Developmental Medicine and Child Neurology最新文献

Aim: To determine whether weight-for-age (WFA) centiles on disease-specific growth charts predict clinical outcomes in children with cerebral palsy (CP).

Method: We conducted a retrospective cohort study of pediatric patients with CP in Gross Motor Function Classification System levels III to V, treated at a tertiary care hospital from January 2016 to June 2022. Patients were categorized as above or below the 20th centile WFA using CP-specific growth curves. Clinical outcomes included emergency department and urgent care visits, hospital and pediatric intensive care unit (PICU) admissions, fracture incidence, surgical procedures, and mortality.

Results: Of 127 patients (62.9% male, age range at study entry 3-20 years; mean age 10 years 7 months, SD 4 years 5 months), 113 were above and 14 were below the 20th centile. The 'below' group had a 122% higher mean number of emergency department and urgent care visits than the 'above' group (p = 0.004, adjusted incidence rate ratio: 2.22; 95% confidence interval: 1.29, 3.8). They also had a median 1.5 more PICU admissions and 5.2 longer PICU days compared to the 'above' group. Mortality was 4.4% (5/113) in the 'above' group and 28.6% (4/14) in the 'below' group.

Interpretation: Children with CP who fall below the 20th centile WFA appear to require more healthcare services and may face increased mortality risk. Maintaining WFA above the 20th centile may represent an important clinical target.

Aim: To identify, qualify, and synthesize the characteristics of interventions for children with diagnosed and suspected developmental coordination disorder (DCD) worldwide.

Method: This was a scoping review, with searches in eight bibliographical databases without language restrictions. All interventions involving children and adolescents with motor coordination disorders were included, with content analyses involving the type and context of the intervention and interventionists, the outcomes addressed, and the findings reported and considered regarding the International Classification of Functioning, Disability and Health framework.

Results: From 30 637 hits, 202 distinct studies were identified, including 206 interventions with a total of 4593 children or adolescents. The children included were often poorly defined. Movement activities were offered through task-oriented, motor skill, and sports training approaches with active video games and sensory-perceptual motor skills training reported the most frequently. Long-term psychosocial and participation outcomes were less explored.

Interpretation: Future intervention studies need to be clearer on the diagnostic criteria and details of DCD, including individual(s) who delivered the training, the type of training, session intensity, and the delivery mode. Outcome measures should consider three critical domains: (1) practical application of learned motor skills in daily life; (2) environmental and psychosocial impacts; and (3) parental awareness and support.

Aim: To predict trajectories of cognitive abilities from ages 2 years to 15 years in children born extremely preterm.

Method: This longitudinal cohort study examined 659 (330 males) children born at 23 weeks to 27 weeks' gestation with cognitive assessments at ages 2 years, 10 years, and 15 years. Early factors analysed included maternal and neonatal characteristics, comorbidities, and neonatal inflammatory proteins.

Results: For verbal, non-verbal, and combined cognitive abilities, greater social disadvantage at birth, male sex, 23 weeks to 24 weeks gestational age, bronchopulmonary dysplasia (BPD), ultrasound-detected cerebral white matter injury (WMI), and elevated inflammatory proteins in neonatal blood were associated with lower scores over the 15-year time frame for all outcomes. Analyses of joint association between socially disadvantaged groups and WMI suggested that the effect of no social disadvantage was evident only among children without WMI, whereas the effect of WMI was evident irrespective of social disadvantage.

Interpretation: In this cohort of children born extremely preterm, social disadvantage at birth, male sex, BPD, WMI, and neonatal systemic inflammation were associated with slower gains in cognitive scores from age 2 years to 15 years. Early WMI moderated the associations between social disadvantage and cognitive functioning. Efforts to address both neonatal morbidities and social factors could improve cognitive functioning in children born extremely preterm.

Aim: To examine motor imagery performance in children with cerebral palsy (CP) compared to typically developing children and develop a composite motor imagery score to differentiate between the two groups.

Method: In this cross-sectional case-control study, 37 participants (17 with CP, 20 typically developing, aged 10-20 years; 22 females) completed the Hand Laterality Task (HLT), judging hand laterality at several rotation angles. Mixed-effects models were used to compare HLT outcomes (reaction time and accuracy) across groups. A composite score was developed to differentiate children with CP from typically developing children. Model performance was evaluated using internal validation with 100 random 70/30 train-test partitions, with classification metrics (mean area under the curve [AUC], accuracy, sensitivity, specificity, precision, F1 score) averaged across iterations.

Results: Children with CP exhibited lower accuracy (p = 0.002) and higher reaction time variability (p < 0.001) than typically developing children, with no significant reaction time differences (p = 0.46). Among multiple models evaluated, the composite score combining accuracy and reaction time variability achieved the best performance compared to models using single parameters. Across 100 random train-test splits, the model demonstrated a mean (SD) of: AUC = 0.89 (0.09), accuracy = 81% (11%), sensitivity = 81% (19%), and specificity = 84% (18%).

Interpretation: The composite score differentiated motor imagery performance in children with CP from that of typically developing children. The findings provide initial evidence for reaction time variability as a distinguishing feature, warranting further research to develop targeted rehabilitation strategies. The findings may also promote clinical use of the HLT for motor imagery.