Showing papers by "Alan Leviton published in 1990"

The long-term effects of exposure to low doses of lead in childhood. An 11-year follow-up report.

Abstract: To determine whether the effects of low-level lead exposure persist, we reexamined 132 of 270 young adults who had initially been studied as primary school-children in 1975 through 1978. In the earlier study, neurobehavioral functioning was found to be inversely related to dentin lead levels. As compared with those we restudied, the other 138 subjects had had somewhat higher lead levels on earlier analysis, as well as significantly lower IQ scores and poorer teachers' ratings of classroom behavior. When the 132 subjects were reexamined in 1988, impairment in neurobehavioral function was still found to be related to the lead content of teeth shed at the ages of six and seven. The young people with dentin lead levels greater than 20 ppm had a markedly higher risk of dropping out of high school (adjusted odds ratio, 7.4; 95 percent confidence interval, 1.4 to 40.7) and of having a reading disability (odds ratio, 5.8; 95 percent confidence interval, 1.7 to 19.7) as compared with those with dentin lead levels less than 10 ppm. Higher lead levels in childhood were also significantly associated with lower class standing in high school, increased absenteeism, lower vocabulary and grammatical-reasoning scores, poorer hand-eye coordination, longer reaction times, and slower finger tapping. No significant associations were found with the results of 10 other tests of neurobehavioral functioning. Lead levels were inversely related to self-reports of minor delinquent activity. We conclude that exposure to lead in childhood is associated with deficits in central nervous system functioning that persist into young adulthood.

Antecedents and correlates of improved cognitive performance in children exposed in utero to low levels of lead.

Abstract: Up to 2 years of age, children with umbilical cord blood lead levels of 10 to 25 micrograms/dL achieve significantly lower scores on tests of cognitive development than do children with lower prenatal exposures. By age 5 years, however, they appear to have recovered from, or at least compensated for, this early insult. Change in performance between 24 and 57 months of age was examined in relation to level of postnatal lead exposure and various sociodemographic factors. Among children with high prenatal lead exposure, greater recovery of function was associated with lower blood level at 57 months, higher socioeconomic status, higher Home Observation for Measurement of the Environment scores, higher maternal IQ, and female gender. The difference between the scores at 57 months of children with optimal and less optimal values on these variables generally exceed 1/2 standard deviation. Higher prenatal lead exposure is associated with an increased risk of early cognitive deficit. Furthermore, the risk that a deficit will persist through the preschool years is increased among children with high prenatal exposure and either high postnatal exposure or less optimal sociodemographic characteristics.

Maternal Glucocorticoid Therapy and Reduced Risk of Bronchopulmonary Dysplasia

Abstract: Because of substantial clinical and laboratory evidence of the efficacy of glucocorticoids in the treatment of acute pulmonary surfactant deficiency in preterm newborns, we explored the hypothesis that maternal antenatal glucocorticoid receipt is followed by reduced risk of bronchopulmonary dysplasia (BPD) A sample of 223 intubated infants weighing less than 1751 g birth weight provided 76 infants with BPD (defined by both oxygen requirement and compatible chest radiograph) and 147 who had neither BPD characteristic by day 28 of life When compared to babies who received a complete and timely course of antenatal glucocorticoids, those whose mothers received no glucocorticoids were at prominently increased risk of BPD (odds ratio = 30; 95% confidence interval = 11, 82) Babies whose mothers received a partial course of glucocorticoids were not at increased risk of BPD (odds ratio = 13; 95% confidence interval = 04, 43) Stratification by gender and birth weight at 1 kg showed a benefit of therapy in all strata except that of extremely low birth weight male infants These data support the hypothesis that maternal antenatal glucocorticoid therapy offers very low birth weight infants protection against BPD

Asthma and eczema in children born to women with migraine.

Abstract: • Migraine and asthma have been reported to occur in the same person more commonly than would be expected if they are independent. The large Collaborative Perinatal Project provided an opportunity to see if children born to women with migraine or with the group of disorders characterized by asthma and/or allergies were more likely to manifest asthma or eczema in the first 7 years of life. Among children whose mothers had neither migraine nor asthma/allergies, 3.2% had asthma. Of children whose mothers had migraine, but not asthma/allergies, more than 6% had asthma. The risk of asthma among children born to women who had both migraine and asthma/allergies was greater than the risk associated with each maternal disease. The risk of eczema in children was not appreciably influenced by the mother's propensity to migraine or asthma/allergies. The results of this first study of migraine in one generation and asthma in the next lead to the conclusion that the two disorders are probably related.

Periventricular-Intraventricular Hemorrhage Sonographic Localization, Phenobarbital, and Motor Abnormalities in Low Birth Weight Infants

Abstract: A total of 228 low birth weight (less than 1750 g), mechanically ventilated infants with and without periventricular-intraventricular hemorrhage were examined at 18 months corrected age to assess the relationship between cranial ultrasonographic findings and specific motor abnormalities. All infants were previously enrolled in a double-blind, randomized, prospective clinical trial of phenobarbital prophylaxis against periventricular-intraventricular hemorrhage. Ultrasonographic abnormalities on the scans performed between 7 and 13 days of life were categorized as germinal matrix hemorrhage, lateral ventricular hemorrhage, parenchymal hemorrhage, ventriculomegaly, and any hemorrhage. Regardless of anatomical location, periventricular-intraventricular hemorrhage was associated with an increased risk for developing motor abnormalities. Hypertonia and hyperreflexia/ankle clonus were most common. No abnormal motor findings distinguished unilateral from bilateral germinal matrix hemorrhage and lateral ventricular hemorrhage or between phenobarbital and placebo treatment. None of the 5 infants with parenchymal hemorrhage had spastic cerebral palsy. Ventriculomegaly was associated with a fivefold increase in risk for spastic cerebral palsy and delayed walking and a threefold increase for hypertonia and hyperreflexia/clonus. The results suggest that ventriculomegaly, observed even as early as the first week of life, might be a significant antecedent of later motor abnormalities among the survivors of periventricular-intraventricular hemorrhage.

Lead and childhood propensity to infectious and allergic disorders: Is there an association?

Abstract: Lead appears to impair both antibody and cellular responses of laboratory animals to a variety of bacteria. These immunosuppressive effects of lead appear at levels below those associated with overt toxicity, and might, therefore, be present among urban children exposed to subtoxic amounts of lead. To examine the role of lead exposure on rates of infectious and allergic diseases in children, the authors compared the prevalence of these illnesses in children classified by the lead level in the umbilical cord blood, and in the dentine of their deciduous teeth. Information about illness was obtained from a mailed questionnaire completed by parents.

Childhood brain tumor: presentation at younger age is associated with a family tumor history

Abstract: In a registry-based sample of 361 children with a brain tumor, those whose grandparents and great-grandparents had a history of any kind of tumor were younger at the time of presentation than were those who lacked this family history (p=0.1). In post hoc analyses, the age difference was most apparent among children with cerebral tumors, and when family history was limited to brain tumors and to great-grandparents. These findings are in keeping with the hypothesis that a familial tumor diathesis contributes to an early age at onset of a brain tumor in some children.

Epilepsy and suicide

Abstract: To the Editor. —To identify risk "factors for attempted suicide among epileptics" requires that all subjects have epilepsy. Nevertheless, in an attempt to achieve this goal, the authors of a recent report chose controls from among nonepileptics.1To draw inferences from a case-control design requires persons with epilepsy who attempted suicide (cases) to be compared with persons with epilepsy who have not attempted suicide (controls). Nonepileptic controls have no place in this study. To use as controls persons who attempted suicide but who do not have epilepsy results in: (1) failure to identify factors related to an increased risk of attempted suicide, since both cases and controls have made the attempt, or (2) identifying factors that may be associated withepilepsybut not with attempted suicide, since it is epilepsy that distinguishes cases and controls. Such a design does not allow for identification of risk factors of attempted suicide