Neonatal cranial ultrasound abnormalities in LBW infants: Relation to cognitive outcomes at age six

bjective: To assess the independent relation of neonatal cranial ultrasound (US) abnormalities in low birth weight (LBW) infants to cognitive outcomes at 6 years of age.Design: Prospective cohort study.Sample and Methods: Six-year follow-up data were obtained on a regional birth cohort of LBW infants (\u3c 2 kg) systematically screened as neonates with serial US. US abnormalities were dichotomized into isolated germinal matrix/intraventricular hemorrhage (GM/IVH) and parenchymal lesions/ventricular enlargement (PL/VE). Global cognitive outcomes (mental retardation, borderline intelligence, and normal intelligence) and selected specific cognitive abilities were assessed at 6 years of age with standardized instruments. Multivariate techniques were used to assess the effects of US independent of maternal social disadvantage at birth and other perinatal and neonatal risk factors.Results: The sample as a whole had a significantly elevated rate of mental retardation (MR; 5%), almost all moderate to profound in severity. PL/VE was independently related to MR (odds ratio [OR], 65.8; confidence interval [CI], 19.1 to 22.4) and borderline intelligence (OR, 3.7; CI, 1.3 to 10.8); isolated GM/IVH was more modestly related to MR (OR, 4.6; CI, 1.2 to 18.6) but not related to borderline intelligence. Approximately half of the cases of MR were attributable to PL/VE independent of other factors. Of non-US factors, the number of days receiving mechanical ventilation increased the risk for MR. Maternal social disadvantage increased the risk for borderline intelligence but not MR. Among children of normal intelligence, those with PL/VE, but not isolated GM/IVH, performed more poorly than those without US abnormalities on tests of visual perceptual organization but not on tests of language, memory, or quantitative skills.Conclusion: Prevention of white matter injury would substantially improve cognitive outcomes for LBW infants

Executive and non-executive functions in low birthweight/preterm adolescents with differing temporal patterns of inattention.

ObjectiveThis study assesses whether low birthweight/preterm (LBW/PT) adolescents with persistent inattention (PIA) have neuropsychological deficits that distinguish them from adolescents with school age limited inattention (SAL) and those largely unaffected (UA).MethodThree latent classes (PIA, SAL, UA), derived from an earlier analysis of a LBW/PT birth cohort were compared on non-executive and executive functioning measures assessed at age 16.ResultsThe PIA class displayed the poorest performance on executive functioning, which was exaggerated in the context of lower IQ. The PIA and the SAL classes had poorer performance on non-executive functioning relative to the UA class. Both types of functioning mediated the relationship of class to school service use and grade retention.ConclusionNeuropsychological impairment characterizes children and adolescents with inattention problems. Problems in executive functioning characterize the subset whose inattention persists through adolescence. Subsequent research can examine the potential for remediating these deficits to address academic and social problems

Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care.

OBJECTIVE: Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB). METHODS: The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway. RESULTS: The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment. CONCLUSIONS: The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers

Supplementary Material, AK_Paper_Supplement_12_01_2015_submission – ADHD Symptoms in a Non-Referred Low Birthweight/Preterm Cohort: Longitudinal Profiles, Outcomes, and Associated Features

<p>Supplementary Material, AK_Paper_Supplement_12_01_2015_submission for ADHD Symptoms in a Non-Referred Low Birthweight/Preterm Cohort: Longitudinal Profiles, Outcomes, and Associated Features by Aaron J. Krasner, J. Blake Turner, Judith F. Feldman, Anna E. Silberman, Prudence W. Fisher, Catherine C. Workman, Jonathan E. Posner, Laurence L. Greenhill, John M. Lorenz, David Shaffer, and Agnes H. Whitaker in Journal of Attention Disorders</p

Features associated with germline CDKN2A mutations: a GenoMEL study of melanoma‐prone families from three continents

Background: The major factors individually reported to be associated with an increased frequency of CDKN2A mutations are increased number of patients with melanoma in a family, early age at melanoma diagnosis, and family members with multiple primary melanomas (MPM) or pancreatic cancer. Methods: These four features were examined in 385 families with [&gt;=]3 patients with melanoma pooled by 17 GenoMEL groups, and these attributes were compared across continents. Results: Overall, 39% of families had CDKN2A mutations ranging from 20% (32/162) in Australia to 45% (29/65) in North America to 57% (89/157) in Europe. All four features in each group, except pancreatic cancer in Australia (p = 0.38), individually showed significant associations with CDKN2A mutations, but the effects varied widely across continents. Multivariate examination also showed different predictors of mutation risk across continents. In Australian families, [&gt;=]2 patients with MPM, median age at melanoma diagnosis [&lt;=]40 years and [&gt;=]6 patients with melanoma in a family jointly predicted the mutation risk. In European families, all four factors concurrently predicted the risk, but with less stringent criteria than in Australia. In North American families, only [&gt;=]1 patient with MPM and age at diagnosis [&lt;=]40 years simultaneously predicted the mutation risk. Conclusions: The variation in CDKN2A mutations for the four features across continents is consistent with the lower melanoma incidence rates in Europe and higher rates of sporadic melanoma in Australia. The lack of a pancreatic cancer-CDKN2A mutation relationship in Australia probably reflects the divergent spectrum of mutations in families from Australia versus those from North America and Europe. GenoMEL is exploring candidate host, genetic and/or environmental risk factors to better understand the variation observe