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Otitis media and the social behavior of day-care-attending children.

Research has suggested that young children who experience chronic middle ear disease (otitis media) in early childhood may display some initial developmental delays in language development as well as later problems in school. This association between otitis media and developmental problems is hypothesized to be linked to the hearing loss that accompanies frequent or long bouts of otitis media. Recent interest has focused on whether otitis media may be linked to behavioral changes in children, making them less responsive to the environment even when well. This study examined the relation between early otitis media in day-care-attending children and their subsequent behavior in the day-care classroom when the children were well. Findings suggest that day-care-attending children with chronic otitis media in the first 3 years of life play more often alone and have fewer positive and fewer negative verbal interactions with peers than nonchronic children in day-care. There were no differences between chronic and nonchronic otitis media children in their nonverbal behavior. Results may also contribute to our understanding of the development of the socially withdrawn child.

Child Care↗

Reassessment of effects on lignification and vascular development in the irx4 Arabidopsis mutant.

The Arabidopsis thaliana irregular xylem4 (irx4) cinnamoyl-CoA reductase 1 (CCR1) mutant was reassessed for its purported exclusive rate-limiting or key effects on lignification. Analyses of gross growth characteristics and stem cross-section anatomy, from seedling emergence to senescence, revealed that stunted irx4 mutant lines were developmentally delayed, which in turn indirectly but predictably led to modest reductions (ca. 10-15%) in overall lignin amounts. Such developmental changes are not generally observed in suppression of other monolignol pathway forming enzymes (e.g., 4-coumarate CoA ligase) even when accompanied by significant reductions in lignin amounts. With the greatly arrested development of the irx4 mutant, formation of the lignin-derived syringyl moieties was also predictably delayed (by about 1-2 weeks), although at maturation the final guaiacyl:syringyl ratios were essentially identical to wild-type. No evidence was obtained for so-called abnormal lignin precursors being incorporated into the lignin, as shown by solid-state 13C NMR spectroscopic analysis in contrast to a claim to the contrary [Jones, L., Ennos, A.R., Turner, S.R., 2001. Cloning and characterization of irregular xylem4 (irx4): a severely lignin-deficient mutant of Arabidopsis. Plant J. 26, 205-216]. A previous claim of an "abnormal" lignin present in stunted CCR downregulated tobacco was also not substantiated, with only trace differences being noted in the presumed cell-wall constituent levels. More importantly, a linear correlation between total lignin amounts and lignin-derived fragmentation products was observed at all stages of Arabidopsis growth/development in both wild-type and irx4 mutant lines, regardless of lignin content, i.e., in harmony with an exquisitely controlled and predictable macromolecular assembly process. Recombinant CCR1 displayed fairly broad substrate versatility for all phenylpropanoid CoA substrates, with both feruloyl and 5-hydroxyferuloyl CoA being the best substrates. Taken together, these data indicate that other CCR isoforms are apparently capable of generating monolignol-derived lignified elements in irx4 when CCR1 is impaired, i.e., indicative of a functionally redundant CCR metabolic network operative in Arabidopsis. Other dwarfed phenotypes have also been observed following downregulation/disruption of unrelated metabolic processes but which also involve CoA ester metabolism, i.e., with hydroxymethylglutaryl CoA reductases in Arabidopsis and a bacterial enoyl CoA hydratase/lyase overexpressed in tobacco. Although the reasons for dwarfing in each case are unknown, a common mechanism for the various pleiotropic effects is proposed through perturbation of CoASH pool levels. Finally, this study demonstrates the need for progressive analyses over the lifespan of an organism, rather than at a single time point which cannot reveal the progressive developmental changes occurring.

Aldehyde Oxidoreductases↗

Periventricular intraparenchymal cystic lesions: critical determinant of neurodevelopmental outcome in preterm infants.

During a four-year period, 154 surviving preterm infants of 32 weeks gestation or less were prospectively examined by cerebral ultrasound for periventricular-intraparenchymal cystic lesions (IPCL) subsequent to ischemic and/or haemorrhagic damage. Neurological and developmental outcome was assessed with examinations at 0, 3, 6, 12, 18, 24, 36, 48 months of age corrected for prematurity. Twenty-four (15.5%) patients were found to have IPCL changes at ultrasound. In 8 cases, a porencephalic cyst subsequent to grade IV IVH (Papile's classification) was found; all had cerebral palsy and severe developmental deficit was present in 4. Diffuse bilateral PVL was found in 8 cases: 1 was not evaluable, 7 developed cerebral palsy; the developmental delay was severe in 4, moderate in 2 patients, and only 1 was normal. Four patients had localized bilateral PVL: 3 patients had mild diplegia and 1 was normal; the developmental outcome was normal only in 1 case, 1 had a severe cognitive delay, and 2 were moderate. In the remaining 4 cases, the ultrasound showed a monolateral localized PVL: 1 patient had mild diplegia and moderate cognitive delay, 3 were normal. - This study confirms the important role of the ultrasonographic diagnosis of IPCL in preterm infants to foresee later neurodevelopmental outcome. Extensive parenchymal lesions were strongly associated with major neurodevelopmental handicaps, while localized and small lesions were correlated with more favorable neurological as well as developmental prognosis.

Cerebral Hemorrhage↗

Cognitive function in preschool children after epilepsy surgery: rationale for early intervention.

PURPOSE: The detrimental effect of frequent early seizures on the cognitive potential of children is a significant clinical issue. Epilepsy surgery in childhood offers a good prognosis for seizure control and improved developmental outcome. We studied the postoperative outcome and the developmental velocity after surgery and analyzed risk factors for developmental delay in 50 consecutive preschool children treated surgically for severe epilepsy at ages 3 to 7 years. METHODS: Pre- and postoperative developmental quotients (DQs) were analyzed with analysis of variance; stepwise linear regressions were performed on preoperative DQs and on a difference score between post- and preoperative DQs to determine risk factors for preoperative development and factors influencing postoperative development. RESULTS: Of the 50 patients, 70% were retarded, with IQ < 70; 16% were of average intelligence, with IQ ranging from 85 to 115. Age at seizure onset and extent of lesion were predictive variables for preoperative cognitive development. Six to 12 months after surgery (early postoperative phase), 66% were seizure free (Engel outcome class I), 26% had substantial to worthwhile seizure reduction (classes II and III), and 8% were unchanged (class IV). Forty-one (82%) children showed stable velocity of development; three children showed gains of >/=15 IQ points; three had developmental decline (loss of >/=10 IQ points), which was transient in two children; and three children moved from not assessable to assessable. At last follow-up (6 months to 10 years after surgery), 11 children showed IQ/DQ gains of >/=15 IQ points. Gains in IQ were observed only in seizure-free children and were stable over time. Shorter duration of epilepsy was significantly associated with a postoperative increase in DQ. CONCLUSIONS: (a) Substantial global mental delay is common in young children treated for epilepsy with surgery; (b) In most patients, postoperative development proceeded at a stable velocity; (c) Catch-up development may occur but only in seizure-free patients; (d) Substantial cognitive losses were noted in only one child. and (e) Early seizure control stabilized developmental velocity in this patient cohort.

Cerebral Cortex↗

Three cell line mosaicism involving structural and numerical abnormalities of chromosome 18 in a 3.5-year-old girl: 47,XX,+18/47,XX,+del(18)(q22)/46,XX.

We report on a 3.5-year-old girl with a mosaic karyotype including full trisomy 18, normal cells and a majority of cells with partial trisomy involving an extra chromosome 18 deleted at band q22. She had cardiac and CNS anomalies, dysmorphic facial features failure to thrive and developmental delay. A gastrostomy tube was placed at 2 years of age. The combination of improved nutrition and optimal developmental therapy has led to her sitting supported, attempting to stand and enhancement of her cognitive and non-verbal communication abilities. Molecular investigation of the patient and her parents using microsatellite analysis has led to the conclusion that, as expected, the additional copy of chromosome 18 constituting the full trisomic cell line is maternal meiosis I in origin. The data, however, indicate that in the trisomic cell line containing the deleted chromosome 18q, the structurally abnormal 18 was of paternal origin. We think this case is the first described with both structural and numerical trisomic mosaicism involving chromosome 18 in a liveborn infant. We propose a mechanism of origin and review the literature, comparing the clinical presentation of this case with individuals having full or partial trisomy 18.

Cells, Cultured↗

Mucolipidosis type IV: clinical manifestations and natural history.

The clinical manifestations and psychomotor development of five patients with mucolipidosis IV (MLIV) from three Ashkenazi-Jewish families are reported. The presenting symptoms were hypotonia, developmental delay, corneal clouding, and puffy eyelids. Four of the patients had convergent strabismus and none progressed beyond a developmental age of 15 months. One patient died of aspiration at 17 years while the oldest patient entered puberty at 20 years, developed a coarse face at 30 years, and is now 32 years old. Histopathological studies in four patients showed storage changes characteristic of MLIV.

Adolescent↗

Phenotypic spectrum and management issues in Kabuki syndrome.

OBJECTIVE: To report the phenotypic spectrum and management issues of children with Kabuki syndrome (Niikawa-Kuroki syndrome) from North America. DESIGN: A case series of children (n = 18) with clinical findings of Kabuki syndrome. SETTING: Medical genetics clinics in Washington, Alaska, and Arizona. RESULTS: Most patients had postnatal growth retardation, and all had developmental delay and hypotonia. Feeding difficulties, with or without cleft palate, were common; 5 patients required gastrostomy tube placement. Developmental quotients/IQs in all but 2 were 60 or less. Seizures were seen in less than half of the patients, but ophthalmologic and otologic problems were common, particularly recurrent otitis media. Congenital heart defects were present in 7 (39%); 3 patients underwent repair of coarctation of the aorta. Other features included urinary tract anomalies, malabsorption, joint hypermobility and dislocation, congenital hypothyroidism, idiopathic thrombocytopenic purpura, and in one patient, autoimmune hemolytic anemia and hypogammaglobulinemia. All patients had negative family histories for Kabuki syndrome. CONCLUSIONS: Kabuki syndrome is a mental retardation-malformation syndrome affecting multiple organ systems, with a broad spectrum of neuromuscular dysfunction and mental ability. Given that 18 ethnically diverse patients were identified from 2 genetics programs, it appears that this syndrome is more common in North American non-Japanese patients than previously appreciated.

Abnormalities, Multiple↗

The high-risk infant.

A large number of infants are born each year with biologic or environmental risk factors that put them at increased risk for developmental disability, although most do not go on to have major disabilities. Some risk factors, for example, intraparenchymal hemorrhage, periventricular cysts, encephalomalacia, and abnormal neurodevelopmental examination, carry a much higher risk of developmental disability than others. There is much overlap among risk factors, and infants with multiple risk factors generally have a greater risk of disability than infants with just a single risk factor. All high-risk infants should receive careful pediatric follow-up that includes developmental screening, but efficient use of so far quite limited resources argues for selection of the highest risk infants for comprehensive developmental follow-up or early intervention programs. A system of tracking and monitoring high-risk infants during infancy and childhood would allow for early identification of developmental delay and appropriate referral for community resources.

Child, Preschool↗

Benefits of early intervention for children with developmental disabilities.

Early intervention programs are designed to enhance the developmental competence of participants and to prevent or minimize developmental delays. Children targeted for early intervention may either include environmentally or biologically vulnerable children, or those with established developmental deficits. There is growing consensus based on the best available evidence that early interventions can exert moderate positive effects. However, this literature is limited by substantial methodological weaknesses in most studies. Therefore further randomized clinical trials are needed to ascertain which programs best meet the needs of children with or at risk for developmental disability.

Child, Preschool↗

Morphological and immunohistochemical differences between gonadal maturation delay and early germ cell neoplasia in patients with undervirilization syndromes.

CONTEXT: Maturation delay of germ cells and their progression into carcinoma in situ (CIS) frequently occurs in intersex patients. A developmentally delayed germ cell resembles a CIS cell and displays prolonged expression of immunohistochemical markers used for the diagnosis of CIS. This questions their applicability in young children. OBJECTIVE: The objective of the study was the elaboration of tools to distinguish germ cells with maturation delay and CIS. DESIGN: The design was a qualitative and quantitative analysis of the expression of diagnostic markers for CIS in gonads of young patients with undervirilization syndromes. SETTING: The study was conducted in the pathology department of a university center, specializing in germ cell tumor pathogenesis. PATIENTS: Fifty-eight formalin-fixed, paraffin-embedded testicular tissue samples of 30 undervirilized patients (1 month to 23 yr of age) were analyzed. INTERVENTIONS: INTERVENTIONS included hematoxylin-eosin staining, immunohistochemistry for octamer binding transcription factor (OCT)3/4, gene encoding the stem cell factor receptor that has tyrosine kinase activity c-KIT, placental/germ alkaline phosphatase (PLAP), testis-specific protein Y encoded (TSPY), and VASA, double staining for OCT3/4 and VASA, with ploidy determination by fluorescent in situ hybridization. MAIN OUTCOME MEASURE: Maturation delay and CIS are characterized by the staining patterns of the immunohistochemical markers. RESULTS: CIS was diagnosed in three of 30 patients (10%) and four of 58 gonads (6.9%). Patient age, distribution of OCT3/4-positive cells throughout the gonad, and their position within the seminiferous tubule differ between maturation delay and CIS. Abnormal OCT3/4 and testis-specific protein Y encoded expression appear to be of pathogenetic relevance in the development of these lesions. CONCLUSION: The dimorphic expression of OCT3/4 allows distinction between maturation delay and CIS. Studies in larger patient series are essential before a biopsy to evaluate the neoplastic risk can eventually be proposed as an alternative for gonadectomy.

Adolescent↗

Health and developmental outcomes at 18 months in very preterm infants with bronchopulmonary dysplasia.

OBJECTIVE: To determine whether very preterm infants who are oxygen-dependent at 28 days of life but not at 36 weeks' gestational age are at high risk of morbidities at 18 months. POPULATION: A total of 217 infants born in a tertiary care center at 24 to 28 weeks' gestation in 1987 to 1992, classified into three groups: neonatal comparison group, O2 <28 days of life (n = 76); bronchopulmonary dysplasia (BPD)-1, O2 >/=28 days but not at 36 weeks' gestational age (n = 48); and BPD-2, O2 >/=36 weeks (n = 93). OUTCOME MEASURES: Growth, persistent respiratory problems (asthma, tracheostomy, home oxygen therapy), surgery, hospitalizations, and neurodevelopmental impairments. RESULTS: Among the three groups, no differences were found in weight, height, head circumference, or total number of days of rehospitalizations for any causes, or in rate of rehospitalizations to the intensive care unit, persistent respiratory problems, cerebral palsy, or sensory impairment. Children with BPD-2 needed more hernia repairs compared with the other two groups (comparison group: 12% vs BPD-1: 10% vs BPD-2: 30%), had more days of readmissions for respiratory problems (comparison group: 2.0 vs BPD-1: 2.0 vs BPD-2 6.3 [BPD-1 vs BPD-2]), had a lower mean developmental quotient (comparison group: 97.4 +/- 15.0 vs BPD-1: 97.9 +/- 11.6 vs BPD-2: 90.7 +/- 19.3). Intraparenchymal cerebral lesions, high family adversity, and prolonged ventilation were the most important factors influencing the developmental outcome. CONCLUSION: Children with BPD-1 are similar in all respect at 18 months to children in the comparison group. Children with BPD-2 are similar to the other groups at 18 months in growth, general health, and neurologic outcome but differ in having a higher number of days of rehospitalizations for respiratory causes, more hernia repairs, and more developmental delays.

Bronchopulmonary Dysplasia↗

Impact of very low birth weight infants on the family and its relationship to parental attitudes.

This study tested common assumptions that very low birth weight (VLBW) infants (less than 1500 g) adversely affected families and that if affected parents could choose again, they would prefer not to save potentially handicapped VLBW infants. A survey of parents, which used a validated impact-on-family questionnaire, was sent to families of all 144 traceable VLBW infants (72.2% response), and families of 25 randomly selected healthy term infants (60% response), born in Newfoundland between 1983 and 1987 (median age 36.5 months, range 12 to 71 months). This revealed that families with developmentally delayed VLBW infants perceived no worse impact on the family than those with healthy term infants. Families with developmentally normal VLBW infants perceived a more positive family impact than the other two groups (P less than .05). Most parents of both VLBW and healthy term infants supported saving all infants regardless of outcome (greater than 80%), believed that parents should be the principal decision makers regarding treatment decisions (greater than 92%), and supported the role of physicians (greater than 59%), but not nurses, ethics committees, or other regulatory bodies, in this decision. For the VLBW group, parental attitudes toward saving VLBW infants were related to their perceptions of family impact (P less than .05) but independent of sociodemographic factors or of the developmental normality of the infant. It is concluded that VLBW infants did not adversely affect these Newfoundland families or change their attitudes toward saving potentially handicapped infants. In the current debate about whether VLBW infants should be saved, cognizance must be taken of parental desires.

Adult↗

Prognosis of intracranial hemnorrhage in neonates.

Eleven of 21 infants with intracranial hemorrhage documented by computerized axial tomography survived and have had serial developmental assessments. Six of nine infants with intraventricular hemorrhage (IVH) are developing normally, as is one of two infants with isolated subtentorial hemorrhage. According to our system for grading the severity of IVH, severe IVH correlated best with mortality and less well with developmental delay in survivors. Contrary to past impressions, IVH, even if severe, does not uniformly lead to a poor developmental outcome in surviving infants.

Age Factors↗

Neurodevelopmental outcome of extremely low birth weight infants in Maryland.

The survival rate of extremely low birth weight (ELBW; i.e. < 1001 grams) infants has significantly improved in the past 10 years secondary to the numerous advances in neonatology. There have been many favorable reports of the neurodevelopmental outcomes of survivors, but the studies often span several years to collect sufficient number of subjects. This study assesses the outcome of 100 ELBW infants born in Maryland in 1990 and analyzes factors that may have contributed to their outcomes at one year corrected age. Of this group, 72% had no evidence of severe disability (e.g., cerebral palsy (CP) or mental retardation (MR); however, 51% of the children had abnormal or suspect neurological examinations, and 24% had CP. Eighteen percent of the children were more than one standard deviation below the mean cognitively; 30% were below normal for motor abilities, and 33% were below normal for language abilities. Prior to this study, many of these children were not recognized by their primary physician as having any developmental problems. Many of these children were not followed in neonatal intensive care unit (NICU) follow-up programs, and most were not receiving appropriate early intervention services (EIS). Previous studies have associated different neonatal events with the risk of developmental delay. Bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) accounted for most of the variance of this sample's developmental outcome. Of these 100 ELBW infants, 56 received surfactant. Analysis demonstrated no significant differences in developmental outcomes between those who received surfactant and those who did not. However, those who received rescue surfactant were more likely to acquire a diagnosis of BPD. As demonstrated by this study, ELBW infants are at risk for significant developmental problems. This supports the need for targeted outreach, developmental monitoring, early intervention services, and parent support and education.

Chi-Square Distribution↗

Olanzapine and the new generation of antipsychotic agents: patterns of use.

As the new generation of atypical antipsychotics becomes available, the limitations of the older typical agents become apparent. The new medications, which have benefits other than the alleviation of positive symptoms of schizophrenia, may also be beneficial for psychotic disorders that have responded poorly to conventional neuroleptics. This article will describe the potential use of the atypical antipsychotics, especially olanzapine, for affective mood disturbances in schizophrenia, psychotic depression and mania, first-break schizophrenia, comorbid schizophrenia and substance abuse disorders, dementia in the elderly and those with late-onset schizophrenia, and behavioral problems in patients with mental retardation or developmental delays.

Antipsychotic Agents↗

CT of cerebrovascular injury after neonatal extracorporeal membrane oxygenation: implications for neurodevelopmental outcome.

One hundred forty-six neonates treated with extracorporeal membrane oxygenation (ECMO) were evaluated with cranial sonography and CT at different times in the course of their disease. Cranial sonography was performed during treatment with ECMO, and CT was done 3-14 days after cessation of ECMO bypass. In 66 (45%), intracranial abnormalities were detected with either sonography or CT. Thirty neonates had hemorrhages only, 24 had nonhemorrhagic abnormalities, and 12 had combined lesions. CT provided additional information in 44 (67%) of the 66 neonates. Sonography was normal in 37 neonates, showed fewer lesions in 10 neonates, and was concordant with CT findings in 14 neonates. It cannot be established whether these lesions went undetected with sonography during ECMO, or occurred after cessation of ECMO bypass. Neurodevelopmental evaluation was performed in 71 of 90 survivors 1 year of age or older. Forty-three infants (61%) were normal; developmental delay was suspected in 12 (17%) and present in 16 (23%). The severity of intracranial abnormality as determined by a neuroimaging score correlated well with short-term developmental outcome. Mean neuroimaging scores were significantly higher, with increasing degree of neurodevelopmental delay (p less than .001 by Kruskal-Wallis rank order test). Although cranial sonography remains the primary technique for the detection of life-threatening hemorrhage during ECMO, cranial CT after ECMO is important in defining the total degree of intracranial injury present in these high-risk neonates.

Cerebral Hemorrhage↗

Sequence comparison methodology for the analysis of movement patterns in infants and toddlers with and without motor delays.

In an attempt to quantify the theoretical construct quality of movement, a set of measurable constructs were identified by subject matter experts, and a scale (the Toddler and Infant Motor Evaluation [TIME]) incorporating those constructs was developed and pilot tested. Sequence comparison data analysis methodology was examined for its applicability to examining series of movements. The study sample consisted of randomly selected children from a pilot edition of the scale. Because research indicates that specific individual positions cannot provide an accurate indication of the normalcy or dysfunction of the motor performance of infants and toddlers, this study researched the ability of series of movement positions in each of five postures (prone, supine, sit, quadruped, and stand) to discriminate between normal and atypical motor development. It was hypothesized that children with motor delays would demonstrate different sequences of movements than children without motor delays. The findings confirmed the hypothesis, because in this sample there was a significant difference in the performance of children with developmental delays in motor abilities compared with that of children who had normal movement abilities. Children with motor delays had poorer mobility, which was characterized by fewer transitions between movement patterns than children with normal motor abilities.

Child, Preschool↗

Establishing reports of saying and doing and discriminations of say-do relations.

The purpose of the present study was to investigate a new procedure for establishing accurate discriminations of delayed acts of saying, of doing and discriminations of say-do correspondence and non-correspondence with three developmentally delayed subjects. A corrective feedback procedure for incorrect discrimination responses, that involved multiple-exemplars, was initially employed, but failed to establish most of the target discriminations for all three subjects. A near-errorless training intervention was subsequently employed that also involved multiple-exemplars. This training used two referents (one for acts of saying and another one for acts of doing) as prompts to produce accurate delayed reports of what they promise to do presently, and accurate delayed reports of what they did. Prompts were also used to indicate whether the say-do relations were the 'same' in terms of correspondence or not the same in terms of non-correspondence. Prompts were subsequently eliminated. All three subjects demonstrated highly accurate reports of delayed saying, doing and say-do correspondence or non-correspondence discriminations in the absence of prompts and with novel stimuli. The results are discussed in terms of generalized classes of behavior. The implications of these findings for the use of the errorless learning paradigm as a means of establishing complex behavior are also discussed.

Adolescent↗