51
|
Barnes-Davis ME, Merhar SL, Holland SK, Parikh NA, Kadis DS. Extremely preterm children demonstrate hyperconnectivity during verb generation: A multimodal approach. Neuroimage Clin 2021; 30:102589. [PMID: 33610096 PMCID: PMC7903004 DOI: 10.1016/j.nicl.2021.102589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/16/2021] [Accepted: 02/02/2021] [Indexed: 01/25/2023]
Abstract
Children born extremely preterm (EPT, <28 weeks gestation) are at risk for delays in development, including language. We use fMRI-constrained magnetoencephalography (MEG) during a verb generation task to assess the extent and functional connectivity (phase locking value, or PLV) of language networks in a large cohort of EPT children and their term comparisons (TC). 73 participants, aged 4 to 6 years, were enrolled (42 TC, 31 EPT). There were no significant group differences in age, sex, race, ethnicity, parental education, or family income. There were significant group differences in expressive language scores (p < 0.05). Language representation was not significantly different between groups on fMRI, with task-specific activation involving bilateral temporal and left inferior frontal cortex. There were group differences in functional connectivity seen in MEG. To identify a possible subnetwork contributing to focal spectral differences in connectivity, we ran Network Based Statistics analyses. For both beta (20-25 Hz) and gamma (61-70 Hz) bands, we observed a subnetwork showing hyperconnectivity in the EPT group (p < 0.05). Network strength was computed for the beta and gamma subnetworks and assessed for correlation with language performance. For the EPT group exclusively, strength of the subnetwork identified in the gamma frequency band was positively correlated with expressive language scores (r = 0.318, p < 0.05). Thus, hyperconnectivity is positively related to language for EPT children and might represent a marker for resiliency in this population.
Collapse
Affiliation(s)
- Maria E Barnes-Davis
- Cincinnati Children's Hospital Medical Center, Perinatal Institute, United States; University of Cincinnati, Department of Pediatrics, United States; University of Cincinnati, Department of Neuroscience, United States.
| | - Stephanie L Merhar
- Cincinnati Children's Hospital Medical Center, Perinatal Institute, United States; University of Cincinnati, Department of Pediatrics, United States
| | - Scott K Holland
- Medpace Imaging Core Laboratory, Medpace Inc., United States; University of Cincinnati, Department of Physics, United States
| | - Nehal A Parikh
- Cincinnati Children's Hospital Medical Center, Perinatal Institute, United States; University of Cincinnati, Department of Pediatrics, United States
| | - Darren S Kadis
- Hospital for Sick Children and University of Toronto are in Toronto, Canada; University of Toronto, Department of Physiology, Canada
| |
Collapse
|
52
|
Abstract
BACKGROUND Inflammation may be an important predictor of long-term neurodevelopment in preterm infants. The identification of specific inflammatory biomarkers that predict outcomes is an important research goal. OBJECTIVES The purpose of this analysis was to identify associations between an early measure of inflammation and neurodevelopment in very preterm infants and to identify differences in the relationship between inflammation and neurodevelopment based on infant gender and race. METHODS We conducted a secondary analysis of data from a randomized controlled trial of a caregiving intervention for preterm infants born less than 33 weeks postmenstrual age. Plasma was collected with a clinically indicated laboratory draw by neonatal intensive care unit nurses and analyzed by multiplex assay for cytokines, chemokines, and growth factors. Neurobehavior was assessed by research nurses at the time of discharge from the neonatal intensive care unit using the motor development and vigor and alertness/orientation clusters from the Neurobehavioral Assessment of the Preterm Infant. Neurodevelopment was assessed at 6 months corrected age by the developmental specialist in the hospital's neonatal follow-up clinic using the Bayley Scales of Infant Development, Third Edition. We used linear regressions to estimate the effect of cytokine levels on neurodevelopment and allowed the effects to differ by infant gender and race. RESULTS In a sample of 62 preterm infants with discharge neurobehavioral assessments and a sample of 40 preterm infants with 6-month neurodevelopmental assessments, we found inconsistent associations between single-time point inflammatory measures and neurobehavior or neurodevelopment in analyses of the total sample. However, regressions with interactions revealed effects for multiple inflammatory measures on early neurobehavior and neurodevelopment that differed by infant gender and race. DISCUSSION Although early single-time point measures of inflammation may be insufficient to predict neurodevelopment for all preterm infants, the effect of inflammation appears to differ by infant gender and race. These demographic factors may be important considerations for future studies of inflammation and neurodevelopment as well was the development of future interventions to optimize outcomes.
Collapse
Affiliation(s)
- Marliese Dion Nist
- Marliese Dion Nist, PhD, RNC-NIC, is Postdoctoral Scholar, The Ohio State University College of Nursing, Columbus. Abigail B. Shoben, PhD, is Associate Professor, Division of Biostatistics, The Ohio State University College of Public Health, Columbus. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health, The Ohio State University College of Nursing, Columbus
| | | | | |
Collapse
|
53
|
Gould JF, Makrides M, Sullivan TR, Anderson PJ, Gibson RA, Best KP, McPhee AJ, Doyle LW, Opie G, Travadi J, Cheong J, Davis PG, Sharp M, Simmer K, Collins CT. Protocol for assessing whether cognition of preterm infants <29 weeks' gestation can be improved by an intervention with the omega-3 long-chain polyunsaturated fatty acid docosahexaenoic acid (DHA): a follow-up of a randomised controlled trial. BMJ Open 2021; 11:e041597. [PMID: 33550243 PMCID: PMC7925903 DOI: 10.1136/bmjopen-2020-041597] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Docosahexaenoic acid (DHA) is an omega-3 (n-3) fatty acid that accumulates into neural tissue during the last trimester of pregnancy, as the fetal brain is undergoing a growth spurt. Infants born <29 weeks' gestation are deprived the normal in utero supply of DHA during this period of rapid brain development. Insufficient dietary DHA postnatally may contribute to the cognitive impairments common among this population. This follow-up of the N-3 fatty acids for improvement in respiratory outcomes (N3RO) randomised controlled trial aims to determine if enteral DHA supplementation in infants born <29 weeks' gestation during the first months of life improves cognitive development at 5 years of age corrected for prematurity. METHODS AND ANALYSIS N3RO was a randomised controlled trial of enteral DHA supplementation (60 mg/kg/day) or a control emulsion (without DHA) in 1273 infants born <29 weeks' gestation to determine the effect on bronchopulmonary dysplasia (BPD). We showed that DHA supplementation did not reduce the risk of BPD and may have increased the risk.In this follow-up at 5 years' corrected age, a predefined subset (n=655) of children from five Australian sites will be invited to attend a cognitive assessment with a psychologist. Children will be administered the Wechsler Preschool and Primary Scale of Intelligence (fourth edition) and a measure of inhibitory control (fruit stroop), while height, weight and head circumference will be measured.The primary outcome is full-scale IQ. To ensure 90% power, a minimum of 592 children are needed to detect a four-point difference in IQ between the groups.Research personnel and families remain blinded to group assignment. ETHICS AND DISSEMINATION The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/17/WCHN/187). Caregivers will give informed consent prior to taking part in this follow-up study. Findings of this study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12612000503820.
Collapse
Affiliation(s)
- Jacqueline F Gould
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Robert A Gibson
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Karen P Best
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Lex William Doyle
- Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Jeanie Cheong
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter G Davis
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Mary Sharp
- King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Karen Simmer
- Neonatal Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Carmel T Collins
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
54
|
Toulmin H, O'Muircheartaigh J, Counsell SJ, Falconer S, Chew A, Beckmann CF, Edwards AD. Functional thalamocortical connectivity at term equivalent age and outcome at 2 years in infants born preterm. Cortex 2021; 135:17-29. [PMID: 33359978 PMCID: PMC7859832 DOI: 10.1016/j.cortex.2020.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/05/2020] [Accepted: 09/23/2020] [Indexed: 11/19/2022]
Abstract
Infants born preterm are at high risk of long-term motor and neurocognitive deficits. In the majority of these infants structural MRI at the time of normal birth does not predict motor or cognitive outcomes accurately, and many infants without apparent brain lesions later develop motor and cognitive deficits. Thalamocortical connections are known to be necessary for normal brain function; they develop during late fetal life and are vulnerable to perinatal adversity. This study addressed the hypothesis that abnormalities in the functional connectivity between cortex and thalamus underlie neurocognitive impairments seen after preterm birth. Using resting state functional connectivity magnetic resonance imaging (fMRI) in a group of 102 very preterm infants without major focal brain lesions, we used partial correlations between thalamus and functionally-derived cortical areas to determine significant connectivity between cortical areas and thalamus, and correlated the parameter estimates of these connections with standardised neurocognitive assessments in each infant at 20 months of age. Pre-motor association cortex connectivity to thalamus correlates with motor function, while connectivity between primary sensory-motor cortex and thalamus correlates with cognitive scores. These results demonstrate the importance and vulnerability of functional thalamocortical connectivity development in the perinatal period for later neurocognitive functioning.
Collapse
Affiliation(s)
- Hilary Toulmin
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK; Neurodevelopmental Service, Brookside Family Clinic, Cambridge and Peterborough NHS Foundation NHS Trust, 18 Trumpington Road, CB2 8AH, UK; Cambridgeshire Community Services NHS Trust, Peacock Centre, Brookfields Hospital, Cambridge, CB1 3DF, UK.
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK; Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK
| | - Andrew Chew
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 HC, Nijmegen, the Netherlands; Department of Clinical Neuroscience, Radboud University Medical Centre, 6500 HB, Nijmegen, the Netherlands; Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, OX3 9DU, UK
| | - A David Edwards
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK; Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| |
Collapse
|
55
|
Abstract
Continuous quality improvement (CQI) has become a vital component of newborn medicine. Applying core principles - robust measurement, repeated small tests of change, collaborative learning through data sharing - have led to improvements in care quality, safety, and outcomes in the Neonatal Intensive Care Unit (NICU). High-risk infant follow-up programs (HRIF) have historically aided such quality improvement efforts by providing outcomes data about NICU interventions. Though as a discipline, HRIF has not universally embraced CQI for its own practice. In this review, we summarize the history of CQI in neonatology and applications of improvement science in healthcare and describe examples of CQI in HRIF. We identify the need for consensus on what defines 'high-risk' and constitutes meaningful outcomes. Last, we outline four areas for future investment: establishing evidence-based care delivery systems, standardizing outcomes and their measures, embracing a family-centered approach prioritizing parent goals, and developing professional standards of care for HRIF.
Collapse
Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center Boston, 330 Brookline Avenue, Rose 3, 02215, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, 750 Welch Road, Suite 315, Palo Alto, 94034, Stanford, CA, USA; California Perinatal Quality Care Collaborative-California Children's Services High Risk Infant Follow-Up Quality of Care Initiative, San Francisco, CA, USA.
| |
Collapse
|
56
|
Barkhuizen M, Abella R, Vles JSH, Zimmermann LJI, Gazzolo D, Gavilanes AWD. Antenatal and Perioperative Mechanisms of Global Neurological Injury in Congenital Heart Disease. Pediatr Cardiol 2021; 42:1-18. [PMID: 33373013 PMCID: PMC7864813 DOI: 10.1007/s00246-020-02440-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/17/2020] [Indexed: 12/01/2022]
Abstract
Congenital heart defects (CHD) is one of the most common types of birth defects. Thanks to advances in surgical techniques and intensive care, the majority of children with severe forms of CHD survive into adulthood. However, this increase in survival comes with a cost. CHD survivors have neurological functioning at the bottom of the normal range. A large spectrum of central nervous system dysmaturation leads to the deficits seen in critical CHD. The heart develops early during gestation, and CHD has a profound effect on fetal brain development for the remainder of gestation. Term infants with critical CHD are born with an immature brain, which is highly susceptible to hypoxic-ischemic injuries. Perioperative blood flow disturbances due to the CHD and the use of cardiopulmonary bypass or circulatory arrest during surgery cause additional neurological injuries. Innate patient factors, such as genetic syndromes and preterm birth, and postoperative complications play a larger role in neurological injury than perioperative factors. Strategies to reduce the disability burden in critical CHD survivors are urgently needed.
Collapse
Affiliation(s)
- Melinda Barkhuizen
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Raul Abella
- Department of Pediatric Cardiac Surgery, University of Barcelona, Vall d'Hebron, Spain
| | - J S Hans Vles
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Luc J I Zimmermann
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Diego Gazzolo
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Fetal, Maternal and Neonatal Health, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Antonio W D Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
- Instituto de Investigación e Innovación de Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Guayaquil, Guayaquil, Ecuador.
- Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| |
Collapse
|
57
|
Jansen L, Peeters-Scholte CMPCD, van den Berg-Huysmans AA, van Klink JMM, Rijken M, van Egmond-van Dam JC, Vermeiren RRJM, Steggerda SJ. Longitudinal Follow-Up of Children Born Preterm: Neurodevelopment From 2 to 10 Years of Age. Front Pediatr 2021; 9:674221. [PMID: 34235124 PMCID: PMC8257021 DOI: 10.3389/fped.2021.674221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the rate and stability of impairments in children born preterm by assessing (1) early and school-age outcome in four developmental domains and (2) individual changes in outcome at both timepoints. Design: Prospective, longitudinal cohort study in children born in 2006-2007, <32 weeks' gestation. Follow-up at 2 and 10 years of age included standardized neurological, motor, cognitive and behavioral assessments. Children were categorized as having no, mild or moderate-severe impairment in these four domains. A composite impairment score was composed and the number of domains with impairments counted. For each child, individual outcomes at both timepoints were compared. Results: Follow-up at both time-points was available in 71/113(63%) children. At group level, there were no significant changes in the severity of impairments per domain. However, at individual level, there were less children with a mild abnormal composite score at 10 years of age (44 vs. 20%; p = 0.006), and more with a moderate-severe abnormal composite score (12 vs. 35%; p = 0.001). Especially children with normal/mild outcome at 2 years were likely to shift to other outcome categories over time. Conclusions: Children with early severe impairment are likely experiencing impairments later on, but early normal/mild abnormal outcomes should be interpreted with care, considering the large individual shifts over time. Long-term follow-up in all children born very preterm should therefore be continued to at least school-age.
Collapse
Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands.,Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Curium, Leiden, Netherlands
| | | | | | - Jeanine M M van Klink
- Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Curium, Leiden, Netherlands
| | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
58
|
Christensen LL, Baker BL. The Etiology of Oppositional Defiant Disorder for Children with and without Intellectual Disabilities: A Preliminary Analysis. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2020; 14:50-69. [PMID: 33959211 PMCID: PMC8095674 DOI: 10.1080/19315864.2020.1856242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Oppositional Defiant Disorder (ODD) appears more prevalent among children with intellectual disabilities (ID) as compared to children with typical development (Christensen et al., 2013). However, it remains unclear what drives this difference. METHODS Data from 70 youth with typical development (TD) and 20 youth with ID were drawn from The Collaborative Family Study. The relationships between child temperament and parent psychopathology (age 3), parenting behavior and child behavior problems (age 5), and ODD diagnosis (age 13) were explored via structural equation modeling. The predicted model was examined in the total sample, among children with and without ID separately, and with status (TD vs. ID) as a predictor. CONCLUSION Many of the predicted relationships hold true for youth with and without ID. However, we found an unexpected relationship between negative-controlling parenting and child externalizing behavior problems for children with ID. The positive role of parental intrusiveness for children with ID is discussed, although limitations are noted due to the small sample size and preliminary nature of this study.
Collapse
Affiliation(s)
- Lisa L Christensen
- USC University Center for Excellence in Developmental Disabilities at Children's Hospital Los Angeles
| | | |
Collapse
|
59
|
Legros L, Zaczek S, Vaivre-Douret L, Mostaert A. Concurrent and predictive validity of the Motor Functional Development Scale for Young Children in preterm infants. Early Hum Dev 2020; 151:105240. [PMID: 33160163 DOI: 10.1016/j.earlhumdev.2020.105240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Motor Functional Development Scale for Young Children (DF-mot) is a developmental tool assessing both gross and fine motor skills in term infants. AIMS To examine the concurrent validity of the DF-mot with the Alberta Infants Motor Scale (AIMS) in preterm infants and compare their ability in predicting scores on the Bayley Scales of Infant-Toddler Development (Bayley-III) at 12 months. STUDY DESIGN Retrospective cohort study. SUBJECTS AND OUTCOME MEASURES Hundred and eleven infants born at less than 32 weeks' gestation or with a birthweight less than 1500 g were assessed simultaneously on the DF-mot and the AIMS at age 3-5 months. Correlation analysis was used to determine the strength of association between the DF-mot and the AIMS. Among these, 62 were reassessed on the Bayley-III at age 9-12 months. Clinimetric properties were calculated to evaluate their ability to predict motor delay on the Bayley-III. RESULTS The concurrent validity study found a good level of correlation between the two scales (r = 0.79). The predictive validity study showed good sensitivity and negative predictive value for the AIMS 25th centile and the DF-mot -1 standard deviation to predict motor delay at 12 months (respectively Se = 100% and 84%; NPV = 100% and 77.8%). CONCLUSIONS The DF-mot is a valid instrument with good predictive validity in preterm infants, suggesting it can be used as a clinical useful tool to assess motor development.
Collapse
Affiliation(s)
- Ludovic Legros
- Departement of Neonatal Intensive Care, CHR Sambre et Meuse, 5000 Namur, Belgium.
| | - Sophie Zaczek
- Follow-up Center for preterm infants, CHR Sambre et Meuse, 5000 Namur, Belgium
| | - Laurence Vaivre-Douret
- Faculty of Health, Division of Medicine Paris Descartes, Université de Paris, 75006 Paris, France; Inserm UMR 1018-CESP, University of Paris Sud-Paris Saclay, UVSQ, 94800 Villejuif, France; Department of Child Psychiatry, Necker - Enfants-Malades University Hospital, AP-HP, 75015 Paris, France; Department of Pediatrics, Paris Center Port Royal-Cochin Hospital, AP-HP, 75014 Paris, France; Institut Universitaire de France (IUF), 75005 Paris, France
| | - Anne Mostaert
- Departement of Neonatal Intensive Care, CHR Sambre et Meuse, 5000 Namur, Belgium; Follow-up Center for preterm infants, CHR Sambre et Meuse, 5000 Namur, Belgium
| |
Collapse
|
60
|
Han S, Kim O, Yoo C, Heo JS, Lee HS, Jeon J. Neurodevelopmental Correlations between the Korean Developmental Screening Test and Bayley Scale III in Very-Low-Birth-Weight Infants. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.4.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
61
|
Flynn RS, Huber MD, DeMauro SB. Predictive Value of the BSID-II and the Bayley-III for Early School Age Cognitive Function in Very Preterm Infants. Glob Pediatr Health 2020; 7:2333794X20973146. [PMID: 33283025 PMCID: PMC7683841 DOI: 10.1177/2333794x20973146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/16/2020] [Accepted: 10/12/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the predictive validity of the Bayley Scales of Infant Development, Second Edition (BSID-II) and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) for cognitive function at early school age in very preterm infants. Methods Seventy-seven former preterm infants (born <32 weeks gestation and ≤2000 g) completed both the BSID-II and the Bayley-III at 2 years corrected age. Children enrolled at hospitals that perform follow-up beyond 2 years had cognitive assessments with the Wechsler Preschool and Primary Scale of Intelligence Fourth Edition (WPPSI-IV). Associations between Bayley and WPPSI scores were assessed using correlation coefficients, linear regression, and Bland-Altman plots. Results Thirty-one of 45 eligible children were tested with the WPPSI-IV at 47 ± 11 months. Average BSID-II Mental Development Index (MDI) was 86 ± 19, Bayley-III Cognitive composite score was 101 ± 12 and WPPSI Full Scale IQ (FSIQ) was 96 ± 12. Correlation between MDI and FSIQ was 0.54 (P < .001); correlation between Bayley-III cognitive composite score and FSIQ was 0.31 (P = .03). Bayley-III language composite had a modestly stronger correlation with FSIQ than cognitive composite (correlation coefficient 0.39; P = .005). Linear regression models also demonstrated that BSID-II was more closely correlated with FSIQ than Bayley-III. This bias was consistent across the full range of scores. Conclusion The BSID-II underestimated FSIQ and the Bayley-III overestimated FSIQ. Children at risk for impairment might be missed with the Bayley-III. As the Bayley-4 is introduced, clinicians and researchers should be cautious about interpretation of scores until performance of this new measure is fully understood.
Collapse
Affiliation(s)
- Rachel S Flynn
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sara B DeMauro
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
62
|
Barnes-Davis ME, Merhar SL, Holland SK, Parikh NA, Kadis DS. Extremely Preterm Children Demonstrate Interhemispheric Hyperconnectivity During Verb Generation: a Multimodal Approach. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.10.30.20222448. [PMID: 33173877 PMCID: PMC7654860 DOI: 10.1101/2020.10.30.20222448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children born extremely preterm (EPT, <28 weeks gestation) are at risk for delays in development, including language. We use fMRI-constrained magnetoencephalography (MEG) during a verb generation task to assess the extent and functional connectivity (phase locking value, or PLV) of language networks in a large cohort of EPT children and their term comparisons (TC). 73 participants, aged 4 to 6 years, were enrolled (42 TC, 31 EPT). There were no significant group differences in age, sex, race, ethnicity, parental education, or family income. There were significant group differences in expressive language scores (p<0.05). Language representation was not significantly different between groups on fMRI, with task-specific activation involving bilateral temporal and left inferior frontal cortex. There were group differences in functional connectivity seen in MEG. To identify a possible subnetwork contributing to focal spectral differences in connectivity, we ran Network Based Statistics analyses. For both beta (20-25 Hz) and gamma (61-70 Hz) bands, we observed a subnetwork showing hyperconnectivity in the EPT group (p<0.05). Network strength was computed for the beta and gamma subnetworks and assessed for correlation with language performance. For the EPT group, exclusively, strength of the subnetwork identified in the gamma frequency band was positively correlated with expressive language scores (r=0.318, p<0.05). Thus, interhemispheric hyperconnectivity is positively related to language for EPT children and might represent a marker for resiliency in this population.
Collapse
Affiliation(s)
- Maria E. Barnes-Davis
- Cincinnati Children’s Hospital Medical Center, Perinatal Institute
- University of Cincinnati, Department of Pediatrics
- University of Cincinnati, Department of Neuroscience
| | - Stephanie L. Merhar
- Cincinnati Children’s Hospital Medical Center, Perinatal Institute
- University of Cincinnati, Department of Pediatrics
| | - Scott K. Holland
- Medpace Imaging Core Laboratory, Medpace Inc
- University of Cincinnati, Department of Physics
| | - Nehal A. Parikh
- Cincinnati Children’s Hospital Medical Center, Perinatal Institute
- University of Cincinnati, Department of Pediatrics
| | - Darren S. Kadis
- Hospital for Sick Children, Neurosciences and Mental Health
- University of Toronto, Department of Physiology
| |
Collapse
|
63
|
Neurodevelopmental evaluation strategies for children with congenital heart disease aged birth through 5 years: recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 2020; 30:1609-1622. [PMID: 33143781 DOI: 10.1017/s1047951120003534] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper provides specific guidelines for the neurodevelopmental evaluation of children aged birth through 5 years with complex congenital heart disease. There is wide recognition that children with congenital heart disease are at high risk for neurodevelopmental impairments that are first apparent in infancy and often persist as children mature. Impairments among children with complex congenital heart disease cross developmental domains and affect multiple functional abilities. The guidelines provided are derived from the substantial body of research generated over the past 30 years describing the characteristic developmental profiles and the long-term trajectories of children surviving with complex congenital heart conditions. The content and the timing of the guidelines are consistent with the 2012 American Heart Association and the American Academy of Pediatrics scientific statement documenting the need for ongoing developmental monitoring and assessment from infancy through adolescence. The specific guidelines offered in this article were developed by a multidisciplinary clinical research team affiliated with the Cardiac Neurodevelopmental Outcome Collaborative, a not-for-profit organisation established to determine and implement best neurodevelopmental practices for children with congenital heart disease. The guidelines are designed for use in clinical and research applications and offer an abbreviated core protocol and an extended version that expands the scope of the evaluation. The guidelines emphasise the value of early risk identification, use of evidence-based assessment instruments, consideration of family and cultural preferences, and the importance of providing multidimensional community-based services to remediate risk.
Collapse
|
64
|
Dewan MV, Serdar M, van de Looij Y, Kowallick M, Hadamitzky M, Endesfelder S, Fandrey J, Sizonenko SV, Herz J, Felderhoff-Müser U, Bendix I. Repetitive Erythropoietin Treatment Improves Long-Term Neurocognitive Outcome by Attenuating Hyperoxia-Induced Hypomyelination in the Developing Brain. Front Neurol 2020; 11:804. [PMID: 32903382 PMCID: PMC7434837 DOI: 10.3389/fneur.2020.00804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/29/2020] [Indexed: 01/29/2023] Open
Abstract
Introduction: Preterm infants born before 28 weeks of gestation are at high risk of neurodevelopmental impairment in later life. Cerebral white and gray matter injury is associated with adverse outcomes. High oxygen levels, often unavoidable in neonatal intensive care, have been identified as one of the main contributing factors to preterm brain injury. Thus, preventive and therapeutic strategies against hyperoxia-induced brain injury are needed. Erythropoietin (Epo) is a promising and also neuroprotective candidate due to its clinical use in infants as erythropoiesis-stimulating agent. Objective: The objective of this study was to investigate the effects of repetitive Epo treatment on the cerebral white matter and long-term motor-cognitive outcome in a neonatal rodent model of hyperoxia-induced brain injury. Methods: Three-day old Wistar rats were exposed to hyperoxia (48 h, 80% oxygen). Four doses of Epo (5,000 IU/kg body weight per day) were applied intraperitoneally from P3-P6 with the first dose at the onset of hyperoxia. Oligodendrocyte maturation and myelination were evaluated via immunohistochemistry and Western blot on P11. Motor-cognitive deficits were assessed in a battery of complex behavior tests (Open Field, Novel Object Recognition, Barnes maze) in adolescent and fully adult animals. Following behavior tests animals underwent post-mortem diffusion tensor imaging to investigate long-lasting microstructural alterations of the white matter. Results: Repetitive treatment with Epo significantly improved myelination deficits following neonatal hyperoxia at P11. Behavioral testing revealed attenuated hyperoxia-induced cognitive deficits in Epo-treated adolescent and adult rats. Conclusion: A multiple Epo dosage regimen protects the developing brain against hyperoxia-induced brain injury by improving myelination and long-term cognitive outcome. Though current clinical studies on short-term outcome of Epo-treated prematurely born children contradict our findings, long-term effects up to adulthood are still lacking. Our data support the essential need for long-term follow-up of preterm infants in current clinical trials.
Collapse
Affiliation(s)
- Monia Vanessa Dewan
- Department of Paediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Meray Serdar
- Department of Paediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Yohan van de Looij
- Division of Child Development and Growth, Department of Paediatrics, School of Medicine, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, Animal Imaging and Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mirjam Kowallick
- Department of Paediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Martin Hadamitzky
- Institute of Medical Psychology and Behavioural Immunobiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Joachim Fandrey
- Institute of Physiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stéphane V. Sizonenko
- Division of Child Development and Growth, Department of Paediatrics, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Josephine Herz
- Department of Paediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Paediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ivo Bendix
- Department of Paediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
65
|
Barnes-Davis ME, Williamson BJ, Merhar SL, Holland SK, Kadis DS. Extremely preterm children exhibit altered cortical thickness in language areas. Sci Rep 2020; 10:10824. [PMID: 32616747 PMCID: PMC7331674 DOI: 10.1038/s41598-020-67662-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022] Open
Abstract
Children born extremely preterm (< 28 weeks gestation, EPT) are at increased risk for language and other neurocognitive deficits compared to term controls (TC). Prior studies have reported both increases and decreases in cortical thickness in EPT across the cerebrum. These studies have not formally normalized for intracranial volume (ICV), which is especially important as EPT children often have smaller stature, head size, and ICV. We previously reported increased interhemispheric functional and structural connectivity in a well-controlled group of school-aged EPT children with no known brain injury or neurological deficits. Functional and structural hyperconnectivity between left and right temporoparietal regions was positively related with language scores in EPT, which may be reflected in measures of cortical thickness. To characterize possible language network cortical thickness effects, 15 EPT children and 15 TC underwent standardized assessments of language and structural magnetic resonance imaging at 4 to 6 years of age. Images were subjected to volumetric and cortical thickness analyses using FreeSurfer. Whole-brain analyses of cortical thickness were conducted both with and without normalization by ICV. Non-normalized results showed thinner temporal cortex for EPT, while ICV-normalized results showed thicker cortical regions in the right temporal lobe (FDRq = 0.05). Only ICV-normalized results were significantly related to language scores, with right temporal cortical thickness being positively correlated with performance.
Collapse
Affiliation(s)
- Maria E Barnes-Davis
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA. .,Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
| | | | - Stephanie L Merhar
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA.,Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Scott K Holland
- Medpace Imaging Core Laboratory, Medpace Inc, Cincinnati, USA.,Department of Physics, University of Cincinnati, Cincinnati, USA
| | - Darren S Kadis
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
| |
Collapse
|
66
|
Hadders‐Algra M, Tacke U, Pietz J, Rupp A, Philippi H. Standardized Infant NeuroDevelopmental Assessment developmental and socio-emotional scales: reliability and predictive value in an at-risk population. Dev Med Child Neurol 2020; 62:845-853. [PMID: 31837010 PMCID: PMC7317584 DOI: 10.1111/dmcn.14423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 01/05/2023]
Abstract
AIM To assess the reliability and predictive validity of the developmental and socio-emotional scales of the Standardized Infant NeuroDevelopmental Assessment (SINDA). METHOD To assess reliability, two sets of three assessors forming eight assessor-pairs independently rated the developmental and socio-emotional scales of 60 infants. To evaluate predictive validity, 223 infants (gestational age 30wks [range 23-41wks]; 117 males, 106 females) attending a non-academic outpatient clinic were assessed by different assessors with SINDA's neurological, developmental, and socio-emotional scales. Atypical neurodevelopmental outcome at a corrected age of 24 months or older implied a Bayley Mental or Psychomotor Developmental Index score of less than 70 or neurological disorder (including cerebral palsy). Behavioural and emotional disorders were classified according to the International Classification of Diseases, 10th Revision. Predictive values were calculated from SINDA (2-12mo corrected age, median 7mo) and typical versus atypical outcome, and for intellectual disability only (Mental Developmental Index <70). RESULTS Assessors highly agreed on the developmental and socio-emotional assessments (developmental scores: Spearman's rank correlation coefficient ρ=0.972; single socio-emotional behaviour items: Cohen's κ=0.783-0.896). At 24 months or older, 65 children had atypical outcome. Atypical neurological scores predicted atypical outcome (sensitivity 83%, specificity 96%); atypical developmental scores predicted intellectual disability (sensitivity 77%, specificity 92%). Atypical emotionality and atypical self-regulation were associated with behavioural and emotional disorders. INTERPRETATION SINDA's three scales are reliable, and have a satisfactory predictive validity for atypical developmental outcome at 24 months or older in a non-academic outpatient setting. SINDA's developmental scale has promising predictive validity for intellectual disability. SINDA's socio-emotional scale is a tool for caregiver counselling. WHAT THIS PAPER ADDS Standardized Infant NeuroDevelopmental Assessment (SINDA)'s developmental and socio-emotional scales have excellent interrater reliability. Replication of the satisfactory validity of SINDA's neurological scale for atypical outcome.
Collapse
Affiliation(s)
- Mijna Hadders‐Algra
- University of GroningenUniversity Medical Center GroningenDepartment of PaediatricsDivision of Developmental NeurologyGroningenthe Netherlands
| | - Uta Tacke
- University Children’s Hospital (UKBB)BaselSwitzerland
| | - Joachim Pietz
- Palliative Care Team for Children and AdolescentsFrankfurtGermany
| | - André Rupp
- Department of NeurologySection of BiomagnetismUniversity of HeidelbergHeidelbergGermany
| | - Heike Philippi
- Centre for Child NeurologyGoethe UniversityFrankfurt am MainGermany
| |
Collapse
|
67
|
Çelik P, Ayranci Sucakli I, Yakut HI. Which Bayley-III cut-off values should be used in different developmental levels? Turk J Med Sci 2020; 50:764-770. [PMID: 31905494 PMCID: PMC7379406 DOI: 10.3906/sag-1910-69] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/02/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim Latest version of Bayley Scales (Bayley-III) and its predecessor (BSID-II) are the most widely used standardized developmental tools in infancy and early childhood. Recent studies showed that Bayley-III scores were higher than BSID-II in 18–24 month-old and mostly premature infants. We aimed to evaluate the generalization of inflated scores of Bayley-III to children aged 6–42 months with different disease groups, and to find out which cut-off points should be used in Bayley-III to detect mild, moderate, and severe developmental delay according to BSID-II standard cut-off points. Materials and methods Two hundred and fifty-five children aged 6–42 months with different diseases and developmental levels were administered both the Bayley-III and BSID-II in the same session between 15 November 2017 and 15 April 2018. Results The mean Bayley-III Cognitive Composite (CC) and Cognitive Language Composite (CLC) scores were respectively 13.1 ± 9.1 and 8.6 ± 8 points higher than BSID-II Mental Development Index (MDI) scores (P < 0.001). The mean Bayley-III Motor Composite (MC) scores were 14.4 ± 10.5 points higher than BSID-II Psychomotor Developmental Index (PDI) scores (P < 0.001). Cognitive delay was found in 126 (49.4%) and 59 (23.1%) children according to BSID-II MDI and Bayley-III CC scores, respectively. Motor delay was found in 174 (69.3%) and 86 (34.3%) children according to the BSID-II PDI and Bayley-III MC scores, respectively. Children had less cognitive (48.6%) and motor delay (54.5%) according to Bayley-III scores. Bayley-III scores were significantly higher than BSID-II scores for all ages (P < 0.001). According to ROC analysis the cut-off scores for mild, moderate, and severe delay were 92.5, 83.2, and 71.2 for Bayley-III CLC; and 98.5, 86.5, and 74.5 for Bayley-III MC, respectively. Conclusion Bayley-III scores should be interpreted carefully for all age ranges and different diagnosis. The risk for underestimation of developmental delays by Bayley-III should be kept in mind. Different Bayley-III cut-off scores should be used to define developmental delay levels.
Collapse
Affiliation(s)
- Pelin Çelik
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Iclal Ayranci Sucakli
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Ankara City Hospital, Ankara, Turkey
| | | |
Collapse
|
68
|
WORLEY GORDON, ERICKSON STEPHENW, GUSTAFSON KATHRYNE, NIKOLOVA YULIYAS, ASHLEY-KOCH ALLISONE, BELSKY DANIELW, GOLDSTEIN RICKIF, LEVY JOSHUAL, MCDONALD SCOTTA, PAGE GRIERP, COTTEN CMICHAEL. Genetic variation in dopamine neurotransmission and motor development of infants born extremely-low-birthweight. Dev Med Child Neurol 2020; 62:750-757. [PMID: 31691959 PMCID: PMC7200269 DOI: 10.1111/dmcn.14383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/31/2022]
Abstract
AIM To determine if genetic variation associated with decreased dopamine neurotransmission predicts a decrease in motor development in a convenience cohort study of infants born extremely-low-birthweight (ELBW). METHOD Four hundred and ninety-eight infants born ELBW had genome-wide genotyping and a neurodevelopmental evaluation at 18 to 22 months of age, corrected for preterm birth. A polygenic risk score (PRS) was created to combine into one predictor variable the hypothesized influences on motor development of alleles at seven independent single nucleotide polymorphisms previously associated with relative decreases in both dopamine neurotransmission and motor learning, by summing the number of alleles present in each infant (range=0-14). The motor development outcome was the Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development, Second Edition. The linear regression models were adjusted for seven clinical and four genetic ancestry covariates. The mean PRS of infants with cerebral palsy (CP) was compared to those without CP. RESULTS PRS was inversely related to PDI (p=0.011). Each 1-point increase in PRS resulted in an average decrease in PDI of 1.37 points. Patients with CP did not have a greater mean PRS than those without (p=0.67), both with and without adjustment for covariates. INTERPRETATION Genetic variation that favors a decrease in dopamine neurotransmission predisposes to a decrease in motor development in infants born ELBW, but not to the diagnosis of CP. WHAT THIS PAPER ADDS Genetic variation in dopamine neurotransmission was associated with a decrease in motor development in infants born at an extremely-low-birthweight. It does not predispose to the diagnosis of cerebral palsy.
Collapse
Affiliation(s)
- GORDON WORLEY
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University Medical Center, Durham, N.C. U.SA
| | - STEPHEN W ERICKSON
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, N.C., U.S.A
| | - KATHRYN E GUSTAFSON
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham N.C., U.S.A
| | - YULIYA S NIKOLOVA
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - ALLISON E ASHLEY-KOCH
- Duke Molecular Physiology Institute, Department of Medicine, Duke University Medical Center, Durham N.C., U.S.A
| | - DANIEL W BELSKY
- Department of Population Health Sciences, Duke University, Durham N.C., U.S.A
| | - RICKI F GOLDSTEIN
- Division of Neonatology, Department of Pediatrics, Kentucky Children’s Hospital, University of Kentucky Chandler Medical Center, Lexington, K.Y., U.S.A
| | - JOSHUA L LEVY
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, N.C., U.S.A
| | - SCOTT A MCDONALD
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, N.C., U.S.A
| | - GRIER P PAGE
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, N.C., U.S.A
| | - C MICHAEL COTTEN
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham N.C., U.S.A
| | | |
Collapse
|
69
|
Veen S, Wassenaer‐Leemhuis AG, Oosterlaan J, Kaam AH, Aarnoudse‐Moens CSH. Eight-year-old very and extremely preterm children showed more difficulties in performance intelligence than verbal intelligence. Acta Paediatr 2020; 109:1175-1183. [PMID: 31742749 PMCID: PMC7317900 DOI: 10.1111/apa.15095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 02/03/2023]
Abstract
Aim This study determined possible discrepancies between verbal IQ and performance IQ in 8‐year‐old very preterm (VPT) and extremely preterm (EPT) children, and examined associations between verbal IQ and performance IQ, and sociodemographic factors, perinatal factors, early cognitive outcomes and also with school achievement scores. Methods This prospective cohort study included 120 eight‐year‐old VPT/EPT children. Cognitive development was assessed at the ages of 2, 5 and 8 years. Eight years’ school achievement results in arithmetic, reading and spelling were collected. Multiple regression analyses were performed to determine predictors of verbal IQ and performance IQ at the age of 8 years and to determine associations with school achievement scores. Results Mean performance IQ (89.8) was significantly lower than mean verbal IQ (99.4; Cohen's d = 0.59) at the age of 8 years. Gestational age (GA), small for GA status, and cognitive scores at the ages of 2 and 5 years significantly predicted verbal IQ and performance IQ at the age of 8 years. Performance IQ at age 8 years was an important predictor for arithmetic scores (β = 0.42). Conclusion Performance IQ was more strongly affected than verbal IQ in 8‐year‐old VPT/EPT children and was strongly related to mathematical difficulties.
Collapse
Affiliation(s)
- Sarit Veen
- Department of Neonatology Emma Children’s Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Department of Pediatrics Amsterdam Reproduction and Development Amsterdam UMC Emma Neuroscience Group at Emma Children’s Hospital University of Amsterdam & Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Aleid G. Wassenaer‐Leemhuis
- Department of Neonatology Emma Children’s Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics Amsterdam Reproduction and Development Amsterdam UMC Emma Neuroscience Group at Emma Children’s Hospital University of Amsterdam & Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Clinical Neuropsychology Section Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Anton H. Kaam
- Department of Neonatology Emma Children’s Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Cornelieke S. H. Aarnoudse‐Moens
- Department of Neonatology Emma Children’s Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Department of Pediatrics Amsterdam Reproduction and Development Amsterdam UMC Emma Neuroscience Group at Emma Children’s Hospital University of Amsterdam & Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Clinical Neuropsychology Section Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Psychosocial Department Emma Children’s Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| |
Collapse
|
70
|
Litt JS, Edwards EM, Lainwala S, Mercier C, Montgomery A, O’Reilly D, Rhein L, Woythaler M, Hartman T. Optimizing High-risk Infant Follow-up in Nonresearch-based Paradigms: The New England Follow-up Network. Pediatr Qual Saf 2020; 5:e287. [PMID: 32656462 PMCID: PMC7297406 DOI: 10.1097/pq9.0000000000000287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/18/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To establish the first regional quality improvement collaborative solely dedicated to follow-through care of high-risk infants after Neonatal intensive care unit (NICU) discharge and to characterize extremely low birth weight (ELBW) follow-up in New England. METHODS Eleven of 14 follow-up programs in New England partnered with the Vermont Oxford Network (VON) ELBW project for an initial data collection project. We collected information about the health status and developmental outcomes of infants born ≤1,000 g or younger than 28 weeks 2014-2016 at the 18-24 months corrected for gestational age (CGA) follow-up visit. VON collected and compiled the data. RESULTS Of 993 eligible infants, 516 (52.0%) had follow-up visits. The rehospitalization rate was 33.9%, mostly respiratory illness. Ninety-six children (19.3%) had weight less than 10th percentile and 44 (8.9%) had weight less than third percentile at 18-24 months. Only 170 (61.4%) children had recommended hearing screening after NICU discharge. Forty-six (9.1%) had cerebral palsy; 81 of the 441 infants that completed all 3 sections of the Bayley Scales of Infant Development, third edition (18.4%) had any composite score less than 70. Over half of the social and demographic data were missing. CONCLUSION Most quality initiatives in neonatology stop at NICU discharge. This first project by the New England Follow-up Network showed a low rate for clinical follow-up. It demonstrated many opportunities to improve postdischarge follow-through specific to NICU-based care. Future projects will aim to improve the quality of follow-through services through collaborative learning, data sharing, and comparative outcomes.
Collapse
Affiliation(s)
- Jonathan S. Litt
- From the Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Mass
| | | | - Shabnam Lainwala
- Division of Neonatology, Connecticut Children’s Hospital, Hartford, Conn
| | - Charles Mercier
- Vermont Oxford Network, Burlington, Vt
- Division of Neonatology, University of Vermont Medical Center, Burlington, Vt
| | - Angela Montgomery
- Division of Neonatology, Yale-New Haven Children’s Hospital, New Haven, Conn
| | - Deirdre O’Reilly
- Division of Neonatology, University of Vermont Medical Center, Burlington, Vt
| | - Lawrence Rhein
- Division of Neonatology, UMASS Memorial Medical Center, Worcester, Mass
| | - Melissa Woythaler
- Division of Neonatology, Massachusetts General Hospital for Children, Boston, Mass
| | - Tyler Hartman
- Division of Neonatology, Children’s Hospital at Dartmouth, Lebanon, N.H
| |
Collapse
|
71
|
Cimon-Paquet C, Bernier A, Matte-Gagné C, Mageau GA. Early maternal autonomy support and mathematical achievement trajectories during elementary school. LEARNING AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.lindif.2020.101855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
72
|
Schonhaut L, Pérez M, Armijo I, Maturana A. Comparison between Ages & Stages Questionnaire and Bayley Scales, to predict cognitive delay in school age. Early Hum Dev 2020; 141:104933. [PMID: 31775095 DOI: 10.1016/j.earlhumdev.2019.104933] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the predictive value of the Spanish Ages & Stages Questionnaire third edition adapted for Chilean population (ASQ-Cl) and the Bayley Scale of Infant and Toddler Development 3rd edition (Bayley-III) for cognitive delay at school age, and to identify the domain predictors. METHODOLOGY Data were collected from 306 term and preterm children of medium-high socio-economic level enrolled in a prospective cohort study. Developmental outcomes at 8, 18 and 30 months were assessed via the ASQ-Cl and Bayley-III; at 6-8 years cognitive development was assessed using the Wechsler Intelligence Scale for Children (WISC-III). The area under the curve (AUC), sensitivity, specificity and predictive values were calculated, and logistic regression analysis was used. RESULTS Of 227 children studied, 6.6% had cognitive delay. ASQ-Cl and Bayley-III generate equivalent AUC [0.77 and 0.80]. Sensitivity 67% and 53%; specificity of 72% and 88%, positive predictive value of 14% and 24%, negative predictive values of 97% and 96% respectively. Greater predictive validity was obtained at 30 months assessment. Deficit in the communication and gross motor skills and problem-solving domains of the ASQ-Cl and all the Bayley-III domains were significantly associated with cognitive delay. CONCLUSIONS ASQ-Cl can be used to identify children at risk for cognitive delay at 6-8 years of age, being comparable with the Bayley-III. Some domains of ASQ-Cl and all domains of Bayley-III were significant predictors for cognitive delay. These results support the use of ASQ-Cl as a screening tool for developmental delay.
Collapse
Affiliation(s)
- Luisa Schonhaut
- Clinica Alemana, Santiago, Chile; Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile.
| | - Marcela Pérez
- Clinica Alemana, Santiago, Chile; Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile
| | - Iván Armijo
- Faculty of Psychology, Universidad del Desarrollo, Santiago, Chile
| | - Andrés Maturana
- Clinica Alemana, Santiago, Chile; Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile
| |
Collapse
|
73
|
Christensen L, Baker BL. Risk-Taking and Delinquent Behaviors Among Youth with and without Intellectual Disabilities. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2020; 13:1-24. [PMID: 32351658 PMCID: PMC7189909 DOI: 10.1080/19315864.2019.1710786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Youth with intellectual disabilities (ID) demonstrate higher rates of disruptive behavior disorders (DBDs) than youth with typical development (TD). DBDs such as oppositional defiant disorder (ODD) predict higher rates of delinquency during adolescence. Yet, few studies have examined risk-taking and delinquency among youth with ID. METHODS We used a self-report measure to determine whether 13-year-old youth with ID (n= 23) reported higher rates of risk-taking and delinquent behavior than their TD peers (n=77). We also examined whether or not youth had a previous diagnosis of ODD. RESULTS Our results suggest that youth with ID reported fewer rule-breaking and risk-taking behaviors than their TD peers. In contrast, youth with a previous diagnosis of ODD reported more of these behaviors. CONCLUSION Our results appear discrepant from previous studies, which find higher rates of risk-taking and delinquency among youth with ID. As such, we discuss the factors that may explain our discrepant results, including our definition and assessment of ID, and the age of our participants.
Collapse
Affiliation(s)
- Lisa Christensen
- USC University Center of Excellence in Developmental Disabilities - Children's Hospital Los Angeles
| | | |
Collapse
|
74
|
Barnes-Davis ME, Williamson BJ, Merhar SL, Holland SK, Kadis DS. Rewiring the extremely preterm brain: Altered structural connectivity relates to language function. Neuroimage Clin 2020; 25:102194. [PMID: 32032818 PMCID: PMC7005506 DOI: 10.1016/j.nicl.2020.102194] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/26/2022]
Abstract
Children born preterm are at increased risk for cognitive impairment, with higher-order functions such as language being especially vulnerable. Previously, we and others have reported increased interhemispheric functional connectivity in children born extremely preterm; the finding appears at odds with literature showing decreased integrity of the corpus callosum, the primary commissural bundle, in preterm children. We address the apparent discrepancy by obtaining advanced measures of structural connectivity in twelve school-aged children born extremely preterm (<28 weeks) and ten term controls. We hypothesize increased extracallosal structural connectivity might support the functional hyperconnectivity we had previously observed. Participants were aged four to six years at time of study and groups did not differ in age, sex, race, ethnicity, or socioeconomic status. Whole-brain and language-network-specific (functionally-constrained) connectometry analyses were performed. At the whole-brain level, preterm children had decreased connectivity in the corpus callosum and increased connectivity in the cerebellum versus controls. Functionally-constrained analyses revealed significantly increased extracallosal connectivity between bilateral temporal regions in preterm children (FDRq <0.05). Connectivity within these extracallosal pathways was positively correlated with performance on standardized language assessments in children born preterm (FDRq <0.001), but unrelated to performance in controls. This is the first study to identify anatomical substrates for increased interhemispheric functional connectivity in children born preterm; increased reliance on an extracallosal pathway may represent a biomarker for resiliency following extremely preterm birth.
Collapse
Affiliation(s)
- Maria E Barnes-Davis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, United States; Department of Pediatrics, University of Cincinnati College of Medicine, United States.
| | - Brady J Williamson
- Department of Psychology, University of Cincinnati, United States; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, United States
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, United States; Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Scott K Holland
- Department of Physics, University of Cincinnati, United States; Medpace Imaging Core Laboratory, Medpace Inc., United States
| | - Darren S Kadis
- Neurosciences and Mental Health Research Institute, Hospital for Sick Children, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Canada
| |
Collapse
|
75
|
Wang X, Carroll X, Wang H, Zhang P, Selvaraj JN, Leeper-Woodford S. Prediction of Delayed Neurodevelopment in Infants Using Brainstem Auditory Evoked Potentials and the Bayley II Scales. Front Pediatr 2020; 8:485. [PMID: 32974249 PMCID: PMC7472886 DOI: 10.3389/fped.2020.00485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Brainstem auditory evoked potentials (BAEP) provide an objective analysis of central nervous system function and development in infants. This study proposed to examine the relationship between infant BAEP values at age 6 months, and their neurodevelopment at age 2 years assessed by the mental development indices (MDI), a form of Bayley Scales of Infant Development. We hypothesized that in infants with BAEP values outside normal range, there may be neurodevelopmental delays, as shown by their MDI scores. Methods: An exploratory investigation was conducted using preterm (28-36 weeks gestation; 95 cases) and term infants (≥37 weeks gestation; 100 cases) who were born with specific perinatal conditions. BAEP values were recorded in these infants from 1 to 8 months of age, and compared with MDI scores in these infants at age 2 years. A multivariate linear regressions model was performed to test the associations between all variables and MDI scores. Stratified linear regression was used to test the interactions between gestational age and BAEP values with MDI scores. Significance was determined at a p < 0.05. Results: We found that BAEP values were inversely associated with MDI scores in premature infants (β = -1.89; 95% confidence interval = -3.42 to -0.36), and that the effect of gestational age and BAEP values on the MDI scores is decreased by 1.89 points due to the interaction between these two variables. In premature babies, the lower the BAEP value below the mean, the greater the decrease in MDI score at age 2 years. Asphyxia and lower socioeconomic status in the family were also covariates associated with lower MDI scores at age 2 years. Conclusion: The data provided evidence that BAEP values outside the normal range in premature infants at age 6 months may predict developmental delays in cognitive and motor skills, as shown by MDI scores. We propose that BAEP assessment may be utilized as a potential indicator for neurodevelopment, and suggest that early intellectual and public health interventions should be encouraged to enrich neurodevelopment in premature babies with BAEP values outside the normal range.
Collapse
Affiliation(s)
- Xiaoyan Wang
- Department of Child Health, Hubei Maternal and Child Health Hospital, Wuhan, China
| | - Xianming Carroll
- Department of Public Health, Mercer University College of Health Professions, Atlanta, GA, United States
| | - Hong Wang
- Department of Child Health, Hubei Maternal and Child Health Hospital, Wuhan, China
| | - Ping Zhang
- Department of Child Health, Hubei Maternal and Child Health Hospital, Wuhan, China
| | | | - Sandra Leeper-Woodford
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA, United States
| |
Collapse
|
76
|
Impact of tracheostomy on language and cognitive development in infants with severe bronchopulmonary dysplasia. J Perinatol 2020; 40:299-305. [PMID: 31659237 PMCID: PMC7222892 DOI: 10.1038/s41372-019-0540-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/01/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The impact of tracheostomy on language and cognitive development in infants with severe bronchopulmonary dysplasia (BPD) is not known. We hypothesize that tracheostomy has an independent negative impact on language and cognitive development in infants with severe BPD. STUDY DESIGN This is a retrospective cohort study of de-identified data of infants with severe BPD who received tracheostomy at <2 years of age, compared with infants with severe BPD without tracheostomy. The primary outcomes measured were total language and cognitive scores at 2-3 years of age as determined by Bayley Scales of Infant and Toddler Development, 3rd Edition. RESULTS A total of 26 patients with tracheostomies and 28 patients without tracheostomies were analyzed. There was no significant difference in total language development or cognitive development between patients with tracheostomies and those without. Insurance status had an effect on language and cognition while controlling for trach status. CONCLUSIONS Tracheostomy does not independently impact the language and cognitive development of infants with severe BPD.
Collapse
|
77
|
Hou W, Tang PH, Agarwal P. The most useful cranial ultrasound predictor of neurodevelopmental outcome at 2 years for preterm infants. Clin Radiol 2019; 75:278-286. [PMID: 31870490 DOI: 10.1016/j.crad.2019.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 11/20/2019] [Indexed: 12/01/2022]
Abstract
AIM To determine the most important cranial ultrasound predictors of abnormality associated with neurodevelopmental outcome at 2 years of age in preterm infants. MATERIALS AND METHODS A total of 343 preterm infants born between 2005 and 2010 and cared for in KK Women's and Children's Hospital, a tertiary paediatric hospital, with birth weight ≤1,250 g were assessed in this retrospective study. Serial cranial ultrasound examinations were examined for intraventricular haemorrhage and cystic periventricular leukomalacia. Ventricular-brain ratio on term equivalent cranial ultrasound was measured. Neurodevelopmental outcome was assessed by the performance on Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 2 years corrected age. Mental delay was defined as having a combined Bayley-III score (the average of cognitive and language scores) <80. RESULTS The mean cognitive, language, and motor scores on Bayley-III in this cohort were 93±15, 83±18, and 92±15, respectively. Twenty-six percent of the preterm infants had mental delay and 4% had cerebral palsy. Ventricular-brain ratio >0.35 was the most significant factor associated with mental delay (odds ratio 5.28, 95% CI: 1.49-18.71, p=0.01). Other significant risk factors for mental delay were male gender, postnatal steroids, and necrotising enterocolitis, whereas maternal tertiary education was a protective factor against adverse outcome. CONCLUSION Ventricular-brain ratio >0.35 on term-equivalent cranial ultrasound in preterm infants is the strongest predictor for mental delay on Bayley score at 2 years of age.
Collapse
Affiliation(s)
- W Hou
- Duke NUS Medical School, 8 College Road, 169857, Singapore
| | - P H Tang
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore.
| | - P Agarwal
- Department of Neonatology, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| |
Collapse
|
78
|
Cai S, Thompson DK, Anderson PJ, Yang JYM. Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis. CHILDREN-BASEL 2019; 6:children6120131. [PMID: 31805647 PMCID: PMC6956113 DOI: 10.3390/children6120131] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 01/23/2023]
Abstract
Sepsis is commonly experienced by infants born very preterm (<32 weeks gestational age and/or <1500 g birthweight), but the long-term functional outcomes are unclear. The objective of this systematic review was to identify observational studies comparing neurodevelopmental outcomes in very preterm infants who had blood culture-proven neonatal sepsis with those without sepsis. Twenty-four studies were identified, of which 19 used prespecified definitions of neurodevelopmental impairment and five reported neurodevelopmental outcomes as continuous variables. Meta-analysis was conducted using 14 studies with defined neurodevelopmental impairment and demonstrated that very preterm infants with neonatal sepsis were at higher risk of impairments, such as cerebral palsy and neurosensory deficits, compared with infants without sepsis (OR 3.18; 95% CI 2.29–4.41). Substantial heterogeneity existed across the studies (I2 = 83.1, 95% CI 73–89). The five studies that reported outcomes as continuous variables showed no significant difference in cognitive performance between sepsis and non-sepsis groups. Neonatal sepsis in very preterm infants is associated with increased risk of neurodevelopmental disability. Due to the paucity of longitudinal follow-up data beyond 36 months, the long-term cognitive effect of neonatal sepsis in very preterm infants could not be conclusively determined. Effects on the development of minor impairment could not be assessed, due to the small numbers of infants included in the studies.
Collapse
Affiliation(s)
- Shirley Cai
- Victorian Infant Brain Study, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia; (S.C.); (P.J.A.)
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Melbourne Medicine School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Deanne K. Thompson
- Victorian Infant Brain Study, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia; (S.C.); (P.J.A.)
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia
- Correspondence:
| | - Peter J. Anderson
- Victorian Infant Brain Study, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Australia; (S.C.); (P.J.A.)
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Neuroscience Research, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Neurosurgery, Royal Children’s Hospital, Parkville, VIC 3052, Australia
| |
Collapse
|
79
|
Lakatos A, Kolossváry M, Szabó M, Jermendy Á, Barta H, Gyebnár G, Rudas G, Kozák LR. Neurodevelopmental effect of intracranial hemorrhage observed in hypoxic ischemic brain injury in hypothermia-treated asphyxiated neonates - an MRI study. BMC Pediatr 2019; 19:430. [PMID: 31718607 PMCID: PMC6849254 DOI: 10.1186/s12887-019-1777-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Identification of early signs of hypoxic ischemic encephalopathy (HIE) with magnetic resonance imaging (MRI) has proven of prognostic significance. Yet, the importance of intracranial hemorrhage (ICH), being present concomitantly had not been investigated yet, despite the known influence of hypothermia on hemostasis. We aimed to determine whether presence of ICH on MRI alongside the signs of HIE have an impact on prognosis in neonates with the clinical diagnosis of HIE. METHODS A retrospective study of consecutively sampled 108 asphyxiated term infants admitted to a tertiary neonatal intensive care unit (between 2007 and 2016), treated with whole body hypothermia and having brain MRI within 1 week of life was conducted. Presence or absence of HIE signs on MRI (basal ganglia-thalamus, watershed pattern and total brain injury) and on MR spectroscopy (lactate peak with decreased normal metabolites measured by Lac/NAA ratio) and/or of the five major types of ICH were recorded. Neurodevelopmental outcome was measured with Bayley Scales of Infant Development-II (BSID-II) test. Death or abnormal neurodevelopment (BSID-II score < 85) was defined as poor outcome in Chi-square test. Multivariate logistic regression analysis was performed on survivors. RESULTS MRI and MR-spectroscopy (MRS) signs of HIE were present in 72% (n = 78). 36% (n = 39) of neonates had ICH, being mainly small in size. Chi-square test showed a relationship between neurodevelopmental outcome and initial MRI. Unadjusted logistic regression showed that neonates presenting MRI and MRS signs of HIE have 6.23 times higher odds for delayed mental development (OR = 6.2292; CI95% = [1.2642; 30.6934], p = 0.0246), than infants without imaging alterations; with no ICH effect on outcome. Adjustment for clinical and imaging parameters did not change the pattern of results, i.e. HIE remained an independent risk factor for delayed neurodevelopment (OR = 6.2496; CI95% = [1.2018; 32.4983], p = 0.0294), while ICH remained to have no significant effect. CONCLUSION HIE related MRI abnormalities proved to be important prognostic factors of poor outcome in cooled asphyxiated infants when present, suggesting that early MRI with MRS is beneficial for prognostication. Interestingly, ICHs present in about one third of all cases had no significant effect on neurodevelopmental outcome, despite the known hemostasis altering effects of hypothermia.
Collapse
Affiliation(s)
- Andrea Lakatos
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Márton Kolossváry
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Miklós Szabó
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Ágnes Jermendy
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Hajnalka Barta
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Gyula Gyebnár
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Gábor Rudas
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Lajos R Kozák
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary.
| |
Collapse
|
80
|
Hiraiwa A, Ibuki K, Tanaka T, Hirono K, Miya K, Yoshimura N, Ichida F. Toddler Neurodevelopmental Outcomes Are Associated With School-Age IQ in Children With Single Ventricle Physiology. Semin Thorac Cardiovasc Surg 2019; 32:302-310. [PMID: 31698030 DOI: 10.1053/j.semtcvs.2019.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 11/11/2022]
Abstract
To examine whether neurodevelopment at preschool age predicts IQ levels and needs for special education services in school-age children with single ventricle (SV) physiology. Thirty-five patients with SV physiology were assessed using the Bayley Scale of Infant and Toddler Development (BSID) II or III at 3 years and the Wechsler Intelligence Scale for Children-Fourth Edition (WISC) at 8 years. Whether the children were receiving special education services was also determined. Factors associated with the mental developmental index (MDI) of the BSID, the full-scale IQ (FSIQ) of the WISC, and special education services were also analyzed. The MDI and FSIQ of children with SV physiology were significantly lower than the values in healthy children (P < 0.01). The MDI at 3 years was moderately correlated with FSIQ at 8 years (P < 0.01, R2 = 0.41). Ten patients (28.6%) received special education services in their school. Children with MDI <85 were more likely than those with MDI ≥85 to require special education services at school age (53% and 10%, respectively, P < 0.01). Weight at birth and stage II were correlated with the MDI, extracorporeal circulation time at stage II was correlated with FSIQ, and age at Fontan operation was correlated with FSIQ and special education services. The toddler neurodevelopment index may predict not only IQ levels but also the need for special education services in school-age children. Children with low neurodevelopmental scores need to be followed closely for a long time.
Collapse
Affiliation(s)
- Akiko Hiraiwa
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan.
| | - Keijiro Ibuki
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Tomomi Tanaka
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kazushi Miya
- Faculty of Human Development, Department of Educational Sciences, University of Toyama, Toyama, Japan
| | - Naoki Yoshimura
- The 1(st) Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Fukiko Ichida
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| |
Collapse
|
81
|
Lind A, Nyman A, Lehtonen L, Haataja L. Predictive value of psychological assessment at five years of age in the long-term follow-up of very preterm children. Child Neuropsychol 2019; 26:312-323. [DOI: 10.1080/09297049.2019.1674267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Annika Lind
- Department of Psychology, University of Turku, Turku, Finland
- Turku Institute for Advanced Studies (TIAS), University of Turku, Turku, Finland
| | - Anna Nyman
- Department of Psychology, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Leena Haataja
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
82
|
Dórea JG. Environmental exposure to low-level lead (Pb) co-occurring with other neurotoxicants in early life and neurodevelopment of children. ENVIRONMENTAL RESEARCH 2019; 177:108641. [PMID: 31421445 DOI: 10.1016/j.envres.2019.108641] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
Lead (Pb) is a worldwide environmental contaminant that even at low levels influences brain development and affects neurobehavior later in life; nevertheless it is only a small fraction of the neurotoxicant (NT) exposome. Exposure to environmental Pb concurrent with other NT substances is often the norm, but their joint effects are challenging to study during early life. The aim of this review is to integrate studies of Pb-containing NT mixtures during the early life and neurodevelopment outcomes of children. The Pb-containing NT mixtures that have been most studied involve other metals (Mn, Al, Hg, Cd), metalloids (As), halogen (F), and organo-halogen pollutants. Co-occurring Pb-associated exposures during pregnancy and lactation depend on the environmental sources and the metabolism and half-life of the specific NT contaminant; but offspring neurobehavioral outcomes are also influenced by social stressors. Nevertheless, Pb-associated effects from prenatal exposure portend a continued burden on measurable neurodevelopment; they thus favor increased neurological health issues, decrements in neurobehavioral tests and reductions in the quality of life. Neurobehavioral test outcomes measured in the first 1000 days showed Pb-associated negative outcomes were frequently noticed in infants (<6 months). In older (preschool and school) children studies showed more variations in NT mixtures, children's age, and sensitivity and/or specificity of neurobehavioral tests; these variations and choice of statistical model (individual NT stressor or collective effect of mixture) may explain inconsistencies. Multiple exposures to NT mixtures in children diagnosed with 'autism spectrum disorders' (ASD) and 'attention deficit and hyperactivity disorders' (ADHD), strongly suggest a Pb-associated effect. Mixture potency (number or associated NT components and respective concentrations) and time (duration and developmental stage) of exposure often showed a measurable impact on neurodevelopment; however, net effects, reversibility and/or predictability of delays are insufficiently studied and need urgent attention. Nevertheless, neurodevelopment delays can be prevented and/or attenuated if public health policies are implemented to protect the unborn and the young child.
Collapse
Affiliation(s)
- José G Dórea
- Universidade de Brasília, Brasília, 70919-970, DF, Brazil.
| |
Collapse
|
83
|
Ghetti C, Bieleninik Ł, Hysing M, Kvestad I, Assmus J, Romeo R, Ettenberger M, Arnon S, Vederhus BJ, Söderström Gaden T, Gold C. Longitudinal Study of music Therapy's Effectiveness for Premature infants and their caregivers (LongSTEP): protocol for an international randomised trial. BMJ Open 2019; 9:e025062. [PMID: 31481362 PMCID: PMC6731830 DOI: 10.1136/bmjopen-2018-025062] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Preterm birth has major medical, psychological and socioeconomic consequences worldwide. Music therapy (MT) has positive effects on physiological measures of preterm infants and maternal anxiety, but rigorous studies including long-term follow-up are missing. Drawing on caregivers' inherent resources, this study emphasises caregiver involvement in MT to promote attuned, developmentally appropriate musical interactions that may be of mutual benefit to infant and parent. This study will determine whether MT, as delivered by a qualified music therapist during neonatal intensive care unit (NICU) hospitalisation and/or in home/municipal settings following discharge, is superior to standard care in improving bonding between primary caregivers and preterm infants, parent well-being and infant development. METHODS AND ANALYSIS: Design: international multicentre, assessor-blind, 2×2 factorial, pragmatic randomised controlled trial; informed by a completed feasibility study. Participants: 250 preterm infants and their parents. Intervention: MT focusing on parental singing specifically tailored to infant responses, will be delivered during NICU and/or during a postdischarge 6-month period. Primary outcome: changes in mother-infant bonding at 6-month corrected age (CA), as measured by the Postpartum Bonding Questionnaire. Secondary outcomes: mother-infant bonding at discharge and at 12-month CA; child development over 24 months; and parental depression, anxiety and stress, and infant rehospitalisation, all over 12 months. ETHICS AND DISSEMINATION The Regional Committees for Medical and Health Research Ethics approved the study (2018/994/REK Nord, 03 July 2018). Service users were involved in development of the study and will be involved in implementation and dissemination. Dissemination of findings will apply to local, national and international levels. TRIAL REGISTRATION NUMBER NCT03564184.
Collapse
Affiliation(s)
- Claire Ghetti
- GAMUT - The Grieg Academy Music Therapy Research Centre, The Grieg Academy - Department of Music, University of Bergen, Bergen, Norway
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Łucja Bieleninik
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
- Institute of Psychology, Uniwersytet Gdanski, Gdansk, Poland
| | - Mari Hysing
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Regional Center for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Ingrid Kvestad
- Regional Center for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Jörg Assmus
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Renee Romeo
- King's Health Economics, King's College London, London, UK
| | - Mark Ettenberger
- Department of Patient and Family Care, Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Colombia
- SONO - Centro de Musicoterapia, Bogota, Colombia
| | - Shmuel Arnon
- Neonatal Department, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tora Söderström Gaden
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| |
Collapse
|
84
|
Bolisetty S, Tiwari M, Sutton L, Schindler T, Bajuk B, Lui K. Neurodevelopmental outcomes of extremely preterm infants in New South Wales and the Australian Capital Territory. J Paediatr Child Health 2019; 55:956-961. [PMID: 30499234 DOI: 10.1111/jpc.14323] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/23/2018] [Accepted: 11/09/2018] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to provide updated information on gestation-specific neurodevelopmental outcomes of extremely to very preterm infants 23-28 weeks' gestation admitted to neonatal intensive care units (NICUs). METHODS This was a population-based retrospective cohort study of infants born between 23+0 and 28+6 weeks' gestation and admitted to a network of NICUs between 2007 and 2012 in a well-defined geographic area of New South Wales (NSW) and the Australian Capital Territory (ACT). Primary outcome was moderate to severe neurodevelopmental impairment. RESULTS Of 2287 infants admitted to NICUs, 1914 (83.7%) survived to discharge, and 1514 (79.8% = 1514/1897) were followed up. Moderate to severe neurodevelopmental impairment was 11% overall, and the incidence decreased with increasing gestational age (GA): 25, 23, 15, 13, 9 and 7% at 23, 24, 25, 26, 27 and 28 weeks, respectively. Male gender, major intraventricular haemorrhage, late-onset sepsis, chronic lung disease and post-natal corticosteroid therapy were found to be independently associated with increased risk of moderate to severe impairment. Compared with an incidence of 16% in the 1998-2004 cohort, there was a significant reduction in moderate to severe neurodevelopmental impairment in the current cohort (unadjusted odds ratio: 0.65, 95% confidence interval: 0.52-0.80). CONCLUSIONS We report the latest neurodevelopmental outcomes of extremely to very preterm infants in NSW and the ACT. Neurodevelopmental outcome rates based on GA alone may not provide the true estimate as these outcomes can vary based on the presence or absence of other relevant perinatal factors.
Collapse
Affiliation(s)
- Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mudita Tiwari
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lee Sutton
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy Schindler
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- Perinatal Services Network, Sydney, New South Wales, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | | |
Collapse
|
85
|
Hortensius LM, van Elburg RM, Nijboer CH, Benders MJNL, de Theije CGM. Postnatal Nutrition to Improve Brain Development in the Preterm Infant: A Systematic Review From Bench to Bedside. Front Physiol 2019; 10:961. [PMID: 31404162 PMCID: PMC6677108 DOI: 10.3389/fphys.2019.00961] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Preterm infants are at high risk for Encephalopathy of Prematurity and successive adverse neurodevelopmental outcome. Adequate nutrition is crucial for healthy brain development. Maternal breast milk is first choice of post-natal enteral nutrition for preterm infants. However, breast milk contains insufficient nutrient quantities to meet the greater nutritional needs of preterm infants, meaning that supplementation is recommended. Aim: To provide an overview of current literature on potential nutritional interventions for improvement of neurodevelopmental outcome in preterm infants, by taking a bench to bedside approach from pre-clinical models of neonatal brain injury to randomized controlled clinical trials (RCTs) in preterm infants. Methods: Separate clinical and pre-clinical searches were performed in Medline and Embase for English written papers published between 08/2008 and 08/2018 that studied a single nutritional component. Papers were included if one of the following components was studied: lipids, carbohydrates, proteins, vitamins, minerals, probiotics, prebiotics, oligosaccharides, fatty acids, or amino acids, with brain injury, brain development or neurodevelopmental outcome as outcome measure in preterm infants (gestational age <32 weeks and/or birth weight <1,500 g) or in animal models of neonatal brain injury. Results: In total, 2,671 pre-clinical studies and 852 RCTs were screened, of which 24 pre-clinical and 22 RCTs were included in this review. In these trials supplementation with amino acids and protein, lipids, probiotics (only clinical), prebiotics (only clinical), vitamins, and minerals was studied. All included pre-clinical studies show positive effect of supplementation on brain injury and/or neurodevelopment. Although some nutrients, such as glutamine, show promising short term outcome in clinical studies, no evident long term effect of any supplemented nutrient was found. Main limitations were inclusion of studies no older than 10 years at time of search and studies that focused on single nutritional components only. Conclusion: Even though many pre-clinical trials demonstrate promising effects of different nutritional interventions on reducing brain injury and/or improving neurodevelopmental outcome, these positive effects have so far not evidently been demonstrated in RCTs. More clinically relevant animal models and long term follow up after clinical trials are needed to move novel nutritional therapies from bench to bedside of preterm infants.
Collapse
Affiliation(s)
- Lisa M. Hortensius
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ruurd M. van Elburg
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Cora H. Nijboer
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Manon J. N. L. Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Caroline G. M. de Theije
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
86
|
Walsh V, Brown JVE, Askie LM, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants. Cochrane Database Syst Rev 2019; 7:CD004204. [PMID: 31314903 PMCID: PMC6636703 DOI: 10.1002/14651858.cd004204.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with nutrient-enriched rather than standard formula might increase nutrient accretion and growth rates and might improve neurodevelopmental outcomes. OBJECTIVES To compare the effects of feeding with nutrient-enriched formula versus standard formula on growth and development of preterm infants. SEARCH METHODS We used the Cochrane Neonatal standard search strategy. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11), MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (until November 2018), as well as conference proceedings, previous reviews, and clinical trials databases. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with nutrient-enriched formula (protein and energy plus minerals, vitamins, or other nutrients) versus standard formula. DATA COLLECTION AND ANALYSIS We extracted data using the Cochrane Neonatal standard methods. Two review authors separately evaluated trial quality and extracted and synthesised data using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed certainty of evidence at the outcome level using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS We identified seven trials in which a total of 590 preterm infants participated. Most participants were clinically stable preterm infants of birth weight less than 1850 g. Few participants were extremely preterm, extremely low birth weight, or growth restricted at birth. Trials were conducted more than 30 years ago, were formula industry funded, and were small with methodological weaknesses (including lack of masking) that might bias effect estimates. Meta-analyses of in-hospital growth parameters were limited by statistical heterogeneity. There is no evidence of an effect on time to regain birth weight (MD -1.48 days, 95% confidence interval (CI) -4.73 to 1.77) and low-certainty evidence suggests that feeding with nutrient-enriched formula increases in-hospital rates of weight gain (MD 2.43 g/kg/d, 95% CI 1.60 to 3.26) and head circumference growth (MD 1.04 mm/week, 95% CI 0.18 to 1.89). Meta-analysis did not show an effect on the average rate of length gain (MD 0.22 mm/week, 95% CI -0.70 to 1.13). Fewer data are available for growth and developmental outcomes assessed beyond infancy, and these do not show consistent effects of nutrient-enriched formula feeding. Data from two trials did not show an effect on Bayley Mental Development Index scores at 18 months post term (MD 2.87, 95% CI -1.38 to 7.12; moderate-certainty evidence). Infants who received nutrient-enriched formula had higher Bayley Psychomotor Development Index scores at 18 months post term (MD 6.56. 95% CI 2.87 to 10.26; low-certainty evidence), but no evidence suggested an effect on cerebral palsy (typical RR 0.79, 95% CI 0.30 to 2.07; 2 studies, 377 infants). Available data did not indicate any other benefits or harms and provided low-certainty evidence about the effect of nutrient-enriched formula feeding on the risk of necrotising enterocolitis in preterm infants (typical RR 0.72, 95% CI 0.41 to 1.25; 3 studies, 489 infants). AUTHORS' CONCLUSIONS Available trial data show that feeding preterm infants nutrient-enriched (compared with standard) formulas has only modest effects on growth rates during their initial hospital admission. No evidence suggests effects on long-term growth or development. The GRADE assessment indicates that the certainty of this evidence is low, and that these findings should be interpreted and applied with caution. Further randomised trials would be needed to resolve this uncertainty.
Collapse
Affiliation(s)
- Verena Walsh
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
| | | | - Lisa M Askie
- University of SydneyNHMRC Clinical Trials CentreLocked Bag 77CamperdownNSWAustralia2050
| | - Nicholas D Embleton
- Newcastle Hospitals NHS Foundation Trust and University of NewcastleNewcastle Neonatal ServiceRichardson RoadNewcastle upon TyneUKNE1 4LP
| | - William McGuire
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
| | | |
Collapse
|
87
|
Garrison L, Morley S, Chambers CD, Bakhireva LN. Forty Years of Assessing Neurodevelopmental and Behavioral Effects of Prenatal Alcohol Exposure in Infants: What Have We Learned? Alcohol Clin Exp Res 2019; 43:1632-1642. [PMID: 31206743 DOI: 10.1111/acer.14127] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023]
Abstract
It has been known for over 4 decades that prenatal alcohol exposure (PAE) can adversely affect neurodevelopment and behavior (NDB). Yet, early detection of altered NDB due to PAE continues to present a major clinical challenge. Identification of altered NDB in the first 2 years of life, before higher-order cognitive processes develop, invites early interventions for affected children to improve long-term outcomes. Studies published in English from January of 1980 to July of 2018 were identified in PubMed/MEDLINE. The review focused on prospective birth cohort studies which used standardized NDB assessments in children up to 2 years of age, wherein PAE was the main exposure and NDB was the main outcome. NDB was categorized into the domains of neurocognitive, adaptive, and self-regulation based on the 2016 Updated Clinical Guidelines for Diagnosing fetal alcohol spectrum disorder. An initial search resulted in 1,867 articles for which we reviewed abstracts; 114 were selected for full-text review; and 3 additional abstracts were identified through review of references in eligible publications. Thirty-one publications met criteria and were included: of these, 24 reported neurocognitive outcomes, 24 reported adaptive behavior outcomes, and 12 reported outcomes in the domain of self-regulation. Although self-regulation was assessed in the fewest number of studies, 8/12 (75%) reported PAE-associated deficits. In contrast, results were mixed for the other 2 domains: 13/24 (54%) of the selected studies that included neurocognitive outcomes showed poorer performance following PAE, and 8/24 (33%) studies that assessed adaptive functioning found significant differences between PAE and comparison infants. There is considerable evidence to support the value of early-life assessments of infant NDB when PAE is known or suspected. More studies focusing on infant self-regulation, in particular, are needed to determine the utility of early evaluation of this critical developmental domain in infants with PAE.
Collapse
Affiliation(s)
- Laura Garrison
- Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education Center, University of New Mexico College of Pharmacy, Albuquerque, New Mexico
| | - Sarah Morley
- Health Sciences Library and Informatics Center, University of New Mexico, Albuquerque, New Mexico
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education Center, University of New Mexico College of Pharmacy, Albuquerque, New Mexico.,Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| |
Collapse
|
88
|
Thomas S, Reynolds D, Morrall MCHJ, Limond J, Chevignard M, Calaminus G, Poggi G, Bennett E, Frappaz D, Slade D, Gautier J, McQuilton P, Massimino M, Grundy R. The European Society of Paediatric Oncology Ependymoma-II program Core-Plus model: Development and initial implementation of a cognitive test protocol for an international brain tumour trial. Eur J Paediatr Neurol 2019; 23:560-570. [PMID: 31182404 DOI: 10.1016/j.ejpn.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
Abstract
It is increasingly accepted that survival alone is an inadequate measure of the success of childhood brain tumour treatments. Consequently, there is growing emphasis on capturing quality of survival. Ependymomas are the third most frequently occurring brain tumours in childhood and present significant clinical challenges. European Society of Paediatric Oncology Ependymoma II is a comprehensive international program aiming to evaluate outcomes under different treatment regimens and improve diagnostic accuracy. Importantly, there has been agreement to lower the age at which children with posterior fossa ependymoma undergo focal irradiation from three years to either eighteen months or one year of age. Hitherto radiotherapy in Europe had been reserved for children over three years due to concerns over adverse cognitive outcomes following irradiation of the developing brain. There is therefore a duty of care to include longitudinal cognitive follow-up and this has been agreed as an essential trial outcome. Discussions between representatives of 18 participating European countries over 10 years have yielded European consensus for an internationally accepted test battery for follow-up of childhood ependymoma survivors. The 'Core-Plus' model incorporates a two-tier approach to assessment by specifying core tests to establish a minimum dataset where resources are limited, whilst maintaining scope for comprehensive assessment where feasible. The challenges leading to the development of the Core-Plus model are presented alongside learning from the initial stages of the trial. We propose that this model could provide a solution for future international trials addressing both childhood brain tumours and other conditions associated with cognitive morbidity.
Collapse
Affiliation(s)
- S Thomas
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Child Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - D Reynolds
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Child Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - M C H J Morrall
- Department of Paediatric Neuropsychology, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - J Limond
- Psychology, College of Life and Environmental Sciences, Washington Singer Laboratories, University of Exeter, Perry Road, EX4 4QG, UK
| | - M Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, 14, rue du Val d'Osne, 94410, Saint Maurice, France; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, 75006 Paris, France
| | - G Calaminus
- University Children's Hospital Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - G Poggi
- Neuro-Oncological Rehabilitation Unit- IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - E Bennett
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - D Frappaz
- Institut d'Hématologie Oncologie pédiatrique, Lyon, France
| | - D Slade
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - J Gautier
- Institut d'Hématologie Oncologie pédiatrique, Lyon, France
| | - P McQuilton
- Department of Paediatric Neuropsychology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Child Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - M Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Grundy
- Child Brain Tumour Research Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| |
Collapse
|
89
|
Prenatal exposure to organohalogen compounds and children’s mental and motor development at 18 and 30 months of age. Neurotoxicology 2019; 72:6-14. [DOI: 10.1016/j.neuro.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/05/2019] [Accepted: 01/16/2019] [Indexed: 11/21/2022]
|
90
|
Ross GS, Perlman JM. Relationships of biological and environmental factors to cognition of preterm infants in the toddler and preschool periods. Dev Psychobiol 2019; 61:1100-1106. [PMID: 31020661 DOI: 10.1002/dev.21855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 01/12/2023]
Abstract
One hundred and nine preterm infants were studied to examine the relative effects of biologic/neurologic factors (length of hospital stay, 18 month cognitive status) and environment (socioeconomic status) on cognition in the toddler (18 months) and preschool periods (3 years). Length of hospital stay was significantly related to toddler cognitive outcome, and less so to preschool outcome. Socioeconomic status predicted only preschool cognitive outcome and not toddler outcome. Cognitive status at 18 months significantly predicted 3 year outcome, and there was relatively little change between those periods. Together, cognitive status at 18 months and socioeconomic status significantly predicted preschool IQ, accounting for 34% of the variance. Results showed that perinatal biologic risks became less salient while socioeconomic status became increasingly important at the preschool period. Relative lack of change in cognitive status indicated the importance of early cognitive evaluation in preterm infants.
Collapse
Affiliation(s)
- Gail S Ross
- Newborn Medicine, Weill Cornell Medical College, New York, New York
| | | |
Collapse
|
91
|
Stålnacke SR, Tessma M, Böhm B, Herlenius E. Cognitive Development Trajectories in Preterm Children With Very Low Birth Weight Longitudinally Followed Until 11 Years of Age. Front Physiol 2019; 10:307. [PMID: 31001126 PMCID: PMC6454032 DOI: 10.3389/fphys.2019.00307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
Background: There is a high prevalence of cognitive dysfunction in very low birthweight (500–1250 g) infants (VLBW). Understanding long-term risk factors associated with cognitive development in preterm children requires longitudinal characterization. Thus, follow-up evaluations, including identification of risks and resilience influences–are important to promote health and cognitive abilities of children born preterm. Aim: To examine changes in cognitive development from birth until 11 years of age in preterm children with very low birthweight. Methods: 24 VLBW infants, at the Karolinska University Hospital, Stockholm, were assessed with regards to cognitive functioning at three times during development at 18 months, 5 and 11 years of age using standardized tests. Longitudinal data were analyzed using Generalized Estimating Equation (GEE) univariate and multivariate models. Results: The follow-up rate was 100%. Level of cognitive functioning at 18 months and at 11 years was similar. Females had higher cognitive scores than males at all three timepoints. We found that intraventricular hemorrhage (IVH) and prolonged invasive ventilatory support (>7 days) had a negative effect on cognitive functioning. Higher levels of parental education had a favorable influence on cognitive functioning over time. Conclusion: Level of cognitive development at 18 months was highly predictive of level of cognitive function at 11 years of age and differences in assessment scores between male and female VLBW infants persisted. Additional longitudinal studies, performed before school entry and across childhood, are needed to further elucidate the cognitive trajectories of preterm children.
Collapse
Affiliation(s)
- Sofia Ryytty Stålnacke
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Mesfin Tessma
- Department of Learning, Informatics, Management and Ethics - LIME, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Böhm
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Herlenius
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
92
|
Balalian AA, Whyatt RM, Liu X, Insel BJ, Rauh VA, Herbstman J, Factor-Litvak P. Prenatal and childhood exposure to phthalates and motor skills at age 11 years. ENVIRONMENTAL RESEARCH 2019; 171:416-427. [PMID: 30731329 PMCID: PMC6814270 DOI: 10.1016/j.envres.2019.01.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Previous reports suggest that prenatal phthalate exposure is associated with lower scores on measures of motor skills in infants and toddlers. Whether these associations persist into later childhood or preadolescence has not been studied. METHODS In a follow up study of 209 inner-city mothers and their children the concentrations of mono-n-butyl phthalate (MnBP), monobenzyl phthalate (MBzP), monoisobutyl phthalate (MiBP), monomethyl phthalate (MEP), mono-carboxy-isooctyl phthalate (MCOP), and four di-2-ethylhexyl phthalate metabolites (ΣDEHP) were measured in spot urine sample collected from the women in late pregnancy and from their children at ages 3, 5, and 7 years. The Bruininks-Oseretsky Test of Motor Proficiency short form (BOT-2) was administered at child age 11 to assess gross and fine motor skills. RESULTS The total number of children included in the study was 209. Of the 209 children, 116(55.5%) were girls and 93 were (45%) boys. Among girls, prenatal MnBP(b=-2.09; 95%CI: [-3.43, -0.75]), MBzP (b=-1.14; [95%CI: -2.13, -0.14]), and MiBP(b=-1.36; 95%CI: [-2.51, -0.21] and MEP(b=-1.23 [95%CI: -2.36, -0.11]) were associated with lower total BOT-2 composite score. MnBP (b= -1.43; 95% CI: [-2.44, -0.42]) was associated with lower fine motor scores and MiBP(b = -0.56; 95% CI: [-1.12, -0.01]) and MEP (b = -0.60; 95% CI: [-1.14, -0.06])was associated with lower gross motor scores. Among boys, prenatal MBzP (b = -0.79; 95% CI: [-1.40, -0.19]) was associated with lower fine motor composite score. The associations between MEP measured at age 3 and the BOT-2 gross motor, fine motor and total motor score differed by sex. In boys, there was an inverse association between ΣDEHP metabolites measured in childhood at ages 3 (b = -1.30; 95% CI: [-2.34, -0.26]) and 7 years (b = -0.96; 95% CI: [-1.79, -0.13]), and BOT-2 fine motor composite scores. CONCLUSIONS Higher prenatal exposure to specific phthalates was associated with lower motor function among 11- year old girls while higher postnatal exposure to ΣDEHP metabolites was associated with lower scores among boys. As lower scores on measures of motor development have been associated with more problems in cognitive, socioemotional functioning and behavior, the findings of this study have implications related to overall child development.
Collapse
Affiliation(s)
- Arin A Balalian
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th street, New York, NY 10032, USA.
| | - Robin M Whyatt
- Columbia Center for Children's Environmental Health, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th street, New York, NY 10032, USA.
| | - Xinhua Liu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th street, New York, NY 10032, USA.
| | - Beverly J Insel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th street, New York, NY 10032, USA
| | - Virginia A Rauh
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th street, New York, NY 10032, USA.
| | - Julie Herbstman
- Columbia Center for Children's Environmental Health, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th street, New York, NY 10032, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th street, New York, NY 10032, USA.
| |
Collapse
|
93
|
Kim CY, Jung E, Lee BS, Kim KS, Kim EAR. Validity of the Korean Developmental Screening Test for very-low-birth-weight infants. KOREAN JOURNAL OF PEDIATRICS 2019; 62:187-192. [PMID: 30999730 PMCID: PMC6528064 DOI: 10.3345/kjp.2018.07381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The importance of the neurodevelopmental outcomes of very-low-birth-weight (VLBW) infants has been emphasized as their mortality rate has markedly improved. This study aimed to assess the validity of the Korean Developmental Screening Test (K-DST), a developmental screening tool approved by the Korean Society of Pediatrics, for the timely diagnosis of neurodevelopmental delay in VLBW infants. METHODS Subjects included VLBW infants enrolled in the Korean Neonatal Network database between January 2012 and December 2014. The collected data were analyzed for sensitivity, specificity, positive predictive value, and negative predictive value (NPV) in the K-DST compared to those in the Bayley Scales of Infant Development-II for VLBW infants. RESULTS A total of 173 patients were enrolled. Their mean gestational age and mean birth weight were 27.5±2.8 weeks and 980.5±272.1 g, respectively. The frequency of failed psychomotor developmental index (PDI) <85 was similar to that in at least one domain of K-DST <1 standard deviation. Failure in more than one K-DST domain compared with a mental developmental index (MDI) <85 showed a sensitivity and NPV of 73.2% and 75.0%, respectively. Failure in more than one K-DST domain compared with PDI <85 showed a sensitivity and NPV of 60.3% and 71.6%, respectively. Each K-DST domain had a stronger correlation with predicting a failing MDI <85 than a failing PDI <85 (P<0.05). CONCLUSION K-DST could be a useful screening tool for predicting mental developmental delay in VLBW infants and referring them for neurodevelopmental assessments.
Collapse
Affiliation(s)
- Chae Young Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Euiseok Jung
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Sop Lee
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Soo Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
94
|
Sileo FG, Pateisky P, Curado J, Evans K, Hettige S, Thilaganathan B. Long-term neuroimaging and neurological outcome of fetal spina bifida aperta after postnatal surgical repair. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:309-313. [PMID: 30663167 DOI: 10.1002/uog.20215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Parents faced with the choice between postnatal management and prenatal surgery for spina bifida need to have up-to-date information on the expected outcomes. The aim of this study was to report the long-term physical and neurological outcomes of infants with prenatally diagnosed isolated spina bifida that underwent postnatal surgical repair and were managed by a multidisciplinary team from a large tertiary center. METHODS This was a retrospective cohort study of all cases of fetal spina bifida managed in a tertiary unit between October 1999 and January 2018. All cases of fetal spina bifida from the local health region were routinely referred to the tertiary unit for further perinatal management. Details on surgical procedures and neonatal neurological outcomes were obtained from institutional case records. Ambulatory status, bladder and bowel continence and neurodevelopment were assessed at a minimum of 3 years. RESULTS During the study period, 241 pregnancies with isolated spina bifida were seen in the unit. Of these, 84 (34.9%) women opted to continue with the pregnancy after multidisciplinary counseling by clinicians. Sixty-seven infants underwent postnatal repair of spina bifida aperta and were included in the analysis. After birth, hindbrain herniation was observed in 91.5% of infants with only seven requiring surgical decompression. Ventriculoperitoneal shunt placement was needed in 64.2% of infants, while normal cognitive development or mild impairment was demonstrated in 85.4% of cases with data for this outcome available, at a mean age of 8 years. Cumulatively, 40% of infants were walking independently or using minor support, and normal or mild impairment of bladder and bowel function was reported in 45.5% and 44.4% of infants, respectively. CONCLUSIONS Neurodevelopmental and neurological outcomes between prenatal and postnatal repair are similar. As with fetal surgery, conventional postnatal surgery is associated with the reversal of hindbrain herniation. Similarly, postnatal ventriculoperitoneal shunt placement appears to be required mainly in fetuses without evidence of significant fetal ventriculomegaly. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- F G Sileo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - P Pateisky
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Curado
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - K Evans
- Department of Paediatric Urology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Hettige
- Department of Paediatric Neurosurgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|
95
|
The reliability and validity of Bayley-III cognitive scale in China's male and female children. Early Hum Dev 2019; 129:71-78. [PMID: 30711715 DOI: 10.1016/j.earlhumdev.2019.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 01/13/2019] [Accepted: 01/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Since publication in 2006, the Bayley-III scale has been used widely in pediatric populations worldwide; however, there have been very few studies which examined the usefulness and the potential sex differences in a Chinese context. AIMS To assess the reliability and validity of the Bayley-III cognitive scale, and detect possible sex differences in term children so as to provide evidence for clinical and research use in China. STUDY DESIGN Cross-sectional study PARTICIPANTS AND OUTCOME MEASURES: Of the 1589 children from 3 healthcare institutions that were initially recruited, a total of 1444 children were included in the final analysis. We randomly selected 5-10% children from the total sample to evaluate the test-retest, inter-rater and criteria-related reliability in order to meet the psychometric criteria of Bayley-III scale. Inter-item consistency, test-retest and inter-rater reliability of the scale were estimated using Split-half method and Intra-class Correlation Coefficient (ICC). The content validity was evaluated by the Item-level Content Validity Index (I-CVI). The Mann-Kendall trend test was performed to assess trends of cognitive development, and post-hos Least Significant Difference test was used to detect age-appropriateness of items. RESULTS Six developmental pediatricians were trained to administer the Bayley-III cognitive scale. Inter-item consistency (n = 1444) with Guttman split-half coefficient was above 0.8, while test-retest (n = 144) and inter-rater reliability (n = 74) had good to excellent ICCs of over 0.9. The criteria-related validity (n = 74) of Bayley-III was acceptable, and associations with Gesell Developmental Schedules (GDS) were mainly above 0.8. The raw score of Bayley-III scale in total subjects (n = 1444) showed an increased trend across all months of age (p < 0.05), and only the score in age group of 35M16D to 36M15D declined in females (p < 0.05, n = 722). Female children presented a higher score than male children in all subjects and in the 18-23 months age group (p < 0.05). CONCLUSIONS Our findings provide important evidence that the Bayley-III cognitive scale is a valid measurement which could be used in Chinese population, as well as the consideration of sex differences when used in a Chinese context.
Collapse
|
96
|
Neurodevelopment of children born very preterm and/or with a very low birth weight: 8-Year follow-up of a nutritional RCT. Clin Nutr ESPEN 2019; 30:190-198. [PMID: 30904221 DOI: 10.1016/j.clnesp.2018.12.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 12/10/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children born very preterm are at risk for cognitive deficits and motor impairment. Enhanced protein intake immediately after very preterm birth has been associated with favorable growth and improved neurodevelopment. It is unknown whether increased protein intake after discharge from the hospital affects long-term neurodevelopment. OBJECTIVE The primary objective was to assess neurodevelopment from infancy to 8 years in preterm-born children who received either protein-enriched formula (PDF), standard term formula (TF), or human milk (HM) after discharge. The secondary objective was to assess the correlation between outcomes obtained at 24 months corrected age (CA) and at 8 years. METHODS This RCT included 152 children born very preterm (gestational age ≤32 weeks) and/or with a very low birth weight (≤1500 g) of whom 102 were randomly assigned to receive PDF (n = 54) or TF (n = 48) from term age to 6 months CA. A control group of infants fed HM (n = 50) was also included. Neurodevelopmental outcomes were assessed at 24 months CA (cognitive and motor functioning; n = 123) and at 8 years (estimated Full Scale Intelligence Quotient, visual-motor skills, verbal memory, attention, and motor functioning; n = 76). RESULTS The PDF and TF groups were not significantly different in neurodevelopmental outcomes. The HM group had a better cognitive score compared with the PDF group: at 24 months CA 92.9 ± 12.5 vs. 105.2 ± 18.6, P < 0.001 and at 8 years 98.1 ± 11.3 vs. 105.8 ± 9.1, P = 0.017 (P = 0.002 and P = 0.080, respectively, after adjustment for parental educational level). Correlations between outcomes at 24 months CA and 8 years were weak: r = 0.35 and r = 0.37 for cognitive and motor outcomes, respectively. CONCLUSIONS PDF did not improve long-term neurodevelopmental outcomes as compared with TF. However, these results should be interpreted with caution considering the substantial attrition at follow-up. Furthermore, the correlation between outcomes at different ages was weak, emphasizing the need for long-term follow-up of nutritional intervention studies in preterm-born children.
Collapse
|
97
|
Bazacliu C, Neu J. Necrotizing Enterocolitis: Long Term Complications. Curr Pediatr Rev 2019; 15:115-124. [PMID: 30864508 DOI: 10.2174/1573396315666190312093119] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022]
Abstract
Necrotizing enterocolitis (NEC) remains the most threatening gastrointestinal complication of prematurity leading to high mortality, morbidity and cost. Common complications of NEC include neurodevelopmental delay, failure to thrive, gastrointestinal problems including strictures and adhesions, cholestasis, short bowel syndrome with or without intestinal failure that can be difficult to manage. Infants who develop NEC benefit from close follow-up for early diagnosis and treatment of complications. Those who present with severe complications such as intestinal failure benefit from a multidisciplinary approach involving careful assessment and treatment. Studies done so far are limited in providing a long-term prognosis. Here we review some of these complications. More studies with a longer follow-up period are needed to better understand the later comorbidities that develop in babies with NEC.
Collapse
Affiliation(s)
- Catalina Bazacliu
- Department of Pediatrics, Division of Neonatology, University of Florida, Florida, United States
| | - Josef Neu
- Department of Pediatrics, Division of Neonatology, University of Florida, Florida, United States
| |
Collapse
|
98
|
Dewan MV, Herrmann R, Schweiger B, Sirin S, Müller H, Storbeck T, Dransfeld F, Felderhoff-Müser U, Hüning B. Are Simple Magnetic Resonance Imaging Biomarkers Predictive of Neurodevelopmental Outcome at Two Years in Very Preterm Infants? Neonatology 2019; 116:331-340. [PMID: 31454812 DOI: 10.1159/000501799] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants are at increased risk of neurodevelopmental impairment due to the vulnerability of the immature brain. Early risk stratification is necessary for predicting outcome in the period of highest neuroplasticity. Several biomarkers in magnetic resonance imaging (MRI) at term equivalent age (TEA) have therefore been suggested. OBJECTIVE To assess the predictive value of simple brain metrics and the total abnormality score (TAS) - a modified score for brain injury and growth - in relation to neurodevelopmental outcome of very preterm infants in MRI at TEA. METHODS Single-centre cohort study including preterm infants with gestational age (GA) ≤32 weeks and birth weight ≤1,500 g. Biparietal width (BPW), interhemispheric distance, transcerebellar diameter (TCD) and TAS were assessed. To detect subtle haemorrhages, additional susceptibility-weighted imaging (SWI) was used in addition to conventional MRI to evaluate its clinical relevance. Neurodevelopment was tested by the Mental and Psychomotor Developmental Index (MDI/PDI) of the Bayley Scales of Infant Development II at a corrected age of 24 months. RESULTS One hundred twenty-nine children with median GA of 28.1 weeks and median birth weight of 980 g were included. BPW significantly correlated with PDI (p= 0.01, R2 = 0.06) and TCD with MDI (p < 0.01, R2 = 0.05) and PDI (p < 0.01, R2 = 0.06) but explained variances were low. TAS was not predictive of neurodevelopmental outcome. By using SWI, additional 4 cases of low grade haemorrhages were identified compared to conventional sequences. In one case this additional information was clinically relevant (MDI/PDI below average). CONCLUSION Simple brain metrics and TAS did not reliably predict neurodevelopmental outcome in a cohort with low prevalence of high grade brain injury. The additional value of SWI is yet to be determined in larger cohorts. The combination of imaging and functional biomarkers may be advisable for the prediction of neurodevelopmental outcome.
Collapse
Affiliation(s)
- Monia Vanessa Dewan
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany,
| | - Ralf Herrmann
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Selma Sirin
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Hanna Müller
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Paediatrics, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tobias Storbeck
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Frauke Dransfeld
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Britta Hüning
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
99
|
Gould JF, Hunt E, Roberts RM, Louise J, Collins CT, Makrides M. Can the Bayley Scales of Infant Development at 18 months predict child behaviour at 7 years? J Paediatr Child Health 2019; 55:74-81. [PMID: 30101998 DOI: 10.1111/jpc.14163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 03/30/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Abstract
AIM Infants born preterm (<37 weeks' gestation) are at risk of poor neurodevelopmental outcomes; hence, many neonatal centres routinely follow up infants using the Bayley Scales of Infant Development (BSID), although the predictive validity of the BSID for children born preterm is questionable. Our objective is to evaluate the predictive capacity of the BSID for behavioural functioning at school age of children born preterm. METHODS Children (n = 657 children born <33 weeks' gestation) were enrolled at birth from five neonatal centres around Australia. A psychologist assessed child development at 18 months using the BSID-II. When children were 7 years (corrected age) of age, parents completed the Strengths and Difficulties Questionnaire, the Behavior Rating Inventory of Executive Function and the Conners 3rd Edition Attention Deficit Hyperactivity Disorder Index. We explored associations between BSID-II at 18 months and behaviour scores at 7 years and examined the interaction effect of the use of an allied health service between the BSID-II and behaviour assessments. RESULTS For every one-point increase on the BSID-II Mental Development Index, behaviour scores decreased by 0.07 points for the Strengths and Difficulties Questionnaire Total Difficulties (95% confidence interval (CI) -0.10, -0.03), 0.12 points for the Behavior Rating Inventory of Executive Function Global Executive Composite (95% CI -0.21, -0.04) and 0.16 points for the Conners 3rd Edition Attention Deficit Hyperactivity Disorder Index (95% CI -0.26, -0.05). CONCLUSION The BSID-II at 18 months was weakly associated with parent-reported behaviour at 7 years in children born preterm.
Collapse
Affiliation(s)
- Jacqueline F Gould
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Hunt
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jennie Louise
- Data Management and Analysis Centre, University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
100
|
O’Meagher S, Norris K, Kemp N, Anderson P. Examining the relationship between performance-based and questionnaire assessments of executive function in young preterm children: Implications for clinical practice. Child Neuropsychol 2018; 25:899-913. [DOI: 10.1080/09297049.2018.1531981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sari O’Meagher
- School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Kimberley Norris
- School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Nenagh Kemp
- School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Peter Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
| |
Collapse
|