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Cognitive and psychosocial outcome of infants dialysed in infancy
S J Madden1, S E Ledermann, M Guerrero-Blanco
1Department of Psychological Medicine, Great Ormond Street Hospital for Children National Health Service Trust, London, UK.
Insights
Children with end-stage renal disease on peritoneal dialysis show improved development. However, 50% experienced psychosocial difficulties, highlighting the need for ongoing psychological monitoring in pediatric renal care.
Area of Science:
- Pediatric Nephrology
- Developmental Psychology
Background:
- End-stage renal disease (ESRD) significantly impacts child development.
- Long-term peritoneal dialysis (PD) is a critical treatment for pediatric ESRD.
Purpose of the Study:
- To assess cognitive and psychosocial outcomes in children with ESRD undergoing long-term PD.
- To understand developmental trajectories in this vulnerable pediatric population.
Main Methods:
- A cohort of 16 children initiating PD in infancy were evaluated.
- Cognitive assessments included Griffiths Mental Development Scales and WISC-III.
- Psychosocial adjustment was measured using the Strengths and Difficulties Questionnaire.
Main Results:
- Most children (87%) scored within two standard deviations of norms, with a mean IQ of 86.6.
- Cognitive development appears to be improving compared to historical data.
- Half of the children exhibited borderline to abnormal psychosocial scores, indicating higher rates of psychological difficulties.
Conclusions:
- Children on long-term PD are developing better than previously reported, likely due to advances in renal treatment and nutrition.
- Despite developmental improvements, a significant proportion of children require psychological support.
- Regular monitoring of psychological adjustment is crucial for children with ESRD on PD.
Objective:
To contribute further to the understanding of cognitive and psychosocial outcome of children with end-stage renal disease undergoing long-term peritoneal dialysis.
Methods:
In total, 16 surviving infants at a single centre beginning peritoneal dialysis in the first year of life were studied. The age range of the children at assessment was 1.6-12.1 years. Children were assessed using the Griffiths Mental Development Scales, the Wechsler Intelligence Scale for Children-Third Edition UK, and the Strengths and Difficulties Questionnaire. Information regarding the child's hospital stay and family background was also collated. A Pearson's Product Moment correlation was used to analyse the results.
Results:
Although 67% of the children's scores fell within the average range, 87% were within at least two SDs of the norms (mean IQ = 86.6). Psychosocial adjustment measures revealed that 50% of scores fell within the borderline to abnormal category, suggesting that the frequency of psychological difficulties was above that of the normal population.
Conclusions:
These findings lend support to recent studies indicating that, developmentally, children undergoing long-term peritoneal dialysis are faring better than in the past. This may indeed be a reflection of improvements in renal treatment and diet. The behavioural results suggest the need to monitor psychological adjustment in this group of children.