A. M. van Furth

Prediction of academic and behavioural limitations in school-age survivors of bacterial meningitis.

Aim: To develop a prediction rule to identify postmeningitic children at high risk of academic and behavioural limitations. Methods: 182 children (mean age 10 y; range 5–14) were selected from a cohort of 674 school‐age survivors of bacterial meningitis. These children had neither meningitis with “complex onset”, nor prior cognitive or behavioural problems, nor severe disease sequelae. On average, 7 y after the meningitis, they were evaluated using an “Academic Achievement Test”, and their parents filled in the “Child Behaviour Checklist”. By reviewing the medical records, potential risk factors for academic and/or behavioural limitations were collected. Independent predictors were identified using multivariate logistic regression analysis, leading to the formulation of a prediction rule. Results: The cumulative incidence of academic and/or behavioural limitations among children who survived bacterial meningitis without severe disease sequelae was 32%. The prediction rule was based on nine independent risk factors: gender, birthweight, educational level of the father, S. pneumoniae, cerebrospinal fluid leukocyte count, delay between admission and start of antibiotics, dexamethasone use, seizures treated with anticonvulsive therapy, and prolonged fever. When 10 was taken as a cut‐off point for the risk score computed using this rule, 76% of the children with limitations could be identified, while 38% of the children in the cohort were selected as at risk for these limitations.

Seasonal variation in the incidence rate of tuberculous meningitis is associated with sunshine hours

Tuberculous meningitis (TBM) is a severe complication of tuberculosis and occurs mainly during early childhood. The incidence rate of TBM varies with season, and serum vitamin D levels, which are dependent on sunlight, might play a role. We studied the association between TBM incidence rate and hours of sunshine in Cape Town, South Africa and found a significant association between the incidence rate of TBM and hours of sunshine 3 months earlier (incidence rate ratio per 100 sunshine hours 0·69, 95% confidence interval 0·54-0·88, P = 0·002). The association supports the hypothesis that vitamin D might play a role in the pathophysiology of TBM. Further prospective studies in which vitamin D status is measured are necessary to determine causality.

Quality of Life and its Determinants in Preschool Children with Down Syndrome

Objective : Children with Down syndrome (DS) show a delay in cognitive and motor development and have various concomitant health problems. We compared Health-Related Quality of Life (HRQoL) in preschool children with DS with a reference group, and investigated child-related factors (i.e., developmental quotient, adaptive function, health problems, problem behaviour), and maternal level of education on HRQoL. Method : In a cohort of 55 children with DS, HRQoL was measured with the TNO-AZL preschool children Quality of Life Questionnaire (TAPQoL). Data from a reference group were used for comparison. Developmental Quotient (DQ) was assessed with the Bayley Scales of Infant Development II, adaptive function with the Pediatric Evaluation of Disability Inventory, health problems were derived from the medical file, and behavioural problems were measured with the Child Behaviour Checklist. Results : Children with DS (N=55; mean age 41.7 months) scored significantly lower on the TAPQoL domains lung and stomach problems, motor function and communication compared to the reference group. DQ had a significant negative correlation with the domains lung problems and liveliness. Children with DS with respiratory or gastro-intestinal problems showed significant lower scores on lung problems and communication. Problem behavior had a significant negative correlation with the domains sleeping, appetite and social function. A low level of maternal education correlated negatively with positive mood. Adaptive function and congenital heart defect (CHD) did not significantly correlate with HRQoL. Conclusion : Preschool children with DS show a lower HRQoL on particular domains of functioning compared to a normative sample. HRQoL of children with DS is correlated to DQ, respiratory and gastro-intestinal health problems, problem behaviour and maternal education, but not to CHD and adaptive function.

Unsuccessful validation of 2004 model for predicting academic or behavioural limitations after childhood bacterial meningitis

In 2004, a model identifying children at risk of academic or behavioural limitations after bacterial meningitis (BM) was presented. Risk factors were male gender, low birthweight, lower educational level of the father, Streptococcus pneumoniae, lower cerebrospinal fluid (CSF) leucocyte count, delay between admission and start of antibiotics, dexamethasone <2 days, seizures and prolonged fever. The aim of this study was to validate that prediction model in an independent cohort.

Advies ten aanzien van de behandeling met dexamethason bij kinderen met verdenking op bacteriële meningitis

SummaryA recent study by De Gans and Van de Beek in the nejm entitled ‘Dexamethasone in adults with bacterial meningitis’ made the question relevant if children suspected of bacterial meningitis should be treated with dexamethasone. Based on the literature available we advise dexamethasone treatment for children older than two months of age who are suspected of acute bacterial meningitis. Dexamethasone should be given just before, or together with the first dose of (intravenous) antibiotics, in a dosage of 0.6 mg/kg/day in four doses during four days.SamenvattingNaar aanleiding van het artikel ‘Dexamethasone in adults with bacterial meningitis’ door De Gans en Van de Beek in de nejm is de vraag in de actualiteit gekomen of dexamethason ook gegeven moet worden aan kinderen die worden verdacht van bacteriële meningitis. Op basis van de beschikbare literatuur adviseren wij kinderen ouder dan twee maanden bij de verdenking op bacteriële meningitis te behandelen met dexamethason. Dexamethason moet vlak voor, of gelijktijdig met de eerste gift (intraveneuze) antibiotica worden gegeven in een dosering van 0,60 mg/kg/dag in vier doses gedurende vier dagen.

Diffusiegewogen MRI bij neonatale Bacillus cereus meningo-encefalitis

SummaryT1 and T2 weighted mr images of the brain are very suitable to demonstrate the integrity of the infants brain. Diffusion weighted mri is a new promising technique which is sensitive to conditions with restricted water diffusion, e.g. cytotoxic edema in infection and ischaemia. The value of this new mri technique will be discussed in relation to two patients with severe neurological problems.Two premature infants developed a Bacillus cereus infection of the central nervous system. T1 weighted mri showed a hyperintense signal in the entire cerebral cortex and white matter; some of these areas were hypointense on T2 weighted mri, suggestive of hemorrhage. On T2 weighted mri part of the cortex was abnormal whereas the basal nuclei appeared normal. dwi showed increased signal in basal nuclei and cortex, probably due to cytotoxic edema.Conclusion: Bacillus cereus infection of the central nervous system can lead to a severe hemorrhagic meningo-encephalitis. mri is an excellent technique to investigate the extent of lesions in the brain. Diffusion weighted mri has an additional value in detecting extra lesions most probably due to cytotoxic edema.samenvattingT1- en T2-gewogen magnetische resonantie beeldvorming (mri) van de hersenen is bij uitstek geschikt om de integriteit van de hersenen in beeld te brengen. Diffusiegewogen mri is een nieuwe, veelbelovende techniek die vooral gevoelig is voor verminderde diffusie van water zoals dat gezien wordt bij cytotoxisch oedeem, onder andere in het kader van acute ischemische veranderingen. De waarde van T1-, T2- en diffusiegewogen mri wordt besproken aan de hand van twee patiëntjes met een ernstig neurologisch ziektebeeld.Twee premature neonaten ontwikkelden een Bacillus cereus-infectie van het centraal zenuwstelsel. Op de T1-gewogen mri-beelden waren hyperintense afwijkingen zichtbaar in de gehele supratentoriële witte stof en cortex; deels waren deze afwijkingen hypo-intens op T2-gewogen beelden, passend bij bloed. Op de T2-gewogen mri-beelden was een deels afwijkende cortex zichtbaar; de basale kernen toonden relatief weinig afwijkingen. Op de diffusiegewogen mri-beelden was bij beide kinderen een verhoogd signaal zichtbaar in de basale kernen en de cortex, passend bij cytotoxisch oedeem.Conclusie: Bij een neonatale Bacillus cereus-infectie van het centraal zenuwstelsel kan een zeer ernstige hemorragische meningo-encefalitis optreden. mri is een zeer gevoelige techniek voor het vaststellen van de uitgebreidheid van de schade aan de hersenen. Hierbij heeft diffusiegewogen mri een toegevoegde waarde voor het vaststellen van extra afwijkingen, die meest waarschijnlijk berusten op cytotoxisch oedeem.

Een pasgeborene met een thrombus in het rechteratrium en persisterende Staphylococcus aureus–sepsis

SummaryWe describe a neonate with an infected right atrial thrombus. The infected thrombus caused an ongoing Staphylococcus aureus-sepsis. Data in literature on treatment of infected thrombi in neonates are limited. Our patient was successfully treated with antibiotics and heparin. If an infected cardiac thrombus in a neonate does not cause severe hemodynamic problems or pulmonary embolism, treatment with antibiotics and heparin can be sufficient.SamenvattingWe beschrijven een pasgeborene met een geïnfecteerde thrombus in het rechteratrium. De geïnfecteerde thrombus veroorzaakte een persisterende Staphylococcus aureus–sepsis. Gegevens over de behandeling van geïnfecteerde thrombi bij pasgeborenen in de literatuur zijn beperkt. Onze patiënt werd succesvol behandeld met heparine en antibiotica. Deze therapie kan worden toegepast bij pasgeborenen indien de thrombus geen ernstige hemodynamische problemen of pulmonale embolieën heeft veroorzaakt.