Decline in head growth and cognitive impairment in survivors of acute lymphoblastic leukaemia

Article Abstract:

The survival of children with acute lymphoblastic leukemia is greatly prolonged by irradiation of the head. Presumably, leukemic cells 'hiding' in the brain could escape the onslaught of chemotherapy and radiation to the body and account for the poor survival observed with previous treatments. However, there is some indication that this treatment, while prolonging survival, is not without its own adverse consequences. Twenty-five children in remission for acute lymphoblastic leukemia, who were without symptoms after having been treated at least two years previously, were examined for possible neurological, neuropsychological, and physical changes which may have resulted from radiation treatment. The most striking finding was a decline in the head size centile in 12 children; the centile simply indicates how a child compares with other children of the same age, e.g. top 10 percent or 90th centile. The twelve children with apparently retarded head growth included six who had received the greatest dose of radiation to the head, in this case 24 Gy (a Gy, or Gary, is 1 joule of energy absorbed per kilogram of tissue). Thirteen of the patients had learning disabilities, and 10 had fallen at least one year behind in school. An additional three children had a specific disability associated only with mathematics. Three children showed abnormalities in sentence repetition tests, digit span tests, and word fluency, and also were found to have an abnormality on CAT scan of the head. However, it could not be determined whether these abnormalities were the result of the leukemia, an infection related to the treatment, or a result of the treatment itself. The observations in this study also confirm previous reports that the greatest risks of abnormal development are in those children diagnosed with leukemia under the age of three years. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Demographic aspects, Radiotherapy, Growth disorders, Lymphoblastic leukemia in children, Acute lymphocytic leukemia, Childhood leukemia

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Is late walking a marker for morbidity?

Article Abstract:

A milestone in the development of a child is the ability to walk. By 18 months of age, 97 percent of all children can walk five steps independently. In some cases, failure to walk at 18 months may be the result of a clear abnormality or impairment, but in many cases there is no obvious cause. To determine to what degree late walking is an indicator of underlying abnormalities (morbidity), the parents of 4,466 children, who were either premature or required special care at birth, were surveyed at 7 to 8 and 18 months of age. Data were obtained for 4,275 children. Follow-up evaluations at three years were obtained to ascertain whether developmental disabilities had become evident. Of the 4,275 for whom data were available, 410 were not walking at 18 months of age. Of those, 230, or 56 percent, were diagnosed as having some sort of abnormality by the age of three. Diagnoses included global delay associated with a chromosomal defect, which occurred in 40 children; hydrocephalus, which occurred in 9; and several isolated conditions, such as cytomegalovirus inclusion disease, which occurred in one child. Late walking was also attributed to non-neurological conditions, such as orthopedic and heart conditions, which accounted for four and five children, respectively. The most common diagnosis among late walkers was cerebral palsy, which was diagnosed in 66 children and suspected in another 11; these 77 children represented 19 percent of the late-walking population. The results indicate that late walking, defined as a failure to walk five independent steps by 18 months of age, is a simple marker for the presence of underlying illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Testing, Statistics, Identification and classification, Motor ability, Motor skills, Child development, Child development deviations, Developmentally disabled children

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Delivery in an obstetric birth chair: a randomized controlled trial

Article Abstract:

To evaluate whether the position of a woman's body during childbirth affects the outcome, a controlled study was carried out with 1,250 women who agreed to be randomly assigned to give birth in a conventional delivery bed or in an obstetric birth chair. In the birth chair, the woman remains in an upright position, which may make some phases of labor easier and reduce the rate of complications. All subjects were delivering their first child and were pregnant with one fetus, which was resting in the head-down position. Results showed that use of the birth chair during the second stage of labor did not lead to a lower rate of the use of instruments for assisting vaginal delivery nor to a lower rate of trauma to the perineal region (the area between the vagina and rectum). Certain complications such as maternal hemorrhage, the need for blood transfusions, and manual removal of the placenta, were more common among women who used the birth chair, but not common enough to be statistically significant. The groups did not differ in the proportion of women who felt comfortable during delivery or in the health of the newborn infants. Overall, delivery in the birth chair did not confer any obvious advantages over delivery in the conventional bed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Equipment and supplies, Labor (Obstetrics)

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