Ages And Stages Questionnaire Research Articles

Concurrent validity of the gross motor component of ages and stages questionnaire-3 with the motor scales of Developmental Assessment Scales for Indian Infants (DASII) in risk infants < 6 Months

Objective: Global developmental delay is the term used when a child lags or has a delay in all the domains of development. Early detection of this delay is a necessity to commence with early intervention. This study aimed to determine the concurrent validity of gross motor component of Ages and Stages Questionnaire-3 (ASQ-3) with the motor scales of Developmental Assessment Scales for Indian Infants (DASII) in risk infants Materials and Methods: This cross-sectional study included risk infants in the age group of 1–6 months (n = 97). They were assessed using the age-appropriate ASQ-3. The parents/caregivers of the children filled in the child-appropriate responses. The children were then assessed using the DASII. The scores of ASQ-3 and DASII were recorded as per the instructions in their respective manuals. Results: One hundred and fifty infants were screened for eligibility, of which only 97 were eligible according to the study criteria. Fifty-four children failed on the gross motor domain of ASQ-3, whereas sixty children failed on the motor scales of DASII. The overall sensitivity and specificity of the ASQ-3 were found to be 73.80% and 89.83%, respectively. The sensitivity of the ASQ-3 at 2 months was 75% and 66.67% at 4 and 6 months. The specificity of the ASQ-3 at 2, 4, and 6 months was 88%, 90%, and 93.33%, respectively. Conclusion: ASQ-3 has strong characteristics to detect motor developmental delay in infants at risk for developmental delay.

Evaluation of evolutionary status of 4–60-month-old children in Kashan and Aran-Bidgol and its related factors in 2016–2017

Background: Paying attention to Children's evolutionary status help to improve their mental capacity and make them more intelligent and creative adults. The present study aimed to investigate the developmental status in 4–60-month-old children of Kashan and Aran-Bidgol and its related factors in 2016–2017. Methods: This descriptive cross-sectional study was performed on 656 children aged 4–60 months in Kashan and Aran-Bidgol that were recruited by a stratified random sampling method. Data were collected through self-report using Ages and Stages Questionnaire (ASQ) and demographic and clinical questionnaire. The ASQ consists of 30 questions in five domains including communication, gross motor, fine motor, problem-solving, and personal-social skills. The inter-rater agreement coefficient of 93%, the Cronbach's alpha coefficient of 0.51–0.87, and the 2-week test–retest correlation of 0.75 are reported for this questionnaire. Data were analyzed using descriptive statistics as well as Chi-square, ANOVA, and t-test. The significance level was considered

Relation between Social Determinants of Maternal Health and Child Development: A Path Analysis

Background: Since several factors, rather than a single cause, contribute to developmental delay in children, identification of the condition's risk factors and their pathway of effects are critical to the design and implementation of appropriate intervention .This study aimed to determine the relation between social determinants of maternal health and child development in Iranian mothers and their children. Materials and Methods: In this analytical cross-sectional study, the subjects were recruited from mother-child health clinics located at general hospitals affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran). A total of 950 mothers and their children were selected using cluster sampling. Based on the WHO conceptual framework of Social determinants of health (SDH) and review of literature, this model was proposed. The questionnaires used for data gathering were: Beck’s Depression Inventory II (BDI-II), Spiel Berger's State-Trait Anxiety Inventory (STAI), the 12-item MSPSS questionnaire for social support, Cohen’s measure of perceived stress, the Ages and Stages Questionnaires (ASQ) of infant developmental status, and socio-economic status questionnaire. The data and theoretical Path Model were analyzed using SPSS software version 19.0 and Lizrel 8.8 software. Results: The mean of Mother’s age was 28.05±4.22 years old.The percentage of children with suspected delay was 12.2%. The final path model fitted well (RMSEA=0.049 GFI=1). Maternal Socioeconomic status had the greatest direct, indirect, and total effects on child development (βTotal=0.35377), and maternal depression had the second most significant direct effects on child development (β= -0.17). Conclusion: The proposed path model regarding the effects of maternal socioeconomic status, perceived social support, perceived stress, anxiety and depression, on the developmental status of 6 to 18 month-old children, fitted well.

323. Childhood Outcomes Following Parechovirus Central Nervous System Infection in Young Infants at a US Children’s Hospital

BackgroundParechovirus (PeV), specifically Parechovirus A type 3 (PeV-A3), is a picornavirus associated with severe infection in young infants, with disease manifestations ranging from undifferentiated fever, to sepsis like illness, and meningoencephalitis. There are limited data regarding long-term outcomes of infected infants. The objective of this study was to describe early childhood outcomes following infantile PeV-CNS infectionMethodsFamilies of Infants hospitalized during 2014 with laboratory confirmed PeV-CNS infection were contacted for neurodevelopmental follow-up. Testing included medical history, standard neurologic examination, parental completion of Ages and Stages questionnaire (ASQ) and determination of Bayley III cognitive, motor, and language quotients. Neurodevelopmental impairment (NDI) was considered present if cognitive, motor, or language quotients were >1 standard deviation (mild) or >2 SD (severe) below the testing norms, the presence of cerebral palsy (CP), or sensory (vision/hearing) impairment. Relationship of childrens’ outcomes to severity of PeV disease (uncomplicated febrile illness [mild], disseminated disease [moderate] or advanced disease requiring intensive care [severe]) was assessed by chi-square analysis.ResultsNineteen children were available for testing at approximately 3 years of age (31–38 months), 12 (63%) with mild, five (26%) moderate, and two (11%) with severe disease. Mean Bayley quotients were within normal limits (see table), one infant had mild CP (5%) and two (11%) had mild NDI. There was no apparent relationship of NDI with infant PeV clinical presentation. ASQ results included 11% at referral level and 32% suspect, and were unrelated to severity of the viral illness. However, all parents of children with moderate or severe presentations of infantile PeV disease had medical or behavior concerns at 3 years of age compared with 25% of those with mild presentation (P = 0.007).Bayley QuotientsMeanRangeIQ9885–125Motor10891–130Language10389–118ConclusionNeurodevelopmental impairments may be seen following infant PeV disease, but may not correlate with severity of clinical disease. Longitudinal monitoring of developmental status through early childhood following PeV infantile disease is warranted.Disclosures All authors: No reported disclosures.

Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial

Background: Delayed cord clamping (DCC) is associated with an improved iron status at 8 months, a reduction of anemia at 12 months, and an improved development at 4 years. Assessment of the development after DCC has not been performed earlier in a setting with a high prevalence of iron deficiency. Objective: The aim of this paper was to investigate the effects of DCC compared to early cord clamping (ECC) on the development evaluated with the Ages and Stages Questionnaire (ASQ) at 12 months of age. Method: We conducted a randomized controlled trial investigating the effect of DCC (≥180 s) versus ECC (≤60 s) in 540 full-term deliveries. Twelve months after delivery, the parents reported their infant’s development by ASQ. Infants having a score < 1 standard deviation (SD) under the mean score were considered “at risk” of affected neurodevelopment. Results: At 12 months of age, 332 (61.5%) infants were assessed. Fewer children in the DCC group were “at risk” of having affected neurodevelopment measured by the ASQ total score, 21 (7.8%) versus 49 (18.1%) in the ECC group. The relative risk was 0.43 (0.26–0.71). Infants in the DCC group had higher mean total scores (SD), 290.4 (10.4) versus 287.2 (10.1), p = 0.01. Significantly fewer infants in the delayed group were “at risk” and had higher scores in the domains “communication”, “gross motor”, and “personal-social”. Conclusions: DCC after 3 min was associated with an improvement of the overall neurodevelopment assessed at 12 months of age as compared to infants in the group with cord clamping within 1 min.

263. Neonatal developmental and behavioral outcomes of immediate delivery versus expectant management in hypertensive disorders of pregnancy: 2-year outcomes of the HYPITAT II trial

Background In the management of hypertensive disorders(HD) in preterm pregnancy, maternal benefits of delivery need to be weighed against the neonatal consequences of preterm birth. We report 2-year child outcomes of the HYPITAT-II trial, which compared delivery versus expectant management(EM) in these women. Objective To compare effects of delivery versus EM in women with hypertension in late preterm pregnancy on neurodevelopmental and behavioral outcomes in their offspring at two years of age. Study design We studied children born in the HYPITAT-II trial, in which 704 women with a HD between 34 and 37 weeks of gestation were randomized to immediate delivery or EM. Participating women were asked to complete the Ages and Stages Questionnaire (ASQ) for developmental outcome and the Child Behavior Checklist (CBCL) for behavioral problems when their toddler was two years old. Outcomes were dichotomized and analyzed by logistic regression analysis. Results We approached 545 (77%) randomized women, of whom 344 (64%) participated. In the delivery group, 45/162 (28%) infants had an abnormal ASQ-score compared to 27/148 (18%) in the EM group (difference in percentage 9.6, CI 0.3 to 18.0); p = 0.045. An abnormal CBCL outcome was found in 31/175 (18%) in the delivery group versus 24/166 (15%) in the EM group (difference in percentage 3.2 (CI − 4.6 to 11.0). After correction for maternal education, management strategy remained an independent predictor of abnormal ASQ-score (OR 0.48, CI 0.24 −0.96, p = 0.03). In multivariable analyses, birth weight, maternal education and management policy were all significantly associated with an abnormal ASQ-score. Conclusions This study suggests that early delivery in women with late preterm HD results in poorer neurodevelopmental outcome at two years of age, indicating an increased risk of developmental delay compared to EM. This should be considered in the timing of delivery in women with a late preterm HD.

Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review

The aim of this systematic review was to investigate screening practices with the Ages and Stages Questionnaires (ASQ) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) in the USA and Scandinavia and to identify practical lessons and research opportunities. The review was performed for ASQ- and ASQ:SE-related studies in children from birth to 5years. From nine databases and 1689 references (published from 1988-2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis. US studies primarily use the ASQ/ASQ:SE to detect delays in general and at-risk populations in medical settings, which increases early detection, clinician-referral, and intervention rates. Scandinavian studies commonly use the ASQ/ASQ:SE to monitor developmental-behavioural differences in intervention/exposure-based cohorts. Pre-visit screening yields completion/return rates of 83% to more than 90% and fosters same-day interpretation. When referrals are indicated, systemwide care coordination or colocation with a developmental-behavioural specialist is beneficial. Practical implementation lessons are reviewed. Research opportunities include investigating and measuring the ASQ/ASQ:SE's 'overall' sections. Danish, Norwegian, and Swedish translations are available but up-to-date norming and validation studies are needed throughout Scandinavia. Randomized controlled trials are needed to investigate outcomes in screened versus unscreened cohorts. General and at-risk populations broadly benefited from periodic Ages and Stages Questionnaires (ASQ) and/or Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) screening. Pre-visit ASQ and/or ASQ:SE screenining implementation systems work best. The ASQ and ASQ:SE 'overall' sections are not quantifiable and under-researched.

Behavioral and neurodevelopmental outcome of children after maternal allopurinol administration during suspected fetal hypoxia: 5-year follow up of the ALLO-trial

ObjectiveTo evaluate the long-term neurodevelopmental and behavioral outcome of antenatal allopurinol treatment during suspected fetal hypoxia.Study designWe studied children born from women who participated in a randomized double-blind placebo controlled multicenter study (ALLO-trial). Labouring women in whom the fetus was suspected to have fetal hypoxia were randomly allocated to receive allopurinol or placebo. At 5 years of age, the children were assessed with 2 parent reported questionnaires, the Ages and Stages Questionnaire (ASQ) and the Child Behavior Checklist (CBCL). A child was marked abnormal for ASQ if it scored below 2 standard deviation under the normative mean of a reference population in at least one domain. For CBCL, a score above the cut-off value (95th percentile for narrowband scale, 85th percentile for broadband scale) in at least one scale was marked as abnormal.ResultsWe obtained data from 138 out of the original 222 mildly asphyxiated children included in the ALLO-trial (response rate 62%, allopurinol n = 73, placebo n = 65). At 5 years of age, the number of children that scored abnormal on the ASQ were 11 (15.1%) in the allopurinol group versus 11 (9.2%) in the placebo group (relative risk (RR) 1.64, 95% confidence interval (CI): 0.64 to 4.17, p = 0.30). On CBCL 21 children (30.4%) scored abnormal in de allopurinol group versus 12 children (20.0%) in the placebo group (RR 1.52, 95% CI: 0.82 to 2.83, p = 0.18).ConclusionWe found no proof that allopurinol administered to labouring women with suspected fetal hypoxia improved long-term developmental and behavioral outcome. These findings are limited due to the fact that the study was potentially underpowered.Trial registrationNCT00189007 Dutch Trial Register NTR1383

Effect of delay at 12 months of age on developmental status at 48 months of age determined using the ages and stages questionnaire: The Japan environment and children's study

Introduction Few population-based studies have previously indicated the trajectory of developmental evaluation using an objective evaluation tool, Ages and Stages Questionnaire (ASQ). The ASQ is a screening tool originally designed to assess children's developmental performance and is the most commonly used parent-completed developmental screener worldwide. The Japan Environment and Children's Study (JECS) is an ongoing, nationwide birth cohort study that initiated in 2011 to investigate environmental factors affecting children's health and development. In this population-based questionnaire study, the 30-item ASQ completed at ages of 12 and 48 months were included. JECS has been conducted in 15 regional centres located throughout Japan. Using a temporary data of a regional centre of the JECS in Yamanashi, this study aimed to examine whether the evaluation at the age of 12 months predicts developmental delay at the age of 48 months. Methods In this study, 1704 participants completed the ASQ at 12 and 48 months. The ASQ consists of five domains: communication (CO), gross motor (GM), fine motor (FM), problem solving (PS) and personal social (PES). Cut-off values of less than two standard deviations (SDs) and 1 SD below the mean for the ASQ in each domain were used to define ‘fail’ and, ‘need to follow-up (follow-up)’, respectively, as recommended in a previous study in the United States. Multiple logistic regression analyses were conducted to examine whether the ‘fail’ and ‘follow-up’ at 12 months predicts ‘fail’ at 48 months in each domain. Results At 12 months, ‘fail’ and ‘follow-up’ rates in each domain were 8% and 27% (CO), 17% and 21% (GM), 12% and 17% (FM), 19% and 20% (PS), and 18% and 19% (PES), respectively. At 48 months, the ‘fail’ rates were 3.4% (CO), 4.1% (GS), 1.1% (FM), 3.0% (PS) and 1.7% (PES), respectively. ‘Fail’ at 12 months in every domain were significantly predictive of ‘fail’ at 48 months [CO, odds ratio (OR): 5.7, 95% confidence interval (CI): 3.6–9.2; GM, OR: 5.4, 95% CI: 3.1–9.4; FM, OR: 9.6, 95% CI: 3.1–29.5; PS, OR: 10.6, 95% CI: 5.1–22; PES, OR: 6.4, 95% CI: 3.0–14.1]. In contrast, ‘follow-up’ in the PES domain was not associated with ‘fail’ at 48 months (OR: 0.33, 95% CI: 0.04–2.6). The other domains of ‘follow-up’ at 12 months were significantly associated, although the OR were smaller than ‘fail’ at 12 months (CO, OR: 2.9, 95% CI: 1.6–5.2; GM, OR: 2.1, 95% CI: 1.1–4.0; FM, OR: 4.3, 95% CI: 1.2–15.1; PS, OR: 3.2, 95% CI: 1.3–7.7). Conclusion There were some differences in screening rates between in Japan and the US. The magnitude of predictability of a later developmental delay is specific depending on the domain.

Effect of breastfeeding on non-verbal cognitive development at 2-years of age in very preterm infants and the role of clinical and social risk: results from the EPICE cohort

Introduction There is a considerable controversy over the nature and the pathways involved in the relation between breastfeeding and cognitive development in very preterm infants. In a European cohort of very preterm infants we investigated the effect of breastfeeding on non-verbal cognitive development at 2 years of corrected age and variation by clinical and social risk. Methods Data were obtained from the EPICE (Effective Perinatal Intensive Care in Europe) population-based prospective cohort of infants born between 22 and 31 completed weeks of gestation, in 19 regions from 11 European countries, in 2011–2012. Of the 6792 infants discharged alive, 4425 children had a follow-up at 2 years of corrected age. For analysis, we included all infants with valid information on breastfeeding initiation, non-verbal cognitive development, and on clinical and social risk (n = 4032). Data on infant, obstetric and maternal characteristics and on neonatal morbidity were retrieved from medical records, using a structured form filled in by clinicians until discharge from the hospital. At 2 years of corrected age, data on child's health and development, breastfeeding and sociodemographic characteristics were collected using a structured questionnaire completed by parents. Non-verbal cognitive ability was measured applying the Parental Report of Children's Abilities (PARCA-R) except for France that used Ages and Stages Questionnaire (ASQ). We defined three risk groups based on perinatal factors: High-risk [born before 28 weeks of gestation or with a severe neonatal morbidity (severe congenital anomaly, bronchopulmonary dysplasia, intraventricular hemorrhage grade III or IV, cystic periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis)] (n = 1394, 34.6%); Medium-risk (birth 28–29 weeks of gestation or having growth restriction, but no morbidities) (n = 1485, 36.8%); Low-risk (birth at 30–31 weeks with no morbidities or growth restriction) (n = 1153, 28.6%). Social high-risk was defined as maternal age Results Overall, 15.8% (n = 638) of the children presented suboptimal non-verbal cognition. Never breastfed children were more likely to have suboptimal non-verbal cognition (Crude RR = 1.40, 95%CI: 1.20–1.64). Never-breastfeeding was associated with a significant increased risk in the clinical high-risk group (Crude RR = 1.52, 95%CI: 1.25–1.85), but not in the medium or low-risk groups (Crude RR = 1.05, 95%CI: 0.76–1.44, Crude RR = 1.22, 95%CI: 0.81–1.85, respectively). The stratified analysis by social risk found a significant effect in both low (Crude RR = 1.29, 95% CI: 1.08–1.54) and high-risk (Crude RR = 1.91, 95% CI: 1.29–2.83) groups. After adjustment for the region of birth, corrected age at completion of the questionnaire (months), migration status, clinical risk, and social risk, never-breastfeeding remained associated with an increased risk for suboptimal non-verbal cognition (RR = 1.27, 95% CI: 1.07–1.50). There was no interaction with clinical and social risk in adjusted models. Conclusions Breastfeeding promotes non-verbal cognitive development of very preterm children, independently of clinical and social risk. It provides evidence for specifically targeted interventions to protect, promote and support breastfeeding among these most vulnerable infants.

VALIDITY OF PARENT-COMPLETED DEVELOPMENTAL SCREENING IN CHILDREN WITH NEW-ONSET EPILEPSY BELOW THE AGE OF 3

Abstract BACKGROUND Infants with childhood-onset epilepsies, including epileptic encephalopathies, are at high risk of developmental challenges such as motor and language delays. There has been a growing focus on developmental screening instruments due to the association between delayed development and long-term adverse outcomes, including negative impacts on health-related quality of life, school achievement and social participation. Therefore, children with developmental delays should be referred as early as possible to rehabilitation services such as occupational, physical, or speech therapy. Developmental screening using standardized tools is recommended in order to identify the high-risk children that require additional developmental assessments. The Ages and Stages Questionnaires (ASQ), a parent-completed developmental screening tool, is one of the more cited and recommended developmental screening tools. However, its utility in children with early-onset epilepsy has yet to be validated. OBJECTIVES This study aimed to determine the validity of the ASQ for identifying children with new-onset epilepsy who require further professional developmental rehabilitation. DESIGN/METHODS Fifty infants (25 males) with seizure onset under 3 years of age were prospectively recruited. Parents completed the ASQ-3 before the first clinic appointment. The ASQ-3 evaluates 5 domains of development. An ASQ score below 2 standard deviations (SD) on any one of the domains was considered abnormal. Once completed, all infants were evaluated by a multidisciplinary team including neurologists, occupational therapists, and physical therapists to determine if they should be referred for further rehabilitation interventions. Accuracy of the ASQ was calculated in terms of sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS Mean age at the initial evaluation was 13.1 months (SD=8.22). Among the 50 infants, 36 (72%) received a score &lt;-2 SD in at least one domain of the ASQ and 43 (86%) were referred for further rehabilitation services after the multidisciplinary assessment. The ASQ had a sensitivity of 81%, a specificity of 71%, a PPV of 93% and a NPV of 36% in identifying children with new-onset epilepsy who would require further rehabilitation services. CONCLUSION The ASQ, a well-known parent-completed developmental screening tool, when abnormal shows adequate validity for the identification of children with early-onset epilepsy who require developmental assessments and interventions by rehabilitation professionals. Our results also provide further evidence that development delay is the rule rather than the exception in infants with new onset epilepsy.

Developmental delay in communication among toddlers and its relationship to caregiving behavior among violence-exposed, posttraumatically stressed mothers

ObjectivesThis study aimed to understand if maternal interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) is associated with delayed language development among very young children (“toddlers”). MethodsData were collected from 61 mothers and toddlers (ages 12–42 months, mean age = 25.6 months SD = 8.70). Child expressive and receptive language development was assessed by the Ages and Stages Questionnaire (ASQ) communication subscale (ASQCS) that measures language acquisition. Observed maternal caregiving behavior was coded from videos of 10-min free-play interactions via the CARE-Index. Correlations, Mann-Whitney tests, and multiple linear regression were performed. ResultsThere was no significant association between maternal IPV-PTSD severity and the ASQCS.Maternal IPV-PTSD severity was associated with continuous maternal behavior variables (i.e. sensitive and controlling behavior on the CARE-Index) across the entire sample and regardless of child gender. Maternal sensitivity was positively and significantly associated with the ASQCS. Controlling behavior was negatively and significantly associated with the ASQCS. ConclusionsResults are consistent with the literature that while maternal IPV-PTSD severity is not associated with child language delays, the quality of maternal interactive behavior is associated both with child language development and with maternal IPV-PTSD severity. Further study is needed to understand if the level of child language development contributes to intergenerational risk or resilience for relational violence and/or victimization.

Internal and inter-rater reliability of the ASQ-3 in Mexican preschoolers

Introduction. Monitoring child development includes the promotion of development in the healthy child and the detection of delays and early indicators of disorders that begin in the first five years of life through easy-to-use, easy to mark, and low-cost screening tests. Objective. To evaluate the internal reliability and inter-rater reliability of the ASQ-3 in Mexican preschool children. Method. The ASQ-3 was applied to parents and/or teachers of 33 - 60 month old children who attended the Centros de Desarrollo Infantil (Child Development Centers-CENDIS) in the public and private sectors of Mexico City. Results. A total of n = 1052 questionnaires were obtained, grouped into six age groups (33, 36, 42, 48, 54, and 60 months of age) according to the Ages and Stages Questionnaire-3 (ASQ-3). The levels of reliability of the ASQ-3 for each of the age groups were acceptable, with a range of α = .77 to α = .88. Regarding inter-rater reliability (parents vs. teachers), moderate correlation levels were observed. Discussion and conclusion. The results obtained suggest that this is a screening instrument that reliably evaluates the five areas of development that make up the ASQ-3 in pre-school children. This represents an opportunity to continue studying the psychometric characteristics of validity of this instrument in representative samples of Mexican children to optimize the process of early childhood development monitoring.

Effect of L- Carnosine, DHA and vitamin D3 on children with down’s syndrome- a pilot study on Indian population

Background: Down syndrome (DS) is one of the leading genetic causes of intellectual disability (ID) accounting 15–20% of ID population across the world. Early intervention is the potential treatment; alternative therapies like occupational and physical therapy are carried to improve different skills in the child with DS. L-Carnosine is the first dietary supplement that helps in improving cognitive and behavioural symptoms. Docosahexaenoic acid (DHA) improves learning and memory abilities. Vitamin D3 is a therapeutic neuroprotector and its supplementation with DHA improves certain behaviours associated with ADHD, bipolar disorder, schizophrenia, and impulsive behaviour by regulating serotonin production and function. This study was aimed to determine the synergetic effect of L-Carnosine, DHA and Vitamin D3 in improving development in children with Down syndrome. Materials and Methods: The basic design of the study was an open label, placebo-controlled study with study duration of six months with 60 patients and analysis were carried out with the questionnaire created in reference to Ages and Stages Questionnaire (ASQ). The main parameters studied were communication, gross motor, fine motor, problem solving, social and vocabulary skills. Results: Our results confirm that parameters related to communication, fine motor, gross motor, social skills, problem solving and vocabulary significantly improved in children who were supplemented with additional nutritional supplementation, when compared to the children who were notand the data were statistically significant p<0.05. Conclusion:The combination of L Carnosine, DHA and Vitamin D3 supplementation yields an increase in cognitive processing speed, language skills and improved motor skills.

Mortality, morbidity and 2-years neurodevelopmental prognosis of twin to twin transfusion syndrome after fetoscopic laser therapy: a prospective, 58 patients cohort study

ObjectiveTo describe the morbidity and mortality and long-term neurodevelopmental outcomes in children born from a Twin-to-Twin Transfusion Syndrome (TTTS) pregnancy treated using laser fetoscopy in Toulouse. Population and methodAll pregnancies with TTTS treated by laser fetoscopy in our centre were included. Antenatal and postnatal morbidity and neonatal morbidity were identified in the medical records retrospectively. The neurodevelopmental outcome was studied using Ages and Stages Questionnaires (ASQ) sent to the parents, an oral interview with the parents and with the child's doctor (last objective neurological examination, rehabilitation needs, learning disabilities). ResultsSeventy-one pregnancies, or 144 foetuses, were included from 2008 to 2014, overall survival at 2 years was 72.9% and the survival of at least one child at 2 years was 91.5%, severe neonatal morbidity was 11.2% of the children, severe brain damage accounted for 3.6% of children admitted to the hospital unit. It was possible to study the neurodevelopmental outcome for 58 children (55.3%), with a corrected age from 24 to 95 months. Five children (8.6%) had severe neurological abnormalities and 17 (29.3%) had moderate neurological abnormalities. DiscussionThe mortality, neonatal morbidity and long-term neurological morbidity of our cohort are higher than those of premature infants (EPIPAGE-2 French cohort), which confirms the severity of this syndrome, and are comparable to those of the TTTS cohorts described in the literature.

Maternal early pregnancy obesity and related pregnancy and pre-pregnancy disorders: associations with child developmental milestones in the prospective PREDO Study.

Previous studies have linked maternal pre-pregnancy obesity (BMI ≥30 kg/m2) with suboptimal neurodevelopment in her offspring; however, the literature is not entirely consistent. Whether these effects are muddled by maternal self-reports of pre-pregnancy weight and height, or are driven or amplified by the well often comorbid hypertensive and diabetic pregnancy and pre-pregnancy disorders, remains unclear. We examined whether maternal early pregnancy obesity is associated with developmental delay in her offspring, and if the associations are driven or amplified by diabetic and hypertensive pregnancy and pre-pregnancy disorders. A total of 2504 mother-child dyads participated in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study. Data on maternal early pregnancy obesity, pre-pregnancy, and gestational hypertension, pre-eclampsia, type 1 and gestational diabetes were derived from the Finnish Medical Birth Register. At the child's mean age of 42.1 (SD = 8.2) months the mothers completed the Ages and Stages Questionnaire (ASQ) Third edition for developmental milestones. Children of obese mothers had 1.81-2.74 (p-values <0.02) higher odds of failing to meet the development that is typical for a child's age (developmental domain score ≤-2SD below the child's age) on the communication, fine and gross motor, problem solving and personal/social skills and children of overweight mothers had 2.14 (p = 0.002) higher odds of failing to meet the development that is typical for the child's age on communication skills. Odds of developmental delay were also higher for children of mothers with pre-eclampsia and gestational diabetes. The associations were robust to covariates and confounders, the effects of overweight/obesity and pre-eclampsia were not driven by the other disorders, and overweight/obesity and hypertensive and diabetic disorders did not show additive effects. Maternal early pregnancy overweight, obesity, and pre-eclampsia are independently associated with neurodevelopmental delay in her offspring. Further studies unraveling the underlying mechanisms are warranted.

Early storybook reading and childhood development: A cross-sectional study in Iran

Background : Development is a process that continues from childhood to death, and most developmental changes occur during childhood. UNICEF introduced early storybook-reading (ESR) and storytelling as part of child care indicators. The aim of this study was to investigate the status of book-reading to children and its relationship with early childhood development in Iran. Methods: This is a descriptive-analytic study conducted in Tehran April-May 2017. In total, 272 mothers of children aged 3-30 months, who were referred to health centers, were selected using a convenience sampling method. Exclusion criteria was scoring below the cutoff point of any developmental domains of the Ages and Stages Questionnaire (ASQ). ESR was assessed by checklist and child development was assessed by the ASQ. Data were analyzed using SPSS. Results: The mean number of children’s books owned was 10.23±8.642, and 84.75% had at least 3 books. The average book reading, storytelling and singing duration for children was 10±9.65, 11.48±11.756, and 23.88 ±17.880 min per day, respectively. Average book reading, storytelling, and singing duration was significantly greater in children 18-30 months than <17 months. There was a significant relationship between the number of books and a child's age, mother's age, family income, income satisfaction, father's employment, and parents’ education. The score of communication domain in the ASQ questionnaire was significantly related to the number of books, duration of reading and storytelling, while problem-solving had a significant relationship only with the number of books (p˂0.05). Based on linear regression, child's age, income, and mother's and father's educational level were models for predicting the number of children's books (p=0.0001 for all). Conclusions: ESR was associated with some developmental domains of communication and problem-solving in the present study. Therefore, creation of ESR culture in Iranian families as an integral part of the life of children is necessary from birth.

Maternal polycystic ovarian syndrome and early offspring development.

Is maternal polycystic ovarian syndrome (PCOS) associated with developmental delays in offspring? Offspring of mothers with PCOS were at higher risk of failure on the Ages and Stages Questionnaire (ASQ). There is growing evidence that offspring of mothers with PCOS may be at higher risk for developmental disorders due to potential exposure to hyperandrogenism and insulin resistance. Few studies exist regarding maternal PCOS and early childhood development in the USA. The Upstate KIDS Study is a population-based prospective cohort study of infants born between 2008 and 2010 in New York State (excluding New York City), originally designed to study-and finding no impact of-infertility treatment exposure on child development. Children were followed up to 36 months of age. In all, 4453 mothers completed one or more developmental screening instruments for 5388 children (35.5% twins) up to 36 months of age. In our study, 458 mothers (10.3%) reported a healthcare provider's diagnosis of PCOS, as well as the related treatment received, on the baseline study questionnaire. Parents completed the ASQ on their child's development at 4, 8, 12, 18, 24, 30 and 36 months of age to assess fine motor, gross motor, communication, personal-social functioning and problem-solving cognitive domains. We used generalized linear mixed models to estimate odds ratios (OR) between PCOS diagnosis and failures in the ASQ adjusted for maternal age, race, BMI, education, marital status, smoking, alcohol consumption, diabetes, insurance and plurality. Diagnosis of PCOS was associated with increased risk of the offspring failing the fine motor domain (adjusted odds ratio (aOR) = 1.77; 95% CI: 1.09, 2.89), largely driven by higher risk in female singletons (aOR = 2.23; 1.16, 4.29). Twins of mothers with PCOS had higher risk of failing the communication (aOR = 1.94; 1.19, 3.18) and personal-social functioning (aOR = 1.76; 1.12, 2.77) domains compared to twins born to mothers without PCOS. Compared to offspring of women without PCOS, offspring of women who reported receiving no treatment for their PCOS had a stronger association with failing the ASQ (aOR = 1.68; 0.95, 2.75) than the association among offspring of women who reported PCOS treatment (aOR = 1.16; 0.79, 1.73). Further study is needed to confirm the role of maternal PCOS in early offspring development with provider-validated diagnosis of PCOS. If confirmed, these findings suggest that offspring of women with PCOS may be at increased risk for developmental delay. Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; contracts HHSN275201200005C, #HHSN267200700019C). Authors have no competing interests to declare. Not applicable.

Factors affecting child development assessed by the Ages and Stages Questionnaire (ASQ) in an Arabic speaking population

• This first study of an Arab population maternal education was a predictor of child development similar to western populations.

Prospective follow-up of a cohort of preterm infants < 33 WG receiving ketamine for tracheal intubation in the delivery room: Neurological outcome at 1 and 2 years

ObjectiveAlthough ketamine analgesia is effective in reducing pain and facilitating the tracheal intubation of newborns in the delivery room, no data on the neurological effects of this treatment are available. This study compared the neurodevelopmental outcomes at 2 years of age in a cohort of preterm newborns having received ketamine prior to tracheal intubation at birth (the ketamine group) and in a control group. MethodsWe included newborns delivered at less than 33 weeks gestational age (WGA) having undergone tracheal intubation at birth. The Ages and Stages Questionnaire (ASQ) was completed at 1 and 2 years of age. The development quotient (DQ) was calculated from the revised Brunet-Lezine score assessed at a corrected age of 2 years. ResultsThere were no statistically significant differences between the ketamine group (n=54 at 1 year and n=51 at 2 years) and the control group (n=16 at 1 and 2 years) in terms of the mean±standard deviation DQ at the age of 2 (98±12 vs. 103±9, respectively; P=0.17) and the ASQ score at the age of 2 (221±44 vs. 230±39, respectively; P=0.55). DiscussionThis prospective cohort of 51 preterm newborns having received ketamine at birth did not reveal any differences in terms of neurological development at the age of 2 (relative to a control group and the literature data). These preliminary results must be confirmed in a randomized trial with longer follow-up.