The objective of this study was to determine whether intelligence and minor motor impairments in children who are born preterm without major disability are associated with cerebral white matter (CWM) and hippocampal abnormalities on magnetic resonance imaging (MRI). A total of 103 preterm children were studied at age 7 y with detailed magnetic resonance brain scans, including a T2-mapping sequence from which T2 relaxation times of the CWM and hippocampal formations were calculated. All of the children had no major motor disability, attended normal school, and had undergone assessment of IQ and a test for minor motor impairment (MMI). Twenty children had visible lesions on MRI, which were associated with lower IQ and more frequent MMI. Mean (SD) IQ was 90 (14.1). Twenty-five children were shown to have MMI (Movement ABC at below the fifth centile). This group was shown to have significantly longer T2 relaxation times for CWM (mean difference 2.1 ms right, 3.1 ms left) but not the hippocampus than the children without MMI.These differences persisted when only children without visible lesions on scans were considered (mean difference 1.5 ms bilaterally). There was no significant correlation between IQ and T2 relaxation times. Children who are born preterm without subsequent major neurodisability may, in addition to visible lesions on MRI scans, have a diffuse abnormality of CWM, manifest as an increase in T2 relaxation time. This abnormality shows a close correlation with minor motor impairment but not with full-scale IQ. The survival of very preterm infants has improved during the past two decades and led to an increased interest in their long-term neurodevelopmental outcome. Reported series of these infants have shown major disability rates of 10% to 15%, caused mostly by cerebral palsy and hearing and visual disabilities (1). The majority of the remainder attend normal schools, but one third to one half of these experience behavioral and specific learning difficulties often associated with minor motor impairment (MMI) (2). In the absence of other neurodisability, this syndrome is often referred to as developmental coordination disorder (3). Whereas imaging techniques have clearly shown lesions associated with major neurodevelopmental disabilities, this has not been the case with MMI. There seems to be little if any correlation between cranial ultrasound-or magnetic resonance imaging (MRI)-detected lesions and subsequent functioning at school age despite the high prevalence of such lesions in children born preterm when compared with term control subjects (4, 5). Preterm infants have been shown to have smaller brains, less cortical complexity than term children, and often delayed myelination. Quantitative MRI in adolescents who were born preterm has shown significant associations between caudate and hippocampal volumes and intelligence (6) and hippocampal volumes and everyday memory (7) MRI is highly sensitive to the age-specific changes in myelination; qualitative assessment of the extent of myelination on MR ima...
Background Recent studies have analysed birth-related clavicular fractures to propose time frames for healing that could be applied to dating of all fractures in cases of suspected child abuse. Objective To assess differences in healing rates between femoral fractures and birth-related clavicular fractures in infants and young children. Materials and methods A retrospective 5-year pilot study of femoral fractures in children younger than 3 years of age was performed. Anonymised radiographs were independently scored by two radiologists for stages of fracture healing. In cases of reader disagreement, radiographs were independently scored by a third radiologist. Results In total, 74 radiographs (30 children) met the inclusion criteria. Fracture healing evolved over time with subperiosteal new bone formation (SPNBF) appearing first, followed by callus then remodelling. A power calculation for a single proportion, with a level of confidence of 95% and a margin of error of 5%, showed that in a definitive study, 359 radiographs would be required. Conclusion Although the overall pattern of healing is similar, in this small pilot study, the earliest times for SPNBF and callus formation in femoral fractures appeared to lag behind healing of birth-related clavicular fractures. Remodelling appeared earlier than remodelling of clavicular fractures. A power calculation has determined numbers of femoral radiographs (359) required for a definitive study.
We report the case of a 9-week-old boy with cystic fibrosis (CF) who presented with intestinal obstruction. He was initially diagnosed with distal intestinal obstruction syndrome (DIOS) and started on laxatives and gastrograffin. This conservative management was unsuccessful and he therefore underwent an exploratory laparotomy. Despite not having undergone any previous surgery, extensive intra-abdominal adhesions were identified as the cause of the intestinal obstruction. The only previous abdominal pathology occurred in the neonatal period prior to his diagnosis of CF, when he was managed conservatively for possible necrotising enterocolitis. We hypothesise that this episode was associated with a subclinical bowel perforation that led to the formation of intra-abdominal adhesions. Although DIOS is the commonest cause of intestinal obstruction in children with CF, this case highlights that surgical causes should always be considered. It also demonstrates that the intra-abdominal adhesions can occur in the absence of previous surgery.
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