Katarina Lindström

Moderate neonatal encephalopathy: Pre- and perinatal risk factors and long-term outcome

Background. The aim was to describe pre‐ and perinatal data and long‐term neurodevelopmental outcome (15–19 years) in children born at term with Apgar score <7 at 5 min and moderate neonatal encephalopathy. Methods. The study is based on a population‐based birth‐cohort of children born in Sweden in 1985. Maternal, delivery, neonatal, and neuropaediatric data were compiled. Neurodevelopmental status was classified according to the presence of 1. cerebral palsy or other major impairments, 2. exclusively cognitive impairments, and 3. no impairments. Results. The majority of the children (81%) had cognitive dysfunctions, with or without other impairments, such as cerebral palsy. The rates of post‐term birth (19% versus 8%) and breech presentation (12% versus 3%) were significantly higher than in the general Swedish population. Pre‐ and perinatal data did not differ notably between the three outcome groups. Questionable or suboptimal obstetric care was common (55%). Conclusions. The study shows that children born at term with moderate neonatal encephalopathy have a high rate of cognitive dysfunctions with or without cerebral palsy at long‐term follow‐up. Our pre‐ and perinatal data did not correlate with outcome.

Diffusion tensor imaging on teenagers, born at term with moderate hypoxic-ischemic encephalopathy.

Hypoxic-ischemic encephalopathy (HIE) is graded with three levels of severity—mild, moderate and severe. The outcome of individuals with mild and severe grades can be reliably predicted from this scheme. Individuals with moderate degree are divided in outcome between those who suffer major neurologic problems (e.g., cerebral palsy) and those who are assumed to recover from the incident. It is however not clear if the recovery is complete and unquestionable.A group of adolescents who had been born at term, diagnosed with moderate HIE but had not developed cerebral palsy, were investigated with diffusion tensor imaging. Fractional anisotropy maps were used as a basis of comparison to a group of controls of the same age and gender distribution.In several white matter areas fractional anisotrophy was lower in the group of individuals with a history of moderate HIE. These areas include the internal capsules (bilaterally in the posterior limb and on the right in the anterior limb), the posterior and anterior corpus callosum as well as frontal inferior white matter areas.These results indicate that even in the absence of such major neurologic impairments as cerebral palsy, moderate HIE causes long term white matter disturbances which are not repaired by adolescence.

Developmental data in preschool children born after prolonged pregnancy.

Aim: To evaluate children born post‐term (gestational age 42 weeks) with respect to developmental data obtained at the ages of 4 and 5.5 y. Methods: The study population included all children (n=354) born in 1991 at Huddinge University Hospital with a gestational age of 42 wk. The births were identified and perinatal data were collected through the Swedish National Birth Registry. Developmental assessments from the child health centres were analysed. Children born at term, but before a gestational age of 42 wk, served as controls. Logistic regression analysis was used to analyse the data. Results: Children born post‐term had more developmental deviations than the controls (estimated odds ratio 2.20; 95% CI: 1.29–3.85). Boys had more deviations than girls (estimated odds ratio 1.92; 95% CI: 1.11–3.45).

One-year follow-up of tick-borne central nervous system infections in childhood.

Background: Neurologic sequelae, including cognitive deficits, after childhood tick-borne encephalitis (TBE) and neuroborreliosis (NB) are not well-characterized. These infections are among the most common affecting the central nervous system in children and can be difficult to diagnose due to vague symptomatology. The aim of this study was to investigate long-term (>1 year) consequences of pediatric TBE and NB as well as the value of markers for brain damage and genetic susceptibility. Methods: From a previous prospective study, children diagnosed with TBE (n = 8) and NB (n = 12) as well as pediatric controls (n = 15) were followed up by clinical examination, semistructured interview and screening for cognitive dysfunction by the Five-to-Fifteen Questionnaire. The follow-up also included detection of serum autoantibodies against the neural proteins; glial fibrillary acidic protein and myelin basic protein, as well as genotyping of a 32 basepair deletion in the chemokine receptor type 5 gene. Results: Children diagnosed with TBE displayed significantly more long-term subjective complaints (ie, fatigue, headache and irritability) compared with the NB and control groups. Significantly higher frequency of disabilities was also detected by the Five-to-Fifteen Questionnaire in the TBE group. Both TBE and NB cause consequences (eg, prolonged convalescence, worries and financial loss) for the families. Markers for genetic susceptibility and brain damage had no prognostic values in this cohort. Conclusions: Pediatric TBE results in long-lasting residual symptoms and neurologic deficits affecting daily life. Vigilance for TBE-related morbidity among pediatricians and long-term clinical follow-up with assessment of cognitive dysfunctions and appropriate interventions seems reasonable for these children.

Impaired balance and neurodevelopmental disabilities among children with congenital cytomegalovirus infection

Although cytomegalovirus (CMV) is the most common congenital infection, existing research has not provided us with a full picture of how this can affect children in the future. The aim of this case–control study was to evaluate disabilities in a well‐defined group of children with congenital cytomegalovirus (CMV) infection, who had been fitted with cochlear implants because of severe hearing impairment.

Previously undiagnosed attention-deficit/hyperactivity disorder associated with poor metabolic control in adolescents with type 1 diabetes

Managing modern diabetes treatment requires efficient executive functions. Patients with attention‐deficit/hyperactivity disorder (ADHD) and type 1 diabetes have poor metabolic control and present with ketoacidosis more often than patients without ADHD.