Adverse Neurodevelopment Outcomes Research Articles

Neurodevelopment Outcome among Preterm Infants Admitted in Neonatal Intensive Care Unit

Introduction: With increasing the survival rates of premature babies, the management of long term complications, especially neurodevelopmental disorder is becoming an important issue for a better life. Aims: To assess the factors associated with adverse neurodevelopment outcome among preterm infants admitted in Neonatal Intensive Care Unit (NICU). Methods and Material: This prospective cohort study was conducted in Department of Neonatology, BSMMU, Dhaka, Bangladesh. Premature infants (<34 weeks) discharged from the NICU were enrolled and followed up for neurodevelopmental assessment at 6 months of age. Prenatal, perinatal, and postnatal features of the babies were recorded. The Bayley-III scale was used to assess the composite scores. Continuous variables were analyzed using an independent t-test and categorical variables with chi-square test. Logistic regression analysis was performed to find out the relationship of risk factors with neurodevelopmental scores. Results: A total 47 patients were analysed at 6 months of age using Bayley scale III. Mean birth weight and gestational age was 1595.11 ± 377.17g and 32.43 ± 1.48 weeks respectively. Mean cognitive, motor and language score were 80.79±14.51, 82.87±14.53 and 82.98±13.72 respectively. Despite the fact that all mean scores were normal, 27.7% of infants in cognition, 23.4% in motor, and 31.9% in language had a BSID-III value < 70. Variables like gestational age < 30 weeks, birth weight <1500 grams, and convulsion have been linked to poor neurodevelopmental outcomes. However, regression analysis revealed none of them were significant. Conclusions: In our study, at six months of age, the cognitive, language, and motor scores of preterm newborns (less than 34 weeks of gestation) were within normal limits. Of the newborns, we observed that 27.7% had cognitive delay and 31.9% experienced language delay. J Dhaka Med Coll. 2022; 31(2) : 251-257

Prenatal exposure to polybrominated diphenyl ether (PBDE) and child neurodevelopment: The role of breastfeeding duration

BackgroundPrenatal and early-life exposure to polybrominated diphenyl ethers (PBDEs) is associated with detrimental and irreversible neurodevelopmental health outcomes during childhood. Breastfeeding may be a child's largest sustained exposure to PBDE— potentially exacerbating their risk for adverse neurodevelopment outcomes. However, breastfeeding has also been associated with positive neurodevelopment. Our study investigates if breastfeeding mitigates or exacerbates the known adverse effects of prenatal exposure to PBDEs and child neurodevelopment. MethodsParticipants included 321 mother-infant dyads from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort in California. PBDE concentrations were measured in maternal serum blood samples collected during pregnancy or at delivery. Using generalized estimated equations (GEE), we estimated associations of PBDE concentrations with children's attention, executive function, and cognitive scores assessed longitudinally between 7 and 12 years of age, stratified by duration of exclusive and complementary breastfeeding. ResultsWe observed that higher maternal prenatal PBDE concentrations were associated with poorer executive function among children who were complementary breastfed for a shorter duration compared to children breastfed for a longer duration; preservative errors (β for 10-fold increase in complementary breastfeeding <7 months = −6.6; 95 % Confidence Interval (CI): −11.4, −1.8; β ≥ 7 months = −5.1; 95 % CI: −10.2, 0.1) and global executive composition (β for 10-fold increase <7 months = 4.3; 95 % CI: 0.4, 8.2; β for 10-fold increase ≥7 months = 0.6; 95 % CI: −2.8, 3.9). ConclusionsProlonged breastfeeding does not exacerbate but may mitigate some previously observed negative associations of prenatal PBDE exposure and child neurodevelopment.

Neonatal Seizures and Neurodevelopmental Outcome

Background: Neonatal period is the most vulnerable time for the occurrence of seizures. There are various etiological factors of neonatal seizures and increasing evidence suggests that neonatal seizures are associated with adverse neurodevelopment outcomes. The aim of the study is to determine of causes of neonatal seizures with outcome during management and long-term post-natal outcome. Methods: This prospective study conducted in Rangpur Mother and Children Hospital from 1st July to 2017 to 30th June 2022. Term newborn babies admitted in NICU with convulsion were the samples. A prepared and pretested “Protocol” containing Part-A and Part-B was used - Part-A in neonatal intensive care unit and Part-B in the attached Disability Research Center. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 200-201

Factors associated with adverse neurodevelopment outcome using Bayley III scale at 3 to 6 month follow-up

Introduction: As the survival rate of preterm infants has increased, the management of long-term complications, especially neurodevelopmental impairment, becomes important. Several studies have suggested that adverse neurodevelopment could be induced by systemic inflammation in preterm infants. Preterm infants with systemic inflammation would have impaired neurodevelopment and which biomarkers and neurophysiologic studies during inflammation are associated with poor neurodevelopment. Objective: To assess the factors associated with adverse neurodevelopment outcome using bayley iii scale at 3 to 6 month follow-up. Materials and methods: This prospective cohort study was conducted in Department of Paediatrics, Mugda Medical College Hospital, Dhaka, Bangladesh from July 2021 to December 2021. After taking informed written consent (annexure-III) from parents of the selected premature infants to participate in the study, a total of 82 neonates were enrolled. Hospitalized inborn and out born babies were included consecutively. Results: A total 54 patients were analyzed in 1st follow up visit by using Bayley scale III. Mean cognitive score were 81.67±7.58 and 73.50±10.16 in ACS exposed and ACS unexposed group (p-0.001).Mean language score were 85.33±6.73 vs. 77.88±9.98, (p- 0.002). Mean motor score were 84.50±9.83 vs. 76.83±12.03 in ACS exposed and ACS unexposed group (p- 0.013). Though all scores were below normal in both groups, ACS exposed group had relatively better score than ACS unexposed group at 3 months of age. During 2nd follow up 47 infants were assessed at 6 months of age, mean cognitive score in ACS group was 84.88±12.32 and in ACS unexposed group was 75.71±15.67.which was statistically significant(p- .030).Motor and language composite scores were higher at 6 months in ACS group but no difference between two groups were statistically significant. Conclusion: Our prospective cohort study showed that systemic inflammation induced by clinical infection and NEC is associated with poor neurodevelopment in preterm infants. These results may help estimate the neurodevelopmental risk of individual patients who have inflammatory illness and narrow down the target population of neuroprotection in the future.

Prenatal/Early-Life Exposure to Polycyclic Aromatic Hydrocarbons (PAHs) and Adverse Neurodevelopment Outcomes in Children: A Systematic Review and Meta-Analysis

Prenatal/Early-Life Exposure to Polycyclic Aromatic Hydrocarbons (PAHs) and Adverse Neurodevelopment Outcomes in Children: A Systematic Review and Meta-Analysis

Long-Term Neurodevelopmental Outcomes after Moderate and Late Preterm Birth: A Systematic Review

To systematically review and perform meta-analyses on the long-term neurodevelopmental outcomes of adults born moderate and late preterm (MLPT) in relation to cognitive functioning and psychiatric disorders. A search was conducted to identify any studies that involved prematurity in adulthood. From these studies, reports that included a group of MLPT adults and included description of cognitive and/or mental health domains (including specific long-term outcomes) were selected. In total, 155 publications were identified, but only 16 papers met the inclusion criteria. A small effect size (g=0.38) was found in MLPT to demonstrate poorer intellectual performance compared with those born at term. Moreover, MLPT adults exhibited greater odds for any psychiatric (OR 1.14), substance use (OR 1.16), mood (OR 1.06), and psychotic disorders (OR 1.40). Despite inconsistency due to the methodologic differences between the selected studies, MLPT showed minor long-term effects into adulthood. However, more studies are needed, because prematurity seems to confer some vulnerability to biological and environmental factors that enhance susceptibility to adverse neurodevelopment outcomes.

Late Preterm Infant Growth and Body Composition at Corrected Term Gestation: A Cohort Study

Introduction: Worldwide major proportion of preterm births is late preterm infants. Preterm infants are deprived of optimal in-utero nutrition leading to immediate consequences of growth failure and long-term complications like adverse neurodevelopment outcomes whereas preterm infants with fast catch up growth after birth have health consequences like obesity and hypertension in adulthood. Aim: To assess growth of late preterm infants at their term equivalent Gestational Age (GA) and compare their growth and body composition with term infants. Materials and Methods: This was a cohort study of late preterm (34 0/7 to 36 6/7 weeks) infants that were Appropriate for Gestational Age (AGA) and controls that were AGA term infants (39 0/7 to 40 6/7 weeks). All enrolled late preterm infants were followed-up at term equivalent (39 0/7 to 40 6/7 weeks). Growth plotted on Fenton’s chart and body composition were calculated using pre-defined formula for total mid-upper arm area (cm2), mid-upper arm muscle area (cm2), mid-upper arm fat area (cm2), and the Arm Fat Index (AFI) (%). The data was analysed using Epi info (version 7.2) with student t-test for continuous variables and chi-square test for dichotomous variables. A p-value of &lt;0.05 was considered statistically significant. Results: Out of the 135 infants enrolled, 45 were late preterm and 90 were term born infants. Median GA of the case cohort was 35 (IQR 35-36) weeks and in the control cohort it was 39 (IQR 39-40) weeks. Total 45.7% (N=35) of the late preterm infants (after excluding loss to follow-up) were below 10th percentile (EUGR) at term GA. At term follow-up, mean weight and length of late preterm infants compared to term born infants was less and statistically significant. The mean Skin Fold Thickness (SKT) (cm) at triceps level 0.55 (SD 0.07) vs. 0.49 (SD 0.06), mean of calculated AFI (%) 31.25 (SD 3.08) vs. 28.19 (SD 2.5) and among late preterm infants at follow-up was more than in term infants and was statistically significant. Conclusion: Failure to thrive is common among the late preterm infants at term equivalent GA. Late preterm infants show postnatal growth characterised by predominant fat mass accretion and less lean mass.

Association of urinary concentrations of phthalate metabolites with quinolinic acid among women: a potential link to neurological disorders

Background/Aim: Quinolinic acid (QA), a neuroactive metabolite produced during tryptophan degradation, is implicated in the pathogenesis of several neurological disorders. Phthalates are structurally similar to QA, and exposure to phthalates has demonstrated increased QA production and excretion in rodent studies. We recently showed that very high exposure to dibutyl phthalate was associated with higher concentrations of urinary QA in men. However, no human studies examined the associations between background (low) phthalate exposures and QA. We examine the associations of urinary phthalate metabolite concentrations with QA. Methods: Female participants (N=126) who participated in a prospective cohort study at a Fertility Center in Boston provided 758 urine samples (273 during pregnancy and 485 during non-pregnancy). Concentrations of 11 phthalate metabolites and QA in urine were measured. We used multivariable linear mixed effect models to estimate the percent change in urinary QA concentrations associated with a doubling (100%) of phthalate metabolite concentration, and evaluated whether there was effect modification by pregnancy.Results: Women’s mean (standard deviation) age was 34.2 (4.0) years with a body mass index of 23.5 (3.7) kg/m2. The women were primarily Caucasian (92%), had ≥a college degree (98%), and none were current smokers. In multivariable-adjusted models, the percent change in urinary QA concentrations was significantly higher for each doubling of several urinary phthalate metabolite concentrations. For example, each doubling of DBP metabolites was associated with a 13.7% (95%CI: 10.6, 16.9) higher QA. Associations between the low molecular weight phthalate metabolites and QA were stronger among samples collected during pregnancy as compared to non-pregnancy.Conclusions: Urinary concentrations of several phthalate metabolites were positively associated with QA among women. These findings, along with the known neurotoxicity of QA, warrant the need to examine whether QA concentrations may serve as a pathway for the adverse neurodevelopment outcomes found in children’s health studies.

Association of urinary concentrations of phthalate metabolites with quinolinic acid among women: A potential link to neurological disorders

BackgroundQuinolinic acid (QA), a neuroactive metabolite produced during tryptophan degradation, is implicated in the pathogenesis of several neurological disorders. Phthalates are structurally similar to QA, and exposure to phthalates has demonstrated increased QA production and excretion in rodent studies. We recently showed that very high exposure to dibutyl phthalate was associated with higher concentrations of urinary QA in men. However, no human studies examined the associations between background (low) phthalate exposures and QA. ObjectivesTo examine the associations of urinary concentrations of phthalate metabolites with QA. MethodsFemale participants (N = 126) who participated in a prospective cohort study at the Massachusetts General Hospital Fertility Center provided 758 urine samples (273 during pregnancy and 485 during non-pregnancy). Concentrations of 11 phthalate metabolites and QA in urine were measured. We used multivariable linear mixed effect models to estimate the percent change in urinary QA concentrations associated with a doubling (100%) of urinary phthalate metabolite concentration, and evaluated whether there was effect modification by pregnancy status. ResultsWomen’s mean (standard deviation) age was 34.2 (4.0) years with a body mass index of 23.5 (3.7) kg/m2. The women were primarily Caucasian (92%), had at least a college degree (98%), and none were current smokers. Pairwise Spearman correlations between concentrations for phthalate metabolites and QA measured in the same urine samples ranged from 0.36 for MEHP to 0.68 for dibutyl phthalate (DBP) metabolites. In multivariable-adjusted models, the percent change in urinary QA concentrations was significantly higher for each doubling of several urinary phthalate metabolite concentrations. For example, each doubling of DBP metabolites was associated with a 13.7% (95%CI: 10.6, 16.9)% higher QA. Associations between the low molecular weight phthalate metabolites and QA were stronger among samples collected during pregnancy as compared to non-pregnancy samples from the same women. ConclusionsUrinary concentrations of several phthalate metabolites were positively associated with QA among women. These findings, along with the known neurotoxicity of QA, warrant the need to examine whether QA concentrations may serve as a pathway for the adverse neurodevelopment outcomes found in children’s health studies.

2801. Post-Natal Zika Virus Infection and Impact on Neurodevelopment Among a Cohort of Children in Rural Guatemala

BackgroundThe impact of early post-natal Zika virus (ZIKV) infection on neurodevelopment (ND) is unknown. A prospective study of post-natal ZIKV infection in rural Guatemala (ZIKV study) enrolled a cohort of children ages 1–5 years, including children previously enrolled in a dengue virus (DENV) study during the 2015–2016 ZIKV epidemic. We evaluated ND outcomes by age and ZIKV infection status.MethodsSubjects enrolled in the ZIKV study June 2017–April 2018 underwent ND testing using the Mullen Scales of Early Learning (MSEL) at baseline and 12 months later. ZIKV/DENV-1/2 FRNT50 was performed on enrollment and on banked serum samples from the 2015 to 2016 subset. ZIKV serostatus and MSEL scores were correlated using multiple linear mixed models, adjusted for age and gender when appropriate, to evaluate their association. Geolocation was used to explore clustering of ZIKV serostatus and MSEL score.ResultsWe enrolled 183 children (43% female, mean age 3.2 years). Of these, 38 (21%) were classified as ZIKV-positive (+), 111 (61%) ZIKV-negative (-), 31 (17%) ZIKV-possible, and 3 (2%) ZIKV-indeterminate. ZIKV(+) cases and higher composite MSEL scores clustered in more densely populated areas (Figure 1). ZIKV(+) serostatus was associated with higher MSEL composite (increase in log score 0.09, P = 0.003) and subdomain scores: fine motor (0.13, P = 0.011), visual reception (0.15, P = 0.002), receptive language (0.09, P = 0.041), gross motor (0.14, P = 0.09), and expressive language (0.09, P = 0.058) (Figure 2). Of the 78 children (43%) with 2015–2016 samples, 46 (59%) remained ZIKV(−), 16 (21%) seroconverted from ZIKV(−) or possible/indeterminate to ZIKV(+), and 16 (21%) were indeterminate when enrolled in the ZIKV study. ZIKV seroconversion was associated with higher composite (0.13, P = 0.02) MSEL scores compared with ZIKV(−).ConclusionIn this exploratory analysis, post-natal ZIKV infection was not associated with adverse ND outcomes in children age 1–5 years. Overall, ZIKV(+) status was associated with higher average ND scores than ZIKV(−), and scores decreased with age for most children, independent of ZIKV status. The correlation of ZIKV(+) status and higher MSEL scores may be confounded by geographic-related factors or other confounders. NIAID Contract HHSN272201300015I Task Order HHSN27200013 (Co-PIs: FMM & EJA). DisclosuresFlor M. Munoz, M.D, Biocryst: Grant/Research Support; CDC: Research Grant; Moderna: Other Financial or Material Support, Safety Monitoring Board Member/Chair; NIH: Research Grant; Novavax: Research Grant; UP to Date: Author and Editor - Royalties, Other Financial or Material Support.

Effect of neonatal hyperoxia followed by concentrated ambient ultrafine particle exposure on cumulative learning in C57Bl/6J mice

Hyperoxia during treatment for prematurity may enhance susceptibility to other risk factors for adverse brain development, such as air pollution exposure, as both of these risk factors have been linked to a variety of adverse neurodevelopmental outcomes. This study investigated the combined effects of neonatal hyperoxia followed by inhalation of concentrated ambient ultrafine particles (CAPS, <100 nm in aerodynamic diameter) on learning. C57BL/6 J mice were birthed into 60% oxygen until postnatal day (PND) 4 and subsequently exposed to filtered air or to CAPS using the Harvard University Concentrated Ambient Particle System (HUCAPS) from PND 4–7 and 10-13. Behavior was assessed on a fixed interval (FI) schedule of reinforcement in which reward is available only after a fixed interval of time elapses, as well as expected reductions in behavior during an extinction procedure when reward was withheld. Both produce highly comparable behavioral performance across species. Performance measures included rate of responding, response accuracy, and temporal control (quarter life). Exposure to hyperoxia or CAPS resulted in lower mean quarter life values, an effect that was further enhanced in males by combined exposure, findings consistent with delayed learning of the FI schedule. Females also initially exhibited greater reductions in quarter life values following the combined exposure to hyperoxia and CAPS and delayed reductions in response rates during extinction. Combined hyperoxia and CAPS produced greater learning deficits than either risk factor alone, consistent with enhanced neurodevelopmental toxicity, findings that could reflect a convergence of both insults on common neurobiological systems. The basis for sex differences in outcome warrants further research. This study highlights the potential for heightened risk of adverse neurodevelopment outcomes in individuals born preterm in regions with higher levels of ultrafine particle (UFP) air pollution, in accord with the multiplicity of risk factors extant in the human environment.

Cerebral Autoregulation, Brain Injury, and the Transitioning Premature Infant.

Improvements in clinical management of the preterm infant have reduced the rates of the two most common forms of brain injury, such as severe intraventricular hemorrhage and white matter injury, both of which are contributory factors in the development of cerebral palsy. Nonetheless, they remain a persistent challenge and are associated with a significant increase in the risk of adverse neurodevelopment outcomes. Repeated episodes of ischemia–reperfusion represent a common pathway for both forms of injury, arising from discordance between systemic blood flow and the innate regulation of cerebral blood flow in the germinal matrix and periventricular white matter. Nevertheless, establishing firm hemodynamic boundaries, as a part of neuroprotective strategy, has challenged researchers. Existing measures either demonstrate inconsistent relationships with injury, as in the case of mean arterial blood pressure, or are not feasible for long-term monitoring, such as cardiac output estimated by echocardiography. These challenges have led some researchers to focus on the mechanisms that control blood flow to the brain, known as cerebrovascular autoregulation. Historically, the function of the cerebrovascular autoregulatory system has been difficult to quantify; however, the evolution of bedside monitoring devices, particularly near-infrared spectroscopy, has enabled new insights into these mechanisms and how impairment of blood flow regulation may contribute to catastrophic injury. In this review, we first seek to examine how technological advancement has changed the assessment of cerebrovascular autoregulation in premature infants. Next, we explore how clinical factors, including hypotension, vasoactive medications, acute and chronic hypoxia, and ventilation, alter the hemodynamic state of the preterm infant. Additionally, we examine how developmentally linked or acquired dysfunction in cerebral autoregulation contributes to preterm brain injury. In conclusion, we address exciting new approaches to the measurement of autoregulation and discuss the feasibility of translation to the bedside.

Purpose‐designed gene panel identifies genetic variants associated with adverse neurodevelopment outcomes in neonates with congenital heart disease

Purpose‐designed gene panel identifies genetic variants associated with adverse neurodevelopment outcomes in neonates with congenital heart disease

Outcome of breastfed infants following post-partum methylergonovine treatment

Objective: To evaluate maternal and breastfed infant’s outcome following post-partum maternal use of methylergonovine.Methods: A prospective, controlled observational study design was used. Mothers who contacted Beilinson Teratology Information Service (BELTIS) were followed by phone interview. Data on lactation, neonatal symptoms and outcomes at the age of 1–3 years were obtained. Mothers’ breastfeeding while treated with methylergonovine and their infants were compared to a matched control group of breastfeeding mothers using a drug known to be safe during lactation (amoxicillin).Results: Follow-up was obtained for 38 of 42 women (90.5%). Of whom, six stopped breastfeeding because of concerns regarding drug treatment and three refused to participate. The remaining 29 women and infant pairs were compared to a control group of 58 women and their infants. Comparison showed no effect of methylergonovine on lactation and similarly showed no difference in rate of neonatal complications (p = 1). At time of follow-up there were no differences in growth or in adverse neurodevelopment outcomes (p = 0.26).Conclusions: No increase in adverse long-term outcomes was found in infants exposed to methylergonovine through breastfeeding. Our data in conjunction with previous estimates of very low drug exposure support continuation of breastfeeding in women requiring treatment with methylergonovine.

PS-166 Neurodevelopment Outcome During Toddlerhood In Very Low Birth Weight Infants With Absent Or Reverse End Diastolic Flow In The Umbilical Artery During Pregnancy

Background and aim Antenatal absent or reverse end-diastolic flow (AREDF) in the umbilical artery (UA) is associated with high perinatal morbidity and mortality. We aimed to assess the neurodevelopment outcome during toddlerhood of very low birth weight preterm infants with AREDF in the UA during pregnancy. Methods We compared longitudinally collected neurodevelopment outcome data of surviving preterm infants born in our institution in 1996–2010 with birth weight Results Forty-one infants for both groups were recruited. Neonatal and socio-demographic characteristics of both groups were similar except for the confounders caesarean section, antenatal corticosteroids (higher in AREDF group, p = 0.01 and 0.02, respectively), and mother’s age (lower in AREDF group, p = 0.01). Mean (SD) mental development index of children with AREDF in the UA (81.8, 16.3) was significantly lower (p = 0.02) compared to controls (92.4, 16.3). This result remains significant after adjustment for confounders. No significant differences in the psychomotor development index or in the distribution of cerebral palsy were observed between the two groups. Conclusion Preterm infants with abnormal antenatal Doppler in the UA have a higher risk for adverse neurodevelopment outcome during toddlerhood compared to sex-, gestational age-, birth weight-, and birth year-matched controls. AREDF in the UA might be considered a prenatal predictor of adverse neurodevelopment outcome in this population.

PO-0270 Use Of Sucrose And Non-pharmacological Methods In Alleviating Newborn Procedural Pain In A Picu Setting

Background Sucrose has become standard practice across neonatal units for reducing procedural pain in preterm and term newborns. In infants admitted to PICU subject to similar procedures, systemic analgesics like morphine remains the preferred choice for procedural pain despite emerging links between these agents and adverse neurodevelopment outcomes. Aim To explore the use of Sucrose and other non-pharmacologic methods for alleviating neonatal procedural pain in a PICU setting. Methods Online survey sent to all medical and nursing staff in a regional PICU about use of sucrose and non-pharmacological methods for procedural pain relief in newborns. Results There were a total of 28 respondents. PICU staff are aware of Sucrose and non-pharmacological methods. However, they do not use these routinely for procedural pain, and 18% would never use a non-pharmacological method or sucrose. 18% staff members do not believe these methods to be effective in controlling pain in newborns. The reasons for not using these measures routinely were that these are unfeasible in post-operative patients (50% respondents) and not required in patients already on morphine (7% respondents). 25% respondents said other staff members discouraged them if they wanted to use these measures. 43% respondents want Sucrose as a part of the guideline for pain management in babies. Conclusions Despite awareness of sucrose and non-pharmacological adjuncts, these are not consistently used in PICU. Incorporating these methods as a part of evidence based guideline for management of procedural pain can reduce the need for systemic analgesia and reduce the adverse neurodevelopmental side effects.

PO-0751 Use Of Postnatal Steroids In Ventilator Dependant Preterm Infants

Background and aim Bronchopulmonary Dysplasia (BPD), results in prolonged hospitalisation, poor growth and adverseneurodevelopment outcome. Postnatal steroids may decrease prolonged ventilation, one of the risk factors for BPD. However, there are concerns about adverse effects of steroids. The aim of the study was to assess the safety and efficacy of hydrocortisonein ventilator dependant preterm infants, thus ensuring safe practice and improve the quality of care given. Methods The study was a retrospective analysis over 17 months (Jan 2012–May 2013) in preterm infants less than 32 weeks gestation. Demographic data along with data on adverse effects related to hydrocortisone was collected. Results Fifteen percent (42/281) of preterm infants received hydrocortisone starting at dose of 5 mg/kg/d to aid extubation. The mean gestation was 25.17 weeks with a mean birth weight of 696 g. Forty-six percent had more than one failed extubation, 54% required >90% oxygen pre-treatment and 70% had either medical or surgical intervention for PDA. Only 24% had a documented discussion with parents regarding steroid treatment. The dose was reduced by 0.5–1 mg/kg, the time frequency of reduction varied between 1–7 days. Adverse events related to hydrocortisone treatment included hypertension, oesophageal perforation, hyponatremic, hyperglycaemic requiring insulin, left ventricular hypertrophy, fractures and poor weight gain. Conclusions The incidence of steroid use reflected that of other centres. Awareness of adverse events related to use of steroids along with improved parental communication is required.

Chlorpyrifos and neurodevelopmental effects: a literature review and expert elicitation on research and policy

BackgroundOrganophosphate pesticides are widely used on food crops grown in the EU. While they have been banned from indoor use in the US for a decade due to adverse health effects, they are still the most prevalent pesticides in the EU, with Chlorpyrifos (CPF) being the most commonly applied. It has been suggested CPF affects neurodevelopment even at levels below toxicity guidelines. Younger individuals may be more susceptible than adults due to biological factors and exposure settings.MethodsA literature review was undertaken to assess the evidence for CPF contributing to neurodevelopmental disorders in infants and children. Other literature was consulted in order to formulate a causal chain diagram showing the origins, uptake, and neurological effects of animal and human exposure to CPF.The causal chain diagram and a questionnaire were distributed online to scientific experts who had published in relevant areas of research. They were asked to assess their confidence levels on whether CPF does in fact contribute to adverse neurodevelopment outcomes and rate their confidence in the scientific evidence. A second questionnaire queried experts as to which kind of policy action they consider justifiable based on current knowledge. In a special workshop session at the EuroTox congress in Dresden in 2009 the results of both questionnaires were further discussed with invited experts, as a basis for a policy brief with main messages for policy makers and stakeholders.ResultsMost experts who responded to the first questionnaire felt that there was already enough evidence to support a ban on indoor uses of CPF in the EU. However, most felt additional research is still required in several areas. The responses from the first questionnaire were used to formulate the second questionnaire addressing the feasibility of government action. In turn, these expert participants were invited to attend a special session at the EuroTox congress in Dresden in 2009.ConclusionsSome of the evidence that CPF contributes to neurodevelopmental disorders is still disputed among experts, and the overall sense is that further research and public awareness are warranted. There have been campaigns in North America making the potential exposure concerns known, but such information is not widely known in the EU. The ability of government action to produce change is strongly felt in some quarters while others believe better knowledge of consumer use trends would have a greater impact.

Follow-up of babies born to substance misusing mother's (SMM) during a 5 year period in an inner city hospital in birmingham

BackgroundMaternal substance misuse has potential serious harmful effects on mother and infant. Association of maternal substance misuse and perinatal complications is well recognized but there is growing concern about long...

Impact of chorioamnionitis and preeclampsia on neurodevelopmental outcome in preterm infants below 32 weeks gestational age

Intrauterine conditions may interfere with foetal brain development. We compared the neurodevelopmental outcome between infants <32 weeks gestational age after maternal preeclampsia or chorioamnionitis and controls. Case-control study on infants with maternal preeclampsia, chorioamnionitis and controls (each n = 33) matched for gestational age. Neurodevelopment at 2 years was assessed with the Bayley Scales of Infant Development II. A total of 99 infants were included with a median gestational age of 29 weeks (range 25-32). Median mental developmental index (MDI) was 96 in the control, 90 in the chorioamnionitis and 86 in the preeclampsia group. Preeclampsia infants had a lower MDI compared with the control group (univariate p = 0.021, multivariate p = 0.183) and with the chorioamnionitis group (univariate p = 0.242; multivariate p = 0.027). Median psychomotor index was 80.5 in the control, 80 in the preeclampsia and 85 in the chorioamnionitis group and was not different between these three groups (p > 0.05). Chorioamnionitis or preeclampsia exposure was not associated with major neurodevelopmental impairments (cerebral palsy, MDI<70, PDI<70). The results of this preliminary study suggest that preeclampsia and chorioamnionitis play a relatively minor role among risk factors for adverse neurodevelopment outcome. Postnatal factors such as ventilation and bronchopulmonary dysplasia may have a greater impact on neurodevelopmental outcome.