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Kapil N, Majmudar-Sheth B, Johnson T. Hammersmith Infant Neurological Examination Subscores Are Predictive of Cerebral Palsy. Pediatr Neurol 2024; 151:84-89. [PMID: 38134865 DOI: 10.1016/j.pediatrneurol.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The Hammersmith Infant Neurological Examination (HINE) is a standardized assessment that identifies early signs of cerebral palsy (CP). In practice, the clinician performs this assessment in its entirety, yielding a global score. This study aimed to investigate the individual HINE subscores and "asymmetries" as predictive indicators of CP. METHODS In this retrospective nested case-control study, a pediatric neurologist performed the HINE on a cohort of three- to four-month-old former neonatal intensive care unit infants. The infants' neurodevelopmental outcomes were determined by chart review when they were aged two to three years. We performed univariate and multivariable logistic regression analyses to yield the accuracy of the global HINE score, HINE subscores, and "asymmetries" in classifying infants with and without CP. RESULTS Of the 108 infants on whom HINE was performed, 50 were either discharged due to normal developmental progress or were lost to follow-up. Of the remaining 58 subjects, 17 had CP and 41 did not. Receiver operator characteristic (ROC) curves of univariate models yielded the following area under the curve (AUC) scores: global HINE score (AUC = 0.75), "reflexes and reactions" (AUC = 0.80), "cranial nerve function" (AUC = 0.76), "asymmetries" (AUC = 0.75), and "movements" (AUC = 0.71). The ROC for our multivariable model (AUC = 0.91) surpassed the global HINE score's predictive value for CP. CONCLUSIONS The weighted combination of HINE subscores and "asymmetries" outperforms the global HINE score in predicting CP. These findings suggest the need for revisiting HINE, but further validation with a larger dataset is required.
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Affiliation(s)
- Namarta Kapil
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Bittu Majmudar-Sheth
- Division of Pediatric Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Neurology, Indiana University School of Medicine, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Tara Johnson
- Division of Pediatric Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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2
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Abstract
Early childhood affords rapid brain development and advancement of the motor system. In High-Risk Infant Follow-Up programs, watchful waiting and monitoring of infants at high risk is shifting toward active surveillance and early diagnosis, followed by immediate targeted very early interventions. Infants with delayed motor skills benefit from developmental care, NIDCAP, and generic or specific motor training. Infants with cerebral palsy benefit from enrichment, targeted skills interventions, and task-specific motor training at high intensity. Infants with degenerative conditions benefit from enrichment but also require accommodations such as powered mobility.
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Affiliation(s)
- Lynda McNamara
- The Children's Hospital Westmead Clinical School, The University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia.
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3
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McCarty DB, Letzkus L, Attridge E, Dusing SC. Efficacy of Therapist Supported Interventions from the Neonatal Intensive Care Unit to Home: A Meta-Review of Systematic Reviews. Clin Perinatol 2023; 50:157-178. [PMID: 36868703 DOI: 10.1016/j.clp.2022.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Infants born preterm or with complicated medical conditions requiring care in the neonatal intensive care unit (NICU) are at high risk for long-term developmental disabilities. The transition from NICU to early intervention/outpatient settings results in a disruptive gap in a therapeutic intervention during a period of maximal neuroplasticity and development. This meta-review evaluated evidence from existing systematic reviews regarding therapeutic interventions that start in the NICU and continue at home with the goal of improving developmental outcomes for infants at high risk for cerebral palsy. We also evaluated the impact of these interventions on parents' mental health outcomes.
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Affiliation(s)
- Dana B McCarty
- Division of Physical Therapy, Department of Health Sciences, The University of North Carolina at Chapel Hill, 3024 Bondurant Hall, CB#7135, Chapel Hill, NC 27599-7135, USA
| | - Lisa Letzkus
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia, 101 Hospital Drive, Charlottesville, VA, 22903 USA
| | - Elaine Attridge
- Claude Moore Health Sciences Library, University of Virginia, PO Box 800722, Charlottesville, VA 22908, USA
| | - Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP 155, Los Angeles CA 90033, USA.
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4
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Peyton C, Millman R, Rodriguez S, Boswell L, Naber M, Spittle A, de Regnier R, Barbosa VM, Sukal-Moulton T. Motor Optimality Scores are significantly lower in a population of high-risk infants than in infants born moderate-late preterm. Early Hum Dev 2022; 174:105684. [PMID: 36209602 PMCID: PMC10243476 DOI: 10.1016/j.earlhumdev.2022.105684] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Motor Optimality Score-Revised (MOS-R) is a detailed scoring of the General Movement Assessment (GMA), measuring the spontaneous behaviors of infants. Infants born moderate-late preterm are not traditionally followed in high-risk clinics, but have increased risk of neurodevelopmental disability. AIMS Compare MOS-R at 3 months corrected age (CA) in high-risk (HR; very preterm or abnormal neuroimaging) infants to infants born moderate-late preterm (MLP). STUDY DESIGN In this prospective cohort study, parents of enrolled infants created video recordings using an app at 3 months CA. Videos were scored with the General Movement Assessment (GMA) and MOS-R. MOS-R scores were divided into "higher-risk" (≤19) and "lower-risk" (≥20). SUBJECTS 181 infants born MLP or categorized as HR. RESULTS Among enrolled infants, 68 (38 %) were in the MLP group, and 113 infants were in the HR group. The HR group had 3.8 increased odds of having an aberrant GMA score compared to the MLP group (p < 0.01, 95 % CI 1.38-10.52). The HR group had significantly lower MOS-R scores (mean 20) than the MLP group (mean 24; p < 0.001; 95%CI 3.3-7.3). The HR group had 11.2 increased odds of having a higher-risk MOS-R score (95%CI 2.5-47.6, p < 0.001) than MLP group. Infants were most likely to have a lower MOS-R score if they had any of the following: VP shunt placement, periventricular leukomalacia, or bronchopulmonary dysplasia. CONCLUSIONS Aberrant GMA and higher-risk MOS-R scores were more common in infants at high-risk, reflecting history of brain lesions and younger gestational age at birth.
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Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL 60611, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL 60611, USA.
| | - Ryan Millman
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL 60611, USA
| | - Sarah Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA
| | - Lynn Boswell
- Ann and Robert H Lurie Children's Hospital, 225 E Chicago Ave, Chicago, IL 60611, USA
| | - Meg Naber
- Loyola University Medical Center, 2160 S. 1st Ave, Maywood, IL 60153, USA
| | - Alicia Spittle
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - RayeAnn de Regnier
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL 60611, USA; Ann and Robert H Lurie Children's Hospital, 225 E Chicago Ave, Chicago, IL 60611, USA
| | | | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL 60611, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL 60611, USA
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5
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Ratanatharathorn C, Sutchritpongsa S, Ritthita W, Rojmahamongkol P. Evaluation of the Developmental Assessment for Intervention Manual (DAIM) for developmental screening in high-risk infants at 12 months of corrected age. Infant Behav Dev 2022; 68:101752. [PMID: 35930823 DOI: 10.1016/j.infbeh.2022.101752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/09/2022] [Accepted: 07/23/2022] [Indexed: 11/22/2022]
Abstract
Early detection of developmental delay provides opportunities for early intervention. The Developmental Assessment for Intervention Manual (DAIM) is the simplified screening tool for detection of developmental delay in Thai young infants implemented country-wide by the Ministry of Public Health since 2015. Unlike standard assessment tool, DAIM can be obtained by lay staff or parents and takes less time. We aimed to evaluate the accuracy of the DAIM for detection of developmental delay among high-risk infants. This single center prospective study was conducted from May, 2017 to December, 2021. The infants with corrected aged of 12 months with history of birth asphyxia or low birth weight (<2500 g) who visited a tertiary hospital for developmental assessment were invited to participate the study. The four developmental domains (gross motor, fine motor, receptive language, and expressive language) were assessed by Bayley-III and followed by DAIM in the same visit. The 126 infants were enrolled, 50% were male. Using Bayley-III score < 7 as reference, the sensitivity for gross motor domain, fine motor domain, receptive language and expressive language were 83.3%, 57.1%, 55% and 19.2%, respectively. Specificity for each domain was 75.4%, 88.2%, 74.5% and 92%. Positive predictive value for each domain was 26.3%, 22.2%, 28.9% and 38.5%. Negative predictive value (NPV) for each domain was 97.7%, 97.2%, 89.8% and 81.4%. With high sensitivity and NPV of DAIM in motor domain, but low in expressive language domains, using DAIM alone in high-risk infants can detect motor delay well but will miss many infants with expressive language delaye.
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Lima CRG, Dos Santos AN, Dos Santos MM, Morgan C, Rocha NACF. Tele-care intervention performed by parents involving specific task- environment- participation (STEP protocol) for infants at risk for developmental delay: protocol of randomized controlled clinical trial. BMC Pediatr 2022; 22:51. [PMID: 35057775 PMCID: PMC8771655 DOI: 10.1186/s12887-022-03126-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/15/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND With the implementation of social distancing due to the Covid-19 pandemic, many at-risk infants are without therapy. An alternative mode of therapy in this situation is tele-care, a therapy in which assessments and interventions are carried out online, in the home environment. We describe a tele-care protocol involving parent delivered task and context specific movement training, participation and environmental adaptation for infants at risk for developmental delay. METHODS Randomized controlled trial. Infants at risk, with 3 to 9 months corrected age, will be included, and randomized into two groups: control group (conventional guidelines) and experimental group (task, environment and participation in context-specific home program). Infants will be assessed for motor capacity (Infant Motor Profile and Alberta Infant Motor Scale); participation (Young Children's Participation and Environment Measure) and environment factors (Parent-Child Early Relational Assessment; Affordances in the Home Environment for Motor Development). The intervention period will be 10 weeks, and evaluations will be carried out before and after that period. All the assessment and intervention procedures will be carried out online, with instructions to parents for home therapy. The statistical analysis will be guided according to the distribution of the data, and a significance level of 5% will be adopted. All ethical approvals were obtained by the Ethics Committee of the University of São Carlos (Case number 31256620.5.0000.5504). The protocol will follow the SPIRIT statement. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences. DISCUSSION The results of this study will describe the effectiveness of a home intervention, focusing on specific activities, participation and environmental changes. These results will support the implementation of a remote protocol, with lower financial costs and focused on the particularities of the family. This type of care model can possibly help public policies to ensure equal access to evidence-based quality healthcare. TRIAL REGISTRATION Brazilian Clinical Trials Registry: RBR8xrzjs , registered September 1, 2020.
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Affiliation(s)
- Camila Resende Gâmbaro Lima
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, São Carlos, SP, 13565-905, Brazil.
| | - Adriana Neves Dos Santos
- Department of Health Science, Universidade Federal de Santa Catarina, Rod. Governador Jorge Lacerda, n° 3201 - Km 35, 4, Araranguá, SC, 88905-355, Brazil
| | - Mariana Martins Dos Santos
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, São Carlos, SP, 13565-905, Brazil
| | - Catherine Morgan
- School of Medicine, Paediatrics and Child Health, Sydney, New South Wales, Australia
| | - Nelci Adriana Cicuto Ferreira Rocha
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, São Carlos, SP, 13565-905, Brazil
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7
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Peyton C, Pascal A, Boswell L, deRegnier R, Fjørtoft T, Støen R, Adde L. Inter-observer reliability using the General Movement Assessment is influenced by rater experience. Early Hum Dev 2021; 161:105436. [PMID: 34375936 DOI: 10.1016/j.earlhumdev.2021.105436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/26/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the inter-observer reliability of the General Movement Assessment (GMA) among a sample of infants at high-risk of cerebral palsy (CP) among raters with various levels of experience. METHODS Video assessments of 150 high-risk infants at 10-15 weeks corrected age were rated by three Prechtl GMA-certified observers with varied experience using the assessment. Videos were scored based on temporal organization of fidgety movements (FMs), presence of abnormal FMs, or absence of FMs. Inter-observer agreements were analyzed with Gwet's AC1 statistic. RESULTS We found fair to moderate agreement when subcategories of normal FMs (continuous and intermittent) were included (AC1 = 0.32-0.57) and moderate to near perfect agreement when normal categories of FMs were combined (AC1 = 0.60-0.95). Reliability was higher among observers with more experience using the GMA (AC1 = 0.57-0.98) than the observer with less experience (AC1 = 0.32-0.61). CONCLUSIONS Caution may be warranted when the GMA is used to differentiate "continuous and intermittent" FMs temporal organization. The GMA is highly reliable among experienced raters when comparing normal FMs to other FMs categorizations.
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Affiliation(s)
- C Peyton
- Department of Physical Therapy and Human Movement Science, Northwestern University, Feinberg School of Medicine, 645 N. Michigan Ave, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - A Pascal
- Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium.
| | - L Boswell
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - R deRegnier
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA; Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - T Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway; Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
| | - R Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway; Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
| | - L Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway; Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
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8
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Spittle AJ, Anderson PJ, Tapawan SJ, Doyle LW, Cheong JLY. Early developmental screening and intervention for high-risk neonates - From research to clinical benefits. Semin Fetal Neonatal Med 2021; 26:101203. [PMID: 33547000 DOI: 10.1016/j.siny.2021.101203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With advances in neonatal care there has been an increase in survival rates for infants born very preterm and/or with complex needs, such as those who require major surgery, who may not have survived decades ago. Despite advances in survival, these infants remain at high-risk for a range of neurodevelopmental delays and/or impairments including motor, cognitive and emotional/behavioural challenges. Research has improved our ability to identify which infants are at high-risk of developmental delay and/or impairments, and there is mounting evidence that early interventions can improve outcomes of these infants. However, clinical practice varies throughout the world regarding recommendations for developmental screening. Moreover, intervention, when available, is often not commenced early enough in development. Given limited resources, those infants most at risk of developmental impairments and their families should be targeted, with further research needed on the cost-effectiveness of surveillance and early interventions.
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Abstract
PURPOSE OF REVIEW Much of our understanding of early development in children with autism spectrum disorder (ASD) comes from studies of children with a family history of autism. We reviewed the current literature on neurodevelopmental profiles and autism prevalence from other high-risk infant groups to expose gaps and inform next steps. We focused on infants with early medical risk (e.g., preterm birth) and genetic risk (tuberous sclerosis complex [TSC]). RECENT FINDINGS About 7% of very preterm infants are later diagnosed with ASD. Prospective studies of early development outside of familial-risk infants are rare; however, recent work within preterm and TSC infants suggests interesting similarities and differences from infants with a family history of ASD. It is essential that we extend our knowledge of early markers of ASD beyond familial-risk infants to expand our knowledge of autism as it emerges in order to develop better, more individualized early interventions.
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Affiliation(s)
- Nicole M McDonald
- UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Shafali S Jeste
- UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
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10
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Abstract
Respiratory syncytial virus (RSV) disease is a significant cause of morbidity and socioeconomic burden worldwide among young children. The majority of RSV-associated lower respiratory tract infections (LRTI) and mortality occurs in developing countries and is associated with various sociodemographic risk factors. Independent risk factors for severe RSV disease include age and premature birth. While RSV mortality in developed countries is lower relative to developing countries, high-risk infants with comorbidities experience higher rates of mortality. RSV LRTI is often severe and is associated with hospitalization, increased need for intensive care unit admission and mechanical ventilation, long-term complications, and caregiver stress and loss of work productivity. Overall, these factors translate to higher health care resource utilization and costs and should be factored into the consideration for RSV prophylaxis. Multiple vaccine candidates and long-acting monoclonal antibodies are in various stages of clinical development. Currently, palivizumab is the only approved RSV immunoprophylaxis available for use in specific high-risk pediatric populations. This review will discuss the socioeconomic impact and health care resource utilization of RSV-related hospitalization (RSVH) as well as various sociodemographic risk factors that can be used to identify children at high risk of developing severe RSV disease.
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Affiliation(s)
- Michal Young
- Department of Pediatrics and Child Health, Howard University Hospital, Washington, DC, USA.
| | - Lynn Smitherman
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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Franchini M, Hamodat T, Armstrong VL, Sacrey LAR, Brian J, Bryson SE, Garon N, Roberts W, Zwaigenbaum L, Smith IM. Infants at Risk for Autism Spectrum Disorder: Frequency, Quality, and Variety of Joint Attention Behaviors. J Abnorm Child Psychol 2020; 47:907-920. [PMID: 30146674 DOI: 10.1007/s10802-018-0471-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Initiation of joint attention is a critical developmental function related to further social communicative development in infancy. Joint attention appears to be impaired very early in life for children with autism spectrum disorder (ASD), well before a formal diagnosis is established. To observe the early development of joint attention, we prospectively followed infant siblings at high risk for ASD (HR) and low-risk (LR) infants. Initiations of joint attention behaviors were coded with respect to frequency, quality, and variety from videos taken during the administration of the Autism Observation Schedule for Infants. Participants were further stratified based on the presence of ASD (n = 17) or language delay (n = 19) at 3 years of age. Our results revealed that initiations of joint attention are impaired from 12 months of age in both children with ASD and those with language delay, especially for use of gestures (i.e., showing and pointing). At 18 months, fewer initiations of joint attention in all three dimensions distinguished infants with ASD, compared to infants with language delay and HR and LR infants without a diagnosis. Beyond the definition of initiation of joint attention as an early sign for ASD, clinical implications of these results concern the importance of intervening on frequency, quality, and variety of joint attention as early as possible in infants at heightened risk for ASD.
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Affiliation(s)
- Martina Franchini
- Autism Research Centre, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada. .,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
| | - T Hamodat
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - V L Armstrong
- Autism Research Centre, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - L-A R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - J Brian
- Bloorview Research Institute, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - S E Bryson
- Autism Research Centre, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - N Garon
- Department of Psychology, Mount Allison University, Sackville, NB, Canada
| | - W Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, ON, Canada
| | - L Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - I M Smith
- Autism Research Centre, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.,Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
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12
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Srinivasan S, Bhat A. Differences in caregiver behaviors of infants at-risk for autism and typically developing infants from 9 to 15 months of age. Infant Behav Dev 2020; 59:101445. [PMID: 32305735 DOI: 10.1016/j.infbeh.2020.101445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/09/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
During an object sharing paradigm, we compared infant-caregiver interactions between two groups: i) infants at high-risk (HR) for being diagnosed with Autism Spectrum Disorder (ASD) and ii) low-risk (LR) infants, observed at 9, 12, and 15 months of age. 16 HR infants (14 infants with an older sibling diagnosed with ASD and 2 preterm infants that received a diagnosis of ASD at 2 years) and 16 LR infants (typically developing infants without older siblings diagnosed with ASD) were included in the study. At each visit, infants played with objects in the presence of their caregivers as crawlers or walkers. Previously, we found that HR infants are less likely to share their object play with caregivers at walker ages. The present study found that caregivers of HR infants used greater directive bids including being more proximal to infants and using greater verbal and non-verbal bids to sustain their infant's attention and to ensure their compliance during the task compared to caregivers of LR infants. Our study emphasizes the bidirectional and dynamic nature of infant-caregiver interactions. Our findings have implications for caregiver training programs that teach parents appropriate strategies to promote early social communication skills in at-risk infants.
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Affiliation(s)
- S Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
| | - A Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE, USA; Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, USA; Psychological and Brain Sciences, University of Delaware, Newark, DE, USA.
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13
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Macari SL, Wu GC, Powell KK, Fontenelle S, Macris DM, Chawarska K. Do Parents and Clinicians Agree on Ratings of Autism-Related Behaviors at 12 Months of Age? A Study of Infants at High and Low Risk for ASD. J Autism Dev Disord 2019; 48:1069-1080. [PMID: 29181689 DOI: 10.1007/s10803-017-3410-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Given the emphasis on early screening for ASD, it is crucial to examine the concordance between parent report and clinician observation of autism-related behaviors. Similar items were compared from the First Year Inventory (Baranek et al. First-Year Inventory (FYI) 2.0. University of North Carolina, Chapel Hill, 2003), a parent screener for ASD, and the ADOS-2 Toddler Module (Lord et al. 2013), a standardized ASD diagnostic tool. Measures were administered concurrently to 12-month-olds at high and low risk for ASD. Results suggest that clinicians and parents rated behaviors similarly. In addition, both informants rated high-risk infants as more impaired in several social-communication behaviors. Furthermore, the format of questions impacted agreement across observers. These findings have implications for the development of a new generation of screening instruments for ASD.
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Affiliation(s)
- Suzanne L Macari
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Grace C Wu
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Stanford University, Stanford, CA, USA
| | - Kelly K Powell
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Scuddy Fontenelle
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Deanna M Macris
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Abstract
We studied visual attention to emotional faces in 10-month-old infant siblings of children with ASD (ASD-sibs; N = 70) and a siblings of typically developing children (N = 29) using static stimuli. Contrary to our predictions, we found no evidence for atypical gaze behavior in ASD-sibs when boys and girls were analyzed together. However, a sex difference was found in ASD-sibs' visual attention to the mouth. Male ASD-sibs looked more at the mouth across emotions compared to male controls and female ASD-sibs. In contrast, female ASD-sibs looked less at the mouth compared to female controls. These findings suggest that some aspects of early emerging atypical social attention in ASD-sibs may be sex specific.
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Affiliation(s)
- Johan Lundin Kleberg
- Department of Psychology, Uppsala Child and Baby Lab, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Pär Nyström
- Department of Psychology, Uppsala Child and Baby Lab, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
| | - Sven Bölte
- Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Terje Falck-Ytter
- Department of Psychology, Uppsala Child and Baby Lab, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
- Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
- The Swedish Collegium for Advanced Study (SCAS), Uppsala, Sweden
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15
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Sgandurra G, Beani E, Giampietri M, Rizzi R, Cioni G. Early intervention at home in infants with congenital brain lesion with CareToy revised: a RCT protocol. BMC Pediatr 2018; 18:295. [PMID: 30185165 PMCID: PMC6126039 DOI: 10.1186/s12887-018-1264-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Congenital brain lesions expose infants to be at high-risk for being affected by neurodevelopmental disorders such as cerebral palsy (CP). Early interventions programs can significantly impact and improve their neurodevelopment. Recently, in the framework of the European CareToy (CT) Project ( www.caretoy.eu ), a new medical device has been created to deliver an early, intensive, customized, intervention program, carried out at home by parents but remotely managed by expert and trained clinicians. Reviewing results of previous studies on preterm infants without congenital brain lesion, the CT platform has been revised and a new system created (CT-R). This study describes the protocol of a randomised controlled trial (RCT) aimed to evaluate, in a sample of infants at high-risk for CP, the efficacy of CT-R intervention compared to the Infant Massage (IM) intervention. METHODS/DESIGN This RCT will be multi-centre, paired and evaluator-blinded. Eligible subjects will be preterm or full-term infants with brain lesions, in first year of age with predefined specific gross motor abilities. Recruited infants will be randomized into CT-R and IM groups at baseline (T0). Based on allocation, infants will perform an 8-week programme of personalized CareToy activities or Infant Massage. The primary outcome measure will be the Infant Motor Profile. On the basis of power calculation, it will require a sample size of 42 infants. Moreover, Peabody Developmental Motor Scales-Second Edition, Teller Acuity Cards, standardized video-recordings of parent-infant interaction and wearable sensors (Actigraphs) will be included as secondary outcome measures. Finally, parents will fill out questionnaires (Bayley Social-Emotional, Parents Stress Index). All outcome measures will be carried out at the beginning (T0) and at end of 8-weeks intervention period, primary endpoint (T1). Primary outcome and some secondary outcomes will be carried out also after 2 months from T1 and at 18 months of age (T2 and T3, respectively). The Bayley Cognitive subscale will be used as additional assessment at T3. DISCUSSION This study protocol paper is the first study aimed to test CT-R system in infants at high-risk for CP. This paper will present the scientific background and trial methodology. TRIAL REGISTRATION NCT03211533 and NCT03234959 ( www.clinicaltrials.gov ).
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Affiliation(s)
- Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital “Santa Chiara”, Via Roma 67, 56126 Pisa, Italy
| | - Riccardo Rizzi
- Neuroscience Center of Excellence and Neonatal Intensive Care Unit, “A. Meyer” University Children’s Hospital, Florence, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
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16
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Hamer EG, La Bastide-Van Gemert S, Boxum AG, Dijkstra LJ, Hielkema T, Jeroen Vermeulen R, Hadders-Algra M. The tonic response to the infant knee jerk as an early sign of cerebral palsy. Early Hum Dev 2018; 119:38-44. [PMID: 29549793 DOI: 10.1016/j.earlhumdev.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Early identification of infants at risk of cerebral palsy (CP) is desirable in order to provide early intervention. We previously demonstrated differences in knee jerk responses between 3-month-old high risk and typically developing infants. AIMS To improve early identification by investigating whether the presence of tonic responses (continuous muscle activity occurring after the typical phasic response), clonus or contralateral responses to the knee jerk during infancy is associated with CP. STUDY DESIGN Longitudinal EMG-study. SUBJECTS We included 34 high-risk infants (median gestational age 31.9 weeks) who participated in the LEARN2MOVE 0-2 years trial. OUTCOME MEASURES Video-recorded knee jerk EMG-assessments were performed during infancy (1-4 times). Developmental outcome was assessed at 21 months corrected age (CA). Binomial generalized estimating equations models with repeated measurements were fitted using predictor variables. RESULTS Infants who later were diagnosed with CP (n = 18) showed more often than infants who were not diagnosed with CP i) tonic responses - from 4 months CA onwards, ii) clonus - from 13 months CA onwards, and iii) contralateral responses - from 15 months CA onwards. LIMITATIONS The main limitation is the relatively small sample size. CONCLUSIONS The assessment of tonic responses to the knee jerk using EMG may be a valuable add-on tool to appraise a high risk of CP.
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Harker CM, Ibañez LV, Nguyen TP, Messinger DS, Stone WL. The Effect of Parenting Style on Social Smiling in Infants at High and Low Risk for ASD. J Autism Dev Disord 2017; 46:2399-407. [PMID: 27007726 DOI: 10.1007/s10803-016-2772-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined how parenting style at 9 months predicts growth in infant social engagement (i.e., social smiling) between 9 and 18 months during a free-play interaction in infants at high (HR-infants) and low (LR-infants) familial risk for autism spectrum disorder (ASD). Results indicated that across all infants, higher levels of maternal responsiveness were concurrently associated with higher levels of social smiling, while higher levels of maternal directiveness predicted slower growth in social smiling. When accounting for maternal directiveness, which was higher in mothers of HR-infants, HR-infants exhibited greater growth in social smiling than LR-infants. Overall, each parenting style appears to make a unique contribution to the development of social engagement in infants at high- and low-risk for ASD.
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Affiliation(s)
- Colleen M Harker
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA.
| | - Lisa V Ibañez
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA
| | - Thanh P Nguyen
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA.,University of Massachusetts Boston, Boston, MA, USA
| | - Daniel S Messinger
- Department of Psychology, University of Miami, Box 249229, Coral Gables, FL, 33124, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA
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18
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Hamer EG, Hielkema T, Bos AF, Dirks T, Hooijsma SJ, Reinders-Messelink HA, Toonen RF, Hadders-Algra M. Effect of early intervention on functional outcome at school age: Follow-up and process evaluation of a randomised controlled trial in infants at risk. Early Hum Dev 2017; 106-107:67-74. [PMID: 28282530 DOI: 10.1016/j.earlhumdev.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The long-term effect of early intervention in infants at risk for developmental disorders is unclear. The VIP project (n=46, originally) evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physiotherapy (TIP). AIMS To evaluate the effect of early intervention on functional outcome at school age. METHODS AND PROCEDURES Parents of 40 children (median age 8.3years) participated in this follow-up study. Outcome was assessed with a standardised parental interview (Vineland Adaptive Behaviour Scale) and questionnaires (Developmental Coordination Disorder Questionnaire, Child Behaviour Checklist, Utrechtse Coping List, and questions on educational approach). Quantified video information on physiotherapeutic actions during infancy was available. OUTCOMES AND RESULTS Child functional outcome in the two randomised groups was similar. Process evaluation revealed that some physiotherapeutic actions were associated with child mobility and parental educational approach at follow-up: e.g., training and instructing were associated with worse mobility. CONCLUSIONS AND IMPLICATIONS Functional outcome at school age after early intervention with COPCA is similar to that after TIP. However, some specific physiotherapeutic actions, in particular the physiotherapist's approach, are associated with outcome. WHAT THIS PAPER ADDS Early intervention is generally applied in infants at risk for developing disorders, with the aim of improving overall functional outcome. However, little is known on the long-term effect. The VIP project evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physical therapy (TIP). Outcome at 18months corrected age was virtually similar. Process evaluation of the physiotherapy actions revealed that some characteristics of COPCA were associated with improved developmental outcome at 18months. This paper presents data on functional outcome at school age (median 8.3years) in 87% of the original participants. Outcome of infants who received three months of COPCA and that of infants who received three months of TIP was similar. Yet, parents of families who had received the COPCA intervention still more often used a trial and error approach when the child learned a new skill than parents of children who had received TIP. Process evaluation showed that more time spent on caregiver training and strict instructions during early intervention was associated with worse mobility. Four other physiotherapeutic actions were associated with parental educational approach. None of the neuromotor actions were associated with child outcome at school age. We conclude that long-term outcome after three months of COPCA or TIP is similar. However, our study does suggest that the professional approach of the physiotherapist can make a difference.
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Affiliation(s)
- Elisa G Hamer
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands
| | - Tjitske Hielkema
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands
| | - Arend F Bos
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Neonatology, Groningen, The Netherlands
| | - Tineke Dirks
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands
| | - Siebrigje J Hooijsma
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands
| | - Heleen A Reinders-Messelink
- University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands; Rehabilitation Centre 'Revalidatie Friesland', Beetsterzwaag, The Netherlands
| | - Rivka F Toonen
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
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Cirelli I, Bickle Graz M, Tolsa JF. Comparison of Griffiths-II and Bayley-II tests for the developmental assessment of high-risk infants. Infant Behav Dev 2015; 41:17-25. [PMID: 26276119 DOI: 10.1016/j.infbeh.2015.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Two important risk factors for abnormal neurodevelopment are preterm birth and neonatal hypoxic ischemic encephalopathy. The new revisions of Griffiths Mental Development Scale (Griffiths-II, [1996]) and the Bayley Scales of Infant Development (BSID-II, [1993]) are two of the most frequently used developmental diagnostics tests. The Griffiths-II is divided into five subscales and a global development quotient (QD), and the BSID-II is divided into two scales, the Mental scale (MDI) and the Psychomotor scale (PDI). The main objective of this research was to establish the extent to which developmental diagnoses obtained using the new revisions of these two tests are comparable for a given child. MATERIAL AND METHODS Retrospective study of 18-months-old high-risk children examined with both tests in the follow-up Unit of the Clinic of Neonatology of our tertiary care university Hospital between 2011 and 2012. To determine the concurrent validity of the two tests paired t-tests and Pearson product-moment correlation coefficients were computed. Using the BSID-II as a gold standard, the performance of the Griffiths-II was analyzed with receiver operating curves. RESULTS 61 patients (80.3% preterm, 14.7% neonatal asphyxia) were examined. For the BSID-II the MDI mean was 96.21 (range 67-133) and the PDI mean was 87.72 (range 49-114). For the Griffiths-II, the QD mean was 96.95 (range 60-124), the locomotors subscale mean was 92.57 (range 49-119). The score of the Griffiths locomotors subscale was significantly higher than the PDI (p<0.001). Between the Griffiths-II QD and the BSID-II MDI no significant difference was found, and the area under the curve was 0.93, showing good validity. All correlations were high and significant with a Pearson product-moment correlation coefficient >0.8. CONCLUSIONS The meaning of the results for a given child was the same for the two tests. Two scores were interchangeable, the Griffiths-II QD and the BSID-II MDI.
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Affiliation(s)
- Ilaria Cirelli
- Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
| | - Myriam Bickle Graz
- Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Jean-François Tolsa
- Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
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20
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Vaudry W, Rosychuk RJ, Lee BE, Cheung PY, Pang XL, Preiksaitis JK. Congenital cytomegalovirus infection in high-risk Canadian infants: Report of a pilot screening study. Can J Infect Dis Med Microbiol 2010; 21:e12-9. [PMID: 21358874 PMCID: PMC2852289 DOI: 10.1155/2010/942874] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Congenital cytomegalovirus (cCMV) is the most common congenital infection; however, the epidemiology in Canada has not been recently examined. The present prospective study pilots tools for a population-based study of cCMV infection in Canada by determining the maternal seroprevalence and risk factors, the clinical characteristics and the incidence of cCMV using a variety of diagnostic tests in a cohort of high-risk infants in northern Alberta. METHODS All infants born at the Royal Alexandra Hospital in Edmonton, Alberta, from June 1, 2003, to May 31, 2004, were screened for the study. Eligible infants were those with very low birth weights (VLBWs) or small for gestational age (SGA). Maternal CMV serostatus was determined, and chart review and parental interviews were completed. Neonatal urine and throat cultures, and polymerase chain reaction (PCR) were performed. Dried blood spots (DBS) were tested for CMV by PCR. RESULTS In total, 213 infants were eligible for the study. Of these, 137 entered the study (79 VLBW and 58 SGA). Some families were not contacted for participation in the study due to neonatal deaths or early discharge. The mean age of the mothers was 27.6 years; 68% of the mothers were Caucasian and 16% were Aboriginal. The maternal CMV seroprevalence was 55%. Seropositivity was significantly associated with ethnicity (First Nations [100%]; Caucasian [34%]) and country of birth (outside Canada [94%]; Canadian born [45%]). The rate of cCMV was two in 137 (1.5%), with a rate of one in 79 (1.3%) for the VLBW infants and one in 58 (1.7%) for the SGA infants. Both had positive throat or urine specimens, but only the symptomatic infant was positive on DBS. CONCLUSIONS A cCMV screening program should be universal and routine to successfully screen all newborns. Maternal CMV seropositivity varies widely within the Canadian population. In the present pilot study, DBS PCR was not a sensitive screening tool and throat swab was the best screening specimen.
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Affiliation(s)
| | | | - Bonita E Lee
- Department of Pediatrics, University of Alberta
- Provincial Laboratory for Public Health (Microbiology), Edmonton, Alberta
| | | | - XL Pang
- Provincial Laboratory for Public Health (Microbiology), Edmonton, Alberta
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21
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Yee W, Ross S. Communicating with parents of high-risk infants in neonatal intensive care. Paediatr Child Health 2006; 11:291-294. [PMID: 19030293 PMCID: PMC2518680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Good communication between parents and staff about the likely outcome of high-risk infants is essential to ensure parents' full involvement in decision-making. The present paper discusses the literature on this topic to explore the best practices for professionals communicating with parents of high-risk infants.
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Affiliation(s)
- Wendy Yee
- Department of Paediatrics, Division of Neonatology, University of Calgary
| | - Sue Ross
- Departments of Obstetrics and Gynaecology, Community Health Sciences and Family Medicine, University of Calgary, Calgary, Alberta
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