Visual impairment in Swedish children. III. Diagnoses

PURPOSE: To gain an overview of the spectrum of diagnoses among Swedish visually impaired children. METHODS: An epidemiological study of all known visually impaired children was made by review of medical records. RESULTS AND CONCLUSION: In all we found 2373 children, 0-19 years of age, with an age-specific prevalence of 10.9/10,000. The two largest diagnostic groups included neuro-ophthalmological and retinal diseases. The most frequent disorders were cerebral visual impairment, non-hereditary optic atrophy, retinal dystrophy (when regarded as a general entity), congenital hypoplasia of the optic nerve and congenital cataract. Nystagmus secondary to brain disorder, albinism, congenital nystagmus, retinopathy of prematurity and high myopia were also found in a considerable number of patients. The leading diagnoses in children with WHO-defined childhood blindness were non-hereditary optic atrophy, cerebral visual impairment and retinopathy of prematurity. A large proportion of the children, especially in the groups with neuro-ophthalmological disorders and malformations of the posterior segment had additional impairments, emphasizing the importance of a multi-disciplinary approach when assessing multi-handicapped children.     

Neuroimaging in children with congenital disorders of the peripheral visual system

The study investigates the neurological substrate in children with congenital disorders of the peripheral visual system (CDPVS), i.e. disorders of the anterior visual pathways and the globe. The design is retrospective; brain MRI and/or CT scans were traced and reviewed for 79 of 254 children with CDPVS on our database. The neuroradiological findings were considered in the context of degree of visual impairment (profound [PVI] and severe [SVI]), developmental outcome (setback and non-setback), and mode of imaging (MRI and CT). Scans were abnormal in 40 of 79 (51%) children; 23 of 40 (58%) had more than one lesion; and in some children lesions not previously reported were found. The number of abnormalities per child was significantly higher in the PVI than the SVI group (P<0.05); the level of significance varied according to the method of scanning (MRI, P<0.001; CT, ns). Seven children were known to have had developmental setback; significantly more brain abnormalities per child were found in the group with setbacks than in the group without (P<0.001). Eighty-six percent (24 of 28) of MRI compared with 38% (22 of 58) of CT scans were abnormal. MRI detected more lesions per child than CT (P< 0.001). Thus, a significant amount of brain pathology occurs in children with CDPVS. The number of lesions varies directly with degree of visual impairment and both correlate with developmental outcome. As brain pathology will be only one of many factors influencing developmental progress in visually impaired children, prospective multifactorial studies of the CDPVS population, which include MRI studies of the neurological substrate, will be required to clarify the latter.     

Children conceived by in vitro fertilisation after fresh embryo transfer

AIMS: To compare the outcome in in vitro fertilisation (IVF) children (after fresh embryo transfer) from multiple and singleton births with one another, and with normally conceived control children. METHODS: A cohort of 278 children (150 singletons, 100 twins, 24 triplets and four quadruplets), conceived by IVF after three fresh embryos had been transferred, born between October 1984 and December 1991, and 278 normally conceived control children (all singletons), were followed up for four years after birth. They were assessed for neonatal conditions, minor congenital anomalies, major congenital malformations, cerebral palsy and other disabilities. Control children, all born at term, were matched for age, sex and social class. RESULTS: The ratio of male:female births was 1.03. Forty six per cent of IVF children were from multiple births; 34.9% were from preterm deliveries; and 43.2% weighed less than 2500 g at birth. The IVF singletons were on average born one week earlier than the controls, weighed 400 g less, and had a threefold greater chance of being born by caesarean section. The higher percentage of preterm deliveries was largely due to multiple births and they contributed to neonatal conditions in 45.0% of all IVF children. The types of congenital abnormalities varied: 3.6% of IVF children and 2.5% of controls had minor congenital anomalies, and 2.5% of IVF children and none of the controls had major congenital malformations. The numbers of each specific type of congenital abnormality were small and were not significantly related to multiple births. IVF children (2.1%) and 0.4% of the controls had mild/moderate disabilities. They were all from multiple births, including two children with cerebral palsy who were triplets. CONCLUSIONS: The outcome of IVF treatment leading to multiple births is less satisfactory than that in singletons because of neonatal conditions associated with preterm delivery and disabilities in later childhood. A reduction of multiple pregnancies by limiting the transfer of embryos to two instead of three remains a high priority.     

Obstetric and perinatal outcome of pregnancies following intracytoplasmic sperm injection

The aim of this study was to describe the obstetric and perinatal outcome for births following intracytoplasmic sperm injection (ICSI). Of 210 infants born, 140 were singletons and 70 were twins. There were no triplets or higher births. The multiple birth frequency was 20%. Overall, 17% of deliveries were preterm, although for singleton pregnancies the incidence was reduced to 9%. The median birth weight of all live born infants was 3168 g and singletons 3470 g. Of all infants, 17% had a low birth weight (<2500 g) and 2% had a very low birth weight (<1500 g). Two major malformations occurred in two singleton children and four minor malformations occurred in four children. This was within the range of expected values in Sweden. Karyotyping was performed in 58 pregnancies. All of them were normal. The perinatal mortality was 0.5%. In conclusion, in this observational study from Sweden of the first infants born after ICSI in our programme, the incidence of multiple births, preterm births, low birth weight babies and congenital malformations was low compared with other series of in-vitro fertilization pregnancies not associated with ICSI.     

The causes of childhood blindness in South Africa

OBJECTIVES: 1. To ascertain the causes of severe visual impairment and blindness in children in schools for the blind in South Africa. 2. To determine the major avoidable causes. 3. To determine causation by ethnic group. DESIGN: A cross-sectional survey, undertaken at 15 of the 16 schools for the blind in South Africa, during May-September 1996, using standard WHO methodology. SUBJECTS: Children less than 16 years of age on May 1996. RESULTS: Of 1,615 eligible children, 1,311 were examined. According to WHO categories of visual impairment, using the corrected visual acuity in the better eye, 30.4% of children were blind (< 3/60, BL), 12.6% had severe visual impairment (< 6/60-3/60, SVI), 42.3% were visually impaired (< 6/18-6/60), and 12.0% had no impairment (6/18 or better). The anatomical sites of SVI/BL in 564 children were: retina 38.5%; optic nerve 15.2%; cornea/phthisis bulbi 11.0% and glaucoma 6.7%. Aetiological categories of SVI/BL were: hereditary diseases 33.0%; intra-uterine factors 0.9%; perinatal conditions 13.1%; acquired conditions of childhood 11.5%. In 41.5% the underlying cause could not be determined. In 38.8% of children with SVI/BL the cause was avoidable, i.e. preventable or treatable. The main causes varied between ethnic groups, the major difference being the higher proportion of retinopathy of prematurity in white and Indian children. CONCLUSIONS: The study suggests that 38.8% of causes of SVI or blindness in children in schools for the blind in South Africa are avoidable, and that specific control measures need to be targeted at different ethnic groups.     

Selection and identification of single domain antibody fragments from camel heavy-chain antibodies

OBJECTIVE: Our purpose was to determine whether women who were themselves small for gestational age at birth are at risk of giving birth to a small-for-gestational-age child and whether women who were themselves preterm at birth are at risk for preterm delivery. STUDY DESIGN: Women born in Copenhagen as subjects in the Danish Perinatal Study (1959 to 1961) were traced through the Danish Population Register. Information was obtained on their pregnancies during 1974 through 1989. RESULTS: A total of 25% of the children of small-for-gestational-age women were small for gestational age compared with 11% of the children of non-small-for-gestational-age women. Eleven percent of the children of preterm women were preterm compared with 7% of the children of women born at term. The adjusted odds ratios were 2.0 (95% confidence interval 1.4 to 3.0) for women who were small for gestational age to have small-for-gestational-age children and 1.5 (95% confidence interval 0.9 to 2.5) for women who were born preterm to have preterm children. Small-for-gestational-age women were not at significantly increased risk of preterm delivery (odds ratio 1.2), and preterm women were not at significantly increased risk of having small-for-gestational-age children (odds ratio 1.3). CONCLUSIONS: Reduced intrauterine growth of the mother is a risk factor for reduced intrauterine growth of her children. However, preterm birth of the mother is not strongly associated with preterm birth of her children.     

Speech and language skills in children who required neonatal intensive care. I. Spontaneous speech at 6.5 years of age

Spontaneous speech at age 6.5 years was studied separately in a follow-up of speech and language skills in a regional cohort of 284 children requiring neonatal intensive care and in 40 controls. Eight aspects of spontaneous speech were evaluated in a conversation: A1, information; A2, speech motor function; A3, sound pattern; A4, word finding; A5, word selection; A6, grammar; A7, interaction; and A8, motivation. The children were grouped by gestational age. Most children had well developed spontaneous speech. The different groups showed very few differences in types of deviations in spontaneous speech. All groups differed from the controls in speech motor function and formal language (A2-A6), but only one child, born at <32 weeks, had a pronounced deviation in one of these aspects. Obvious deviations in one or more aspects of spontaneous speech were more common among children born at 28-31 weeks and in those born fullterm (> or =37 weeks) than among extremely preterm children born at 23-27 weeks.     

The importance of prenatal factors in childhood blindness in India

The causes of visual loss in 1411 children attending schools for the blind in different geographical areas in India are described. Ninety-three percent (1318) of the children were severely visually impaired (SVI) or blind (i.e. corrected acuity in the better eye of <20/200 [<6/60]). In 60% of SVI/blind children vision loss was attributable to factors operating in the prenatal period, in 47% the prenatal factors were known and definite, and in 13% prenatal factors were the most probable causes. Hereditary retinal dystrophies and albinism were seen in 19% of SVI/blind children and 23% had congenital ocular anomalies. There were variations in the relative importance of different causes by state. The observed pattern of causes of visual loss is intermediate between those seen in industrialised countries and in the poorest developing countries. This suggests that strategies to combat childhood blindness in India need to address concurrently both preventable and treatable causes. The need for aetiological studies, particularly on anophthalmos and microphthalmos, is highlighted.     

Cerebral visual impairment in periventricular leukomalacia: MR correlation

PURPOSE: To evaluate the involvement of central visual pathways in cases of periventricular leukomalacia, and to correlate the neuroradiologic findings with the degree of visual acuity. METHODS: The MR brain examinations of 27 preterm children affected by cerebral palsy resulting from periventricular leukomalacia and without significant ophthalmologic lesions were reviewed retrospectively to search for possible involvement of the optic radiations and/or of the calcarine cortex. The data were compared with the degree of visual acuity estimated by means of the Teller Acuity Cards test. RESULTS: Seventeen (63%) of the 27 patients had cerebral visual impairment, which correlated strongly with MR lesions. Quantitative reduction and signal hyperintensity of the peritrigonal white matter and atrophy of the calcarine cortex were present in the more severe cases. In two blind patients, an altered MR signal was detected in the lateral geniculate bodies. CONCLUSION: This study clearly establishes a relationship between specific MR findings and visual impairment in children with periventricular leukomalacia. The finding of hyperintensity in the lateral geniculate bodies was interpreted as an axonal reaction. MR imaging is useful for detecting potential visual impairment and for improving clinical diagnosis.     

Prospective follow-up study of 423 children born after intracytoplasmic sperm injection

In order to evaluate the safety of the intracytoplasmic sperm injection (ICSI) procedure, a prospective follow-up study of 423 children born after ICSI was carried out. The aim of this study was to compile data on karyotypes, congenital malformations, growth parameters and developmental milestones. Before starting the infertility treatment, couples were asked to participate in a follow-up study including genetic counselling and prenatal diagnosis. The follow-up study of the child was based on a visit to the paediatrician-geneticist at birth or at 2 months of age, at 1 year and at 2 years of age when a physical examination for major and minor malformations and a psychomotoric evaluation were done. Between April 1991 and September 1994, 320 pregnancies obtained after ICSI led to the birth of 423 children (222 singletons, 186 twins and 15 triplets). Prenatal diagnosis determined a total of 293 karyotypes, one of which was abnormal (0.3%), and four were benign familial structural aberrations, all inherited from the paternal side. A total of 14 (3.3%) major malformations were observed, defined as those causing functional impairment or requiring surgical correlation. Neurological or developmental problems at the age of 2 months were found in 14 children, four of whom were multiples. Compared to most registers of children born after assisted reproduction and to registers of malformations in the general population, the figure of 3.3% major malformations is within the expected range. Before drawing any firm conclusion, further careful evaluations of the available data are necessary.     

Correction to Van Braeckel et al. (2010).

Reports an error in "Difference rather than delay in development of elementary visuomotor processes in children born preterm without cerebral palsy: A quasi-longitudinal study" by Koenraad Van Braeckel, Phillipa R. Butcher, Reint H. Geuze, Maritje A. J. van Dujin, A. F. Bos and Anke Bourma (Neuropsychology, 2010[Jan], Vol 24[1], 90-100). In the current article the names of authors Marijtje A. J. van Duijn and Anke Bouma were misspelled as Maritje A. J. van Dujin and Anke Bourma, respectively. The online versions of this article have been corrected. (The following abstract of the original article appeared in record 2010-00119-012.) Follow-up studies of preterm children without serious neonatal medical complications have consistently found poor visuomotor and visuospatial skills. In the first round of current follow-up study, we found a deficit in elementary visuomotor processes in preterm children without Cerebral Palsy (CP). To determine whether the development of these processes was delayed or different, we carried out a quasi-longitudinal study in which kinematic characteristics of pointing movements in 7- to 11-year-old preterm born children without CP and in an age-matched full-term group were analyzed. Multi-level analysis suggested a difference rather than a delay in the preterm born group: we found a regression around 8 years of age in the control but not in the preterm group. To our knowledge, this study is the first to provide longitudinal data confirming this regression in the development of movement control in typically developing children. Our results are also consistent in suggesting that elementary visuomotor processes are less efficient in preterm born children without CP: their movements were either slower or less accurate. While these differences were subtle, they persisted until 11 years of age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Difference rather than delay in development of elementary visuomotor processes in children born preterm without cerebral palsy: A quasi-longitudinal study.

[Correction Notice: An erratum for this article was reported in Vol 24(2) of Neuropsychology (see record 2010-04449-002). In the current article the names of authors Marijtje A. J. van Duijn and Anke Bouma were misspelled as Maritje A. J. van Dujin and Anke Bourma, respectively. The online versions of this article have been corrected.] Follow-up studies of preterm children without serious neonatal medical complications have consistently found poor visuomotor and visuospatial skills. In the first round of current follow-up study, we found a deficit in elementary visuomotor processes in preterm children without Cerebral Palsy (CP). To determine whether the development of these processes was delayed or different, we carried out a quasi-longitudinal study in which kinematic characteristics of pointing movements in 7- to 11-year-old preterm born children without CP and in an age-matched full-term group were analyzed. Multi-level analysis suggested a difference rather than a delay in the preterm born group: we found a regression around 8 years of age in the control but not in the preterm group. To our knowledge, this study is the first to provide longitudinal data confirming this regression in the development of movement control in typically developing children. Our results are also consistent in suggesting that elementary visuomotor processes are less efficient in preterm born children without CP: their movements were either slower or less accurate. While these differences were subtle, they persisted until 11 years of age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential sparing of depth perception, orienting, and optokinetic nystagmus after neonatal versus adult lesions of cortical areas 17, 18, and 19 in the cat.

Performance by cats with lesions of the visual cortex made in infancy or adulthood was examined on tasks of visually guided behavior that do not require specific training. Cats with lesions confined to areas 17, 18, and 19 made during the 1st postnatal week showed more sparing of function on a visual cliff, at orienting to targets suddenly appearing in the visual field, and at optokinetic nystagmus than did cats with equivalent damage incurred as adults. Cats with lesions that included areas 17, 18, 19 and most of the contiguous visual areas were severely impaired at all tasks whether the lesions were incurred neonatally or in adulthood. These findings suggest that sparing of vision after neonatal lesions of cortical areas 17, 18, and 19 is not confined to pattern learning tasks and that remaining lateral cortical visual areas are importantly involved in such sparing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extreme prematurity in healthy 5-year-old children: a re-analysis of sex effects on event-related brain activity

A male disadvantage has been reported in several outcome studies of children born preterm. Twenty-two healthy premature children (10 girls, 12 boys) born between 25 and 28 weeks of gestation and 20 controls born full-term (10 boys, 10 girls) were matched on socioeconomical status and age. Event-related potentials (ERPs) were recorded by using 14 electrodes in a visual oddball task, with 75% frequent and 25% rare stimuli. This task elicited a larger P3 to the rare than to the frequent stimuli, with a prominent parietocentral localization. However, the amplitude was larger in full-term boys than in full-term girls, a difference that was not observed between preterm boys and preterm girls, especially to targets and on the central electrodes. In addition, the preterm group was characterized by a frontal slow wave larger in boys than in girls. In these prematures, the lack of the sex-related difference may be accounted by differences in the strength of the neuronal generators in males, as they might have been affected by the high level of androgens by the fetal testis under the control of placental gonadotropes during the first two thirds of gestation.     

Extent of recovery from neonatal damage to the cortical visual system in cats.

Cats that received either marginal or marginal plus extramarginal lesions as 3-day-old kittens were assessed on a series of tests of visually guided behavior. These Ss were not conspicuously different from normal controls in avoiding obstacles or in activity level. Yet these same operated Ss were severely impaired in performance on the visual cliff and in visual discrimination learning, even when lesions were limited to the geniculocortical portion of the visual system. Maximum losses in pattern and form discrimination learning were observed only in Ss with severe retrograde degeneration in both the lateral geniculate nucleus and the complex of the pulvinar and nucleus lateralis posterior. Photically evoked potentials were recorded in the lateral regions of the neocortex more reliably from operated Ss that had made fewer errors in discrimination learning than from more severely debilitated cases; this relation was present even among cases with nearly equivalent amounts of retrograde degeneration in the visual thalamus. These findings suggest that in the cat (a) recovery of vision is incomplete after neonatal lesions of the visual cortex, and (b) a cortical system lateral to the geniculocortical projections may be involved in pattern vision. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speech and language development of children born at < or = 32 weeks' gestation: a 5-year prospective follow-up study

Speech and language comprehension and production were assessed at the age of 5 years in a cohort of children born preterm at < or = 32 weeks' gestational age (N=55) in comparison with children born at term and of similar age, sex, and social backgrounds. Data both including and excluding major neurological disabilities are presented. Mean performance for the entire group of preterm children was significantly lower than for the controls on most of the measures including the composite IQ scores. When the nine children who had major neurological disabilities were excluded from the preterm group, statistically significant differences were found on four of the total 12 speech and language measures. Intellectually normal preterm children without major neurological disability were slower than the controls on rapid word retrieval. In addition, difficulties in comprehending relative concepts were typical for the preterm children. The results suggest 'subtle dysnomia', which is indicative of later reading problems. On global verbal measures and on the basic speech and language aspects the study groups did not differ. Specific language impairment, defined as a discrepancy of > 1SD between Performance IQ and Verbal IQ scores, showed a tendency to be more common in the control group. Within both the study groups, the boys showed a tendency for a greater discrepancy between their Performance and Verbal IQ scores.     

Differential effects of preterm birth and small gestational age on cognitive and motor development

AIMS: To determine the differential effects of preterm birth and being small for gestational age on the cognitive and motor ability of the child. METHODS: A longitudinal cohort of all infants of gestational age < or = 32 weeks born to mothers resident in the counties of Cheshire and Merseyside in 1980-1 was studied. The children were assessed at the age of 8 to 9 years using the Wechsler Intelligence Scale for Children, the Neale analysis of reading ability, and the Stott-Moyes-Henderson test of motor impairment. Adequacy of fetal growth was determined by the birthweight ratio--that is, the ratio of the observed birthweight to the expected birthweight for a given gestational age. Children with clinically diagnosed motor, learning or sensory disabilities were excluded. Information on social variables was obtained by a questionnaire completed by the parents. Of the 182 children, 158 were assessed. RESULTS: IQ was positively correlated with birthweight ratio but not with birthweight or gestational age. Motor ability was associated with birthweight, gestational age, and birthweight ratio. Reading comprehension was associated with birthweight ratio, but reading rate and accuracy were best explained by social variables and sex. IQ remained associated with birthweight ratio, after adjusting for maternal education, housing status, and number of social service benefits received. Reading ability was related to these social variables but motor ability was not. CONCLUSIONS: The effects of SGA and preterm birth differed: SGA was associated with cognitive ability, as measured by IQ and reading comprehension; motor ability was additionally associated with preterm birth. Reading rate and accuracy were not associated with SGA or preterm birth but were socially determined.     

U-83836E prevents kainic acid-induced neuronal damage

Tsukuba College of Technology is the first national university established as an institute of higher education for the visually and hearing impaired. We have been systematically conducting a University Personality Inventory (UPI) survey on our students since 1989 to understand their mental health. In this study, we compared the UPI scores of the new students of Tsukuba College of Technology in 1993 and 1994 with unimpaired students from the University of Tsukuba (control group), but found no significant difference in the UPI scores of the visually impaired and the control group. However, we noticed a significant difference in the average UPI scores between the hearing impaired and the control group. The visually impaired group were divided into four subgroups, UPI scores descended in order from degree 1 (total blindness), to degrees 2 and 3 (amblyopia), to degree 4 (visual acuity > or = 0.3). The UPI scores of the degree 4 subgroup were significantly lower than those of the control group. An investigation of the items for which the check rate was at least 50% showed that the visually impaired students had a variety of psychological problems, most of which seemed to concern depression or anxiety as did the normal control group. The number of affirmative responses increased with low visual acuity. The only one belonging to the 'lie' scale item was observed in the group of hearing impaired students. Thus, comparing these three groups from the viewpoint of mental health, we noticed the hearing impaired group was slightly different from the other two groups, but the visually impaired group was similar to the normal control group.     

Visual control of the arm, the wrist and the fingers: pathways through the brain

Sperry and his colleagues had shown that section of the corpus callosum blocks the normally strong interocular transfer of visual learning in chiasma sectioned monkeys. Although interhemispheric transfer of learning was blocked, monkeys could be readily trained to use any combination of eye and hand in a task that required rapid visually guided responses. Sperry suggested that there must be a subcortical pathway linking sensory to motor areas of the brain. We tested monkeys in a task which required them to orient their wrist and fingers correctly in order to remove a morsel of food from a slotted disc. Animals in which we made lesions of the dorsal extrastriate visual areas of the parietal lobe were profoundly impaired in performing this task, but showed no deficit in visual discrimination learning. A monkey with an extensive lesion of the ventral, temporal lobe extrastriate areas showed no deficit in the visuomotor task but was profoundly impaired in visual discrimination learning. Lesions of peri-arcuate cortex, a major cortical target of parietal lobe visual areas, produced only a mild deficit which was motor in character. We suggest that the visuomotor deficit caused by parietal lobe lesions is brought about by depriving the cerebellum of its cortical visual input.     

Population policies and reproductive patterns in Vietnam

BACKGROUND: Vietnam's population policy since the 1980s had stipulated a limit on family size to two children, born 3-5 years apart, and recommends a minimum age of 19 for the mother of a first child. We analysed trends in the timing of marriages and births, and in fertility and abortion rates, among women born between 1945 and 1970, to assess the impact of these policies on reproductive patterns. METHODS: Reproductive histories were recorded in a random sample of 1432 married women aged 15-49 in a rural province in northern Vietnam. Mean age at marriage and at birth of the first child, birth intervals, fertility, and abortion rates were examined in relation to the woman's year of birth. FINDINGS: Later-born women married and had their first child at a younger age than women born earlier. Birth intervals had increased among later-born women but 25% still had only a 1-year interval between first and second child. Fertility had gradually decreased while abortion ratios had increased rapidly. Childbearing patterns had become "earlier, longer, and fewer" rather than "later, longer, and fewer" as stipulated by the policies. The results also show that women with more schooling married and had their first child later. Women involved in farming had shorter spacing between children. INTERPRETATION: There are signs that Vietnam's population policy has focused too strongly on contraception and abortion while ignoring the connection between fertility and women's opportunities for education and employment. In these respects, rural women are at particular risk.