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Kg S, Balakrishnan U, Amboiram P, N U, Chandran R, V S. Risk Factors Associated with Long Term Adverse Neurodevelopmental Outcome in Very Preterm Infants. Indian J Pediatr 2024; 91:748. [PMID: 38175497 DOI: 10.1007/s12098-023-04990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Sachin Kg
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
| | - Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India.
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
| | - Udayakumar N
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
| | - Rabindran Chandran
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
| | - Sangeetha V
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
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Jung YM, Park SM, Kim HJ, Choi BY, Won S, Park JY, Oh KJ. Prognosis of remaining fetus in twin pregnancy after demise of one fetus according to its location. BMC Pregnancy Childbirth 2024; 24:430. [PMID: 38877391 PMCID: PMC11177461 DOI: 10.1186/s12884-024-06621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND To investigate the prognosis of the remaining fetus in twin pregnancy after experiencing one fetal demise in the first trimester according to the location of the demised fetus. METHODS This was a retrospective study of twin pregnancies with one fetal demise after the first trimester (14 weeks of gestation) delivered between September 2004 and September 2022. The study population was divided into two groups based on the location of the demised fetus as determined by the last recorded ultrasonography results: Group 1 included twin pregnancies where the presenting fetus was demised (n = 36) and Group 2 included twin pregnancies where the non-presenting fetus was demised (n = 44). The obstetric and neonatal outcomes were also reviewed. RESULTS A total of 80 pregnant women were included. The median gestational age for the diagnosis of fetal demise was 24.1 weeks. The gestational age of the demised fetus was not different between Groups 1 and 2; however, the gestational age of the remaining fetus at delivery was significantly earlier in Group 1 than it was in Group 2 (33.8 vs. 37.3 weeks, P = .004). The rate of preterm birth before 28 weeks was almost five times higher in Group 1 than in Group 2 (22.2% vs. 4.5%, P = .037). Regression analysis demonstrated significant differences between Groups 1 and 2. Respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, and jaundice were more common in Group 1 than in Group 2; however, the association was not significant after adjusting for gestational age at delivery. CONCLUSIONS When the presenting fetus is demised in a twin pregnancy, the remaining fetus tends to be delivered earlier than when the non-presenting fetus is demised.
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Affiliation(s)
- Young Mi Jung
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sun Min Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Hyun Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Bo Young Choi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Seunghyun Won
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
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Haga M, Kanai M, Motojima Y, Saito K, Itoh K, Saito T, Ishiguro A, Takada E, Kunikata T, Sobajima H, Namba F, Kabe K. Predictability of the neurodevelopmental assessment based on the Kyoto Scale of Psychological Development 2001 at 18-24 months of corrected age and 3 years of age in identifying cognitive impairment at 6 years of age in very preterm infants: A retrospective study at a Japanese tertiary center. Early Hum Dev 2024; 193:106015. [PMID: 38688106 DOI: 10.1016/j.earlhumdev.2024.106015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND It is unknown how accurately the current Japanese classification system for neurodevelopmental delay based on the assessment with the Kyoto Scale of Psychological Development (KSPD) at toddlerhood and pre-school periods predicts cognitive impairment at school age. METHODS This single-center retrospective cohort study enrolled infants born at 22-29 weeks of gestational age. At 18-24 months of corrected age and 3 years of age, the patients were categorized according to the current Japanese criteria for neurodevelopmental delay based on their overall developmental quotient calculated using the KSPD-2001. Cognitive impairment at 6 years of age was classified according to the calculated or estimated full-scale intelligence quotient. The predictability of the current Japanese classification of neurodevelopmental delay for cognitive impairment at 6 years of age was investigated. RESULTS Of 566 eligible patients, 364 (64 %) completed the protocol. The current classification for the neurodevelopmental delay showed significant agreement with the severity of cognitive impairment at 6 years of age. The sensitivity and specificity of the KSPD-2001-based assessment for any cognitive impairment at 6 years of age were 0.64 and 0.74 at 18-24 months of corrected age and 0.83 and 0.70 at 3 years of age. The corresponding sensitivity and specificity for moderate/severe cognitive impairment were 0.51 and 0.96 at 18-24 months of corrected age and 0.68 and 0.95 at 3 years of age. CONCLUSION The KSPD-2001 is a useful tool to predict the severity of cognitive impairment at school age.
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Affiliation(s)
- Mitsuhiro Haga
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Masayo Kanai
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan.
| | - Yukiko Motojima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Kana Saito
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Kanako Itoh
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Takami Saito
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Akio Ishiguro
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan; Department of Pediatrics, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Eiko Takada
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Tetsuya Kunikata
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan; Department of Pediatrics, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan
| | - Hisanori Sobajima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Kazuhiko Kabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
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4
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Aksoğan Y, Kuzucu P, Soysal Acar AŞ, Şahin MB, Gücüyener K, Börcek AÖ. Evaluation of neurocognitive and social developments after craniosynostosis surgery. Childs Nerv Syst 2024; 40:1489-1499. [PMID: 38294493 DOI: 10.1007/s00381-024-06303-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The study focused on assessing the potential neurocognitive and social developmental issues in children with non-syndromic craniosynostosis (NSC) who received optimal surgical treatment. The primary objective was to determine whether NSC, even after optimal surgical treatment, could have negative effects on brain development. METHODS The study included a total of 73 pediatric patients aged between 2 and 6 years who had previously undergone surgery for NSC at the Gazi University Faculty of Medicine, Department of Neurosurgery. These patients were carefully matched with 107 healthy children who visited the outpatient clinic of the same department in terms of sociodemographic characteristics such as age, gender, and social status. To assess the neurocognitive and social development of the participants, the child psychologist administered a developmental scale to the child and his/her family via video conference. This scale was adapted from the Bayley-III Infant and Child Development Scale by the Gazi University Faculty of Medicine, Division of Pediatric Neurology. RESULTS The study found no social or gross motor developmental issues in patients who had undergone optimal surgical treatment for NSC. However, the risk of fine motor developmental deficiencies was 4.79 times higher than that of the normal population, and the risk of language developmental deficiencies was 5.75 times higher than that of the normal population. CONCLUSIONS Despite timely treatment of NSC, long-term neurocognitive and social development issues may arise in affected children. Therefore, it is crucial to monitor these patients after completing surgical treatment and thoroughly examine their development using a multidisciplinary approach.
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Affiliation(s)
- Yiğit Aksoğan
- Department of Neurosurgery, Bayburt State Hospital, Bayburt, Turkey.
| | - Pelin Kuzucu
- Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Azime Ş Soysal Acar
- Department of Pediatric Health and Diseases, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Merve Büke Şahin
- Department of Public Health, Etimesgut District Health Directorate, Ankara, Turkey
| | - Kıvılcım Gücüyener
- Division of Pediatric Neurology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Alp Ö Börcek
- Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Gale-Grant O, Chew A, Falconer S, França LGS, Fenn-Moltu S, Hadaya L, Harper N, Ciarrusta J, Charman T, Murphy D, Arichi T, McAlonan G, Nosarti C, Edwards AD, Batalle D. Clinical, socio-demographic, and parental correlates of early autism traits in a community cohort of toddlers. Sci Rep 2024; 14:8393. [PMID: 38600134 PMCID: PMC11006842 DOI: 10.1038/s41598-024-58907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample.
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Affiliation(s)
- Oliver Gale-Grant
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK.
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK.
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.
| | - Andrew Chew
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Lucas G S França
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle Upon Tyne, UK
| | - Sunniva Fenn-Moltu
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Laila Hadaya
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicholas Harper
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Judit Ciarrusta
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Dafnis Batalle
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
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Mulkey SB, Williams ME, Peyton C, Arroyave-Wessel M, Berl MM, Cure C, Msall ME. Understanding the multidimensional neurodevelopmental outcomes in children after congenital Zika virus exposure. Pediatr Res 2024:10.1038/s41390-024-03056-z. [PMID: 38438554 DOI: 10.1038/s41390-024-03056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024]
Abstract
Since 2016, international research groups have focused on assessing outcomes of children with in utero Zika virus (ZIKV) exposure. While the more severe outcomes of congenital Zika syndrome (CZS) occur in up to 10% of children with antenatal exposure, early findings among ZIKV-exposed children without CZS ages 0-5 years suggest that they may also have differences in multiple domains of neurodevelopment. Thus, longitudinal follow-up of all children with antenatal ZIKV exposure has been recommended. This review presents a summary of neurodevelopmental phenotypes of infants and children following antenatal ZIKV exposure. We present a multidimensional framework to understand child neurodevelopment from an interdisciplinary and whole-child perspective (International Classification of Functioning, Disability and Health model) and multi-domain ZIKV Outcome Toolboxes. The toolboxes are for clinicians, researchers, child educators, and others to implement longitudinal multi-domain neurodevelopmental assessments between ages 0-12 years. Recent innovations in telehealth and neuroimaging can help evaluate outcomes in ZIKV exposed children. The objective is to describe the multiple facets of neurodevelopmental focused care that can support the health, function, and well-being of children with antenatal ZIKV exposure. The research and clinical follow-up strategies are applicable to ZIKV and other congenital infectious or environmental exposures that can impact child neurodevelopment. IMPACT: International longitudinal cohort studies have revealed a range of differences in neurodevelopment among children with antenatal Zika virus (ZIKV) exposure. A multidimensional and whole-child framework is necessary to understand the neurodevelopment of children with antenatal ZIKV exposure in relation to family life, community participation, and environment. Multi-domain toolboxes that utilize parent questionnaires and child evaluations are presented. These toolboxes can be used internationally alongside telehealth, brain imaging, and other innovations to improve understanding of child outcomes.
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Affiliation(s)
- Sarah B Mulkey
- Children's National Hospital, Washington, DC, USA.
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | | | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | | | - Madison M Berl
- Children's National Hospital, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Michael E Msall
- University of Chicago Medicine Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, IL, USA
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Feragne M, Tucker R, Mayne J, Vohr B. Language outcomes at 18-24 months of preterm infants from US Spanish- and English-speaking homes. Acta Paediatr 2024; 113:239-246. [PMID: 37874258 DOI: 10.1111/apa.17006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
AIM To evaluate the association of Spanish compared to English primary household language on preterm (PT) infants' language outcomes in the United States and to examine associations with socio-economic factors. METHODS This was a retrospective cohort of PT infants born <32 weeks gestation from Spanish-speaking (n = 95) and English-speaking homes (n = 1030) born 2005-2019. Language (primary outcome) and cognitive and motor skills (secondary outcomes) were measured using the BSID-III at 18-24 months corrected age. Group differences were evaluated using bivariate comparisons and logistic regression analyses. RESULTS Mothers reporting Spanish-speaking homes had higher rates of public insurance and lower educational achievement. Group newborn characteristics were similar. Preterm infants from Spanish-speaking homes had significantly lower BSID-III language composite, cognitive composite, receptive and expressive scores compared to infants from English-speaking homes. Logistic regression modelling identified independent negative effects of Spanish-speaking household OR 3.26 (CI 1.89-5.62) and public insurance OR 2.31 (CI 1.71-3.12) with a protective benefit derived from breast milk OR 0.68 (CI 0.50-0.92) when adjusting for medical morbidities, socio-economic factors and gestational age. CONCLUSION Public health policies and interventions in the United States should target language and cognitive outcomes of PT infants from Spanish-speaking homes.
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Affiliation(s)
- Megan Feragne
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Richard Tucker
- Women and Infants Hospital, Providence, Rhode Island, USA
| | - Julia Mayne
- Women and Infants Hospital, Providence, Rhode Island, USA
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Betty Vohr
- Women and Infants Hospital, Providence, Rhode Island, USA
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
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8
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Mahabee-Gittens EM, Harun N, Glover M, Folger AT, Parikh NA. Prenatal tobacco smoke exposure and risk for cognitive delays in infants born very premature. Sci Rep 2024; 14:1397. [PMID: 38228701 PMCID: PMC10791619 DOI: 10.1038/s41598-024-51263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
Prenatal tobacco smoke exposure (TSE) and prematurity are independent risk factors for abnormal neurodevelopment. The objectives were to compare differences in Bayley-III cognitive, language, and motor scores at 2 years corrected age (CA) in 395 infants born very preterm (≤ 32 weeks gestation) with and without prenatal TSE. We performed multivariable linear regression analyses to examine associations between prenatal TSE and neurodevelopmental outcomes and a mediation analysis to estimate direct effects of prenatal TSE on outcomes and indirect effects through preterm birth. In total, 50 (12.6%) infants had prenatal TSE. Infants with prenatal TSE had lower mean [95% CI] Cognitive score (82.8 [78.6, 87.1]) vs. nonexposed infants (91.7 [90.1, 93.4]). In children with and without prenatal TSE, there were significant differences in mean [95% CI] Language scores (81.7 [76.0, 87.4] vs. 92.4 [90.2, 94.6], respectively) and mean [95% CI] Motor scores (86.5 [82.2, 90.7] vs. 93.4 [91.8, 95.0], respectively); scores remained significant after controlling for confounders. Preterm birth indirectly mediated 9.0% of the total effect of prenatal TSE on Cognitive score (P = NS). However, 91% of the remaining total effect was significant and attributable to TSE's direct harmful effects on cognitive development (β = - 5.17 [95% CI - 9.97, - 0.38]). The significant association is largely due to TSE's direct effect on cognitive development and not primarily due to TSE's indirect effect on preterm birth.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meredith Glover
- Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alonzo T Folger
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nehal A Parikh
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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9
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Shikwambana MM, Fourie JV. Supporting a Tsonga learner living with Bardet-Biedl syndrome, a rare complex disability. Afr J Disabil 2023; 12:1181. [PMID: 38204908 PMCID: PMC10777427 DOI: 10.4102/ajod.v12i0.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/30/2023] [Indexed: 01/12/2024] Open
Abstract
Background Bardet-Biedl syndrome (BBS) is a rare, systemic, hereditary disorder characterised by obesity, polydactyly, visual and auditory impairment, and cognitive disability. Providing quality education in appropriate schools for children who present with such complex chronic conditions is challenging. Objectives This study explored the dimensions of psycho-educational support needs for a child with BBS in South Africa to contribute to the improvement of early detection and holistic interventions. Method A descriptive in-depth qualitative case study of Gezani, an adolescent Tsonga boy diagnosed with BBS, was undertaken. Semi-structured interviews were conducted with his parents and teachers to ascertain the boy's psycho-educational support needs. Medical reports provided information on the complexities and prognosis of the syndrome. Observations in the classroom corroborated the learner's symptoms and behaviours. Results Thematic content analysis revealed the key areas of support needs. Gezani's cognitive disability required a modified, slow-paced curriculum. His visual impairment required mobility orientation training and learning Braille. His emotional needs were supported with psychotherapy to maintain a sense of well-being. Medical monitoring was recommended with interventions for walking and managing his diet and weight. Speech therapy supported his communication skills. Conclusion Learners with multiple disabilities require carefully planned, individualised psycho-educational support programmes addressing their unique needs and delays with targeted remedial interventions in appropriate special needs schools. Contribution This study informs educators about BBS and provides multi-faceted, holistic support. The Department of Basic Education could bring special schools and national policies in tighter alignment for learners presenting with complex disabilities.
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Affiliation(s)
- Mfungana M Shikwambana
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
| | - Jean V Fourie
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
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Lowe J, Bann CM, Dempsey AG, Fuller J, Taylor HG, Gustafson KE, Watson VE, Vohr BR, Das A, Shankaran S, Yolton K, Ball MB, Hintz SR. Do Bayley-III Composite Scores at 18-22 Months Corrected Age Predict Full-Scale IQ at 6-7 Years in Children Born Extremely Preterm? J Pediatr 2023; 263:113700. [PMID: 37640232 PMCID: PMC10840976 DOI: 10.1016/j.jpeds.2023.113700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To determine the ability of the Bayley-III cognitive and language composite scores at 18-22 months corrected age to predict WISC-IV Full Scale IQ (FSIQ) at 6-7 years in infants born extremely preterm. STUDY DESIGN Children in this study were part of the Neuroimaging and Neurodevelopmental Outcome cohort, a secondary study to the SUPPORT trial and born 240/7-276/7 weeks gestational age. Bayley-III cognitive and language scores and WISC-IV FSIQ were compared with pairwise Pearson correlation coefficients and adjusted for medical and socioeconomic variables using linear mixed effect regression models. RESULTS Bayley-III cognitive (r = 0.33) and language scores (r = 0.44) were mildly correlated with WISC-IV FSIQ score. Of the children with Bayley-III cognitive scores of <70, 67% also had FSIQ of <70. There was less consistency for children with Bayley-III scores in the 85-100 range; 43% had an FSIQ of <85 and 10% an FSIQ of <70. Among those with Bayley-III language scores >100, approximately 1 in 5 had an FSIQ of <85. A cut point of 92 for the cognitive composite score resulted in sensitivity (0.60), specificity (0.64). A cut point of 88 for the language composite score produced sensitivity (0.61), specificity (0.70). CONCLUSIONS Findings indicate the Bayley-III cognitive and language scores correlate with later IQ, but may fail to predict delay or misclassify children who are not delayed at school age. The Bayley-III can be a useful tool to help identify children born extremely preterm who have below average cognitive scores and may be at the greatest risk for ongoing cognitive difficulties. TRIAL REGISTRATION Extended Follow-up at School Age for the SUPPORT Neuroimaging and Neurodevelopmental Outcomes (NEURO) Cohort: NCT00233324.
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Affiliation(s)
- Jean Lowe
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Carla M Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Allison G Dempsey
- Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Hospital, Denver, CO
| | - Janell Fuller
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - H Gerry Taylor
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH
| | - Kathryn E Gustafson
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | - Betty R Vohr
- Department of Pediatrics, Duke University, Durham, NC
| | - Abhik Das
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI
| | - Seetha Shankaran
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Kimberly Yolton
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - M Bethany Ball
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
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11
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Winter EL, Caemmerer JM, Trudel SM, deLeyer-Tiarks J, Bray MA, Dale BA, Kaufman AS. Does the Degree of Prematurity Relate to the Bayley-4 Scores Earned by Matched Samples of Infants and Toddlers across the Cognitive, Language, and Motor Domains? J Intell 2023; 11:213. [PMID: 37998712 PMCID: PMC10671985 DOI: 10.3390/jintelligence11110213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/30/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
The literature on children born prematurely has consistently shown that full-term babies outperform preterm babies by about 12 IQ points, even when tested as adolescents, and this advantage for full-term infants extends to the language and motor domains as well. The results of comprehensive meta-analyses suggest that the degree of prematurity greatly influences later test performance, but these inferences are based on data from an array of separate studies with no control of potential confounding variables such as age. This study analyzed Bayley-4 data for 66 extremely premature infants and toddlers (<32 weeks), 70 moderately premature children (32-36 weeks), and 133 full-term children. All groups were carefully matched on key background variables by the test publisher during the standardization of the Bayley-4. This investigation analyzed data on the five subtests: cognitive, expressive communication, receptive communication, fine motor, and gross motor. A multivariate analysis of covariance (MANCOVA) assessed for group mean differences across the three subsamples, while controlling for the children's age. Extremely premature children scored significantly lower than moderately premature children on all subtests, and both preterm groups were significantly outscored by the full-term sample across all domains. In each set of comparisons, the cognitive and motor subtests yielded the largest differences, whereas language development, both expressive and receptive, appeared the least impacted by prematurity. A follow-up MANOVA was conducted to examine full-term versus preterm discrepancies on the five subtests for infants (2-17 months) vs. toddlers (18-42 months). For that analysis, the two preterm groups were combined into a single preterm sample, and a significant interaction between the age level and group (full-term vs. preterm) was found. Premature infants scored lower than premature toddlers on receptive communication, fine motor, and cognitive. Neither expressive communication nor gross motor produced significant discrepancies between age groups The findings of this study enrich the preterm literature on the degree of prematurity; the age-based interactions have implications for which abilities are most likely to improve as infants grow into toddlerhood.
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Affiliation(s)
- Emily L Winter
- School of Health Sciences Clinical PsyD Program, Touro University, New York, NY 10036, USA
| | | | - Sierra M Trudel
- Department of Occupational and Environmental Medicine, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | | | - Melissa A Bray
- Department of Educational Psychology, University of Connecticut, Storrs, CT 06268, USA
| | - Brittany A Dale
- Department of Special Education, Ball State University, Muncie, IN 47306, USA
| | - Alan S Kaufman
- Department of Educational Psychology, University of Connecticut, Storrs, CT 06268, USA
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12
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Janvier A, Bourque CJ, Pearce R, Thivierge E, Duquette LA, Jaworski M, Barrington KJ, Synnes AR, Church P, Luu TM. Fragility and resilience: parental and family perspectives on the impacts of extreme prematurity. Arch Dis Child Fetal Neonatal Ed 2023; 108:575-580. [PMID: 36997307 DOI: 10.1136/archdischild-2022-325011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVES Extremely preterm babies have a significant risk of neurodevelopmental impairment (NDI). There has been little investigation regarding the impact of prematurity on families. The objective of this study was to explore parental perspectives regarding the impact of prematurity on themselves/their family. METHODS Over 1 year, parents of children born <29 weeks' gestational age (GA) who were between 18 months old and 7 years old and came for their follow-up visit were invited to participate. They were asked to categorise the impacts of prematurity on their life and their family as positive, negative or both and to describe those impacts in their own words. Thematic analysis was performed by a multidisciplinary group, including parents. Logistic regression was performed to compare parental responses. RESULTS Among parents (n=248, 98% participation rate), most (74%) reported that their child's prematurity had both positive and negative impacts on their life or their family's life, while 18% reported only positive impacts and 8% only negative impacts. These proportions were not correlated with GA, brain injury, nor level of NDI. The positive impacts reported included: an improved outlook on life, such as gratitude and perspective (48%), stronger family relationships (31%) and the gift of the child (28%). The negative themes were stress and fear (42%), loss of equilibrium due to medical fragility (35%) and concerns about developmental outcomes including the child's future (18%). CONCLUSION Parents report both positive and negative impacts after an extremely preterm birth, independent of disability. These balanced perspectives should be included in neonatal research, clinical care and provider education.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics and Clinical Ethics, Bureau de l'éthique clinique, Université de Montréal, Montreal, Quebec, Canada
- Neonatology, Palliative Care, Reserch Center, Unité d'éthique Clinique, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Claude Julie Bourque
- Department of Pediatrics, CHU Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada
- Clinical Ethics and Family Partnership Research Unit, CHU Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada
| | - Rebecca Pearce
- Parent Representative, Canadian Premature Baby Foundation, Montreal, Quebec, Canada
| | - Emilie Thivierge
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | | | - Magdalena Jaworski
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
- CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Keith J Barrington
- Department of Neonatology, Centre de Recherche, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Anne R Synnes
- Department of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Paige Church
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Thuy Mai Luu
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
- Pediatrics and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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13
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Green CE, Tyson JE, Heyne RJ, Hintz SR, Vohr BR, Bann CM, Das A, Bell EF, Debsareea SB, Stephens E, Gantz MG, Petrie Huitema CM, Johnson KJ, Watterberg KL, Mosquera R, Peralta-Carcelen M, Wilson-Costello DE, Colaizy TT, Maitre NL, Merhar SL, Adams-Chapman I, Fuller J, Hartley-McAndrew ME, Malcolm WF, Winter S, Duncan AF, Myer GJ, Kicklighter SD, Wyckoff MH, DeMauro SB, Hibbs AM, Stoll BJ, Carlo WA, Van Meurs KP, Rysavy MA, Patel RM, Sánchez PJ, Laptook AR, Cotten CM, D'Angio CT, Walsh MC. Use of term reference infants in assessing the developmental outcome of extremely preterm infants: lessons learned in a multicenter study. J Perinatol 2023; 43:1398-1405. [PMID: 37542155 PMCID: PMC10615749 DOI: 10.1038/s41372-023-01729-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/17/2023] [Accepted: 07/10/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Extremely preterm (EP) impairment rates are likely underestimated using the Bayley III norm-based thresholds scores and may be better assessed relative to concurrent healthy term reference (TR) infants born in the same hospital. STUDY DESIGN Blinded, certified examiners in the Neonatal Research Network (NRN) evaluated EP survivors and a sample of healthy TR infants recruited near the 2-year assessment age. RESULTS We assessed 1452 EP infants and 183 TR infants. TR-based thresholds showed higher overall EP impairment than Bayley norm-based thresholds (O.R. = 1.86; [95% CI 1.56-2.23], especially for severe impairment (36% vs. 24%; p ≤ 0.001). Difficulty recruiting TR patients at 2 years extended the study by 14 months and affected their demographics. CONCLUSION Impairment rates among EP infants appear to be substantially underestimated from Bayley III norms. These rates may be best assessed by comparison with healthy term infants followed with minimal attrition from birth in the same centers. CLINICALTRIALS GOV ID Term Reference (under the Generic Database Study): NCT00063063.
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Affiliation(s)
- Charles E Green
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Jon E Tyson
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Roy J Heyne
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Susan R Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Betty R Vohr
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA
| | - Carla M Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, Greensboro, NC, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, USA
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Sana Boral Debsareea
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Houston McGovern Medical School, Houston, TX, USA
| | - Emily Stephens
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marie G Gantz
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, Greensboro, NC, USA
| | | | - Karen J Johnson
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | | | | | | | - Deanne E Wilson-Costello
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Tarah T Colaizy
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Nathalie L Maitre
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephanie L Merhar
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ira Adams-Chapman
- Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Janell Fuller
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | | | | | - Sarah Winter
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrea F Duncan
- Department of Pediatrics, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Gary J Myer
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Myra H Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sara B DeMauro
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Maria Hibbs
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara J Stoll
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Waldemar A Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Krisa P Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Matthew A Rysavy
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Ravi M Patel
- Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Pablo J Sánchez
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Abbot R Laptook
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA
| | | | - Carl T D'Angio
- Department of Pediatrics, Wake Medical Center, Raleigh, NC, USA
| | - Michele C Walsh
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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14
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Laccetta G, Di Chiara M, De Nardo MC, Tagliabracci M, Travaglia E, De Santis B, Spiriti C, Dito L, Regoli D, Caravale B, Cellitti R, Parisi P, Terrin G. Quantitative ultrasonographic examination of cerebral white matter by pixel brightness intensity as marker of middle-term neurodevelopment: a prospective observational study. Sci Rep 2023; 13:16816. [PMID: 37798394 PMCID: PMC10556025 DOI: 10.1038/s41598-023-44083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023] Open
Abstract
Non-cystic white matter (WM) injury has become prevalent among preterm newborns and is associated with long-term neurodevelopmental impairment. Magnetic resonance is the gold-standard for diagnosis; however, cranial ultrasound (CUS) is more easily available but limited by subjective interpretation of images. To overcome this problem, we enrolled in a prospective observational study, patients with gestational age at birth < 32 weeks with normal CUS scans or grade 1 WM injury. Patients underwent CUS examinations at 0-7 days of life (T0), 14-35 days of life (T1), 370/7-416/7 weeks' postmenstrual age (T2), and 420/7-520/7 weeks' postmenstrual age (T3). The echogenicity of parieto-occipital periventricular WM relative to that of homolateral choroid plexus (RECP) was calculated on parasagittal scans by means of pixel brightness intensity and its relationship with Bayley-III assessment at 12 months' corrected age was evaluated. We demonstrated that: (1) Left RECP values at T1 negatively correlated with cognitive composite scores; (2) Right RECP values at T2 and T3 negatively correlated with language composite scores; (3) Left RECP values at T1 and T2 negatively correlated with motor composite scores. Thus, this technique may be used as screening method to early identify patients at risk of neurodevelopmental issues and promptly initiate preventive and therapeutic interventions.
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Affiliation(s)
- Gianluigi Laccetta
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Maria Di Chiara
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara De Nardo
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Monica Tagliabracci
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Elisa Travaglia
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Benedetta De Santis
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Caterina Spiriti
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Lucia Dito
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Regoli
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Barbara Caravale
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Raffaella Cellitti
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
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15
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Neel ML, Conroy S, Srinivas R, Taylor HG, Stark AR, de Silva A, Busch T, Maitre NL. Bayley trajectories predict school readiness better than single assessments in formerly very preterm preschoolers. Pediatr Res 2023; 94:1392-1399. [PMID: 37217606 DOI: 10.1038/s41390-023-02656-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/19/2023] [Accepted: 02/22/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Development of children born very preterm (VPT) is evaluated using the Bayley Scales of Infant Development. Early Bayley scores may not predict later outcomes. We studied whether VPT Bayley trajectories in the early years predicted school readiness better than single assessments. METHODS We prospectively evaluated 53 VPT at 4-5 years using standardized measures of school readiness, including the domains of cognition, early mathematical and literacy abilities, and motor skills. Predictors were Bayley-III scores obtained 1-5 times/child between 6 and 35 months. Linear mixed models (LMM) with random effects extracted estimated random effect for slope (change in Bayley score/1 year) and fixed+random effect sum for the intercept (initial Bayley score) for each participant, to then evaluate 4-5-year outcomes prediction. RESULTS Variability of individual trajectories prevailed across developmental domains. For the initial LMM, adding Bayley change to models with only initial score improved model fits for several Bayley-III domains. Models containing estimates for initial Bayley scores and Bayley change explained significantly more variability in school readiness scores (21-63%) than either variable alone. CONCLUSION Neurodevelopmental follow-up of VPT is more relevant to school readiness when children are assessed multiple times in the first 3 years. Neonatal intervention research could use early trajectories rather than single timepoints as outcomes. IMPACT This study is the first to examine individual Bayley scores and trajectories to predict school readiness of formerly preterm children at 4-5 years. Modeling demonstrated extreme variability of individual trajectories compared to the group's average trajectories. Models containing initial Bayley scores and Bayley change over time explained more variability in preschool readiness than either variable alone. Using the Bayley to predict future school readiness is enhanced by administration across multiple follow-up visits and inclusion of change across the first 3 years. Follow-up care models and clinical trial design for neonatal interventions may benefit from a trajectory-based approach to outcomes evaluation.
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Affiliation(s)
- Mary Lauren Neel
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Sara Conroy
- Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Biostatistics Resource at Nationwide Children's Hospital, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rachelle Srinivas
- Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hudson Gerry Taylor
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ann R Stark
- Department of Neonatology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| | - Aryanne de Silva
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tyler Busch
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nathalie L Maitre
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
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16
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Janning A, Lademann H, Olbertz D. Predictive Value of the Münchener Funktionelle Entwicklungsdiagnostik Used to Determine Risk Factors for Motor Development in German Preterm Infants. Biomedicines 2023; 11:2626. [PMID: 37893000 PMCID: PMC10604727 DOI: 10.3390/biomedicines11102626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/03/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
Early diagnosis of developmental delays is essential to providing early developmental care. The Münchener Funktionelle Entwicklungsdiagnostik (MFED) is a simple and cost-effective tool for diagnosing the development of infants and young children. Nevertheless, the MFED has not been a well-studied part of current research. This retrospective cohort study aims to detect risk factors and assess the impact of developmental care during the first twelve months of life, using the MFED. Furthermore, it determines the MFED's predictive value by comparing results with an international gold standard, the Bayley Scales of Infant Development II (BSID II). The study included 303 infants born between 2008-2013 in Rostock, Germany, with a birth weight of ≤1500 g and/or a gestational age of ≤32 weeks, who were evaluated with the MFED at twelve months of age. To ascertain the predictive value, 213 infants underwent BSID II assessment at 24 months of age. Intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and periventricular leukomalacia (PVL) were significantly associated with a higher risk of developmental delay across various domains. Post-discharge developmental care therapies did not indicate any clear beneficial effect on the infant's development. Nevertheless, some domains of MFED demonstrate predictive value, warranting increased attention for this diagnostic.
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Affiliation(s)
- Anna Janning
- Department for Pediatrics, Universitätsklinikum Würzburg, 97070 Würzburg, Bavaria, Germany
| | - Hanne Lademann
- Department of Pediatrics, University Rostock, 18057 Rostock, Mecklenburg-Vorpommern, Germany;
| | - Dirk Olbertz
- Department for Neonatology, Klinikum Südstadt Rostock, 18059 Rostock, Mecklenburg-Vorpommern, Germany
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17
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Cuervo S, Creaghead N, Vannest J, Hunter L, Ionio C, Altaye M, Parikh NA. Language Outcomes of Children Born Very Preterm in Relation to Early Maternal Depression and Anxiety. Brain Sci 2023; 13:1355. [PMID: 37891724 PMCID: PMC10605035 DOI: 10.3390/brainsci13101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Unaddressed maternal psychological distress within the first year postpartum is known to have numerous negative consequences on the child's developmental outcomes, including language acquisition. This study examined the relationship between early maternal psychosocial factors and the language outcomes of children born very preterm (VPT; ≤32 weeks gestational age). It used data from the Cincinnati Infant Neurodevelopment Early Prediction Study, an ongoing National-Institutes-of-Health-funded prospective, multicenter cohort investigation of VPT infants. A total of 243 (125 boys; 118 girls) children born VPT (M = 29.03 weeks of gestation; SD = 2.47) and their corresponding 207 mothers (34 with multiple infants) were included in this study. We did not find an association between maternal depression or anxiety and Bayley-III (M = 92.3, SD = 18.9) language scores. Additionally, maternal grit and self-efficacy did not modify the relationship between depression and anxiety and language scores. A higher level of maternal education and infant female sex were significantly associated with higher language scores. While preterm birth typically results in higher rates of depression and anxiety for parents, the findings suggest that maternal depression, anxiety, and grit and the self-efficacy of the mothers in this sample did not relate to the language development of their children, independent of maternal education and infant female sex.
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Affiliation(s)
- Sisan Cuervo
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nancy Creaghead
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
| | - Lisa Hunter
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
| | - Chiara Ionio
- Department of Psychology, Catholic University of the Sacred Heart, 00168 Milano, Italy;
| | - Mekibib Altaye
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nehal A. Parikh
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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18
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Shaw RJ, Givrad S, Poe C, Loi EC, Hoge MK, Scala M. Neurodevelopmental, Mental Health, and Parenting Issues in Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1565. [PMID: 37761526 PMCID: PMC10528009 DOI: 10.3390/children10091565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
The World Health Organization in its recommendations for the care of preterm infants has drawn attention to the need to address issues related to family involvement and support, including education, counseling, discharge preparation, and peer support. A failure to address these issues may translate into poor outcomes that extend across the lifespan. In this paper, we review the often far-reaching impact of preterm birth on the health and wellbeing of the parents and highlight the ways in which psychological stress may have a negative long-term impact on the parent-child interaction, attachment, and the styles of parenting. This paper addresses the following topics: (1) neurodevelopmental outcomes in preterm infants, including cognitive, sensory, and motor difficulties, (2) long-term mental health issues in premature infants that include elevated rates of anxiety and depressive disorders, autism, and somatization, which may affect social relationships and quality of life, (3) adverse mental health outcomes for parents that include elevated rates of depression, anxiety, and symptoms of post-traumatic stress, as well as increased rates of substance abuse, and relationship strain, (4) negative impacts on the parent-infant relationship, potentially mediated by maternal sensitivity, parent child-interactions, and attachment, and (5) impact on the parenting behaviors, including patterns of overprotective parenting, and development of Vulnerable Child Syndrome. Greater awareness of these issues has led to the development of programs in neonatal mental health and developmental care with some data suggesting benefits in terms of shorter lengths of stay and decreased health care costs.
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Affiliation(s)
- Richard J. Shaw
- Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA; (E.C.L.); (C.P.)
| | - Soudabeh Givrad
- Division of Child and Adolescent Psychiatry, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065, USA;
| | - Celeste Poe
- Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA; (E.C.L.); (C.P.)
| | - Elizabeth C. Loi
- Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA; (E.C.L.); (C.P.)
| | - Margaret K. Hoge
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Melissa Scala
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA;
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19
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Kaempf JW, Guillen U, Litt JS, Zupancic JAF, Kirpalani H. Change in neurodevelopmental outcomes for extremely premature infants over time: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2023; 108:458-463. [PMID: 36270779 DOI: 10.1136/archdischild-2022-324457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Survival rates of extremely premature infants are rising, but changes in neurodevelopmental impairment (NDI) rates are unclear. Our objective was to perform a systematic review of intrainstitutional variability of NDI over time. DESIGN Systematic review and meta-analysis. DATA SOURCES Ovid MEDLINE, Embase, PubMed, Cochrane Library and Google Scholar. STUDY SELECTION Study eligibility: (1) at least two discrete cohorts of infants born <27 weeks' gestation or <1000 g birth weight, (2) one cohort born after 1990 and at least one subsequent cohort of similar gestational age, (3) all cohorts cared for within the same Neonatal Intensive Care Unit(s) (NICU) and (4) neurodevelopmental outcomes at 18-36 months corrected age. MAIN OUTCOME Change in NDI rates. Quality, validity and bias were assessed using Grading of Recommendations, Assessment, Development, and Evaluation and Quality in Prognosis Studies guidelines. RESULTS Of 203 publications, 15 were eligible, including 13 229 infants. At the first time point, average NDI rate across study groups weighted by sample size was 41.0% (95% CI 34.0% to 48.0%). The average change in NDI between time points was -3.3% (95% CI -8·8% to 2.2%). For each added week of gestation at birth, the rate of NDI declined by 9.7% (95% CI 6.2% to 13.3%). Most studies exhibited moderate-severe bias in at least one domain, especially attrition rates. CONCLUSIONS When comparing discrete same-centre cohorts over time, there was no significant change in NDI rates in infants born <27 weeks' gestation or <1000 g. Higher survival rates unaccompanied by improvement in neurodevelopment highlight urgency for renewed focus on the causes of NDI and evidence-based strategies to reduce brain injury.
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Affiliation(s)
- Joseph W Kaempf
- Women and Children's Services, Providence Health System, Portland, Oregon, USA
| | - Ursula Guillen
- Division of Neonatology, ChristianaCare, Wilmington, Delaware, USA
| | - Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Haresh Kirpalani
- Emeritus, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Emeritus, Division of Neonatology, McMaster University, Hamilton, Massachusetts, Canada
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20
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Blasco P, Saxton S, Gullion LM, Oo TZ, Amukune S, Józsa K. Assessment of Mastery Motivation and Neurodevelopment of Young Children at High Risk for Developmental Delays. J Intell 2023; 11:115. [PMID: 37367517 DOI: 10.3390/jintelligence11060115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Young children's mastery motivation and neurodevelopmental evaluation can contribute to overall early assessment for early intervention evaluation. At present, children born preterm (<37 weeks gestation) and with a low birth weight (LBW; <2500 g) are at increased risk of experiencing developmental delays and more nuanced cognitive and language challenges. The main objective of this exploratory study was to examine the connection between preterm children's mastery motivation and their neurodevelopment, as well as to determine whether assessing mastery motivation can enhance assessment practices for early intervention (EI) programs. Parents of children born preterm completed the revised Dimensions of Mastery Motivation Questionnaire (DMQ18). Neurodevelopment was measured on the Bayley Scales of Infant and Toddler Development (BSID-III). Results revealed significant correlations between DMQ18 and BSID-III measures. Multivariate analysis showed that infants and toddlers born with a very low birth weight (VLBW; <1500 g) scored significantly lower on the infant DMQ18 and the BSID-III measures. Regression analyses revealed that birth weight and home environment were significant predictors of the children's eligibility for EI programs. Infants' social persistence with other children, gross motor persistence, and mastery pleasure, as well as toddlers' objective cognitive persistence, social persistence with adults, gross motor persistence, mastery pleasure, and negative reaction to frustration, were important markers for evidenced-based practices in EI programs. This study demonstrates the utility of the DMQ18 as a contributory assessment measure and the importance of birth weight and home environment in predicting EI enrollment.
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Affiliation(s)
- Patricia Blasco
- Institute on Development and Disability, Department of Pediatrics, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Sage Saxton
- Institute on Development and Disability, Department of Pediatrics, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Lily Marie Gullion
- Division of Occupational Science and Occupational Therapy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Tun Zaw Oo
- MTA-MATE Early Childhood Research Group, 7400 Kaposvár, Hungary
- Institute of Education, Hungarian University of Agriculture and Life Sciences, 7400 Kaposvár, Hungary
| | - Stephen Amukune
- MTA-MATE Early Childhood Research Group, 7400 Kaposvár, Hungary
- School of Education, Pwani University, Kilifi 80108, Kenya
| | - Krisztián Józsa
- Institute of Education, Hungarian University of Agriculture and Life Sciences, 7400 Kaposvár, Hungary
- Institute of Education, University of Szeged, 6722 Szeged, Hungary
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21
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Douglas E, Hodgson KA, Olsen JE, Manley BJ, Roberts CT, Josev E, Anderson PJ, Doyle LW, Davis PG, Cheong JLY. Postnatal corticosteroids and developmental outcomes in extremely preterm or extremely low birth weight infants: The Victorian Infant Collaborative Study 2016-17 cohort. Acta Paediatr 2023; 112:1226-1232. [PMID: 36719082 PMCID: PMC10953334 DOI: 10.1111/apa.16696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023]
Abstract
AIM Systemic postnatal corticosteroids are used to treat or prevent bronchopulmonary dysplasia (BPD) in extremely preterm (EP) or extremely low birth weight (ELBW) infants but are associated with long-term harm. We aimed to assess the relationship between cumulative postnatal corticosteroid dose and neurodevelopmental outcomes. METHODS Longitudinal cohort study of all EP/ELBW livebirths in Victoria, Australia 2016-2017. Perinatal data were collected prospectively. Neurodevelopmental assessment was performed at 2 years' corrected age. Linear and logistic regression were used to determine relationships between cumulative corticosteroid dose and neurodevelopment, adjusted for gestational age, birth weight, sex and major intraventricular haemorrhage. RESULTS Seventy-six EP/ELBW infants received postnatal corticosteroids to treat or prevent BPD, 62/65 survivors were seen at 2 years. Median (IQR) cumulative postnatal corticosteroid dose was 1.36 (0.92-3.45) mg/kg dexamethasone equivalent. Higher cumulative corticosteroid dose was associated with increased odds of cerebral palsy, adjusted OR (95% CI) 1.47 (1.04, 2.07). Higher cumulative corticosteroid dose was also associated with lower cognitive and motor developmental scores, however, this weakened after adjustment for confounding variables: cognitive composite score adjusted coefficient (95% CI) -1.3 (-2.7, 0.1) and motor composite score adjusted coefficient (95% CI) -1.3 (-2.8, 0.2). CONCLUSION Higher cumulative postnatal corticosteroid dose in EP/ELBW infants is associated with increased odds of cerebral palsy at 2 years' corrected age. Adequately powered studies are needed to assess the independent effects of cumulative steroid dose on neurodevelopmental outcomes.
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Affiliation(s)
- Ellen Douglas
- Newborn Research CentreRoyal Women's HospitalMelbourneVictoriaAustralia
| | - Kate A. Hodgson
- Newborn Research CentreRoyal Women's HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Joy E. Olsen
- Newborn Research CentreRoyal Women's HospitalMelbourneVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Brett J. Manley
- Newborn Research CentreRoyal Women's HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyThe University of MelbourneMelbourneVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Calum T. Roberts
- Monash NewbornMonash Children' HospitalMelbourneVictoriaAustralia
- Ritchie CentreHudson Institute of Medical ResearchMelbourneVictoriaAustralia
| | - Elisha Josev
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
- Mercy Hospital for WomenMelbourneVictoriaAustralia
| | - Peter J. Anderson
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
- Turner Institute for Brain and Mental Health & School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Lex W. Doyle
- Newborn Research CentreRoyal Women's HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyThe University of MelbourneMelbourneVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Peter G. Davis
- Newborn Research CentreRoyal Women's HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyThe University of MelbourneMelbourneVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Jeanie L. Y. Cheong
- Newborn Research CentreRoyal Women's HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyThe University of MelbourneMelbourneVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
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22
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Zimmerman E, Aguiar A, Aung MT, Geiger SD, Hines M, Woodbury ML, Martens A, Huerta-Montanez G, Cordero JF, Meeker JD, Schantz SL, Alshawabkeh AN. Examining the association between prenatal maternal stress and infant non-nutritive suck. Pediatr Res 2023; 93:1285-1293. [PMID: 34916626 PMCID: PMC9200902 DOI: 10.1038/s41390-021-01894-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study examined the relationship between prenatal maternal stress (PREMS) and non-nutritive suck (NNS) and tested its robustness across 2 demographically diverse populations. METHODS The study involved 2 prospective birth cohorts participating in the national Environmental influences on Child Health Outcomes (ECHO) Program: Illinois Kids Development Study (IKIDS) and ECHO Puerto Rico (ECHO-PROTECT). PREMS was measured during late pregnancy via the 10-item Perceived Stress Scale (PSS-10). NNS was sampled from 1- to 8-week-olds using a custom pacifier for ~5 min. RESULTS Overall, 237 mother-infant dyads completed this study. Despite several significant differences, including race/ethnicity, income, education, and PREMS levels, significant PREMS-NNS associations were found in the 2 cohorts. In adjusted linear regression models, higher PREMS, measured through PSS-10 total scores, related to fewer but longer NNS bursts per minute. CONCLUSIONS A significant association was observed between PREMS and NNS across two diverse cohorts. This finding is important as it may enable the earlier detection of exposure-related deficits and, as a result, earlier intervention, which potentially can optimize outcomes. More research is needed to understand how NNS affects children's neurofunction and development. IMPACT In this double-cohort study, we found that higher maternal perceived stress assessed in late pregnancy was significantly associated with fewer but longer sucking bursts in 1- to 8-week-old infants. This is the first study investigating the association between prenatal maternal stress (PREMS) and infant non-nutritive suck (NNS), an early indicator of central nervous system integrity. Non-nutritive suck is a potential marker of increased prenatal stress in diverse populations. Non-nutritive suck can potentially serve as an early indicator of exposure-related neuropsychological deficits allowing for earlier interventions and thus better prognoses.
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Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA.
| | - Andréa Aguiar
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Max T Aung
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Sarah Dee Geiger
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
| | - Megan L Woodbury
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alaina Martens
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
| | | | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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23
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Caesar RA, Boyd RN, Cioni G, Ware RS, Doherty J, Jackson MP, Salthouse KL, Colditz PB. Early detection of developmental delay in infants born very preterm or with very low birthweight. Dev Med Child Neurol 2023; 65:346-357. [PMID: 37017185 PMCID: PMC10952560 DOI: 10.1111/dmcn.15381] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/19/2022]
Abstract
AIM This study aimed to identify early clinical biomarkers from birth to 16 weeks corrected age to predict typical outcome and developmental delay in infants born very preterm or with very low birthweight. METHOD A prospective cohort of infants on the Sunshine Coast, Australia, was assessed using the Premie-Neuro Examination, the General Movement Assessment (GMA), the Alberta Infant Motor Scale, and the Infant Sensory Profile 2. At 24 months corrected age, delay was identified using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Neurosensory Motor Developmental Assessment (NSMDA). RESULTS One hundred and four infants were recruited; 79 completed outcome assessments (43 females, 36 males; mean gestational age 30 weeks [SD 1 week 6 days], mean birthweight 1346 g [SD 323]). The incidence of developmental delay (motor or cognitive) was 6.3%. Suboptimal quality of fidgety general movements (temporal organization) at 16 weeks corrected age demonstrated the best predictive accuracy (Bayley-III motor: sensitivity 100% [95% confidence interval {CI} 3-100], specificity 75% [95% CI 63-84], area under the curve [AUC] 0.87); Bayley-III cognitive: sensitivity 100% [95% CI 3-100], specificity 75% [95% CI 64-84], AUC 0.88); NSMDA motor: sensitivity 100% [95% CI 40-100], specificity 81% [95% CI 70-90], AUC 0.91 [95% CI 0.86-0.95]). GMA trajectories that combined abnormal writhing general movements at 4 to 5 weeks corrected age with suboptimal quality of fidgety movement at 16 weeks corrected age were strongly predictive of developmental delay, superior to all other clinical tools, and perinatal and demographic variables investigated (p = 0.01, Akaike information criterion method 18.79 [score corrected for small sample size], accounting for 93% of the cumulative weight). INTERPRETATION Only the GMA had sufficient predictive validity to act as a biomarker for both conditions: typical outcome and developmental delay (motor or cognitive). GMA trajectories that assessed both writhing general movements at 4 to 5 weeks corrected age and quality of fidgety movement at 16 weeks corrected age predicted adverse neurodevelopmental outcome, accurately differentiating between infants with typical outcomes and those at increased risk for motor or cognitive delay.
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Affiliation(s)
- Rebecca A. Caesar
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
| | - Giovanni Cioni
- Department of Developmental NeuroscienceIRCCS Fondazione Stella MarisPisaItaly
| | - Robert S. Ware
- Griffith University, Menzies Health Institute QueenslandGold CoastAustralia
| | - Julie Doherty
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Maxine P. Jackson
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Kaye L. Salthouse
- Women's and Children's ServiceSunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS)Sunshine CoastAustralia
| | - Paul B. Colditz
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of MedicineThe University of Queensland, Child Health Research CentreBrisbaneAustralia
- The University of Queensland Centre for Clinical Research, Faculty of MedicineThe University of Queensland, Royal Brisbane and Women's HospitalBrisbaneAustralia
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24
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Episodic and prospective memory difficulties in 13-year-old children born very preterm. J Int Neuropsychol Soc 2023; 29:257-265. [PMID: 35388789 DOI: 10.1017/s1355617722000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Children born very preterm (VP) are susceptible to a range of cognitive impairments, yet the effects of VP birth on long-term, episodic, and prospective memory remains unclear. This study examined episodic and prospective memory functioning in children born VP compared with their term-born counterparts at 13 years. METHOD VP (n = 81: born <30 weeks' gestation) and term (n = 26) groups were aged between 12 and 14 years. Children completed: (i) standardized verbal and visuospatial episodic memory tests; and (ii) an experimental time- and event-based prospective memory test that included short-term (within assessment session) and long-term (up to 1-week post-session) tasks. Parents completed a questionnaire assessing memory functions in everyday life. RESULTS The VP group performed worse on all measures of verbal and visuospatial episodic memory than the term group. While there were no group differences in event-based or long-term prospective memory, the VP group performed worse on time-based and short-term prospective memory tasks than term-born counterparts. Parents of children born VP reported more everyday memory difficulties than parents of children born at term, with parent-ratings indicating significantly elevated rates of everyday memory challenges in children born VP. CONCLUSIONS Children born VP warrant long-term surveillance, as challenges associated with VP birth include memory difficulties at 13 years. This study highlights the need for greater research and clinical attention into childhood functional memory outcomes.
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25
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Kim C, Zimmerman E, Huerta-Montañez G, Rosario-Pabón ZY, Vélez-Vega CM, Alshawabkeh AN, Cordero JF, Meeker JD, Watkins DJ. Associations between biomarkers of prenatal metals exposure and non-nutritive suck among infants from the PROTECT birth cohort in Puerto Rico. FRONTIERS IN EPIDEMIOLOGY 2022; 2:1057515. [PMID: 38455310 PMCID: PMC10911005 DOI: 10.3389/fepid.2022.1057515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 03/09/2024]
Abstract
Background/Aim Infant non-nutritive suck (NNS) has been used as an early marker of neonatal brain function. Although there is an established relationship between prenatal exposure to certain metals and brain development, the association between metal exposure and NNS has not been explored. Therefore, in this study we assessed associations between maternal urinary metal(loid) concentrations and NNS measurements among infants from the Puerto Rico PROTECT birth cohort. We hypothesized that maternal urinary metal(loid) concentrations are significantly associated with infant NNS measures in a sex-dependent manner. Methods We measured urinary concentrations of 14 metal(loid)s in pregnant women at up to three time points in pregnancy. The geometric mean of each metal(loid) for each pregnant woman was calculated and used as an exposure measurement across gestation. NNS measurements (duration, frequency, amplitude, bursts/min, cycles/burst, cycles/min) were collected from infants between 4 and 6 (±2 weeks) weeks of age using our custom research pacifier. Linear regression was used to estimate associations between urinary metal(loid) concentrations across pregnancy and continuous NNS variables. Sex-specific effects were estimated using interaction terms between NNS variables and infant sex. Results We observed significant positive associations between mercury, manganese, and tin with NNS duration (mercury: %Δ = 1.08, 95% CI: 0.42, 1.74; manganese: %Δ = 0.67, 95% CI: 0.15, 1.20; tin: %Δ = 0.83, 95% CI: 0.17, 1.49) and NNS cycles/burst (mercury: %Δ = 1.85, 95% CI: 0.58, 3.11; manganese: (%Δ = 1.37, 95% CI: 0.40, 2.34; tin: %Δ = 1.68, 95% CI: 0.46, 2.91). Furthermore, the association between NNS cycles/min with cadmium (%Δ = 8.06, 95% CI: 3.33, 12.78), manganese (%Δ = 4.44, 95% CI: 1.40, 7.47), and tin (%Δ = 4.50, 95% CI: 0.81, 8.18) were in the opposite direction from its association with zinc (%Δ = -9.30, 95% CI: -14.71, -3.89), as well as with copper (%Δ = -6.58, 95% CI: -12.06, -1.10). For the sex-stratified analysis, the negative associations between metal(loid)s and NNS duration were predominantly driven by male infants; however, the negative associations between metal(loid)s and NNS bursts/min were mainly driven by female infants. Conclusion We observed significant associations between prenatal metal(loid) exposure and NNS measurements among infants from the ongoing Puerto Rico PROTECT cohort. Similar to previous studies that have demonstrated associations between NNS and subsequent neurodevelopment, this study highlights the potential of NNS as a quantitative index to measure altered neurodevelopment from prenatal metal(loid) exposures. We believe this study will inform future efforts aimed at reducing health risks related to early life metal exposures, such as developing early identification of metal-induced adverse outcomes in child neurodevelopment.
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Affiliation(s)
- Christine Kim
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States
| | - Gredia Huerta-Montañez
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - Zaira Y. Rosario-Pabón
- UPR Medical Sciences Campus, University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
| | - Carmen M. Vélez-Vega
- UPR Medical Sciences Campus, University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
| | | | - José F. Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, United States
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Deborah J. Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
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26
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Edwards T, Alsweiler JM, Gamble GD, Griffith R, Lin L, McKinlay CJD, Rogers JA, Thompson B, Wouldes TA, Harding JE. Neurocognitive Outcomes at Age 2 Years After Neonatal Hypoglycemia in a Cohort of Participants From the hPOD Randomized Trial. JAMA Netw Open 2022; 5:e2235989. [PMID: 36219444 PMCID: PMC9554702 DOI: 10.1001/jamanetworkopen.2022.35989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Neonatal hypoglycemia is common, but its association with later neurodevelopment is uncertain. OBJECTIVE To examine associations between neonatal hypoglycemia and neurocognitive outcomes at corrected age 2 years. DESIGN, SETTING, AND PARTICIPANTS Exploratory cohort analysis of the Hypoglycaemia Prevention With Oral Dextrose (hPOD) randomized clinical trial was conducted. The trial recruited participants from January 9, 2015, to May 5, 2019, with follow-up between January 26, 2017, and July 31, 2021. Infants were recruited from 9 maternity hospitals in New Zealand and assessed at home or in a research clinic. Children born late preterm and at term at risk of neonatal hypoglycemia but without evidence of acute or imminent illness in the first hour after birth were screened and treated to maintain blood glucose concentrations greater than or equal to 47 mg/dL. EXPOSURES Hypoglycemia was defined as any blood glucose concentration less than 47 mg/dL, recurrent as 3 or more episodes, and severe as less than 36 mg/dL. MAIN OUTCOMES AND MEASURES Neurologic examination and tests of development (Bayley III) and executive function. The primary outcome was neurosensory impairment (any of the following: blindness, deafness, cerebral palsy, developmental delay, or executive function total score worse than 1.5 SD below the mean). RESULTS A total of 1197 of 1321 (91%) eligible children were assessed at a mean of corrected age 24 months; 616 (52%) were male. Compared with the normoglycemia group, children who experienced hypoglycemia were more likely to have neurosensory impairment (111 [23%] vs 125 [18%]; adjusted risk ratio [aRR], 1.28; 95% CI, 1.01-1.60), particularly if they experienced severe episodes (30 [28%] vs 125 [18%]; aRR, 1.68; 95% CI, 1.20-2.36), but not recurrent episodes (12 [19%] vs 125 [18%]; aRR, 1.06; 95% CI, 0.63-1.80). The risk of cognitive, language, or motor delay was similar between groups, but children who experienced hypoglycemia had lower Bayley-III composite cognitive (adjusted mean difference [aMD], -1.48; 95% CI, -2.79 to -0.18) and motor scores (aMD, -2.05; 95% CI, -3.30 to -0.79). CONCLUSIONS AND RELEVANCE In children born at risk of hypoglycemia but otherwise well, those who experienced neonatal hypoglycemia were more likely to have neurosensory impairment at corrected age 2 years, with higher risks after severe episodes. Further research is required to determine causality.
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Affiliation(s)
- Taygen Edwards
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jane M. Alsweiler
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Greg D. Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Rebecca Griffith
- Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
| | - Luling Lin
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Christopher J. D. McKinlay
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
| | - Jenny A. Rogers
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, Waterloo, Canada
- Center for Eye and Vision Research, Hong Kong
| | - Trecia A. Wouldes
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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Ali R, Li H, Dillman JR, Altaye M, Wang H, Parikh NA, He L. A self-training deep neural network for early prediction of cognitive deficits in very preterm infants using brain functional connectome data. Pediatr Radiol 2022; 52:2227-2240. [PMID: 36131030 PMCID: PMC9574648 DOI: 10.1007/s00247-022-05510-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/09/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Deep learning has been employed using brain functional connectome data for evaluating the risk of cognitive deficits in very preterm infants. Although promising, training these deep learning models typically requires a large amount of labeled data, and labeled medical data are often very difficult and expensive to obtain. OBJECTIVE This study aimed to develop a self-training deep neural network (DNN) model for early prediction of cognitive deficits at 2 years of corrected age in very preterm infants (gestational age ≤32 weeks) using both labeled and unlabeled brain functional connectome data. MATERIALS AND METHODS We collected brain functional connectome data from 343 very preterm infants at a mean (standard deviation) postmenstrual age of 42.7 (2.5) weeks, among whom 103 children had a cognitive assessment at 2 years (i.e. labeled data), and the remaining 240 children had not received 2-year assessments at the time this study was conducted (i.e. unlabeled data). To develop a self-training DNN model, we built an initial student model using labeled brain functional connectome data. Then, we applied the trained model as a teacher model to generate pseudo-labels for unlabeled brain functional connectome data. Next, we combined labeled and pseudo-labeled data to train a new student model. We iterated this procedure to obtain the best student model for the early prediction task in very preterm infants. RESULTS In our cross-validation experiments, the proposed self-training DNN model achieved an accuracy of 71.0%, a specificity of 71.5%, a sensitivity of 70.4% and an area under the curve of 0.75, significantly outperforming transfer learning models through pre-training approaches. CONCLUSION We report the first self-training prognostic study in very preterm infants, efficiently utilizing a small amount of labeled data with a larger share of unlabeled data to aid the model training. The proposed technique is expected to facilitate deep learning with insufficient training data.
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Affiliation(s)
- Redha Ali
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH, 45229, USA
| | - Hailong Li
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH, 45229, USA
- Center for Artificial Intelligence in Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Center for Prevention of Neurodevelopmental Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH, 45229, USA
- Center for Artificial Intelligence in Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Center for Prevention of Neurodevelopmental Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hui Wang
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH, 45229, USA
- MR Clinical Science, Philips, Cincinnati, OH, USA
| | - Nehal A Parikh
- Center for Prevention of Neurodevelopmental Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lili He
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH, 45229, USA.
- Center for Artificial Intelligence in Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Center for Prevention of Neurodevelopmental Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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28
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Huf IU, Baque E, Colditz PB, Chatfield MD, Ware RS, Boyd RN, George JM. Neurological examination at 32-weeks postmenstrual age predicts 12-month cognitive outcomes in very preterm-born infants. Pediatr Res 2022; 93:1721-1727. [PMID: 36151299 PMCID: PMC10172122 DOI: 10.1038/s41390-022-02310-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine the diagnostic accuracy of Hammersmith Neonatal Neurological Examination (HNNE) at 30-32 weeks postmenstrual age (PMA, 'Early') and term equivalent age (TEA) in infants born <31 weeks PMA to predict cognitive outcomes at 12 months corrected age (CA). METHODS Prospective cohort study of 119 infants (73 males; median 28.4 weeks gestational age at birth) who underwent Early and TEA HNNE. At 12 months CA, 104 participants completed Bayley Scales of Infant and Toddler Development, 3rd Edition, (Bayley-III). Optimum cut-off points for each HNNE subscale were determined to establish diagnostic accuracy for predicting adverse cognitive outcomes on the Bayley-III Cognitive Composite Scale (≤85). RESULTS The best diagnostic accuracy for HNNE total score at 30-32 weeks PMA predicting cognitive impairment occurred at cut-off ≤16.7 (sensitivity (Se) = 71%, specificity (Sp) = 51%). The Abnormal Signs subscale demonstrated the best balance of sensitivity/specificity combination (Se = 71%, Sp = 71%; cut-off ≤1.5). For HNNE at TEA, the total score at cut-off ≤24.5 had Se = 71% and Sp = 47% for predicting cognitive impairment. The Tone Patterns subscale demonstrated the strongest diagnostic accuracy at TEA (Se = 71%, Sp = 63%; cut-off ≤3). CONCLUSIONS Early and TEA HNNE demonstrated moderate diagnostic accuracy for cognitive outcomes at 12-months CA in infants born <31 weeks gestational age. CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry; Trial Registration Number: ACTRN12613000280707; web address of trial: http://www.ANZCTR.org.au/ACTRN12613000280707.aspx . IMPACT Early Hammersmith Neonatal Neurological Examination (HNNE) assessment at 30-32 weeks postmenstrual age has moderate diagnostic accuracy for cognitive outcomes at 12 months corrected age in infants born <31 weeks gestation. Early HNNE at 30-32 weeks has stronger predictive validity than HNNE at term equivalent age. Early HNNE may provide an early marker for risk-stratification to optimise the planning of post-discharge support and follow-up services for infants born preterm.
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Affiliation(s)
- Isabel U Huf
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia
| | - Emmah Baque
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Paul B Colditz
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Mark D Chatfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. .,Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia.
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Aledo-Serrano Á, Mingorance A, Villanueva V, García-Peñas JJ, Gil-Nagel A, Boronat S, Aibar J, Cámara S, Yániz MJ, Aras LM, Blanco B, Sánchez-Carpintero R. The Charlotte Project: Recommendations for patient-reported outcomes and clinical parameters in Dravet syndrome through a qualitative and Delphi consensus study. Front Neurol 2022; 13:975034. [PMID: 36119672 PMCID: PMC9481303 DOI: 10.3389/fneur.2022.975034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The appropriate management of patients with Dravet Syndrome (DS) is challenging, given the severity of symptoms and the burden of the disease for patients and caregivers. This study aimed to identify, through a qualitative methodology and a Delphi consensus-driven process, a set of recommendations for the management of DS to guide clinicians in the assessment of the clinical condition and quality of life (QoL) of DS patients, with a special focus on patient- and caregiver-reported outcomes (PROs). Methods This study was conducted in five phases, led by a multidisciplinary scientific committee (SC) including pediatric neurologists, epileptologists, a neuropsychologist, an epilepsy nurse, and members of DS patient advocates. In phases 1 and 2, a questionnaire related to patients' QoL was prepared and answered by caregivers and the SC. In phase 3, the SC generated, based on these answers and on a focus group discussion, a 70-item Delphi questionnaire, covering six topic categories on a nine-point Likert scale. In phase 4, 32 panelists, from different Spanish institutions and with a multidisciplinary background, answered the questionnaire. Consensus was obtained and defined as strong or moderate if ≥80% and 67–79% of panelists, respectively, rated the statement with ≥7. Phase 5 consisted of the preparation of the manuscript. Results The panelists agreed on a total of 69 items (98.6%), 54 (77.14%), and 15 (21.43%) with strong and moderate consensus, respectively. The experts' recommendations included the need for frequent assessment of patient and caregivers QoL parameters. The experts agreed that QoL should be assessed through specific questionnaires covering different domains. Likewise, the results showed consensus regarding the regular evaluation of several clinical parameters related to neurodevelopment, attention, behavior, other comorbidities, and sudden unexpected death in epilepsy (SUDEP). A consensus was also reached on the instruments, specific parameters, and caregivers' education in the routine clinical management of patients with DS. Conclusions This consensus resulted in a set of recommendations for the assessment of clinical and QoL parameters, including PROs, related to the general evaluation of QoL, neurodevelopment, attention, behavior, other comorbidities affecting QoL, SUDEP, and QoL of caregivers/relatives and patients with DS.
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Affiliation(s)
- Ángel Aledo-Serrano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
- *Correspondence: Ángel Aledo-Serrano
| | - Ana Mingorance
- Dracaena Consulting SL, Loulou Foundation, London, United Kingdom
| | | | | | - Antonio Gil-Nagel
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
| | | | | | - Silvia Cámara
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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30
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Gebus M, Chevallier M, Hatton L, Jacquez L, Vilotitch A, Ego A, Pin I, Debillon T. Neurodevelopment at two years and appropriate schooling at five years in children born very preterm. Acta Paediatr 2022; 111:1729-1735. [PMID: 35608527 DOI: 10.1111/apa.16421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
AIM This single-centre French cohort study evaluated the relationship between standardised assessment at 2 years of corrected age and schooling level at 5 years of age in children born at ≤32 weeks' gestational age. METHODS This was a single-centre retrospective study of children born preterm between 2010 and 2014 included in a follow-up network. At 5 years of age, the population was divided into 2 groups: (1) 'appropriate schooling', defined as age-appropriate schooling without support, and (2) 'schooling with support'. At 2 years of corrected age, the developmental quotient (DQ) was calculated using the revised Brunet-Lezine test. Neonatal variables and DQ categories were compared between the 2 groups on univariate and multivariate analyses. RESULTS DQ was available for 251 of the 270 children included (93%), with a median score of 93.0 (IQR [87.0-100.0]), and 171 children (68%) were in the schooling without support group. On multivariate analysis, DQ ≥100 (n = 67) was the only variable that significantly associated with schooling without support (OR = 13.9; 95% CI: 5.5-35.4) at 5 years of age. CONCLUSION This result may be useful for clinicians in their routine practice and for information given to parents in neonatal follow-up.
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Affiliation(s)
- Maya Gebus
- Neonatal Intensive Care Unit Grenoble Alpes University Hospital Grenoble France
| | - Marie Chevallier
- Neonatal Intensive Care Unit Grenoble Alpes University Hospital Grenoble France
- TIMC‐MESP Grenoble Alpes University Hospital, CNRS Grenoble France
| | - Laure‐Anne Hatton
- Neonatal Intensive Care Unit Grenoble Alpes University Hospital Grenoble France
| | - Laure Jacquez
- Neonatal Intensive Care Unit Grenoble Alpes University Hospital Grenoble France
| | - Antoine Vilotitch
- TIMC‐MESP Grenoble Alpes University Hospital, CNRS Grenoble France
- Data Engineering Unit Public Health Department Grenoble Alpes University Hospital Grenoble France
| | - Anne Ego
- Univ. Grenoble Alpes, CNRS Public Health Department Grenoble Alpes University Hospital, TIMC‐IMAG Grenoble France
| | - Isabelle Pin
- Paediatric Unit Grenoble Alpes University Hospital Grenoble France
| | - Thierry Debillon
- Neonatal Intensive Care Unit Grenoble Alpes University Hospital Grenoble France
- TIMC‐MESP Grenoble Alpes University Hospital, CNRS Grenoble France
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31
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Neurodevelopmental profiles of infants born <30 weeks gestation at 2 years of age. Pediatr Res 2022; 91:1579-1586. [PMID: 34880445 PMCID: PMC9177895 DOI: 10.1038/s41390-021-01871-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Infants born <30 weeks postmenstrual age (PMA) are at increased risk for neurodevelopmental impairment by age 2. Prior studies report rates of impairment for individual outcomes separately. Our objective was to describe neurodevelopmental profiles of children born <30 weeks PMA, using cognitive, language, motor, and behavioral characteristics. METHODS We studied 587 children from a multi-center study of infants born <30 weeks PMA. Age 2 outcomes included Bayley-III subscale scores, Child Behavior Checklist syndrome scores, diagnosis of cerebral palsy (CP), and positive screen for autism spectrum disorder (ASD) risk. We used latent profile analysis (LPA) to group children into mutually exclusive profiles. RESULTS We found four discrete neurodevelopmental profiles indicating distinct combinations of developmental and behavioral outcomes. Two of the profiles included 72.7% of the sample with most having Bayley scores within the normal range. The other two profiles included the remaining 27.3% of the sample with most having Bayley scores outside of the normal range. Only one profile (11% of sample) was comprised of children with elevated behavioral problems. CONCLUSION Child-centered analysis techniques could facilitate the development of targeted intervention strategies and provide caregivers and practitioners with an integrative understanding of child behavior. IMPACT Most studies examining neurodevelopmental outcomes in very preterm children report rates of impairment for individual outcomes separately. Comprehensive, "child-centered" approaches that integrate across multiple domains can be used to identify subgroups of children who experience different types of neurodevelopmental impairments. We identified four discrete neurodevelopmental profiles indicating distinct combinations of developmental and behavioral outcomes in very preterm children at 24 months. "Child-centered" analysis techniques may provide clinically useful information and could facilitate the development of targeted intervention strategies for high-risk children.
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32
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Edwards T, Alsweiler JM, Crowther CA, Edlin R, Gamble GD, Hegarty JE, Lin L, McKinlay CJD, Rogers JA, Thompson B, Wouldes TA, Harding JE. Prophylactic Oral Dextrose Gel and Neurosensory Impairment at 2-Year Follow-up of Participants in the hPOD Randomized Trial. JAMA 2022; 327:1149-1157. [PMID: 35315885 PMCID: PMC8941358 DOI: 10.1001/jama.2022.2363] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Prophylactic oral dextrose gel reduces neonatal hypoglycemia, but later benefits or harms remain unclear. OBJECTIVE To assess the effects on later development of prophylactic dextrose gel for infants born at risk of neonatal hypoglycemia. DESIGN, SETTING, AND PARTICIPANTS Prospective follow-up of a multicenter randomized clinical trial conducted in 18 Australian and New Zealand hospitals from January 2015 to May 2019. Participants were late preterm or term at-risk infants; those randomized in 9 New Zealand centers (n = 1359) were included and followed up between January 2017 and July 2021. INTERVENTIONS Infants were randomized to prophylactic 40% dextrose (n = 681) or placebo (n = 678) gel, 0.5 mL/kg, massaged into the buccal mucosa 1 hour after birth. MAIN OUTCOMES AND MEASURES The primary outcome of this follow-up study was neurosensory impairment at 2 years' corrected age. There were 44 secondary outcomes, including cognitive, language, and motor composite Bayley-III scores (mean [SD], 100 [15]; higher scores indicate better performance). RESULTS Of eligible infants, 1197 (91%) were assessed (581 females [49%]). Neurosensory impairment was not significantly different between the dextrose and placebo gel groups (20.8% vs 18.7%; unadjusted risk difference [RD], 2.09% [95% CI, -2.43% to 6.60%]; adjusted risk ratio [aRR], 1.13 [95% CI, 0.90 to 1.41]). The risk of cognitive and language delay was not significantly different between the dextrose and placebo groups (cognitive: 7.6% vs 5.3%; RD, 2.32% [95% CI, -0.46% to 5.11%]; aRR, 1.40 [95% CI, 0.91 to 2.17]; language: 17.0% vs 14.7%; RD, 2.35% [95% CI, -1.80% to 6.50%]; aRR, 1.19 [95% CI, 0.92 to 1.54]). However, the dextrose gel group had a significantly higher risk of motor delay (2.5% vs 0.7%; RD, 1.81% [95% CI, 0.40% to 3.23%]; aRR, 3.79 [95% CI, 1.27 to 11.32]) and significantly lower composite scores for cognitive (adjusted mean difference [aMD], -1.30 [95% CI, -2.55 to -0.05]), language (aMD, -2.16 [95% CI, -3.86 to -0.46]), and motor (aMD, -1.40 [95% CI, -2.60 to -0.20]) performance. There were no significant differences between groups in the other 27 secondary outcomes. CONCLUSIONS AND RELEVANCE Among late preterm and term infants born at risk of neonatal hypoglycemia, prophylactic oral 40% dextrose gel at 1 hour of age, compared with placebo, resulted in no significant difference in the risk of neurosensory impairment at 2 years' corrected age. However, the study may have been underpowered to detect a small but potentially clinically important increase in risk, and further research including longer-term follow-up is required. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12614001263684.
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Affiliation(s)
- Taygen Edwards
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane M. Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | | | - Richard Edlin
- Health Systems, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Greg D. Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Christopher J. D. McKinlay
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
| | - Jenny A. Rogers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, Waterloo, Ontario, Canada
- Center for Eye and Vision Research, Hong Kong
| | - Trecia A. Wouldes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Chen M, Li H, Fan H, Dillman JR, Wang H, Altaye M, Zhang B, Parikh NA, He L. ConCeptCNN: A novel multi-filter convolutional neural network for the prediction of neurodevelopmental disorders using brain connectome. Med Phys 2022; 49:3171-3184. [PMID: 35246986 DOI: 10.1002/mp.15545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Deep convolutional neural network (CNN) and its derivatives have recently shown great promise in the prediction of brain disorders using brain connectome data. Existing deep CNN methods using single global row and column convolutional filters have limited ability to extract discriminative information from brain connectome for prediction tasks. PURPOSE This paper presents a novel deep Connectome-Inception CNN (ConCeptCNN) model, which is developed based on multiple convolutional filters. The proposed model is used to extract topological features from brain connectome data for neurological disorders classification and analysis. METHODS The ConCeptCNN uses multiple vector-shaped filters extract topological information from the brain connectome at different levels for complementary feature embeddings of brain connectome. The proposed model is validated using two datasets: the Neuro Bureau ADHD-200 dataset and the Cincinnati Early Prediction Study (CINEPS) dataset. RESULTS In a cross-validation experiment, the ConCeptCNN achieved a prediction accuracy of 78.7% for the detection of ADHD in adolescents and an accuracy of 81.6% for the prediction of cognitive deficits at 2-year corrected age in very preterm infants. In addition to the classification tasks, the ConCeptCNN identified several brain regions that are discriminative to neurodevelopmental disorders. CONCLUSIONS We compared the ConCeptCNN with several peer CNN methods. The results demonstrated that proposed model improves overall classification performance of neurodevelopmental disorders prediction tasks. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ming Chen
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Hailong Li
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Howard Fan
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hui Wang
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,MR Clinical Science, Philips, Cincinnati, OH, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nehal A Parikh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili He
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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34
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Neurodevelopmental outcomes at 6, 12, and 24 months of age in preterm infants with very low birth weights in Taiwan. J Formos Med Assoc 2022; 121:1804-1812. [DOI: 10.1016/j.jfma.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 12/25/2022] Open
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Muggli E, Halliday J, Elliott EJ, Penington A, Thompson D, Spittle AJ, Forster D, Lewis S, Hearps S, Anderson PJ. Cohort profile: early school years follow-up of the Asking Questions about Alcohol in Pregnancy Longitudinal Study in Melbourne, Australia (AQUA at 6). BMJ Open 2022; 12:e054706. [PMID: 35039298 PMCID: PMC8765013 DOI: 10.1136/bmjopen-2021-054706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The Asking Questions about Alcohol in Pregnancy (AQUA) study, established in 2011, is a prebirth cohort of 1570 mother and child pairs designed to assess the effects of low to moderate prenatal alcohol exposure and sporadic binge drinking on long-term child development. Women attending general antenatal clinics in public hospitals in Melbourne, Australia, were recruited in their first trimester, followed up three times during pregnancy and at 12 and 24 months postpartum. The current follow-up of the 6-8-year-old children aims to strengthen our understanding of the relationship between these levels of prenatal alcohol exposure and neuropsychological functioning, facial dysmorphology, brain structure and function. PARTICIPANTS Between June 2018 and April 2021, 802 of the 1342 eligible AQUA study families completed a parent-report questionnaire (60%). Restrictions associated with COVID-19 pandemic disrupted recruitment, but early school-age neuropsychological assessments were undertaken with 696 children (52%), and 482 (36%) craniofacial images were collected. A preplanned, exposure-representative subset of 146 children completed a brain MRI. An existing biobank was extended through collection of 427 (32%) child buccal swabs. FINDINGS TO DATE Over half (59%) of mothers consumed some alcohol during pregnancy, with one in five reporting at least one binge-drinking episode prior to pregnancy recognition. Children's craniofacial shape was examined at 12 months of age, and low to moderate prenatal alcohol exposure was associated with subtle midface changes. At 2 years of age, formal developmental assessments showed no evidence that cognitive, language or motor outcome was associated with any of exposure level. FUTURE PLANS We will investigate the relationship between prenatal alcohol exposure and specific aspects of neurodevelopment at 6-8 years, including craniofacial shape, brain structure and function. The contribution of genetics and epigenetics to individual variation in outcomes will be examined in conjunction with national and international collaborations.
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Affiliation(s)
- Evelyne Muggli
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Halliday
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Elliott
- Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Anthony Penington
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Plastic and Maxillofacial Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Deanne Thompson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Jane Spittle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Della Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sharon Lewis
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Reproductive Epidemiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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Nishijima M, Yoshida T, Matsumura K, Inomata S, Nagaoka M, Tamura K, Kawasaki Y, Makimoto M. Correlation between the Bayley-III at 3 years and the Wechsler Intelligence Scale for Children, Fourth Edition, at 6 years. Pediatr Int 2022; 64:e14872. [PMID: 34081822 DOI: 10.1111/ped.14872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although several studies have investigated the association between Bayley-III results in infancy and future intellectual development, conclusions remain unclear. We used the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 3 years of age and the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) at 6 years of age to assess the neurodevelopment of very low birthweight infants. METHODS We investigated the correlation between Bayley-III's cognitive, language, and motor scores and the WISC-IV's Full-Scale Intelligence Quotient (FSIQ). We also determined the optimal cut-off value of Bayley-III to enter the normal development zone (FSIQ ≥ 85). RESULTS We found a strong correlation between the Bayley-III and the FSIQ. Optimal cut-off scores of the Bayley-III to enter the normal range on the WISC-IV were 95 for the cognitive scale, 89 for the language scale, and 91 for the motor development scale. CONCLUSIONS Although Bayley-III scores strongly correlated with the WISC-IV FSIQ, the lower normal limit of 85 on the Bayley-III suggests a potential overestimation of development in children who were VLBW infants.
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Affiliation(s)
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Kenta Matsumura
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Satomi Inomata
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Mitsuhide Nagaoka
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Kentaro Tamura
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Yukako Kawasaki
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Masami Makimoto
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
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Olsen JE, Lee KJ, Spittle AJ, Anderson PJ, Doyle LW, Cheong JLY. The causal effect of being born extremely preterm or extremely low birthweight on neurodevelopment and social-emotional development at 2 years. Acta Paediatr 2022; 111:107-114. [PMID: 34494301 DOI: 10.1111/apa.16098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022]
Abstract
AIM To assess the causal effect of being born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g), compared with being born at term, on neurodevelopment and social-emotional development at 2 years' corrected age. METHODS Prospective geographical cohort study of children born EP/ELBW over 12 months in 2016 from Victoria, Australia, and term-born controls. Children were assessed at 2 years' corrected age with the Bayley Scales of Infant and Toddler Development-3rd edition and the Infant-Toddler Social and Emotional Assessment. Delay was defined as <-1 standard deviation relative to the mean of controls. The estimand of interest was the mean difference/odds ratio (OR) between the EP/ELBW and control groups estimated using linear/logistic regression, adjusted for multiple pregnancy and social risk. RESULTS A total of 205 EP/ELBW and 201 controls were assessed at 2 years. Delay/concerns were more common in the EP/ELBW group compared with controls, for cognitive (OR 3.7 [95% confidence interval 2.3, 6.0]), language (5.3 [3.1, 9.0]) and motor (3.9 [2.3, 6.3]) development, and social-emotional competence (4.1 [1.6, 10.2]). CONCLUSION Being born EP/ELBW has an adverse effect on cognitive, language and motor development, and social-emotional competence at 2 years' corrected age. Close developmental surveillance, including social-emotional development, is recommended.
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Affiliation(s)
- Joy E. Olsen
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
| | - Katherine J. Lee
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
| | - Alicia J. Spittle
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Physiotherapy The University of Melbourne Melbourne Victoria Australia
| | - Peter J. Anderson
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Turner Institute for Brain and Mental Health & School of Psychological Sciences Monash University Melbourne Victoria Australia
| | - Lex W. Doyle
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Melbourne Victoria Australia
| | - Jeanie L. Y. Cheong
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Melbourne Victoria Australia
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Neurodevelopmental Outcome of Children with Congenital Heart Disease: A Cohort Study from Infancy to Preschool Age. J Pediatr 2021; 239:126-135.e5. [PMID: 34454950 DOI: 10.1016/j.jpeds.2021.08.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/25/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize the neuropsychological outcome of children with congenital heart disease (CHD) at age 5 years; the stability of cognitive and language abilities across childhood; and to identify early neurodevelopmental markers of neuropsychological outcomes in these children. STUDY DESIGN Five-year-old children (n = 55) with complex CHD were assessed using standardized and comprehensive neuropsychological measures. Stability of language and cognitive performance was assessed by comparing standardized scores between ages 1, 2, and 5 years old. Association between 5-year-old skills and scores obtained in early childhood was studied to identify potential early markers of preschool performance. Receiver operating characteristic curves were used to evaluate the classification accuracy of Bayley Scales of Infant Development, Third Edition scales in identifying later impairments. RESULTS At age 5 years, our cohort obtained scores significantly below the norms on most developmental domains, with 35% to 65% of participants showing impaired short-term/working memory, attention, and preacademic skills. Developmental patterns measured between ages 1 and 5 years were different for cognitive and language domains, with a decline with age for cognitive functioning and stable results for expressive language. The Bayley Scales of Infant Development, Third Edition language scores at age 2 years provided a good predictive value in identifying children with impaired language at age 5 years. CONCLUSIONS In our cohort, we found a high prevalence of impairments affecting higher-order cognitive domains. Although language difficulties can be detected as early as 2 years of age, other neuropsychological impairments, such as attention and pre-academic skills, only appear later during development, which reinforces the need for long-term monitoring and systematic assessment before school entry.
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Paudel N, Thompson B, Chakraborty A, Harding J, Jacobs RJ, Wouldes TA, Yu ST, Anstice NS. Relationship between visual and neurodevelopmental measures at 2 years with visual acuity and stereopsis at 4.5 years in children born at risk of neonatal hypoglycaemia. Ophthalmic Physiol Opt 2021; 42:195-204. [PMID: 34747032 DOI: 10.1111/opo.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Mild to moderate vision loss affects many children and can negatively impact a child's early literacy and academic achievement. Nevertheless, there is no consensus on which factors present in early childhood indicate the need for long-term ophthalmic follow up, particularly in children with a history of perinatal adversity. This study identified the relationship between visual, cognitive, motor and demographic factors at 2 years of age and visual acuity (VA) and stereoacuity at 4.5 years of age. METHODS Five hundred sixteen children identified as being at risk of neonatal hypoglycaemia were recruited soon after birth. At 2 years of age, binocular VA, stereoacuity and non-cycloplegic refraction were measured and a clinical neuro-developmental assessment with the Bayley Scales of Infant Development III (BSID-III) was conducted by a trained examiner. Monocular VA and stereoacuity were measured at 4.5 years of age. RESULTS Three hundred twenty-eight children completed both the 2 and 4.5 year vision and neurodevelopmental assessments. Multiple linear regression showed oblique astigmatism and motor function at 2 years were significantly associated with VA at 4.5 years of age, while spherical equivalent refraction, motor scores and stereoacuity at 2 years were significantly associated with stereoacuity at 4.5 years of age. BSID-III motor scores had the best sensitivity (81.8%) and specificity (51.5%) for identifying impaired stereoacuity at 4.5 years. However, all measures at 2 years were poorly associated with VA at 4.5 years old. CONCLUSION Vision and neurodevelopmental measures at 2 years were poorly associated with visual function at 4.5 years of age. However, lower scores on tests of motor function at 2 years may be associated with vision abnormalities, particularly reduced stereopsis, at 4.5 years of age and referral for comprehensive vision assessment for these children may be warranted.
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Affiliation(s)
- Nabin Paudel
- Centre for Eye Research, Ireland, Technological University Dublin, Dublin, Ireland.,School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Centre for Eye and Vision Research, Shatin, Hong Kong
| | - Arijit Chakraborty
- Chicago College of Optometry, Midwestern University, Downers Grove, Illinois, USA
| | - Jane Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Robert J Jacobs
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Trecia A Wouldes
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Sandy Ty Yu
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Nicola S Anstice
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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Månsson J, Källén K, Eklöf E, Serenius F, Ådén U, Stjernqvist K. The ability of Bayley-III scores to predict later intelligence in children born extremely preterm. Acta Paediatr 2021; 110:3030-3039. [PMID: 34289173 DOI: 10.1111/apa.16037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
AIM To investigate the ability of the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), scores to predict later Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), performances in a cohort of children born extremely preterm. METHODS 323 children, born <27 gestational weeks, were tested with the Bayley-III at corrected age 2.5 years and with the WISC-IV at 6.5 years. Regression analyses investigated the association between Bayley-III scores and WISC-IV full-scale intelligence quotient (IQ). The ability of Bayley-III Cognitive Index scores to predict low IQ was evaluated using receiver operating characteristic curves. RESULTS Bayley-III Cognitive Index scores and IQ had a moderately positive correlation and accounted for 38% of the IQ variance. Using a Bayley-III cut-off score of 70, the sensitivity to detect children with IQ<70 was 18%, and false positive rate was 7%. A Bayley-III cut-off score of 85 corresponded to sensitivity and false positive rates of 44% and 7%, respectively. CONCLUSIONS Results emphasise the relative importance of Bayley-III Cognitive Index scores as predictors of IQ. An 85 score cut-off for suspecting subnormal IQ is supported. A less conservative threshold would increase identification of true cases yet increase the risk of wrongly diagnosing children.
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Affiliation(s)
- Johanna Månsson
- Department of Neonatal care and Pediatric surgery Skane University Hospital Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
| | - Karin Källén
- Centre of Reproductive Epidemiology Lund University Lund Sweden
| | - Eva Eklöf
- Department of Medical Psychology Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Fredrik Serenius
- Section for Pediatrics Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Department of Pediatrics Institute of Clinical Sciences Umeå University Umeå Sweden
| | - Ulrika Ådén
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
- Neonatal medicine Karolinska University Hospital Stockholm Sweden
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Salas AA, Carlo WA, Do BT, Bell EF, Das A, Van Meurs KP, Poindexter BB, Shankaran S, Younge N, Watterberg KL, Higgins RD. Growth Rates of Infants Randomized to Continuous Positive Airway Pressure or Intubation After Extremely Preterm Birth. J Pediatr 2021; 237:148-153.e3. [PMID: 34157349 PMCID: PMC8478787 DOI: 10.1016/j.jpeds.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/03/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effects of early treatment with continuous positive airway pressure (CPAP) on nutritional intake and in-hospital growth rates of extremely preterm (EPT) infants. STUDY DESIGN EPT infants (240/7-276/7 weeks of gestation) enrolled in the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT) were included. EPT infants who died before 36 weeks of postmenstrual age (PMA) were excluded. The growth rates from birth to 36 weeks of PMA and follow-up outcomes at 18-22 months corrected age of EPT infants randomized at birth to either early CPAP (intervention group) or early intubation for surfactant administration (control group) were analyzed. RESULTS Growth data were analyzed for 810 of 1316 infants enrolled in SUPPORT (414 in the intervention group, 396 in the control group). The median gestational age was 26 weeks, and the mean birth weight was 839 g. Baseline characteristics, total nutritional intake, and in-hospital comorbidities were not significantly different between the 2 groups. In a regression model, growth rates between birth and 36 weeks of PMA, as well as growth rates during multiple intervals from birth to day 7, days 7-14, days 14-21, days 21-28, day 28 to 32 weeks PMA, and 32-36 weeks PMA did not differ between treatment groups. Independent of treatment group, higher growth rates from day 21 to day 28 were associated with a lower risk of having a Bayley-III cognitive score <85 at 18-22 months corrected age (P = .002). CONCLUSIONS EPT infants randomized to early CPAP did not have higher in-hospital growth rates than infants randomized to early intubation.
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Affiliation(s)
- Ariel A. Salas
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Barbara T. Do
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Abhik Das
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Krisa P. Van Meurs
- Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Brenda B. Poindexter
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA
| | | | - Noelle Younge
- Department of Pediatrics, Duke University, Durham, NC
| | | | - Rosemary D. Higgins
- National Institute of Child Health and Human Development, Bethesda, MD and Department of Global and Community Health, George Mason University, Fairfax, VA
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Cheong JLY, Olsen JE, Lee KJ, Spittle AJ, Opie GF, Clark M, Boland RA, Roberts G, Josev EK, Davis N, Hickey LM, Anderson PJ, Doyle LW. Temporal Trends in Neurodevelopmental Outcomes to 2 Years After Extremely Preterm Birth. JAMA Pediatr 2021; 175:1035-1042. [PMID: 34279561 PMCID: PMC8290336 DOI: 10.1001/jamapediatrics.2021.2052] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 11/14/2022]
Abstract
Importance Survival of infants born extremely preterm (EP) (<28 weeks' gestation) has increased since the early 1990s. It is necessary to know whether increased survival is accompanied by increased neurodevelopmental disability. Objective To examine changes in major (ie, moderate or severe) neurodevelopmental disability and survival free of major neurodevelopmental disability at 2 years in infants born EP. Design, Setting, and Participants Four prospective longitudinal cohort studies comprising all EP live births at 22 to 27 weeks' gestation from April 1, 2016, to March 31, 2017, and earlier eras (1991-1992, 1997, and 2005), and contemporaneous term-born controls in the state of Victoria, Australia. Among 1208 live births during the periods studied, data were available for analysis of 2-year outcomes in 1152 children: 422 (1991-1992), 215 (1997), 263 (2005), and 252 (2016-2017). Data analysis was performed from September 17, 2020, to April 15, 2021. Exposures Extreme preterm live birth. Main Outcomes and Measures Survival, blindness, deafness, cerebral palsy, developmental delay, and neurodevelopmental disability at 2 years' corrected age. Developmental delay comprised a developmental quotient less than -1 SD relative to the control group means on the Bayley Scales for each era. Major neurodevelopmental disability comprised blindness, deafness, moderate to severe cerebral palsy, or a developmental quotient less than -2 SDs. Individual neurodevelopmental outcomes in each era were contrasted relative to the 2016-2017 cohort using logistic regression adjusted for gestational age, sex, birth weight z score, and sociodemographic variables. Changes in survival free of major neurodevelopmental disability over time were also assessed using logistic regression. Results Survival to 2 years was highest in 2016-2017 (73% [215 of 293]) compared with earlier eras (1991-1992: 53% [225 of 428]; 1997: 70% [151 of 217]; 2005: 63% [170 of 270]). Blindness and deafness were uncommon (<3%). Cerebral palsy was less common in 2016-2017 (6%) than in earlier eras (1991-1992: 11%; 1997: 12%; 2005: 10%). There were no obvious changes in the rates of developmental quotient less than -2 SDs across eras (1991-1992: 18%; 1997: 22%; 2005: 7%; 2016-2017: 15%) or in rates of major neurodevelopmental disability (1991-1992: 20%; 1997: 26%; 2005: 15%; 2016-2017: 15%). Rates of survival free of major neurodevelopmental disability increased steadily over time: 42% (1991-1992), 51% (1997), 53% (2005), and 62% (2016-2017) (odds ratio, 1.30; 95% CI, 1.15-1.48 per decade; P < .001). Conclusions and Relevance These findings suggest that survival free of major disability at age 2 years in children born EP has increased by an absolute 20% since the early 1990s. Increased survival has not been associated with increased neurodevelopmental disability.
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Affiliation(s)
- Jeanie L. Y. Cheong
- Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
| | - Joy E. Olsen
- Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Katherine J. Lee
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Alicia J. Spittle
- Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Gillian F. Opie
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
- Neonatal Services, Mercy Hospital for Women, Melbourne, Australia
| | - Marissa Clark
- Department of Neonatology, Monash Medical Centre, Melbourne, Australia
| | - Rosemarie A. Boland
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Paediatric Infant Perinatal Emergency Retrieval, Royal Children’s Hospital, Melbourne, Australia
| | - Gehan Roberts
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Centre for Community and Child Health, Royal Children’s Hospital, Melbourne, Australia
- Population Health, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Elisha K. Josev
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Neonatal Services, Mercy Hospital for Women, Melbourne, Australia
| | - Noni Davis
- Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
| | - Leah M. Hickey
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Neonatal Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Peter J. Anderson
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Lex W. Doyle
- Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Korček P, Korčeková Z, Berka I, Kučera J, Straňák Z. Corpus Callosum Growth and Neurodevelopmental Outcome Are Negatively Influenced by Systemic Infection in Very Low-Birth-Weight Infants. J Child Neurol 2021; 36:883-887. [PMID: 34048279 DOI: 10.1177/08830738211016239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic infection may negatively modulate the development of cerebral white matter and long-term outcome of neonates. We analyzed the growth of corpus callosum (using cranial ultrasonography) and neurodevelopment (Bayley Scales of Infant Development, Third Edition) in 101 very low-birth-weight newborns. We observed significantly reduced corpus callosum length at 3 months of corrected age (44.5 mm vs 47.7 mm, P = .004) and diminished corpus callosum growth (0.07 mm/d vs 0.08 mm/d, P = .028) in infants who experienced systemic infection. The subgroup exhibited inferior neurodevelopmental outcomes with predominant motor impairment. The results suggest that length and growth of corpus callosum might be affected by systemic inflammatory response in preterm newborns. The changes in corpus callosum can contribute to adverse neurodevelopment at 2 years of corrected age. Serial ultrasonographic measurements of the corpus callosum may be suitable to identify preterm infants with increased risk of neurodevelopmental impairment.
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Affiliation(s)
- Peter Korček
- 119444Institute for the Care of Mother and Child, Neonatology, Prague, Czech Republic.,Charles University, 3rd Faculty of Medicine, Prague, Czech Republic
| | - Zuzana Korčeková
- 119444Institute for the Care of Mother and Child, Neonatology, Prague, Czech Republic
| | - Ivan Berka
- 119444Institute for the Care of Mother and Child, Neonatology, Prague, Czech Republic.,Charles University, 3rd Faculty of Medicine, Prague, Czech Republic
| | - Jáchym Kučera
- 119444Institute for the Care of Mother and Child, Neonatology, Prague, Czech Republic
| | - Zbyněk Straňák
- 119444Institute for the Care of Mother and Child, Neonatology, Prague, Czech Republic.,Charles University, 3rd Faculty of Medicine, Prague, Czech Republic
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Dufford AJ, Salzwedel AP, Gilmore JH, Gao W, Kim P. Maternal trait anxiety symptoms, frontolimbic resting-state functional connectivity, and cognitive development in infancy. Dev Psychobiol 2021; 63:e22166. [PMID: 34292595 PMCID: PMC10775911 DOI: 10.1002/dev.22166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
Exposure to maternal anxiety symptoms during infancy has been associated with difficulties in development and greater risk for developing anxiety later in life. Although previous studies have examined associations between prenatal maternal distress, infant brain development, and developmental outcomes, it is still largely unclear if there are associations between postnatal anxiety, infant brain development, and cognitive development in infancy. In this study, we used resting-state functional magnetic resonance imaging to examine the association between maternal anxiety symptoms and resting-state functional connectivity in the first year of life. We also examine the association between frontolimbic functional connectivity and infant cognitive development. The sample consisted of 21 infants (mean age = 24.15 months, SD = 4.17) that were scanned during their natural sleep using. We test the associations between maternal trait anxiety symptoms and amygdala-anterior cingulate cortex (ACC) functional connectivity, a neural circuit implicated in early life stress exposure. We also test the associations between amygdala-ACC connectivity and cognitive development. We found a significant negative association between maternal trait anxiety symptoms and left amygdala-right ACC functional connectivity (p < .05, false discovery rate corrected). We found a significant negative association between left amygdala-right ACC functional connectivity and infant cognitive development (p < .05). These findings have potential implications for understanding the role of postpartum maternal anxiety symptoms in functional brain and cognitive development in infancy.
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Affiliation(s)
| | - Andrew P. Salzwedel
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John H. Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wei Gao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Pilyoung Kim
- Department of Psychology, University of Denver, Denver, Colorado, USA
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Jansen L, van Steenis A, van den Berg-Huysmans AA, Wiggers-de Bruine ST, Rijken M, de Vries LS, Vermeiren RRJM, Peeters-Scholte CMPCD, Steggerda SJ. Associations between Neonatal Magnetic Resonance Imaging and Short- and Long-Term Neurodevelopmental Outcomes in a Longitudinal Cohort of Very Preterm Children. J Pediatr 2021; 234:46-53.e2. [PMID: 33577803 DOI: 10.1016/j.jpeds.2021.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess associations between neonatal brain injury assessed by magnetic resonance imaging and cognitive, motor, and behavioral outcomes at 2 and 10 years of age, in a longitudinal cohort of children born very preterm. STUDY DESIGN There were 112 children born at <32 weeks of gestation who participated in a longitudinal prospective study on brain injury and neurodevelopmental outcome. Using the Kidokoro score, neonatal brain injury and altered brain growth in white matter, cortical and deep gray matter, and the cerebellum were assessed. Cognitive, motor, and behavioral outcomes were assessed during follow-up visits at both 2 (corrected) and 10 years of age. RESULTS After adjusting for perinatal factors and level of maternal education, the global brain abnormality score was associated with cognition (B = -1.306; P = .005), motor skills (B = -3.176; P < .001), and behavior (B = 0.666; P = .005) at 2 years of age, but was not associated with cognition at 10 years of age. In the subgroup of children with a moderate-severe global brain abnormality score, magnetic resonance imaging was independently associated with cognitive impairment at 10 years of age. For children with milder forms of brain injury, only birth weight and level of maternal education were associated with cognitive outcomes. CONCLUSIONS Neonatal brain injury, assessed by a standardized scoring system, was associated with short-term neurodevelopmental outcomes, but only with motor skills and behavior in childhood. Environmental factors, such as level of maternal education, become more important for cognitive development as children grow older, especially for children with relatively mild neonatal brain injury.
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Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands; Curium-LUMC Department of Child and Adolescent Psychiatry, Leiden, the Netherlands.
| | - Andrea van Steenis
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Sylke J Steggerda
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
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46
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Zimmerman E, Watkins DJ, Huerta-Montanez G, Rosario Pabon Z, Feric Z, Manjourides J, Velez-Vega CM, Figueroa A, Hines M, Martens A, Cordero J, Alshwabekah A, Meeker JD. Associations of gestational phthalate exposure and non-nutritive suck among infants from the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) birth cohort study. ENVIRONMENT INTERNATIONAL 2021; 152:106480. [PMID: 33740674 PMCID: PMC8713051 DOI: 10.1016/j.envint.2021.106480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND Infant non-nutritive suck (NNS), or sucking on a pacifier with no nutrients being delivered, has been used as in index of brain function and has been linked to subsequent neurodevelopment. Yet, no data are available connecting NNS to environmental exposures in utero. The goal of this study was to examine the relationship between gestational exposure to phthalates (a group of chemicals found in personal care products, PVC plastics, and other products) and NNS among infants in a birth cohort study in Puerto Rico. METHODS Urinary phthalate metabolite levels were measured in women at up to three time points in pregnancy as a measure of in utero exposure to the child. We calculated the geometric mean of each metabolite for each woman as a measure of exposure across gestation. Infants had their NNS sampled using our custom research pacifier between 4-6 (± 2 weeks) weeks of age, yielding the following NNS dependent measures: cycles/burst, frequency, amplitude, bursts/min, and cycles/min. RESULTS Two hundred and eight mother-infant dyads completed this study We used multiple linear regression to assess associations between individual phthalate metabolites and NNS measurements, adjusting for infant sex, birthweight, and urinary specific gravity. An interquartile range (IQR) increase in mono carboxyisononyl phthalate across pregnancy was associated with 3.5% (95%CI: -6.2, -0.8%) lower NNS frequency and 8.9% (0.6, 17.3%) higher NNS amplitude. Similarly, an IQR increase in mono-2-ethylhexyl phthalate was also associated with 3.4% (-6.5, -0.2%) lower NNS frequency, while an IQR increase in di-2-ethylhexyl terephthalate metabolites was associated with 11.2% (2.9, 19.5%) higher NNS amplitude. Gestational exposure to phthalates may alter NNS amplitude and frequency in full-term infants. These findings indicate that the infants may be increasing their NNS amplitude to compensate for their slower NNS frequency. These preliminary findings could have important clinical implications for earlier detection of exposure-related deficits in neurofunction as well as implications for subsequent neurodevelopment and related interventions.
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Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA.
| | - Deborah J Watkins
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, Michigan, USA
| | - Gredia Huerta-Montanez
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Zaira Rosario Pabon
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Zlatan Feric
- College of Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Justin Manjourides
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Carmen M Velez-Vega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Abigail Figueroa
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - Alaina Martens
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - José Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Akram Alshwabekah
- College of Engineering, Northeastern University, Boston, Massachusetts, USA
| | - John D Meeker
- University of Michigan School of Public Health, Department of Environmental Health Sciences, Ann Arbor, Michigan, USA
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47
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Parikh MN, Chen M, Braimah A, Kline J, McNally K, Logan JW, Tamm L, Yeates KO, Yuan W, He L, Parikh NA. Diffusion MRI Microstructural Abnormalities at Term-Equivalent Age Are Associated with Neurodevelopmental Outcomes at 3 Years of Age in Very Preterm Infants. AJNR Am J Neuroradiol 2021; 42:1535-1542. [PMID: 33958330 DOI: 10.3174/ajnr.a7135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Microstructural white matter abnormalities on DTI using Tract-Based Spatial Statistics at term-equivalent age are associated with cognitive and motor outcomes at 2 years of age or younger. However, neurodevelopmental tests administered at such early time points are insufficiently predictive of mild-moderate motor and cognitive impairment at school age. Our objective was to evaluate the microstructural antecedents of cognitive and motor outcomes at 3 years' corrected age in a cohort of very preterm infants. MATERIALS AND METHODS We prospectively recruited 101 very preterm infants (<32 weeks' gestational age) and performed DTI at term-equivalent age. The Differential Ability Scales, 2nd ed, Verbal and Nonverbal subtests, and the Bayley Scales of Infant and Toddler Development, 3rd ed, Motor subtest, were administered at 3 years of age. We correlated DTI metrics from Tract-Based Spatial Statistics with the Bayley Scales of Infant and Toddler Development, 3rd ed, and the Differential Ability Scales, 2nd ed, scores with correction for multiple comparisons. RESULTS Of the 101 subjects, 84 had high-quality DTI data, and of these, 69 returned for developmental testing (82%). Their mean (SD) gestational age was 28.4 (2.5) weeks, and birth weight was 1121.4 (394.1) g. DTI metrics were significantly associated with Nonverbal Ability in the corpus callosum, posterior thalamic radiations, fornix, and inferior longitudinal fasciculus and with Motor scores in the corpus callosum, internal and external capsules, posterior thalamic radiations, superior and inferior longitudinal fasciculi, cerebral peduncles, and corticospinal tracts. CONCLUSIONS We identified widespread microstructural white matter abnormalities in very preterm infants at term that were significantly associated with cognitive and motor development at 3 years' corrected age.
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Affiliation(s)
- M N Parikh
- From the Perinatal Institute (M.N.P., J.K., L.H., N.A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - M Chen
- Imaging Research Center (M.C., A.B., W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Electronic Engineering and Computer Science (M.C.), College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio
| | - A Braimah
- Imaging Research Center (M.C., A.B., W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - J Kline
- From the Perinatal Institute (M.N.P., J.K., L.H., N.A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - K McNally
- Center for Perinatal Research (K.M., J.W.L.), The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - J W Logan
- Center for Perinatal Research (K.M., J.W.L.), The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - L Tamm
- Department of Pediatrics (L.T., L.H., N.A.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio.,Center for ADHD (L.T.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - K O Yeates
- Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, and University of Calgary, Alberta, Canada
| | - W Yuan
- Imaging Research Center (M.C., A.B., W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology (W.Y.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - L He
- From the Perinatal Institute (M.N.P., J.K., L.H., N.A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Imaging Research Center (M.C., A.B., W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics (L.T., L.H., N.A.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - N A Parikh
- From the Perinatal Institute (M.N.P., J.K., L.H., N.A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio .,Department of Pediatrics (L.T., L.H., N.A.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
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Griffith R, Hegarty JE, Alsweiler JM, Gamble GD, May R, McKinlay CJD, Thompson B, Wouldes TA, Harding JE. Two-year outcomes after dextrose gel prophylaxis for neonatal hypoglycaemia. Arch Dis Child Fetal Neonatal Ed 2021; 106:278-285. [PMID: 33148686 PMCID: PMC8062278 DOI: 10.1136/archdischild-2020-320305] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the effect of prophylactic dextrose gel for prevention of neonatal hypoglycaemia on neurodevelopment and executive function at 2 years' corrected age. DESIGN Prospective follow-up of a randomised trial. SETTING New Zealand. PATIENTS Participants from the pre-hypoglycaemia Prevention with Oral Dextrose (pre-hPOD) trial randomised to one of four dose regimes of buccal 40% dextrose gel or equivolume placebo. MAIN OUTCOME MEASURES Coprimary outcomes were neurosensory impairment and executive function. Secondary outcomes were components of the primary outcomes, neurology, anthropometry and health measures. RESULTS We assessed 360 of 401 eligible children (90%) at 2 years' corrected age. There were no differences between dextrose gel dose groups, single or multiple dose groups, or any dextrose and any placebo groups in the risk of neurosensory impairment or low executive function (any dextrose vs any placebo neurosensory impairment: relative risk (RR) 0.77, 95% CI 0.50 to 1.19, p=0.23; low executive function: RR 0.50, 95% CI 0.24 to 1.06, p=0.07). There were also no differences between groups in any secondary outcomes. There was no difference between children who did or did not develop neonatal hypoglycaemia in the risk of neurosensory impairment (RR 1.05, 95% CI 0.68 to 1.64, p=0.81) or low executive function (RR 0.73, 95% CI 0.34 to 1.59, p=0.43). CONCLUSION Prophylactic dextrose gel did not alter neurodevelopment or executive function and had no adverse effects to 2 years' corrected age, but this study was underpowered to detect potentially clinically important effects on neurosensory outcomes.
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Affiliation(s)
- Rebecca Griffith
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | | | - Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Greg D Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Robyn May
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Christopher Joel Dorman McKinlay
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Kids First Neonatal Care, Counties District Health Board, Auckland, New Zealand
| | - Benjamin Thompson
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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49
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Salas AA, Bhatia A, Carlo WA. Postnatal growth of preterm infants 24 to 26 weeks of gestation and cognitive outcomes at 2 years of age. Pediatr Res 2021; 89:1804-1809. [PMID: 32942289 PMCID: PMC7965787 DOI: 10.1038/s41390-020-01158-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Weight z scores at 36 weeks of postmenstrual age (PMA) define postnatal growth failure (PGF) and malnutrition. This study aimed to determine weight z scores at 36 weeks PMA that are associated with adverse cognitive outcomes at 2 years of age. METHODS In this retrospective cohort study, 350 infants 24-26 weeks of gestation born between 2006 and 2014 and followed at 2 years were included. Weight z scores at birth and at 36 weeks PMA were calculated using the INTERGROWTH-21st growth curves. The primary outcome was cognitive delay at 2 years of age (Bayley-III cognitive score < 85). RESULTS Neither the traditional definition of PGF (z score below -1.3) nor the recently proposed definition of malnutrition (z score decline of 1.2 or greater) was associated with cognitive delay. Both a weight z score below -1.0 at 36 weeks PMA (RR: 1.65; 95% CI: 1.10-2.49; p < 0.05) and a decline below -1.0 in weight z score from birth to 36 weeks PMA (RR: 1.40; 95% CI: 1.00-1.94; p < 0.05) were associated with a higher risk of cognitive delay. CONCLUSION With optimal cutoffs, INTERGROWTH-21st weight z scores can predict the risk of cognitive delay. IMPACT New growth curves generated with longitudinal data could overcome some limitations of traditional growth curves generated with cross-sectional data. When these new growth curves are used to assess the growth of preterm infants, alternative definitions for postnatal growth alterations may be needed. This study examines the association between postnatal growth alterations defined by the INTEGROWTH-21st growth curves and adverse cognitive outcomes at 2 years of age. With alternative definitions of postnatal growth failure and malnutrition, the INTERGROWTH-21st growth curves can help establish the association between postnatal growth of extremely preterm infants and adverse neurodevelopmental outcomes in early childhood.
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Affiliation(s)
- Ariel A. Salas
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Anisha Bhatia
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
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50
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Ahmed K, Ali AS, Delwadia N, Greven MA. Neurodevelopmental Outcomes Following Intravitreal Bevacizumab With Laser Versus Laser Photocoagulation Alone for Retinopathy of Prematurity. Ophthalmic Surg Lasers Imaging Retina 2021; 51:220-224. [PMID: 32348538 DOI: 10.3928/23258160-20200326-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess neurodevelopmental outcomes of infants with treatment-warranted retinopathy of prematurity (TW-ROP) treated with intravitreal bevacizumab (IVB) plus diode laser photocoagulation (DLP) compared to DLP alone. PATIENTS AND METHODS A retrospective review was performed of infants who underwent treatment for TW-ROP with IVB+DLP or DLP alone from 2010 to 2017. Baseline characteristics and coexisting medical comorbidities were recorded. The presence of neurodevelopmental delay (NDD) at 2-year follow-up and composite Bayley-III scores were recorded. RESULTS Sixty-six infants were included in the study; 18 received IVB+DLP, and 48 received DLP alone. Average Bayley-III scores for cognition, language, and motor, as well as rates of documental NDD, did not differ between the groups. CONCLUSION This study does not demonstrate an increased risk of NDD in infants with TW-ROP treated with IVB+DLP compared with DLP alone. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:220-224.].
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