Trastornos neuropsicológicos y del neurodesarrollo en el prematuro.
ABSTRACT El niño prematuro presenta unas manifestaciones morfológicas y funcionales características de su propia inmadurez, que le predisponen a presentar una serie de complicaciones precoces o tardías, siendo la más frecuente la enfermedad de la membrana hialina que produce asfixia perinatal. Ésta puede generar hemorragias intraventriculares y periventriculares. Hay muy pocos estudios sobre la evolución posterior de estos sujetos. En cuanto al neurodesarrollo, los prematuros sin complicaciones presentan en la etapa neonatal una reducción de la sustancia gris cortical, un aumento de los ventrículos laterales y una afectación de la sustancia blanca que se hace más evidente en edades más avanzadas. A los 3-8 años principalmente se observa déficit en el coeficiente de inteligencia, y a los 14-15 se suma la lectura y el cálculo. Por otro lado el prematuro con complicaciones presenta dilatación ventricular, leucomalacia periventricular y atrofia de algunas estructuras subcorticales. En la infancia y a los 13 años se observan dificultades en el rendimiento cognitivo general y en algunas habilidades específicas como la memoria. Ante la escasez de datos, proponemos un estudio neuropsicológico y de neuroimagen exhaustivo y a largo plazo, que muestre las consecuencias de la prematuridad asociada o no a complicaciones.
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ABSTRACT: Several studies have shown an increased incidence of neurodevelopmental impairment in very preterm survivors at school age compared with controls. To compare findings in the same cohort at 8 years and 15 years. A total of 151 of the 224 eligible infants born before 33 weeks of gestation from 1979 to 1982, and who were living in the UK, were assessed at 8 and 15 years. Items common to both assessments were compared to evaluate changes in neurodevelopmental function. The assessment included a structured neurological examination, psychometric tests using the WISC-R (in subjects born in 1981-82), a test of visuomotor integration (Beery), and a school questionnaire. There was a significant increase in the proportion of subjects classified as impaired with disability from 11% at 8 to 22% at 14-15 years of age. The proportion of subjects classified as impaired without disability increased from 16% at 8 to 26% at 14-15 years of age. Full scale IQ decreased from 104 to 95 from childhood to adolescence, and more adolescents (24%) were requiring extra educational provision than they had at the age of 8 years (15%). Results indicate that between the ages of 8 and 15 years in this cohort of very preterm survivors there is an apparent deterioration in neurodevelopmental outcome category, cognitive function, and extra educational support. It is not clear whether this represents a genuine deterioration in neurocognitive function or whether it represents the expression of pre-existing cerebral pathology in an increasingly complex environment.Archives of Disease in Childhood 04/2004; 89(3):207-11. · 3.05 Impact Factor
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ABSTRACT: To relate structural and functional findings in one adolescent dizygotic twin pair with prenatal alcohol exposure. Neuropsychological and volumetric magnetic resonance studies were carried out on a 13-year-old preterm dizygotic twin pair with prenatal alcohol exposure. Neuropsychological and brain structural findings differed between the twins. The child with the more affected phenotype had large-scale cognitive deficits and presented significant atrophy in several brain structures. Both subjects had white matter volume reductions relative to the whole cerebral volume. The neuropsychological and neuroimaging data reflect long-term consequences of prenatal alcohol exposure.Alcohol and Alcoholism 01/2004; 39(4):321-4. · 1.96 Impact Factor
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ABSTRACT: Neurodevelopmental and behavioural problems have been repeatedly reported in very preterm survivors, often showing themselves later in childhood as poor school performance. Early identification of problems would mean that appropriate remedial therapy can be implemented. We have previously shown that neurodevelopmental status at 1 year was predictive of outcome at 8 years in a cohort of preterm infants. The aim of this paper was to see if neurodevelopmental outcome in adolescence could be predicted by assessment by 1 year in the same cohort of preterm infants. Prospective cohort study. 150 adolescents, born before 33 weeks gestation. Neurological examination, developmental quotient, vision and hearing by 1 year. At 14-15 years, neurological examination, school performance questionnaire, Schonnell test of reading age, a premorbid adjustment score, Rutter behavioural score and for those born from 1981, cognitive tests (WISC-R). A highly significant relationship existed between neurological status by 1 year and the need for extra educational provision, overall neurodevelopmental status, cognitive function in those that had their IQs measured and premorbid adjustment score of prepsychotic symptoms in adolescence. However, status at 1 year was not predictive of adolescent reading age or behavioural score. Neurodevelopmental assessment at 1 year is predictive of school performance and outcome in the adolescent period.Early Human Development 01/2002; 65(2):81-9. · 2.02 Impact Factor