Diarrhoeal disease is a major cause of infant mortality in this and other developing countries. The assessment of the degree of dehydration in these children is often based on subjective findings alone. These have been shown to be inaccurate as an assessment of the degree of dehydration. Whole-body impedance (WBI) is a method of measuring total body water which is used to assess body composition. This WBI technology, which operates at a single frequency, has been applied to the assessment of dehydration in children with diarrhoeal disease. The normal range of WBI was determined on a group of normally hydrated children and was found to have a mean of 746 Ω, a standard deviation of 85 Ω and 95 % confidence interval for the mean from 720 Ω to 772 Ω. WBI did not depend on age, mass, height or sex. The WBI of a group of children dehydrated from infantile gastroenteritis was measured both before and after rehydration. The dehydrated group had a mean WBI on admission of 1089 Ω and a standard deviation of 149 Ω with a 95 % confidence interval for the mean from 950 Ω to 1109 Ω. This value was significantly greater than that of the normal group. The WBI of the dehydrated group after rehydration was not significantly different from the normal group. In addition a variable frequency bioimpedance analyser was designed and tested. It was found to have an error of less than 1 % over the frequency range 1 to 100 kHz. The device was evaluated on 11 normal and dehydrated children. Four dehydrated children were tested before and after rehydration and this data was compared to a standard electrical model for WBI. It was found that the model could represent the measured data over this frequency range. The extracellular resistive element of the model was mainly responsible for the changes seen during rehydration, suggesting that dehydration in gastroenteritis is mainly due to fluid loss from the ECF compartment.

The aim of this study was to evaluate gaze behaviour in relation to cognitive development among infants with epilepsy. Our sample consisted of 60 infants with epilepsy that underwent cognitive testing and developmental assessment. We tested visual ability to orient and fixate gaze to a screen, re-orient visual attention at an initial test visit and in follow up tests and the improvement in these visual abilities between initial and traced improvements in follow-up visits. We found significant differences in the initial level and in improvement in the ability to orient and fixate to the screen between infants categorized as typical, having mild deficit or global deficit in development by the age of 2 years. Significant differences were observed between the global group compared to the mild and normal groups, respectively and we also found significant differences between the normal and the mild developmental group. Our results also showed that initial ability to orient and fixate to the screen and improvements of this ability across time are significantly associated with cognitive performance at the age of two years. These results provide the first proof-of-concept for using serial eye tracking assessments at the individual level. Further research is needed to better control for various clinical factor, including a comparison with a healthy control group and to identify gaze behavior parameters diagnostic of developmental outcome. / Syftet med den här studien var att utvärdera blickbeteende i relation till kognitiv utveckling. Vår testgrupp bestod av 60 spädbarn med epilepsi som genomgick kognitiva tester och utvecklingsbedömningar. Vi testade hur visuell förmåga att rikta och fixera blicken på skärmen, byta visuellt fokus och utvecklingen av dessa visuella förmågor över uppföljningvisit. Vi fann at signifikanta skillnader i de initiala förmågorna och förbättring av förmågan att orientera och fixa skärmen mellan barn kategoriserade som typiska, med litet underskott eller global underskott i utveckling vid en ålder av 2 år. Signifikanta skillnader observerades i jämförelsen mellan en grupp av svår epilepsi och mild grad av epilepsi. Vi fann även signifikanta skillnader mellan normalt utvecklade barn och barn med mild epilepsi. Våra resultat visar också att initial förmåga att rikta blicken och förändringen av denna förmåga över tid är signifikant associerad med kognitiv förmåga vid två års ålder. Dessa resultat ger preliminära stöd för användningen av ögonrörelseregistrering för bedömningar på individnivå. Ytterligare forskning är nödvändig där flera kliniska faktorer kontrolleras bättre, inklusive en jämförelse med en frisk kontrollgrupp, för att identifiera blickparametrar som är diagnostiska för barns utveckling.

Kutane Hämangiome finden sich bei acht bis zwölf Prozent aller Säuglinge bis zum Ende des ersten Lebensjahres. Die Behandlungsempfehlungen unterliegen einer regen Diskussion. In der vorliegenden Arbeit wurden 269 Kinder im Alter von 4 Wochen bis 15 Jahren mit 334 kutanen Hämangiomen untersucht, die in der Klinik und Poliklinik für Kinderchirurgie der Universitätsklinik Leipzig behandelt wurden. In einer retrospektiven Analyse wurde das Krankengut bzgl. ihrer Behandlungsbedürftigkeit und im Behandlungsfall hinsichtlich der erzielten Resultate, bezogen auf die gewählte Therapieform, beurteilt. Gleichzeitig wurde der Frage nachgegangen, ob patientenseitige Voraussetzungen (Alter, Geschlecht, Hämangiom-größe, Hämangiomlokalisation) oder therapeutische Parameter (Kryotherapie, Lasertherapie, Energieapplikation, Zahl der Sitzungen) das Behandlungsergebnis beeinflussen. Die Ergeb-nisse der Arbeit werden vor dem Hintergrund einer aktuellen Literaturrecherche diskutiert.:Inhaltsverzeichnis Abbildungsverzeichnis 4 Tabellenverzeichnis 5 1 Ziel der Arbeit 6 2 Hämangiome 7 2.1 Vorbemerkungen, Definitionen 7 2.2 Epidemiologie und Klinik 8 2.3 Diagnostik 10 2.4 Klassifikation 10 2.5 Therapieziele 11 3 Therapiemöglichkeiten 12 3.1 Kryotherapie 12 3.2 Lasertherapie 13 3.3 „Wait and see“-Strategie 16 3.4 Operative Therapie 17 3.5 Andere Therapieformen 18 3.5.1 Steroidbehandlung 18 3.5.2 Interferon Alpha 2a 19 3.5.3 Beta-Rezeptorblocker 20 3.5.4 Embolisation und Sklerosierung 20 3.5.5 Röntgenbestrahlung 21 4 Material und Methoden 23 5 Eigene Ergebnisse 26 5.1 Kryotherapie 26 5.2 Lasertherapie 31 5.3 „Wait and see“ 37 5.4 Chirurgische Entfernung 40 6 Diskussion 42 6.1 Zusammenfassung 42 6.2 Epidemiologische Daten 43 6.3 Diskussion der Ergebnisse der Kryotherapie 44 6.4 Diskussion der Ergebnisse der Lasertherapie 47 6.5 Diskussion der Ergebnisse der „wait and see“-Strategie 51 6.6 Diskussion der Ergebnisse der chirurgischen Entfernung von Hämangiomen 53 6.7 Einflussfaktoren auf die Therapieentscheidung 55 6.8 Kritik an der Methode 58 6.9 Empfehlungen für die praktische Arbeit 59 7 Anhang 62 7.1 Tabellen 62 7.2 Erfassungsbogen Hämangiompatienten 63 Zusammenfassung der Arbeit 66 Literaturverzeichnis 68 Erklärung über die eigenständige Abfassung der Arbeit 74 Danksagung 75 Lebenslauf 76

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Children from different socioeconomic backgrounds often have different long-term outcomes in terms of school, language, and emotional wellbeing. At this time, no reasons for these differences have been agreed upon by experts across disciplines. Parents with different personal characteristics and life situations use different types and amounts of interactions with their infants. The social interactions infants experience during their first year of life provide the start of their developmental path in the areas of language and executive control while also guiding their expectations for interactions with people around them. This study used previously unpublished data from a sample of 79 young infants, age 3 to 9 months, and their mothers. There was a set of five research questions. The first question guided exploration of how socioeconomic status (SES; represented by maternal education and family income) was associated with the parenting behaviors mothers used with their infants. The second question guided exploration of how mothers’ psychosocial resources (represented by child development knowledge and parenting stress) were associated with the parenting behaviors mothers used with their infants. The third question addressed whether associations between maternal education and parenting behavior were directly connected or if the amount of child development knowledge influenced the association. The fourth question addressed whether associations between family income and parenting behavior were directly connected or if the amount of mothers’ parenting stress influenced the association. The final question addressed whether associations between mothers’ psychosocial parenting resources and infant development were directly connected or if the associations were instead connected by mothers’ psychosocial resources. During a single home visit with each mother and her young infant, the research visitor assessed infant development, video recorded the mother and infant playing during a free play session, and asked mothers to fill out questionnaires. Project questionnaires addressed mothers’ education and family income as well as their levels of child development knowledge and parenting stress. None of the findings directly related to the five hypotheses were statistically significant. However, follow-up analyses provided information about potential future directions for investigating the links between SES, parenting interactions, and infant competencies using smaller categories of education and income levels. These findings from follow-up questions may guide potential future directions for identifying SES and psychosocial influences on early parenting interaction behaviors and young infants’ early development.

Early behavior problems, such as childhood aggression, emerge in the second year of life and decrease prior to school entry for typically developing children. However, some children show frequent and persistent aggression and may be at risk for subsequent difficulties that lead to poor school and life outcomes. The current study aimed to identify aggression patterns in children from toddlerhood to early adolescence for boys and girls together and separately. This study also explored early influences on aggressive behaviors at age two, such as mothers’ parenting behaviors, cumulative family risk, and early child characteristics. A range of difficulties in early adolescence were investigated, including poor social skills, low academic success, internalizing problems (e.g., depression and anxiety), and delinquent behaviors. Data from a previous study of 3,000 families and children, the Early Head Start Research and Evaluation longitudinal study, which followed families and children from infancy to early adolescence were examined. Four aggression patterns were found, characterized by changes over time in the amount of aggressive behaviors exhibited, applicable to both boys and girls: low-stable, moderate-decreasing, moderate-increasing, and high-stable. Early parenting and development during toddlerhood discriminated these distinctive aggression patterns. Compared with children in the low-stable group, boys in the moderate-decreasing and high-stable groups, and girls in the high-stable group were less likely to have mothers using positive parenting behaviors. Boys in the moderate-decreasing group and girls in the high-stable group were more likely to show delayed language development. Boys in the moderate-decreasing and high-stable groups were more likely to indicate poor emotional regulation. Moreover, compared with children in the low-stable group, those in the moderate-decreasing, moderate-increasing, or high-stable groups tended to show difficulties in early adolescence, such as lack of social skills, lower academic success, more internalizing problems, and delinquent behaviors. Altogether, young children exhibiting high levels of aggression over time were at the highest risk for later social, behavioral, and academic problems when, at age two, they had mothers with less positive parenting behaviors or when they showed poor language development or poor emotional regulation.

Orientador: Claudinei Magno Magre Mendes / Banca: Zélia Lopes da Silva / Banca: Beatriz Anselmo Olinto / Banca: Ivana Guilherme Simili / Banca: Tania Regina de Luca / Resumo: O presente trabalho busca analisar a construção de um modelo de assistência à infância e amparo à maternidade no Brasil entre os anos de 1927-1940. Pretende, também, examinar como foi o processo de elaboração que levou à centralização da assistência à infância aos cuidados da União, passando pelo debate entre juristas e médicos na Construção do Código de Menores e na Constituinte de 1934. Neste período, o saber médico-social prevaleceu, juntamente com o modelo de assistência que buscava dividir as responsabilidades de atendimento entre o público e o particular. Porém, manteria como responsabilidade do Estado a formulação de diretrizes e normatizações referentes ao assunto, criando para este fim um organismo nacional que foi o responsável por organizar, pesquisar, fiscalizar e divulgar as medidas que deveriam ser implementadas em relação à Assistência à Infância e o Amparo à Maternidade em todo o território nacional. / Abstract: The present work searches to analyse the construction of a model of assistance to infancy and support to the maternity in Brazil during the period of 1927-1940. It intends, also, to examine as it was the elaboration process that led to the centralization of the assistance to infancy to the cares of the Union, passing for the debate between jurists and doctors in the Construction of the Code of Minors and in the Constituent of 1934. In this period, doctor-social knowing would prevail together with the assistance model that it searched to divide the responsibilities of attendance between the public and the particular one. However, it would keep as responsibility of the State the referring building of the lines of direction and polices to the subject, creating for this end a national organism, called DNCr, that would be the responsible one for organizing, searching, finalising and publicising the measures that would have all to be implemented in relation to the Assistance to Infancy and the Support to the Maternity in the national territory. / Doutor

Congenital and infant acute leukemia remain one of the most puzzling clinical issues in pediatric hematology-oncology. There is a paucity of studies focused on these rare, aggressive, acute leukemias; specifically, there is little study on the differences in disease in the youngest of infants less than 1 year of age unlike the numerous studies of the disease in older children. The United States National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) cancer population registry program has been integral for a plethora of clinical population and pathology research studies for numerous diseases in the last 40 years and has an excellent resource for investigation of the infant population. Laboratory medicine and pathology professionals must use pathology results not only to diagnose individuals after the disease has been discovered, but the information must be applied retrospectively to develop new testing strategies. By classifying the intense heterogeneity within these cancers, the distinct changes of the diseases within individuals can be established, ultimately reshaping diagnostic methodologies. Through the application of Integrative Molecular Pathological Epidemiology to a 325-infant case series from the SEER program from 2008 to 2014, this dissertation study was used to evolve the classification of these pediatric cancers with the application of scientific nosology. This dissertation study has documented characteristics of this population for application in further precision medicine investigations to influence laboratory medicine algorithms for diagnosis and management of patients guiding health policy that are aimed at improving outcomes in the youngest of children.

Indiana University-Purdue University Indianapolis (IUPUI) / The Riley Children's Hospital Craniofacial Anomalies Team rigorously follows a treatment protocol developed by Dr. Sheldon Rosenstein for the treatment of cleft lip and palate patients. Rosenstein's protocol incorporates primary bone grafting and alveolar molding appliances for cleft lip and palate patients. While other cleft lip and palate treatment centers utilize alveolar molding appliances, there remains debate concerning the efficacy of primary bone grafting. The principal detraction of primary bone grafting is the concern that such early surgical treatment affects maxillary and craniofacial growth and development. The purpose of this retrospective study was to analyze post-treatment lateral head plates and dental casts of cleft lip and palate circumpubertal patients treated in infancy at Riley Hospital in Indianapolis by the Craniofacial Team following Rosenstein's protocol. The hypothesis was that primary alveolar bone grafting in conjunction with the use of alveolar molding appliances contributes to the early stabilization of the alveolar segments, and produces no statistically significant difference in craniofacial development among primary bone grafted patients and nongrafted patients. The dental arch dimensions of the nongrafted patients (control group) consisted of the same data utilized by Moorrees in his study of the dentition of the growing child. The dental arch dimensions of nongrafted cleft patients consisted of the same data utilized by Athanasiou in his study of the dentition of cleft patients treated surgically without bone grafting. Of the eight measurements made by the three examiners, six demonstrated excellent interexaminer agreement, one demonstrated moderate interexaminer agreement, and one demonstrated poor interexaminer agreement. The arch width and length for the grafted group was significantly smaller (p < .05, Student's t-test) than the normal group in all measures except for the mandibular canine width. The arch width and length for the grafted group was not significantly different (p < .05, Student's t-test) than the nongrafted group, except for the maxillary molar width where the grafted group was smaller than the nongrafted group. The cephalometric values of the Riley group were compared against a nongrafted group, an early primary grafted group, and the Bolton standard values cited in Rosenstein's study. The Bolton standard values were used as the control group. This study found the cephalometric values of the Riley experimental group (treated following Rosenstein's protocol) to be of no statistically significant difference (p < .05, Students t-test) when compared with cephalometric values of the nongrafted and primary alveolar grafted groups cited in Rosenstein's 1982 study. The cephalometric values of the Riley experimental group were less than the cephalometric values of the nonclefted patients (Bolton standard control group) cited in Rosenstein's 1982 study. Interexaminer agreement ranged from poor to good with the poorest agreement among the linear values of ANS/PNS and GO/ME. The intraclass correlation coefficient values for SNA,m ANB, and SNB ranged from fair to moderate. The Riley cephalometric values were equal or slightly better than Rosenstein's grafted and nongrafted groups. Though smaller than the control group, the Riley cephalometric values were of no statistical significance (p < .05, Students t-test) when compared with the same parameters cited in Rosenstein's study. Although these findings infer that the patients treated following Rosenstein's protocol demonstrate some degree of craniofacial growth attenuation when compared with nonclefted patients (Bolton standard control group), the Riley patients showed no worse growth attenuation than similar patients treated without Rosenstein's protocol for primary alveolar grafting. The hypothesis of this thesis was that Rosenstein's protocol was viable and non-detrimental when compared with other treatment regimens. The results of this study support the hypothesis that Rosenstein's surgical protocol is not a contributing factor in craniofacial growth attenuation among cleft lip and palate patients.