PubMed · 60766
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K S Holt. 1976. Letter: Developmental assessment.. https://pubmed.ncbi.nlm.nih.gov/60766/
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OBJECTIVE: Medical and technical advances make it possible to treat young children with end-stage renal disease with far-reaching methods such as continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis (HD). We investigated whether chronic renal failure has deleterious effects on motor function and cognitive development. SETTING: The pediatric dialysis centres of the university hospitals of Nijmegen, Utrecht and Rotterdam. DESIGN: Prospective study. METHODS: 18 patients (mean age 37 months) with chronic renal failure since infancy and 18 healthy children (mean age 35 months) as controls were assessed on cognitive and behavioural parameters. Nine patients and 17 control subjects were tested on their motor function. RESULTS: A significant delay (more than one SD) was found in the motor as well as in the cognitive development of the patient group. Within this group a large difference was noticed between patients under conservative treatment (n = 8; mean dev. index 92.0) and those under CAPD or HD treatment (n = 10; mean dev. index 72.4). CONCLUSION: Young dialysis patients are evidently at risk for developmental retardation. Monitoring this vulnerable group by developmental screening and intensive counselling of the parents is strongly recommended.
The 5-year outcome of 101 extremely low birthweight (ELBW, < 1000 g) children discharged from the Neonatal Intensive Care Unit was reported. Over this period, there were four post-discharge deaths. The neurodevelopmental impairment rate was 18% overall: cerebral palsy 7%, blindness 3%, deafness 3% and developmental delay 10%. Seventy-one percent of children were readmitted to hospital. The mean number of admissions was 2.4 per child and the mean duration of total hospital stay was 11.3 days per child in the 5-year period. A trend was observed in a reduction in the readmission rate and hospital days in the 2-5-year period compared to the period between discharge and 2 years, though the differences were not statistically significant. The most common reason for readmission was for surgical procedures, primarily aural ventilation tube insertion and tonsillectomy and adenoidectomy. Significant health problems included recurrent wheezing episodes, stridor and croup in the period up to 2 years and otitis media and tonsillitis between 2 and 5 years. There was some catch-up growth, especially in height, between 2 and 5 years. Children with < 800 g birthweight had similar rates of neurodevelopmental impairment and hospital readmission to those of 800-999 g birthweight. However, they experienced more otitis media and pneumonia, had more ear, nose and throat operations, and at 5 years of age, more were below the 3rd centile for weight. This study showed that the health status of ELBW children had improved between 2 and 5 years, but they continued to experience recurrent health problems and hospital readmissions which would have resulted in added financial and emotional burdens to their families.
Morbidity and mortality of these preterm infants weighing < 1000 g at birth was reported in another paper. The mortality and neuro-developmental prognosis improved clearly in the last 3 years. A particular attention is given for protecting these babies against brain lesions. These ELBW have a high risk of neurodevelopmental disturbances. Therefore, a multidisciplinary team follows the neurological evolution to assess the quality of neonatal care and detect and treat developmental abnormalities as early as possible. We present the weight and height evolutions, the neurological, social and familial outcome of our 15 survivors. Economical and ethical discussions are open.