Developmental Medicine and Child Neurology最新文献

Aim: To examine long-term outcomes in children and adolescents after first-time arterial ischaemic stroke (AIS) or cerebral sinovenous thrombosis (CSVT).

Method: Patients (0-18 years) diagnosed with a first-time cerebral thrombosis between 1994 and 2006 were followed until 2017 in this descriptive follow-up study. Patients were identified, and age- and sex-matched 1:10 with individuals from the general population. Data were extracted from national registries of patients. Outcomes included all-cause mortality, and hospital diagnoses of neurological and psychiatric disorders after cerebral thrombosis.

Results: A total of 251 patients with cerebral thrombosis were followed up for a median of 16 years (interquartile range 13 years 1 month-19 years 4 months). Cumulative all-cause mortality at 23 years 8 months was 11.4% (95% confidence interval [CI] 7.1-17.9). Hazard ratios indicated an increased risk of 64.0 times (95% CI 35.3-116.0) for cerebral palsy, 17.9 times (95% CI 10.2-31.5) for vision problems, and 4.1 times (95% CI 2.0-8.4) for being diagnosed with severe mental disorders during follow-up for those with previous cerebral thrombosis compared with the general population. The risk of morbidity was significantly increased following both AIS and CSVT.

Interpretation: Children and adolescents experience a higher all-cause mortality and a high risk of neurological and psychiatric diagnoses after AIS or CSVT compared with the general population.

Aim: To estimate life expectancies for individuals with open spina bifida, stratified by age, sex, functional ability, and specific impairments.

Method: In the present study, extensive data from 1659 persons in California (1986-2019) were analysed using standard methods. Empirical mortality rates were calculated, and rates were also derived for various cohorts using logistic regression. Life tables were then constructed, from which life expectancies were obtained.

Results: Survival varied significantly by ambulatory and feeding ability, and by bowel/bladder continence. For example, at age 5 years the life expectancy was 27 additional years for males in the most severely impaired group and 65 years in the least severely impaired, compared with 70 in the general population. There was a modest secular trend-mortality decreasing by roughly 1% per year-which is accounted for in the life expectancy calculations.

Interpretation: Life expectancy in open spina bifida varies by age, sex, severity of disability, and bowel/bladder continence. Survival has improved over the past 30 years.

Aim: To investigate the relationship between gestational age and clinical and magnetic resonance imaging (MRI) characteristics in infants with unilateral cerebral palsy (CP).

Method: This was a retrospective study of infants with unilateral CP in the Canadian CP Registry. Gestational age was considered as continuous and categorical. Neonatal signs were encephalopathy or seizures. M patterns were focal, white matter injury (WMI), and other. Additional impairments included seizures and non-motor-related impairments. The relationships between gestational age, imaging, and impairments were evaluated using multivariable and multinomial regression.

Results: There were 826 participants: 572 (69.3%) were born at term (>36.9 weeks), 121 (14.6%) were born moderate-to-late preterm (32-36.9 weeks), and 133 (16.1%) were born very-to-extremely preterm (< 32 weeks). Neonatal clinical signs (encephalopathy, seizures) were less common in infants born from 32 to 36.9 weeks (odds ratio [OR] = 0.24, 95% confidence interval [CI] = 0.10-0.57) than infants born at term. Common MRI patterns were focal injury in 417 (68.2%) and WMI in 68 (11.1%). Focal injury increased with gestational age (OR = 1.06, 95% CI = 1.02-1.1), while WMI decreased (OR = 0.88, 95% CI = 0.83-0.93). Impairments did not vary with gestational age but were associated with specific MRI patterns.

Interpretation: Most children with unilateral CP are born at term without neonatal signs of neurological injury. Gestational age at delivery was associated with neonatal signs and MRI pattern but not development of specific severe impairments.