Cranial ultrasound and neurophysiological testing to predict neurological outcome in infants born very preterm.

A clinical analysis of children with developmental delay.

Assessing the performance of diagnostic test accuracy measures

To estimate how many children in mainstream primary schools have cerebral visual impairment (CVI)-related vision problems and to investigate whether some indicators might be useful as red flags, if they were associated with increased risk for these problems. We conducted a survey of primary school children aged 5 to 11years, using whether they were getting extra educational help and/or teacher- and parent-reported behaviour questionnaires to identify children at risk for CVI. These and a random 5% sample were assessed for CVI-related vision problems. We compared the usefulness of potential red flags using likelihood ratios. We received questionnaires on 2298 mainstream-educated children and examined 248 children (152 [61%] males, 96 females [39%]; mean age 8y 1mo, SD 20mo, range 5y 6mo-11y 8mo). We identified 78 out of 248 children (31.5% of those examined, 3.4% of the total sample), who had at least one CVI-related vision problem. The majority (88%) were identified by one or more red flag but none were strongly predictive. Fewer than one in five children with any CVI-related vision problem had reduced visual acuity. Children with CVI-related vision problems were more prevalent than has been appreciated. Assessment of at-risk children may be useful so that opportunities to improve outcomes for children with CVI-related vision problems are not missed.

A Critique on Contemporary Reporting of Likelihood Ratios in Test Power Analysis

Little is known about the extent to which a developmental delay identified in infancy persists into early childhood. This study examined the persistence of developmental delays in a large nationally representative sample of infants and toddlers who did not receive early intervention. In a sample (n ≈ 8700) derived from the early childhood longitudinal study, birth cohort, we examined developmental changes between 9 and 24 months. Motor and cognitive delays were categorized as none, mild, and moderate/severe. Adjusted ordinal logistic regression models estimated the likelihood of worse developmental delay at 24 months. About 24 % of children had a cognitive delay and 27 % had a motor delay at either 9- or 24-months. About 77 % of children with mild and 70 % of children with moderate/severe cognitive or motor developmental delay at 9-months had no delay at 24-months. Children with mild cognitive delay at 9-months had 2.4 times the odds of having worse cognitive function at 24-months compared to children with no cognitive delay at 9 months. Children with moderate/severe cognitive delay at 9-months had three times the odds of having worse cognitive abilities at 24-months than children who had no cognitive delay at 9-months. Similar results were found for motor skills. Developmental delays in infants are changeable, often resolving without treatment. This work provides knowledge about baseline trajectories of infants without and without cognitive and motor delays. It documents the proportion of children's delays that are likely to be outgrown without EI and the rate at which typically-developing infants are likely to display developmental delays at 2-years of age.

Use of letrozole challenge test to adjust gonadotropin dose in non–down-regulated cycles

Objective Neuropsychological impairment is an important co-morbidity of chronic epilepsy. The aim of this study was to determine the state of the cognitive and motor development of patients with refractory epilepsy. Materials & Methods We studied 150 consecutive children with epilepsy who were referred to Mofid Children Hospital, a third level public referral University Hospital in Tehran, Iran, from October 2007 to October 2008. Refractory epilepsy was defined as therapeutic failure of three antiepileptic drugs which were used appropriately. Data regarding sex, age, age at which the first seizure occurred, microcphaly, muscle tonicity, EEG findings, kind of treatment for controlling seizures and cognitive and motor development delay were collected from medical records. Development delay was defined as delay in acquiring cognitive ability and motor skills for age according to the Denver Scale II. Results Of 150 patients 72% were younger than 2 years old and 56.7% were male. About 35.3% were microcephalic while 76% had normal muscular tonicity.Only 2.7% had normal EEGs. About 37.3% showed a good response to anticonvulsive drugs and became seizure free, 13.3% showed a relative response to anticonvulsants but 49.3% did not respond. In the present study, 68% had cognitive developmental delay and 60.7% suffering motor delay. There was a significant difference in response to treatment between patients with cognitive and motor development delay. Conclusion Cognitive developmental delay was more frequent in patients with refractory epilepsy, suggesting that early cognitive screening and introduvtion of rehabilitation programs are necessary for patients with refractory epilepsy .

To obtain performance values of magnetic resonance (MR) imaging for restaging locally advanced rectal cancer after neoadjuvant treatment regarding tumor staging, nodal staging, and tumor-free circumferential resection margins (CRMs). MEDLINE, EMBASE, and Cochrane databases were searched for studies regarding restaging compared with a reference standard by using the terms rectal neoplasms, MR imaging, and chemotherapy. The Quality Assessment of Diagnostic Accuracy Studies tool was used, and data on imaging criteria, histopathologic criteria, and restaging were extracted. Responders were defined as positives and nonresponders, as negatives. Mean sensitivity, mean specificity, and positive and negative likelihood ratios (LRs) were determined by using a bivariate random-effects model. A positive LR greater than 5 implied moderate results for responders. Thirty-three studies evaluated 1556 patients. For tumor stage, mean sensitivity was 50.4%, mean specificity was 91.2%, positive LR was 5.76, and negative LR was 0.54. Diffusion-weighted (DW) imaging showed comparable positive LR with significantly improved sensitivity (P = .01) and negative LR (P = .04). Experienced observers showed higher sensitivity (P = .01) and lower negative LR (P = .03) compared with less experienced observers. For CRM, mean sensitivity, mean specificity, positive LR, and negative LR were 76.3%, 85.9%, 5.40, and 0.28, respectively. For nodal stage per patient, mean sensitivity, mean specificity, positive LR, and negative LR were 76.5%, 59.8%, 1.90, and 0.39, respectively; and for nodal stage on a lesion basis, these values were 90.7%, 73.0%, 3.37, and 0.13, respectively. MR imaging showed heterogeneous results of diagnostic performances for restaging rectal cancer after neoadjuvant treatment, but significantly better results were demonstrated when DW imaging was used or with experienced observers. MR imaging can also be used for evaluation of CRM staging, but nodal staging remains challenging.

Children with a significant cognitive and motor developmental delay are pre-symbolic communicators. The primary aim of this study was to reveal the variability within the communicative functioning of this group of children in terms of communication level, the reasons to communicate and behavioural expressions. Twenty-six children between 14 and 58months with a significant cognitive and motor developmental delay were recruited. The Communication Matrix of Rowland (2011, Communication Disorders Quarterly, 32, 190) was used to integrate different sources of information on the children's communicative functioning. These children primarily communicated at the level of pre-intentional and intentional behaviour, aimed at refusing, obtaining and, to a lesser extent, social purposes. To develop or adapt early intervention strategies, and to monitor progress in communicative development, an even more nuanced view on these children's communicative utterances in terms of frequency, duration, idiosyncrasy and context relatedness is needed.

Lessons learned: A critical reflection on child- and contextual variables related to the development of children with a significant cognitive and motor developmental delay

Use of Likelihood Ratio Computation to Standardize the Predictive Power of Noninvasive Cardiovascular Tests

Value of Magnetic Resonance Imaging for Nodal Staging in Patients with Head and Neck Squamous Cell Carcinoma: A Meta-analysis

To determine whether moderate neonatal hypoglycemia in otherwise healthy infants is associated with adverse neurodevelopmental outcome in pre-school children. Population-based cohort study with prospectively collected register data from Sweden. All singletons born July 1st 2008 through December 31st 2012 (n = 101,060) in the region were included. Infants with congenital malformations, infants treated in neonatal intensive care unit, infants with inborn errors of metabolism and infants to mothers with diabetes were excluded. Infants were followed-up until 2014, at 2–6 years of age. Exposure was neonatal moderate hypoglycemia. Main outcomes were a compiled neurological or neurodevelopmental outcome; any developmental delay; motor developmental delay; and cognitive developmental delay. In adjusted regression analyses, the odds ratio (OR) of any neurological or neurodevelopmental outcome was 1.48 (95% confidence interval: 1.17–1.88) in hypoglycemic compared to normoglycemic infants. The adjusted risk of any developmental delay was more than doubled (OR 2.53 [1.71–3.73]), the adjusted risk of motor developmental delay was almost doubled (OR: 1.91 [1.06–3.44]) and the adjusted risk of cognitive developmental delay was almost tripled (OR 2.85 [1.70–4.76]). Infants with early neonatal hypoglycemia (< 6 h) had a double risk (OR 1.94 [1.30–2.89]) of any neurological or neurodevelopmental outcome and a tripled risk of cognitive developmental delay (OR 3.17 [1.35–7.43]), compared to normoglycemic infants. In the first population-based study on this topic, we show that moderate neonatal hypoglycemia is associated with increased risks of impaired neurodevelopment. Current treatment routines for uncomplicated hypoglycemia should be followed.

ObjectivesWe aimed to evaluate the ability of feed-forward neural networks (fNNs) to predict the neurodevelopmental outcome (NDO) of very preterm neonates (VPIs) at 12 months corrected age by using biomarkers of cerebral MR proton spectroscopy (1H-MRS) and diffusion tensor imaging (DTI) at term-equivalent age (TEA).MethodsIn this prospective study, 300 VPIs born before 32 gestational weeks received an MRI scan at TEA between September 2013 and December 2017. Due to missing or poor-quality spectroscopy data and missing neurodevelopmental tests, 173 VPIs were excluded. Data sets consisting of 103 and 115 VPIs were considered for prediction of motor and cognitive developmental delay, respectively. Five metabolite ratios and two DTI characteristics in six different areas of the brain were evaluated. A feature selection algorithm was developed for receiving a subset of characteristics prevalent for the VPIs with a developmental delay. Finally, the predictors were constructed employing multiple fNNs and fourfold cross-validation.ResultsBy employing the constructed fNN predictors, we were able to predict cognitive delays of VPIs with 85.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99.1% negative predictive value (NPV). For the prediction of motor delay, we achieved a sensitivity of 76.9%, a specificity of 98.9%, a PPV of 90.9% and an NPV of 96.7%.ConclusionFNNs might be able to predict motor and cognitive development of VPIs at 12 months corrected age when employing biomarkers of cerebral 1H-MRS and DTI quantified at TEA.Key Points• A feed-forward neuronal network is a promising tool for outcome prediction in premature infants.• Cerebral proton magnetic resonance spectroscopy and diffusion tensor imaging can be used for the construction of early prognostic biomarkers.• Premature infants that would most benefit from early intervention services can be spotted at the time of optimal neuroplasticity.

Paper 27; The Diagnostic Accuracy of Clinical Tests in Identifying Those with Deep Gluteal Nerve Entrapment