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Evaluation of short-term neurodevelopmental outcomes in the premature patients with periventricular-intraventricular hemorrhage
Abstract
Despite the significant advancements in perinatal care, it is not clear whether or not the neurodevelopmental outcome in children with intraventricular hemorrhage (IVH) has improved in parallel with the declining incidence of periventricular-IVH. In this study, we aimed to assess the periventricular-IVH-induced mortality and morbidity rates, as well as the short-term neurodevelopmental outcomes in premature infants. Two hundred and sixty five patients who were admitted between September 2005 and May 2006 were investigated for periventricular-IVH. Sixty-six patients with periventricular-IVH were compared with 66 premature infants who were not associated with hemorrhage. Of the periventricular-IVH diagnosed premature infants, 59% were born at or before week 32, 61% had a body weight below 1500 g, and 24.9% had hemorrhage. In cases with periventricular-IVH, the rates of premature retinopathy and periventricular leukomalacia were significantly high (P < 0.05). There was no statistically significant relation between periventricular-IVH and mortality (P > 0.05) while the relation between periventricular-IVH and neuromotor developmental retardation was significant (P < 0.05). The outcome was poorer as the grade of bleeding increased (P < 0.05). As a conclusion, regardless of risk factors, periventricular-IVH is an important early indicator of neurodevelopmental retardation, and those cases having such condition should be always assessed with a neurodevelopmental evaluation. The detection of neurodevelopmental retardation in short term with appropriate educational strategy could be beneficial for long-term outcome.
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Background
Encountering a patient with Münchausen syndrome (MS) or with MS by proxy is more frequent than it is assumed. Treating this type of patient is indeed a challenge, thus, knowing to depict the signs is important for every doctor. A specific therapeutic approach is needed and sometimes, even law enforcement must be involved.
Objective
We plan to highlight the signs and consequences of Münchausen syndrome and Münchausen syndrome by proxy.
Method
Clinical data were collected during admissions of patients in the psychiatric hospital. A literature review has been performed.
Results
We report the case of a nurse diagnosed with MS, who had multiple admissions with different diagnostics, before the patient was exposed with the factious disorder diagnosis. We also report the case of a mother diagnosed with MS by proxy and the case of another mother where the obsessive-compulsive elements of her depressive disorder are combined with signs of MS by proxy, both of them inflicting consequences upon the child in care.
Discussion and conclusions
Patients suffering from Münchausen syndrome and Münchausen syndrome by proxy can be a burden for society and for themselves. The relationship with them is sabotaged from the start. The diagnostic is difficult to establish. Numerous expensive procedures are being taken and a considerable amount of funds is spent. Most importantly, the abuse of a child with a parent or guardian suffering from this disease is incommensurable and can even lead to death. It is vital to take action as soon as these syndromes are discovered.
Epidemiologic studies show that by late adolescence OCD has a lifetime prevalence of 2% to 3%. The age of onset is earlier in boys than in girls, and has a first peak around puberty and another in early adulthood. The natural course of the disorder is fairly stable, with a complete remission rate of 10% to 15%, although fluctuations in symptom level may make short-term apparent outcome unreliable. Comorbid conditions include depression, movement disorders, and anxiety disorders. Although the prevalence of OC symptoms and of OCD are not different for boys and girls, there may be gender differences in the symptom types. The boundary of the diagnosis of OCD is not always easy to determine, and individuals may meet threshold and subthreshold criteria at different times.
The prevalence and consequences of verbal abuse of staff nurses by physicians were examined in the context of Lazarus' stress-coping model. Of the 130 staff nurses completing a mailed Verbal Abuse Questionnaire, 90 per cent reported experiencing at least one episode of verbal abuse during the past year. The average number of reported incidents during the year was between 6 and 12. The most frequent and most stressful types of verbal abuse came in the forms of abusive anger, ignoring, and condescension. Nurses tended to interpret the abuse in an adaptive fashion, eg, they viewed the abusing physician as someone with a problem and perceived themselves as not deserving the abuse. They used a variety of adaptive palliative as well as problem-focused coping skills. The most severe long-term effects of verbal abuse were a negative relationship with the offending physician and negative effects on job satisfaction. These findings show clearly that verbal abuse of nurses by physicians continues to exist and is associated with negative consequences on their personal as well as professional well-being. Nurse and physician educators as well as nurse administrators must address this problem through educational activities as well as protective hospital policies. (Index words: Stress; Verbal abuse). J Prof Nurs 13:48-55, 1997. Copyright © 1997by W.B. Saunders Company
Long-term hypertension contributes to significant cardiovascular and renal morbidity and mortality. Although chronic hypertension is much rarer in the adolescent population than in adults, identifying the hypertensive adolescent and intervening with risk factors such as obesity that may promote hypertension is important for the clinician treating adolescents. Since both primary and secondary causes of hypertension may exist in the adolescent, a thorough and sequential clinical and diagnostic evaluation must be undertaken, including screening urinalysis, blood chemistries, and renal sonography. There are pitfalls in interpreting casual blood pressure measurements in adolescents, and the role of ambulatory blood pressure monitoring is evolving. Lifestyle modifications, including diet, exercise, and limitation of sodium intake, remain the foundation of treatment. Commonly used medications include calcium channel blockers, angiotensin receptor blockers and converting enzyme inhibitors, beta blockers, and diuretics. When considering medication in the hypertensive adolescent, potential complications of therapy must be reviewed in light of the physical and psychosocial changes ongoing in this age group.
