Premature Infant Gut Microbiome relationships with childhood behavioral scales: preliminary insights

Introduction

Very Low Birth Weight (VLBW) infants, born weighing less than 1,500 grams, are at risk for both gut dysbiosis and later neuropsychological developmental deficits. Behavioral effects, while related to neurodevelopment, are often more subtle and difficult to measure. The extent of later neurobehavioral consequences associated with such microbial dysbiosis has yet to be determined. We explored associations between the infants' gut microbiome and early childhood behavior at 4 years of age and identified the bacterial taxa through a multivariate analysis by linear models.

Methods

Parents completed the Child Behavior Checklist (CBCL) focused on different DSM diagnostic categories: affective, anxiety, pervasive developmental, attention deficit/hyperactivity, and oppositional defiant. All the CBCL scores were corrected for gender, delivery method, gestational age, infant birth weight, occurrence of sepsis, and days on antibiotics prior statistical analyses. Canonical correlation analysis (CCA) was performed to determine the relationship between early life gut microbiome and the adjusted CBCL scores. The association of bacterial Amplicon sequence Variants (ASVs) to the CBCL scores were tested with multivariate analysis by linear models (MaAsLin).

Results

Nineteen children who were previously born with very low birth weight and studied while hospitalized in the Neonatal Intensive Care Unit (NICU) were included in this study. Statistically significant associations were observed between early life gut bacteria such as Veillonella dispar, Enterococcus, Escherichia coli, and Rumincococcus to later behavior at 4 years. No significant association could be observed with early-life gut microbiome alpha diversity and behavioral measures at 4 years.

Discussion

These preliminary observational data provide insight into the relationships between VLBW gut microbiome dysbiosis and childhood behavior. This study contributes to the literature on gut microbiome analysis by examining various behavioral domains using a standardized tool linked to the Diagnostic and Statistical Manual of Mental Disorders (DSM).

A nutrition education intervention to improve eating behaviors of children with autism spectrum disorder: Study protocol for a pilot randomized controlled trial

Autism spectrum disorder (ASD) is a developmental disorder that affects communication and social behaviors. Children with ASD often experience mealtime behavior challenges and selective eating behaviors. They also tend to consume fewer fruits and vegetables and more high-energy dense foods, compared to neurotypical peers. A nutrition intervention was designed to prevent the development of feeding disorders and the long-term negative health impacts associated with poor dietary intake. This randomized controlled trial will evaluate the feasibility and preliminary efficacy of the nutrition education intervention for children with ASD and their parents through the Early Intervention (EI) services. We will recruit EI providers and parent-child dyads (n = 48) from EI programs, and randomly assign them into Autism Eats intervention (n = 24) or enhance usual care (EUC) comparison group (n = 24). The Autism Eats is 10 weekly sessions delivered individually as part of EI, while the EUC group will receive only 1 nutrition education session and then weekly parent handouts. The Autism Eats integrates ASD-specific feeding strategies and behaviorally-focused intervention strategies such as goal setting. Feasibility indicators include reach/participation, attrition, completion, fidelity, compatibility, and qualitative participant feedback. Outcome measures include dietary intakes and mealtime behaviors of children with ASD using 3-day food records and a validated questionnaire, the Brief Autism Mealtime Behavior Inventory (BAMBI). We will examine whether there are differences in children's food intakes, variety, diet quality, and mealtime behaviors between Autism Eats and EUC groups at post-intervention and 5-month follow-up assessment. This study will provide critical data to inform a full-scale randomized controlled trial.

Integrated Nutrition Education Through the Part C Early Intervention Services for Children With Autism Spectrum Disorder: Material Reviews Involving Providers and Parents

Objectives

To collect provider and parent feedback on feasibility of a nutrition education intervention, Autism Eats, for children with ASD through the Part C Early Intervention (EI) Services, and to refine the manual and intervention materials based on the feedback.

Methods

A formative survey study was conducted. EI providers (n = 9) and parents of children with ASD (n = 7) reviewed the 10-lessons of Autism Eats intervention and provided their feedback online. The survey consisted of seven Likert-type (1 = strongly disagree to 5 = strongly agree) questions on the following aspects: (1) the amount of preparation time; (2) clarity of instructions; (3) the amount of allocated time for lesson procedure; (4) relevance of activities to the goal and objectives; (5) feasibility of families’ completing activities; (6) satisfaction with provider notes; and (7) relevance to improving nutrition in children with ASD. Additionally, participants completed three open-ended questions to provide written feedback. Descriptive statistics for quantitative data and content analysis for open-ended responses were used.

Results

The mean of overall scores for all lessons was 4.4 ± 0.5 from the EI providers and 4.1 ± 0.2 from the parent participants, on a 5-point scale, indicating that both providers and parents perceived the intervention materials as feasible and acceptable. The mean of each of seven aspects of the lessons ranged from 3.9 (the amount of allocated time) to 4.5 (relevance to improving nutrition in children with ASD) on a 5-point scale. Common themes for the qualitative analysis included reducing technical terms, condensing instructions, reordering the lesson sequence, improve clarity, more visuals, more elaboration/explanation on certain parts, and positive feedback. One of the parent participants commented, “Introducing anything new to a child with autism could be really hard. This handbook has really helped in way I didn't think of working with my son with ASD.”

Conclusions

Based on the findings, Autism Eats intervention materials have been revised. The final intervention includes10-weekly nutrition sessions, two-monthly booster sessions, and social media components. These updates will be utilized for the pilot randomized controlled trial in 2022–2023.

Funding Sources

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The Diabetes Simulation Challenge: Enhancing Patient Perspective-Taking for Medical Students

The Diabetes Simulation Challenge is a unique training tool to foster empathy, a key facet of patient-centered care, for medical students. Thirty-two medical students participated in a 24-hour perspective-taking activity as part of their curriculum, during which they simulated some common experiences of living with a chronic health condition, specifically type 1 diabetes. Students' written reflections were analyzed using a phenomenological qualitative approach to provide a composite description of the experience. An exhaustive, iterative method of thematic analysis that included manual coding was used to determine whether this activity led to expressions of empathy or thoughts and beliefs consistent with patient-centered health care. Nine unique themes emerged, six of which indicated that students adopted the perspective of an individual with a chronic illness. Most of the students' reflections illustrated an understanding of the behavioral, social, and emotional challenges related to living with type 1 diabetes, as well as increased empathy toward individuals with the disease. Medical students who aim to provide patient-centered care benefited from this perspective-taking exercise, and training programs should consider using such methods to extend learning beyond traditional didactic education.

Diet quality in an ethnically diverse sample of children and adolescents with autism spectrum disorder compared with nationally representative data

BACKGROUND

Children with developmental disabilities are at an increased risk of unhealthy eating habits, which may contribute to compromised growth and development. Children with autism spectrum disorder (ASD) exhibit unique risk factors for unhealthy dietary patterns, including sensory issues and cognitive rigidity at mealtimes.

OBJECTIVE

This cross-sectional study examined diet quality in a sample of children with ASD in Florida compared to nationally representative National Health and Nutrition Examination Survey (NHANES) 2009-2014/2013-2014 data using the Healthy Eating Index-2015 (HEI-2015).

METHODS

A 24-h food record was completed by 41 parents of children with ASD aged 2-17 years, and food and beverage items consumed by each child were reported per standardized 24-h recall protocol. Two models were used to compare mean total and component HEI-2015 scores to NHANES means: (1) comparing means for our full sample to published NHANES means for children aged 2-18 years and (2) a matched model with subjects matched 1:1 by age, gender, race/ethnicity, and parent education level.

RESULTS

HEI component scores were significantly lower (poorer) in children with ASD for whole fruit, total vegetables, dairy, total protein foods, and seafood and plant protein. Whole grains, fatty acids, added sugars, and refined grains scores were higher (better) in our sample. However, total HEI scores and HEI scores for all 13 components were similar among children with ASD and the matched cases from the NHANES data.

CONCLUSIONS

There are potential discrepancies in diet quality between children with ASD and general population. Further research with a larger sample size, reporting both total and component HEI scores, is needed.

Feeding Infants with Neonatal Abstinence Syndrome: Finding the Sweet Spot

PURPOSE

The purpose of this study is to learn how caregivers who are expert in feeding infants with neonatal abstinence syndrome (NAS) successfully feed these infants during withdrawal.

DESIGN/SAMPLE

Focus group methodology was used to gather information from self-identified experts from three large regional NICUs. Twelve NICU nurses and speech therapists participated in open-ended, recorded discussions. Detailed flip chart notes were taken, reviewed, and verified by the participants before the group ended.

RESULTS

Four major themes emerged verified by the participants: (1) optimal medication management, (2) follow the baby's cues, (3) calm and comfortable, and (4) nurture the relationship. Participants reported using both common and creative techniques. Keeping the infant calm was crucial to being successful, as well as maintaining good control of withdrawal signs. Feeding the infant facing away from them to avoid eye contact was used, as well as vertical rocking, continuous butt patting, bundling, "shhing" sound, and a novel feeding position.

Characteristics of Maternal-Infant Interaction During Treatment for Opioid Withdrawal

PURPOSE

The purpose of this study was to describe the interactions between mothers in a methadone treatment program and their infants during a bottle feeding and compare the findings with normed data.

DESIGN

A comparative-descriptive design was used.

SAMPLE

Data from 12 opiate-exposed mother-infant dyads were compared with normed data.

MAIN OUTCOME VARIABLE

Nursing Child Assessment Satellite-Training Scale scores.

RESULTS

The opiate-exposed dyads scored significantly lower than the normed dyads in the infant subscales of clarity of cues (p < .001, 95% confidence interval [CI], 1.56-4.08) and responsiveness to caregiver (p < .01, 95% CI, 0.27-2.5), as well as the total score (p < .001, 95% CI, 2.42-6.15). Parent sensitivity to infant cues subscale (p < .01, 95% CI, 0.42-2.37) and parent contingency score (p < .01, 95% CI, 0.55-3.81) were also significantly lower. The cognitive growth fostering subscale scores were significantly higher in the neonatal abstinence syndrome (NAS) group (p < .01, 95% CI,- 2.94 to- 0.7).

Long-Term Outcomes of Infants with Neonatal Abstinence Syndrome

Parents of infants with neonatal abstinence syndrome (NAS) in the NICU may have questions about the long-term consequences of prenatal exposure to methadone, both asked and unasked. Although the signs of withdrawal will abate relatively quickly, parents should be aware of potential vision, motor, and behavioral/cognitive problems, as well as sleeping disturbances and ear infections so their infants can be followed closely and monitored by their pediatrician with appropriate referrals made. Furthermore, this knowledge may inspire parents to enroll their infants in an early intervention program to help optimize their outcomes. There are still many unanswered questions about epigenetic consequences, risk for child abuse/neglect, and risk of future substance abuse in this population.

Student perceptions of a patient- centered medical training curriculum

OBJECTIVE

To evaluate a patient-centered medical training curriculum, the SELECT program, through perceptions of the inaugural student cohort.

METHODS

Data were collected from two focus groups conducted in the university setting, comprised of fifteen first-year medical students who participated in the SELECT program during its inaugural year. A questioning protocol was used to guide the focus group discussion, which was transcribed and hand-coded through thematic analyses.

RESULTS

Various themes related to patient-centered care were identified. Students noted changes in their attitudes towards interacting with patients in an empowering and educative manner as a result of communication and motivational interviewing exercises. Additionally, they recognized certain external, structural barriers as well as internal conflict between pragmatism and emotional intelligence that could potentially hinder patient-centered care. The impact of family dynamics and social support on quality of life and health outcomes was acknowledged. Students also emphasized the value of collaborating with multiple health professionals. Lastly, students provided suggestions for program improvement, namely additional simulations, more education regarding other healthcare professionals' roles, more standardized experiences, and application of principles to acute and primary care.

CONCLUSIONS

Upon completion of the first year of the SELECT program, students gained an appreciation for patient-centered care and various factors and skills that facilitate such care. Additionally, they experienced a dissonance between didactic concepts from the curriculum and observed medical practices. This study highlights the educational benefits of a patient-centered medical curriculum and provides suggestions for future improvement.

Cultivating Healthy Eating, Exercise, and Relaxation (CHEER)

Attrition from weight management programs and difficulty maintaining success are of significant concern for pediatric overweight patients. Patient and family variables associated with completing and maintaining outcomes from a healthy weight program include understanding and buy-in for treatment, parental motivation, and valuing of weight loss to quality of life. Such findings highlight the need for comprehensive intervention that involves family members and addresses motivation and relapse prevention. The present study describes a family-centered and mindfulness-based cognitive-behavioral intervention implemented with a 15-year old, clinically obese male with associated symptoms including elevated blood pressure and sleep apnea. This pilot implementation resulted in improved pre–post outcomes in regard to weight, blood pressure, and health-promoting behaviors. Improvements in healthy lifestyle were maintained 1-year post-treatment. These results add to the growing literature on ecologically relevant intervention for obese adolescents at risk for future health complications. Technical issues and clinical implications related to recruitment and retention are discussed.