Long-Term Outcome After Neonatal Parenchymatous Brain Lesions
| Autor: | C Van Tuil, Martin Häusler, U. Merz, V T Ramaekers |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Adolescent Leukomalacia Periventricular Birth weight Gestational Age CBCL Child Behavior Disorders Infant Premature Diseases Cerebral palsy Epilepsy Risk Factors Intellectual Disability medicine Birth Weight Humans Child Child Behavior Checklist Tetraplegia Cerebral Hemorrhage Periventricular leukomalacia business.industry Infant Newborn Infant Gestational age Neuromuscular Diseases medicine.disease Treatment Outcome Child Preschool Pediatrics Perinatology and Child Health Brain Damage Chronic Female Psychomotor Disorders business Social Adjustment Follow-Up Studies |
| Zdroj: | Klinische Pädiatrie. 216:244-251 |
| ISSN: | 1439-3824 0300-8630 |
| DOI: | 10.1055/s-2004-44900 |
| Popis: | Background Although considered of high prognostic impact, knowledge on the long-term outcome after neonatal parenchymatous brain lesions (PBL) is limited. Patients 29 children with either unilateral (n = 19) or bilateral (n = 10) hemorrhagic/ischemic PBL. Methods The patients were reinvestigated at 9 9/12 +/- 3 4/12 years of age, using a standardized clinical investigation, the Beery-Buktenica Scales of Visuomotor Integration (VMI) and the Bruininks-Oseretzky Test of Motor Proficiency (BOT). The parents were questioned by means of a standardized questionnaire and the Child Behavior Checklist (CBCL). Results 90 % of the children showed cerebral palsy (including 12 with hemi- and 8 with tetraplegia). Only 11 % showed normal results on BOT and 39 % on VMI testing. 50 % were bed wetters. Six had required ventriculoperitoneal shunting and 11 were on long-term antiepileptic therapy. Herewith bilateral versus unilateral lesions and low 5-minute APGAR scores were associated with poorer outcome (Cox model and Kaplan-Meier analysis). During follow-up the impact of different disabilities changed. Despite the high rate of cerebral palsy, 71 % learned to walk unaided and 86 % to communicate with words. The last patient learned to walk at 7 years of age. Only one showed poor seizure control. No severe shunt-related complications occurred after 5 years of age. Social, cognitive and behavioral problems increased with age. Only 34 % could attend mainstream schools or kindergartens, and only 50 % displayed normal behavior according to CBCL data, with attention deficiency and social problems being the most important domains. In consequence, nearly all children required 24-hour supervision. Conclusions After birth, organic problems such as delayed motor development, epilepsy and ventriculoperitoneal shunting are of major importance for children with PBL. Although delayed, basic skills such as verbal communication are achieved by the majority of patients. In later childhood and adolescence, social, behavioral and cognitive problems increase. In the future, vast resources will be required to provide adequate education and carers as substitutes for elderly parents. |
| Databáze: | OpenAIRE |
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