Winnie Goh

White Matter Volume and Anisotropy in Preterm Children: A Pilot Study of Neurocognitive Correlates

The objectives of this study were to evaluate the differences in whole brain white matter (WM) volume and anisotropy between preterm and term children and to determine the relationships with cognitive outcome. Twenty-five low birth weight (BW), preterm, neurologically normal children between 8.8 and 11.5 y of age were recruited for volumetric and diffusion-tensor magnetic resonance imaging (DTI), together with 13 age-matched term control subjects. Subsequent intelligence quotient (IQ) testing was performed for 21 preterm children within 6 mo of imaging studies. We computed the mean volume and fractional anisotropy (FA) of the whole brain WM and compared the differences between the two groups. Mean WM volume and FA were significantly lower in the preterm group (p = 0.014 and p < 0.001, respectively). Multiple regression analysis found both WM volume and FA to be independent variables significantly affecting full scale IQ (FSIQ) (r2 = 0.407, p = 0.021 and r2 = 0.496, p = 0.005, respectively) after adjusting for BW, gestational age (GA), and gender. In the evaluation of the whole brain WM of preterm children, we found that both volume and FA remain reduced at late childhood with both parameters significantly affecting long-term cognitive outcome.

T2-weighted hyperintensities (unidentified bright objects) in children with neurofibromatosis 1: Their impact on cognitive function

The impact of magnetic resonance imaging (MRI)—identified T2-weighted hyperintensities (unidentified bright objects) on the cognitive function of children with neurofibromatosis 1 is controversial. We recruited 32 right-handed children with neurofibromatosis 1 (22 boys, 10 girls) aged between 5 and 16 years (mean age 10.2 years) for magnetic resonance imaging examinations and neuropsychologic evaluation. Statistical analysis was performed to evaluate the significance of the hyperintensities. Twenty-four children had unidentified bright objects, whereas eight children did not. Using the t-test, thalamic lesions were associated with lower intellectual function (P = .031). Left globus pallidus hyperintensities were associated with a lower attention score ( P = .04), and right middle cerebellar peduncle hyperintensities were associated with a lower sensorimotor score (P = .05). The size of the thalamic lesions correlated with cognitive function (P < .05). Among the group with unidentified bright objects, there was a significant association between more involved sites on the dominant hemisphere and impaired verbal function (r = —.55; P = .005). Unidentified bright objects in the thalamus, globus pallidus, and middle cerebellar peduncles and the laterality of the lesions had an impact on cognitive function. (J Child Neurol 2004; 19:853-858).

Diffusion-Weighted Imaging and Proton Magnetic Resonance Spectroscopy in Perinatal Hypoxic-Ischemic Encephalopathy: Association With Neuromotor Outcome at 18 Months of Age:

We evaluated early diffusion-weighted imaging findings, the quantitative apparent diffusion coefficient, and magnetic resonance spectroscopy (the presence of lactate and ratios of N-acetylaspartate to total creatine and choline to total creatine) in the prediction of the 18-month neuromotor outcome of term newborns with hypoxic-ischemic encephalopathy. Conventional T1- and T2-weighted and diffusion-weighted imaging was performed in 20 asphyxiated term newborns, with additional basal ganglia magnetic resonance spectroscopy in 15 newborns between 2 and 18 days of life (mean 7.3 days). Neuromotor outcome was dichotomized into normal and abnormal for statistical analysis. Statistically significant differences in the ratios of N-acetylaspartate to total creatine, but not apparent diffusion coefficient values and ratios of choline to total creatine, were found between infants with a normal and an abnormal outcome (Mann-Whitney U-test, P = .010). There was a significant association between the presence of a lactate peak and an abnormal outcome (chi-square test, P = .017). The presence of a lactate peak for predicting an abnormal outcome had a sensitivity of 100% and a specificity of 80%, and the odds ratio was 37.4. Ischemic lesions were more conspicuous and/or extensive on diffusion-weighted imaging in all except one neonate. The presence of normal findings on both diffusion-weighted imaging and conventional magnetic resonance imaging is predictive of a normal neuromotor outcome, whereas lactate and a reduced ratio of N-acetylaspartate to total creatine in the basal ganglia, but not an apparent diffusion coefficient, are associated with an abnormal outcome at 18 months of age. (J Child Neurol 2004;19:872—881).

Ganglioneuroma of the spinal cord

This report describes a 2-year-old boy who harbored an intramedullary ganglioneuroma involving almost the entire length of the spinal cord. The terminology, pathology, and neurobiological behavior of this tumor is discussed.

Video-fluoroscopic study of swallowing in children with neurodevelopmental disorders.

Abstract Background : Children with neurodevelopmental disorders can have feeding problems. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Video‐fluoroscopic study of swallowing (VFSS) is essential in understanding the pathological mechanisms involved during swallowing.

Pediatric epilepsy and first afebrile seizure in Singapore: epidemiology and investigation yield at presentation.

The authors studied pediatric epilepsy and first afebrile seizure at presentation in Singapore. A total of 211 participants aged 1 month to 15 years with first presentation for afebrile seizures were recruited from November 2002 to May 2004; 108 with ≥2 prior afebrile seizures (newly diagnosed epilepsy) and 103 with first afebrile seizures. A χ2 analysis of demographics, risk factors, examination, and investigation findings showed significant differences in development (normal in 87% [newly diagnosed epilepsy] and 93% [first afebrile seizure], P = .046), neurological examination (normal in 92% [newly diagnosed epilepsy] and 98% [first afebrile seizure], P = .016), and electroencephalogram findings (abnormal in 75% [newly diagnosed epilepsy] and 36.9% [first afebrile seizure], P < .005). Pediatric epilepsy incidence at our institution is 24 per 100 000 person-years and is highest in early childhood. Focal epilepsy is more common than generalized epilepsy. Patients with first afebrile seizure and abnormal development, neurological examination, and electroencephalogram findings should be monitored for future development of epilepsy. Population-based studies are recommended.

Service Practice Evaluation of the Early Intervention Programs for Infants and Young Children in Singapore

This study evaluated the extent to which family-centered practices were implemented in 11 Early Intervention Programs for Infants and Young Children (EIPIC). The EIPIC centers offer center-based interventions to young children with moderate and severe disabilities in Singapore. A mixed-method approach was used to evaluate the study. The Measure of Processes of Care (MPOC-20) questionnaire was administered to 310 parents. Exploratory factor analyses were performed and generated 16 items that loaded on to 4 factors: Enabling and Partnership, Provision of General Information, Provision of Child-specific Information, and Respectful and Supportive Care. The factor “Coordinated and Comprehensive Care” failed to emerge as a dimension of family-centered care giving. Focus group discussions with 70 parents provided further in-depth information to delineate and elaborate family-oriented factors that parents perceived as important in contributing to family well-being. These included: the nature of support they liked from professional staff, opportunities to build parent capacity to care for their child with disability, and the provision of specific kinds of information and resources. Limitations and implications for practice were discussed.