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Objective: To investigate the clinical manifestations of autoimmune thyroiditis (AIT) leading to referral in children and adolescents, in addition to disease course and long-term outcome., Design: Chart review., Setting: Major tertiary hospital., Patients: 114 children/adolescents (92 female, 22 male; mean (SD) age 11.8 (35) years) with AIT referred for evaluation/treatment., Main Outcome Measures: Clinical characteristics at presentation, reasons for referral, treatment and long-term (mean 6 years) outcome; by thyroid and pubertal status., Results: The male/female (1:4.2) ratio was lower than in adult AIT (1:10) and varied by age. Patients with noticeable goitre at presentation (39.5%) accounted for half the total number in whom goitre was eventually diagnosed. Other reasons for referral were clinical symptoms of hypothyroidism (28.9%) and findings on work-up for an unrelated problem (19.2%) or for high-risk groups (10.5%). There was no difference in management or outcome between patients who underwent ultrasound (n = 79) or not. Treatment was initiated shortly after diagnosis in all 42 hypothyroid patients and 44/48 compensated hypothyroid patients, and within 16 months in 19/24 euthyroid patients. There was no change in thyroid status in the nine untreated patients. Height standard deviation score (SDS) was normal at referral and last visit and correlated with parental height SDS. Puberty was normal. There was no significant difference in body mass index SDS at referral by pubertal or thyroid status. There was no difference from the general population in the prevalence of obesity., Conclusions: Although goitre is the main symptom leading to diagnosis of AIT, it is still often overlooked, underscoring the need for thorough thyroid evaluation on routine physical examination. Acquired hypothyroidism is not often associated with obesity, and ultrasound usually has no added diagnostic value. Adequate treatment in this age group leads to normal growth, puberty and final height.

Parenchymal echogenicities that break down into extensive cystic lesions are generally followed by severe motor deficit. However, the effect of echodensities in the periventricular white matter, so called 'flares', on later development is less well documented. The aim of the present study was to investigate the impact of neonatal flares in preterm infants on neurological status and motor competence at 6 years of age and to see to what extent outcome was related to duration of flares. Forty four children with flares, subdivided into three groups according to the duration of flares, and 62 children with normal scans were assessed on Touwen's neurological examination, the Movement ABC, and the British Ability Scales. No differences in cognitive abilities were found between the groups. The results of the motor assessments showed that performance decreased significantly with increasing duration of flares. In addition, there was a suggestion that this trend was stronger in measures assessing lower limb function than those of upper limb. Teachers were also able to identify differences between the groups of children on the basis of their motor performance in school.

We recruited 275 full term and preterm infants into a prospective evaluation of continuous four channel electroencephalographic (EEG) monitoring in the diagnosis and prognosis of neonatal seizures. EEG seizure activity was found in 55 infants; clinical signs were completely simultaneous in only 12 of these, they were present but limited in another 20, and were completely absent in the remaining 23. EEG seizure activity, with or without clinical signs, were equally associated with serious cerebral lesions and with adverse clinical outcome. The four channel EEG recording provided sufficient data on abnormality to be prognostically specific in 79% of the 43 infants who either died or had serious neurological impairment.

During a two year period prospective continuous electroencephalographic (EEG) monitoring of 275 infants identified seizure activity in 55 cases, 31 of whom were treated with anticonvulsant drugs on clinical grounds. EEG and clinical response was complete in only two and equivocal in another six. Clinical response with persistent EEG seizures occurred in 13 and neither clinical nor EEG response in 10. There was no significant improvement in the generally poor neurological outcome compared with that in 24 infants whose seizures were not treated because of limited or absent clinical manifestations. Background EEG abnormality (as an index of associated cerebral dysfunction) was a guide to potential lack of response to anticonvulsant drugs; it was also predictive of subsequent clinical outcome irrespective of treatment. This study shows that commonly used anticonvulsant drugs (phenobarbitone, paraldehyde, phenytoin, and diazepam) have little effect on seizure control or neurological outcome in neonatal seizures associated with haemorrhagic, hypoxic, or ischaemic cerebral lesions. In view of the variable clinical appearance of EEG seizure activity, continuous EEG monitoring should be an essential feature of further study of neonatal anticonvulsant treatment.

A total of 338 infants of gestational age 34 weeks or less were scanned regularly with real time ultrasound. Definite intraventricular haemorrhage was present in 126 (37%) infants, of whom 17 (13.5%) showed extension in the size of the initial haemorrhage, mostly into the cerebral parenchyma. These 17 infants were carefully matched with 17 others who had an initial haemorrhage of the same size and the same number of adverse perinatal factors. On analysis those infants with extension of intraventricular haemorrhage were constantly more acidotic and more anaemic than the control group. It is possible that careful attention to maintaining optimal condition after the onset of intraventricular haemorrhage may reduce the risk of extension.