Among perinatal factors, only the Apgar score is associated with specific language impairment

Prolactin-secreting tumors, dopamine agonists and pregnancy: a longitudinal experience of a tertiary neuroendocrine center

PURPOSE

Prolactin (PRL)-secreting tumours are associated with infertility and can be reverted by dopamine agonist (DA) therapy. The suspension of DA is recommended once pregnancy is established, as all DAs cross the placenta. The aim of the study was to evaluate the rate of maternal-foetal complications in women treated with cabergoline (CAB) or bromocriptine (BRM) for prolactinoma during gestation and the effect of pregnancy on prolactinoma progression.

METHODS

This was a retrospective observational study involving 43 women affected by prolactinoma who became pregnant during therapy with CAB or BRM for a total of 58 pregnancies. For each patient, medical records were analysed by integrating the data with outpatient or telephone interview.

RESULTS

At the time of conception, 18 women were in the BRM group, while 40 were in CAB group. No differences were found in obstetric or neonatal outcomes between the two groups. There was a significant difference (p = 0.046) in child complications reported in maternal interview found exclusively in the CAB group. No further confounding factors were detected. Disease remission rate after the first pregnancy was 42.9% and the main predictor was a lower PRL nadir before pregnancy (p = 0.023). No difference was detected between the two groups in terms of tumor remission. Breastfeeding did not modify the outcome.

CONCLUSION

Foetal exposure to DAs during the first weeks of embryogenesis is not associated with a greater risk of complications. The transient and mild developmental disorders recorded resolved spontaneously and the prevalence was substantially overlapping with that observed in the general population.

What risk factors for Developmental Language Disorder can tell us about the neurobiological mechanisms of language development

Language is a complex multidimensional cognitive system that is connected to many neurocognitive capacities. The development of language is therefore strongly intertwined with the development of these capacities and their neurobiological substrates. Consequently, language problems, for example those of children with Developmental Language Disorder (DLD), are explained by a variety of etiological pathways and each of these pathways will be associated with specific risk factors. In this review, we attempt to link previously described factors that may interfere with language development to putative underlying neurobiological mechanisms of language development, hoping to uncover openings for future therapeutical approaches or interventions that can help children to optimally develop their language skills.

Low Five-Minute Apgar Score and Neurological Morbidities: Does Prematurity Modify the Association?

(1) Background: We aimed to study whether a low 5 min Apgar score is associated with pediatric neurological morbidities throughout childhood. (2) Methods: A population-based retrospective cohort study was conducted. The exposed group was defined as offspring with a 5 min Apgar score <7, and the remaining offspring served as the comparison group. The primary outcome was defined as pediatric hospitalizations with any neurological morbidity. Multivariable survival models were used to evaluate the association between the exposure and outcome while adjusting for potential confounders. Additional models were used to study this association separately among term- and preterm-born offspring. (3) Results: The study population included 349,385 singletons born between the years 1991 and 2021, 0.6% (n = 2030) of whom had a 5 min Apgar score <7 (exposed). The cohort was followed for up to 18 years (median ~ 10.6). The incidence of neurological morbidity-related hospitalizations was higher among the exposed group versus the unexposed group (11.3% versus 7.5%, hazard ratio = 1.84; 95%CI 1.58−2.13). A low 5 min Apgar score remained a significant risk factor for neurological hospitalizations after adjusting for preterm delivery, maternal age, hypertension during pregnancy, gestational diabetes mellitus, chorioamnionitis, and delivery mode (adjusted hazard ratio = 1.61; 95%CI 1.39−1.87). However, after modeling term and preterm offspring separately, a low 5 min Apgar score was independently associated with neurological hospitalizations only among offspring born at term (adjusted hazard ratio = 1.16; 95%CI 0.87−1.55 and 1.70; 95%CI 1.42−2.02 for preterm and term offspring, respectively). (4) Conclusions: A low 5 min Apgar score is independently associated with childhood neurological morbidity, specifically among term-born offspring. Although not designed to identify risk for long-term health complications, Apgar scores may be a marker of risk for short- and long-term neurological morbidities among term newborns.

Risk indicators for hearing loss and language acquisition and their relationship with socioeconomic, demographic and obstetric variables in preterm and term babies

PURPOSE

To compare the frequency of risk indicators in preterm and full-term babies; to analyze the possible relationships among the presence of risk for hearing loss with language acquisition and socioeconomic, demographic and obstetric variables.

METHODS

This is a longitudinal cohort study, with a sample of 87 babies. Gestational, obstetric and sociodemographic data were collected from mothers and babies. The socioeconomic classification status of the families were classified using the Brazilian Criteria for Economic Classification. The risk for language was assessed using the Language Acquisition Enunciation Signs and the Denver II test. The data were analyzed using the STATISTICA 9.1 software, using the chi-square and the Mann-Whitney U tests and simple and multiple linear regression models.

RESULTS

Permanence in a neonatal intensive care (65.52%), ototoxic (48.28%), mechanical ventilation (39.66%) and hyperbilirubinemia (46.55%) were the more frequent risk indicators in the sample. Regarding socioeconomic, demographic and obstetric factors, there was a correlation among prenatal care, gestational age, birth weight, feeding with hearing risk. Acquisition and development of language showed statistical significance with varicella, HIV, Apgar score and birth weight >1500 grams.

CONCLUSION

Preterm babies showed higher frequency of risk indicators compared to full-term babies. Among environmental factors, prenatal care, which interferes in the outcome of gestational age, birth weight, Apgar score and presence of infectious diseases, as well as feeding, emerged as significant factors related to hearing and language acquisition. Prematurity was the relevant biological factor related to hearing and language risk.

Maternal recurrent pregnancy loss is associated with an increased risk for long-term neurological morbidity in offspring

AIM

To determine whether maternal history of recurrent pregnancy loss (RPL) impacts on the long-term neurological health of the offspring.

METHOD

A population-based cohort analysis was performed, including all singletons born between 1991 and 2014 at a single regional tertiary centre. Neurological morbidity up to age 18 years (including cognitive, motor, and psychiatric disorders) in children born to mothers with and without a history of RPL was compared. Cumulative neurological morbidity incidence was compared with survival curves and a Weibull multivariable survival model to control for follow-up time and relevant confounders.

RESULTS

A total of 242 187 deliveries met the inclusion criteria during the study period, 5% (n=12 182) of which were in mothers with RPL. Epilepsy and developmental disorders were significantly more common in the group with RPL (0.95 vs 0.74/1000 person-years [p=0.009] and 0.22 vs 0.09/1000 person-years [p<0.001]). The survival curves demonstrated significantly higher cumulative incidences of epilepsy and developmental disorders in the group with RPL. The multivariable model exhibited an independent association between maternal RPL and childhood epilepsy (adjusted hazard ratio 1.23; 95% confidence interval 1.01-1.50) and developmental disorders in the offspring (adjusted hazard ratio 2.41; 95% confidence interval 1.60-3.64).

INTERPRETATION

A history of maternal RPL appears to be independently associated with long-term neurological morbidity of the offspring.

WHAT THIS PAPER ADDS

Hospitalizations for epilepsy and developmental disorders are significantly more common among children of mothers with a history of recurrent pregnancy loss.

Food insecurity is associated with maternal depression and child pervasive developmental symptoms in low-income Latino households

The objective of this study was to investigate associations between household food insecurity, maternal clinical depression, and child behavior problems in low-income Latino households. Data were collected from a cohort of 168 children and their Latina mothers recruited prenatally at two San Francisco hospitals from 2006 to 2007. Food insecurity at year four was associated with increased odds of maternal clinical depression at years four to five (adjusted OR 1.22, 95% confidence interval 1.03 to 1.43). Food insecurity at year four was associated with child pervasive developmental problems at year five (B=0.21, p=0.041) in adjusted models. The association between food insecurity at year four and oppositional defiant problems at year five was partially mediated (28.7% mediation, p=0.046) by maternal clinical depression in years four and five. Our results suggest that household food insecurity is associated with greater maternal depression, and both food insecurity and maternal depression uniquely predict certain types of child behavior problems. Assessing for and addressing household food insecurity may be beneficial additions to psychosocial interventions targeting maternal and child mental health.

Specific language impairment is associated with maternal and family factors

BACKGROUND

This study aimed to identify risk factors associated with specific language impairment (SLI).

METHODS

In a nested case-control design, 253 children attending special needs schools for severe speech and language difficulties in the Netherlands were matched for sex and date of birth with 253 children attending mainstream education. Data on perinatal, maternal and family issues were retrieved from well-child care files registered shortly after birth.

RESULTS

Children with SLI had younger mothers than children in the control group (mean 30 years 9 months vs. mean 31 years 9 months) (P = 0.02). Children with SLI were less frequently breastfed directly after birth (55% vs. 71%) (P = 0.0007) and were less frequently firstborns (33.3% vs. 46.2%) (P = 0.002). No statistically significant differences were found for any of the other risk factors.

CONCLUSIONS

A relationship was found between SLI and maternal age, being breastfed and place in the birth order. Perinatal risk factors do not seem to be strongly associated with SLI.

No Association between Obesity and Behavior in Low-income, Preschool Latino Children

BACKGROUND

The relationship between behavioral problems and obesity in early childhood in Latinos is largely unknown.

METHODS

Cross-sectional anthropometric and behavioral data of children at three years of age were gathered from a cohort of 174 children of Latina mothers at two San Francisco hospitals. Child behaviors were assessed using the preschool Child Behavior Checklist (CBCL/1½-5). Logistic regression was used to analyze the association between behavior and obesity.

RESULTS

At three years, 27.7% were obese. There were no associations between affective (OR = 1.89; 95% confidence interval [CI] 0.42-8.59), anxiety (OR = 1.86; 95% CI 0.53-6.47), pervasive developmental (OR = 0.42; 95% CI 0.13-1.36), attention deficit hyperactivity (OR = 0.58; 95% CI 0.12-2.76), or oppositional defiant (OR = 6.49; 95% CI 0.65-64.49) problems and obesity.

CONCLUSIONS

Though psychological problems and obesity are associated among older children and adolescents, there was no association in Latino three-year olds in a low-income sample.

Predicting functional communication ability in children with cerebral palsy at school entry

AIM

To explore the value of demographic, environmental, and early clinical characteristics in predicting functional communication in children with cerebral palsy (CP) at school entry.

METHOD

Data are from an Australian prospective longitudinal study of children with CP. Children assessed at 18 to 24 and 48 to 60 months corrected age were included in the study. Functional communication was classified at 48 to 60 months using the Communication Function Classification System (CFCS). Predictive variables included communication skills at 18 to 24 months, evaluated using the Communication and Symbolic Behavioural Scales Developmental Profile (CSBS-DP) Infant-Toddler Checklist. Early Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, and motor type and distribution were evaluated by two physiotherapists. Demographic and comorbid variables were obtained through parent interview with a paediatrician or rehabilitation specialist.

RESULTS

A total of 114 children (76 males, 38 females) were included in the study. At 18 to 24 months the mean CSBS-DP was 84.9 (SD 19.0). The CFCS distribution at 48 to 60 months was I=36(32%), II=25(22%), III=20(18%), IV=19(17%), and V=14(12%). In multivariable regression analysis, only CSBS-DP (p<0.01) and GMFCS (p<0.01) at 18 to 24 months were predictors of functional communication at school entry.

INTERPRETATION

Body structure and function and not environmental factors impact functional communication at school entry in children with CP. This provides valuable guidance for early screening, parent education, and future planning of intervention programs to improve functional communication.