Showing posts with label neurology. Show all posts
Showing posts with label neurology. Show all posts

Monday, August 10, 2015

Tracking Cognitive Function of Very Preterm and Very Low Birth Weight Infants into Adulthood

By: Lewis First, MD, MS; Editor-in-Chief       

The ability to follow a cohort of high-risk infants from birth into adulthood is becoming more and more commonplace nowadays. What we are learning about the life trajectories of preterm or low birth weight infants from these cohorts is fascinating, and this important new knowledge may help us to do more to improve long-term quality of life.  
Take for example the study by Breeman et al. (doi: 10.1542/peds.2015-0608) that we are publishing this week. The authors look at how cognitive function in very preterm (VP) and very low birth weight (VLBW) infants progresses over time compared to term infants.  The authors followed more than 250 VP/VLBW babies in a cohort over their first 25 years of life assessing development and IQ at multiple points over that period of time.  The results show that cognitive function is generally stable after 20 months for the VP/VLBW children and predictive of adult IQ whereas the cognitive function of term infants is not predictive of adult IQ until at least 6 years of age.  
The implications of this study suggest that we should do an even better job of assessing our VP/VLBW patients in  infancy and early toddlerhood so that developmental support services, if needed, can be implemented as early as possible with the hope of improving cognitive function.  As to why the differences between VP/VLBW cognitive stability and that of term infants, you will need to read this study and see how the authors develop their interpretation of the data—and there is lots more to learn from this important study.  It provides a remarkable look at the longitudinal follow-up of this unique, yet more and more common cohort of at-risk preterm and low birth weight patients.


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Monday, May 11, 2015

Why Would an Article on Alzheimer Disease Appear in Pediatrics?


By: Lewis First, MD, MS; Editor-in-Chief   

          Hopefully the headline for today’s blog caught your attention.  What’s our interest in Alzheimer Disease in a pediatric journal? Believe it or not, two markers of insulin resistance have been associated in adults with an increased risk of developing Alzheimer Disease and dementia, and Luciano et al. (doi:10.1542/peds.2014-2391) opted to look for these markers early by measuring them in normal, overweight, and obese preschoolers and adolescents.  
      Correlations of the Alzheimer biomarkers were significantly associated with elevated body mass index (BMI) in conjunction with insulin resistance suggesting that perhaps seeing these markers early on may signal a later risk of developing the cognitive abnormalities associated with Alzheimer Disease and dementia.  How these markers in childhood might result in the brain changes that cause this disease of adults and what we might do about this while our patients are still young raises perhaps more questions than answers—but that’s what reading our journal is all about.  
     Hopefully an article like this will raise awareness enough to trigger other studies to confirm these findings, follow the cohort of overweight and obese children with insulin resistance and see if reducing the level of resistance also improves mentation as these children age.  Read this study and you’ll see yet another example of how the prevention work we strive to do as pediatricians pays off not just in childhood but throughout our patients’ lives.

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Monday, April 27, 2015

Neurodevelopmental Outcomes in Infants Who Experienced Cardiac Surgery: Are We Doing Better?

By: Lewis First, MD, MS; Editor-in-Chief    

          There have been a number of studies that have focused on neurodevelopmental differences in children who as infants undergo cardiac surgery for their congenital heart lesion.  Etiologies for these differences may range from simply hypoxia to the brain to the use of anesthetic agents—but given the decades of ongoing improvement in our surgical techniques—are we seeing better and better outcomes neurodevelopmentally as well?  Gaynor et al. (doi:10.1542/peds.2014-3825) get to the heart of the matter in an interesting study being released this week.  The authors reviewed all studies of developmental outcome in infants undergoing cardiac surgery from 1996 through 2009 to determine risk factors for poorer developmental outcomes.   
     Once one adjusts for these innate risk factors, one begins to see developmental improvement over time—but there is much more to learn from this study and to think about—since developmental abnormalities continue to be seen in this surgical population of patients. Dr. Leonard Rappaport, a behavioral and developmental pediatrician who published some of the earliest studies on developmental outcomes in infants undergoing cardiac surgery shares his perspective on how far we have come and yet how far we still need to go in an accompanying commentary (doi: 10.1542/peds.2015-0719) well worth reading along with this heartfelt summary of where we are developmentally over the past decade and a half of congenital cardiac surgical care.

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Monday, March 30, 2015

Follow-up Studies of Preterm and Late Preterm Infant Neurocognitive Performance Continue To Develop


By: Lewis First, MD, MS; Editor-in-Chief  
  
     Our readers tell us they learn a lot reading the studies we publish on long-term follow-up of infants born early particularly in terms of their neurodevelopment. Well this week we don’t want to disappoint our readers and therefore bring you three studies of interest in the area of cognitive development of preterm, and late preterm infants. 
      The first study by Burnett et al. (doi: 10.1542/peds.2014-3188) focuses on extremely preterm (less than 28 weeks) and extremely low birth weight (less than1000 g) infants in terms of their executive function, not just in infancy and toddlerhood but into adolescence. 
     Sadly, poor performance in executive function tasks seen early in life carries on into the teen years, and while some aspects of executive function improve over time, a number of aspects do not, suggesting the need to intervene sooner than later to try to further develop executive function skills over time.
      A second study by Heinonen et al. (doi: 10.1542/peds.2014-3556) looks at late preterm infants and follows their neurocognitive performance not just into adolescence, but into late adulthood. The authors traced a cohort of more than 900 men and women born in Finland in 1934-44 who were assessed  as adults with a battery of tests to identify signs of Alzheimer disease and believe it or not, those who were identified as late-preterm had a higher risk of showing neurocognitive impairment.  Interestingly enough however, those who were able to pursue higher education did not show such findings. 
     Finally there is a third study by Schonhaut et al. (doi:10.1542/peds.2014-1957)  that looks at developmental impairment relative to gestational age in moderate, late preterm and early term infants and once again, there is an inverse association between gestational age and developmental delay.
     There are a lot of interesting comments one can make about the findings in all three studies, and at the same time, one has to be amazed that cohorts of infants are now being followed not just into early childhood but through adolescence and into adulthood without major losses to follow-up.  As a result, we are learning more and more about the developmental outcomes associated with being born early.   
     To help make even more sense of these types of studies and what we can do to perhaps improve developmental outcomes in these patients, Dr. Betty Vohr (doi: 10.1542/peds.2015-0227) offers her perspective in a very interesting commentary.  Read all three studies and the commentary and then see what develops in regard to interventional strategies to improve developmental outcomes in these infants born preterm.

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Friday, March 6, 2015

Preterm and Late Preterm Infant Neurocognitive Performance Follow-up Studies Continue To Develop

By: Lewis First, MD, MS; Editor-in-Chief 

         Our readers tell us they learn a lot reading the studies we publish on long-term follow-up of infants born early particularly in terms of their neurodevelopment. Well this week we don’t want to disappoint, and therefore bring you three studies of interest in the area of cognitive development of preterm, and late preterm infants. The first study by Burnett et al.  (doi:10.1542/peds.2014-3556) focuses on extremely preterm (less than 28 weeks) and extremely low birth weight (less than 1000 g) infants in terms of their executive function, not just in infancy and toddlerhood but into adolescence. 
         Sadly, poor performance in executive function tasks seen early in life carries on into the teen years, and while some aspects of executive function improve over time, a number of aspects do not, suggesting the need to intervene sooner than later to try to further develop executive function skills over time.
         A second study by Heinonen et al. (doi:10.1542/peds.2014-3556) looks at late preterm infants and follows their neurocognitive performance not just into adolescence, but into late adulthood. The authors traced a cohort of more than 900 men and women born in Finland in 1934-44 who were assessed  as adults with a battery of tests to identify signs of Alzheimer disease and believe it or not, those who were identified as late-preterm had a higher risk of showing neurocognitive impairment.  Interestingly enough however, those who were able to pursue higher education did not show such findings. 
          Finally there is a third study by Schonhaut et al. (doi:10.1542/peds.2014-1957)  that looks at developmental impairment relative to gestational age in moderate, late preterm and early term infants and once again, there is an inverse association between gestational age and developmental delay.
          There are a lot of interesting comments one can make about the findings in all three studies, and at the same time, one has to be amazed that cohorts of infants are now being followed not just into early childhood but through adolescence and into adulthood without major losses to follow-up.  As a result, we are learning more and more about the developmental outcomes associated with being born early.  To help make even more sense of these types of studies and what we can do to perhaps improve developmental outcomes in these patients, Dr. Betty Vohr (doi:10.1542/peds.2015-0227) offers her perspective in a very interesting commentary.  Read all three studies and the commentary and then see what develops in regard to interventional strategies to improve developmental outcomes in these infants born preterm.

Related Links: