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Pediatric asphyxial cardiac arrest (ACA) often leaves children with physical, cognitive, and emotional disabilities that affect overall quality of life, yet rehabilitation is neither routinely nor systematically provided. Environmental enrichment (EE) is considered a preclinical model of neurorehabilitation and thus we sought to investigate its efficacy in our established model of pediatric ACA. Male Sprague-Dawley rat pups (post-natal day 16-18) were randomly assigned to ACA (9.5 min) or Sham injury. After resuscitation, the rats were assigned to 21 days of EE or standard (STD) housing during which time motor, cognitive, and anxiety-like (i.e., affective) outcomes were assessed. Hippocampal CA 1 cells were quantified on post-operative day-22. Both ACA + STD and ACA + EE performed worse on beam-balance vs. Sham controls (p < 0.05) and did not differ from one another overall (p > 0.05); however, a single day analysis on the last day of testing revealed that the ACA + EE group performed better than the ACA + STD group (p < 0.05) and did not differ from the Sham controls (p > 0.05). Both Sham groups performed better than ACA + STD (p < 0.05) but did not differ from ACA + EE (p > 0.05) in the open field test. Spatial learning and declarative memory were improved and CA 1 neuronal loss was attenuated in the ACA + EE vs. ACA + STD group (p < 0.05). Collectively, the data suggest that providing rehabilitation after pediatric ACA can reduce histopathology and improve motor and cognitive ability., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Aim: Hypoxic-ischemic encephalopathy is associated with damage to deep gray matter; however, white matter involvement has become recognized. This study explored differences between patients and clinical controls on diffusion tensor imaging, and relationships between diffusion tensor imaging and neurodevelopmental outcomes., Method: Diffusion tensor imaging was obtained for 31 neonates after hypoxic-ischemic encephalopathy treated with therapeutic hypothermia and 10 clinical controls. A subgroup of patients with hypoxic-ischemic encephalopathy (n = 14) had neurodevelopmental outcomes correlated with diffusion tensor imaging scalars., Results: Group differences in diffusion tensor imaging scalars were observed in the putamen, anterior and posterior centrum semiovale, and the splenium of the corpus callosum. Differences in these regions of interest were correlated with neurodevelopmental outcomes between ages 20 and 32 months., Conclusion: Therapeutic hypothermia may not be a complete intervention for hypoxic-ischemic encephalopathy, as neonatal white matter changes may continue to be evident, but further research is warranted. Patterns of white matter change on neonatal diffusion tensor imaging correlated with neurodevelopmental outcomes in this exploratory pilot study.

The consequences of perinatal asphyxia (PA) include alterations which may manifest as schizophrenia. Characteristic features of this disease include a decrease in specific subpopulations of GABAergic cells and deterioration of social interaction. The purpose of this study is to assess if a deep and short-hypothermic treatment can ameliorate this damage in a model of PA. Rats offsprings were exposed to 19 min of asphyxia by immersing the uterus horns in water at 37 °C followed by 30 min in air at 10 °C that resulted in 15 °C body temperature. At postnatal day 36-38, the rats were tested in the open field and social interaction paradigms and processed for immunostaining of calbindin and reelin. A brief exposure to deep hypothermia reversed the deterioration produced by PA in play soliciting. PA decreased the density of calbindin neurons in layer II of the Anterior Insular Cortex, while deep hypothermia reversed this effect. Paradoxically, in AIC, there was a significant increase in the number of reelin-secreting neurons in layers II and III generated by PA and this increase was reversed by hypothermia. This suggests a compensatory mechanism, where reelin neurons trend to compensate for the loss of calbindin neurons, at least within Anterior Insular Cortex. Finally, the deep hypothermic shock might represent a valuable therapeutic alternative to treat PA., (© 2018 Wiley Periodicals, Inc.)

Objectives : Dorsal-stream functions are vulnerable to early brain injury associated with neonatal encephalopathy (NE) following perinatal asphyxia, even in children not developing cerebral palsy (CP). Since therapeutic hypothermia (TH) became the standard treatment for NE, the incidence of CP is reduced but the impact on dorsal-stream functions is unknown. We aimed to compare dorsal-stream functions in TH-treated survivors of NE, without CP, with those of matched controls. Methods : We administered tests of dorsal-stream function to 29 case children aged 6-to-8 years treated with TH for NE and without CP, and 20 age, sex and social class matched controls. We used the Conner's Continuous Performance Test (CPT) 2 nd Edition to assess attentiveness, based upon Hit Reaction Time (HRT) percentile score and HRT standard error percentile, the CPT HRT block change measure to assess sustained attention and the NEPSY-II block construction and arrows tests to assess visuo-spatial performance and mental rotation. Results : Case children performed significantly worse than controls on measures of attention and visuo-spatial function. Conclusions : Children given TH treatment for NE can have subtle attention difficulties with slower reaction times and reduced visuo-spatial processing. These findings illustrate the continued vulnerability of dorsal-stream functions following NE despite the use of TH.

Objective: To assess the impact of hypothermic neural rescue at birth on health-related quality of life (HRQL) in middle childhood., Design: Six-year to 7-year follow-up of surviving children from the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) Trial., Setting: Community study including a single parental questionnaire to collect information on children's HRQL., Patients: 145 children (70 in the control group, 75 in the hypothermia group) whose parents consented and returned the questionnaire., Interventions: Intensive care with cooling of the body to 33.5°C for 72 hours or intensive care alone., Main Outcome Measures: HRQL attributes and utility scores using the Health Utilities Index (HUI)., Results: At 6-7 years, speech appeared disproportionately affected when compared with other aspects of HRQL but levels of normal emotional functioning were similar in both groups. The mean (SE) HUI3 HRQL scores were 0.73 (0.05) in the hypothermia group and 0.62 (0.06) in the control group; mean difference (95% CI) 0.11 (-0.04 to 0.26)., Conclusions: Findings of non-significant differences were not unexpected; the study used data from long-term survivors in a neonatal trial and was underpowered. However, results favoured moderate hypothermia and so complement the clinical results of the TOBY Children study. The work provides further insight into the long-term HRQL impact of perinatal asphyxial encephalopathy and provides previously unavailable utility data with which to contemplate the longer term cost-effectiveness of hypothermic neural rescue., Trial Registration Number: This study reports on the follow-up of the TOBY clinical trial: ClinicalTrials.gov number NCT01092637., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: Two important risk factors for abnormal neurodevelopment are preterm birth and neonatal hypoxic ischemic encephalopathy. The new revisions of Griffiths Mental Development Scale (Griffiths-II, [1996]) and the Bayley Scales of Infant Development (BSID-II, [1993]) are two of the most frequently used developmental diagnostics tests. The Griffiths-II is divided into five subscales and a global development quotient (QD), and the BSID-II is divided into two scales, the Mental scale (MDI) and the Psychomotor scale (PDI). The main objective of this research was to establish the extent to which developmental diagnoses obtained using the new revisions of these two tests are comparable for a given child., Material and Methods: Retrospective study of 18-months-old high-risk children examined with both tests in the follow-up Unit of the Clinic of Neonatology of our tertiary care university Hospital between 2011 and 2012. To determine the concurrent validity of the two tests paired t-tests and Pearson product-moment correlation coefficients were computed. Using the BSID-II as a gold standard, the performance of the Griffiths-II was analyzed with receiver operating curves., Results: 61 patients (80.3% preterm, 14.7% neonatal asphyxia) were examined. For the BSID-II the MDI mean was 96.21 (range 67-133) and the PDI mean was 87.72 (range 49-114). For the Griffiths-II, the QD mean was 96.95 (range 60-124), the locomotors subscale mean was 92.57 (range 49-119). The score of the Griffiths locomotors subscale was significantly higher than the PDI (p<0.001). Between the Griffiths-II QD and the BSID-II MDI no significant difference was found, and the area under the curve was 0.93, showing good validity. All correlations were high and significant with a Pearson product-moment correlation coefficient >0.8., Conclusions: The meaning of the results for a given child was the same for the two tests. Two scores were interchangeable, the Griffiths-II QD and the BSID-II MDI., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Intrapartum-related complications (previously called 'birth asphyxia') are a significant contributor to deaths of newborns in Bangladesh. This study describes some of the perceived signs, causes, and treatments for this condition as described by new mothers, female relatives, traditional birth attendants, and village doctors in three sites in Bangladesh. Informants were asked to name characteristics of a healthy newborn and a newborn with difficulty in breathing at birth and about the perceived causes, consequences, and treatments for breathing difficulties. Across all three sites 'no movement' and 'no cry' were identified as signs of breathing difficulties while 'prolonged labour' was the most commonly-mentioned cause. Informants described a variety of treatments for difficulty in breathing at birth, including biomedical and, less often, spiritual and traditional practices. This study identified the areas that need to be addressed through behaviour change interventions to improve recognition of and response to intrapartum-related complications in Bangladesh.

Objective: Free-radical-induced reperfusion injury has been recognised as an important cause of brain tissue damage after birth asphyxia. Allopurinol reduces the formation of free radicals, thereby potentially limiting the amount of hypoxia-reperfusion damage. In this study the long-term outcome of neonatal allopurinol treatment after birth asphyxia was examined., Design: Follow-up of 4 to 8 years of two earlier performed randomised controlled trials., Setting: Leiden University Medical Center, University Medical Center Groningen and University Medical Center Utrecht, The Netherlands., Patients: Fifty-four term infants were included when suffering from moderate-to-severe birth asphyxia in two previously performed trials., Intervention: Infants either received 40 mg/kg allopurinol (with an interval of 12 h) starting within 4 h after birth or served as controls., Main Outcome Measures: Children, who survived, were assessed with the Wechsler Preschool and Primary Scales of Intelligence test or Wechsler Intelligence Scale for Children and underwent a neurological examination. The effect of allopurinol on severe adverse outcome (defined as mortality or severe disability at the age of 4-8 years) was examined in the total group of asphyxiated infants and in a predefined subgroup of moderately asphyxiated infants (based on the amplitude integrated electroencephalogram)., Results: The mean age during follow-up (n=23) was 5 years and 5 months (SD 1 year and 2 months). There were no differences in long-term outcome between the allopurinol-treated infants and controls. However, subgroup analysis of the moderately asphyxiated group showed significantly less severe adverse outcome in the allopurinol-treated infants compared with controls (25% vs 65%; RR 0.40, 95%CI 0.17 to 0.94)., Conclusions: The reported data may suggest a (neuro)protective effect of neonatal allopurinol treatment in moderately asphyxiated infants.

The outcomes of hypoxic-ischemic encephalopathy vary between death and intact survival. The spectrum of long-term morbidity in survivors ranges from mild motor and cognitive deficits to cerebral palsy and severe cognitive deficits. Our literature review reinforces the notion that the spectrum of hypoxic-ischemic encephalopathy outcomes represents a continuum, which has important implications for the prediction of outcome and the indications for intervention. We summarize predictive criteria at 3 time points: the first 6 hours of life, 6-72 hours of life, and at hospital discharge. In this era of neuroprotection, predictive models that aid therapeutic decision making, including the withdrawal of support, need to be revised., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Purpose: This study examines the experience of mothers whose very low-birth-weight infants require the delivery of supplemental oxygen during their hospitalization in the neonatal intensive care unit (NICU)., Subjects: Eleven mothers of very low-birth-weight infants who have received various supplemental oxygen delivery methods in the NICU for a minimum of 7 days were selected for interview., Design: Qualitative descriptive., Methods: One semistructured interview exploring mothers' experiences surrounding oxygen delivery methods was conducted. Qualitative content analysis was undertaken to describe mothers' experience., Principle Results: Four themes emerged related to the oxygen therapy and the various methods of delivery: Oxygen therapy is a positive, worries about the adverse effects for my baby now and in the future, a learning experience, and the delivery of supplemental oxygen is a barrier to mothering., Conclusion: Mothers balanced the positive aspects of oxygen therapy with their fears of the negative consequences. They were able to adapt to the equipment and trajectory of having their infant on supplemental oxygen delivery methods. Mothers were particularly distressed by the physical barriers created by oxygen delivery methods (ie, unable to hold, hear, or see their baby). Nurses in the NICU should support mothers' positive reframing as a way of coping, provide education about the consequences of this therapy, encourage mothers to touch and hold their infants, and provide opportunities for them to see their infants' faces.

Some studies on neurodevelopmental outcomes after neonatal encephalopathy have suggested that cognitive deficits do not occur in the absence of cerebral palsy. It is increasingly apparent that childhood survivors of overt neonatal encephalopathy may have cognitive impairments, even in the absence of functional motor deficits. The risk of cognitive deficits is related to the severity of neonatal encephalopathy and the pattern of brain injury on neuroimaging, particularly the watershed pattern of injury. A better understanding of the risk factors for cognitive abnormalities after neonatal encephalopathy will ultimately lead to interventions to prevent these deficits. Identifying the full spectrum of neurodevelopmental outcomes after neonatal encephalopathy will also allow care givers to identify children requiring early intervention to maximise their potential for independent function throughout development.

Background: The corpus callosum (CC) is a cerebral structure that reflects cognitive status in several neurological pathologies. Visual inspection of MRI has shown that hypoxic-ischemic encephalopathy(HIE) causes callosal damage., Primary Objective: To quantify the CC surface in a sample of patients with antecedents of HIE and a group of matched controls., Research Design: Comparisons of CC measures among control subjects, mild HIE patients and moderateHIE patients as well as correlates of CC surface and neuropsychological performance., Methods: Twenty-one adolescent patients with childhood antecedents of HIE were compared to 21 controls. ANALYZE software was used to semi-automatically measure the CC area., Main Outcomes and Results: Patients with moderate HIE showed corpus callosum reduction. The isthmus and genus were the most affected regions. Corpus callosum size correlated with cognitive function., Conclusions: Corpus callosum quantification provides new evidence of subtle residual deficits in subjects with HIE antecedents without apparent neurological sequelae.

Introduction and Aims: Prematurity has often been associated with a general intellectual deficit and with different structural brain disorders which can be revealed by volumetric measurements performed by magnetic resonance imaging (MRI). In turn, perinatal asphyxia, even when it is not accompanied by neurological disorders, is related to a deficit in specific neuropsychological functions., Case Report: This study describes the case of three 13 year old female triplets, with a history of extreme prematurity and perinatal asphyxia, the long term effects of which are evaluated in terms of cognitive performance. We studied their performance in the neuropsychological functions of intelligence, memory, and visual perceptual, visual constructive, visual spatial and frontal functions. In two of the subjects, structural MRI and volumetric analysis of the hippocampuses were performed. In all the subjects, intelligence was found to be above average, the most notable result being the superior score in case 1. Verbal learning and the long term retention of verbal material were altered in case 3, where there was also a smaller hippocampal volume., Conclusions: In the context of a multiple birth, we have seen that extreme prematurity, accompanied by non severe perinatal asphyxia without hypoxic ischemic encephalopathy, can exert very diverse effects on neurocognitive development. It can be normal, and even superior, or show a deficit in some skill. In our case, the functions that were most liable to suffer these antecedents are long term memory and verbal learning. This disorder is accompanied by bilateral involvement of the hippocampus, which can be observed using MRI.

This personal account is about a labor and delivery experience that brought together two women--the author, an obstetric nurse, and Mrs. Hamilton,* the patient she cared for. This uneventful labor ended with the rapid delivery of Mrs. Hamilton's second son, who experienced a nuchal cord injury. This narrative describes selected aspects of her labor and delivery experience as well as short- and long-term outcomes for her newborn son. The unique nurse-patient relationship with its focus on caring and support is emphasized, in an attempt to illustrate the value and power of nursing by sharing one's own experiences of nursing practice.

Aim: Brain injury after neonatal cardiopulmonary resuscitation in the term baby is often described as an all-or-nothing phenomenon, but little is known about possible late cognitive consequences. The aim of this study was therefore to investigate whether children who needed cardiopulmonary resuscitation because of presumed mild and moderate intra-partum asphyxia with no evidence of neurological impairments at 18 mo of age may display neuropsychological impairments later in life., Methods: A long-term follow-up of young adults was carried out. A blinded comprehensive neuropsychological assessment of the main aspects of cognitive functions was made. The subjects who were resuscitated were divided into two groups according to the clinical course: 20 cases with mild asphyxia and 11 cases with moderate asphyxia, all followed prospectively and compared with 18 healthy controls. The 31 subjects were born at term or near-term and selected randomly from 59 infants born in 1969-1978 at Sahlgren's Hospital, Göteborg. All infants with early neurological impairments were excluded., Results: No major differences could be established between the two clinical groups and normal controls in any aspects of cognitive function or intelligence. All the groups performed within the normal range in all tests. A tendency toward minor deficits in verbal ability in the mild group compared to the controls was found. Only one subject had a clear, defined memory deficit., Conclusions: Infants who underwent cardiopulmonary resuscitatation at birth without neurological deficits at 18 mo of age did not show any cognitive deficits or neuropsychological impairments in adulthood even though inferior performance on some verbal subtests was observed compared to the control group.

Objective: To investigate the long-term neuropsychological consequences of perinatal asphyxia (PA)., Methods: A group of adolescents were assessed with antecedents of mild (n = 8) and moderate (n = 20) PA, and a matched group of 28 healthy adolescents as a control group. Neuropsychological assessment included tests of memory, perceptual-motor skills, and frontal lobe functions, because these are areas of cognitive functioning susceptible to hypoxic conditions., Results: Subjects with moderate PA showed significant differences from the control group on tests related to delayed recall for both verbal and visual information, perceptual-motor speed, and tests assessing attention and executive functions. Conversely, subjects in the mild PA group exhibited scores which were similar to those of the control group in all the assessed variables., Conclusion: The present findings demonstrate that subtle but persistent neuropsychological deficits were observed in adolescents with antecedents of moderate PA, but not in those classified with mild asphyxia.

Two tryptophan metabolites, the anti-excitotoxic N-methyl-D-aspartate (NMDA) receptor antagonist kynurenic acid (KYNA) and the free radical generator 3-hydroxykynurenine (3-HK), have been proposed to influence neuronal viability in the mammalian brain. In rats, the brain content of both KYNA and 3-HK decreases immediately after birth, possibly to ensure normal postnatal functioning of NMDA receptors. Because complications of birth asphyxia have been suggested to be associated with anomalous NMDA receptor function, we examined the acute effects of an asphyctic insult on the brain levels of KYNA and 3-HK in neonatal rats. Asphyxia was induced in animals delivered by cesarean section on the last day of gestation, using the procedure introduced by Bjelke et al. (Brain Res 543: 1-9, 1991). KYNA and 3-HK levels were determined in the brain at seven time points between 10 min and 24 h after asphyxia. Up to 6 h, asphyxia caused 160-267% increases in KYNA levels. In the same tissues, 3-HK levels decreased (significantly at five of the seven time points), demonstrating an asphyxia-induced shift in kynurenine pathway metabolism toward the neuroprotectant KYNA. This shift might constitute the brain's attempt to counter the ill effects of birth asphyxia. Furthermore, the transient increase in the brain KYNA/3-HK ratio in these animals might be causally related to the well-documented detrimental long-term effects of asphyxia.

Objective: To study the short and long term prognosis of fetal distress., Methods: 60 newborns with fetal distress (study group) and 60 normal newborns (control group) were assessed by neonatal behavior neurological assessment (20 items) in neonatal period and by reformed wechsler intelligence scale children-revised at 2 years of age., Results: The total scoring of study group was significantly different from that of control group (P < 0.01). In the study group, there were 41 cases without neonatal asphyxia whose scoring was significantly different from that in the normal group (P < 0.05), whereas the scoring of other 19 cases with neonatal asphyxia was significantly lower than that of the control group (P < 0.001). We also found that the scoring of 38 acute fetal distress cases was significantly different from that of 22 chronic cases (P < 0.01). In two years follow-up study, the scoring of children's intelligence test in acute distress cases was not different from that of controls, but the scoring of intelligence test in chronic distress cases was markedly different from that of controls (P < 0.01)., Conclusion: Fetal distress could affect neonatal behavior and their intellectual development.

This prospective, longitudinal study examined neuropsychological consequences of different conditions associated with risks of perinatal asphyxia. Four groups of children, 5 to 9 years of age, were studied: (1) very low birth weight (VLBW) children born small for gestational age (SGA) (n = 34); (2) VLBW children born appropriate for gestational age (AGA) (n = 43); (3) children with signs of birth asphyxia at term (birth asphyxia) (n = 36), and (4) control children (n = 45). Moderately and severely disabled children were excluded. The WISC-R and the NEPSY, a new neuropsychological assessment consisting of attention, language, motor, sensory, visuospatial, and memory subtests, were administered. The VLBW-SGA group had the poorest test results. The VLBW-AGA group was somewhat less impaired, whereas the birth asphyxia group performed at the control group level. Impairment, when present, tended to be diffuse in all groups, affecting psychometric intelligence, naming, visuo-motor performance, tactile finger discrimination, attention, and phonological analysis.

Objective: To determine the relationship between the results of cerebral proton magnetic resonance spectroscopy (1H-MRS) and neuromotor development in neonates with hypoxia., Design: Descriptive., Setting: Wilhelmina Childrens' Hospital and University Hospital, Utrecht, The Netherlands., Methods: 32 infants with hypoxic-ischaemic encephalopathy (Sarnat grade I (mild; n = 5), grade II (moderate; 20), grade III (severe; 7)) were examined at a mean of 8 days following the hypoxic event (range 2-22). 1H-MRS of the periventricular white matter and part of the basal ganglia was performed in a 1.5 T field: TR/TE: 2000/272 ms. Peak-to-peak NAA/Cho ratios were calculated. The presence of a lactate resonance was considered abnormal. Assessment of neuromotor development of the survivors was performed at 6, 9 and 18 months of age., Results: 6 patients died (all grade III), 10 survived with handicaps (I grade III, 9 grade II). Handicaps consisted of spastic quadriplegia (n = 7), hemiplegia and mental retardation (n = 1), and global developmental delay (n = 2). The other 16 survivors were normal at 18 months. 1H-MRS showed NAA/Cho ratios of 0.97 (SD:0.13) in the patients with a normal outcome and 0.74 (0.17) in the patients with an adverse outcome (handicaps or death); p < 0.0001 (t-test). Lactate was demonstrated in all 7 grade III neonates, but not in any of the other infants., Conclusion: Cerebral 1H-MRS was related to neurodevelopmental outcome of neonates with HIE. A low NAA/Cho ratio and presence of a lactate resonance predicted an adverse outcome.

Several studies have shown no correlation between individual perinatal risk factors and outcome. Rather, the children's development depends more on social factors. In our retrospective study we compared the development of 26 at-risk newborns with that of a same-sex healthy sibling 10 to 16 years later. Data were collected by interview, questionnaires and neuropsychological tests. In the parents' view, the children who were at-risk newborns had a special position in the family (close mother-child relationship, overprotectiveness, child cause for concern). They had more educational and behavioral problems and their social network was limited. With one exception (d2 test), the neuropsychological tests showed no significant differences between the two groups of children. However, overall the at-risk children had more attention deficit disorders with hyperactivity (ICD-10, F90.0) and more selected learning disturbances (F81). A division of the children into those with minor and major perinatal risk factors was not of predictive value for outcome. There was only a low correlation between the parent's assessments of the at-risk children and more objective criteria (need for professional help or special schooling). The authors discuss the types of support that should be provided to parents with at-risk newborns.

Schizophrenics have been repeatedly found to experience more obstetric complications (OCs) at birth. The meaning of such a finding is debated, and the aim of this study is to contribute to the understanding of OCs' aetiological role in schizophrenia. We compared a group of schizophrenic patients with their siblings and controls, on the basis of obstetric files stemming from the same University Hospital Maternity Ward. Schizophrenic patients had more frequent umbilical cord complications and atypical presentations, as well as higher scores on a scale measuring OCs linked to possible neonatal asphyxia.

This study evaluates research on gestational and neonatal factors implicated as causes of schizophrenia. These include obstetrical complications (particularly gestational hypoxia), viral infections, autoimmune agents, developmental deficits, and maternal stress. Evidence strongly suggests that these factors are importantly connected to the onset of adult schizophrenia.

Studies of Tourette's syndrome have indicated that the etiology may be either primary or secondary. Secondary Tourette's syndrome has been reported in association with numerous neurological conditions, but there have been no previous reports of Tourette's syndrome and its relationship to neonatal anoxia. This report presents the case of a 15-year-old boy with a history of Tourette's syndrome and neonatal anoxia and examines whether or not there is a connection between the two. To test the hypothesis that this is the first documented case of cerebral anoxia at birth followed by Tourette's, a review of the pertinent literature on secondary Tourette's syndrome is presented. Evidence of perinatal anoxia, subsequent Tourette's syndrome, a negative family history, as well as an examination of the statistical chances of anoxia and Tourette's syndrome co-existing and of all previous reports of acquired Tourette's syndrome tend to favor an organic perinatal insult as having caused the later development of Tourette's syndrome in the case of this adolescent.

Case report on a repressed pregnancy in a 19 year old women. Her short biography is demonstrated. For explaining this phenomenon theoretical models of defense behaviour from the perspective of psychoanalysis and information psychology had been described. These considerations are discussed connected with the case report.

A total of 176 subjects (53 male students, 65 female students, and 58 mothers) were exposed to 1 of 6 types of infant cries coming from an adjacent room while their behavioral and affective responses were observed. The cries were the pain cries of 2 normal newborns, 1 infant with maladie du cri du chat, 1 with Down syndrome, 1 asphyxiated infant with brain damage, and one asphyxiated infant without brain damage. Subsequently the subjects rated the overhead cry on a series of affective, attributional, and perceptual dimensions. The results indicated that the 6 cries differentially affected the subjects' affective, self-reported, and behavioral responses, as well as their tendency to report not hearing the cry. In general, the findings suggested that the highest- pitched cries (those of the asphyxiated infants), in comparison to the lowest-pitched cries (those of the normal and Down infants), elicited less optimal responses from the listeners.

Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infants whose long-term outcome is being followed prospectively at our institution. The extracorporeal membrane oxygenation procedure allows temporary cardiopulmonary support for critically ill full-term neonates who are refractory to maximum ventilatory and medical management as a consequence of severe persistent pulmonary hypertension. The technique necessitates both the permanent ligation of the right common carotid artery and jugular vein and systemic heparinization. The survivors constitute a unique group of high-risk infants, from the standpoint of the hypoxic-ischemic insults preceding extracorporeal membrane oxygenation and the risks associated with the procedure. Our results indicate that most of our survivors are developing normally at 1 year. Major morbidity, in terms of either significant developmental delay (Bayley mental and motor indices less than 70) or significant neuromotor abnormality, occurred in only 10% of these infants. Poor outcome was associated with major intracranial hemorrhage and chronic lung disease. Ligation of the right carotid artery and jugular vein was not associated with a consistent lateralizing lesion. Long-term follow-up through school age is essential.

Neonatal asphyxia, defined in this study as delay of greater than 1 minute in onset of spontaneous respiration at birth, occurred in 1% of 13,221 live-born infants of birth weight greater than 500 gm between 1970 and 1971. Seventy-five (56%) of 133 asphyxiated infants survived the neonatal period. Survival was directly related to gestational age. The 65 survivors of asphyxia available for study were seen at a mean age of 4.8 years to determine the incidence and extent of neurologic and developmental abnormalities. Twelve children (18.5%) had severe impairment: nine had both neurologic and intellectual handicaps, two had neurologic impairment alone, and one had intellectual impairment alone. The incidence and severity of impairment were not related to gestational age. Postasphyctic seizures were associated with poor outcome.

The behavior of 4 groups of infants--healthy term, healthy preterm, sick preterm, and sick full-term--was assessed in the neonatal period using the Neonatal Behavioral Assessment Scale (NBAS). At 3 months postterm, infants and their mothers were observed and videotaped in a free-play session. Both the NBAS and mother-infant interaction data were analyzed to assess the effects of maturity (term vs. preterm), illness (sick vs. healthy), and their interaction. Results revealed that illness of the infant affected both NBAS performance and maternal behavior during the interaction at 3 moths. Infants who were ill performed poorly on the NBAS orientation dimension; this dimension was found to be significantly associated with maternal and infant behaviors at 3 months. These data demonstrate an association between early infant characteristics and subsequent mother and child interactive behaviors. They also identify postnatal illness as an important influence on the development of the mother-infant dyad.

This study attempted to identify within the first 48 hours of life those infants sustaining hypoxic-ischemic insults and destined to have neurodevelopmental abnormalities at one year of age. Neurological examination and cranial CT scan were quantitated to provide a post-asphyxia score and CT low-density index for each of 34 fullterm infants. The post-asphyxia score and CT infarction index were used to predict infants with normal and abnormal outcomes at one year of age, and both were valuable predictors of neurodevelopmental sequelae.

Maternal-infant interaction patterns were observed for high-and low-risk, first-, and later-born infants at 3 months of age. The high-risk subjects included healthy preterm infants, sick preterm infants, and sick full-term infants. "Sickness" at birth was defined as respiratory distress or birth asphyxia. The low-risk group consisted of healthy full-term infants. The subjects were divided into first-born and later-born groups. Birth order was expected to interact with prematurity and illness in affecting maternal behavior. Multivariate analyses of variance indicated that this was the case; birth order had a significant impact among the high-risk but not the low-risk subjects. First-born preterm infants received more overall maternal stimulation than later-born preterms. Sick first-borns had more responsive mothers than sick later-born infants. The results suggest that high-risk later-born infants may be at greater risk as a result of both birth trauma and less optimal maternal interaction patterns.

Observations were performed on 45 very low birth weight (VLBW) newborns at 7 and 21 days of life, using a Neonatal Behavioral Assessment Scale specifically modified for the extremely premature infant. Findings were analyzed using multiple and stepwise regression techniques to determine the influence of intrapartum and neonatal factors which might influence neurobehavior . Perinatal asphyxial descriptors accounted for significant variance on day 7 behavior; however, their impact was muted for day 21. At this time, jaundice and postnatal nutrition revealed a prominent and independent behavioral influence on the VLBW survivor.

Clinical and electroencephalographic assessments were performed on 39 children with febrile convulsions showing EEG evidence of rolandic discharges and 23 epileptic children showing rolandic discharges with a preceding history of febrile convulsions. Ten families in which EEGs from the proband and his (or her) sibling or cousin demonstrated rolandic discharges were also described. The results of these studies stress a close genetic relationship between febrile convulsions with rolandic discharges and focal seizures or generalized convulsions that occur during sleep, namely, benign epilepsy of childhood with rolandic discharges. This indicates that the febrile convulsions with rolandic discharges constitute a particular subtype of febrile convulsions.

Standardized individual psychoeducational school-readiness tests were completed by 127 nondisabled survivors of moderate (lethargy, hypotonia, and suppressed primitive reflexes) or mild (hyperalertness, hyperexcitibility) neonatal encephalopathy associated with term birth asphyxia. Application of the readiness test battery to the children with moderate or mild encephalopathy and a peer population, revealed that children with moderate encephalopathy had significantly lower scores for many tests than those in the other groups. Children with mild encephalopathy performed well. We found no significant differences due to social variables. For the moderate group, we found an increased number of types of anticonvulsants and abnormal findings on the neurologic examination at neonatal intensive care unit (NICU) discharge to be predictors of low achievement on school-readiness tests. Also for the nondisabled moderate group, multiple regression analysis of the independent variables with the 5.5-year scores added variables suggestive of intrauterine growth retardation to the prediction of lower scores on many school-readiness tests. We conclude that clinical categorizing of moderate neonatal encephalopathy associated with birth asphyxia in term infants selects a group of children with an increased percentage of school-readiness delay, and could be a useful indicator for clinicians and educators in defining those neonates who may need special preschool evaluation and benefit from a modified early school program.

The evolutionary changes of evoked potentials (EPs) were studied from the neonatal period up to 1 year of age in 41 infants with various perinatal disorders. Abnormal EPs in the first week of life recovered quickly. In infants with normal outcome, abnormal EPs became normal within a month. In infants with cerebral palsy (CP) or mental retardation (MR), EPs recovered within 2-3 months of age. Infants with more severe neurological damage showed abnormal EPs even beyond 6 months of age. Abnormal EPs beyond 2 weeks of age indicated poor prognosis. As for the wave form of EPs, absent responses or abnormal wave form reflected more severe brain dysfunction. AEPs tended to show more profound abnormalities than VEP. However, some infants with absent AEP in the first week of life had a favorable prognosis. AEPs seemed to be more easily affected by brain dysfunction.

Developmental psychophysiologists have long been interested in a means for evaluating infants at risk for cognitive disabilities. The current research addressed the utility of a noninvasive measure of cardiac vagal tone in predicting developmental outcome. At 40 weeks conceptional age, 3 min of resting EKG were recorded from 80 infants. Four groups of infants were evaluated: prematures who had no medical complications in the postnatal period; prematures who experienced respiratory distress syndrome during the postnatal period; term infants who experienced birth asphyxia during labor and/or postdelivery; and healthy term infants. The mental scale of the Bayley Scales of Mental Development was administered at 8 and 12 months conceptional age. Heart period data were analyzed to derive mean heart period, heart period variability, and estimates of vagal tone for each subject. Analyses of the relationship between the heart period variables and 8- and 12-month outcome (i.e., Bayley Scales) indicated that infants with high vagal tone at 40 weeks conceptional age always had positive developmental outcome at both eight and 12 months of age. Infants with low vagal tone had varied outcomes. Measures of medical complications and other measures of heart period variability were not related to developmental outcome. The results suggest that measurement of cardiac vagal tone may provide an important means for assessing risk in birth stressed populations.

Twenty-three infants suffering the effects of moderate or severe hypoxic-ischaemic encephalopathy were continuously monitored for intracranial pressure (ICP) by means of a subarachnoid catheter for a total of 1083 hours. Cerebral perfusion pressure (CPP) was also continuously monitored for 21 of the infants. The median age at the start of ICP monitoring was 17 hours, and the opening pressure correlated poorly with maximum sustained pressures. Maximum sustained ICP allowed the infants to be divided into three groups: (1) those with no elevation of ICP (nine), of whom two died and five had a normal outcome; (2) those with sustained rises in ICP which were resistent to treatment (nine), of whom seven died and two survivors are severely handicapped; and (3) those in whom the pressure was elevated but could be controlled medically (five), of whom two survived to be quite normal. No infant with a sustained elevation of ICP of 15mmHg or more survived to be normal, nor any who had had a CPP below 20mmHg for one hour or more. Hypotension was the cause of low CPP in most cases. There was a highly significant correlation between sustained elevation of ICP above 10mmHg and poor outcome, but no correlation between outcome and minimum CPP. It was not possible to predict clinically which infants would develop intracranial hypertension, and some infants with very severe perinatal asphyxia did not develop intracranial hypertension, and some infants with very severe perinatal asphyxia did not develop raised intracranial pressure at any time.

A group of 15 children for whom cerebral blood flow (CBF) had been determined during the first few hours of life were examined between the ages of 3 years 9 months and four years. Clinical neurological and psychological (Stanford-Binet) tests were carried out and in three cases a computerised tomographic examination was made. Poor articulation, dysphasia, attention deficits and low IQ were found significantly more often among the five children with a documented episode of ischaemia (CBF less than 20 ml/100g/min) in the neonatal period. By summarizing the number of abnormal findings, the difference between the groups was found to be highly significant. It is concluded that ischaemia during the first hours of life is a critical determinant for the development of congitive disorders.

The author in his present paper discusses the results obtained in his examinations of a group of 15-year-olds who during birth underwent a shorter or longer asphyxia. The cases were recorded on the basis of notes on the course of birth in the obstetrical clinic in Opava in 1950. The children, after 15 years, are examined psychiatrically, psychologically by special methods of test, neurologically, and electroencephalographically, and the objective anamnesis is obtained from both parents and school and is analyzed. The results obtained confirm some information given in literature on the increased incidence of pseudoneurotic phenomena and on very discrete neurological symptomatology in individuals with perinatal damages. There were found neither gross defects of intellect nor any indications of a pronounced lesion of the central nervous system. The author also presented the results of statistical investigations by reference to the occurrence of selected symptoms in the basic group in comparison with a control group of children that did not suffer from asphyxia.