No abstract

LED and CFT phototherapy units were equally efficacious in the management of non-hemolytic hyperbilirubinemia in healthy term and late preterm neonates.

A Randomized Controlled trial was done on 30 (CP) children of age range 6 mon to 2 y with an objective to see the efficacy of Neurofacilitation of Developmental Reaction (NFDR) approach over Neurodevelopmental Therapy (NDT) for integration / modification of early motor behavior (Primitive Reflexes) in Cerebral Palsy (CP). The baseline evaluation was done for tone, postural reactions and GMFM. The subjects were randomly allocated to two groups. With group A, NFDR and group B, conventional approach (NDT) was used for 3 mon followed by re-evaluation. Between groups analysis was done and p value was found to be significant. It was concluded that NFDR approach is more effective than NDT for integration / modification of early motor behavior in children with CP.

Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates. Neonates admitted to neonatal intensive care unit (NICU), over a period of 1 year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Diagnosis of VAP was made by the guidelines given by National Nosocomial infection Surveillance System (NNIS, 1996). Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 10 5 CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The risk factors such as birth weight, prematurity (gestational age < 37 weeks), duration of mechanical ventilation, number of reintubations, length of hospital stay, primary diagnosis of neonate, postnatal age and small for gestational age (SGA) were studied for the development of VAP. Risk factors found significant on bivariate analysis were subjected to multiple regression analysis to determine the most important predictors of VAP. The study group comprised of 98 neonates out of which, 30 neonates developed VAP (30.6%). VAP rates were 37.2 per 1000 days of mechanical ventilation. Most common bacterial isolated from endotracheal aspirate of VAP patients was Klebsiella spp (32.8%), E.coli (23.2%) and Acinetobacter (17.8%) being the other two common organisms. Very low birth weight (<1500 grams), prematurity (gestational age < 37 week), duration of mechanical ventilation, number of reintubations and length of NICU stay were significantly associated with VAP in bivariate analysis. Multiple regression analysis revealed that duration of mechanical ventilation (OR 1.10, 95% CI 1.02, 1.21; P = 0.021) and very low birth weight (OR 3.88, 95% CI 1.05, 14.34; P = 0.042) were two single independent and statistically significant risk factors for predicting VAP. VAP developed in nearly one third of intubated neonates having gram negative organisms as predominant etiological agent.

Age-dependent changes in the normal cerebral white matter have been reported; however, there is no study on normal cerebellar white matter maturation in developing brain using diffusion tensor imaging (DTI). We performed DTI in 21 children who had normal neurological assessment along with no evidence of any abnormality on imaging. The aim of this study was to compare the age-related changes in fractional anisotropy (FA) and mean diffusivity (MD) quantified from cerebral white matter (splenium and genu of the corpus callosum and posterior limb of the internal capsule) and cerebellar white matter (middle cerebellar peduncles, superior cerebellar peduncles, and inferior cerebellar peduncles) regions in healthy children ranging in age from birth to 132 months. Log-linear regression model showed best fit to describe the age-related changes in FA and MD both for cerebral and cerebellar white matter. In cerebral white matter, an initial sharp increase in FA was observed up to the age of 24 months followed by a gradual increase up to 132 months. In cerebellar white matter, sharp increase in FA was observed up to 36 months, which then followed a gradual increase. However, MD showed a sharp decrease in cerebral white matter up to 24 months followed by a more gradual decrease thereafter, while in cerebellar white matter after an initial decrease (6 months), it followed a stable pattern. This study provides normative database of brain white matter development from neonates to childhood. This quantitative information may be useful for assessing brain maturation in patients with developmental delay of the cerebral and cerebellar white matter.

No abstract

The DTI-derived FA quantification with its GFAP immunohistologic correlation in cortical regions of the various lobes of the cerebral hemispheres supports region-specific migrational and maturational events in human fetal brain.

Region of interest based morphometric diffusion tensor imaging analysis, has been used extensively for the assessment of age-related changes in human brain, is limited to two dimensions and does not reflect the whole fiber bundle; however, diffusion tensor tractography (DTT) offers an overall view of individual fiber bundle in three-dimensional spaces. Quantitative DTT was performed on 51 healthy subjects of pediatric age range and young adults to compare age-related fractional anisotropy (FA) changes in corpus callosum, sensory and motor pathways, limbic tracts [cingulum (CNG) and fornix (Fx)], and superior and inferior longitudinal fascicules. In corpus callosum, inferior longitudinal fascicules, limbic tracts (CNG and Fx), sensory pathways, and motor pathways, an initial sharp increase in FA was observed up to the age of 2 y followed by a gradual increase up to 21 y. In superior longitudinal fascicules, sharp increase in FA was observed up to 3 y followed by a gradual increase. The FA value of the left CNG (p ϭ 0.01, sign test) was observed to be significantly greater than that of the right CNG. We conclude that white matter fiber tracts mature with age and can be assessed by using DTT that may greatly improve our understanding of the human brain development. (Pediatr Res 66: 636-641, 2009) I n humans, a great deal of the axonal organization is established by birth; however, axonal wiring and pruning processes as well as myelination in white matter (WM) tracts are known to extend to the postnatal periods and continues till adulthood (1-3). Postmortem studies of the young population are very limited (4). Even with postmortem samples, there are no reliable histology-based techniques that can quantitatively assess the axonal architecture of the entire fiber tracts.Conventional magnetic resonance imaging (MRI) has provided an opportunity to visualize the progression of myelination in WM tracts throughout infancy and childhood noninvasively (5). Magnetization transfer imaging has been shown to be sensitive for the evaluation of brain maturation (6). However, conventional MRI is unable to delineate individual WM fiber tracts. Recent developments in diffusion MRI have put this imaging modality to forefront of neuroscience research. By virtue of its diffusion-driven displacement, water molecules probe tissue structure at a microscopic scale in diffusion imaging (7). It has been shown that ordered axonal structure, cell membrane, and myelin sheath strongly influence water diffusion (8) that directly links it to axonal orientation and integrity in the brain (9). Diffusion tensor imaging (DTI) allows us to estimate dominant fiber orientation at each pixel. The most commonly used DTI analysis is based on a two dimensional (2D) region of interest (ROI) in an image dataset that is user specific. DTI studies in healthy pediatric and adult individuals using 2D ROI approach indicate that mean diffusivity (MD) in central WM tracts decreases with age, whereas fractional anisotropy (FA) increases up to the age of 70 y....