The grasp reflex and moro reflex in infants: hierarchy of primitive reflex responses

Predictive Ability of Conventional and Combined Apgar Scores versus Neonatal Resuscitation and Adaptation Score in Early Neonatal Assessment

OBJECTIVE

 The aim of this study was to assess the Neonatal Resuscitation and Adaptation Score (NRAS) value compared with the conventional and combined Apgar scores in predicting neonatal morbidity and mortality.

STUDY DESIGN

 A prospective cohort study was conducted on 289 neonates delivered at the Menoufia University Hospital. Trained physicians measured conventional Apgar score, combined Apgar score, and NRAS for the neonates at 1 and 5 minutes after delivery in the delivery room. Admitted neonates were followed during their stay to detect any adverse outcomes.

RESULTS

 Morbidities such as the need for neonatal intensive care unit admission, mechanical ventilation, surfactant and inotropes administration, need for extensive phototherapy, intravenous immunoglobulin or exchange transfusion, anemia, metabolic acidosis, abnormal liver and kidney function tests, coagulopathies, hypoglycemia, development of seizures in the first 72 hours of life, and positive changes in cranial ultrasound were significantly higher in neonates who lie within low or moderate NRAS than conventional and combined Apgar scores (p < 0.05). As predictors of mortality, the low and moderate values of the NRAS had higher positive predictive values at 1 (73.91 and 30.61%) and 5 minutes (88.89 and 50.94%) than the conventional Apgar scores at 1 (49.18 and 20.53%), 5 minutes (81.25 and 41.27%) and the combined Apgar scores at 1 (35.63 and 12.45%) and 5 minutes (53.1 and 41.33%).

CONCLUSION

 Our study suggests that the NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity and mortality. Furthermore, a depressed 5-minute NRAS is more predictive of mortality than 1-minute score.

KEY POINTS

· NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity.. · NRAS is more predictive of mortality than conventional and combined Apgar scores.. · A depressed 5-minute NRAS is more predictive of mortality than 1-minute score..

Quantitative assessments of honeybee colony's response to an artificial vibrational pulse resulting in non-invasive measurements of colony's overall mobility and restfulness

In this work we aim to provide a quantitative method allowing the probing of the physiological status of honeybee colonies by providing them with a gentle, short, external artificial vibrational shockwave, and recording their response. The knock is provided by an external electromagnetic shaker attached to the outer wall of a hive, driven by a computer with a 0.1 s long, monochromatic vibration at 340Hz set to an amplitude that occasionally yields a mild response from the bees, recorded by an accelerometer placed in the middle of the central frame of the colony. To avoid habituation, the stimulus is supplied at randomised times, approximately every hour. The method is pioneered with a pilot study on a single colony hosted indoors, then extended onto eight outdoors colonies. The results show that we can quantitatively sense the colony's overall mobility, independently from another physiological aspect, which is phenomenologically explored. Using this, a colony that is queenless is easily discriminated from the others.

Beyond Nature Versus Nurture: the Emergence of Emotion

Affective science is stuck in a version of the nature-versus-nurture debate, with theorists arguing whether emotions are evolved adaptations or psychological constructions. We do not see these as mutually exclusive options. Many adaptive behaviors that humans have evolved to be good at, such as walking, emerge during development - not according to a genetically dictated program, but through interactions between the affordances of the body, brain, and environment. We suggest emotions are the same. As developing humans acquire increasingly complex goals and learn optimal strategies for pursuing those goals, they are inevitably pulled to particular brain-body-behavior states that maximize outcomes and self-reinforce via positive feedback loops. We call these recurring, self-organized states emotions. Emotions display many of the hallmark features of self-organized attractor states, such as hysteresis (prior events influence the current state), degeneracy (many configurations of the underlying variables can produce the same global state), and stability. Because most bodily, neural, and environmental affordances are shared by all humans - we all have cardiovascular systems, cerebral cortices, and caregivers who raised us - similar emotion states emerge in all of us. This perspective helps reconcile ideas that, at first glance, seem contradictory, such as emotion universality and neural degeneracy.

Comparison of the neurobehavioural profile of early-preterm infants against term and late-preterm infants using the Hammersmith neonatal neurological examination

AIM

To compare the neurobehavioural profile of early-preterm infants (<32 weeks gestation) at term-corrected age (39⁺⁰ -41⁺⁶ weeks) versus late-preterm and full-term infants at similar term gestational ages.

METHODS

Early-preterm infants were assessed neurologically at term-corrected age using the Hammersmith neonatal neurological examination. The raw scores of the 34 Hammersmith neonatal neurological examination items were converted to optimality scores. Pairwise comparison of neurobehavioural patterns between early-preterm infants at term-corrected age versus late-preterm and full-term infants at similar gestational ages were made using independent sample t tests. Differences in optimality scores between the three groups were evaluated using one-way analysis of variance.

RESULTS

Sixty-eight early-preterm infants assessed at term-corrected age were compared against 75 late-preterm infants and 133 full-term infants. Mean total optimality scores (±standard deviation) of early-preterm, late-preterm and full-term infants at term-corrected age were 27.68 (±3.97), 29.09 (±2.45) and 31.58 (±1.39), respectively (P < 0.001). The mean optimality score of early-preterm infants was significantly lower when compared pairwise with late-preterm infants and full-term infants with mean difference of -1.42 (P = 0.013) and -3.91 (P < 0.001), respectively.

CONCLUSION

The neurobehavioural profile of early-preterm infants lags significantly behind those of late-preterm and full-term infants at term-corrected age. This study also provides reference raw and optimality scores for all items in the Hammersmith neonatal neurological examination for early-preterm infants in a predominantly Asian population.

Factor Analysis of the Einstein Neonatal Neurobehavioral Assessment Scale in Infants with Congenital Heart Disease and Healthy Controls

Background: Administration of the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS) can be time-consuming, and items can be highly correlated. We aimed to determine: (1) its factor analytic structure; (2) the validity of the factor structure; and (3) the associations of physiologic measures with factor scores. Methods: A factor analysis reduced 21 ENNAS items into 5 factors in 57 congenital heart disease (CHD) and 35 healthy infants. Multiple linear regressions examined the association of factor scores with group, gestational age, and physiologic variables. Results: 5-factor solution: 1 (Orienting Reflex), 2 (Extensor Axial Tone), 3 (Primitive Reflexes), 4 (Flexor Tone), 5 (Reflexive Tone Around Extremity Joints). Moderate to strong evidence supported: face, discriminant, and construct validity of these factors, with Factor 2 having the strongest. Conclusions: Components of Factor 2 may provide similar information about neonatal development, thus reducing the time for and burden of administration for researchers and clinicians.

Palmitoylethanolamide attenuates neurodevelopmental delay and early hippocampal damage following perinatal asphyxia in rats

Impaired gas exchange close to labor causes perinatal asphyxia (PA), a neurodevelopmental impairment factor. Palmitoylethanolamide (PEA) proved neuroprotective in experimental brain injury and neurodegeneration models. This study aimed to evaluate PEA effects on the immature-brain, i.e., early neuroprotection by PEA in an experimental PA paradigm. Newborn rats were placed in a 37°C water bath for 19 min to induce PA. PEA 10 mg/kg, s.c., was administered within the first hour of life. Neurobehavioral responses were assessed from postnatal day 1 (P1) to postnatal day 21 (P21), recording the day of appearance of several reflexes and neurological signs. Hippocampal CA1 area ultrastructure was examined using electron microscopy. Microtubule-associated protein 2 (MAP-2), phosphorylated high and medium molecular weight neurofilaments (pNF H/M), and glial fibrillary acidic protein (GFAP) were assessed using immunohistochemistry and Western blot at P21. Over the first 3 weeks of life, PA rats showed late gait, negative geotaxis and eye-opening onset, and delayed appearance of air-righting, auditory startle, sensory eyelid, forelimb placing, and grasp reflexes. On P21, the hippocampal CA1 area showed signs of neuronal degeneration and MAP-2 deficit. PEA treatment reduced PA-induced hippocampal damage and normalized the time of appearance of gait, air-righting, placing, and grasp reflexes. The outcome of this study might prove useful in designing intervention strategies to reduce early neurodevelopmental delay following PA.

Retained Primitive Reflexes and Potential for Intervention in Autistic Spectrum Disorders

We provide evidence to support the contention that many aspects of Autistic Spectrum Disorder (ASD) are related to interregional brain functional disconnectivity associated with maturational delays in the development of brain networks. We think a delay in brain maturation in some networks may result in an increase in cortical maturation and development in other networks, leading to a developmental asynchrony and an unevenness of functional skills and symptoms. The paper supports the close relationship between retained primitive reflexes and cognitive and motor function in general and in ASD in particular provided to indicate that the inhibition of RPRs can effect positive change in ASD.

Associations between the size of individual plantar intrinsic and extrinsic foot muscles and toe flexor strength

Background

The size of the plantar intrinsic and extrinsic foot muscles has been shown to be associated with toe flexor strength (TFS). Previous studies adopted the size of limited plantar intrinsic foot muscles or a compartment containing several muscles as an independent variable for TFS. Among the plantar intrinsic and extrinsic foot muscles, therefore, it is unclear which muscle(s) primarily contributes to TFS production. The present study aimed to clarify this subject.

Methods

In 17 young adult men, a series of anatomical cross-sectional area of individual plantar intrinsic and extrinsic foot muscles was obtained along the foot length and the lower leg length, respectively, using magnetic resonance imaging. Maximal anatomical cross-sectional area (ACSA_max) and muscle volume (MV) for each constituent muscle of the plantar intrinsic foot muscles (flexor hallucis brevis; flexor digitorum brevis, FDB; abductor hallucis; adductor hallucis oblique head, ADDH-OH; adductor hallucis transverse head, ADDH-TH; abductor digiti minimi; quadratus plantae) and extrinsic foot muscles (flexor hallucis longus; flexor digitorum longus) were measured. TFS was measured with a toe grip dynamometry.

Results

TFS was significantly associated with the ACSA_max for each of the ADDH-OH (r = 0.674, p = 0.003), ADDH-TH (r = 0.523, p = 0.031), and FDB (r = 0.492, p = 0.045), and the MV of the ADDH-OH (r = 0.582, p = 0.014). As for the ADDH-OH, the correlation coefficient with TFS was not statistically different between ACSA_max and MV (p = 0.189). Stepwise multiple linear regression analysis indicated that ACSA_max and MV of the ADDH-OH alone explained 42 and 29%, respectively, of the variance in TFS.

Conclusion

The ADDH-OH is the primary contributor to TFS production among the plantar intrinsic and extrinsic foot muscles as the result of the stepwise multiple linear regression analysis.

Changes in Sensorimotor Connectivity to dI3 Interneurons in Relation to the Postnatal Maturation of Grasping

Primitive reflexes are evident shortly after birth. Many of these reflexes disappear during postnatal development as part of the maturation of motor control. This study investigates the changes of connectivity related to sensory integration by spinal dI3 interneurons during the time in which the palmar grasp reflex gradually disappears in postnatal mice pups. Our results reveal an increase in GAD65/67-labeled terminals to perisomatic Vglut1-labeled sensory inputs contacting cervical and lumbar dI3 interneurons between postnatal day 3 and day 25. In contrast, there were no changes in the number of perisomatic Vglut1-labeled sensory inputs to lumbar and cervical dI3 interneurons other than a decrease between postnatal day 15 and day 25. Changes in postsynaptic GAD65/67-labeled inputs to dI3 interneurons were inconsistent with a role in the sustained loss of the grasp reflex. These results suggest a possible link between the maturation of hand grasp during postnatal development and increased presynaptic inhibition of sensory inputs to dI3 interneurons.

Drosophila as a model to explore secondary injury cascades after traumatic brain injury

Drosophilae are emerging as a valuable model to study traumatic brain injury (TBI)-induced secondary injury cascades that drive persisting neuroinflammation and neurodegenerative pathology that imposes significant risk for long-term neurological deficits. As in mammals, TBI in Drosophila triggers axonal injury, metabolic crisis, oxidative stress, and a robust innate immune response. Subsequent neurodegeneration stresses quality control systems and perpetuates an environment for neuroprotection, regeneration, and delayed cell death via highly conserved cell signaling pathways. Fly injury models continue to be developed and validated for both whole-body and head-specific injury to isolate, evaluate, and modulate these parallel pathways. In conjunction with powerful genetic tools, the ability for longitudinal evaluation, and associated neurological deficits that can be tested with established behavioral tasks, Drosophilae are an attractive model to explore secondary injury cascades and therapeutic intervention after TBI. Here, we review similarities and differences between mammalian and fly pathophysiology and highlight strategies for their use in translational neurotrauma research.

Dance on the Brain: Enhancing Intra- and Inter-Brain Synchrony

Dance has traditionally been viewed from a Eurocentric perspective as a mode of self-expression that involves the human body moving through space, performed for the purposes of art, and viewed by an audience. In this Hypothesis and Theory article, we synthesize findings from anthropology, sociology, psychology, dance pedagogy, and neuroscience to propose The Synchronicity Hypothesis of Dance, which states that humans dance to enhance both intra- and inter-brain synchrony. We outline a neurocentric definition of dance, which suggests that dance involves neurobehavioral processes in seven distinct areas including sensory, motor, cognitive, social, emotional, rhythmic, and creative. We explore The Synchronicity Hypothesis of Dance through several avenues. First, we examine evolutionary theories of dance, which suggest that dance drives interpersonal coordination. Second, we examine fundamental movement patterns, which emerge throughout development and are omnipresent across cultures of the world. Third, we examine how each of the seven neurobehaviors increases intra- and inter-brain synchrony. Fourth, we examine the neuroimaging literature on dance to identify the brain regions most involved in and affected by dance. The findings presented here support our hypothesis that we engage in dance for the purpose of intrinsic reward, which as a result of dance-induced increases in neural synchrony, leads to enhanced interpersonal coordination. This hypothesis suggests that dance may be helpful to repattern oscillatory activity, leading to clinical improvements in autism spectrum disorder and other disorders with oscillatory activity impairments. Finally, we offer suggestions for future directions and discuss the idea that our consciousness can be redefined not just as an individual process but as a shared experience that we can positively influence by dancing together.

Clinical Evidence of Vestibular Dysregulation in Colicky Babies Before and After Chiropractic Treatment vs. Non-colicky Babies

Background: To date, after 65 years of research that was primarily directed at differentiating between normal and colicky crying, the cause of infantile colic remains elusive and no definitive cure has been found. Given the general absence of pathology, colicky crying is widely considered the extreme end of a spectrum of normal crying behavior. However, evidence gleaned from scattered sources throughout the literature suggests that infantile colic may be the behavioral expression of physiological brainstem dysregulation, particularly of the vestibular and autonomic systems. The purpose of this study is to present a five-point clinical index of vestibular (hyper) activity and its application to investigate vestibular dysregulation in colicky and non-colicky babies. Methods: One hundred and twenty consecutive colicky babies were evaluated using this index, before and after a very gentle vibratory treatment, and compared to 117 non-colicky babies. Results: Before treatment, of 120 colicky babies only 2 (1.7%) scored 0, whereas 118 (98.3%) scored 1-5. Of 117 non-colicky babies 89 (76.1%) scored 0 and 28 (23.9%) scored 1-3, none scored 4-5. The odds ratio is OR (CI 95%) 187.54 (43.52-808.09). After treatment 111 (92.5%) scored 0 and 9 (7.5%) scored 1-3, none scored 4-5. A McNemar test showed the difference before and after to be significant (χ² = 109.00, p < 0.001). For colicky babies the mean vestibular score is 2.88 (SD 1.22), compared to 0.37 (SD 0.73) for non-colicky babies, a difference of 87.2%. After treatment the score decreased from 2.88 (SD 1.12) to 0.10 (SD 0.40), or 96.5%. Conclusion: Colicky babies are not just infants who cry a lot. They also show clinical evidence of vestibular dysregulation. Treatment aimed at relaxing tight sub-occipital musculature by means of gentle vibrational stimulation may be effective in decreasing vestibular hyperactivity, signifying an improvement in brainstem regulation. The vestibular index opens the prospect for development into a tool toward an objective and practical clinical diagnosis of infantile colic.

In utero exposure to protease inhibitor-based antiretroviral regimens delays growth and developmental milestones in mice

Antiretroviral therapy (ART) in pregnancy has dramatically reduced HIV vertical transmission rates. Consequently, there is a growing number of children that are HIV exposed uninfected (CHEUs). Studies suggest that CHEUs exposed in utero to ART may experience developmental delays compared to their peers. We investigated the effects of in utero ART exposure on perinatal neurodevelopment in mice, through assessment of developmental milestones. Developmental milestone tests (parallel to reflex testing in human infants) are reflective of brain maturity and useful in predicting later behavioral outcomes. We hypothesized that ART in pregnancy alters the in utero environment and thereby alters developmental milestone outcomes in pups. Throughout pregnancy, dams were treated with boosted-atazanavir combined with either abacavir/lamivudine (ATV/r/ABC/3TC), or tenofovir/emtricitabine (ATV/r/TDF/FTC), or water as control. Pups were assessed daily for general somatic growth and on a battery of tests for primitive reflexes including surface-righting, negative-geotaxis, cliff-aversion, rooting, ear-twitch, auditory-reflex, forelimb-grasp, air-righting, behaviors in the neonatal open field, and olfactory test. In utero exposure to either ART regimen delayed somatic growth in offspring and evoked significant delays in the development of negative geotaxis, cliff-aversion, and ear-twitch reflexes. Exposure to ATV/r/ABC/3TC was also associated with olfactory deficits in male and forelimb grasp deficits in female pups. To explore whether delays persisted into adulthood we assessed performance in the open field test. We observed no significant differences between treatment arm for males. In females, ATV/r/TDF/FTC exposure was associated with lower total distance travelled and less ambulatory time in the centre, while ATV/r/ABC/3TC exposure was associated with higher resting times compared to controls. In utero PI-based ART exposure delays the appearance of primitive reflexes that involve vestibular and sensory-motor pathways in a mouse model. Our findings suggest that ART could be disrupting the normal progress/maturation of the underlying neurocircuits and encourage further investigation for underlying mechanisms.

Carrying human infants - An evolutionary heritage

We propose that infant carrying is a biological norm for human caregiving, given that human infants have evolved a capacity to cling onto an upright caregiver whose body co-evolved to enable offspring carrying. The origins of this mutual adaptation may date back 4 million years, with the emergence of bipedalism, which precluded the infant horizontal and gravity-supported position on the back of a quadrupedal caregiver. We describe infant cooperative reflexes and behaviors, including the carrying-induced calming response and discuss hypotheses for the invention of infant carrier tools. Carrying involves several physiological and behavioral parent-infant co-adaptations that imply it is an evolutionarily conserved strategy. Epigenetic transmission of reproductive behavior through generations affects the development of the offspring, as well as the mental health of the parent. Carrying might have contributed to the evolution of Hominidae, potentially aiding dexterity, handedness, language acquisition, and social interactions. We review the evolutionary milestones and time points where the infant-caregiver interactions might have changed, exploring infant carrying as it intersects with biological and cultural evolution. We briefly summarize the effects of infant carrying on physiological, epigenetic, and socio-emotional outcomes.

Epi: An open humanoid platform for developmental robotics

Epi is a humanoid robot developed by Lund University Cognitive Science Robotics Group. It was designed to be used in experiments in developmental robotics and has proportions to give a childlike impression while still being decidedly robotic. The robot head has two degrees of freedom in the neck and each eye can independently move laterally. There is a camera in each eye to make stereovision possible. The arms are designed to resemble those of a human. Each arm has five degrees of freedom, three in the shoulder, one in the elbow and one in the wrist. The hands have four movable fingers and a stationary thumb. A force distribution mechanism inside the hand connect a single servo to the movable fingers and makes sure the hand closes around an object regardless of its shape. The rigid parts of the hands are 3D printed in PLA and HIPS while the flexible parts, including the joints and the tendons, are made from polyurethane rubber. The control system for Epi is based on neurophysiological data and is implemented using the Ikaros system. Most of the sensory and motor processing is done at 40 Hz to allow smooth movements. The irises of the eyes can change colour and the pupils can dilate and contract. There is also a grid of LEDs that resembles a mouth that can be animated by changing colour and intensity.

Infant crying and the calming response: Parental versus mechanical soothing using swaddling, sound, and movement

Background

Frequent infant crying is associated with parental exhaustion, depression, or even infant hospitalization and shaken baby syndrome. Effective prompt soothing methods are lacking for infants under 6 months. We examined whether swaddling, sound, and movement evoked an immediate calming response (CR) when parents soothed their infants and using a smart crib, and whether infant age affected the CR.

Methods

Infants’ CR was assessed in a community sample of 69 infants (0–6 months) in a counterbalanced experiment with two conditions (parent, smart crib) each composed of three two-minute phases (baseline, supine, soothing). During baseline 1, parent and infant were sitting together; in supine 1, fussiness was elicited by putting the infant suddenly supine, followed by parental soothing (shushing and jiggling of the swaddled infant). Baseline 2, supine 2, and soothing by the crib followed. Fussiness was observed and infant heart rate (HR) and heart rate variability (HRV) were recorded. The CR was operationalized as decreased fussiness and HR, and increased HRV during soothing compared to lying supine.

Results

Infant fussiness and HR were lower in both soothing phases compared to the supine phases. Infant HRV tended to be higher during parental soothing than during supine, but did not significantly differ between mechanical soothing and supine. Younger infants responded with a stronger CR (decreased fussiness and increased HRV) to parental soothing, but not to mechanical soothing. For HR, infants’ CR was stronger in the crib than in the parent condition, whereas for HRV, infants’ CR was stronger in the parent condition. For fussiness, infants’ CR tended to be stronger in the parent condition.

Conclusion

Parental and mechanical soothing using swaddling, sound, and movement promptly induced a CR in infants. This has important clinical implications for soothing fussy and crying infants. Future studies should investigate the effects of parental versus mechanical soothing in the home setting.

Learning and Acting in Peripersonal Space: Moving, Reaching, and Grasping

The young infant explores its body, its sensorimotor system, and the immediately accessible parts of its environment, over the course of a few months creating a model of peripersonal space useful for reaching and grasping objects around it. Drawing on constraints from the empirical literature on infant behavior, we present a preliminary computational model of this learning process, implemented and evaluated on a physical robot. The learning agent explores the relationship between the configuration space of the arm, sensing joint angles through proprioception, and its visual perceptions of the hand and grippers. The resulting knowledge is represented as the peripersonal space (PPS) graph, where nodes represent states of the arm, edges represent safe movements, and paths represent safe trajectories from one pose to another. In our model, the learning process is driven by a form of intrinsic motivation. When repeatedly performing an action, the agent learns the typical result, but also detects unusual outcomes, and is motivated to learn how to make those unusual results reliable. Arm motions typically leave the static background unchanged, but occasionally bump an object, changing its static position. The reach action is learned as a reliable way to bump and move a specified object in the environment. Similarly, once a reliable reach action is learned, it typically makes a quasi-static change in the environment, bumping an object from one static position to another. The unusual outcome is that the object is accidentally grasped (thanks to the innate Palmar reflex), and thereafter moves dynamically with the hand. Learning to make grasping reliable is more complex than for reaching, but we demonstrate significant progress. Our current results are steps toward autonomous sensorimotor learning of motion, reaching, and grasping in peripersonal space, based on unguided exploration and intrinsic motivation.

Evaluation of neurological behaviour in late-preterm newborn infants using the Hammersmith Neonatal Neurological Examination

AIM

We hypothesise that clinically well late-preterm infants (LPI) (34⁺⁰ -36⁺⁶ weeks) are neurologically more immature than their term counterparts, and this immaturity persists even when these infants reach term-corrected age (TCA). The primary aim of our study was to characterise and contrast the neurodevelopmental profile of well LPI with full-term infants (FTI) (39⁺⁰ -41⁺⁶ weeks) using the Hammersmith Neonatal Neurological Examination (HNNE). Our secondary aim was to obtain local reference ranges for the 34 items in the HNNE in an Asian-dominant population.

METHODS

LPI were assessed at two time points: 12-72 h of life and at TCA of 39⁺⁰ -41⁺⁶ weeks, while FTI were assessed at 12-72 h of life using the HNNE. Each of the 34 items on the HNNE was assigned an optimality score (OS) of 0, 0.5 or 1, totalling up to 34. A quantitative comparison of the neurobehavioral patterns was made using two-sample t-tests.

RESULTS

A total of 212 infants (79 LPI and 133 FTI) were recruited. Mean OSs for LPI and FTI at birth were (25.11 ± 3.36)/34 and (31.19 ± 1.50)/34, respectively, with a mean difference of 6.08 (P value <0.0001). The mean OS for LPI on reaching TCA was (28.91 ± 2.30)/34, with a mean difference of 2.28 (P value <0.0001). Reference OSs for the 34 items on the HNNE were also obtained.

CONCLUSION

LPI are more immature than their term counterparts even on reaching TCA, with discrepancies most apparent in 'tone' and 'movement'. We provide reference OSs of 34 items in the HNNE for infants in an Asian-dominant population.

Neurodevelopmental Reflex Testing in Neonatal Rat Pups

Neurodevelopmental reflex testing is commonly used in clinical practice to assess the maturation of the nervous system. Neurodevelopmental reflexes are also referred to as primitive reflexes. They are sensitive and consistent with later outcomes. Abnormal reflexes are described as an absence, persistence, reappearance, or latency of reflexes, which are predictive indices of infants that are at high risk for neurodevelopmental disorders. Animal models of neurodevelopmental disabilities, such as cerebral palsy, often display aberrant developmental reflexes, as would be observed in human infants. The techniques described assess a variety of neurodevelopmental reflexes in neonatal rats. Neurodevelopmental reflex testing offers the investigator a testing method that is not otherwise available in such young animals. The methodology presented here aims to assist investigators in examining developmental milestones in neonatal rats as a method of detecting early-onset brain injury and/or determining the effectiveness of therapeutic interventions. The methodology presented here aims to provide a general guideline for investigators.

Improvement and Neuroplasticity after Combined Rehabilitation to Forced Grasping

The grasp reflex is a distressing symptom but the need to treat or suppress it has rarely been discussed in the literature. We report the case of a 17-year-old man who had suffered cerebral infarction of the right putamen and temporal lobe 10 years previously. Forced grasping of the hemiparetic left upper limb was improved after a unique combined treatment. Botulinum toxin type A (BTX-A) was first injected into the left biceps, wrist flexor muscles, and finger flexor muscles. Forced grasping was reduced along with spasticity of the upper limb. In addition, repetitive facilitative exercise and object-related training were performed under low-amplitude continuous neuromuscular electrical stimulation. Since this 2-week treatment improved upper limb function, we compared brain activities, as measured by near-infrared spectroscopy during finger pinching, before and after the combined treatment. Brain activities in the ipsilesional sensorimotor cortex (SMC) and medial frontal cortex (MFC) during pinching under electrical stimulation after treatment were greater than those before. The results suggest that training under electrical stimulation after BTX-A treatment may modulate the activities of the ipsilesional SMC and MFC and lead to functional improvement of the affected upper limb with forced grasping.

Holding-on: co-evolution between infant carrying and grasping behaviour in strepsirrhines

The origin and evolution of manual grasping remain poorly understood. The ability to cling requires important grasping abilities and is essential to survive in species where the young are carried in the fur. A previous study has suggested that this behaviour could be a pre-adaptation for the evolution of fine manipulative skills. In this study we tested the co-evolution between infant carrying in the fur and manual grasping abilities in the context of food manipulation. As strepsirrhines vary in the way infants are carried (mouth vs. fur), they are an excellent model to test this hypothesis. Data on food manipulation behaviour were collected for 21 species of strepsirrhines. Our results show that fur-carrying species exhibited significantly more frequent manual grasping of food items. This study clearly illustrates the potential novel insights that a behaviour (infant carrying) that has previously been largely ignored in the discussion of the evolution of primate manipulation can bring.

A Battery of Motor Tests in a Neonatal Mouse Model of Cerebral Palsy

As the sheer number of transgenic mice strains grow and rodent models of pediatric disease increase, there is an expanding need for a comprehensive, standardized battery of neonatal mouse motor tests. These tests can validate injury or disease models, determine treatment efficacy and/or assess motor behaviors in new transgenic strains. This paper presents a series of neonatal motor tests to evaluate general motor function, including ambulation, hindlimb foot angle, surface righting, negative geotaxis, front- and hindlimb suspension, grasping reflex, four limb grip strength and cliff aversion. Mice between the ages of post-natal day 2 to 14 can be used. In addition, these tests can be used for a wide range of neurological and neuromuscular pathologies, including cerebral palsy, hypoxic-ischemic encephalopathy, traumatic brain injury, spinal cord injury, neurodegenerative diseases, and neuromuscular disorders. These tests can also be used to determine the effects of pharmacological agents, as well as other types of therapeutic interventions. In this paper, motor deficits were evaluated in a novel neonatal mouse model of cerebral palsy that combines hypoxia, ischemia and inflammation. Forty-eight hours after injury, five tests out of the nine showed significant motor deficits: ambulation, hindlimb angle, hindlimb suspension, four limb grip strength, and grasping reflex. These tests revealed weakness in the hindlimbs, as well as fine motor skills such as grasping, which are similar to the motor deficits seen in human cerebral palsy patients.

Effect of maternal exposure to Tityus bahiensis scorpion venom during lactation on the offspring of rats

Scorpion stings are a public health problem in Brazil and lactating women may be affected. We aimed to study the effects of Tityus bahiensis venom in the offspring of rats treated during lactation. Mothers received a subcutaneous injection of saline (1.0ml/kg) or venom (2.5mg/kg) or an intraperitoneal injection of LPS (lipopolysaccharide) (100μg/kg) on postnatal (PN) days 2 (PN2), 10 (PN10) or 16 (PN16). The offspring were evaluated during the childhood and adulthood. Pups showed a delay in physical and reflexological development, and a decrease in motor activity. Adults displayed low anxiety. There was an increase in the number of viable neuronal cells in hippocampal areas CA1 and CA4. The levels of IFN-γ (interferon-gamma) increased in the experimental groups. Several of the parameters analyzed showed important differences between the sexes. Thus, the scorpion venom affects the development in the offspring of mothers envenomed during the lactation.

Evaluation of a Comprehensive Delivery Room Neonatal Resuscitation and Adaptation Score (NRAS) Compared to the Apgar Score: A Pilot Study

This study evaluated the interrater reliability and perceived importance of components of a developed neonatal adaption score, Neonatal Resuscitation Adaptation Score (NRAS), for evaluation of resuscitation need in the delivery room for extremely premature to term infants. Similar to the Apgar, the NRAS highest score was 10, but greater weight was given to respiratory and cardiovascular parameters. Evaluation of provider (N = 17) perception and scoring pattern was recorded for 5 clinical scenarios of gestational ages 23 to 40 weeks at 1 and 5 minutes and documenting NRAS and Apgar score. Providers assessed the tool twice within a 1-month interval. NRAS showed superior interrater reliability (P < .001) and respiratory component reliability (P < .001) for all gestational ages compared to the Apgar score. These findings identify an objective tool in resuscitation assessment of infants, especially those of smaller gestation age, allowing for greater discrimination of postbirth transition in the delivery room.

Early gait development in human infants: Plasticity and clinical applications

In this paper we focus on how a developmental perspective on plasticity in the control of human movement can promote early therapy and improve gait acquisition in infants with developmental disabilities. Current knowledge about stepping development in healthy infants across the first year of life highlights strong plasticity, both in behavioral outcome and in underlying neuro-muscular activation. These data show that stepping, like other motor skills, emerges from the interaction between infant's maturation and the environment. This view is reinforced by showing that infants with different internal resources (like genetic disorder or neural tube defect) show unique developmental trajectories when supported on a treadmill, yet do respond. Moreover, we will show that their behavior can be improved by context manipulations (mostly sensory stimulation) or practice. Overall, plasticity in the neural, skeletal, and muscle tissues create new opportunities for optimizing early intervention by creatively tapping into the same developmental processes experienced by healthy infants.

The babkin reflex in infants: clinical significance and neural mechanism

BACKGROUND

There have been very few studies concerning the Babkin reflex-opening of the mouth and flexion of the arms in response to stimulation of the palms. We attempted to clarify the clinical significance and neural mechanism of the reflex through systematic review.

METHODS

Searches were conducted on Medline, Embase, and Google Scholar from their inception through August 2012.

RESULTS

In normal term infants, the Babkin reflex can be elicited from the time of birth, becomes increasingly suppressed with age, and disappears in the great majority by the end of the fifth month of age. A marked response in the fourth or fifth month of age and persistence of the reflex beyond the fifth month of age are generally regarded as abnormal. On the other hand, because there are some normal infants showing no response during the neonatal period or early infancy, the absence of the response during these periods is not necessarily an abnormal finding.

CONCLUSIONS

Infants with these abnormal findings should be carefully observed for the appearance of neurological abnormalities including cerebral palsy and mental retardation. It is most likely that the Babkin reflex is mediated by the reticular formation of the brainstem, which receives inputs from the nonprimary motor cortices. On the basis of the hand-mouth reflex, more adaptive movement develops as control of the nonprimary motor cortices over the reflex mechanism in the reticular formation increases. Soon it evolves into the voluntary eye-hand-mouth coordination necessary for food intake as the control of the prefrontal cortex over the nonprimary motor cortices becomes predominant.