Neurodevelopmental Impairments 1 Year After Cerebral Malaria

John T. Langfitt; Michael P. McDermott; Rachel Brim; Sebastian Mboma; Michael J. Potchen; Sam D. Kampondeni; Karl B. Seydel; Margaret Semrud-Clikeman; Terrie E. Taylor

doi:10.1542/peds.2018-1026

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FIGURE 1
Patient flow through the study. Primary analyses were conducted for the 185 participants who completed the 12-month follow-up visit.
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FIGURE 2
Mean DC z scores in case patients and patients in the control group who were either HIV-positive or HIV-negative. Case patients differed from patients in the control group (P < .001), and patients who were HIV-positive differed from those who were HIV-negative (P = .02), with no change over time or interactions (all P ≥ .25). The filled symbols indicate HIV-positive status; the unfilled symbols indicate HIV-negative status. CM+, case patients; CM−, patients in the control group; HIV-, HIV-negative; HIV+, HIV-positive.
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FIGURE 3
Heat map revealing the association of MRI findings in 71 case patients ranked by degree of developmental and cognitive impairment (global DC z score). BST, brain stem; CAU, caudate nucleus; CC, corpus callosum; GBP, globus pallidus; PVW, periventricular white matter; SCW, subcortical white matter.
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FIGURE 4
Heat map revealing the association of MRI findings in 54 case patients ranked by degree of impairment in inhibition and self-control (BRIEF ISCI z scores). BST, brain stem; CAU, caudate nucleus; CC, corpus callosum; GBP, globus pallidus; PVW, periventricular white matter; SCW, subcortical white matter.

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TABLE 1

Associations Between MRI Findings, Baseline Characteristics, and Outcomes at the 12-Month Assessment

Group Differences	Atrophy			Focal Abnormalities
Group Differences	Severe Versus Mild, Mean Difference (95% CI)	Mild Versus None, Mean Difference (95% CI)	Severe Versus None, Mean Difference (95% CI)	Multifocal Versus Unifocal, Mean Difference (95% CI)	Unifocal Versus None, Mean Difference (95% CI)	Multifocal Versus None, Mean Difference (95% CI)
Age, y	−1.45 (0.10 to −3.00)	−0.32 (−1.67 to 0.02)	−1.77^a (−3.30 to −0.25)	−1.04 (−2.63 to 0.55)	−1.44^a (−2.70 to −0.20)	−2.48^a (−4.02 to −0.93)
Coma duration, h	45.8^a (19.1 to 72.6)	6.8 (16.6 to 30.2)	52.6^a (26.2 to 79.0)	19.0 (−14.2 to 52.2)	6.2 (−19.6 to 32.1)	25.2 (−6.9 to 57.4)
White blood cell count, cells per mm³	4.80^a (0.10 to 9.50)	−0.97 (−5.20 to 3.30)	3.80 (−0.77 to 8.40)	1.36 (−3.90 to 6.60)	0.89 (−3.40 to 5.12)	2.25 (−2.90 to 7.40)
DC, z score units	−1.13^a (−2.00 to −0.25)	−0.26 (−1.02 to 0.51)	−1.39^a (−2.25 to −0.52)	−1.15^a (−2.15 to −0.15)	0.14 (−0.64 to 0.91)	−1.02^a (−2.00 to −0.05)
BRIEF ISCI, z score units	0.44 (−0.60 to 1.50)	−0.10 (−1.00 to 0.90)	0.37 (−0.75 to 1.50)	0.53 (−0.52 to 1.59)	0.47 (−0.44 to 1.38)	1.00 (−0.07 to 2.10)