Developmental Medicine and Child Neurology最新文献

Children who are born very early (before 32 weeks of pregnancy) often face challenges as they grow up. One area that can be affected is working memory. This is the ability to keep information in mind for a short time and use it — for example, remembering a teacher's instructions or where you placed your keys. Working memory is important for school and everyday life.

In our study, we compared 53 children born very preterm with 53 children born full-term, all between 9 and 13 years old. We measured their working memory using a computer task and recorded brain activity simultaneously. We further assessed their motor skills, such as balance and manual dexterity.

Our results indicated that children born very preterm had more difficulty storing and using visual information in working memory. Their brain activity patterns also suggested challenges when the task became more demanding. Importantly, we discovered that differences in motor skills explained much of the gap in working memory performance. Children born very preterm who had poorer balance and hand skills also showed the greatest difficulties with working memory.

Aim: To examine associations between motor skills and cognitive development from birth to 5 years in typically developing children and children diagnosed with or at high risk of cerebral palsy (CP).

Method: Following prospective registration, five databases (PubMed, Web of Science, Embase, PsycINFO, and Cochrane) were searched to identify studies reporting motor and cognitive outcomes in children aged from birth to 5 years. Findings were synthesized using Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines.

Results: Thirty-three studies met the inclusion criteria. In typically developing children, motor skills consistently showed positive associations with later cognitive abilities, with fine motor skills having particularly strong predictive value. Among children with or at high risk of CP, developmental trajectories were more variable, yet motor delays were frequently associated with poorer cognitive performance.

Interpretation: Early motor proficiency is consistently associated with cognitive outcomes during early childhood. Motor impairments among children with or at high risk for CP may constrain cognitive development. Future research should investigate underlying mechanisms and explore integrated interventions targeting motor and cognitive domains.

Cerebral palsy (CP), the most prevalent childhood-onset motor disability, frequently entails progressive musculoskeletal complications. This comprehensive review synthesizes existing knowledge of microscopic and molecular alterations in CP skeletal muscle. Considerable methodological variability, heterogeneous patient cohorts, and inconsistent control groups significantly complicate comparative interpretations across studies. Nonetheless, some structural abnormalities consistently emerge, including increased variability in muscle fibre size, altered fibre type distribution, long sarcomeres at standardized joint positions, increased collagen content, disrupted neuromuscular junction integrity, reduced capillary density, and mitochondrial and satellite cell impairments. Investigations of satellite cell function in vitro further underscore potential mechanistic alterations, although findings remain inconsistent. Remarkably, few studies have systematically explored the cellular and molecular consequences of standard clinical interventions, revealing a notable research gap. In conclusion, the overall literature reveals considerable divergence in reported outcomes, reflecting the profound complexity of CP muscle biology. We believe that resolving this complexity will require more coordinated and collaborative research approaches.

Aim: To (1) identify and extract common data elements (CDEs) reported in registry- and population-based cerebral palsy (CP) studies in Arabic-speaking countries (ASCs), (2) compare reporting across study designs to ensure consistency of extraction and comparability of CDEs, (3) classify reporting consistency of the CDEs across six categories of frequency of reporting, and (4) assess the alignment of CDEs with data elements from international registry networks.

Method: The review was conducted using the JBI methodology for scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The Rayyan web application was used as a screening tool. Thirty-eight studies from 11 ASCs were analyzed. CDEs were extracted and grouped by frequency and thematic domains. Fisher's exact test and Cohen's kappa (κ) measured agreement across study types and with three international CP registry networks.

Results: Across 38 studies, core demographic and clinical CP classification data (age, sex, motor type, and topographical distribution) and birth-related characteristics (gestational age, birthweight, and mode of delivery) were consistently reported. Functional classifications, parental demographics, socioeconomic status, and rehabilitation services were less frequently included, particularly in population-based studies. Agreement with international registries was fair with the Australian Cerebral Palsy Register (κ = 0.26) and Global Low and Middle Income Cerebral Palsy Registers (κ = 0.24), but only slight with the Surveillance of Cerebral Palsy in Europe (κ = 0.17). Twelve elements were consistently reported across ASC studies and all three registry networks, covering demographic, perinatal, and core functional classifications.

Interpretation: ASC studies capture core CP data but remain inconsistent in reporting functional classifications, family context, and rehabilitation services. Establishing a harmonized minimum data set and registry network for ASCs would strengthen data quality, guide evidence-informed policy, and enhance both regional and global research impact.

This review provides clinicians and researchers in developmental medicine and paediatric neurology with a guide to using generalized estimating equations (GEEs) for longitudinal paediatric data. We present a concise primer on core GEE concepts for non-statistical audiences, emphasizing paediatric applications. Using a randomized trial of oestrogen versus placebo for postnatal depression, we provide a reproducible workflow (in R code) for continuous and binary outcomes. We compare exchangeable and autoregressive (first-order autoregressive model) working correlations and discuss implications for efficiency and interpretation. Because the data set is maternal and contains no child outcomes, we treat it as a perinatal case study relevant to child development and use it to illustrate marginal (population-averaged) inference in longitudinal clinical data. GEEs yielded stable marginal estimates across correlation structures when the mean model was correctly specified. Oestrogen was associated with significantly lower odds of postnatal depression than placebo, with negligible differences in model fit (correlation information criterion). Statistical choices mainly affected efficiency and standard errors rather than effect sizes. GEEs provide a robust, interpretable framework for analysing correlated outcomes in paediatric research. Paired with a reproducible example, this helps clinicians and researchers select appropriate models, report working correlations transparently, and interpret marginal effects in practice.

Aim: To study the relationship between brain and cerebrovascular imaging and neurocognitive metrics in children with moyamoya.

Method: This was a retrospective observational study of 34 children with moyamoya. Intellectual function was assessed using the Wechsler scales. Neuroimaging variables included the Suzuki stage, ivy sign score, paediatric moyamoya MRI score (PMMS), and a novel angiogram score.

Results: Intellectual function was significantly below average (mean IQ = 86.6). Ivy sign and PMMS were negatively associated with all indices of intellectual function (r = -0.32 to 0.5, p < 0.05). The angiogram score was negatively correlated with non-verbal reasoning, full-scale IQ (FSIQ), and working memory (r = -0.32 to -0.4, p < 0.05). Children with posterior circulation involvement had significantly lower mean IQ scores in the mild-moderate impairment range compared to the average range for children without. The posterior cerebral artery (PCA) ivy sign score and PMMS together significantly explain 35% of the variance in FSIQ (p < 0.001), and accurately classified children with moyamoya who had weak cognitive ability (FSIQ <85), with area under the curve of 0.76 (p = 0.01) and 0.735 (p = 0.02) respectively.

Interpretation: This study reliably identified a relationship between simple, routine neuroradiology sequences and neuropsychological outcomes in paediatric moyamoya. PMMS and/or PCA ivy sign score can be used to identify those children most at risk of cognitive impairment.

Directed acyclic graphs (DAGs) are increasingly used to clarify assumptions, identify sources of bias, and structure reasoning about causal pathways across the health sciences. In developmental medicine, where causes often span the preconception to postnatal periods, DAGs offer a systematic way to navigate complexity. This review introduces foundational DAG concepts for clinicians and researchers in childhood-onset disability, with an emphasis on accessibility and applied relevance. We review examples involving cerebral palsy, autism, and attention-deficit/hyperactivity disorder, showing how DAGs support confounder control, effect estimation, and study design. The figures throughout the review use a consistent, clinically grounded example to walk readers through concepts like mediation, backdoor paths, and collider bias. Beyond modeling rigor, DAGs help foster collaboration across disciplines and communicate causal structure to families and individuals with lived experience. We also show how DAGs can support intervention prioritization by identifying strategic leverage points using network measures such as node centrality and graph characteristics. Finally, we emphasize the importance of drawing DAGs before data collection, when their guidance is most actionable.

Aim: To systematically examine evidence on the impact of attending mainstream compared with special secondary school for adolescents with Down syndrome, in terms of health, education, and well-being outcomes.

Method: We searched four bibliographic databases for studies comparing education and health (including social and self-care) outcomes in adolescents with Down syndrome who attended mainstream secondary school to those attending special secondary school.

Results: Of 4458 publications, we identified three studies from the UK and the Netherlands, which involved 246 adolescents with Down syndrome: 49 attended mainstream and 197 attended special secondary school. Of three studies examining education outcomes, two reported improved attainment among adolescents attending mainstream school, but both were at risk of bias from participant selection, missing data, and deviations to the intended intervention. One study reported social and self-care outcomes, with no significant differences. No studies reported health outcomes. Studies provided only cursory information about teaching support.

Interpretation: Parents, policy-makers, and others who make choices about education for adolescents with Down syndrome lack evidence on whether outcomes differ, on average, between mainstream and special secondary schools. Well-designed studies are needed to quantify the impact of secondary school type on outcomes among adolescents with Down syndrome.