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Disturbances of brain maturation and neurodevelopment during chronic renal failure in infancy
G H Bock1, C K Conners, J Ruley
1Department of Child Health and Development, George Washington University School of Medicine, Washington, D.C.
Insights
Infants with congenital renal disease may experience neurodevelopmental delays. Impaired brain maturation in infants with renal failure can lead to cognitive function deterioration.
Area of Science:
- Pediatric Nephrology
- Neurodevelopmental Pediatrics
- Clinical Neurophysiology
Background:
- Congenital renal disease can impact infant development.
- Early identification of neurodevelopmental issues in these infants is crucial.
Purpose of the Study:
- To prospectively assess neurodevelopmental and neurophysiologic outcomes in infants with congenital renal disease.
- To identify factors associated with neurodevelopmental trajectories in this population.
Main Methods:
- Serial assessments of renal function, neurodevelopment (Mental Development Index), neurophysiology (electroencephalography), and anthropometry.
- Comparison of outcomes between infants maintaining normal cognitive development (Group 1) and those with delays or declines (Group 2).
Main Results:
- Group 2 infants exhibited poorer growth (length, head circumference) and higher serum creatinine levels.
- Electroencephalography revealed a lack of age-expected increase in cerebral cortical activity frequency in Group 2, particularly in the left hemisphere.
- While motor development was initially more delayed in Group 2, it did not significantly change over the study period for either group.
Conclusions:
- Infants with renal failure show impaired cerebral hemispheric maturation, potentially affecting cognitive development.
- Neurodevelopmental abnormalities in infants with renal disease may be linked to delayed brain maturation, manifesting as cognitive decline.
Abstract:
Fifteen infants with moderate to severe congenital renal disease were prospectively studied by serial renal, neurodevelopmental, neurophysiologic, and anthropometric assessments. The observation period ranged from 3 to 25 months (mean = 10.9). Eight patients maintained a Mental Development Index (MDI) above the 16th percentile (greater than -1 SD) and comprised group 1. Of the remaining seven patients (group 2), three had an MDI less than 16th percentile when first studied and four had serial decreases of the MDI to less than 16th percentile. Although motor development was more delayed in group 2 at study entry, there were no significant changes of motor performance levels for either group during the study period. Group 2 patients had smaller length (p less than 0.05) and head circumference (p less than 0.05) standard deviation scores in comparison with group 1, and they had higher serum creatinine values (mean = 3.8 vs 1.3 mg/dl, respectively; p less than 0.01). By spectral electroencephalography, the expected progressive increase of the frequency of cerebral cortical background activity with age was demonstrated in group 1 but was not seen in group 2 (multivariate analysis of variance p less than 0.03). This increase of faster-frequency activity was primarily manifested in the left cerebral hemisphere of group 1 patients (p less than 0.01), a finding that was also absent in group 2. The frequent occurrence of neurodevelopmental abnormalities in infants with renal failure is possibly a consequence of impaired dominant hemispheric maturation in the first several years of life, which is clinically manifested as deterioration of cognitive function.