Pediatrics – Neurology
Review: Chronic Low-Level Lead Poisoning
3 Nov, 2024 | 01:15h | UTCIntroduction: Lead poisoning, historically known as plumbism, remains a significant health concern despite reductions in lead use. Chronic low-level lead exposure has been identified as a critical risk factor for cardiovascular disease in adults and cognitive deficits in children, even at blood lead concentrations previously deemed safe. This review by Lanphear et al. explores the multifaceted effects of chronic, low-level lead poisoning, emphasizing its impact on neurodevelopment, kidney function, and cardiovascular health, and underscores the urgent need for effective prevention strategies.
Key Findings:
- Exposure and Absorption: Lead exposure occurs primarily through ingestion and inhalation, with children absorbing lead more readily than adults. Absorption is enhanced in the presence of iron or calcium deficiency. Once absorbed, lead is predominantly stored in the skeleton, and factors altering bone metabolism can mobilize lead back into the bloodstream.
- Neurodevelopmental Effects: Lead exposure is linked to preterm birth, cognitive deficits, attention deficit–hyperactivity disorder (ADHD), and behavioral disorders in children. Notably, cognitive deficits are proportionately larger at lower blood lead levels, with significant IQ reductions observed even at the lowest measurable concentrations.
- Kidney Disease: Chronic lead exposure is a risk factor for chronic kidney disease. Higher blood lead levels are associated with reduced glomerular filtration rates and an increased risk of developing chronic kidney conditions.
- Cardiovascular Disease: Lead induces hypertension and atherosclerosis through mechanisms such as oxidative stress and endothelial dysfunction. It is a leading risk factor for mortality from cardiovascular disease, with substantial risk increases even at low blood lead concentrations. Studies indicate that lead exposure may have contributed to historical trends in coronary heart disease mortality.
- Global Burden: In 2019, lead exposure accounted for approximately 5.5 million deaths from cardiovascular disease and the loss of 765 million IQ points in children globally. The economic cost associated with lead-related health outcomes is estimated at $6 trillion annually, representing about 7% of the global gross domestic product.
- Screening and Treatment: Screening high-risk populations is recommended, including children in older housing and workers in certain industries. While chelation therapy can reduce body lead burden, its effects on health outcomes are inconsistent, highlighting the importance of primary prevention.
- Prevention Strategies: Eliminating environmental sources of lead through government-funded population strategies is essential. This includes replacing lead-containing infrastructure like water service lines, banning leaded aviation fuel, reducing lead in consumer products, and remediating contaminated soils and older housing with lead-based paints.
Conclusion: Chronic low-level lead poisoning continues to pose a significant global health threat, contributing to cardiovascular disease and neurodevelopmental deficits. The disproportionate effects at even the lowest exposure levels underscore the necessity for robust, population-wide prevention strategies. Implementing stringent regulatory actions to eliminate sources of lead exposure is imperative to reduce the substantial morbidity, mortality, and economic burdens associated with lead poisoning.
Meta-Analysis: Daily Sedation Interruption Shortens PICU Stay Without Impacting Mortality or Ventilation Duration in Pediatric MV Patients – JAMA Netw Open
11 Aug, 2024 | 13:19h | UTCStudy Design and Population: This systematic review and meta-analysis included six randomized clinical trials (RCTs) involving 2,810 pediatric patients receiving mechanical ventilation (MV) in the pediatric intensive care unit (PICU). The trials compared the effects of daily sedation interruption (DSI) with continuous intravenous (IV) sedation on clinical outcomes such as MV duration and PICU length of stay.
Main Findings: The analysis found that DSI was associated with a significant reduction in the length of PICU stay (mean difference of -1.45 days, p = 0.03). However, there was no significant difference in the duration of MV between DSI and continuous sedation (mean difference of -0.93 days, p = 0.06). Additionally, there were no significant differences in total sedative doses, adverse events, or mortality between the two groups.
Implications for Practice: The findings suggest that DSI may reduce the length of PICU stay without increasing the risk of adverse events, making it a potentially valuable strategy in managing sedation for pediatric patients on MV. However, further research is needed to explore the long-term neurodevelopmental outcomes associated with DSI.
Cohort Study: Prenatal opioid exposure linked to modest increase in neuropsychiatric disorders – The BMJ
25 May, 2024 | 19:50h | UTCThis nationwide birth cohort study from South Korea investigated the impact of prenatal opioid exposure on the risk of neuropsychiatric disorders among children. The study followed 3,128,571 infants born between 2010 and 2017 until the end of 2020. Researchers found that infants exposed to opioids prenatally showed a slightly increased risk of developing neuropsychiatric disorders, including mood disorders, attention deficit hyperactivity disorder, and intellectual disability. The increased risk was more pronounced with higher opioid doses, longer duration of use, and exposure during the first trimester of pregnancy. However, this association was not significant in sibling comparison cohorts, indicating a modest overall clinical impact. The study emphasizes the need for cautious interpretation due to its observational design and the specific conditions under which risk increases.
Reference (link to free full-text):
Clinical Trial Follow-up: Antenatal corticosteroids not associated with adverse neurodevelopmental outcomes in late preterm births – JAMA
2 May, 2024 | 23:25h | UTCStudy Design and Population:
This research involved a prospective follow-up study of a multicenter randomized clinical trial, specifically focusing on children aged 6 years or older whose birthing parents were enrolled in the Antenatal Late Preterm Steroids (ALPS) trial. The trial initially examined the impact of administering 12 milligrams of intramuscular betamethasone, given twice 24 hours apart, on late preterm infants (34-36 completed weeks). The follow-up study involved 949 children from 13 centers in the Maternal-Fetal Medicine Units (MFMU) Network, assessed for neurodevelopmental outcomes.
Main Findings:
The primary outcome measured was the General Conceptual Ability score less than 85 on the Differential Ability Scales, 2nd Edition (DAS-II). Results showed no statistically significant differences between the betamethasone group (17.1%) and the placebo group (18.5%) in achieving this score. Secondary outcomes related to motor function and social responsiveness also showed no significant differences between the groups. Sensitivity analyses further confirmed these findings, suggesting that the administration of betamethasone did not adversely affect neurodevelopmental outcomes at age 6 or older.
Implications for Practice:
These findings support the continued use of antenatal corticosteroids for improving short-term neonatal respiratory outcomes in late preterm deliveries without concern for long-term neurodevelopmental harm. Clinicians can consider these results reassuring, as the study effectively dispels earlier concerns about potential negative long-term effects related to neurodevelopment from antenatal steroid use in late preterm infants.
Reference (link to abstract – $ for full-text):
Cohort Study: No increased risk of autism, ADHD, or intellectual disability from acetaminophen use in pregnancy
29 Apr, 2024 | 12:34h | UTCThis cohort study investigated the association between acetaminophen use during pregnancy and the risk of autism, ADHD, and intellectual disability in children. The study utilized a population-based sample of nearly 2.5 million Swedish children born between 1995 and 2019, with data analyzed up to 2021. Initial findings without sibling controls suggested a marginal increase in the risks of autism and ADHD. However, sibling control analyses, which help adjust for familial confounding, showed no significant associations (HR for autism and ADHD at 0.98, and intellectual disability at 1.01). These results imply that earlier observed risks might be due to unaccounted familial factors, not acetaminophen exposure.
Reference (link to abstract – $ for full-text):
M-A | Exploring perinatal interventions and their impact on severe intraventricular hemorrhage in preterm neonates
4 Aug, 2023 | 11:56h | UTC
Commentary on Twitter
A meta-analysis by @DrAbdulRazak_MD & colleagues on perinatal interventions are associated with a reduction or increase of IVH and PVL #EBNEOalerts #neoEBM #neotwitter https://t.co/SPzNHwy3HD pic.twitter.com/KDQBSYZjdq
— Evidence-Based Neo (@EBNEO) April 26, 2023
Review | Treatment of pediatric convulsive status epilepticus
4 Aug, 2023 | 11:42h | UTCTreatment of pediatric convulsive status epilepticus – Frontiers in Neurology
Prospective Study | Intelligence likely remains intact after pediatric concussion
20 Jul, 2023 | 11:06h | UTCIQ After Pediatric Concussion – Pediatrics (free for a limited period)
Commentaries:
IQ After Pediatric Concussion: Clinical Considerations – Pediatrics
No Evidence Seen for Differences in IQ After Pediatric Concussion – HealthDay
Concussions do not affect IQ in children, study finds – News Medical
Nationwide Cohort Study | Adolescent hypertension linked with increased stroke risk in young adulthood
18 Jul, 2023 | 13:49h | UTCCommentary: The Relationship Between Adolescent Hypertension and Stroke Risk After Age 40 Years – Neurology Advisor
Cohort Study | Long-term risk of epilepsy following invasive Group B Streptococcus disease in neonates
9 May, 2023 | 14:25h | UTC
RCT | Cerebral oximetry monitoring fails to reduce death or severe brain injury in extremely preterm infants
25 Apr, 2023 | 14:45h | UTCCerebral Oximetry Monitoring in Extremely Preterm Infants – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In extremely preterm infants, the use of cerebral oximetry monitoring to guide treatment for the first 72 hours after birth did not reduce the risk of death or severe brain injury at 36 weeks’ postmenstrual age. Full study: https://t.co/JX7Ra3OpjM pic.twitter.com/VACbUUAq3i
— NEJM (@NEJM) April 19, 2023
M-A | Retinopathy of prematurity and neurodevelopmental outcomes in preterm infants
10 Apr, 2023 | 13:36h | UTC
Review of noninvasive neuromonitoring modalities in children: EEG, qEEG
27 Mar, 2023 | 12:50h | UTCReview of Noninvasive Neuromonitoring Modalities in Children II: EEG, qEEG – Neurocritical Care (if the link is paywalled, try this one)
RCT | Safety and efficacy of pitolisant in children aged 6 years or older with narcolepsy with or without cataplexy
23 Mar, 2023 | 12:44h | UTCSafety and efficacy of pitolisant in children aged 6 years or older with narcolepsy with or without cataplexy: a double-blind, randomised, placebo-controlled trial – The Lancet Neurology (link to abstract – $ for full-text)
RCT | Impact of two ketogenic diet types in refractory childhood epilepsy
16 Mar, 2023 | 13:13h | UTCImpact of two ketogenic diet types in refractory childhood epilepsy – Pediatric Research
Related:
Efficacy and Safety of Dietary Therapies for Childhood Drug-Resistant Epilepsy: A Systematic Review and Network Meta-analysis – JAMA Pediatrics (link to abstract – $ for full-text)
Safety, Efficacy, and Tolerability of Modified Atkins Diet in Persons With Drug-Resistant Epilepsy: A Randomized Controlled Trial – Neurology (link to abstract – $ for full-text)
SR | Surgical treatments for epilepsies in children aged 1–36 months
10 Mar, 2023 | 14:21h | UTCSurgical Treatments for Epilepsies in Children Aged 1–36 Months: A Systematic Review – Neurology
Commentary on Twitter
Tsou and colleagues summarize findings of a systematic review commissioned by the @AmEpilepsySoc to assess evidence and identify evidence gaps for surgical treatments for #epilepsy in children aged 1–36 months without infantile spasms. Read the article: https://t.co/Q1WW8Yy0Jf pic.twitter.com/Ko1c27x6cw
— Neurology Journal (@GreenJournal) January 9, 2023
10-year follow-up on preterm prelabor rupture of membranes: induced labor vs. expectant management childhood outcomes
16 Feb, 2023 | 15:05h | UTCSummary: This study aimed to compare the long-term outcomes of children born after singleton pregnancies complicated by preterm prelabor rupture of membranes and managed by induction of labor vs. expectant management in RCTs undergone between 2007 and 2011. The study assessed the children’s cognition, motor function, and behavior as the primary outcomes. It found that expectant management did not improve long-term outcomes compared to induction of labor for children born after pregnancies with preterm prelabor (between 34 0/7 and 36 6/7 weeks of pregnancy) rupture of membranes. The confidence in the results of this follow-up study is diminished because only 35% of the children who participated in the original trials participated in the follow-up study.
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
Diagnostic Study | Level of attention to motherese speech as an early marker of autism spectrum disorder
14 Feb, 2023 | 11:04h | UTCSummary: A study was conducted to determine if levels of attention to motherese speech can be used as a diagnostic marker for autism spectrum disorder (ASD) and if they are associated with social and language abilities. The study involved 653 toddlers aged 12 to 48 months and used gaze-contingent eye tracking to measure attention to motherese speech. The results showed that toddlers without ASD had high levels of fixation on motherese speech, while those with ASD had significantly reduced levels. If a toddler fixated on motherese speech at or below 30%, the probability of them being accurately diagnosed with ASD was 94%, and it was also associated with reduced social and language abilities. The findings suggest that attention to motherese speech may be a diagnostic and prognostic marker of ASD.
(By ChatGPT, reviewed and edited)
Commentaries:
Toddlers’ Attention to ‘Motherese’ Could Give Clues to Autism – HealthDay
Cohort Study | In utero exposure to ADHD medication does not seem to result in worse offspring neurodevelopmental outcomes
14 Feb, 2023 | 10:54h | UTCSummary: The authors conducted a study to investigate the long-term effects of in utero exposure to ADHD medication (methylphenidate, amphetamine, dexamphetamine, lisdexamphetamine, modafinil, atomoxetine, clonidine) on offspring. The study followed 1,068,073 liveborn singletons from 1998 to 2018 and compared the outcomes of children whose mothers continued or discontinued ADHD medication during pregnancy. The main outcomes were neurodevelopmental psychiatric disorders, impairments in vision or hearing, epilepsy, seizures, or growth impairment during childhood or adolescence. After adjustment for demographic and psychiatric characteristics of the mother, no increased risk of any developmental disorders was found in offspring exposed to ADHD medication compared to those not exposed. The results provide reassurance for women with ADHD who depend on medication and consider continuing it during pregnancy.
(By ChatGPT, reviewed and edited)
Article: In utero exposure to ADHD medication and long-term offspring outcomes – Molecular Psychiatry (link to abstract – $ for full-text)
Commentary from the author on Twitter (thread – click for more)
In-utero exposure to ADHD medication is not associated with long-term adverse neurodevelopmental disorders and growth restriction in the offspring.
Read the thread below 🧵on our new paper just published in @molpsychiatry
👉 https://t.co/MKZ0aeFnhU#ADHD— Kathrine Bang Madsen (@Kathrine_BaMa) February 9, 2023
M-A | Comparative antiseizure medications for adjunctive treatment in children with drug-resistant focal-onset seizures
9 Feb, 2023 | 13:22h | UTC
Cohort Study | Neurodevelopmental outcomes after late-onset meningitis in children born extremely preterm
7 Feb, 2023 | 13:38h | UTCCommentary: Late-Onset Meningitis ID’d in 1 Percent of Extreme Preemies – HealthDay
Commentary on Twitter
A cohort study in @JAMANetworkOpen examines neurodevelopmental outcomes in infants born < 26 weeks with late onset meningitis https://t.co/AmnRiKaeYt #EBNEOalerts #neoEBM #neotwitter pic.twitter.com/USlLDbG2UY
— Evidence-Based Neo (@EBNEO) December 28, 2022
M-A | Effect of early childhood development interventions to improve cognitive outcomes in children at 0–36 months
6 Feb, 2023 | 13:14h | UTCEffect of early childhood development interventions delivered by healthcare providers to improve cognitive outcomes in children at 0–36 months: a systematic review and meta-analysis – Archives of Disease in Childhood (free for a limited period)
M-A | Efficacy and safety of dietary therapies for childhood drug-resistant epilepsy
6 Feb, 2023 | 13:00h | UTCEfficacy and Safety of Dietary Therapies for Childhood Drug-Resistant Epilepsy: A Systematic Review and Network Meta-analysis – JAMA Pediatrics (link to abstract – $ for full-text)
Related:
Commentary on Twitter
Modified Atkins diet may have better tolerability and higher probability of short-term seizure reduction than ketogenic diet. https://t.co/B416ypjUWr
— JAMA Pediatrics (@JAMAPediatrics) January 30, 2023
Cohort Study | Associations between infant screen use, electroencephalography markers, and cognitive outcomes
1 Feb, 2023 | 13:34h | UTCCommentaries:
Infant Screen Use Linked to Alterations in Cortical EEG Before Age 2 – HealthDay
Your child’s academic success may start with their screen time as infants, study says – CNN
RCT | Assessment of infant position and timing of stylet removal to improve lumbar puncture success in neonates
31 Jan, 2023 | 14:07h | UTCNews Release: Lumbar punctures in newborn babies are more successful when performed in sitting position – Oxford Population Health
Commentary on Twitter
NEW: The NeoCLEAR RCT found improved success rates with #neonatal #lumberpuncture when sitting rather than lying.
Sitting lumbar puncture is safe, cost neutral, and well tolerated.
Paper by @ndy__marshall, @ccroehr & team: https://t.co/A1OTGBTNm0#neoEBM
— The Lancet Child & Adolescent Health (@LancetChildAdol) November 30, 2022