1
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Spittle AJ, Thompson DK, Olsen JE, Kwong A, Treyvaud K. Predictors of long-term neurodevelopmental outcomes of children born extremely preterm. Semin Perinatol 2021; 45:151482. [PMID: 34456065 DOI: 10.1016/j.semperi.2021.151482] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children born extremely preterm (<28 weeks' gestation) are at high risk of a range of adverse neurodevelopmental outcomes in later childhood compared with their peers born at term, including cognitive, motor, and behavioral difficulties. These difficulties can be associated with poorer academic achievement and health outcomes at school age. In this review, we discuss several predictors in the newborn period of early childhood neurodevelopmental outcomes including perinatal risk factors, neuroimaging findings and neurobehavioral assessments, along with social and environmental influences for children born extremely preterm. Given the complexity of predicting long-term outcomes in children born extremely preterm, we recommend multi-disciplinary teams in clinical practice to assist in determining an individual child's risk for adverse long-term outcomes and need for referral to targeted intervention, based upon their risk.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Parkville, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Physiotherapy and Newborn Services, The Royal Women's Hospital, Parkville, Australia.
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Physiotherapy and Newborn Services, The Royal Women's Hospital, Parkville, Australia
| | - Amanda Kwong
- Department of Physiotherapy, University of Melbourne, Parkville, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Physiotherapy and Newborn Services, The Royal Women's Hospital, Parkville, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia; Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
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2
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Sato J, Safar K, Vandewouw MM, Bando N, O'Connor DL, Unger SL, Taylor MJ. Altered Functional Connectivity During Face Processing in Children Born Very Low Birth Weight. Soc Cogn Affect Neurosci 2021; 16:1182-1190. [PMID: 34089054 PMCID: PMC8599272 DOI: 10.1093/scan/nsab070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/26/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Structural brain alterations have been reported in key emotional face processing regions following preterm birth; however, few studies have investigated the functional networks underlying these processes in children born with very low birth weight (VLBW). Using magnetoencephalography (MEG), we examined the functional networks related to the implicit processing of happy and angry faces in 5-year-old VLBW (n = 28) and full-term (FT; n = 24) children. We found that VLBW children showed atypical recruitment of emotional face processing networks in theta (4–7 Hz) compared to FT children. VLBW children showed reduced theta connectivity during processing of angry faces only. This hypo-connected theta-band network was anchored in the left orbitofrontal and parietal regions, involved in the higher level processing of faces and emotion regulation. At the behavioural level, despite VLBW children performing within the normal range, FT children had significantly higher affect recognition scores. Our MEG results suggest a selective impairment in processing angry faces, which would negatively impact social functioning in VLBW children. In FT children, greater recruitment of this theta-band network was positively associated with improved affect recognition scores. Thus, our findings suggest an important role of theta oscillations in early face processing, deficits which may contribute to broader socio-emotional impairments in VLBW children.
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Affiliation(s)
- Julie Sato
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Psychology, University of Toronto, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kristina Safar
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marlee M Vandewouw
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Bando
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Sharon L Unger
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, Sinai Health, Toronto, Ontario, Canada.,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margot J Taylor
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.,Psychology, University of Toronto, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Medical Imaging, University of Toronto, Ontario, Canada
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3
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Gattis M, Winstanley A, Sperotto R, Putnick DL, Bornstein MH. Foundations of attention sharing: Orienting and responding to attention in term and preterm 5-month-old infants. Infant Behav Dev 2020; 61:101466. [PMID: 32927260 PMCID: PMC7768091 DOI: 10.1016/j.infbeh.2020.101466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/01/2022]
Abstract
Attention is the gateway to perceptual, cognitive, and socioemotional development in humans. We observed 104 5-month-old term and preterm infants and their mothers in social interactions to address three questions about the role of maturation in orienting and responding to attention. We used a fine-grained coding system to allow parallel comparisons across infant and maternal orienting, and sequential analysis to evaluate infant and maternal responding to attention. Orienting and responding to attention differed for attention to people versus objects, as did the relations between maturity and attention. We conclude that maturity contributes to orienting and responding to attention and that orienting and responding to attention are specific rather than homogenous. We discuss the implications of these conclusions for future studies of how attention influences cognitive and communicative development.
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Affiliation(s)
| | | | | | - Diane L Putnick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA; Institute for Fiscal Studies, London, UK; UNICEF, New York, NY, USA
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4
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Lakatos PP, Matic T, Carson M, Williams ME. Child-Parent Psychotherapy with Infants Hospitalized in the Neonatal Intensive Care Unit. J Clin Psychol Med Settings 2020; 26:584-596. [PMID: 30941622 DOI: 10.1007/s10880-019-09614-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hospitalization in the Neonatal Intensive Care Unit (NICU) is a stressful and potentially traumatic experience for infants as well as their parents. The highly specialized medical environment can threaten the development of a nurturing and secure caregiving relationship and potentially derail an infant's development. Well-timed, dose-specific interventions that include an infant mental health approach can buffer the impact of medical traumatic stress and separations and support the attachment relationship. Many psychological interventions in the NICU setting focus on either the parent's mental health or the infant's neurodevelopmental functioning. An alternative approach is to implement a relationship-based, dyadic intervention model that focuses on the developing parent-infant relationship. Child-parent psychotherapy (CPP) is an evidence-based trauma-informed dyadic intervention model for infants and young children who have experienced a traumatic event. This article describes the adaptation of CPP for the NICU environment.
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Affiliation(s)
- Patricia P Lakatos
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA.
| | - Tamara Matic
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Melissa Carson
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Marian E Williams
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
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5
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Modi N, Ashby D, Battersby C, Brocklehurst P, Chivers Z, Costeloe K, Draper ES, Foster V, Kemp J, Majeed A, Murray J, Petrou S, Rogers K, Santhakumaran S, Saxena S, Statnikov Y, Wong H, Young A. Developing routinely recorded clinical data from electronic patient records as a national resource to improve neonatal health care: the Medicines for Neonates research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background
Clinical data offer the potential to advance patient care. Neonatal specialised care is a high-cost NHS service received by approximately 80,000 newborn infants each year.
Objectives
(1) To develop the use of routinely recorded operational clinical data from electronic patient records (EPRs), secure national coverage, evaluate and improve the quality of clinical data, and develop their use as a national resource to improve neonatal health care and outcomes. To test the hypotheses that (2) clinical and research data are of comparable quality, (3) routine NHS clinical assessment at the age of 2 years reliably identifies children with neurodevelopmental impairment and (4) trial-based economic evaluations of neonatal interventions can be reliably conducted using clinical data. (5) To test methods to link NHS data sets and (6) to evaluate parent views of personal data in research.
Design
Six inter-related workstreams; quarterly extractions of predefined data from neonatal EPRs; and approvals from the National Research Ethics Service, Health Research Authority Confidentiality Advisory Group, Caldicott Guardians and lead neonatal clinicians of participating NHS trusts.
Setting
NHS neonatal units.
Participants
Neonatal clinical teams; parents of babies admitted to NHS neonatal units.
Interventions
In workstream 3, we employed the Bayley-III scales to evaluate neurodevelopmental status and the Quantitative Checklist of Autism in Toddlers (Q-CHAT) to evaluate social communication skills. In workstream 6, we recruited parents with previous experience of a child in neonatal care to assist in the design of a questionnaire directed at the parents of infants admitted to neonatal units.
Data sources
Data were extracted from the EPR of admissions to NHS neonatal units.
Main outcome measures
We created a National Neonatal Research Database (NNRD) containing a defined extract from real-time, point-of-care, clinician-entered EPRs from all NHS neonatal units in England, Wales and Scotland (n = 200), established a UK Neonatal Collaborative of all NHS trusts providing neonatal specialised care, and created a new NHS information standard: the Neonatal Data Set (ISB 1595) (see http://webarchive.nationalarchives.gov.uk/±/http://www.isb.nhs.uk/documents/isb-1595/amd-32–2012/index_html; accessed 25 June 2018).
Results
We found low discordance between clinical (NNRD) and research data for most important infant and maternal characteristics, and higher prevalence of clinical outcomes. Compared with research assessments, NHS clinical assessment at the age of 2 years has lower sensitivity but higher specificity for identifying children with neurodevelopmental impairment. Completeness and quality are higher for clinical than for administrative NHS data; linkage is feasible and substantially enhances data quality and scope. The majority of hospital resource inputs for economic evaluations of neonatal interventions can be extracted reliably from the NNRD. In general, there is strong parent support for sharing routine clinical data for research purposes.
Limitations
We were only able to include data from all English neonatal units from 2012 onwards and conduct only limited cross validation of NNRD data directly against data in paper case notes. We were unable to conduct qualitative analyses of parent perspectives. We were also only able to assess the utility of trial-based economic evaluations of neonatal interventions using a single trial. We suggest that results should be validated against other trials.
Conclusions
We show that it is possible to obtain research-standard data from neonatal EPRs, and achieve complete population coverage, but we highlight the importance of implementing systematic examination of NHS data quality and completeness and testing methods to improve these measures. Currently available EPR data do not enable ascertainment of neurodevelopmental outcomes reliably in very preterm infants. Measures to maintain high quality and completeness of clinical and administrative data are important health service goals. As parent support for sharing clinical data for research is underpinned by strong altruistic motivation, improving wider public understanding of benefits may enhance informed decision-making.
Future work
We aim to implement a new paradigm for newborn health care in which continuous incremental improvement is achieved efficiently and cost-effectively by close integration of evidence generation with clinical care through the use of high-quality EPR data. In future work, we aim to automate completeness and quality checks and make recording processes more ‘user friendly’ and constructed in ways that minimise the likelihood of missing or erroneous entries. The development of criteria that provide assurance that data conform to prespecified completeness and quality criteria would be an important development. The benefits of EPR data might be extended by testing their use in large pragmatic clinical trials. It would also be of value to develop methods to quality assure EPR data including involving parents, and link the NNRD to other health, social care and educational data sets to facilitate the acquisition of lifelong outcomes across multiple domains.
Study registration
This study is registered as PROSPERO CRD42015017439 (workstream 1) and PROSPERO CRD42012002168 (workstream 3).
Funding
The National Institute for Health Research Programme Grants for Applied Research programme (£1,641,471). Unrestricted donations were supplied by Abbott Laboratories (Maidenhead, UK: £35,000), Nutricia Research Foundation (Schiphol, the Netherlands: £15,000), GE Healthcare (Amersham, UK: £1000). A grant to support the use of routinely collected, standardised, electronic clinical data for audit, management and multidisciplinary feedback in neonatal medicine was received from the Department of Health and Social Care (£135,494).
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Affiliation(s)
- Neena Modi
- Department of Medicine, Imperial College London, London, UK
| | - Deborah Ashby
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Kate Costeloe
- Centre for Genomics and Child Health, Queen Mary University of London, London, UK
| | | | - Victoria Foster
- Department of Social Sciences, Edge Hill University, Ormskirk, UK
| | - Jacquie Kemp
- National Programme of Care, NHS England, London, UK
| | - Azeem Majeed
- School of Public Health, Imperial College London, London, UK
| | | | - Stavros Petrou
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Katherine Rogers
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | | | - Hilary Wong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Alys Young
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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6
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Promoting Parenting Supports and Engagement for Infants Born Preterm. J Pediatr 2019; 210:10-12. [PMID: 31056201 DOI: 10.1016/j.jpeds.2019.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
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7
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You J, Yang HJ, Hao MC, Zheng JJ. Late Preterm Infants' Social Competence, Motor Development, and Cognition. Front Psychiatry 2019; 10:69. [PMID: 30842745 PMCID: PMC6391324 DOI: 10.3389/fpsyt.2019.00069] [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: 09/10/2018] [Accepted: 01/30/2019] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to compare the social competence, motor development, and cognition of late preterm infants (LPIs) with full-term infants. Several studies in the recent past indicated that LPIs are at high risk of social development problems. We compared the development of motor skills, cognition, and social competency of LPIs with full-term infants at between 2 and 2.5 years old. The Chinese versions of the Gesell Development Diagnosis scale and the Normal Development of Social Skills from Infants to Junior High School Children scale were used for the assessment. LPIs were not more socially competent than their full-term counterparts. Each skill-namely, adaptability, gross motor, fine motor, language, and personal-social responses-was separately associated with the total level of social skills. It was found that gross motor skills had a positive correlation with the self-help and locomotive abilities, and fine motor skills had a positive association with locomotion abilities. LPIs had risk factors due to their delayed social skills in areas including motor disorders and physiological and perinatal factors. LPIs under three were at a higher risk of impairment in social competency. Therefore, it is recommended that they be monitored regularly to identify the development of social and cognitive disorders at an early stage.
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Affiliation(s)
- Jia You
- Early Child Development Center, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Hong-Juan Yang
- Early Child Development Center, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Mei-Chen Hao
- Early Child Development Center, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Jing-Jing Zheng
- Early Child Development Center, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
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8
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Amygdala functional connectivity is associated with social impairments in preterm born young adults. NEUROIMAGE-CLINICAL 2018; 21:101626. [PMID: 30545688 PMCID: PMC6413301 DOI: 10.1016/j.nicl.2018.101626] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/19/2018] [Accepted: 12/01/2018] [Indexed: 01/25/2023]
Abstract
Survivors of preterm birth experience long-lasting behavioral problems characterized by increased risk of depression, anxiety, and impairments in social functioning. The amygdala is a key region for social functioning and alterations in amygdala structure and connectivity are thought to underlie social functioning deficits in many disorders, including preterm birth. However, functional connectivity of the amygdala and its association with social impairments is not well-studied in preterm participants (PTs). In a group of late adolescents born very PT (600–1250 g birth weight), measures of social and emotional development were examined using the Child Behavior Checklist (CBCL) administered at age 16 (66 term and 161 preterm participants), the Youth Self Report (YSR) administered at age 16 (56 term and 45 preterm participants), and the Vineland Adaptive Behavior Scales (VABS) administered at age 18 (71 term and 190 preterm participants). Amygdala functional connectivity was also examined using resting-state functional magnetic resonance imaging at age 20 (17 term and 19 preterm participants). By parent report, preterm-born adolescents demonstrate increased social impairment compared to their term-born peers. Amygdala connectivity is altered for those prematurely-born, and markers of social functioning correlate with altered amygdala-PCC connectivity. These findings add to knowledge regarding the developmental trajectory of amygdala connectivity in PT and suggest a possible neural underpinning for the well-characterized social impairment experienced by prematurely-born individuals. By parent report, preterm adolescents demonstrate increased social impairment. By self-report, preterm adolescents demonstrate no social impairment. Amygdalar connectivity is altered for those preterm young adults. Markers of social functioning correlate with altered amygdala-PCC connectivity.
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9
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Boone KM, Brown AK, Keim SA. Screening Accuracy of the Brief Infant Toddler Social-Emotional Assessment to Identify Autism Spectrum Disorder in Toddlers Born at Less Than 30 Weeks' Gestation. Child Psychiatry Hum Dev 2018; 49:493-504. [PMID: 29147839 DOI: 10.1007/s10578-017-0768-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Despite the higher prevalence of autism spectrum disorder (ASD) in children born preterm, valid screening tools for use in preterm populations are lacking. We aimed to evaluate the screening accuracy of the Brief Infant Toddler Social-Emotional Assessment (BITSEA) and to compare it to the Pervasive Developmental Disorders Screening Test-II, Stage 2, Developmental Clinic Screener (PDDST-II-DCS) in identifying ASD diagnosis in toddlers born at < 30 weeks' gestation. Caregivers (94% mothers) of 555 children completed questionnaires (BITSEA, PDDST-II-DCS, socio-demographics) when the children (58% male) were 18-36 months. Medical charts were abstracted 3.5 years later and showed that 4% (n = 24) of children had an ASD diagnosis. BITSEA competence (sensitivity = .74; specificity = .76) and ASD (sensitivity = .70; specificity = .73) subscales demonstrated better accuracy in identifying ASD compared to the recommended PDDST-II-DCS cut-score (sensitivity = .73; specificity = .64), specifically as it related to specificity. Additional studies are needed in other preterm populations to replicate these findings.
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Affiliation(s)
- Kelly M Boone
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
- Crane Center for Early Childhood Research and Policy and Schoenbaum Family Center, The Ohio State University, 175 East 7th Avenue, Columbus, OH, 43201, USA.
| | - Anne K Brown
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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10
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Gray PH, Edwards DM, Hughes IP, Pritchard M. Social-emotional development in very preterm infants during early infancy. Early Hum Dev 2018; 121:44-48. [PMID: 29775884 DOI: 10.1016/j.earlhumdev.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Peter H Gray
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
| | - Dawn M Edwards
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
| | - Ian P Hughes
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
| | - Margo Pritchard
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia; Australian Catholic University, Mater Health Services, South Brisbane, Queensland, Australia.
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11
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Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy? Dev Med Child Neurol 2018; 60:147-154. [PMID: 29105760 DOI: 10.1111/dmcn.13602] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Robert Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, PA, USA
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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12
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Peralta-Carcelen M, Carlo WA, Pappas A, Vaucher YE, Yeates KO, Phillips VA, Gustafson KE, Payne AH, Duncan AF, Newman JE, Bann CM. Behavioral Problems and Socioemotional Competence at 18 to 22 Months of Extremely Premature Children. Pediatrics 2017; 139:peds.2016-1043. [PMID: 28562255 PMCID: PMC5470499 DOI: 10.1542/peds.2016-1043] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Behavior and socioemotional development are crucial aspects of child development . METHODS A total of 2505 children born at <27 weeks' gestation was evaluated at 18 to 22 months' corrected age between January 1, 2008 and December 12, 2012 (86% follow-up). The Brief Infant and Toddler Social and Emotional Assessment was used to evaluate behavioral and socioemotional problems. Cognition and language were evaluated by using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Logistic regression analysis was used to evaluate for perinatal and demographic factors associated with behavioral problems (≥75th percentile) and delayed socioemotional competence (≤15th percentile). Structural equation modeling with bootstrapping was used to identify possible associated risk factors and Bayley-III scores as mediators. RESULTS Thirty-five percent (873) of children had behavioral problems, and 26% (637) displayed deficits in socioemotional competence. Male sex, public insurance, mothers with less than a high school education, and lower maternal age were associated with behavioral problems. Deficits in competence were associated with lower birth weight, public insurance, mothers with less than a high school education, and abnormal neuromotor exam. Bayley-III language and cognitive scores were significant mediators of the relationships between risk factors and both behavioral and competence scores (P < .05). CONCLUSIONS Extremely premature children are at risk for behavioral problems and deficits in socioemotional competence. Sociodemographic factors were associated with both socioemotional competence and behavioral problems. Deficits in socioemotional competence were also associated with neuromotor abnormalities and cognitive and language function.
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Affiliation(s)
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Yvonne E. Vaucher
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Keith Owen Yeates
- Department of Pediatrics, Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Vivien A. Phillips
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Allison H. Payne
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Andrea F. Duncan
- University of Texas at Houston McGowen Medical School, Houston, Texas; and
| | | | - Carla M. Bann
- RTI International, Research Triangle Park, North Carolina
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13
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Weber A, Harrison TM, Steward D, Sinnott L, Shoben A. Oxytocin trajectories and social engagement in extremely premature infants during NICU hospitalization. Infant Behav Dev 2017; 48:78-87. [PMID: 28552589 DOI: 10.1016/j.infbeh.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
Extremely premature infants, born 28 weeks gestation or less, are at high risk for impaired socioemotional development, due in part to exposure to early stressful social experiences that alter brain development. Understanding mediators that link experience with outcomes is necessary to assess premature infant responses to social experiences that are critical to brain development. The hormone oxytocin (OT), released during supportive interactions, has potential as a biomarker of the premature infant's responses to social experiences. The purpose of this study was to examine associations among infant plasma OT trajectories and maternal-infant social engagement behaviors during initial hospitalization. This study also examined demographic correlates of engagement behaviors in mothers and infants. Plasma from 28 extremely premature infants, born gestational ages 25-28 6/7 weeks, was collected at 14 days of life, then weekly until 34 weeks. Social engagement behaviors were measured by the Parent-Child Early Relational Assessment during a videotaped feeding when the infant was receiving one-quarter full oral feeds. Maternal-infant demographics were extracted from the medical record. Higher infant plasma OT was associated with lower infant social engagement, but no associations were found with maternal social engagement. Infant social engagement was positively related to maternal social engagement. Maternal parity was related to maternal social engagement, and infant demographics did not predict infant social engagement. The significant, yet negative, association between infant OT and engagement provides support for the measurement of OT as a neurobiological antecedent to infant social behaviors. Finally, this research suggests that during the earliest period of infant socio-behavioral development, premature infants are behaviorally reactive to the social engagement behaviors of their mothers.
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Affiliation(s)
- Ashley Weber
- Case Western Reserve University, N0B040 Frances Payne Bolton School of Nursing, 2120 Cornell Road, Cleveland, OH 44106, USA.
| | - Tondi M Harrison
- The Ohio State University College of Nursing, Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Deborah Steward
- The Ohio State University College of Nursing, Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Loraine Sinnott
- The Ohio State University College of Nursing, Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Abigail Shoben
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210, USA.
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14
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Browne JV, Martinez D, Talmi A. Infant Mental Health (IMH) in the Intensive Care Unit: Considerations for the Infant, the Family and the Staff. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Papini C, White TP, Montagna A, Brittain PJ, Froudist-Walsh S, Kroll J, Karolis V, Simonelli A, Williams SC, Murray RM, Nosarti C. Altered resting-state functional connectivity in emotion-processing brain regions in adults who were born very preterm. Psychol Med 2016; 46:3025-3039. [PMID: 27523311 PMCID: PMC5080670 DOI: 10.1017/s0033291716001604] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Very preterm birth (VPT; <32 weeks of gestation) has been associated with impairments in emotion regulation, social competence and communicative skills. However, the neuroanatomical mechanisms underlying such impairments have not been systematically studied. Here we investigated the functional integrity of the amygdala connectivity network in relation to the ability to recognize emotions from facial expressions in VPT adults. METHOD Thirty-six VPT-born adults and 38 age-matched controls were scanned at rest in a 3-T MRI scanner. Resting-state functional connectivity (rs-fc) was assessed with SPM8. A seed-based analysis focusing on three amygdalar subregions (centro-medial/latero-basal/superficial) was performed. Participants' ability to recognize emotions was assessed using dynamic stimuli of human faces expressing six emotions at different intensities with the Emotion Recognition Task (ERT). RESULTS VPT individuals compared to controls showed reduced rs-fc between the superficial subregion of the left amygdala, and the right posterior cingulate cortex (p = 0.017) and the left precuneus (p = 0.002). The VPT group further showed elevated rs-fc between the left superficial amygdala and the superior temporal sulcus (p = 0.008). Performance on the ERT showed that the VPT group was less able than controls to recognize anger at low levels of intensity. Anger scores were significantly associated with rs-fc between the superficial amygdala and the posterior cingulate cortex in controls but not in VPT individuals. CONCLUSIONS These findings suggest that alterations in rs-fc between the amygdala, parietal and temporal cortices could represent the mechanism linking VPT birth and deficits in emotion processing.
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Affiliation(s)
- C. Papini
- Department of Psychosis Studies,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London, De
Crespigny Park, London, UK
- Department of Developmental Psychology and
Socialisation, University of Padua,
Padua, Italy
| | - T. P. White
- Department of Psychosis Studies,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London, De
Crespigny Park, London, UK
- School of Psychology,
University of Birmingham, Edgbaston,
Birmingham, UK
| | - A. Montagna
- Division of Imaging Sciences and Biomedical
Engineering, Centre for the Developing Brain,
King's College London, St. Thomas’
Hospital, London, UK
| | - P. J. Brittain
- Department of Psychosis Studies,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London, De
Crespigny Park, London, UK
| | - S. Froudist-Walsh
- Department of Psychosis Studies,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London, De
Crespigny Park, London, UK
| | - J. Kroll
- Department of Psychosis Studies,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London, De
Crespigny Park, London, UK
| | - V. Karolis
- Department of Psychosis Studies,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London, De
Crespigny Park, London, UK
| | - A. Simonelli
- Department of Developmental Psychology and
Socialisation, University of Padua,
Padua, Italy
| | - S. C. Williams
- Department of Neuroimaging,
Centre for Neuroimaging Sciences, Institute of
Psychiatry, Psychology and Neuroscience,
King's College London, De Crespigny Park,
London, UK
| | - R. M. Murray
- Department of Psychosis Studies,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London, De
Crespigny Park, London, UK
| | - C. Nosarti
- Department of Psychosis Studies,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London, De
Crespigny Park, London, UK
- Department of Developmental Psychology and
Socialisation, University of Padua,
Padua, Italy
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16
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Predictors of developmental status in young children living in institutional care in Kazakhstan. Matern Child Health J 2016; 19:1408-16. [PMID: 25480471 DOI: 10.1007/s10995-014-1647-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The main objective of this study was to assess the developmental status of children living in the severely adverse environment of institutional care and the examination of risk factors with regard to developmental status, including degree of stunting and emotional-behavioral and anemia status. The Bayley Scales of Infant Development were used to assess development status in 103 children aged 14.9 months (SD = 6.8) in six Kazakh institutions. The Behavioral Rating Scales were used to assess emotional-behavioral regulation. Physical growth measures were converted to z scores using World Health Organization growth charts. Venous blood was collected for assessment of anemia. Our findings indicated that young children in institutions were developmentally compromised, with duration of institutional care correlated with the severity of delay. Negative predictors of developmental status included: Poor emotional-behavioral regulation, degree of stunting and age at assessment. A particularly large percentage of children were found to be anemic. Additionally, low birth weight was found to be a significant negative predictor of development. Our findings indicate that institutional care has a detrimental impact on the development and emotional regulation of young children. Time in institutional care is a negative predictor for cognitive status for children placed at birth. Moreover stunting was found to be a useful indicator of the degree of impact of early adversity on cognitive development. Particular attention is needed for special-needs children such as those with low birth weight, since their development was found to be more sensitive to early adversity than that of normal birth weight children.
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17
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Welch MG, Firestein MR, Austin J, Hane AA, Stark RI, Hofer MA, Garland M, Glickstein SB, Brunelli SA, Ludwig RJ, Myers MM. Family Nurture Intervention in the Neonatal Intensive Care Unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry 2015; 56:1202-11. [PMID: 25763525 DOI: 10.1111/jcpp.12405] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preterm infants are at high risk for adverse neurodevelopmental and behavioral outcomes. Family Nurture Intervention (FNI) in the Neonatal Intensive Care Unit (NICU) is designed to counteract adverse effects of separation of mothers and their preterm infants. Here, we evaluate effects of FNI on neurobehavioral outcomes. METHODS Data were collected at 18 months corrected age from preterm infants. Infants were assigned at birth to FNI or standard care (SC). Bayley Scales of Infant Development III (Bayley-III) were assessed for 76 infants (SC, n = 31; FNI, n = 45); the Child Behavior Checklist (CBCL) for 57 infants (SC, n = 31; FNI, n = 26); and the Modified Checklist for Autism in Toddlers (M-CHAT) was obtained for 59 infants (SC, n = 33; FNI, n = 26). RESULTS Family Nurture Intervention significantly improved Bayley-III cognitive (p = .039) and language (p = .008) scores for infants whose scores were greater than 85. FNI infants had fewer attention problems on the CBCL (p < .02). FNI improved total M-CHAT scores (p < .02). Seventy-six percent of SC infants failed at least one of the M-CHAT items, compared to 27% of FNI infants (p < .001). In addition, 36% of SC infants versus 0% of FNI infants failed at least one social-relatedness M-CHAT item (p < .001). CONCLUSIONS Family Nurture Intervention is the first NICU intervention to show significant improvements in preterm infants across multiple domains of neurodevelopment, social-relatedness, and attention problems. These gains suggest that an intervention that facilitates emotional interactions between mothers and infants in the NICU may be key to altering developmental trajectories of preterm infants.
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Affiliation(s)
- Martha G Welch
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Morgan R Firestein
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Judy Austin
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amie A Hane
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Psychology, Williams College, Williamstown, MA, USA
| | - Raymond I Stark
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Myron A Hofer
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Marianne Garland
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | | | - Susan A Brunelli
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Robert J Ludwig
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Michael M Myers
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
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18
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Duncan AF, Bann C, Boatman C, Hintz SR, Vaucher YE, Vohr BR, Yolton K, Heyne RJ. Do currently recommended Bayley-III cutoffs overestimate motor impairment in infants born <27 weeks gestation? J Perinatol 2015; 35:516-21. [PMID: 25634519 PMCID: PMC4531094 DOI: 10.1038/jp.2014.243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/14/2014] [Accepted: 11/20/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether a Bayley-III motor composite score of 85 may overestimate moderate-severe motor impairment by analyzing Bayley-III motor components and developing cut-point scores for each. STUDY DESIGN Retrospective study of 1183 children born <27 weeks gestation at NICHD Neonatal Research Network centers and evaluated at 18-22 months corrected age. Gross Motor Function Classification System determined gross motor impairment. Statistical analyses included linear and logistic regression and sensitivity/specificity. RESULTS Bayley-III motor composite scores were strong indicators of gross/fine motor impairment. A motor composite cut-point of 73 markedly improved the specificity for identifying gross and/or fine motor impairment (94% compared with a specificity of 76% for the proposed new cut-point of 85). A Fine Motor Scaled Score <3 differentiated mild from moderate-severe fine motor impairment. CONCLUSIONS This study indicates that a Bayley-III motor composite score of 85 may overestimate impairment. Further studies are needed employing term controls and longer follow-up.
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Affiliation(s)
- Andrea F. Duncan
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Carla Bann
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC, USA
| | | | - Susan R. Hintz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yvonne E. Vaucher
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Betty R. Vohr
- Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, RI, USA
| | - Kimberly Yolton
- Department of Pediatrics, Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Roy J. Heyne
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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