Psychoeducational outcome at school age of preterm infants with bronchopulmonary dysplasia

Objective: To investigate the cognitive performance and educational attainment at school-age of children with bronchopulmonary dysplasia (BPD), compared with a preterm control group of children. Methods: Seventy preterm infants with BPD and 61 birth weight matched controls were prospectively followed-up to school-age. The Weschler Intelligence Scale for Children - III (WISC), the Wide Range Achievement Test (WRAT) and the Developmental Test of Visual Motor Integration (VMI) were administered. The results were compared between the two groups and multiple regression analyses were performed to determine the effect of confounding variables. Results: The children in the BPD group performed less well on the Full Scale IQ (mean 86.7 vs 93.5; 95% CI, 1.9-11.7), Verbal IQ (mean 87.1 vs 94.1; 95% CI, 2.0-12.0) and the Performance IQ (mean 88.6 vs 95.2; 95% CI, 2.0-11.2) of the WISC, the reading component of the WRAT (mean 93.8 vs 98.9; 95% CI, 0.3-9.8) and the VMI (mean 88.9 vs 93.3; 95%, CI 1.1-7.8). Despite controlling for social and biological variables, statistical differences persisted for Full Scale and Verbal IQ and reading. A Verbal IQ >1 SD below the mean was found in 41% of BPD children compared to 21% of controls, while on the reading component of the WRAT a greater proportion of BPD children also had scores>1 SD below the mean. Conclusion: Impaired psychoeducational performance was found in preterm children with BPD compared to controls, especially in the areas of language abilities and reading skills. This supports a greater need for special educational services and counseling for parents for these children

Surveillance of birth defects: Brazil and the US Vigilância epidemiológica em anomalias congênitas: Brasil e Estados Unidos

The impacts of birth defects in the society have substantially increased over the last decades in countries where the reduction of infant mortality by other causes has occurred. Birth defects surveillance represents an important source of information for planning X health policies and resource allocation. In this article, we discuss the potential utilizations, methodology options, limitations, and policy issues related to birth defects surveillance. Also, the birth defects surveillance programs from US and Brazil are described and compared as an illustration of the development of surveillance systems in two countries with clearly dissimilar health systems and resource allocation for birth defects programs. Finally, we propose measures for the improvement of the existing systems in both countries focusing at the utilization of preexisting resources.<br>O impacto das anomalias congênitas na sociedade vem aumentando substancialmente nas últimas décadas nos países onde ocorreu a diminuição da mortalidade infantil por outras causas. A vigilância epidemiológica em anomalias congênitas representa uma importante fonte de informação para o planejamento de políticas de saúde e alocação de recursos. Neste artigo, os potenciais usos, opções de metodologia, limitações e questões de políticas de saúde relacionadas à vigilância epidemiológica em anomalias congênitas são abordados. Além disso, os programas dos Estados Unidos e Brasil são descritos e comparados para ilustrar sistemas em dois países com sistemas de saúde e alocação de recursos para as anomalias congênitas claramente diferentes. Finalmente, apresentamos propostas de medidas para melhorar os sistemas existentes em ambos os países, focalizando na utilização de recursos pré-existentes