History Of Perinatal Complications Research Articles

Early-Onset Virilization May Rarely be Due to an Adrenocortical Neoplasm

Background: Adrenocortical tumors are rare neoplasms of childhood; most of which are functional in childhood, producing excess hormones. Virilization, precocious puberty, and Cushing's syndrome are common presenting features. Clinical Description: A 6-year-8-month-old girl presented with features of virilization, which started appearing at 2 ½ years of age. The mother gave a history of progressive enlargement of the clitoris with the development of pubic, axillary, and facial hair over the years. There was no history of perinatal complications, features of adrenal insufficiency, atypical external genitalia at birth, or family history of malignancy. On examination, she had features of heterosexual peripheral precocious puberty. The hormonal investigation was suggestive of cortisol and androgen excess. Radiologically, she had an adrenal tumor appearing like adrenocortical carcinoma (ACC)-large size, high noncontrast Hounsfield units, and poor washout. Management and Outcome: As virilization was not present since birth and there was no evidence of adrenal insufficiency, therefore, the possibility of congenital adrenal hyperplasia was unlikely. Investigations revealed that the testosterone levels were much higher than other adrenal androgen precursors like dehydroepiandrosterone sulfate. This was a clinical clue to the well-differentiated and benign nature of the tumor although radiologically it appeared like ACC. The child underwent en bloc resection of the mass, and histopathology was suggestive of a benign adrenocortical adenoma. Seven days after surgery, the serum testosterone had dropped substantially. Conclusion: This case creates awareness about the possibility of an adrenocortical neoplasm in a child with early-onset virilization, which can be diagnosed correctly by following a step-wise, logical sequence of investigations.

A study on the relationship between non-epileptic fast (40 – 200 Hz) oscillations in scalp EEG and development in children

ObjectivePhysiological gamma and ripple activities may be linked to neurocognitive functions. This study investigated the relationship between development and non-epileptic, probably physiological, fast (40–200 Hz) oscillations (FOs) including gamma (40 – 80 Hz) and ripple (80 – 200 Hz) oscillations in scalp EEG in children with neurodevelopmental disorders. MethodsParticipants were 124 children with autism spectrum disorder (ASD) and/or attention deficit/hyperactivity disorder (ADHD). Gamma and ripple oscillations were explored from 60-second-long sleep EEG data in each subject using a semi-automatic detection tool supplemented with visual confirmation and time–frequency analysis. ResultsGamma and ripple oscillations were detected in 25 (20.2%) and 22 (17.7%) children, respectively. The observation of one or more occurrence(s) of ripple oscillations, but not gamma oscillations, was significantly related to lower age at EEG recording (odds ratio, OR: 0.727 [95% confidence interval, CI: 0.568–0.929]), higher intelligence/developmental quotient (OR: 1.041, 95% CI: 1.002–1.082), and lack of a diagnosis with ADHD (OR: 0.191, 95% CI: 0.039 – 0.937) according to a binominal logistic regression analysis that included diagnosis with ASD, sex, history of perinatal complications, history of febrile seizures, and use of a sedative agent for the EEG recording as the other non-significant parameters. Diagnostic group was not related to frequency or power of spectral peaks of FOs. ConclusionThe production of non-epileptic scalp ripples was confirmed to be associated with brain development and function/dysfunction in childhood. Further investigation is necessary to interpret all of the information on higher brain functions that may be embedded in scalp FOs.

Associations between the oxytocinergic system genes, perinatal complications and interpersonal relationships in patients with schizophrenia

To search for the associations between genes of the oxytocinergic pathway and psychosocial functioning in schizophrenia, namely, the ability of schizophrenic patients to form interpersonal relationships, taking into account the influence of such an environmental factor as perinatal complications. The study included 383 people (140 women and 243 men, mean age 32.6±11.4 years), of whom 107 had a history of perinatal complications, and 276 did not. Psychosocial functioning was assessed using the Personal and social relationships domain of The Personal and Social Performance scale (PSP). Polymorphisms rs53576, rs4686302, rs1042778 in the oxytocin receptor gene (OXTR) and polymorphism rs3796863 in the transmembrane glycoprotein (CD38) gene were genotyped. There is the association between the OXTR rs53576 polymorphism and scores on the interpersonal relations domain (p=0.005). Significant differences are found between carriers of the GG genotype and carriers of the A allele (p=0.003). In the group without perinatal complications, the genotype does not have a significant effect on PSP score. There are no associations between other polymorphisms and the level of interpersonal relationships in any of the studied groups. The results are in accordance with the notions accepted on the basis of numerous evidences that link the genes of the oxytocinergic system with social behavior. We obtained new data on the influence of the known polymorphism OXTR rs53576 on the phenotype, which has not been studied previously in this aspect - the ability to form interpersonal relationships in patients with schizophrenia, while it was shown that the effect of the genotype depends on the environmental risk factor (perinatal complications).

C-57 Prematurity and Perinatal Insult: Examining the relationships between parent and teacher ratings of executive functioning and academic readiness

Abstract Objective Extremely preterm children and those with a history of perinatal insult (e.g., hemorrhage, hypoxic-ischemic injury) show higher rates of cognitive and academic problems, including executive functioning (EF). EF becomes increasingly important in elementary school as curriculum demands increase. The current study examines the relationship between parent- and teacher-reported EF and early academic performance in this population at school-age. Method This study reviewed retrospective neuropsychological evaluations in a sample of 135 patients (ages 3:9-10:5 years, M = 5.8) from an outpatient neurodevelopmental follow-up program for children with perinatal complication. Parent and teacher measures included: Behavior Assessment Scale for Children (BASC-2, 3) and Behavioral Rating Inventory of Executive Functioning (BRIEF, P, 2). Standardized child measures included: Bracken School Readiness (BBCS-III), and subtests from Wechsler Individual Achievement Test (WIAT-III) and Comprehensive Test of Phonological Processing (CTOPP-2). Results BRIEF parent ratings of working memory (p = 0.34) and emotional control (p = .025) were negatively correlated with school readiness. BRIEF teacher inhibition and working memory ratings were negatively correlated with math performance (p = .004 to p = .044), as well as rapid naming (p = .002 to p = .047) and school readiness (p = .048). BRIEF teacher ratings of planning/organization (p = .027), shifting (p = .024), and emotional control (p = .010) were negatively correlated with pre-reading measures. A 95% confidence interval was used. Conclusions Parent and teacher ratings of EF were significantly correlated with measures of academic readiness, early math skill, and pre-reading measures in this sample of children with a history of perinatal complications. Caregiver ratings can be useful in identifying children at-risk for academic problems upon school entry and requiring further neuropsychological evaluation.

Neonatal hyperbilirubinaemia is associated with a subsequent increased risk of childhood-onset type 1 diabetes

ABSTRACTBackground: Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood. Whether neonatal hyperbilirubinaemia increases the risk of T1D remains unclear.Aim: To estimate the association between neonatal hyperbilirubinaemia and phototherapy and the risk of T1D using a large nationwide population-based cohort.Methods: This retrospective study was conducted using data from the National Health Insurance Research Database in Taiwan from 2001 until 2005. Altogether, 23,784 neonates aged <30 days diagnosed with hyperbilirubinaemia and 47,568 neonates without hyperbilirubinaemia were enrolled and frequency-matched to the hyperbilirubinaemia group by gender, age, parental occupation and urbanisation. Cox regression analysis was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CI).Results: Of the 71,352 neonates included, those with hyperbilirubinaemia had a higher incidence of T1D (4.76 vs 2.68 per 10,000 person-years, p < 0.001) and an earlier mean age at onset of T1D [4.13 (2.80) vs 5.80 (2.67) years, p < 0.001] than those without hyperbilirubinaemia. After adjusting for confounding factors in multivariable analysis, the neonates with hyperbilirubinaemia had a 66% increased risk of developing T1D (HR 1.66, 95% CI 1.26–2.18). Girls had a 1.41-fold (HR 1.41, 95% CI 1.10–1.82) greater risk of T1D than boys. Additionally, neonates with a history of perinatal complications (HR 1.66, 95% CI 0.99–2.80) and neonatal infections (HR 2.13, 95% CI 1.45–3.15) had an increased subsequent risk of T1D.Conclusions: The results suggest that neonatal hyperbilirubinaemia is associated with a subsequently increased risk of childhood-onset T1D.Abbreviations: T1D, type 1 diabetes; CI, confidence interval; NHI, national health insurance; NHIA, National Health Insurance Administration; NHIRD, National Health Insurance Research Database; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; G6PD, glucose-6-phosphate dehydrogenase; LBW, low birthweight; HRs, hazard ratios.

The relationship between infant iron status and risk of neurological impairment

Background Iron deficiency (ID) is a commonly found nutritional disorder and a persistent problem, especially in Indonesia. Iron deficiency during the critical period in childhood brain development is estimated to cause irreversible damage that hinders infant development.Objective To determine the relationship between infant iron status and neurological development.Methods We conducted a cross-sectional study at the Growth and Development Outpatient Clinic, Prof. Dr. R. D. Kandou Hospital, Manado, from March to May 2015. By consecutive sampling, we obtained 44 healthy infants aged 7 to 10 months who fulfilled the inclusion criteria. Infants with a history of perinatal complications, such as head trauma, hypoglycemia, respiratory distress syndrome, infection, or malaria were excluded Subjects’ serum hemoglobin and ferritin were examined for iron status. Infants’ risk of neurological impairment was assessed by the Bayley Infant Neurodevelopmental Screener (BINS). Results were analyzed by descriptive analysis for the characteristics and Spearman’s rank correlation coefficient analysis for the relationship between iron status and neurological development.Results From 14 infants with ID, 8 infants had a high risk of developmental impairment. Of the 30 non-ID subjects, 4 infants had a high risk of developmental impairment. Of the 30 non-ID infants, 16 infants had a low risk of impaired development, while 2 infants with ID had low risk of developmental impairment. Spearman’s rho revealed that infant iron deficiency was significantly associated with high risk of neurological impairment. (r=-0.547; P&lt;0.0001).Conclusion Lower serum ferritin levels (iron deficiency) is significantly associated with greater risk of impaired neurological development in infants aged 7-10 months.

The relationship between infant iron status and risk of neurological impairment

Background Iron deficiency (ID) is a commonly found nutritional disorder and a persistent problem, especially in Indonesia. Iron deficiency during the critical period in childhood brain development is estimated to cause irreversible damage that hinders infant development.Objective To determine the relationship between infant iron status and neurological development.Methods We conducted a cross-sectional study at the Growth and Development Outpatient Clinic, Prof. Dr. R. D. Kandou Hospital, Manado, from March to May 2015. By consecutive sampling, we obtained 44 healthy infants aged 7 to 10 months who fulfilled the inclusion criteria. Infants with a history of perinatal complications, such as head trauma, hypoglycemia, respiratory distress syndrome, infection, or malaria were excluded Subjects’ serum hemoglobin and ferritin were examined for iron status. Infants’ risk of neurological impairment was assessed by the Bayley Infant Neurodevelopmental Screener (BINS). Results were analyzed by descriptive analysis for the characteristics and Spearman’s rank correlation coefficient analysis for the relationship between iron status and neurological development.Results From 14 infants with ID, 8 infants had a high risk of developmental impairment. Of the 30 non-ID subjects, 4 infants had a high risk of developmental impairment. Of the 30 non-ID infants, 16 infants had a low risk of impaired development, while 2 infants with ID had low risk of developmental impairment. Spearman’s rho revealed that infant iron deficiency was significantly associated with high risk of neurological impairment. (r=-0.547; P&lt;0.0001).Conclusion Lower serum ferritin levels (iron deficiency) is significantly associated with greater risk of impaired neurological development in infants aged 7-10 months.

The thing of which she could not speak: transient biopercular syndrome as a very late complication of unsuccessful chemical abortion

A 40-year-old schoolteacher with no medical history developed a left hemicranial headache accompanied with vertigo, followed by anarthria, sialorrhea, and paresthesias in both cheeks and in the tip of the tongue. The symptoms lasted approximately half an hour. When she consulted the next morning, she only presented with a slight left central facial paresis and a hypoesthesia that resolved in the following days. Fluid attenuated inversion recovery sequences of a magnetic resonance imaging (MRI) showed a corticosubcortical hypersignal, interpreted as gliosis, of the posterior part of the left frontal lobe and the right prerolandic region, on both sides extending into the insula, but sparing the most superficial cortical layers and mild local cortical atrophy (Fig. 1a, b). There were no hemosiderin deposits on T2 gradient sequences or signs of gadolinium uptake. Technetium 99-m single photon emission computed tomography showed a disruption of cortical activity in both opercular regions (Fig. 1c). Electroencephalography (on day 1) and blood analysis including basic metabolic panel, C-reactive protein, liver and thyroid function, antinuclear antibodies and anticoagulation tests were normal. There was no serological evidence for a bacterial, viral or parasitic infection and routine cerebrospinal fluid analysis was normal. Formal neuropsychological testing was normal. Given the absence of persisting clinical signs compared to the extension and the chronic character of the lesions, the biopercular syndrome might be attributed to an epileptic decompensation of otherwise silent perinatal brain injuries. Initially, there was no history of perinatal complications, but later on, the patient’s mother confessed that she had undergone an attempt of a chemical abortion. Eight years later and without treatment, the patient is still symptom free.

047 Convulsive epilepsy in a rural district of northern Tanzania: risk factors and classification

BackgroundFew community-based studies of epilepsy from sub-Saharan Africa (SSA) have included neuroimaging or neurophysiology. There have been only two case-control studies to define risk factors.MethodsWe identified 291 people with epilepsy...

Co-morbidity of Sanfilippo Syndrome type C and d-2-hydroxyglutaric aciduria

Dear Sirs,A13 -year-old girl was seen at the Neurology and Med-ical Genetics Clinics with delayed milestones, macro-cephaly and developmental regression. She had no historyof perinatal complications other than delivery via cesareansection because of breech presentation. Over the preceding2 years she had developed nystagmus, occurring 4–5 timesa week. She had staring spells but had a normal EEG. Hermilestones, which included standing at 18 months of age,first words at 2 years of age, walking at 2 years of age,and writing letters at 6–7 years of age, were delayed. Herdevelopmental regression included enuresis, day time lossof bladder control and use of incorrect words for identifi-cation. Her gait had become unsteady, speech less under-standable because of mumbling, and she experiencedintermittent difficulty in recognizing her mother. Herfamily history was unremarkable with no consanguinity.On examination she had macrocephaly, mild facial coars-ening, thick eye brows, dark coarse hair, mild synophrys,thick lips, high arched palate, low anterior and posteriorhairline, intermittent tonic up gaze, nystagmus, and hypo-tonia with normal muscle bulk. MRI of the brain (Fig. 1)showed enlarged extra-axial spaces, hypoplastic temporallobes, open Sylvian fissures, mild ventriculomegaly andenlarged perivascular spaces. Skeletal survey was normal.Additional laboratory work up including lactic acid,pyruvic acid, mitochondrial respiratory enzyme analysis,CoQ10 levels, neurotransmitter profile (5-methyltetrahy-drofolate, 5-hydroxyindoleacetic acid, homovanillic acid,3-O-methyldopa, neopterin, tetrahydrobiopterin, succinyl-adenosine and pyridoxal 5 phosphate), karyotype, chro-mosomal microarray (44K custom Agilent platform),plasma amino acids and acylcarnitine profile was normal.Urine organic acid analysis revealed significant 2-hydrox-yglutaric aciduria, which was confirmed to be the

Profile of developmental delay in children under five years of age in a highly consanguineous community: A hospital-based study – Jordan

Aim To assess etiologies and risk factors for global developmental delay (GDD) in children. Patients and methods Between January 2006 and 2007, a retrospective study was carried out at the Child Neurology Clinic of Jordan University Hospital on all 229 children under five years of age presenting with GDD. To assess risk factors for GDD, 229 age-matched healthy children were included as controls. Results A definite etiology for GDD could be determined in 102 (44.5%) patients, while 127 (55.5%) patients remained undiagnosed .The most common category for the GDD was cerebral palsy (CP) seen in 72 patients (31.4%), of which the underlying etiology was determined in 50 patients (69.5%). The second most common category was metabolic disorders where a definite metabolic cause was reached in 15 (6.5%) patients and a possible metabolic cause was suspected in 16 (6.9%) cases. Other etiologies included other monogenic disorders in 12 (5.2%) patients, brain malformations in 7 (3.0%) patients, chromosomal abnormalities in 6 (2.6%) patients, and autism in 12 (5.2%) patients. History of perinatal complications and consanguinity were major risk factors ( p < 0.05). Conclusion To our knowledge this is the first and largest study on GDD in a highly consanguineous Arab population. Cerebral palsy and metabolic disorders were the most common causes of GDD in Jordan, while perinatal complications and consanguinity were the major risk factors contributing to GDD.

Augmented vasoreactivity in adult life associated with perinatal vascular insult

Adverse environmental events occurring early in life have received little attention as predictors of disease in the later stages of life. At birth, the transition from gas exchange by the placenta to gas exchange by the lungs requires dramatic changes in the pulmonary circulation, which during this period is particularly vulnerable to noxious stimuli. We measured pulmonary-artery pressure responses to high-altitude exposure, a stimulus that causes pronounced pulmonary vasoconstriction, in young adults who had had transient perinatal hypoxic pulmonary hypertension and in controls of similar age and sex distribution. Review of neonatal-care records at the Lausanne University Hospital for Children identified 15 individuals who met the eligibility criteria (birth at > or = 34 weeks of gestation, persistence of hypoxaemia during ventilation with oxygen during the first week of life, and persistence of fetal circulation). Ten of these individuals agreed to take part; the control group was ten volunteers without any history of perinatal complications. Systolic pulmonary-artery pressure (by echocardiography) and arterial oxygen saturation were measured at baseline and at high altitude (4559 m). The mean increase in pulmonary-artery pressure at high altitude was significantly greater (p=0.01) in the participants who had had perinatal pulmonary hypertension (from 26.2 mm Hg [SD 2.1] to 62.3 mm Hg [7.3]) than in the controls (from 25.8 mm Hg [2.3] to 49.7 mm Hg [11.3]). The fall in arterial oxygen saturation was similar in the two groups. These findings suggest that a transient perinatal insult to the pulmonary circulation leaves a persistent and potentially fatal imprint, which when activated in adult life predisposes to a pathological response. Survivors of perinatal pulmonary hypertension may be at risk of developing this disorder in later life.

The prevalence and associated factors of epilepsy in children in Calicut District, Kerala, India.

To determine the prevalence of epilepsy and its association with indices of malnutrition, infection and perinatal complications in children in Calicut District, Kerala, India, a door-to-door two-stage survey was conducted in two local government districts. Among the random sample of 1172 children aged 8-12 y, 26 conformed to the definition of epilepsy giving a 5-y period prevalence of 22.2/1000. A history of perinatal complications, low BMI and recent physical symptoms were independently associated with active epilepsy. The results suggest epilepsy is highly prevalent in this population of children and that further research is needed into its cause.

Perinatal complications and genetic loading in schizophrenia: Preliminary findings

History of perinatal complications (PCs) and first degree family history (FH) of psychiatric illness were examined in groups of schizophrenic/ schizoaffective ( n = 21) and bipolar ( n = 10) patients. PCs were significantly more frequent in the schizophrenic and schizoaffective patients than in bipolar patients. An inverse relationship was found between PCs and FH status, with FH-positive patients having significantly fewer PCs than the FH-negative group. This relationship persisted when the bipolar patients were excluded. Findings emphasize the etiological importance of genetics and perinatal events in the psychoses, and support the validity of a familial/sporadic distinction.

Hearing and Verbal-Cognitive Abilities in High-Risk Preterm Infants Prone to Otitis Media with Effusion

Preterm infants with a history of perinatal complications are at risk for language learning difficulties, and are more likely than full-term infants to show recurrent otitis media. The present study looks at the association between these risk outcomes in the preschool period. Twenty-three otitis-prone preterm children (referred to as cases) were compared with 20 non-otitis-prone children with similar perinatal and demographic characteristics (controls). Hearing thresholds were depressed for the cases in conjunction with abnormal tympanograms, and hearing was significantly poorer than for controls. Some language and verbal cognitive abilities were significantly poorer for the cases. The findings suggest the importance of medical intervention, audiometric assessment, and speech and language follow-up for high-risk premature infants prone to otitis media with effusion.

The origin of left hand preference: Pathological and non-pathological influences

Models of the origin of left hand preference were tested with prospective data. Infants with and without a history of perinatal complications, matched for age, sex and parental handedness, were filmed at 6 weeks of age. Children with a history of perinatal complications lacked the rightward headturning bias of those children without a history of perinatal trauma. Children with a history of perinatal complications were also deviant with reference to the duration of a postural reflex and its degree of lateralization. Perinatal complications may delay the establishment of volitional hand use as well as increase the probability of left-handedness. The data were interpreted as supporting SATZ's ( Cortex 8, 121–135, 1972) rather than Bakan et al.'s ( Neuropsychologia 11, 363–366, 1973) model of “pathological” left-handedness.

Computed tomographic findings in congenital hemiparesis in childhood and their relation to etiology and prognosis.

40, 1-14-year-old children suffering from congenital hemiparesis were re-examined neurologically and admitted to CT. According to our morphological results we found three different types of CT patterns: 1. unilateral enlargement of the lateral ventricle or parts of it (20 patients), 2. cavity in the cortex and subcortical white matter within the supply area of the middle cerebral artery (17 patients), 3. normal CT scans (3 patients). Patients with a cortical and subcortical cavity consistently had a moderate to severe hemiparesis and suffered more often from epilepsy and intellectual impairment than patients with unilateral ventricular enlargement and those with normal CT findings. Most patients with cortical defects had a history of perinatal complications, while abnormal pregnancies and prematurity prevailed in patients with unilateral ventricular enlargement. We believe that a cavity in the cortex and subcortical white matter is of arterial-ischemic origin, whereas unilateral ventricular enlargement with destruction of the deep white matter is related to venous hemorrhage. But it must be emphasized that CT cannot detect the causes, mechanisms and timing of the underlying brain lesions in congenital hemiparesis.