RESUMEN
OBJECTIVE: To determine the impact of prenatal exposure to maternal anti-Ro antibodies, slow fetal heart rate, and/or prolonged dexamethasone therapy for immune-mediated congenital atrioventricular heart block (CAVB) on the cognitive and academic performance of these children at school age. METHODS: We performed a prospective, blinded assessment of the cognitive functioning of 3 cohorts of children ages 6-16 years with in utero exposure to maternal anti-Ro antibodies in the following groups: no CAVB and no prenatal dexamethasone treatment (n = 14), CAVB without prenatal treatment (n = 10), and CAVB with prenatal dexamethasone treatment (n = 16). Domains assessed included intelligence, visual perceptual and visual motor skills, auditory and visual attention, verbal learning and memory, visual memory, executive function, and behavior. RESULTS: All cohorts scored within the normal range and were not significantly different in terms of intelligence scores, verbal comprehension, perceptional reasoning, working memory, and processing speed. For children with CAVB who were treated prenatally, there were no significant associations between the neurocognitive function scores, the minimal fetal heart rate (range 47-80 beats per minute), and either the duration (range 2-15 weeks) or dosage (range 56-824 mg) of dexamethasone therapy. CONCLUSION: CAVB and transplacental treatment with dexamethasone was not associated with neurocognitive impairment in school-age children. Larger numbers of children are needed to validate our observation, and assessment of other cognitive abilities is warranted.
Asunto(s)
Anticuerpos Antinucleares/inmunología , Desarrollo Infantil , Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Bloqueo Cardíaco/congénito , Frecuencia Cardíaca Fetal , Adolescente , Niño , Femenino , Feto/inmunología , Feto/fisiopatología , Bloqueo Cardíaco/tratamiento farmacológico , Humanos , Masculino , Pruebas Neuropsicológicas , Embarazo , Efectos Tardíos de la Exposición Prenatal/inmunología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
AIM: To review the outcome of homozygous alpha-thalassaemia without prior intra-uterine therapy treated in neonatal intensive care unit and identify the factors associated with survival. METHODS: The hospital records of all patients with homozygous alpha-thalassaemia treated in our neonatal intensive care unit in the last 15 years were reviewed. A literature search beginning in the year 1980 was done to identify homozygous alpha-thalassaemia actively treated in neonatal intensive care units. Those receiving prior intra-uterine therapy were excluded. The following information was collected: the severity of hydrops, sizes of liver and spleen, haemoglobin level, Apgar score at 5 min, ventilator settings, timing and forms of red blood cell transfusion and presence of persistent hypoxaemia. The survivors and the non-survivors were compared. RESULTS: In our centre, in the last 15 years there were six infants born with homozygous alpha-thalassaemia who did not receive intra-uterine therapy; one survived and five succumbed despite aggressive respiratory therapy. In our literature search there were more reports of survivors (10) than non-survivors (six) for these infants, suggesting a reporting bias towards selection of rare cases of survival. Apgar score of four or above occurred in seven of the eight survivors with data available in the reports, whereas this occurred in four of the 11 non-survivors (P = 0.035, Fisher Exact test). Five of the 11 survivors had abnormal neurological outcome including developmental delay and spastic quadriplegia. CONCLUSION: Without prior intra-uterine therapy, homozygous alpha-thalassaemia has grave outlook in terms of mortality and morbidity despite aggressive respiratory therapy.
Asunto(s)
Resultado del Tratamiento , Talasemia alfa/epidemiología , Talasemia alfa/terapia , Puntaje de Apgar , Transfusión de Sangre Intrauterina , Homocigoto , Hong Kong/epidemiología , Humanos , Recién Nacido , Cuidado Intensivo Neonatal , Terapia Respiratoria , Factores de Riesgo , SobrevidaRESUMEN
Severe acute respiratory syndrome (SARS) is a newly discovered infectious disease caused by a novel coronavirus. During the community outbreak in Hong Kong, 5 liveborn infants were born to pregnant women with SARS. A systematic search for perinatal transmission of the SARS-associated coronavirus, including serial reverse transcriptase-polymerase chain reaction assays, viral cultures, and paired serologic titers, failed to detect the virus in any of the infants. In addition, none of the infants developed clinical, radiologic, hematologic, or biochemical evidence suggestive of SARS. One preterm infant developed jejunal perforation and another developed necrotizing enterocolitis with ileal perforation shortly after birth. This case series is the first report to describe the clinical course of the first cohort of liveborn infants born to pregnant women with SARS.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/virología , Síndrome Respiratorio Agudo Grave/transmisión , Adulto , Antiinflamatorios/efectos adversos , Antiinflamatorios/uso terapéutico , Antivirales/efectos adversos , Antivirales/uso terapéutico , Cesárea , Estudios de Cohortes , Brotes de Enfermedades , Enterocolitis Necrotizante/etiología , Femenino , Retardo del Crecimiento Fetal/etiología , Hong Kong/epidemiología , Humanos , Enfermedades del Íleon/etiología , Recién Nacido , Recien Nacido Prematuro , Perforación Intestinal/etiología , Enfermedades del Yeyuno/etiología , Masculino , Metilprednisolona/efectos adversos , Metilprednisolona/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Síndrome de Dificultad Respiratoria del Recién Nacido/complicaciones , Ribavirina/efectos adversos , Ribavirina/uso terapéutico , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo/aislamiento & purificación , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico , Síndrome Respiratorio Agudo Grave/epidemiologíaRESUMEN
Severe acute respiratory syndrome (SARS), a new contagious respiratory disease associated with a novel coronavirus, has spread worldwide and become a global health concern after its first outbreak in Guangdong Province of the People's Republic of China in November 2002. The clinical presentation and the radiologic, hematologic, biochemical, and microbiologic findings of a 56-day-old male infant with SARS are described. Some clinical and laboratory features are similar to those reported in adult and pediatric patients. However, this infant had a more severe clinical course as compared with the older children. This is the youngest patient with symptomatic SARS reported to date.