Bcl Touwen

Neurological differences between 9-year-old children fed breast-milk or formula-milk as babies

The presence of minor neurological dysfunction is associated with behavioural and cognitive development at school age. We have previously shown a relation between minor neurological dysfunction and perinatal disorders, especially abnormal neonatal neurological condition. We have now investigated the relation between breastfeeding and long-term neurological development. We studied 135 breastfed (for > or = 3 weeks) and 391 formula-fed children, born at term in the University Hospital Groningen between 1975 and 1979. A standard neonatal neurological examination was used to classify the infants as normal (247), slightly abnormal (213), or frankly abnormal (66). At 9 years of age the children were reexamined. In 1993 their mothers were asked to complete a questionnaire about how the children were fed as infants. After adjustment for obstetric, perinatal, neonatal neurological, and social differences, a small advantageous effect of breastfeeding on neurological status at 9 years of age was found (odds ratio for neurological non-normality 0.54 [95% CI 0.30-0.97]). Although a retrospective design cannot lead to definite conclusions, our data suggest a beneficial effect of breast-feeding on postnatal neurological development. Longer-chain polyunsaturated fatty acids, which are present in breast-milk but not in most formula-milks, may have a role since they are vital for brain development.

PERINATAL CORRELATES OF MAJOR AND MINOR NEUROLOGICAL DYSFUNCTION AT SCHOOL AGE - A MULTIVARIATE-ANALYSIS

A prospective study was carried out on 747 infants: 147 neurologically abnormal, 300 with mild neurological abnormalities and 300 normal infants. They were re‐examined at nine years of age, with special attention being paid to minor neurological dysfunction (MND). Extensive data on obstetrical abnormality, risk factors contributing significantly to later handicap were low one‐minute Apgar scores, a disturbed neonatal course, low social‐class and interval complications: obstetrical events were conspicuous by their absence. Two aetiologically and clinically distinct kinds of MND were distinguished on the basis of a neurological cluster profile: MND‐1 (one or two abnormal clusters) was only associated with a birthweight below the 2·3 centile and male gender, and MND‐2 (more than two abnormal clusters) was associated with neonatal neurological findings, social class, obstetrical optimality score and gender.

Preterm or small-for-gestational-age infants

In 166 full term, small-for-gestational-age (FT-SGA), 53 preterm, appropriate-for-gestational-age (PT-AGA), 27 PT-SGA and 206 FT-AGA infants a neurological examination at the age of 6 years was carried out. Data were collected on behaviour and school achievement. Major and minor neurological abnormalities were more frequent in the three low birth weight groups, especially in the PT-SGA group. Multivariate analysis showed that the development of major and minor neurological abnormalities was explained by a varying set of risk factors, in which besides prematurity and growth retardation, neonatal neurological condition, social class, neonatal course and interval complications were preponderant. The results suggest a temporal difference in potentially harmful factors: for neurological handicap early in pregnancy, for minor neurological dysfunction (MND) the second half of gestation and the first 2 years of life. No striking behavioural differences were found between the three low birth weight groups and the FT-AGA group; behaviour was related to neonatal and follow-up neurological condition, sex, gestational age and birth weight to a limited extent only. Three (4%) of the preterms entered a special school (already at the age of 6). School achievement was mainly related to the present neurological condition and social class, which underlines the importance of the latter.

NEUROLOGICALLY DEVIANT NEWBORNS: NEUROLOGICAL AND BEHAVIOURAL DEVELOPMENT AT THE AGE OF SIX YEARS

Of 1655 newborns examined neurologically at term, 80 were found to be abnormal. 76 were traced at six years of age, together with a control group of 77 neonatally normal children. In the study group five children had died, six were severely handicapped and 21 had minor neurological dysfunction (MND). In the control group two had died and four had MND. Obstetrical and neonatal paediatric effects, as well as complications in the intervening years, appeared to have a cumulative effect on the relationship between the neonatal neurological condition and the neurological findings at six years. There were no large differences in behaviour between the study group and the controls, but the study‐group MND children showed a stronger tendency for undesirable behaviour and poor school achievements. Although environmental influences are preponderent for the development of behaviour and school performance, a contribution of both neonatal and later neurological conditions seems likely.

Is clonidine a behavioural teratogen in the human

Twenty-two children prenatally exposed to clonidine and no other hypotensive drugs were compared at a mean age of 6.3 +/- 1.6 years to a non-exposed control group, matched for degree of maternal hypertension, sex, birthweight and gestational age. There were no differences in head circumference, neurological findings, school performance and a number of behavioural characteristics except for a marginal excess of hyperactivity and an excess of sleep disturbances in the study group. It is questionable whether the differences represent a direct effect of clonidine on prenatal development but the dose-effect relationship and the fact that the same effects have been found in rats suggest that this may be so.

Neurological outcome in school-age children after in utero exposure to coumarins

The effect of prenatal exposure to coumarins (acenocoumarol, phenprocoumon) on neurological outcome was assessed in a cohort of 306 children aged 7-15 years. Findings were compared with those in a non-exposed cohort of 267 children, matched for sex, age, and demographic region. We used a neurological examination technique which pays special attention to minor neurological dysfunction (MND), None of the children tvas found to be neurologically abnormal. However, exposure to coumarins during gestation increases the risk for MND in children of school age, odds ratio (OR) 1.9 (CI95 1.1-3.4), predominantly after exposure in the second or third trimester, odds ratio 2.1 (CI95 1.2-3.8). We found a dose-response relationship with an odds ratio of 1.2 (CI95 1.0-1.5) per mg coumarin derivative prescribed per day. The results suggest that coumarins have an influence on the development of the brain which can lead to mild neurological dysfunctions in children of school age

Non-Ketotic Hyperglycinemia (NKH): An Inborn Error of Metabolism Affecting Brain Function Exclusively

Publisher Summary In vivo and in vitro studies have shown that the defect in non-ketotic hyperglycinemia (NKH) is due to an abnormality in the glycine cleavage reaction. In the normal human infant, glycine cleavage is shown to occur in liver, kidney, and brain. This chapter discusses the aspect of glycine neurotoxicity in patients with NKH, and in animal experiments, to study the potential of strychnine as an antidote for glycine neurotoxicity. Besides a systematic neurological examination of a newborn infant suffering from NKH, the chapter describes the experiments that aimed to simulate in animals the abnormal glycine concentration found in patients and then to investigate the effect of strychnine administration. The neurological sequence of the patients is in accordance with a glycine neurotoxicity than with a deficiency of some metabolic factor, both because of its sudden onset and because the abnormalities could be simulated in newborn rats by injecting glycine. Moreover, the very rapid change seen in the infant is more likely the result of a toxic action than the expression of an abnormality in a synthetic process. The type of clinical abnormalities shows that the toxicity is expressed as an extreme inhibition of both voluntary and involuntary movements. This is consistent with the idea that the glycine neurotransmission system is hyperactive.

Do girls with minor neurological dysfunction mature at a later age

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FOLLOW-UP OF GROWTH-RETARDED CHILDREN BORN BY ELECTIVE CESAREAN-SECTION BEFORE 33 WEEKS

25 singleton pregnancies were terminated by cesarean section between 28 and 33 weeks of gestation because of suspected growth retardation and abnormal unstressed cardiotocograms. Only infants with birth weights below the tenth centile were considered. 17 survived and were neurologically examined at 2.5-7 years of age. 2 were neurologically abnormal (1 had an adrenogenital syndrome) and 1 showed minor neurological dysfunction. Cesarean section appears acceptable in the management of intrauterine growth retardation with fetal distress in the early third trimester.

LONG-TERM NEUROLOGICAL AND COGNITIVE OUTCOME OF CHILDREN WHO WERE PRENATALLY EXPOSED TO COUMARINS - A PILOT-STUDY

Perinatal studies have shown that intra-uterine exposure to coumarins may influence the development of bone and neural tissues. To study the late effects of prenatal exposure to coumarins, physical, neurological, and mental development were assessed. In a pilot study 21 index (1) children and 17 controls (C) were examined at the age 8-10 years.Conclusions: No statistical significant differences were found between the index and control group in this small study. Nevertheless, an indication seemed to be present for a possible effect of prenatal exposure to coumarins. Five children showed minor neurological dysfunction (MND); the two children with the more serious variant (NOS = neurological optimally score 42-48) had both been exposed to coumarins. The distribution of the IQ-scores corresponded with the distribution of the scores in the Dutch standardization sample. There were 3 children with an IQ < 80. All three had been exposed to oral anticoagulants during pregnancy in the 2nd and 3rd (n = 2), or in the 3rd trimester only. One child with severe abnormalities, namely hypoplasia of both optic nerves, cerebral palsy and retardation, had been exposed during the 2nd and 3rd trimester of pregnancy. Paediatric exam directly post partum revealed no abnormalities. In view of these results a large follow-up study is required.