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Birth weight andCNS tumors

—Robert W. Wilmott, MD

The relationship between birth weight, birth order, and the risk of central nervoussystem tumors in childhood was evaluated by MacLean et al from Stanford Univer-

sity. The results of this study show that the risk of high-grade gliomas increases withbirth order and birth weight. The authors speculate that factors that drive growth inutero may alter the risk of gliomas.

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Growth of childrenwhose mothers have

depressive symptoms—Sarah S. Long, MD

Investigators in Pelotas in southern Brazil entered an entire 2004 birth cohort of in-fants and mothers into a 4-year study to assess the effect of sustained maternal de-

pression on children’s growth. A remarkably high rate of depression (17.9%) andpersistent depression (4.7%) was observed in mothers. In crude analysis, maternal de-pression was associated with underweight and stunting. After adjusted analyses forconfounding variables, however, maternal depression was not associated with anthro-pometric abnormalities, suggesting that both are the consequences of multiple adver-sities.

In the accompanying editorial, Grupp-Phelan both praises many aspects of thestudy and cautions interpretation of this and many studies that attempt to bringinto black-and-white relief a highly complex, intertwined set of risk factors for mater-nal and child morbidities, as well as data for analysis.

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Neurodevelopmentin children withhypoplastic leftheart syndrome

—Stephen R. Daniels, MD, PhD

There are concerns about neurodevelopment in patients with hypoplastic left heartsyndrome as successful surgical treatment becomes more common. In this issue of

The Journal, Sarajuuri et al compared neurodevelopment at a median age of 30 monthsin patients with hypoplastic left heart syndrome, univentricular heart, and healthycontrols. The mean developmental index was lower in patients with hypoplastic leftheart syndrome compared with patients with other forms of single ventricle and con-trols. The mean psychomotor developmental index was lower for both groups withcongenital heart disease compared with controls. It is clear that ongoing neurodeve-lopmental assessment is needed for patients with hypoplastic left heart syndrome,but psychomotor assessment may be needed more broadly for patients with complexcongenital heart disease.

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How important isa bicuspid

aortic valve?—Stephen R. Daniels, MD, PhD

B icuspid aortic valve is the most common congenital anomaly in children, witha prevalence of 1% or more in the general population. It usually has been consid-

ered to be a relatively unimportant defect, but good epidemiologic data have beenlacking. In this issue of the Journal, Mahle et al review information from a large singleinstitutional cohort with isolated bicuspid aortic valve. They found a low incidence ofadverse cardiac events. Patients with bicuspid aortic valve may develop mild ascendingaortic dilation, but this was not clinically important, and aortic dissection did not oc-cur. However, it is not known if aortic dilation could be progressive with aging in somepatients. Longer term follow up is required.

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Vol. 157, No. 3