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Biomedical subjects

J H Ruys

Publications and source records attributed to J H Ruys.

At least 19 recordsLinked to original sources
PubMed2004

Sudden infant death syndrome in child care settings in the Netherlands.

BACKGROUND: In the Netherlands, there is a very low incidence of sudden infant death syndrome (SIDS) due to effective preventive campaigns. METHODS: During the period September 1996 to August 2002, nationwide 161 deaths from SIDS (about 85% of all cases of SIDS during that time) were investigated by the Cot Death Committee of the Dutch Paediatric Association. RESULTS AND DISCUSSION: Over 10% of cases of SIDS took place during some type of child care. From a national survey carried out in 2000/01 information was available on the child care attendance of 2000 Dutch infants aged 3-6 months. Based on the hours usually spent in child care by these infants, the number of similarly aged infants that died from SIDS while attending child care was 4.2 times higher than expected. Remarkably, the prevalence of known risk factors for SIDS, such as sleeping position and parental smoking, was favourable in the SIDS cases in child care settings. The adherence of child care facilities to the safe sleeping recommendations is high in the Netherlands, and no explanation as to why child care settings may be associated with an increased risk of SIDS is apparent. The possibility of other explanations, such as stress and change in routine care, is hypothesised.

Female↗
PubMed1995

Paroxysmal phenomena in the first two years of life.

The prevalence of paroxysmal phenomena in the first two years of life was assessed in 1854 children of Dutch-speaking mothers of a population-based birth cohort. At each visit to the Child Health Clinic (CHC), mothers were asked whether they had noted sudden change of consciousness, involuntary movements, deviation of the eyes or apnoea, and if so, whether these appeared to be related to feeding. Paroxysmal episodes occurred in a quarter of the children: in 8 per cent only in relation to feeding, in 19 per cent also not related to feeding. The latter children were more frequently admitted to hospital and had more disabilities at age two years. No connection with epilepsy in the family or with congenital anomalies could be demonstrated. Special attention should be paid by the CHC team to children with paroxysmal phenomena not associated with feeding.

Birth Weight↗
PubMed1994

[Use of health care services by children in the first 2 years of life in The Netherlands].

OBJECTIVE: To assess consumption of medical care for infants and toddlers provided by general practitioners and specialists, and of hospital admissions for young children. DESIGN: Descriptive. SETTING: Dutch Child Health Clinics (CHC). METHOD: An aselect cohort of newborns of 1988/89 of the Social Medical Survey of children attending Child health Clinics (SMOCC) were followed for two years; at maximally 8 CHC visits data were collected on the preceding interval. RESULTS: Health problems as observed in the CHCs like hearing disorders, strabismus, congenital hip dysplasia and growth disturbances were present as a cause for consultation of a GP or specialist in one out of six. Over 95% of the children went to consult their GP, 30% to a paediatrician, 20% to another specialist. Twelve per cent of the children was admitted to hospital, 10% of these more than once. Accidents caused 10% of all visits to a doctor in primary or secondary health care. Children with any form of disability at the age of two (6%) made use of the health care system as indicated in this study about three times more frequently than the non-disabled children. CONCLUSION: Nearly every child under two visited a GP, many a specialist. Timely recognition of specific health problems at the CHC prevents delay in treatment, and limits the harm in development as well as the costs.

Amblyopia↗
PubMed1994

[The significance of convulsion-like signs in the first 2 years of life].

OBJECTIVE: Assessment of the prevalence of convulsion-like symptoms in 1854 children of Dutch-speaking mothers of a population-based birth cohort. METHOD: At each child health clinic (CHC) visit mothers were asked whether they had noted any of the following signs: loss of consciousness, involuntary movements, eye rotation movements and apnoea, and if so, whether these appeared to be related to feeding. Registration was done by the CHC physician during eight consultations. RESULTS: Convulsion-like symptoms occurred in a quarter of the children: in 8% exclusively in relation to feeding, almost without exception in the first three months of life, in 19% also without relation to feeding, continuing until the second birthday. The latter children were more frequently admitted into hospital, even for non-neurological problems, than the former or than children without any such signs. They also have more disabilities at the age of two years. No connection with epilepsy in the family or with congenital anomalies could be demonstrated. CONCLUSION: Convulsion-like symptoms were observed in a quarter of children up to the age of two years. Special attention should be paid by the CHC team to children with signs not connected with feeding.

Child, Preschool↗
PubMed1994

[Birth weight percentiles of premature infants needs to be updated].

OBJECTIVE: To analyse whether the conventional so-called Kloosterman charts for birthweight of preterm infants based on data from 1931-1965 are still valid. DESIGN: Descriptive investigation. LOCATION: The Netherlands. METHOD: Data were obtained from the 'project of the premature and small for gestational age' (POPS) survey in 1983. The population consisted of 855 Caucasian infants born after a pregnancy of 24-31 weeks. RESULTS: In nearly all gestational age categories the percentages of small-for-gestational age infants were higher than the 10% they should have been by definition; the percentages of large-for-gestational age infants were much lower than 10%. After exclusion of elective births the percentages remained different. CONCLUSION: These shifts in the birthweight distribution are probably the result of changes in obstetrics. The birthweight percentiles for preterm births will have to be updated.

Birth Weight↗
PubMed1994

Otitis media, respiratory tract infections and hearing loss in pre-term and low birthweight infants.

In 1983, 1338 liveborn infants with a gestational age of less than 32 weeks and/or a birthweight of less than 1500 g, were enrolled in a national follow-up study in The Netherlands. At the age of 5 years, 966 children were alive. Of these, 927 (96%) were assessed on a home visit 2-6 weeks after their fifth birthday by three specially trained paediatricians. An assessment of ENT morbidity was made and compared with ENT morbidity in full-term children of the same age group. Markedly preterm birth or very low birthweight does not seem to be a risk factor for developing middle ear disease in childhood, however, the rate of ENT problems seems to be higher than in the general population of Dutch pre-school children.

Child, Preschool↗
PubMed1994

Comparison of mortality and rates of cerebral palsy in two populations of very low birthweight infants.

Comparisons of mortality and rates of cerebral palsy in different populations can be confusing. This is illustrated by comparing two populations of very low birthweight infants born in the 1980s, one from the Netherlands, the other from the UK (Oxford region). Although a number of biases were controlled for while comparing two large geographically defined populations, by assessing the survivors at similar ages and describing their health status in a standard way, some problems in interpretation of outcome remained. Differences in registration practice of live births at early gestational ages, as well as differences in withholding or withdrawing treatment, which occurred in about half of the cases of neonatal death in the Netherlands and in about one third of those in the Oxford region, may have influenced the incidence of registered live births, neonatal mortality, and the rate of cerebral palsy.

Blindness↗
PubMed1994

Sex difference in disability and handicap at five years of age in children born at very short gestation.

OBJECTIVE: The objective of this study was to examine the relationship between sex and disabilities or handicaps at 5 years of age in infants born at less than 32 weeks gestation. DESIGN: From the nationwide collaborative survey starting in 1983, including perinatal data obtained during routine perinatal care and follow-up assessments by the attending pediatricians, data from 1008 infants fulfilling the criteria were used. At age 5 years, a detailed assessment was performed by three specially trained pediatricians in 96% surviving infants (n = 648), of which 345 were boys. Each child was categorized as disabled or handicapped, using World Health Organization definitions. RESULTS: The prevalence of handicaps was three times greater in boys than in girls (21% vs 7%, odds ratio 3.2). Adjustment for gestational age and birth weight (logistic regression analysis) did not change this (odds ratio 3.5). Further adjustment by including perinatal variables such as idiopathic respiratory distress syndrome did not alter the odds ratios. The male excess in handicaps was not related to lower mortality, and therefore was not a mere consequence of a higher survival rate. The excess in handicaps was found in all assessed areas. CONCLUSIONS: Infants' sex seems to be an important determinant of handicaps. The perinatal variables used in the present study do not explain the difference in handicaps. These findings emphasize the need to include the sex distribution of a study population more systematically in analyses in future studies concerning long-term outcome of very preterm birth or low birth weight.

Child, Preschool↗
PubMed1993

[Relationship between socioeconomic status and differences in health care utilization in pregnancy, delivery and puerperium].

OBJECTIVE: Description of differences in pre-, peri- and postnatal care, according to socio-economic status (SES). SETTING: Geographically defined areas of 21 child health clinics (CHC) in several parts of the Netherlands. DESIGN: Retrospective cohort study. MATERIALS AND METHOD: Of all women who delivered a live-born child in the period April 1988-October 1989 and who were residents of the districts of the CHCs (n = 2119), data were recorded during the home visit post partum by the district nurses. Complete data were available of 2060 (97.2%) mothers. The care provided was defined as prenatal care and attendance at delivery (midwife, general practitioner, obstetrician and combinations), place and mode of delivery, and place of lying-in period. The indicator for SES was the educational level of the mother. In multivariate analyses, age, parity, degree of urbanisation of residential area, distance between home and hospital, ethnicity, height, smoking, health problems during pregnancy, obstetrical history, preterm birth and low birth weight were included in order to correct for possible confounding effects of these factors. RESULTS: Compared to the higher SES group, there was an increased risk in the lower SES group for a delivery in hospital (OR 1.60; 95% CI 1.16-2.20); the probability of having a complete lying-in period at home decreased according to the SES level (low SES: OR 0.47; 95% CI 0.34-0.65). Differences in mode of delivery (notably caesarean section) were very small and not significant. CONCLUSIONS: In the Netherlands there are socio-economic differences in perinatal care and the place of the lying-in period. Women of higher SES delivered more often at home and more often had their lying-in period at home, irrespective of other factors. Preferences of the mothers with respect to place of confinement were not taken into account in this study.

Adolescent↗
PubMed1993

[Congenital disorders in the first year of life].

OBJECTIVE: Assessment of the prevalence of congenital malformations in a population-based birth cohort of 2151 children. METHOD: Information about congenital malformations was obtained of 2092 infants by the Child Health Clinic nurses and by the CHC physician during six consultations in the first year of life. RESULTS: In 29% of the infants a congenital malformation was diagnosed. In 37 children (1.8%) 40 major malformations were found. More than three quarters of the malformations were diagnosed in the first three months of life. Using the EUROCAT criteria, a difference existed between the incidence of congenital malformations in liveborn infants in SMOCK (4.0%) and in EUROCAT (2.3%). This difference is mainly caused by the difference in the number of reports on congenital hip dislocation. The prevalence of major defects was similar in both SMOCK (central nervous system: 14/10,000; circulatory system: 67/10,000; ventricular septal defect 29/10,000; schisis: 14/10,000; Down syndrome: 14/10,000) and EUROCAT: CONCLUSION: By systematic and structured reporting it is possible to obtain more complete information on the prevalence of congenital malformations than by voluntary notification. One quarter of the congenital malformations is not detected before the age of 3 months.

Cohort Studies↗
PubMed1993

Hearing loss in very preterm and very low birthweight infants at the age of 5 years in a nationwide cohort.

In a geographically defined population of very preterm and very low birthweight infants (gestational age < 32 weeks and/or birthweight < 1500 g) hearing was evaluated in 890 children by pure-tone audiometry at the age of 5 years. Hearing loss was conductive/unspecified in 123 (13.8%) and sensorineural in 13 (1.5%) children. The prevalence of sensorineural hearing loss was 15 times as high as in 5-7 year old children in the Dutch population at large. The sensorineural hearing loss prevalence in very low birthweight and extremely low birthweight infants was similar. On account of communication disorders 10 (1.1%) children were classified as disabled and 6 (0.7%) as handicapped, following the definitions of the International Classification of Impairments, Disabilities, and Handicaps of the World Health Organisation. Children with conductive hearing loss had a higher risk of impairments, disabilities and handicaps of language and speech development, than children with normal hearing, the difference being statistically significant. The same holds for children with sensorineural hearing loss; moreover they had a significantly higher risk of impairments, disabilities and handicaps of mental development. Overall comparison of children with and without sensorineural hearing loss proved that the children with sensorineural hearing loss had a significantly less favourable outcome, based on 15 perinatal factors simultaneously. The age at which sensorineural hearing loss in very preterm and/or very low birthweight infants is detected has to be improved.

Audiometry, Pure-Tone↗
PubMed1993

Prediction of height achievement at five years of age in children born very preterm or with very low birth weight: continuation of catch-up growth after two years of age.

To predict height at five years in a cohort of 565 very preterm and/or very low-birth-weight children, hypothesized growth determinants were subjected to discriminant analysis. Many neonatal parameters were not significantly associated with short stature at five years of age. A correct classification of stature (smaller/larger than the 10th percentile at five years of age) could be obtained in 85% of children, using the following variables: height at two years of age; total (or mid) parental height; parental level of education; length at one year of age; hypertension during pregnancy; sex; weight at two years of age; length percentile at one year of age. However, when compared to actual longitudinal data, the false-positive rate was 37%. The survey also demonstrated the continuing catch-up growth in very preterm and very low-birth-weight infants after two years of age.

Biometry↗
PubMed1992

Standardised method of follow-up assessment of preterm infants at the age of 5 years: use of the WHO classification of impairments, disabilities and handicaps. Report from the collaborative Project on Preterm and Small for gestational age infants (POPS) in The Netherlands, 1983.

A nationwide, prospective study was initiated in The Netherlands in 1983, involving 1338 liveborn infants with a gestational age less than 32 weeks and/or a birthweight less than 1500 g. Pre- and perinatal data, methods and results of follow-up until the corrected age of 2 years have been published previously. In this paper, methods of follow-up at the age of 5 years are described. At that age, 966 children were alive, of which 927 (96%) were assessed during a home visit 2 to 6 weeks after their fifth birthday by three specially trained paediatricians. A questionnaire served to collect data on medical history, respiratory function, behaviour and socio-economic factors. Standardised tests were carried out covering the following 10 areas: congenital malformations, neuromotor function, mental development, hearing, visual function, language and speech development, behaviour, musculoskeletal system, respiratory tract and ENT problems, and growth. The outcome was recorded for separate areas and for the child as a whole using the WHO classification of impairments, disabilities and handicaps.

Abnormalities, Multiple↗
PubMed1992

Evaluation of care for the preterm infant: review of literature on follow-up of preterm and low birthweight infants. Report from the collaborative Project on Preterm and Small for Gestational Age Infants (POPS) in The Netherlands.

Since the introduction of neonatal intensive care in the 1960s, mortality in very preterm and very low birthweight infants has been decreasing steadily. Consequently, interest in the outcome of surviving infants is growing. Restriction of health care resources has stressed the need for information concerning the effect of individual treatment components on mortality and morbidity. Concern about the quality in apparently normal survivors has been increasing as well. The current flood of papers on these subjects illustrates the interest in these issues. The first part of this paper reviews the methodology used in follow-up studies in the past decades. It aims at methodological problems that hamper comparison between studies and preclude unequivocal conclusions. New treatment techniques seldom were but should be evaluated by randomised trials. To monitor the combined effects of changing obstetric and neonatal techniques on perinatal outcome, studies in geographically defined populations are recommended using data from early pregnancy until at least preschool age. Comparability of outcomes could be enhanced by international agreement on standardisation of assessment methods and outcome measures. In the second part the results concerning gestational age- and birthweight-specific mortality, impairments and disabilities and the risk factors for such disorders are discussed. Increased survival of even the tiniest infants is clearly established. This increase in survival has not yet been accompanied by an apparent increase in major morbidity. However, many minor impairments are reported, occurring often in combination and predisposing these children to deviations of normal development. Important changes in the manifestation of brain damage appear to occur during development. These findings stress the importance of long-term follow-up studies.

Follow-Up Studies↗
PubMed1991

Impairments, disabilities, and handicaps of very preterm and very-low-birthweight infants at five years of age. The Collaborative Project on Preterm and Small for Gestational Age Infants (POPS) in The Netherlands.

The Project On Preterm and Small for gestational age infants (POPS) was started in the Netherlands in 1983 to investigate the relation between prenatal/perinatal factors and mortality/morbidity in very preterm and very-low-birthweight infants. Of the 1338 liveborn infants (less than 32 weeks and/or less than 1500 g) 966 were enrolled in the five-year (chronological age) follow-up programme; 96% of these children were assessed during a home visit. The overall outcome was expressed as impairments, disabilities, and handicaps according to World Health Organisation criteria. Of the assessed children, 13% had a disability and 14% were handicapped, which are much higher frequencies than those found in the general population. Handicaps were due mainly to abnormalities of neuromotor function, mental development, or language and speech development. Compared with the handicap frequency in the same cohort at two years of age, a more favourable outcome at five years of age was seen in 10%, and a less favourable outcome in 7% of the children. The findings show that most of those high-risk children survived without handicap or serious disability at preschool age.

Child, Preschool↗
PubMed1991

Maternal hypertension and very preterm infants' mortality and handicaps.

In a nationwide survey on liveborn very preterm and/or very low birthweight infants in The Netherlands, mortality and handicaps at the corrected age of 2 years were studied in infants born to mothers with or without hypertensive disorders during pregnancy. The neonatal and in-hospital mortality was significantly lower in infants born to hypertensive mothers. In surviving infants, a similar handicap rate was found at the corrected age of 2 years for both groups.

Congenital Abnormalities↗