our results suggest that TST index, density and morphology variability may be a function of CA.

Electroencephalography↗
PubMed2003

Sleep organization in children with partial refractory epilepsy.

Although it is currently known that sleep can influence epilepsy and epilepsy can influence sleep organization, few data have been published on this mutual interaction concerning the pediatric population. The objective of this study was to verify the eventual presence of sleep alterations in children with partial refractory epilepsy. Seventeen patients with partial refractory epilepsy were submitted to whole-night polysomnography as part of their epilepsy investigation. Polysomnographic recordings were performed on a digital video-electroencephalography (EEG) system and consisted of the registration of EEG (24 channels), electro-oculogram, electromyogram, electrocardiogram, and nasal airflow and abdominal respiratory movements. Sleep stages were visually scored following standard criteria, and ictal events were classified according to the international classification of seizures. The patients were also subdivided into two subgroups based on the presence or absence of ictal episodes during the recording night. The results concerning sleep organization were compared with those obtained from a normal control group. The analysis of the sleep parameters showed a reduction of total time in bed and total sleep time in both subgroups of epileptic children; there was a higher number of stage shifts per hour in the control group than in both epileptic subgroups. The percentage of stage 2 shifts is significantly reduced in patients with epilepsy and seizures during the night and the percentage of stage 3 to 4 shifts is increased. Nonsignificant differences are evident for the number of awakenings per hour and the percentage of stage 1 shifts. The percentage of rapid eye movement (REM) sleep is reduced, and first REM latency is increased in both epileptic subgroups, compared with normal controls, without statistical significance. Nine of 17 patients had seizures during the polysomnographic recording; nocturnal ictal events occurred mostly during non-REM sleep stage 2. Our results show that patients with partial refractory epilepsies have only mild sleep structure abnormalities, and this can be considered as an effect of the epileptic syndrome per se or as a result of the chronic antiepilepsy drug treatment.

Adolescent↗
PubMed2002

Heart rate variability during sleep in children with partial epilepsy.

Alterations in autonomic control of cardiac activity in epileptic patients have been reported by several studies in the past, and both ictal and interictal modifications of heart rate regulation have been described. Alterations of autonomic control of cardiac activity can play an important role in sudden unexplained death in patients with epilepsy (SUDEP). However, the presence of specific changes in heart rate variability (HRV) during sleep, not correlated with seizures, has not been assessed in children with epilepsy; for this reason, we evaluated features of cardiac autonomic function during sleep without ictal epileptiform electroencephalogram (EEG) activity in a group of children with partial epilepsy. Eleven patients (five males and six females; mean age 11.5 years, SD: 3.65 years) affected by partial epilepsy were admitted to this study; 11 normal subjects (five males and six females; mean age 12.9 years, SD: 2.72 years) served as a control group. All subjects slept in the laboratory for two consecutive nights. The data were analyzed during the second night. Sleep was polygraphically recorded [including one electrocardiography (ECG) channel] and signals were digitally stored. A series of 5-min ECG epochs were chosen from each sleep stage, during periods without evident ictal epileptiform activity in the EEG. Electrocardiography signals were analyzed for automatic detection of R-waves and, subsequently, a series of time- and frequency-domain measures were calculated. Epileptic subjects tended to show an overall lower HRV in both time- and frequency-domain parameters, principally during rapid eye movement (REM) sleep and, to a lesser extent, during sleep stage 2. Among the different bands, this decrease was most evident for the high-frequency band (HF) absolute power. For this reason, the ratio between the low-frequency band (LF) and HF was always higher in epileptic patients than in normal controls and the difference was statistically significant during sleep stages 3 and/or 4 and REM sleep. Our results indicate that during sleep, a particular condition of basal modification in autonomic characteristics occurs (mostly during REM sleep) in partial epilepsy patients. This finding might represent an important factor contributing to the complex mechanism of SUDEP which takes place most often during sleep and supports the need of studying HRV specifically during this state in subjects with seizures.

Anticonvulsants↗
PubMed2002

Pyridoxine-dependent seizures associated with hypophosphatasia in a newborn.

Pyridoxine dependency and congenital hypophosphatasia are unusual metabolic disorders. We report a female infant born from healthy consanguineous parents with shortening of limbs, detected during pregnancy by ultrasonography. Immediately after delivery, the baby was admitted to the neonatal intensive care unit because of respiratory distress. A bone radiograph showed hypomineralization of all bones, and serum alkaline phosphatase was very low (10 U/L). Within the first day of life, seizures (focal clonic and tonic) started. The seizures were refractory to phenobarbital and other antiepileptic drugs. The first electroencephalogram (EEG) showed a burst-suppression pattern. Pyridoxine was administered (50 mg/kg) and completely controlled the seizures. Antiepileptic drugs were discontinued, and a maintenance dose of pyridoxine (10 mg/day) was established. A postpyridoxine EEG revealed the disappearance of the burst-suppression pattern. The patient died at age 26 days. Pyridoxine-dependent seizures, when recognized early and treated, have a more favorable prognosis. However, hypophosphatasia detected at birth almost always has a lethal outcome.

Bone Density↗
PubMed2002

[Sleep disorders]

OBJECTIVE: The aim of this article is to review and update the knowledge about sleep disorders in childhood. SOURCES: Normal sleep ontogenesis and therapeutics for the most prevalent sleep disorders were reviewed. The text was based on classical articles and books and on Medline (publications from 2000 and 2001) using the key words sleep disorders and childhood. the article was structured on descriptive topics containing definition of the sleep disorder, age, clinical presentation and therapeutics. SUMMARY OF THE FINDINGS: Sleep disorders are frequent concerns referred in pediatrics outpatient clinics, and a correct diagnosis is the main goal to establish therapeutic procedures. CONCLUSIONS: In the majority of cases clinical history is sufficient to establish diagnosis and assuring parents of the benign evolution of the symptoms the better treatment.

Journal Article↗
PubMed2002

[Progressive bulbar palsy (Fazio-Londe disease): case report].

Progressive bulbar palsy, also called Fazio -Londe disease, is characterized by progressive impairment of cranial nerves in children. It was first reported by Fazio in 1892 and until now only 30 cases have been published in the literature. Both sexes can be affected and clinical course can be divided on early (< 6 years age, predominance of respiratory symptoms) and late course (6-20 years of age, predominance of motor symptoms on superior limbs). We report a 4 years old boy that started with intense stridor and respiratory distress, initially being diagnosed as an acute asthma attack. Clinical signs worsened and 12 months latter he already had impairment of cranial nerves V, VII, VIII, IX and X confirmed by clinical examination and neurophysiological evaluation.

Bulbar Palsy, Progressive↗
PubMedDate not supplied

Apparent life-threatening episodes as the first manifestation of epilepsy.

Apparent life-threatening episodes (ALTE) can be the first manifestation of an epileptic seizure in children. However, the diagnosis of ALTE is generally delayed because the interictal EEG often appears normal and the presence of gastroesophageal reflux may mislead the diagnosis of the epileptic manifestation. We report 6 children with epilepsy who presented an ALTE as their first seizure manifestation. The retrospective analysis of our cases demonstrated that ictal EEGs, when available, appeared to be the most helpful test to confirm the diagnosis, although an abnormal-appearing cerebral imaging was also contributive in the patients when only interictal EEGs were available.

Anticonvulsants↗
PubMedDate not supplied

[Instructions from teaching hospital maternity wards to parents concerning the sleeping position of newborns].

The prone sleeping position has been causally linked to sudden infant death syndrome (SIDS). This survey aimed to determine whether maternity hospitals in Brazil were promoting the prone sleeping position for newborns. Information was also collected on SIDS prevention messages. The study adopted a multicenter collaborative approach in hospitals with training in pediatrics, using questionnaires. Correctly completed questionnaires were received from 55 hospitals. The number of deliveries/year varied at the hospitals from 240 to 11,000 (median 2,750). The majority of hospitals encouraged the lateral (side) sleeping position in the normal care nurseries (44.4%) and at discharge (67%). In conclusion, the majority of hospitals surveyed are not promoting the supine sleeping position or any other intervention for SIDS prevention, although verbal information is provided to parents about breastfeeding (100%), immunization (100%), and smoking (85%).

Attitude of Health Personnel↗