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Biomedical subjects

E Tirosh

Publications and source records attributed to E Tirosh.

At least 19 recordsLinked to original sources
PubMed1995

CPAP treatment of obstructive sleep apnoea and neurodevelopmental deficits.

Four boys aged 6-16 years with neurodevelopmental deficits were treated with CPAP for obstructive sleep apnoea. Their diagnoses were: Obesity with mild mental retardation, (2) attention deficit hyperactivity disorder, (3) epilepsy associated with left hemiparesis and (4) mild mental retardation due to fragile X syndrome. Previous therapeutic attempts, including adenotonsillectomy, amitriptyline and methylphenidate in our patients prior to CPAP treatment were unsuccessful. A follow-up period of 12-48 months demonstrated a number of clinical benefits such as improvement in sleep quality and daily arousal, and a decrease in the frequency of seizures and episodes of pneumonia. Polysomnographic studies indicated a significant improvement in sleep parameters such as apnoea frequency, awakenings, sleep efficiency and arterial oxygen saturation. Side effects were mild and readily alleviated. CPAP is a feasible therapeutic intervention in intractable obstructive sleep apnoea of childhood, even when associated with neurodevelopmental deficits.

Adolescent↗
PubMed1995

Apparent life-threatening event: a neurologic perspective.

Of 46 infants who were investigated for apparent life-threatening events, central nervous system disorders were diagnosed in seven (15%). Convulsive disorders, intraventricular hemorrhage and hydrocephalus, absent corpus callosum, and development deficits were found. In four of the seven, no neurologic deficit was suspected before the event. Electroencephalographic studies (overnight in two) would have identified the disorder in all four. Electroencephalography is therefore a recommended routine procedure in investigation of apparent life-threatening events. Central nervous system disorders should be routinely ruled out in cases of apparent life-threatening event, even in the absence of clinical clues.

Brain Diseases↗
PubMed1994

Unexpected death in infancy. An epidemiologic study in the Haifa district, Israel.

The incidence of unexpected death in infancy (UDI) (2 weeks-12 months) in the Haifa area is 1.17 per 1000 live births. We found a significant interethnic difference between Israeli Jews and Arabs. The incidence among Arabs was 4 per 1000, but was only 0.77 per 1000 among Jews (p < 0.01). When the UDI Jewish group was compared to both the group of infants dying of known causes and the surviving group, the only significant factors related to UDI were found to be: young maternal age and low maternal education. No such association was evident among Arabs. Following logistic regression analysis, low maternal age and low socioeconomic status, but not ethnicity, were significantly associated with UDI as compared to the non-UDI infants. In comparison to non-UDI, UDI was significantly more prevalent during the cold season. UDI incidence has apparently been stable over the past 15 years. Demographic risk factors are similar to those reported from other communities, and ethnicity is possibly mediated through those factors.

Age Distribution↗
PubMed1994

Fine motor deficit: an etiologically distinct entity.

The prevalence of risk and adverse factors associated with fine motor disorder (n = 35) were compared with gross motor deficit (n = 158), global developmental delay (n = 336), and combined fine and gross motor deficit among 1,241 children up to 3 years of age identified in the Haifa health district. A significantly increased preponderance of males was observed among the study group as compared to the group with gross motor deficit. Intranatal problems were significantly increased among children with fine motor deficits as compared to those with gross motor deficits as were minor physical anomalies, seizures, and behavioral deficits. Less significant differences were observed between the study group and children with global developmental delay or fine and gross motor deficit. The different risk factor profiles indicated that the children with fine motor deficits constituted an etiologically distinct group highly associated with early antepartum, possibly genetic, origins.

Brain Damage, Chronic↗
PubMed1994

Relationship between the parachute reactions and standing and walking in normal infants.

Assumption of the vertical position and independent walking are potentially hazardous motor milestones in the developing infant. It has been presumed that the parachute reactions evolved to protect infants from injury during this developmental stage. To determine the relationship between the appearance of the upper and lower parachute reactions and the developmental milestones of unsupported standing and independent walking, 190 normal infants were prospectively studied. The upper parachute reaction was found to precede the lower by less than a month (mean age of appearance: 8.9 and 9.2 months, respectively). More than one-half of the cohort achieved standing without either the upper (49%) or lower parachute reaction (57%); however, no independent walking occurred without the upper parachute reaction, and only 2 of 190 infants (1%) walked independently without the lower parachute reaction. Onset of walking occurred about 4 months after the appearance of the upper parachute reaction. The significance of these findings is discussed.

Accidental Falls↗
PubMed1994

Relationship of sweat electrolytes to apparent life-threatening events (ALTE): a case control study.

Twenty infants aged 25 days to 6 months who were consecutively investigated for apparent life-threatening events (ALTE) with negative results and 20 matched normal controls underwent an iontophoresis sweat test. A statistically significant elevated sweat potassium level (22.1 +/- 8.9 versus 12.4 +/- 6.5 mol/l) was noted in the ALTE patients compared with the control group (p < 0.001). No difference was found, however, between sweat sodium and chloride levels in the two groups. Na/K ratio in sweat was significantly different between the groups (p < 0.001). A between-groups discriminant analysis, using Na/K ratio as a discriminant variable, resulted in 80% accuracy in group assignment. A significant increase in sweat potassium concentration at night compared with day time was evident in ALTE patients. Elevated sweat potassium levels specifically characterized infants who experienced ALTE and may possibly indicate an underlying mechanism involving enhanced sympathetic activity.

Circadian Rhythm↗
PubMed1994

The relationship between joint hypermobility and neurodevelopmental attributes in elementary school children.

Joint hypermobility is associated with motor developmental delay in infancy. To assess this finding in school-aged children, 320 first- and second-grade elementary school children and 110 children attending a special education program were assessed. Joint hypermobility was found in 40 (12.4%) and seven (6.4%) of the children attending the regular and special education classes, respectively. No difference in the neurologic status or verbal and eye-hand coordination task performance was found between the children of the study group and their age- and sex-matched controls. It appears that joint hypermobility and neurodevelopmental dysfunctions are not causally related and have a different maturational course.

Child↗
PubMed1993

Effects of methylphenidate on sleep in children with attention-deficient hyperactivity disorder. An activity monitor study.

OBJECTIVE: To assess the effects of methylphenidate hydrochloride on sleep patterns in children diagnosed as having attention-deficit hyperactivity disorder (ADHD). DESIGN: A double-blind, controlled drug-placebo cross-over design. SETTING: Home. SUBJECTS: Ten children (aged 6 years 9 months to 12 years & months) diagnosed as having ADHD were consecutively recruited and compared with age- and sex-matched normal controls. TREATMENT: Methylphenidate hydrochloride (0.3 to 0.4 mg/kg) or placebo was administered at 7:30 AM. MEASUREMENTS AND RESULTS: Each child underwent activity monitoring at home during 6 days of no treatment (baseline) followed by placebo and methylphenidate treatment. The results of the three trial stages, as well as those of the 20 age- and sex-matched normal controls, were compared. A shorter total sleep duration was evident during the methylphenidate treatment compared with that of baseline and placebo treatment. The amount of quiet sleep was lower (however, not significantly) among the study group compared with controls, whereas no such difference was noted during methylphenidate treatment. Night-to-night sleep pattern stability was found. No other differences were found either between children with ADHD and controls or between on and off stages of methylphenidate treatment. CONCLUSIONS: These results support the notion that ADHD is a centrally generated disorder attributable to hypoarousal, which subsequently stimulates motor overactivity. Methylphenidate does not appear to affect sleep patterns adversely and possibly normalizes them in patients with ADHD.

Analysis of Variance↗
PubMed1993

An effective community-based approach to the identification of neurodevelopmental delay in childhood.

The contribution of specially trained developmental nurses (DNs) to the accuracy of developmental screening in well-baby units was assessed. Of 13,580 children between two and 48 months of age, the well-baby clinic identified definitive developmental delay in 310, and 357 children were classified as 'questionable'. After DN assessment at 12 months follow-up, only 31 per cent of the questionable group required referral to the Child Development Centre (CDC). Comparison of the original queried recommendations to the CDC with the DN's recommendation indicated a false-positive and -negative rate of 60 and 20 per cent, respectively. This procedure resulted in false-positive and -negative screening accuracies of 1.2 and 6 per cent, respectively, for the total cohort of children screened. The economic and clinical advantages of this model are discussed.

Child Development↗
PubMed1993

Developmental disabilities among children between birth and 3 years old in the Haifa district: a population study.

The incidence of major neurodevelopmental deficits among children between birth and 3 years of age in the Haifa district was evaluated. Routine standardized developmental screening at the well-baby clinics was employed. The records of all children referred to the only two child developmental centers in the district during a period of 4 years were analyzed. The overall incidence was 31 per 1000 and was lower than expected. The age at diagnosis and associated disorders are discussed. In 30% of the cohort the diagnosis was inaccurate, and a 22% false positive referral rate was noted. A more thorough training in the early diagnosis of psychomotor developmental problems in childhood in the well-baby clinics is indicated.

Child Behavior Disorders↗
PubMed1992

[Masturbation in infancy simulating convulsive disorder].

We describe a 7-month-old girl referred for evaluation of a convulsive disorder. The tentative diagnosis of epilepsy was based on what were apparently paroxysmal events which occurred many times during a day. A cousin had suffered from infantile spasms and is mentally retarded. The episodic "attacks" in our patient consisted of sudden rhythmic body movements, crossing of thighs, altered awareness, glassy stare and profuse sweating. While the attacks subsided spontaneously, they could easily be aborted by changing the infant to a sitting position or by picking it up and holding it, when it would revert to completely normal behavior. A detailed history and personal observation of the "attacks" made it clear that they were really physical manifestations of masturbation. The diagnosis of epilepsy was therefore discarded. Awareness of masturbation in infants is essential for establishing the correct diagnosis, and spares infants and families many superfluous investigations and the anxiety associated with a diagnosis of convulsive disorder in children.

Diagnosis, Differential↗
PubMed1992

Toddlers' sleep and temperament: reporting bias or a valid link? A research note.

Objective sleep measures derived from a computerized movement detector attached to the child's leg, were obtained for a group of 31 toddlers (mean age: 18.5 months). The monitored sleep parameters were compared with maternal assessment of the child's sleep and her perception of his temperament. The validity of maternal diaries as a measure of the child's sleep was not supported. Nevertheless, a link between both subjective and objective sleep measures with temperament dimensions was indicated. The modest association between sleep and temperament may suggest either a continuity between some aspects of day- and night-time functioning or, alternatively, the influence of the child's sleep behavior in shaping the mother's perceptions of her toddler's temperament.

Child, Preschool↗
PubMed1992

Relationship between neonatal behavior and subsequent temperament.

The validity of the neonatal behavioral assessment scale in predicting later infant temperament is of theoretical and clinical importance. The scale was administered to 47 full-term healthy neonates. Of these, 40 were followed and the infant characteristics questionnaire was given at four months of age. Significant correlations were revealed between the neonatal assessment items from the clusters of orientation and motor maturity and the temperament factors "fussy-difficult" and "unpredictable". Items from the cluster of autonomic stability correlated with the temperament factor "unadaptable." These correlations possibly indicate that perceived temperament does reflect intrinsic infant qualities.

Adaptation, Physiological↗
PubMed1992

Neonatal behavior of Panamanian and Israeli infants: a cross-cultural study.

The behavior of third-generation Israeli neonates belonging to two ethnic groups--Ashkenazic infants (n = 20) and Sephardic infants (n = 20)--and the behavior of a group of full-term Panamanian infants (n = 30) were compared in order to examine cross-cultural and interethnic predispositions. The Israeli and Panamanian infants differed on 5 of a total of 27 neonatal behavioral assessment items: the difference in 3 of these items, representing the autonomic stability and motor clusters, exceeded 1 scale score. A comparison of the two Israeli ethnic subgroups with the Panamanian group (Duncan's multiple-range test) revealed significant differences between Ashkenazic and Sephardic infants on 2 auditory habituation items, whereas the Panamanian infants differed significantly from both Israeli subgroups on 10 of the items, representing the motor, range of state, and autonomic stability clusters. These results corroborate previous observations concerning cross-cultural neonatal behavioral differences and the possible role of environmental factors in the ongoing modeling process of human behavioral traits and personality.

Child Behavior↗
PubMed1992

Variability in head circumference growth rate during the first 2 years of life.

The head circumference (HC) curves were plotted for a group of 415 healthy full-term babies over the first 2 years of life. Two hundred ten (51%) of the cohort demonstrated HC variability, defined as an HC acceleration or deceleration of at least 1 centile curve for at least 2 months. Of these, the deceleration pattern was predominant (80.9%), and also frequently permanent (87%). The HCs of 3 (1.42%) of 210 infants with HC variability ended up with a deviation of 2 standard deviations or more from the mean. The onset of HC transition occurred from the mean age of 1.3 months, and the new curve had stabilized by age 13 months in 95% of the study group. Parallel changes occurred in body weight and body length in approximately 48% of the total cohort, but more frequently in the variable-HC group. The clinical interpretation of these findings is discussed.

Body Height↗
PubMed1991

Prognosis of motor development and joint hypermobility.

In a study of 59 infants aged 18 months there were 20 with joint hypermobility and delayed motor development, 19 with joint hypermobility and normal motor development, and 20 normal controls. They were reassessed for motor function 3.5 years later at the age of 5 years. Both gross and fine motor performance were significantly delayed in the group of children who exhibited joint hypermobility and motor delay in infancy. No significant delay was evident in those with joint hypermobility only. Joint hypermobility resolved more frequently in children who presented normal motor development at age 18 months. Infants with joint hypermobility and motor delay are a subgroup associated with a less favourable motor outcome and careful follow up is indicated.

Attitude to Health↗
PubMed1991

Relationship between neonatal excitability and respiratory habituation.

The Brazelton Neonatal Behavioral Assessment Scale was administered and analyzed in the cases of 25 full-term infants in order to assess the relationship between a behavioral measure of excitability and respiratory habituation. Sound and light stimuli were sequentially delivered, and prestimulus and poststimulus respiratory amplitude mean and standard deviation were analyzed. The stimulus with the least interperiod difference was considered as habituation. The correlation between arousal behavioral items and respiratory habituation ranged between 0.16 and 0.44. The two significant correlations were between peak of excitement and respiratory habituation to light (0.44) and between rapidity of buildup and respiratory habituation to sound (0.38). These results may indicate an interrelation in neonates between temperamental excitability attributes and respiratory regulation.

Acoustic Stimulation↗