Bayley Scores Research Articles

Follow-up of Extremely Preterm Infants; the Long and the Short of It.

* Abbreviation: EF — : executive function The study by Cheong et al,1 “Changing neurodevelopment at 8 years of children born extremely preterm since the early 1990s” in this issue of Pediatrics , once again reminds us of the challenges and limitations of follow-up studies. The authors have done a commendable job following 3 cohorts (1991 to 1992, 1997, and 2005) of extremely preterm infants from 22 to 27 weeks' gestation to 8 years of age. Although the authors previously had shown that there was no improvement in moderate to severe disability at 8 years between 1991 to 1992 and 1997,2 their report3 of all 3 cohorts at 2 years of age identified a significant decrease in severe disability (15.4% to 3.7%) and severe developmental delay (14.8% to 3.7%) between 1997 and 2005 attributed to improvements in perinatal interventions. The Bayley Scales of Infant and Toddler Development, Third Edition ,4 however, which was first used with the 2005 cohort, is known to underestimate developmental delay. In addition, Bayley scores are not strong predictors of school-age outcomes.5,6 The purpose of the current study was to additionally compare neurodevelopmental outcomes of the … Address correspondence to Betty R. Vohr, MD, Department of Pediatrics, Women & Infants Hospital of Rhode Island, 101 Dudley St, Providence, RI 02905. E-mail: bvohr{at}wihri.org

Neonatal Vein of Labbé Infarction Size is Associated With Long-Term Language Outcomes

BackgroundThe vein of Labbé is a superficial cortical vein, which drains the lateral surface of the temporal lobe. Thrombosis of the vein of Labbé can occur in the neonatal period. The developmental outcomes of infants who had vein of Labbé thrombosis are unknown as few studies of outcomes exist. MethodsWe completed a retrospective review of infants born ≥34 weeks of gestation, diagnosed with vein of Labbé thrombosis, and/or infarction on neuroimaging during the first 30 days of life. Size of each temporal lobe infarction was estimated based on the number of temporal lobe segments involved. Primary outcomes were the presence of major neurodevelopmental impairments in childhood and Bayley scores at two years. ResultsOur cohort of 19 infants had a median gestational age of 38 weeks (interquartile range 36 to 39) and mean birth weight 2892 ± 920 grams. The most common presenting symptoms of vein of Labbé thrombosis and infarction of surrounding tissue were seizures, apnea, lethargy, and either hypertonia or hypotonia. At the latest clinical follow-up appointment documented in the electronic medical record (mean 4.4 ± 3.08 years), 44% had major neurodevelopmental impairment. Patients with large vein of Labbé infarctions had significantly worse average Bayley scores than those with small to moderate lesions, and differences in language composite were statistically significant (72.7 vs 107.8, P = 0.017). ConclusionsNeonates with large vein of Labbé infarctions are more likely to have poor language outcomes. This finding suggests a need for targeted surveillance to ensure early identification of deficits and referral for intervention.

Differential Effects of the Single-Family Room Neonatal Intensive Care Unit on 18- to 24-Month Bayley Scores of Preterm Infants

To determine the effects of human milk and social/environmental disparities on developmental outcomes of infants born preterm cared for in a single-family room (SFR) neonatal intensive care unit (NICU). Outcomes were compared between infants weighing ?1250 g cared for in an open-bay NICU (1/2007-8/2009) (n?=?394) and an SFR NICU (1/2010-12/2011) (n?=?297). Human milk provision at 1 week, 4 weeks and discharge, and 4 week volume (mL/kg/day) were analyzed. At 18-24 months of age, the Bayley III was administered. Group differences were evaluated and multiple linear regression analyses were run. Infants cared for in the SFR NICU had higher Bayley III cognitive and language scores, higher rates of human milk provision at 1 and 4 weeks, and higher human milk volume at 4 weeks. In adjusted regression models, the SFR NICU was associated with a 2.55-point increase in Bayley cognitive scores and 3.70-point increase in language scores. Every 10?mL/kg/day increase of human milk at 4 weeks was independently associated with increases in Bayley cognitive, language, and motor scores (0.29, 0.34, and 0.24, respectively). Medicaid was associated with decreased cognitive (?4.11) and language (?3.26) scores, and low maternal education and non-white race with decreased language scores (?4.7 and ?5.8, respectively). Separate models by insurance status suggest there are differential benefits from SFR NICU and human milk between infants with Medicaid and private insurance. Infants born preterm cared for in the SFR NICU have higher Bayley language and cognitive scores and receive more human milk. Independent effects on outcomes were derived from SFR NICU, provision of human milk, and social and environmental factors.

The impacts of maternal iron deficiency and being overweight during pregnancy on neurodevelopment of the offspring.

Both maternal Fe deficiency (ID) and being overweight or obese (Ow/Ob, BMI≥25 kg/m2) may negatively affect offspring brain development. However, the two risk factors correlate and their independent effects on infant neurodevelopment are unclear. PREOBE is a prospective observational study that included 331 pregnant Spanish women, of whom 166 had pre-gestational Ow/Ob. Fe status was analysed at 34 weeks and at delivery, and babies were assessed using Bayley III scales of neurodevelopment at 18 months. In confounder-adjusted analyses, maternal ID at 34 weeks was associated with lower composite motor scores at 18 months (mean 113·3 (sd 9·9) v. 117·1 (sd 9·2), P=0·039). Further, the offspring of mothers with ID at delivery had lower cognitive scores (114·0 (sd 9·7) v. 121·5 (sd 10·9), P=0·039) and lower receptive, expressive and composite (99·5 (sd 8·6) v. 107·6 (sd 8·3), P=0·004) language scores. The negative associations between maternal ID at delivery and Bayley scores remained even when adjusting for maternal Ow/Ob and gestational diabetes. Similarly, maternal Ow/Ob correlated with lower gross motor scores in the offspring (12·3 (sd 2·0) v. 13·0 (sd 2·1), P=0·037), a correlation that remained when adjusting for maternal ID. In conclusion, maternal ID and pre-gestational Ow/Ob are both negatively associated with Bayley scores at 18 months, but independently and on different subscales. These results should be taken into account when considering Fe supplementation for pregnant women.

Local food supplementation and psychosocial stimulation improve linear growth and cognitive development among Indonesian infants aged 6 to 9 months.

To evaluate the effect of culturally-relevant food supplementation and psychosocial stimulation on infant growth and development. A community-based randomized controlled trial was conducted in 40 clusters from 5 selected villages in Tanah Datar District of West Sumatera, Indonesia. We assessed 355 infants aged 6 to 9 months at the beginning of the study. The infants were divided into 4 groups: 1) Food Supplementation (FS); 2) Psychosocial Stimulation (PS); 3) Food Supplementation and Psychosocial Stimulation (FS+PS); and 4) Control Group (CG). The formula food supplement was comprised of a variety of local food sources (local MP-ASI) and adjusted for the local habits. The quality of psychosocial stimulation was assessed with the Infant HOME inventory method. Progress at 6 months was assessed by anthropometry and the Bayley scores of cognition, language and motor function. There were improvements in linear growth, cognitive and motor development of children in the FS (p<0.05) and the FS+PS (p<0.01) groups compared to the CG. After six months of intervention, mean length increased to 6.86±2.08 cm and 6.66±2.41 cm for FS and FS+PS respectively (p<0.05). With the combination of food supplementation and psychosocial stimulation (FS+PS), cognitive development increased to 21.4±12.2 points (effect size 0.56) (p<0.01) and motor development increased to 20.7±18.4 points (effect size 0.50) (p<0.001). Combined intervention with local food supplementation and psychosocial stimulation improved infant growth, cognitive and motor development.

The Use of Cardiac Orienting Responses as an Early and Scalable Biomarker of Alcohol-Related Neurodevelopmental Impairment.

Considered the leading cause of developmental disabilities worldwide, fetal alcohol spectrum disorders (FASD) are a global health problem. To take advantage of neural plasticity, early identification of affected infants is critical. The cardiac orienting response (COR) has been shown to be sensitive to the effects of prenatal alcohol exposure and is an inexpensive, easy to administer assessment tool. The purpose of this study was to evaluate the COR effectiveness in assessing individual risk of developmental delay. As part of an ongoing longitudinal cohort study in Ukraine, live-born infants of women with some to heavy amounts of alcohol consumption in pregnancy were recruited and compared to infants of women who consumed low or no alcohol. At 6 and 12months, infants were evaluated with the Bayley Scales of Infant Development-II. CORs were also collected during a habituation/dishabituation learning paradigm. Using a supervised logistic regression classifier, we compared the predictive utility of the COR indices to that of the 6-month Bayley scores for identification of developmental delay based on 12-month Bayley scores. Heart rate collected at each second (Standard COR) was compared to key features (Key COR) extracted from the response. Negative predictive values (NPV) were 85% for Standard COR, 82% for Key COR, and 77% for the Bayley, and positive predictive values (PPV) were 66% for Standard COR, 62% for Key COR, and 43% for the Bayley. Predictive analysis based on the COR resulted in better NPV and PPV than the 6-month Bayley score. As the resources required to obtain a Bayley score are substantially more than in a COR-based paradigm, the findings are suggestive of its utility as an early scalable screening tool based on the COR. Further work is needed to test its long-term predictive accuracy.

Second-Trimester Ultrasound as a Tool for Early Detection of Fetal Alcohol Spectrum Disorders.

Early detection of fetal alcohol spectrum disorders (FASDs) is desirable to allow earlier and more comprehensive interventions to be initiated for the mother and infant. We examined prenatal ultrasound as an early method of detecting markers of the physical features and neurobehavioral deficits characteristic of FASD. A longitudinal cohort of pregnant women in Ukraine was recruited as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Women were enrolled into a moderately to heavy-alcohol-exposed group or a low- or no-alcohol exposure group and were followed to pregnancy outcome. In the second trimester, a fetal ultrasound was performed to measure transverse cerebellar diameter, occipital frontal diameter (OFD), caval-calvarial distance, frontothalamic distance (FTD), interorbital distance (IOD), outer orbital diameter, and orbital diameter (OD). Live born infants received a dysmorphological examination and a neurobehavioral evaluation using the Bayley Scales of Infant Development. These data were used to classify infants with respect to FASD. Comparisons were made on the ultrasound measures between those with and without features of FASD, adjusting for gestational age at ultrasound and maternal smoking. A total of 233 mother/child dyads were included. Children classified as FASD had significantly longer IOD and lower FTD/IOD, OFD/IOD, and FTD/OD ratios (p<0.05). Children with a Bayley score <85 had significantly shorter FTD, longer IOD, lower OFD/IOD, and FTD/IOD ratios (p<0.05). In general, mean differences were small. Ultrasound variables alone predicted <10% of the variance in the FASD outcome. Some ultrasound measurements were associated with FASD, selected facial features of the disorder, and lower neurobehavioral scores. However, mean differences were relatively small, making it difficult to predict affected children based solely on these measures. It may be advantageous to combine these easily obtained ultrasound measures with other data to aid in identifying high risk for an FASD outcome.

Adapting the Bayley Scales of infant and toddler development in Ethiopia: evaluation of reliability and validity.

BackgroundThere is a need for valid and reliable observational measures of early child development in low‐income and middle‐income country settings.MethodsThe aims of the study were to adapt the Bayley Scales of Infant Development (Bayley III) for a rural Ethiopian setting and evaluate reliability and validity. The study was carried out between January 2008 and January 2009 in the Butajira demographic surveillance site, south central Ethiopia. The Bayley III was adapted to be socioculturally appropriate for a rural Ethiopian context. Nurses and high school graduates were trained in administration of the measure for 10 days. Inter‐rater reliability was evaluated (n = 60). Content, construct and convergent validity was then examined on a population‐based cohort of children at the ages of 30 (n = 440) and 42 months (n = 456). Mokken scale analysis was used to determine the scalability of items in unidimensional, hierarchical sub‐scales. The mean score was compared by age of child and by stunting status (less than −2 z scores below the standard height‐for‐age).ResultsThe intra‐class correlations between raters were above 0.90 for all sub‐scales of the child development measure. Some scale items were not contextually relevant and showed poor scalability. However, the majority of items scaled onto the existing sub‐scales of the international measure to form adequate‐to‐strong hierarchical scales with good internal consistency (Cronbach's α above 0.70 except for gross motor and expressive language sub‐scales). Item‐scale coefficients were good. The mean score of all sub‐scales was significantly higher in the older group of children (33.02 higher total score; P < 0.001) and in the children who were stunted (total Bayley score 2.58 (95% confidence interval 0.07 to 5.10) points lower at 30 months and 3.87 (1.94 to 5.81) points lower at 42 months.ConclusionsAn adapted version of an international, observational measure of child development was found to be reliable, valid and feasible in a rural Ethiopian setting.

Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis.

To determine whether prolonged latency after preterm prelabour rupture of membranes (PPROM) is associated withan increased risk for adverse neurodevelopmental outcomes. This is a secondary analysis of the randomised controlled trial of magnesium sulphate for the prevention of cerebral palsy. Multicentre trial. A total of 1305 women with PPROM were analysed, 1056 of whom had an interval of <3weeks between diagnosis and delivery and 249 of whom had an interval of ≥3weeks between diagnosis and delivery. We evaluated whether the time interval between diagnosis of PPROM and delivery was associated with an increased risk for adverse neurodevelopmental outcomes. Latency was analysed as a continuous variable and categorised by weeks of latency. The primary outcome was motor and mental Bayley scores of <70 at 2years of age. Secondary outcomes included motor and mental Bayley scores <85 and mean Bayley scores. Logistic regression was used to control for confounding factors. In the univariate analysis, motor and mental Bayley scores of <70 were similar in the <3weeks (16.8 and 14.4%) and ≥3weeks (15.3 and 14.1%) groups. In the regression analysis adjusting for confounding factors, PPROM for ≥3weeks was an independent risk factor for motor (adjusted odds ratio (aOR)2.12; 95%confidence interval, 95%CI 1.29-3.49) and mental (aOR1.83, 95%CI 1.13-3.00) Bayley scores of <70. Neonatal sepsis, gestational age at delivery, maternal education, and race were significantly associated with neurodevelopmental outcomes. Whereas delivery at later gestational age is associated with improved prognosis for many outcomes, prolonged exposure to an intrauterine environment of PPROM is an independent risk factor for adverse neurodevelopmental outcomes. Prolonged PPROM was associated with motor and mental Bayley scores of <70.

Neurodevelopmental Outcomes Following Bevacizumab Injections for Retinopathy of Prematurity.

Bevacizumab intravitreal injection, a vascular endothelial growth factor inhibitor, is used to treat retinopathy of prematurity (ROP). However, concerns have been raised regarding its systemic absorption and effect on developing tissues including brain. This study compared neurodevelopment at 18 months' corrected age in preterm infants of <29 weeks' gestation treated with bevacizumab versus laser ablation. Data from the Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network databases were retrospectively reviewed. Infants born at <29 weeks' in 2010-2011 with treated ROP were studied. Neurodevelopmental outcome at 18 months was assessed by using neurologic examination and the Bayley Scales of Infant and Toddler Development Third Edition. Regression analyses were performed. Of 125 treated infants, 27 received bevacizumab and 98 laser. The bevacizumab group, compared with laser, obtained a median Bayley Scales of Infant and Toddler Development Third Edition motor composite score of 81 (interquartile range, 70-91) versus 88 (79-97), a language composite score of 79 (65-97) versus 89 (74-97), and a cognitive score of 90 (80-100) versus 90 (85-100). Difference was detected on the motor score only (P = .02). Odds of severe neurodevelopmental disabilities (Bayley scores <70, severe cerebral palsy, hearing aids, or bilateral blindness) was 3.1 times higher (95% confidence interval: 1.2-8.4) in infants treated with bevacizumab versus laser after adjusting for gestational age, gender, maternal education, Score for Neonatal Acute Physiology-II score, bronchopulmonary dysplasia, sepsis, and severe brain injury. Preterm infants treated with bevacizumab versus laser had higher odds of severe neurodevelopmental disabilities. Further investigation on the long-term safety of antivascular endothelial growth factor treatment of ROP is needed.

Congenital Central Hypoventilation Syndrome: Neurocognition Already Reduced in Preschool-Aged Children.

Congenital Central Hypoventilation Syndrome (CCHS) is a rare neurocristopathy characterized by severe hypoventilation and autonomic dysregulation, with typical presentation in the neonatal period, and deficient cognitive skills in school-aged patients. We hypothesized that younger (preschool) children with CCHS would also show neurocognitive delay and that CCHS-related physiologic factors would impact neurocognitive test results. We studied developmental (Bayley) test results collected during routine clinical care in 31 children (mean age 25.0 ± 8.5 months; range, 6-40 months) with PHOX2B mutation-confirmed CCHS by comparing them with the normative reference mean from the Bayley standardization sample; we also examined associations between Bayley scores and CCHS disease-related factors. Preschool patients with CCHS fell significantly below the normative mean of 100 on Bayley indices of mental (mean, 83.35 ± 24.75) and motor (mean, 73.33 ± 20.48) development (P < .001 for both). Significantly lower Bayley mental and motor scores were associated with severe breath-holding spells, prolonged sinus pauses, and need for 24 h/d artificial ventilation. Lower Bayley motor scores were also associated with seizures. Bayley scores differed among children with the three most common polyalanine repeat expansion mutation genotypes (mental, P = .001; motor, P = .006), being essentially normal in children with the 20/25 genotype but significantly lower in the other genotype groups (P < .05). These results confirm neurodevelopmental impairment of CCHS preschoolers, with severity related to physiologic compromise and PHOX2B genotype. These findings suggest that adverse effects begin early in the disease process, supporting the need for neurodevelopmental monitoring and intervention from early infancy.

Congenital diaphragmatic hernia: Observed/expected lung-to-head ratio as a predictor of long-term morbidity

AimThe aim of this study was to investigate the association of observed/expected (O/E) lung-to-head ratio (LHR) with long-term morbidity for isolated fetal congenital diaphragmatic hernia (CDH) patients in a single institution. MethodsWe performed a retrospective study of prenatally diagnosed CDH from 18 to 38weeks of gestation (01/2002–04/2010). Two cohorts of O/E LHR were defined (22.6–45%, 45.1–78.3%) based upon previous studies. Survivors with at least 1-year follow-up of prospectively collected long-term morbidity assessments were included. ResultsO/E LHR was available in 43 survivors (median 40%, range 22.8–78.3%). Follow-up data were available in 41 survivors (M:F=24:17, left CDH=39/41). Median follow-up was 6.5years (1–11years). Height/weight trajectories were similar between the two cohorts, with the majority below the 50th centile. There were no differences between the two cohorts by age 3years for Bayley scales (developmental domains) and/or REEL-3 (language development). In addition, V/Q scans in the two cohorts demonstrated similar degrees of mismatch (mean delta V/Q=35.4 versus 31.3). ConclusionsIn fetuses with isolated CDH, a reduction in O/E LHR does not predict a worse outcome in long-term follow-up. There is no association between a lower O/E LHR and a reduction in REEL-3 or Bayley score nor V/Q mismatch.

Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy

BackgroundData on the long-term outcome of children who are exposed to maternal cancer with or without treatment during pregnancy are lacking.MethodsIn this multicenter case–control study, we compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis. We used a health questionnaire and medical files to collect data regarding neonatal and general health. All children were prospectively assessed (by means of a neurologic examination and the Bayley Scales of Infant Development) at 18 months, 36 months, or both. A cardiac assessment was performed at 36 months.ResultsA total of 129 children (median age, 22 months; range, 12 to 42) were included in the group whose mother had cancer (prenatal-exposure group) with a matching number in the control group. During pregnancy, 96 children (74.4%) were exposed to chemotherapy (alone or in combination with other treatments), 11 (8.5%) to radiotherapy (alone or in combination), 13 (10.1%) to surgery alone, 2 (1.6%) to other drug treatments, and 14 (10.9%) to no treatment. Birth weight was below the 10th percentile in 28 of 127 children (22.0%) in the prenatal-exposure group and in 19 of 125 children (15.2%) in the control group (P=0.16). There was no significant between-group difference in cognitive development on the basis of the Bayley score (P=0.08) or in subgroup analyses. The gestational age at birth was correlated with the cognitive outcome in the two study groups. Cardiologic evaluation among 47 children at 36 months of age showed normal cardiac findings.ConclusionsPrenatal exposure to maternal cancer with or without treatment did not impair the cognitive, cardiac, or general development of children in early childhood. Prematurity was correlated with a worse cognitive outcome, but this effect was independent of cancer treatment. (Funded by Research Foundation–Flanders and others; ClinicalTrials.gov number, NCT00330447.)

Developmental outcomes at three years of age of infants with esophageal atresia

Background/aimsPrevious work assessing early developmental outcomes of infants at one year of age following surgery for esophageal atresia (OA) and/or tracheoesophageal fistula (TOF) found a significantly lower score in expressive language compared with control infants. The purpose of this study was to determine whether these differences were still evident at three years of age. MethodsBetween August 2006 and July 2008, infants who required surgical correction of OA/TOF were prospectively enrolled as part of a large study which examined developmental outcomes following surgery. Patients were reassessed using the Bayley Scales of Infant and Toddler Development Version III. Cognition, expressive and receptive language, fine motor and gross motor skills scores were compared with both the standardized norms and also with contemporaneous control infants. Results24 of the 31 infants (77%) assessed at one year were reassessed at three years of age. There was no significant difference between the Bayley scores of the infants with OA/TOF and the standardized norms of the tests in four of the subsets: cognition, expressive language, fine and gross motor skills. Infants with OA scored higher than normative values for the receptive language subscale (P=0.001). When compared with the controls, there were no significant differences in any of the subscales. ConclusionCompared with the outcomes at one year, infants with OA/TOF have improved and were scoring within the normal range for the assessment at three years. This may in part be because of the early intervention services which many of these children were provided.

Hypothyroxinemia in extremely low birth weight infants

Hypothyroxinemia of prematurity (HOP) is a transient alteration in thyroid hormone availabilityfound in more than half of extremely low birth weight infants (ELBW) born at less than 30 weeks [1]. HOP is characterized by very low total T4 (TT4) and free T4 (FT4) levels with a normal or low thyroid stimulating hormone (TSH); TT4 and FT4 show a nadir at 7-10 days of life and they may remained low for the first 3-6 weeks of life depending from the severity of prematurity[2]. The reason for this hypothyroxinemia is multifactorial including the loss of maternal transfer of T4, immaturity of the hypothalamic-pituitary-thyroid axis, limited thyroid capacity to increase synthesis and metabolism, immaturity of peripheral tissue deiodination, reduced iodine availability and excessive losses, drugs affecting thyroid function and other adverse perinatal events [3]. Thyroid hormones are critical for a normal maturation of the developing brain in the fetus and infant, including cerebral neurogenesis, neural migration and differentiation, axonal and dendritic growth and synaptogenesis, gliogenesis, myelogenesis[4,5]. HOP has been associated with adverse neurodevelopmental outcomes such as deficits in developmental of motor, cognitive, language, memory, attention and it seem to be an independent risk factor for cognitive and behavioral deficits [6], however it is not clear the need to treat [7]. In a large trial of prophylacticthyroxine treatment van Wassenaer et al. [8]observed an 18-point improvement in mental development Bayley scores at 2 years postnatal age in infant born at less than 27 weeks gestation but, treated infants of more than 27 weeks had a 10-point deficit in Bayley scores. Overall there is insufficient evidence to determine whether use of thyroid hormones for treatment of preterm infants with transient hypothyroxinemia results in changes in neonatal morbidity and mortality, or reductions in neurodevelopmental impairments, but T4 supplementation may be beneficial in infants born at less than 27 weeks. Recently Scratch et al. [5], contrary to expectations, reported that in children born at less than 30 weeks’ gestation, higher concentrations of free thyroxine over the first 6 weeks of life were associated with poorer cognitive function at 7 years of age. Future studies should be directed in understanding unexpected endocrine patterns after very preterm birth.

Desenvolvimento motor e cognitivo de bebês de mães adolescentes e adultas: estudo longitudinal

The aims of this study were to investigate in infants of adolescent and adult mothers: (1) the risk factors for child development; (2) changes in cognitive and motor development over four months of follow-up, (3) correlation between cognitive and motor development over four months of follow-up. This is a longitudinal study with 40 infants, 20 infants of adolescent mothers and 20 of adult mothers from Porto Alegre and Butia, state of Rio Grande do Sul, Brazil. Three evaluations of motor and cognitive development were performed using the Alberta Motor Infant Scale (AIMS) and the Bayley Scale Infant Development II. Significant difference in the supine position of AIMS was observed between groups in the third evaluation. Infants of adolescent mothers showed lower scores than those of adult mothers. The motor scores of each position and total AIMS score showed significant difference during overall time and in each group. The Bayley-II mental score also showed significant difference during overall time and in each group. There was a positive, strong and significant association between AIMS and Bayley scores in all three evaluation stages as in the group of infants of adolescent and adult mothers. It was concluded that infants of adolescent mothers showed worse results in the supine position during the third evaluation than those of adult mothers. There was a significant association between motor and cognitive development in both groups of infants over time.

Desenvolvimento motor e cognitivo de bebês de mães adolescentes e adultas: estudo longitudinal

The aims of this study were to investigate in infants of adolescent and adult mothers: (1) the risk factors for child development; (2) changes in cognitive and motor development over four months of follow-up, (3) correlation between cognitive and motor development over four months of follow-up. This is a longitudinal study with 40 infants, 20 infants of adolescent mothers and 20 of adult mothers from Porto Alegre and Butia, state of Rio Grande do Sul, Brazil. Three evaluations of motor and cognitive development were performed using the Alberta Motor Infant Scale (AIMS) and the Bayley Scale Infant Development II. Significant difference in the supine position of AIMS was observed between groups in the third evaluation. Infants of adolescent mothers showed lower scores than those of adult mothers. The motor scores of each position and total AIMS score showed significant difference during overall time and in each group. The Bayley-II mental score also showed significant difference during overall time and in each group. There was a positive, strong and significant association between AIMS and Bayley scores in all three evaluation stages as in the group of infants of adolescent and adult mothers. It was concluded that infants of adolescent mothers showed worse results in the supine position during the third evaluation than those of adult mothers. There was a significant association between motor and cognitive development in both groups of infants over time.

Fetal and Childhood Exposure to Phthalate Diesters and Cognitive Function in Children Up to 12 Years of Age: Taiwanese Maternal and Infant Cohort Study.

Few studies have examined the association between environmental phthalate exposure and children’s neurocognitive development. This longitudinal study examined cognitive function in relation to pre-and postnatal phthalate exposure in children 2–12 years old. We recruited 430 pregnant women in their third trimester in Taichung, Taiwan from 2001–2002. A total of 110, 79, 76, and 73 children were followed up at ages 2, 5, 8, and 11, respectively. We evaluated the children’s cognitive function at four different time points using the Bayley and Wechsler tests for assessing neurocognitive functions and intelligence (IQ). Urine samples were collected from mothers during pregnancy and from children at each follow-up visit. They were analyzed for seven metabolite concentrations of widely used phthalate esters. These esters included monomethyl phthalate, monoethyl phthalate, mono-butyl phthalate, mono-benzyl phthalate, and three metabolites of di(2-ethylhexyl) phthalate, namely, mono-2-ethylhexyl phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate, and mono(2-ethyl-5-oxohexyl) phthalate. We constructed a linear mixed model to examine the relationships between the phthalate metabolite concentrations and the Bayley and IQ scores. We found significant inverse associations between the children’s levels of urinary mono(2-ethyl-5-oxohexyl) phthalate and the sum of the three metabolites of di(2-ethylhexyl) phthalate and their IQ scores (β = -1.818; 95% CI: -3.061, -0.574, p = 0.004 for mono(2-ethyl-5-oxohexyl) phthalate; β = -1.575; 95% CI: -3.037, -0.113, p = 0.035 for the sum of the three metabolites) after controlling for maternal phthalate levels and potential confounders. We did not observe significant associations between maternal phthalate exposure and the children’s IQ scores. Children’s but not prenatal phthalate exposure was associated with decreased cognitive development in the young children. Large-scale prospective cohort studies are needed to confirm these findings in the future.

Plasma IL‐6 Levels are Elevated During the Third Trimester in Alcohol‐Exposed Women with Children Diagnosed with Fetal Alcohol Spectrum Disorder (FASD) Compared to Alcohol–Exposed Women with Normally Developed Children

Elevated plasma IL‐6 concentrations during pregnancy are associated with certain neurological disorders (e.g. autism and schizophrenia) in offspring. We investigated the hypothesis that IL‐6 is a risk factor in women who gave birth to a child with FASD. Alcohol‐exposed and control women were recruited during mid pregnancy (mean gestational age 20.4±7.0 wk). A subset of blood samples were obtained from women in the third trimester and analyzed for plasma cytokines. Children were examined at 6 and 12 months and were classified as having FASD if they presented with both physical features and one Bayley Score of Infant Development test below 85. There were no differences in IL‐10 or TNF‐α concentrations among the groups. In contrast, alcohol‐exposed women with children displaying features of FASD had significantly higher plasma IL‐6 levels (n=26, ‐0.21±0.07 log pg/mL) compared to alcohol‐exposed women who bore children with no features of FASD (n=25, ‐0.48±0.07 log pg/mL, p=0.007) when controlled for smoking and socioeconomic status. There were no differences in IL‐6 levels in the control women (n=13, ‐0.26±0.09 log pg/mL) compared to either alcohol‐exposed group. These data suggest that IL‐6 can be a contributor in FASD and further investigation is warranted.

Accuracy of Bayley Scores as Outcome Measures in Trials of Neonatal Therapies

Accuracy of Bayley Scores as Outcome Measures in Trials of Neonatal Therapies