Intellectual Outcome Research Articles

The quality of preterm infants’ spontaneous movements: an early indicator of intelligence and behaviour at school age

The quality of very preterm infants' spontaneous movements at 11 to 16 weeks post-term age is a powerful predictor of their later neurological status. This study investigated whether early spontaneous movements also have predictive value for the intellectual and behavioural problems that children born very preterm often experience. Spontaneous movement quality was assessed, using Prechtl's method, at 11 to 16 weeks post-term in 65 infants born at <or= 33 weeks of gestation in a single centre. Intelligence and behaviour were assessed with standardised tests at 7 to 11 years of age. Neurological status was assessed with Touwen's test. Multiple regression was used to determine the predictive value of movement quality for intelligence and behavioural problems. The Sobel test was used to determine if neurological status mediated associations found between early movement quality and outcome. Spontaneous movement quality at 11 to 16 weeks post-term was significantly, positively associated with later intelligence. The number of normal postural patterns displayed contributed most strongly to the association, which was not mediated by neurological status. Fidgety movements, strong predictors of later neurological dysfunction, were not associated with intelligence. Spontaneous movement quality was not associated with internalising or externalising problems but showed a trend to an association with attention problems. These findings suggest that, in children born preterm, early spontaneous movement quality has clear prognostic value for neurological and intellectual outcome, and to a lesser extent, for attentional outcome. However, cognitive outcome was associated with the presence of specific, age-appropriate postural patterns, while neurological outcome has been associated with the presence of global movement abnormalities. The presence of specific, age-appropriate postural patterns may reflect the integrity of areas of the brain involved in cognitive processing and the regulation of attention later in childhood. Alternately, it may facilitate cognitive and attentional development.

Epidemiology of congenital hypothyroidism.

According to world-wide data obtained from neonatal thyroid screening programs congenital hypothyroidism (CH) occurs with an incidence of 1:3000 to 1:4000. Differences of CH-incidence are more likely due to iodine deficiency thyroid disorders or to the type of screening method than to ethnic affiliation. CH is caused by an absent or defective thyroid gland classified into agenesis (22-42%), ectopy (35-42%) and gland in place defects (24-36%). Although a few cases of thyroid dysgenesis have been described as a result of gene mutations, there is no common link to explain the etiological background of the majority of cases. Neonatal screening is severely affected by iodine deficiency leading to an increasing rate of false positive, transient and permanent cases of CH. Despite of low T4 and T3 levels the majority of low-birth-weight infants are not at risk of transient hypothyroidism. Neonatal screening in early discharged neonates mostly is not recommended before day 4. Since the intellectual outcome of CH seems below normal in Germany a CH registry and monitoring program on a national basis is recommended.

Results of the Screening program for congenital hypothyroidism in Berlin (1978–1995)

Screening for congenital hypothyroidism for all newborns of the former western parts of the city of Berlin was instituted in 1978 by determination of the TSH levels in dried filter paper blood spots of the 3rd to 5th day of life. Since 1991 the newborns of the former eastern parts have been also included in the same screening program. From 1978 to 1995 a total number of 104 newborns with permanent congenital hypothyroidism have been detected resulting in a prevalence of congenital hypothyroidism of 1:3800. The etiological diagnosis of hypothyroidism was made by imaging studies (ultrasonography or 99mTc scintigraphy) and assessment of serum thyroglobulin and thyroid hormone levels. Using this approach in 37 children (30 female, 7 male) the diagnosis of athyrosis, in 20 children (15 female, 5 male) the diagnosis of ectopy and in 21 children (18 female, 3 male) the diagnosis of thyroid hypoplasia was made, 16 children (8 female, 8 male) had a normally sized gland and 4 (1 female, 3 male) had congenital goiter. In 86% of all patients the age at onset of thyroxine (L-T4) replacement therapy was 8 or 9 days of life (3-42 days) and the median initial L-T4 dose was 14 micrograms/kg/day (10-16 micrograms/kg/day). The intellectual outcome of 77 children (2-16 years) was studied and normal scores for the intelligence (IQ) and developmental (DQ) quotients were found in 71 (92%). Outcome was not correlated to the age at onset of treatment, the initial dose and the severity of hypothyroidism, but there was a positive correlation of the socioeconomic status of the family and the IQ of the patients. The results of the screening program in Berlin document that an early and efficient thyroxine replacement can normalize the intellectual outcome of patients with congenital hypothyroidism independent of the severity of the disease as assessed by the residual thyroid function detectable at diagnosis.

Intellectual Outcomes Following Protocol Management in Crouzon, Pfeiffer, and Muenke Syndromes

Patients with craniosynostosis syndromes are traditionally managed by a dedicated craniofacial unit. Optimal long-term management of these anomalies is unclear, but in the Australian Craniofacial Unit, it involves ongoing care by an integrated multidisciplinary team, following a protocol that commences at birth and continues until the patient reaches skeletal maturity. The Australian Craniofacial Unit has, for the last 35 years, collected a significant series of patients with these conditions who have completed management from birth to maturity.The aim of this study was to review this series of patients and assess the long-term outcomes of protocol management, focusing in particular on psychologic and social aspects.This review demonstrates that these patients can do well in society, and many achieve higher education and find full-time employment. Regular follow-up and comprehensive multidisciplinary management allows for timely identification of any problems and appropriate intervention. This then helps to maximize the overall outcome for these patients.

Service-Learning: A Venue for Enhancing Pre-ServiceEducators’ Knowledge Base for Teaching

Scholarship of Teaching and Learning research examining the impact of service-learning on student’s personal qualities has shown positive results. Findings indicate that students participating in high quality service-learning programs show increases in their perceptions of self-efficacy, civic responsibility, social justice, and diversity awareness. Less information regarding the effect of participation in service-learning on student’s intellectual and knowledge outcomes is known. This case study examined the influence of participation in a service-learning program on pre-service educators’ knowledge base for teaching. Participants included 31 undergraduate physical education majors enrolled in a Motor Skill Development for Children course at a large state university in the southwestern United States. Findings from multiple data sources (i.e., journals, interviews, and observations of instruction) revealed that pre-service educators participating in a service-learning program enhanced their pedagogical content knowledge. Teacher education programs should consider implementing service-learning programs within the curriculum to benefit preservice educators’ knowledge base for teaching.

Phenotypic variability in trisomy 13 mosaicism: Two new patients and literature review

Trisomy 13 mosaicism occurs when two cell lines, one with a normal complement of chromosomes and the other with an additional chromosome 13, are present in the same individual. We present two children with trisomy 13 mosaicism and summarize the literature in 47 published cases. Our first patient is a 4-year-old male with normal development and dysmorphic features that include right microtia, tall forehead, bulbous nose, and high arched palate. The second patient died at 1 day of life secondary to laryngeal stenosis, a previously undocumented finding in trisomy 13. His other dysmorphic features included micrognathia, cleft soft palate, and an axillary pterygium. Several published case reports of patients with trisomy 13 mosaicism have had the typical phenotype of complete trisomy 13 with death in the neonatal period, while others have had few dysmorphic features and prolonged survival. The most common malformations in all 49 cases included ear anomalies, cleft lip and palate, and various congenital heart defects. Intelligence varied from normal in six patients to significant delays and mental retardation in the remainder of cases. There is no clear correlation between the percentage of trisomic cells and the level of intellectual function. The dysmorphic features seen vary considerably from one patient to the next, often making the clinical diagnosis of trisomy 13 mosaicism difficult. In counseling families, medical professionals should state that trisomy 13 mosaicism may lead to physical abnormalities and poor intellectual outcomes, but that the condition does not do so universally with normal development occurring in some individuals.

Newborn Screening for Krabbe Disease: A Model of Cooperation

Nearly 50 years ago, it was recognized that if infants with phenylketonuria (PKU) were identified and treated with a special diet from earliest infancy, dramatic improvements in their intellectual outcomes were seen. At that time, Dr. Robert Guthrie, a scientist working in Buffalo, New York, developed a screening test with simple technology using dried blood spots on filter paper. Very soon after the development of this test, newborn screening for PKU began and within a rather short period of time was being performed in the whole of the United States.

Application of behavioral interventions for autism exceed evidence of efficacy

This issue of The Journal includes the report of a study by Australian investigators Spreckley and Boyd, who performed a systematic review of studies of acute behavioral intervention (ABI) in preschool-aged children with autism spectrum disorder. They evaluated robustness of study methodologies using the physiotherapy evidence database (PEDro) scale and performed meta-analysis using selected studies in order to assess efficacy of interventions on intellectual and behavioral outcomes. Considering that only three randomized controlled trials (including a total of 76 children) have been published, that subjects were not always stratified by age at intervention or cognitive ability, and that control groups participated in uncontrolled interventions, it may not be surprising that ABIs had little demonstrable value added for long-term outcomes. The authors provide critically important information to the medical community and highlight gaping holes in our knowledge of the best ways to support preschool children with an autistic spectrum disorder and their families.In an accompanying editorial, Msall agrees fully with the authors' conclusions and adds the context of US children affected and dollars that would be required to apply ABI. Most importantly, he stresses the opportunity and necessity for parents and developmental professionals to be allies in the challenge of each child's care and also in planning research. As Msall points out, it is critical to measure broad outcomes that include the caregiver's physical and mental health, the sibling's physical and mental health, and the impact on family life. This issue of The Journal includes the report of a study by Australian investigators Spreckley and Boyd, who performed a systematic review of studies of acute behavioral intervention (ABI) in preschool-aged children with autism spectrum disorder. They evaluated robustness of study methodologies using the physiotherapy evidence database (PEDro) scale and performed meta-analysis using selected studies in order to assess efficacy of interventions on intellectual and behavioral outcomes. Considering that only three randomized controlled trials (including a total of 76 children) have been published, that subjects were not always stratified by age at intervention or cognitive ability, and that control groups participated in uncontrolled interventions, it may not be surprising that ABIs had little demonstrable value added for long-term outcomes. The authors provide critically important information to the medical community and highlight gaping holes in our knowledge of the best ways to support preschool children with an autistic spectrum disorder and their families. In an accompanying editorial, Msall agrees fully with the authors' conclusions and adds the context of US children affected and dollars that would be required to apply ABI. Most importantly, he stresses the opportunity and necessity for parents and developmental professionals to be allies in the challenge of each child's care and also in planning research. As Msall points out, it is critical to measure broad outcomes that include the caregiver's physical and mental health, the sibling's physical and mental health, and the impact on family life.

Phenylketonuria: High plasma phenylalanine decreases cerebral protein synthesis

Left untreated, phenylketonuria biochemically results in high phenylalanine concentrations in blood and tissues, and clinically especially in severe mental retardation. Treatment consists of severe dietary restriction of phenylalanine with more or less normal intellectual outcome as result when started early enough. It is unclear whether treatment for life is necessary. A clear relationship between plasma phenylalanine concentrations and cerebral outcome exists, but the precise pathophysiological mechanism is not understood. In studies in mice with phenylketonuria, the cerebral protein synthesis rate is decreased when compared to controls. The aim of the present study was to determine the protein synthesis rate in relation to the plasma phenylalanine concentrations in-vivo in patients with phenylketonuria by positron emission tomography brain studies after an intravenous l-[1-11C]-tyrosine bolus. Results showed a significant negative relationship (R2=0.40, p<0.01) between plasma phenylalanine concentration and the cerebral protein synthesis rate in 19 patients with phenylketonuria. At increased plasma phenylalanine concentrations, i.e. above 600–800μmol/l, the cerebral protein synthesis rate is clearly decreased compared to lower phenylalanine concentrations. These data suggest that cerebral protein metabolism in untreated adults with phenylketonuria can be abnormal due to high plasma phenylalanine concentrations. Hence, we speculate that it is important to continue dietary treatment into adulthood, aiming at plasma phenylalanine concentrations <600–800μmol/l.

Clinical Heterogeneity of Duchenne Muscular Dystrophy (DMD): Definition of Sub-Phenotypes and Predictive Criteria by Long-Term Follow-Up

BackgroundTo explore clinical heterogeneity of Duchenne muscular dystrophy (DMD), viewed as a major obstacle to the interpretation of therapeutic trialsMethodology/Principal FindingsA retrospective single institution long-term follow-up study was carried out in DMD patients with both complete lack of muscle dystrophin and genotyping. An exploratory series (series 1) was used to assess phenotypic heterogeneity and to identify early criteria predicting future outcome; it included 75 consecutive steroid-free patients, longitudinally evaluated for motor, respiratory, cardiac and cognitive functions (median follow-up: 10.5 yrs). A validation series (series 2) was used to test robustness of the selected predictive criteria; it included 34 more routinely evaluated patients (age>12 yrs). Multivariate analysis of series 1 classified 70/75 patients into 4 clusters with distinctive intellectual and motor outcomes: A (early infantile DMD, 20%): severe intellectual and motor outcomes; B (classical DMD, 28%): intermediate intellectual and poor motor outcome; C (moderate pure motor DMD, 22%): normal intelligence and delayed motor impairment; and D (severe pure motor DMD, 30%): normal intelligence and poor motor outcome. Group A patients had the most severe respiratory and cardiac involvement. Frequency of mutations upstream to exon 30 increased from group A to D, but genotype/phenotype correlations were restricted to cognition (IQ>71: OR 7.7, 95%CI 1.6–20.4, p<0.003). Diagnostic accuracy tests showed that combination of “clinical onset <2 yrs” with “mental retardation” reliably assigned patients to group A (sensitivity 0.93, specificity 0.98). Combination of “lower limb MMT score>6 at 8 yrs” with “normal or borderline mental status” reliably assigned patients to group C (sensitivity: 1, specificity: 0.94). These criteria were also predictive of “early infantile DMD” and “moderate pure motor DMD” in series 2.Conclusions/SignificanceDMD can be divided into 4 sub-phenotypes differing by severity of muscle and brain dysfunction. Simple early criteria can be used to include patients with similar outcomes in future therapeutic trials.

Children With Congenital Hypothyroidism: Long-Term Intellectual Outcome After Early High-Dose Treatment

We aim to determine long-term intellectual outcome of adolescents with early high-dose treated congenital hypothyroidism (CH). Sixty-three prospectively followed children with CH were assessed at age of 14 y with the Wechsler Intelligence Scale for Children-Revised and compared with 175 healthy controls. Median age at onset of treatment was 9 d (range 5-18 d) and median starting dose of levothyroxine (L-T4) was 14.7 microg/kg/d (range 9.9-23.6 microg/kg/d). Full-scale intelligence quotient (IQ) was significantly lower than in controls after adjustment for socioeconomic status (SES) and gender (101.7 versus 111.4; p < 0.0001). Children with athyreosis had a lower performance IQ than those with dysgenesis (adjusted difference 7.6 IQ scores, p < 0.05). Lower initial thyroxine (T4) levels correlated with poorer IQ (r = 0.27, p = 0.04). Lower SES was associated with poorer IQ, in particular in children with CH (interaction, p = 0.03). Treatment during childhood was not related to IQ at age 14 y. Adolescents with CH manifest IQ deficits when compared with their peers despite early high-dose treatment and optimal substitution therapy throughout childhood. Those adolescents with athyreosis and lower SES are at particular risk for adverse outcome. Therefore, early detection of intellectual deficits is mandatory in children with CH.

Children With Congenital Hypothyroidism: Long-Term Intellectual Outcome After Early High-Dose Treatment

Children With Congenital Hypothyroidism: Long-Term Intellectual Outcome After Early High-Dose Treatment

Intellectual Functioning in Children with Early Shunted Posthemorrhagic Hydrocephalus

Objectives: Early intervention for cognitive impairments seen in children with hydrocephalus is key to successful developmental outcome. Thus, the examination of the cognitive and behavioral functioning of children with hydrocephalus is important, given increasing survival rates and the potential to implement successful cognitive interventions. The current literature suggests that intellectual impairment is common in hydrocephalus patients, yet the findings vary concerning the extent and specifics of the cognitive deficits seen in these children. To better understand the pattern of cognitive impairment observed in children with shunted hydrocephalus, the present study examined a cohort of children with hydrocephalus uniformly shunted with a nonsiphoning valve in the first year of life. Methods: Forty-one children and adolescents with a history of congenital hydrocephalus, who were shunted with nonsiphoning valves in the first year of life and are currently achieving academically within 1 year of appropriate school grade for their chronological age, were compared to 16 nonaffected age- and education-level-matched controls. The subjects completed a comprehensive neuropsychological battery that included the Wechsler Intelligence Scale for Children, Third Edition, (WISC-III) as a measure of general intellectual functioning. Performances across the WISC-III were compared between the 2 groups. Results: The data were normally distributed for both groups. The children shunted for hydrocephalus scored approximately 1 standard deviation lower than the controls on the measures of general intellectual functioning (shunted group mean WISC-III full-scale intelligence quotient = 83.8 vs. control mean full-scale intelligence quotient = 102.9, p ≤ 0.001), verbal intellectual skill development [shunted group mean WISC-III verbal IQ (VIQ) = 86.6 vs. control mean VIQ = 107.1, p ≤ 0.001] and visuospatial and perceptual-organizational skill development [shunted group mean WISC-III performance IQ (PIQ) = 83.6 vs. control mean PIQ = 98.2; p ≤ 0.006]. History of shunt revisions, infections, prematurity, seizures and hemorrhage was not significantly correlated with intellectual functioning. While VIQ and PIQ have been reported as discrepant in many previous studies of cognitive functioning after shunting due to hydrocephalus, the current results revealed statistically similar VIQ/PIQ performance (Spearman’s ρ rank order r_s = 0.685, p ≤ 0.001). Conclusions: Intellectual functioning in this selected group of children with hydrocephalus is normally distributed, yet significantly below that of nonaffected peers. Previously reported discrepancies between VIQ and PIQ were not evident in our study. This finding may be accounted for by the selectivity of our study population, implying a differential effect of etiology and treatment on intellectual function outcome in hydrocephalic children.

Quantitative diffusion tensor imaging and intellectual outcomes in spina bifida

Patients with spina bifida (SB) have variable intellectual outcomes. The authors used diffusion tensor (DT) imaging to quantify whole-brain volumes of gray matter, white matter, and cerebrospinal fluid (CSF), and perform regional quantitative microstructural assessments of gray matter nuclei and white matter tracts in relation to intellectual outcomes in patients with SB. Twenty-nine children with myelomeningoceles and 20 age- and sex-matched children with normal neural tube development underwent MR imaging with DT image acquisition and assessments of intelligence. The DT imaging-derived metrics were the fractional anisotropy (FA), axial (parallel), and transverse (perpendicular) diffusivities. These metrics were also used to segment the brain into white matter, gray matter, and CSF. A region-of-interest analysis was conducted of the white and gray matter structures implicated in hydrocephalus. The amount of whole-brain gray matter was decreased in patients with SB, with a corresponding increase in CSF (p < 0.0001). Regional transverse diffusivity in the caudate nucleus was decreased (p < 0.0001), and the corresponding FA was increased (p < 0.0001), suggesting reduced dendritic branching and connectivity. Fractional anisotropy in the posterior limb of the internal capsule increased in the myelomeningocele group (p = 0.02), suggesting elimination of some divergent fascicles; in contrast, the FA in several white matter structures (such as the corpus callosum genu [p < 0.001] and arcuate fasciculus) was reduced, suggesting disruption of myelination. Diffusion tensor imaging-metrics involving gray matter volume and the caudate nucleus, but not other structures, predicted variations in IQ (r = 0.37-0.50; p < 0.05). Diffusion tensor imaging-derived metrics provide noninvasive neuronal surrogate markers of the pathogenesis of SB and predict variations in general intellectual outcomes in children with this condition.

Cognitive Function and Army Rejection Rate in Young Adult Male Offspring of Women With Diabetes: A Danish Population-Based Cohort Study

Perinatal complications are more frequent in cases of maternal diabetes, but little is known about the long-term intellectual outcome of offspring born to diabetic mothers. This study followed a cohort of Danish males born in the years 1976–1984 whose mothers were diabetic. These 282 subjects were followed up to the time of military conscription along with 870 population-based control subjects. The instrument used to gauge intelligence was the Boerge-Prien test, a 45-minute validated measure whose results correlate closely with those obtained using the Wechsler Adult Intelligence Scale. The rejection rate was 52.5% for diabetes-exposed subjects and 45.4% for control subjects. The risk difference was 7.3%, with a 95% confidence interval (CI) of 0.6 to 14.01. Analysis of the medical reasons for rejection failed to disclose diagnoses that could be related to cognitive performance. Among those who were not rejected, mean cognitive scores were 41.4 units (95% CI, 40.2–42.6) in diabetes-exposed individuals and 42.7 units (95% CI, 42.0–43.4) in control subjects. The findings were not altered when stratifying subjects by gestational age at birth or Apgar score. In a subgroup of 39 pregnancies with available data, a 1% point increase in maternal AIC (glycosylated hemoglobin) was associated with a 2.6% point decrease in cognitive score (95% CI, 1.8–4.8). Men whose maternal AIC was less than 7% had cognitive scores identical to those of control subjects. These findings point to a real, if minor, reduction in intelligence in young adult males whose mothers are diabetic. The negative association between AIC and cognitive scores stresses the need to strive for optimal metabolic control in diabetic women who are—or are planning to become—pregnant.

Intellectual outcome, motor skills and BMI of children with congenital hypothyroidism: a population‐based study

To evaluate intellectual outcome, motor skills and anthropometric data of children with congenital hypothyroidism (CH). Children with permanent CH who were born in 1999 in Bavaria were eligible for this prospective, population-based study. Cognitive performance was evaluated by the Kaufman Assessment Battery for Children and motor skills were assessed by the motor test, Motoriktest für vier-bis sechsjahrige Kinder (MOT) 4-6. Eighteen of 21 eligible children participated (86%). Median age of the children was 5.5 years (range 4.9-5.8). Treatment with levothyroxine was started after a median of 7.2 days (range 4-15) with a median dose of 12.0 microg/kg (range 7.2-17.0). Mean intelligence quotient (IQ) of the children was 100.4 (standard deviation [SD] 10.1): no children had IQ values below the normal range. Reactivity and speed of movement were significantly reduced in children with CH. Children with an initial thyroid-stimulating hormone (TSH) value of >200 mU/L performed significantly worse than children with TSH value of <or=200 mU/L (p=0.003). Children with CH had a significant increased risk for overweight (risk ratio [RR] 3.91, 95% confidence interval [CI] 1.22-11.75, p=0.005) compared to the Bavarian reference children. In this study, children with CH had an increased prevalence of overweight compared to reference data. Partially impaired motor skills could be shown, whereas the intellectual development was normal.

Impairment of intellectual functions after surgery and posterior fossa irradiation in children with ependymoma is related to age and neurologic complications

BackgroundTo investigate the neuropsychological outcome of children treated with surgery and posterior fossa irradiation for localized infratentorial ependymoma.Methods23 patients (age 0.3 – 14 years at diagnosis) who were treated with local posterior fossa irradiation (54 Gy) underwent one (4 patients) or sequential (19 patients) neuropsychologic evaluation. The last evaluation was performed at a median of 4.5 (1 to 15.5) years after RT.ResultsMean last full scale IQ (FSIQ), verbal IQ (VIQ) and PIQ were 89.1, 94.0, and 86.2 respectively. All patients had difficulties with reading, and individual patients showed deficits in visuospatial, memory and attentional tasks. There was no trend for deterioration of intellectual outcome over time. All 5 children with IQ scores ≤ 75 were under the age of four at diagnosis. There was a significant association between the presence of cerebellar deficits and impaired IQ (72.0 vs 95.2, p < 0,001). The absence of hydrocephalus was an indicator of better neuropsychologic outcome (mean FSIQ of 102.6 vs 83.9, p = 0.025).ConclusionWithin the evaluated cohort, intellectual functions were moderately impaired. Markedly reduced IQ scores were only seen with early disease manifestation and treatment, and postoperative neurological deficits had a strong impact on intellectual outcome.

Evaluation of quality of life and description of the sociodemographic state in adolescent and young adult patients with phenylketonuria (PKU)

BackgroundNormal intellectual and personal development can be expected in early-diagnosed and treated PKU patients. Aim of the study was to analyse quality of life and social status, which are important parameters for an overall estimation of success of treatment apart from intellectual outcome in adult PKU patients.Methods67 patients completed a questionnaire on quality of life and social status. Data was compared to the German census on an age matched control collective.ResultsQuality of life measured with the Profile of Quality of Life in the Chronically Ill (PLC) revealed mean values for capacity of performance in the patient group in the same range as in the control collective.The analysis of the social state of PKU patients revealed a tendency towards lower or delayed autonomy, and a low rate of forming normal adult relationships in which to have children. Schooling and professional career corresponded approximately to the control collective.ConclusionThough every chronic disorder must be regarded as restraining, it shows that PKU does not preclude healthy emotional adjustment when the disease is diagnosed early and treated well.

Core neurocognitive functions in children treated for posterior fossa tumors.

Identifying cognitive deficits associated with pediatric brain tumors and their treatment is important in delineating the mechanisms of intellectual decline often associated with these diseases. The authors evaluated sustained attention, information processing speed, working memory, and IQ in 64 patients with posterior fossa tumors, including those treated with either: (a) surgery and cranial radiation (n = 32), and (b) surgery without radiation (n = 32). Ten patients treated for non-CNS solid tumors were included as a comparison group. The authors also examined the impact of relevant demographic and medical variables on neurocognitive outcome. The authors found that neither age at, nor time since, diagnosis predicted cognitive outcome in this sample. Further, sustained attention and working memory were largely intact and there were no differences between groups. Patients treated with cranial radiation demonstrated lowered short-form IQ and slow information processing speed: Patients treated with cranial radiation and who experienced postsurgical complications demonstrated the poorest performance. The authors consider information processing speed to be an excellent candidate mechanism in understanding the impact of cranial radiation on intellectual outcome.

Research summaries for normal birth.

In this column, the author summarizes research studies relevant to normal birth. The studies summarized include a large trial evaluating the effect of prior vaginal births after a cesarean on outcomes in subsequent births; a study linking umbilical cord blood pH with intellectual outcomes in childhood; and a prospective trial evaluating the effect of routine antenatal nonstress testing on maternal anxiety. The author also highlights four articles about normal birth in a recent nursing journal series dedicated to the topic.