Developmental Medicine and Child Neurology最新文献

The clinical care for children with severe neurological impairment (SNI) has undergone major advances, and services have adapted with the promise of many potential new treatments on the horizon. Children with SNI are living longer and patients with complex needs have outpaced the number of clinicians trained to adequately provide care.

This growing gap and the limited supports places added pressure on clinicians. They struggle with uncertainty and feel ill-equipped to provide appropriate management and counselling for children with rare and complex SNI.

This research study asked clinicians about their experiences caring for children with SNI. We also asked clinicians what could be developed to better support them in their role.

We conducted 24 interviews with clinicians. We asked clinicians to tell us about their experiences caring for children with SNI and how their experiences impacted their mental, physical, and social–emotional wellbeing over time.

Clinicians described a combination of physical, emotional, and mental health impacts. Stressors were related to inadequate training and support for patients with SNI. This often caused clinicians to experience isolation, anxiety, and self-doubt and a sense of powerlessness. Many clinicians were able to make use of strategies to help them cope with complex challenges including creating meaningful connections with families and their clinical teams. Learning to approach scenarios with greater acceptance of the limitations of their medical knowledge and capacity to change the situation was associated with increased clinician wellbeing.

Injections with botulinum neurotoxin A (BoNT-A) are frequently used as treatment of spasticity (increased muscle tone) in children with cerebral palsy (CP). However, the evidence of a functional effect, like improved walking, is insufficient.

The aim of this study was to investigate whether BoNT-A makes walking easier in children with CP. Energy cost during comfortable walking was used to assess ease of walking before and after treatment. We also wanted to investigate if walking capacity improved, habitual physical activity increased, and if leg pain was reduced. The children also reported self-perceived effect.

The study was a randomized controlled trial where the children were randomly allocated to receive either BoNT-A or saline water (placebo).

The results showed that one treatment with BoNT-A did not make walking easier compared to placebo within a time span of 12 weeks. However, a decrease in energy cost, twice as large as in the placebo group, was observed at 6 months follow-up. This suggests a possible delayed effect. On the other hand, we did not find any improvement in walking capacity or in habitual physical activity. However, there was some evidence that leg pain was reduced in children treated with BoNT-A.

Infants born extremely preterm (at less than 28 weeks gestational age), have high risks of severe neonatal brain injury (SNBI). SNBI includes cystic periventricular haemorrhage and severe intraventricular haemorrhage, leading to high hazards of neurodevelopmental impairment (NDI) like cerebral palsy and significant cognitive impairment.

Over the years, the number of infants with these brain problems has gone down. Infants without SNBI may still have risks of NDI potentially caused by altered brain development as a result of medical complications and challenges in their family-social environment.

This study looked at whether there are improving trends of 24-month NDI outcomes in infants born extremely preterm at different gestational ages (22–25, 26–28, 29–30 weeks) from 2011 to 2020. We compared the results in two different situations: with vs without inclusion of infants who had SNBI.

In cerebral palsy (CP), muscles often develop contractures, where the muscle is shorter and stiffer than healthy muscle. This impairs muscle function, limiting the ability of children with CP to have full range of motion and function of their muscles.

Muscles are made up of millions of cells and several different cell types. One of these key cell types form new muscle when the muscle is injured or growing. Another cell type produces a network of proteins that provide support and structure to the muscle. The goal of this study was to understand how these two cell types change with contracture. This will allow us to identify changes in cell behavior in CP and therefore identify targets to improve muscle function.

To do so, we compared cells taken from muscle biopsies of six children with CP and six typically developing (TD) children. We found that cells from children with CP did not form muscle as much as TD cells. These cells also had worse muscle formation on stiffnesses that represent contractures compared to healthy-like stiffnesses. This indicates that when the muscle is injured in CP, it cannot recover as easily. We found that treatment with a drug called verteporfin slightly improved muscle formation. We also found that the cells that produce the proteins and structure in muscle change into a more diseased state in CP compared to TD.

Aim: To systematically review the evidence for intensive mobility training in cerebral palsy (CP) and to determine the minimum effective dose to improve mobility.

Method: Randomized controlled trials (RCTs) or quasi-RCTs that included participants with CP, and which used intensive task-oriented training (TOT) mobility interventions and reported mobility outcomes, were included. Five databases were searched; two independent reviewers selected studies and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane Risk of Bias 2 tool were used to rate the certainty of evidence at the outcomes level and to determine the risk of bias respectively. Meta-analyses were conducted with clinically homogeneous studies. Threshold dose was analysed through meta-regression.

Results: Forty-six RCTs with 1449 participants (mean age range 1 year 2 months to 16 years 4 months) were included. TOT had statistically and clinically significant effects on walking speed (p = 0.001), cadence (p = 0.02), gross motor function (p = 0.03), and functional mobility (p = 0.009) compared with control interventions. The threshold dose was undeterminable owing to the high heterogeneity of studies.

Interpretation: TOT may improve walking speed, walking endurance, and balance. Studies with homogeneous samples and outcomes are needed to support clinical recommendations for intensive mobility interventions.

Aim: To evaluate the effect of a parent-administered sensorimotor intervention (PASI) program on developmental outcomes of infants born preterm during their stay in the neonatal intensive care unit (NICU).

Method: A randomized clinical study was conducted with 94 infants (mean gestational age 31 weeks [SD 2.2 weeks]; 1658 g [SD 478 g]; 49 males, 45 females) initially enrolled and randomly assigned to an experimental or a control group. Infants in the experimental group received a PASI, consisting of tactile input to oral structures, trunk/limbs, and non-nutritive sucking for 15 minutes, once a day, for 10 days. Infants in the control group received standard care. Outcomes included attainment of complete oral feeds, occurrence of direct breastfeeding at hospital discharge, and motor function assessed using the Test of Infant Motor Performance (TIMP).

Results: A total of 80 infants completed the study. Infants in the experimental group achieved complete oral feeds sooner (11.9 [SD 4.3] vs 15.3 [SD 6.5] days, p = 0.013), and a greater number of them received direct breastfeeds (22 vs 12, p = 0.010) than controls. Infants in both groups had equivalent motor functions scores on the TIMP (46.9 [SD 4.8], 46.8 [SD 8.4], p = 0.961).

Interpretation: A PASI program may enhance an infant's oral feeding skills. These findings provide evidence to advocate for the institution of PASI in NICUs.