Pediatrics Subject Collection: Neurology & Psychiatry

Cortical Visual Impairment [INTERNET-ONLY ARTICLE]

Ospina, L. H. — 2009-11-01

Objectives Objectives Definition Epidemiology Causes and Pathogenesis Diagnosis and Evaluation Associated Neurologic and... Neuroimaging Visual Evoked Potentials (VEP) Visual Improvement Beyond the Striate Cortex Prognosis Rehabilitation and Management References After completing this article, readers should be able to: Recognize cortical visual impairment (CVI) as an important cause of pediatric visual loss. Identify the most frequent causes of pediatric CVI and, more specifically, understand the role of hypoxia as a cause of central visual damage. Describe the different pat ...

Care of the Child Assisted by Technology [ARTICLES]

Glader, L. J. — 2009-11-01

Objectives Objectives Introduction Who Are Technology-dependent... Specific Technologies Psychosocial Issues General Management Principles Prognosis Websites for Families References After completing this article, readers should be able to: Describe children who are dependent on technology. List common indications for and complications of gastrostomy tubes. Define invasive and noninvasive mechanical ventilation. Recognize the psychosocial effects of having a child dependent on technology. Introduction Objectives Introduction Who Are Techn ...

Index of Suspicion [ARTICLES]

Vo, M. — 2009-11-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Case 3 Discussion A previously healthy 9-year-old girl presents with a 1-week history of intermittent confusion, dysphagia, visual changes, and involuntary movements of the face and left hand. During this period, she has had two episodes of disorientation and memory loss that were not associated with alteration in consciousness or behavioral changes. The involuntary movements of the left arm and leg have become progressively worse throughout the week. The facial movements are described as lip smacking and excessive blinking. Four days ago, she complained of one episode of diplopia. She denies nausea, vomiting, fever, symptoms of uppe ...

Structural Correlates of Preterm Birth in the Adolescent Brain [ARTICLES]

Nagy, Z. — 2009-11-01

OBJECTIVE: The Stockholm Neonatal Project involves a prospective, cross-sectional, population-based, cohort monitored for 12 to 17 years after birth; it was started with the aim of investigating the long-term structural correlates of preterm birth and comparing findings with reports on similar cohorts. METHODS: High-resolution anatomic and diffusion tensor imaging data measuring diffusion in 30 directions were collected by using a 1.5-T MRI scanner. A total of 143 adolescents (12.18-17.7 years of age) participated in the study, including 74 formerly preterm infants with birth weights of [≤]1500 g (range: 645-1486 g) and 69 term control subjects. The 2 groups were well matched with respect to demographic and socioeconomic data. The anatomic MRI data were used for calculation of total brain volumes and voxelwise comparison of gray matter (GM) volumes. The diffusion tensor imaging data were used for voxelwise comparison of white matter (WM) microstructural integrity. RESULTS: The formerly preterm individuals possessed 8.8% smaller GM volume and 9.4% smaller WM volume. The GM and WM volumes of individuals depended on gestational age and birth weight. The reduction in GM could be attributed bilaterally to the temporal lobes, central, prefrontal, orbitofrontal, and parietal cortices, caudate nuclei, hippocampi, and thalami. Lower fractional anisotropy was observed in the posterior corpus callosum, fornix, and external capsules. CONCLUSIONS: Although preterm birth was found to be a risk factor regarding long-term structural brain development, the outcome was milder than in previous reports. This may be attributable to differences in social structure and neonatal care practices.

Who Will Care for Me Next? Transitioning to Adulthood With Hydrocephalus [REVIEW ARTICLE]

Simon, T. D. — 2009-11-01

OBJECTIVES: Hydrocephalus is a prototypical chronic condition that follows children into adulthood. The objectives of this study were to (1) review how the health care needs of young adults with hydrocephalus are not being met, (2) estimate the numbers of adults with childhood-onset hydrocephalus, (3) describe a novel program to provide care for young adults with hydrocephalus and other chronic pediatric conditions, and (4) propose national strategies to promote successful hydrocephalus transition care. RESULTS: Adults with hydrocephalus need continuous access to expert surgical and medical providers. Existing care models fail to meet this need. The number of young adults who have hydrocephalus, are aged 18 to 35 and need treatment in the United States is predicted to exceed 40000 annually within the next 2 decades. We are developing integrated teams of pediatric and adult medical and surgical specialists to provide continuous, coordinated, comprehensive care for individuals with hydrocephalus in a pediatric setting. This setting will train our future physician workforce on optimal transition care. Coordinated national efforts are also needed. CONCLUSIONS: Providers need to implement appropriate management and transition care for individuals with hydrocephalus. We must work at local and national levels to transform the care model, improve the quality of health care delivery, and improve outcomes for young adults with hydrocephalus.

Practical Management of Asthma [ARTICLES]

Wood, P. R. — 2009-10-01

Objectives Objectives Introduction Initial Assessment Medical Management The Physician-family Partnership... Periodic Monitoring Management of Acute... References Additional Resources After completing this article, readers should be able to: Identify the major environmental factors and comorbid conditions that affect asthma. Describe the role of a written asthma action plan in the management of asthma. Know how to assess asthma control and adjust therapy appropriately. Discuss the evaluation and management of the child who has an acute exacerbation of asthma. ...

Complementary, Holistic, and Integrative Medicine: Nocturnal Enuresis [ARTICLES]

Adams, D. — 2009-10-01

Introduction Introduction Acupuncture/Acupressure Mind/Body Conclusions References Nocturnal enuresis (NE) is characterized by the involuntary discharge of urine at night in those 5 years of age or older. Primary NE (PNE) is diagnosed in an individual who has never achieved nighttime dryness; in secondary NE (SNE), incontinence follows a dry period of at least 6 months. In either, the enuresis must not be due exclusively to a medical condition or diuretic therapy. Prevalence is estimated at 5% to 10% among 5-year-olds, 3% to 5% among 10-year-olds, and 1% among those 15 years of age and older. Between 5% and 10% of cases resolve annually without treatment. (1) The causes of PNE and SNE remain unclear, although physical, neurologic, and psyc ...

Munchausen Syndrome by Proxy [IN BRIEF]

Brown, P. — 2009-10-01

Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000:781 -783 Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting. Stirling J and the Committee on Child Abuse and Neglect. Pediatrics. 2007;119 :1026 -1030 Munchausen Syndrome by Proxy. Hettler J. Pediatr Emerg Care. 2002;18 :371 -374 ...

A Scoring System for Early Prognostic Assessment After Neonatal Seizures [ARTICLES]

Pisani, F. — 2009-10-01

OBJECTIVE: The aim of this study was to devise a scoring system that could aid in predicting neurologic outcome at the onset of neonatal seizures. METHODS: A total of 106 newborns who had neonatal seizures and were consecutively admitted to the NICU of the University of Parma from January 1999 through December 2004 were prospectively followed-up, and neurologic outcome was assessed at 24 months' postconceptional age. We conducted a retrospective analysis on this cohort to identify variables that were significantly related to adverse outcome and to develop a scoring system that could provide early prognostic indications. RESULTS: A total of 70 (66%) of 106 infants had an adverse neurologic outcome. Six variables were identified as the most important independent risk factors for adverse outcome and were used to construct a scoring system: birth weight, Apgar score at 1 minute, neurologic examination at seizure onset, cerebral ultrasound, efficacy of anticonvulsant therapy, and presence of neonatal status epilepticus. Each variable was scored from 0 to 3 to represent the range from "normal" to "severely abnormal." A total composite score was computed by addition of the raw scores of the 6 variables. This score ranged from 0 to 12. A cutoff score of [≥]4 provided the greatest sensitivity and specificity. CONCLUSIONS: This scoring system may offer an easy, rapid, and reliable prognostic indicator of neurologic outcome after the onset of neonatal seizures. A final assessment of the validity of this score in routine clinical practice will require independent validation in other centers.

Relationship of Serum S100B Levels and Intracranial Injury in Children With Closed Head Trauma [ARTICLES]

Bechtel, K. — 2009-10-01

OBJECTIVE: To determine if serum levels of S100B are higher in children with CHT and ICI as detected by cranial CT and if long bone fractures affect the level of S100B in children with CHT and skeletal injury. METHODS: Children <18 years of age who presented to an urban pediatric emergency department or were transferred from a referral hospital within 6 hours after accidental closed head trauma and who underwent cranial computed tomography were enrolled prospectively. Mean serum S100B levels for children with or without intracranial injury (ICI) and long-bone fractures were evaluated through analysis of covariance. RESULTS: One hundred fifty-two children, 24 with ICI and 128 without ICI, were enrolled prospectively. Twenty-five children had long-bone fractures. Children with ICI were significantly younger than those without ICI (6.9 vs 9.8 years; P = .01). The time of venipuncture after injury was significantly later in children with ICI (P = .03). Mean S100B levels were significantly greater for children with ICI (212.9 vs 84.4 ng/L; P = .001), children with long-bone fractures (P = .008), and nonwhite children (P = .03). After controlling for time of venipuncture, long-bone fractures, and race, mean S100B levels were still greater for children with ICI (409 vs 118 ng/L; P = .001). The ability of serum S100B measurements to detect ICI, determined as the area under the curve, was 0.67. CONCLUSIONS: After controlling for time of venipuncture, long-bone fractures, and race, S100B levels were still higher in children with ICI than in those without ICI. However, the ability of serum S100B measurements to detect ICI was poor.