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
Eating disorders are complex, often chronic, biopsychosocial disorders characterized by a pursuit for control which, in interaction with familial factors, results in disturbed patterns of relating to food and its meaning. Overt and covert resistance to intervention at the family level can reflect family dynamics but can be mitigated by engaging families of adolescents with eating disorders, by using multidisciplinary teams, and by hospitalization.