Delay In Infants Research Articles

Antenatal magnesium sulfate for both tocolysis and fetal neuroprotection in premature rupture of the membranes before 32 weeks’ gestation

Objective: We aimed to assess the impact of antenatal MgSO4 therapy given to women with PPROM before 32 weeks’ gestation on latency, maternal outcomes, perinatal outcomes, and neurodevelopmental outcomes.Methods: We undertook a retrospective cohort observational study of 184 singleton pregnancies complicated by PPROM at 23°–316 weeks who were hospitalized and received magnesium therapy for tocolysis (MgSO4 group) or did not receive tocolytic therapy (no MgSO4 group) between 2005 and 2013. Furthermore, patients were subdivided into two groups based on the gestational age at the onset of PPROM (23°–276 weeks’ gestation and 28°–316 weeks’ gestation).Results: We included 184 women, of whom 143 received magnesium therapy and 41 did not. The latency period was significantly longer in the MgSO4 group compared with no MgSO4 group (7.9 ± 9.0 versus 4.0 ± 6.0 days, p = .0017). Antenatal magnesium therapy was significantly associated with decreased stillbirth (1.4% versus 14.6%, p = .0012) and perinatal mortality (7% versus 19.5%, p = .0375) without significant increase in the risk of neonatal morbidities and chorioamnionitis. However, neonates who were exposed to antenatal MgSO4 were associated with higher Mg levels (3.63 ± 1.05 mg/dl versus 2.13 ± 0.48 mg/dl, p < .0001) and phosphate levels (6.90 ± 1.36 mg/d versus 6.40 ± 1.01 mg/dl, p = .0459) than those who were not exposed. Neonates who were exposed to MgSO4 showed significantly reduced risks of IVH (20.4% versus 58.3%; RR, 0.35; 95%CI, 0.17–0.71) and PVL (27.8% versus 58.3%; RR, 0.48; 95%CI, 0.25–0.91) in the subgroup of 23°–276 weeks’ gestation. And the incidence of developmental delay in the subgroup of 23°–276 weeks’ gestation was significantly lower in the MgSO4 group (6.5% versus 36.4%; RR, 0.18; 95%CI, 0.05–0.69). However, there were no significant differences in the development of IVH, PVL, and developmental delay between the two groups for patients in the subgroup of 28°–316 weeks’ gestation. A similar trend was observed for cerebral palsy, with 22.2% of unexposed children affected compared with only 7.0% of exposed children (RR, 0.31; 95%CI, 0.10–1.00).Conclusions: Antenatal magnesium therapy in women with PPROM before 32 weeks’ gestation could prolong latency period, allowing for corticosteroid benefit. Moreover, MgSO4 showed fetal neuroprotective effects for neonatal IVH and PVL, and for developmental delay in infancy while prolonging latency. However, these benefits were primarily limited to the subgroup of 23°–276 weeks’ gestation and prolonged in utero exposure to MgSO4 was associated with bone mineralization in the neonates.

In utero exposure to fluoride and cognitive development delay in infants

The objective of this study was to evaluate the association between in utero exposure to fluoride (F) and Mental and Psychomotor Development (MDI and PDI) evaluated through the Bayley Scale of Infant Development II (BSDI-II) in infants. The sample included 65 mother-infant pairs. Environmental exposure to F was quantified in tap and bottled water samples and F in maternal urine was the biological exposure indicator; samples were collected during the 1st, 2nd and 3rd trimester of pregnancy. The mean values of F in tap water for the 1st, 2nd and 3rd trimester were 2.6±1.1mg/l, 3.1±1.1mg/l and 3.7±1.0mg/l respectively; above to 80% of the samples exceeded the reference value of 1.5mg/l (NOM-127-SSA1-1994). Regarding F in maternal urine, mean values were 1.9±1.0mg/l, 2.0±1.1mg/l and 2.7±1.1mg/l for the 1st, 2nd and 3rd trimester respectively. The infants with MDI and PDI scores less than 85 points were 38.5% and 20.9% respectively. After adjusting for potential confounding factors (gestational age, age of child, marginalization index and type of water for consumption), the MDI showed an inverse association with F levels in maternal urine for the first (β=−19.05, p=0.04) and second trimester (β=−19.34, p=0.01). Our data suggests that cognitive alterations in children born from exposed mothers to F could start in early prenatal stages of life.

What can we do for people with drug-resistant epilepsy? The 2016 Wartenberg Lecture.

Treatment goals for epilepsy are no seizures, no side effects, as soon as possible, but these goals are too often unmet. Approximately 1 million people in the United States continue to have seizures despite adequate treatment with antiseizure drugs, representing 40% of those with epilepsy, and 80% of the cost of epilepsy. Drug-resistant epilepsy (DRE) can be associated with developmental delay in infants and young children, and severe disability and morbidity in older children and adults, as well as a mortality rate 5-10 times that of the general population. While diagnosis and treatment at a full-service (levels 3 and 4) epilepsy center are demonstrated to improve seizure control, fewer than 1% of people with DRE are referred, and those who are, are referred an average of over 20 years after onset of habitual seizures. A possible reason for this is the misconception that all these epilepsy centers offer is surgery. Specialized multidisciplinary teams, consisting of neurologists, clinical neurophysiologists, neurosurgeons, neuroradiologists, psychologists, psychiatrists, social workers, and counselors, which constitute full-service epilepsy centers, can recognize and address pseudopharmacoresistance due to nonadherence, seizures that are not epilepsy, treatable underlying conditions, misdiagnosis of epilepsy syndromes, treatment with the wrong drug or wrong dosage, and lifestyle issues that are remediable. A variety of alternative treatment approaches are offered in addition to surgery, and for patients who continue to have seizures, full-service epilepsy centers have psychologists, psychiatrists, social workers, and counselors specialized in recognizing, and addressing, the psychological and social challenges experienced by people with epilepsy. Surgery for epilepsy remains, arguably, the most underutilized of all acceptable medical interventions, and the reasons for this are unclear. Often, excellent surgical candidates are not recognized as such by general neurologists, but if more patients with DRE were referred to full-service epilepsy centers, more surgical candidates would be identified by epilepsy specialists. All patients with medication-resistant epilepsy, defined as failure of 2 appropriate trials of antiseizure drugs due to inefficacy and not intolerance, who continue to be compromised by seizures deserve a timely consultation at a full-service epilepsy center. Early referral provides the best opportunity to avoid irreversible psychological and social problems, a lifetime of disability, and premature death.

Оцінка ризику значної затримки розвитку дітей, які народились з дуже і надзвичайно малою масою тіла

Оцінка ризику значної затримки розвитку дітей, які народились з дуже і надзвичайно малою масою тіла

A three-tier algorithm for guanidinoacetate methyltransferase (GAMT) deficiency newborn screening.

Guanidinoacetate methyltransferase (GAMT) deficiency is a rare disorder of creatine biosynthesis presenting with epilepsy and developmental delay in infancy. Excellent developmental outcomes have been reported for infants treated from birth due to a family history. The BC Newborn Screening Program initiated a 3year pilot screening study for GAMT deficiency to evaluate the performance of a novel three-tiered screening approach. Over 36months all bloodspots submitted for routine newborn screening were included in the pilot study (de-identified). Initial GAA measurement was integrated into the standard acylcarnitine/amino acid first-tier assay. All samples with elevated GAA were subjected to second-tier GAA analysis by LC-MS/MS integrated into an existing branched-chain amino acid (MSUD) method. GAMT gene sequencing was completed on the original bloodspot for all specimens with elevated GAA on the second-tier test. The protocol allowed for re-identification for treatment of any specimen with one or two likely pathogenic GAMT mutations. Over the study period 135,372 specimens were tested with 259 (0.19%) over the first-tier GAA cut-off. The second-tier assay removed an interference falsely elevating GAA levels, and only 3 samples required genotyping. No mutations were identified in any samples, all were deemed negative screens and no follow-up was initiated. A three-tier algorithm for GAMT newborn screening showed excellent test performance with zero false positives. No cases were detected, supporting a low incidence for this disorder. Given the low incremental costs and evidence of positive outcomes with early intervention, GAMT deficiency remains an excellent candidate for newborn screening.

Genotype–phenotype correlation of Charcot-Marie-Tooth type 1E patients with PMP22 mutations

Charcot-Marie-Tooth disease type 1E (CMT1E) is a demyelinating motor and sensory neuropathy with peripheral myelin protein 22 (PMP22) point mutations. The objective of this study was to identify genetic causes and determine genotype–phenotype correlation in two Korean demyelinating CMT patients based on whole exome sequencing (WES), histological examination of distal sural nerve, and magnetic resonance imaging (MRI) of leg. WES revealed two de novo PMP22 mutations in the two demyelinating CMT patients, including one novel p.Leu82Pro (c.245T>A) mutation in one patient and one previously reported p.Ser72Leu (c.215C>T) mutation in the other patient. Both mutation sites were located in the well conserved second transmembrane domain. No control had the same mutations. The affected individual with the novel p.Leu82Pro mutation showed early onset, scoliosis, and sensory ataxia with ability to walk without assistance. Histopathological examination showed severe damage of myelin and axons. No compound muscle action potentials (CMAPs) were evoked in the upper or lower limb nerves. Leg MRIs revealed mild fatty infiltration of the bilateral peronei muscles consistent with clinical manifestations. The patient with the p.Ser72Leu mutation showed developmental delay in infancy. No CMAPs were elicited. However, she was also able to walk without assistance. In spite of markedly severe electrophysiological defects, leg MRIs showed almost normal findings except slight muscle atrophies of the lower legs. Both patients presented similar clinical features including no CMAPs in electrophysiological tests and mild fatty replacement in the lower leg MRI. Therefore, there was a good genotype–phenotype correlation in both cases.

Prevalence and nature of communication delays in a South African primary healthcare context

Background . Communication delays are the most common impairment in early childhood and have a negative effect on long-term academic, psychological and social development. Baseline prevalence of communication delays or disorders enables adequate planning of service delivery and successful implementation of intervention strategies, to reduce disorder prevalence. Objective . To determine the prevalence and describe the nature of communication delays in infants aged 6 - 12 months in underserved communities in South Africa (SA). Method . A parent interview and the Rossetti Infant-Toddler Language Scale (RITLS) were used to collect data from the caregivers of 201 infants aged 6 - 12 months by means of convenience sampling at primary healthcare facilities in the Tshwane district, SA. Results . Thirteen percent (n=26) of infants were diagnosed with communication delay. Associations affecting language delays were established for three risk factors (i.e. housing status, age of mother and number of siblings). The effect of combined risk factors on language development revealed that an infant was at greatest risk (27% probability) of developing a language delay when: (i) mothers were between the ages of 19 and 34 years; (ii) parents owned their own home; and (iii) there were three or more children in the household. Conclusion . The prevalence of communication delays in the sample population was high, possibly because the majority of infants were exposed to risk factors. The implementation of preventive measures such as awareness campaigns and developmental screening and surveillance should be considered in the SA primary healthcare context.

Risks for communication delays and disorders in infants in an urban primary healthcare clinic

Background. Many risk factors may result in a communication delay. Reliable identification methods are essential to identify infants at risk of communication difficulties in the primary healthcare context. Literature on identifying both at-risk and established risk factors associated with communication disorders in South Africa is limited. Objective. To identify and describe risk factors for communication delays in infants 0 - 12 months of age at Daspoort Polyclinic in Gauteng. Methods. A structured interview schedule was utilised to conduct an interview with the caregiver participants. Convenience sampling was used to select 96 caregiver participants. Results. The results obtained indicated that all infant participants presented with exposure to one or more risk factors that may possibly impact communication development. High frequencies of risk factors included colds and/or flu during pregnancy, previous miscarriages, maternal smoking, low educational levels and unemployment. Conclusion. The high frequency of at-risk conditions within the Daspoort population justifies the importance of implementation of early communication intervention services in primary healthcare.

Risks for communication delays and disorders in infants in an urban primary healthcare clinic

Background. Many risk factors may result in a communication delay. Reliable identification methods are essential to identify infants at risk of communication difficulties in the primary healthcare context. Literature on identifying both at-risk and established risk factors associated with communication disorders in South Africa is limited. Objective. To identify and describe risk factors for communication delays in infants 0 - 12 months of age at Daspoort Polyclinic in Gauteng. Methods. A structured interview schedule was utilised to conduct an interview with the caregiver participants. Convenience sampling was used to select 96 caregiver participants. Results. The results obtained indicated that all infant participants presented with exposure to one or more risk factors that may possibly impact communication development. High frequencies of risk factors included colds and/or flu during pregnancy, previous miscarriages, maternal smoking, low educational levels and unemployment. Conclusion. The high frequency of at-risk conditions within the Daspoort population justifies the importance of implementation of early communication intervention services in primary healthcare.

Early detection of communication delays with the PEDS tools in at-risk South African infants.

BackgroundPrevalence of communication delays or disorders is increasing, possibly because of various environmental risk factors. Selection and implementation of effective screening tools are important to detect at-risk infants as early as possible. This study aimed to evaluate the accuracy of the Parents’ Evaluation of Developmental Status (PEDS), PEDS-Developmental Milestones and PEDS tools to detect communication delays in infants (6–12 months) in a South African primary healthcare context.MethodA comparative study design evaluated the accuracy of the PEDS tools to detect communication delays, using an internationally accepted diagnostic assessment tool, the Rossetti Infant-Toddler Language Scale (RITLS). A convenience sample of 201 infants was selected at primary healthcare clinics.ResultsExpressive and receptive language sensitivity scores were low across all three screens (ranging between 14% and 44%). The PEDS tools had high sensitivity (71%) and specificity (73%) ratings for the receptive and expressive language and socio-emotional domain in combination.ConclusionIn the sample population, the PEDS tools did not accurately detect receptive and expressive language delays; however, communication delays in general were identified. Future research determining accuracy of the PEDS, PEDS-Developmental Milestones and PEDS tools for children aged 2–5 years in detecting communication delays should be prioritised.

Differences in object sharing between infants at risk for autism and typically developing infants from 9 to 15 months of age

Object sharing abilities of infants at risk for autism (AR infants) and typically developing (TD) infants were compared from 9 to 15 months of age. Specifically, we examined the effects of infants’ locomotor abilities on their object sharing skills. 16 TD infants and 16 AR infants were observed during an “object sharing” paradigm at crawling and walking ages. Overall, AR walking infants demonstrated lower rates of object sharing with caregivers compared to TD walking infants. Specifically, AR walking infants had lower rates of giving and approaches toward caregivers compared to TD walking infants. AR walking infants also had lower step rates toward task-appropriate targets, i.e. caregivers and objects compared to TD walking infants. No group differences in object sharing were observed at crawling ages. Object sharing could be a valuable context for early identification of delays in infants at risk for developing Autism spectrum disorder.

Infant vaccination timing: Beyond traditional coverage metrics for maximizing impact of vaccine programs, an example from southern Nepal

BackgroundImmunization programs currently measure coverage by assessing the proportion of children 12–24 months who have been immunized but this does not address the important question of when the scheduled vaccines were administered. Data capturing the timing of vaccination in first 6 months, when severe disease is most likely to occur, are limited. ObjectiveTo estimate the time to Bacillus Calmette–Guérin (BCG) (recommended at birth), diphtheria-tetanus-pertussis-H, influenza b-hepatitis B (DTP-Hib-HepB), and oral polio vaccine (OPV) (recommended at 6, 10, and 14 weeks) vaccinations and risk factors for vaccination delay in infants <6 months of age in a district in southern Nepal where traditional coverage metrics are high. Design/methodsInfants enrolled in a randomized controlled trial of maternal influenza vaccination were visited weekly at home from birth through age 6 months to ascertain if any vaccinations had been given in the prior week. Infant, maternal, and household characteristics were recorded. BCG, DTP-Hib-HepB, and OPV vaccination coverage at 4 and 6 months was estimated. Time to vaccination was estimated through Kaplan–Meier curves; Cox-proportional hazards models were used to examine risk factors for delay for the first vaccine. ResultsThe median age of BCG, first OPV and DTP-Hib-HepB receipt was 22, 21, and 18 weeks, respectively. Almost half of infants received no BCG by age 6 months. Only 8% and 7% of infants had received three doses of OPV and DTP-Hib-HepB, respectively, by age 6 months. ConclusionA significant delay in receipt of infant vaccines was found in a prospective, population-based, cohort in southern Nepal despite traditional coverage metrics being high. Immunization programs should consider measuring time to receipt relative to the official schedule in order to maximize benefits for disease control and child health.

Clinical correlation between hearing impairment and developmental delay in infants: a prospective cohort study

Background: Significant hearing loss is a common disorder at birth, occurring in 1 to 6 per 1000 newborns. Hearing loss leads to delayed language development, difficulties with behavior and psychosocial interactions, and poor academic achievement. Universal newborn hearing screening (UNHS) identifies congenital hearing loss at an earlier age, allowing for earlier interventions. This study aims to assess hearing of all newborns in our hospital, and to find the prevalence of hearing impairment to find out the delay in development for those babies with hearing impairment, and its correlation. Methods: A prospective cohort study conducted among 1000 newborns in our hospital that were screened for hearing loss. Hearing impaired babies were followed up and developmental assessment was done. Results: The prevalence of hearing impairment was found to be 0.5%. All the hearing impaired term new born had developmental delay in all four domains. Conclusions: Hearing impairment is a significant problem in newborn. Hearing impairment can cause delayed development in all domains. So all newborns should undergo hearing screening at birth, and should be kept under follow-up for developmental assessment.

Investigating the Influences of Language Delay and/or Familial Risk for Dyslexia on Brain Structure in 5-Year-Olds.

Early language delay has often been associated with atypical language/literacy development. Neuroimaging studies further indicate functional disruptions during language and print processing in school-age children with a retrospective report of early language delay. Behavioral data of 114 5-year-olds with a retrospective report of early language delay in infancy (N = 34) and those without (N = 80) and with a familial risk for dyslexia and those without are presented. Behaviorally, children with a retrospective report of early language delay exhibited reduced performance in language/reading-related measures. A voxel-based morphometry analysis in a subset (N = 46) demonstrated an association between reduced gray matter volume and early language delay in left-hemispheric middle temporal, occipital, and frontal regions. Alterations in middle temporal cortex in children with a retrospective report of early language delay were observed regardless of familial risk for dyslexia. Additionally, while children with isolated familial risk for dyslexia showed gray matter reductions in temporoparietal and occipitotemporal regions, these effects were most profound in children with both risk factors. An interaction effect of early language delay and familial risk was revealed in temporoparietal, occipital, and frontal cortex. Our findings support a cumulative effect of early behavioral and genetic risk factors on brain development and may ultimately inform diagnosis/treatment.

Identifying Infants and Toddlers at High Risk for Persistent Delays.

Little is known about the extent to which a developmental delay identified in infancy persists into early childhood. This study examined the persistence of developmental delays in a large nationally representative sample of infants and toddlers who did not receive early intervention. In a sample (n ≈ 8700) derived from the early childhood longitudinal study, birth cohort, we examined developmental changes between 9 and 24 months. Motor and cognitive delays were categorized as none, mild, and moderate/severe. Adjusted ordinal logistic regression models estimated the likelihood of worse developmental delay at 24 months. About 24 % of children had a cognitive delay and 27 % had a motor delay at either 9- or 24-months. About 77 % of children with mild and 70 % of children with moderate/severe cognitive or motor developmental delay at 9-months had no delay at 24-months. Children with mild cognitive delay at 9-months had 2.4 times the odds of having worse cognitive function at 24-months compared to children with no cognitive delay at 9 months. Children with moderate/severe cognitive delay at 9-months had three times the odds of having worse cognitive abilities at 24-months than children who had no cognitive delay at 9-months. Similar results were found for motor skills. Developmental delays in infants are changeable, often resolving without treatment. This work provides knowledge about baseline trajectories of infants without and without cognitive and motor delays. It documents the proportion of children's delays that are likely to be outgrown without EI and the rate at which typically-developing infants are likely to display developmental delays at 2-years of age.

Risks associated with communication delays in infants from underserved South African communities.

BackgroundFor optimal development young children need warm, responsive, enriched and communicative environments for learning social, language, and other skills. Infants and toddlers exposed to psychosocial risk lack enriched environments and may present with communication delays.AimTo investigate the relationship between psychosocial risks and communication delays in infants from underserved communities in South Africa.SettingPrimary healthcare facilities in Tshwane district, South Africa.MethodsA parent interview and Rossetti Infant Toddler Language Scales were used to collect data from caregivers of 201 infants aged 6–12 months, selected through convenience sampling. Associations between communication delays and risks were determined (Chi-square and Fisher's exact tests). A log-linear model analysis was used to model the simultaneous effect of significant risks on the probability of having communication delays.ResultsCommunication delays were present in 13% of infants. Infants with two or more siblings, born from mothers aged 18–29 years who own their house, had a 39% chance of presenting with communication delays.ConclusionDevelopmental screening and early intervention is important in primary healthcare contexts in South Africa, as a clear relationship has been established between three risk factors and communication delays in infants.ContexteRisques associés à des retards de communication verbale chez les nourrissons des communautés sud-africaines non desservies.Pour s'épanouir complètement les jeunes enfants ont besoin d'un environnement chaud, réceptif, enrichi et communicatif pour apprendre le langage social et d'autres compétences. Les nourrissons et les tout-petits exposés à des risques psychosociaux souffrent d'un manque d'environnements enrichissants et pourraient souffrir de retards de communication verbale.ObjectifPour étudier la relation entre les risques psychosociaux et les retards de communication verbale chez les nourrissons des communautés non desservies en Afrique du Sud.LieuServices de soins primaires dans le district de Tshwane, en Afrique du Sud.MéthodesUne entrevue avec les parents et l'Echelle de Compétence linguistique pour les Nourrissons de Rossetti ont été utilisés pour rassembler les données de 201 nourrissons de 6 à 12 mois provenant de leurs gardiens, sélectionnés au moyen d'échantillonnages de proximité. On a remarqué un lien entre les retards et les risques de communication verbale (tests Chi carré et de Fisher). On a utilisé un modèle d'analyse log-linéaire pour modéliser l'effet simultané des risques importants sur la probabilité d'avoir des retards de communication verbale.RésultatsOn a trouvé des retards de communication verbale chez 13% des nourrissons. Les nourrissons qui vivent avec deux frères ou sœurs ou plus, nés de mères âgées de 18 à 29 ans qui ont leur propre maison, avaient 39% plus de chance d'avoir des retards de communication verbale.

Retrospective Analysis of Motor Development in Infants at High and Low Risk for Autism Spectrum Disorder.

To measure upper-extremity and gross motor skill development in infants with and without risk factors for autism spectrum disorder (ASD). Data were coded retrospectively from 39 infants who participated in longitudinal structured early developmental assessments. Twenty-five infants were at high risk for ASD, and the remaining 14 infants were classified as low risk. Upper-extremity and motor skill development were coded at ages 2, 4, and 6 mo. Five infants went on to receive an ASD diagnosis at age 2-4 yr. Infants at high risk for ASD demonstrated fewer midline behaviors with the upper extremities and delayed motor skill development than the low-risk group. Differences in motor skills were most apparent at age 4 mo. Early monitoring for motor delay in infants at high risk for ASD is warranted. Midline control and play with the upper extremities and overall motor skill development are possible assessment and therapeutic targets.

Correlation Between Mothers' Depression and Developmental Delay in Infants Aged 6-18 Months.

Background:Regarding the importance of children’s developmental status and various factors that delay their development, this study was conducted to examine the correlation between mothers’ depression levels and the developmental delay in infants.Methods:This descriptive study was performed on 1053 mothers and their infants’ age 6 to18 month-old in medical centers affiliated with Shahid Beheshti University of Medical Sciences, Iran, in 2014-2015. The participants were selected through multi-stage random sampling. The following instruments were used in this study: A demographic and obstetric specification questionnaire, infant specification questionnaire, the Beck Depression Inventory, and the Ages and Stages Questionnaire to determine the status of the children’s development. The data were analyzed using SPSS19 software, Mann-Whitney; independent T-test and logistic-Regression tests were used.Results:The results showed that 491 mothers (46.7%) suffered mild to extremely severe depression. The delay in infant development was 11.8%. The Mann–Whitney test showed a correlation between mothers’ depression levels and developmental delay in infants (P=0.001). Moreover, there was a significant correlation between mothers’ depression and developmental delays in gross-motor and problem-solving skills (P<0/05). In logistic model age of infants showed significant correlation with developmental delay (P=0.004 OR=1.07), but unwanted pregnancy, gender of infants, type of delivery and socioeconomic status had no correlation with developmental delay.Conclusion:Given the correlation between mothers’ depression and infant development, it is recommended to screen mothers for depression in order to perform early interventions in developmental delay.

Measuring pragmatic skills: early detection of infants at risk for communication problems.

For the early detection of children who are at risk of communication problems, we need appropriate assessment instruments. Two Dutch-language standardised screening instruments are available: the Dutch version of the Non Speech Test (NNST) and the Dutch version of the MacArthur Communicative Development Inventories (N-CDIs). These instruments gauge the precursors of language development, early vocabulary and early morphosyntactic skills. However, they do not adequately assess pragmatic skills. To develop a norm-referenced instrument to examine the pragmatic skills of Dutch-speaking infants that is translatable into other languages. The instrument 'Lists for the Evaluation of Pragmatic Skills in Infants' is based on 'The Pragmatics Profile of Everyday Communication Skills in Children' Dewart and Summers (1995). We translated the instrument into Dutch and transformed the structured interview format into a parent questionnaire. The parent questionnaire-Evaluatie van Pragmatische Vaardigheden (EPV)-was created following extensive research on item selection, norm table development, and reliability and validity studies. The EPV1 is applicable to children 6-15 months old; EPV2 is applicable to children 16-30 months old. We developed norm tables for the number of pragmatic skills achieved by the child and also for how and to what extent the skills are exhibited. For the norming study of EPV1 and EPV2 we included 390 and 534 infants respectively. The reliability scores are high for both lists. Concept validity and criterion validity studies demonstrate adequate results for the overall lists, the subscale components and specific items. The parent questionnaire is a valuable tool that specifically targets pragmatic skills in infants. The instrument can detect communication delays in infants. It is translatable into other languages and avoids having the infant examined directly by a stranger.

Male infants and infants born small for gestational age are at risk of fine motor delay in infancy

introducing the RISQ to the department. Notes were sampled until 50 RISQ forms were retrieved for each sample. Results: The level of uptake was 100% (n= 46: 25 and 21 patients for each sample). 84.7% of the combined sampled notes had the RISQ at their first appointment with 98.2% present at follow-up appointments (relating to 22 patients). At their first appointments, patients identified an impact on 65.4% of the domains, with missing data (MD) for 7.7%. 38.1% of the domains had written comments with 51.3% patients describing a question or concern (MD=25.6%). Expectations of treatment were described by 71.8% of patients. At follow-up, the level of completion for the impact across the four domains was 97.7% with 73.6% identified as affected and 25.5% having written comments. On-going or new questions/concerns were identified on 27.3% of the follow-up forms, with written questions or concerns about treatment on 7.4% of forms. There was 99.3% compliance for completion of all of the numerical rating scales. Conclusion(s): This notes audit indicated better uptake for the RISQ at follow-up appointments than first, with high levels of completion. Findings from this audit (and concurrent focus groups) resulted in changes to wording of the RISQ and strategies for distribution prior to therapy. For comparison, thesemethods are currently being applied to evaluate engagement in two sites naive to the RISQ. Future research could focus on exploration of the psychometric properties of the RISQ and its role for influencing patient care and outcomes. Implications: The RISQ, a patient-centred questionnaire inviting written comments, previously demonstrated user acceptability: this pragmatic service-evaluation demonstrates high levels of patient engagement. Web-based articles and training videos, and further research (with publication and conference presentations) will need to be undertaken to encourage further uptake and determine its value in clinical practice.