Marcy Gringlas

Clinical Antecedents of Neurologic and Audiologic Abnormalities in Survivors of Neonatal Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation is an effective rescue treatment for severe cardiorespiratory failure in term or near-term neonates, although cerebral palsy, mental retardation, and sensorineural hearing loss are observed in 10 to 20% of survivors. The objective of the present study was to identify potential risk factors that may explain the neurologic and audiologic sequelae noted in 19% of 181 survivors of neonatal extracorporeal membrane oxygenation from our hospital. Our results suggest the following findings in survivors of severe cardiorespiratory failure treated with neonatal extracorporeal membrane oxygenation: (1) hypotension or the need for cardiopulmonary resuscitation before extracorporeal membrane oxygenation significantly increases the risk of spastic cerebral palsy, (2) profound hypocarbia before extracorporeal membrane oxygenation is associated with a significantly increased risk of hearing loss, (3) mental retardation in the absence of spastic cerebral palsy is unexplained except when due to abnormal fetal brain development, and (4) hypoxemia in the absence of hypotension does not increase the risk of neurologic or audiologic sequelae. (J Child Neurol 1997;12:415-422).

Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls

OBJECTIVE Cancer is diagnosed in approximately 1 per 1000 pregnant women. Lifesaving cancer therapy given to the mother during pregnancy appears in conflict with the interest of the developing fetus. Often, termination of pregnancy is suggested but has not been proven in any type of cancer to improve maternal prognosis, while very few studies have documented the long-term effects of in utero chemotherapy exposure on child outcome. To counsel patients about the risk of continuing a pregnancy while undergoing cancer treatment, we performed developmental testing to provide more detailed follow-up on children exposed in utero to chemotherapy. STUDY DESIGN Mother-infant pairs, enrolled in the Cancer and Pregnancy Registry, were offered developmental testing for children who were ≥18 months of age. Based on age, the Bayley Scales of Infant Development-Third Edition, the Wechsler Preschool and Primary Scale of Intelligence-Revised, the Wechsler Intelligence Scale for Children, Third Edition, or the Wechsler Individual Achievement Test was administered. All parents or primary caregivers completed the Child Behavior Checklist, a parent questionnaire to assess behavior and emotional issues. Results of children exposed to chemotherapy before delivery were compared with children whose mothers were also diagnosed with cancer during pregnancy but did not receive chemotherapy before delivery. RESULTS No significant differences were noted in cognitive skills, academic achievement, or behavioral competence between the chemotherapy-exposed group and the unexposed children. Of children, 95% scored within normal limits on cognitive assessments; 71% and 79% of children demonstrated at or above age equivalency in mathematics and reading scores, respectively; and 79% of children scored within normal limits on measures of behavior. Older children had significantly higher rates of internalizing behavior problems. CONCLUSION We could not demonstrate a significant difference in cognitive ability, school performance, or behavioral competence for children exposed to chemotherapy in utero compared with nonexposed controls. The majority of these children scored within normal limits on all developmental measures. Premature birth was more prevalent in the chemotherapy-exposed group yet did not predict developmental outcome. Older children in the sample demonstrated higher rates of internalizing behavior problems.

The More Things Change...Single Parenting Revisited

Weinraub and Wolf investigated maternal and preschool child functioning in households headed by solo mothers. Solo mothers—nonadolescent women raising children from birth without a male partner—differed from demographically matched, married counterparts with regard to stress and social supports, yet no differences in child outcomes were observed. Twenty-eight families (70%) from that original sample were reassessed as children entered preadolescence. Child measures included maternal and teacher report of behavior problems, social competence, and academic performance. Maternal measures included parenting, social supports, and stress. According to teachers, preadolescent children of solo mothers had more behavior problems, lower social competence, and poorer school performance than children of married mothers. Solo mothers continued to be less satisfied with emotional supports and reported higher stress. Maternal stress moderated family status effects on child outcome. Longitudinal analyses revealed stability over time for maternal and child variables, with greater vulnerability for children of solo mothers.

Neonatal electroencephalogram does not predict cognitive and academic achievement scores at early school age in survivors of neonatal extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation is an effective rescue treatment for severe cardiorespiratory failure in term or near-term neonates, although a wide range of neurologic sequelae have been noted in a substantial minority of survivors. The objective of the present study was to determine the value of the neonatal electroencephalogram (EEG) for predicting Wechler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), Wide Range Achievement Test, and Wide Range Assessment of Memory and Language scores at early school age in 66 testable survivors of extracorporeal membrane oxygenation who were not severely brain damaged. Technically satisfactory EEG recordings were obtained at least twice following admission to our nursery and prior to discharge. The EEGs were classified and graded according to standard criteria. The developmental test results of those who had only normal or mildly abnormal neonatal EEGs (group 1, n = 9) were compared with those who had at least one moderately or markedly abnormal recording (group 2, n = 57). School-age test and subtest scores were not statistically significantly worse in group 2 versus group 1 infants. No child in group 1 and five children in group 2 had WPPSI-R Full-Scale IQ scores of less than 70. Of the nine children in group 2 who had at least one markedly abnormal neonatal EEG recording (graded as burst suppression or as electrographic seizure), only two had abnormally low WPPSI-R Full-Scale IQ scores. We conclude that EEG recordings obtained during the neonatal course of neonates treated with extracorporeal membrane oxygenation do not predict cognitive and academic achievement test results in survivors at early school age who were testable and not severely brain damaged. (J Child Neurol 2001;16:745-750).

PRIMARY DIAGNOSES AS PREDICTORS OF LONG-TERM DEVELOPMENTAL OUTCOME IN SCHOOL AGE SURVIVORS OF EXTRACORPOREAL LIFE SUPPORT (ECLS): A LONGITUDINAL STUDY. ▴ 1581

PRIMARY DIAGNOSES AS PREDICTORS OF LONG-TERM DEVELOPMENTAL OUTCOME IN SCHOOL AGE SURVIVORS OF EXTRACORPOREAL LIFE SUPPORT (ECLS): A LONGITUDINAL STUDY. ▴ 1581

Neurodevelopment and Medical Follow-up of Infants Treated with Inhaled Nitric Oxide (NO). † 1250

Neurodevelopment and Medical Follow-up of Infants Treated with Inhaled Nitric Oxide (NO). † 1250

CLINICAL ANTECEDENTS OF NEUROLOGIC AND AUDIOLOGIC ABNORMALITIES IN NEONATAL ECMO SURVIVORS. † 1529

CLINICAL ANTECEDENTS OF NEUROLOGIC AND AUDIOLOGIC ABNORMALITIES IN NEONATAL ECMO SURVIVORS. † 1529