Development Index Scores Research Articles

Neurodevelopmental evaluation of very low birth weight infants with sepsis at 18 to 24 months’ corrected age

In this cohort study, neurodevelopmental outcome of 20 of 24 surviving very low birth weight infants with sepsis followed up between 2008 and 2009 was compared with 20 control (uninfected infants). We found that plasma interleukin 6 and C reactive protein values were negatively correlated with mental developmental index scores (r = - 0.33, P = 0.03 and r = - 0.40, P = 0.01, respectively) at 18 to 24 months' corrected age. The results of this study indicate that sepsis experienced in the neonatal period seems to be related to low mental developmental index scores at 18 to 24 months' corrected age.

Developmental Status of 1-Year-Old Infants Fed Breast Milk, Cow’s Milk Formula, or Soy Formula

Although soy formula has been reported to support normal development, concerns exist regarding potential adverse developmental effects of phytochemicals associated with soy protein. This study characterized developmental status (mental, motor, and language) of breastfed (BF), milk-based formula-fed (MF), or soy protein-based formula-fed (SF) infants during the first year of life. Healthy infants (N = 391) were assessed longitudinally at ages 3, 6, 9, and 12 months. Development was evaluated by using the Bayley Scales of Infant Development and the Preschool Language Scale-3. Mixed effects models were used while adjusting for socioeconomic status, mother's age and IQ, gestational age, gender, birth weight, head circumference, race, age, and diet history. No differences were found between formula-fed infants (MF versus SF). BF infants scored slightly higher than formula-fed infants on the Mental Developmental Index (MDI) score at ages 6 and 12 months (P < .05). Infants who were breastfed also had higher Psychomotor Development Index scores than SF infants at age 6 months and slightly higher Preschool Language Scale-3 scores than MF infants at ages 3 and 6 months (P < .05). In addition, BF infants had a lower probability to score within the lower MDI quartile compared with MF infants and a higher likelihood to score within the upper quartile for the MDI and Psychomotor Development Index compared with SF infants. This unique study showed that all scores on developmental testing were within established normal ranges and that MF and SF groups did not differ significantly. Furthermore, this study demonstrated a slight advantage of BF infants on cognitive development compared with formula-fed infants.

Neurologic Outcomes in Very Preterm Infants Undergoing Surgery

To investigate the relationship between surgery in very preterm infants and brain structure at term equivalent and 2-year neurodevelopmental outcome. A total of 227 infants born at <30 weeks gestation or at a birth weight of <1250 g were prospectively enrolled into a longitudinal observational cohort for magnetic resonance imaging and developmental follow-up. The infants were categorized retrospectively into either a nonsurgical group (n=178) or a surgical group (n=30). Nineteen infants were excluded because of incomplete or unsuitable data. The surgical and nonsurgical groups were compared in terms of clinical demographic data, white matter injury, and brain volume at term. Neurodevelopmental outcome was assessed at age 2 years. Compared with the nonsurgical group, the infants in the surgical group were smaller and more growth-restricted at birth, received more respiratory support and oxygen therapy, and had longer hospital stays. They also had smaller brain volumes, particularly smaller deep nuclear gray matter volumes. Infants who underwent bowel surgery had greater white matter injury. Mental Developmental Index scores were lower in the surgical group, whereas Psychomotor Developmental Index scores did not differ between the groups. The Mental Developmental Index difference became nonsignificant after adjustment for confounding variables. Preterm infants exposed to surgery and anesthesia had greater white matter injury and smaller total brain volumes, particularly smaller deep nuclear gray matter volumes. Surgical exposure in the preterm infant should alert the clinician to an increased risk for adverse cognitive outcome.

Length of prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants: effects on neonatal adaptation and psychomotor development

This study evaluated the question whether length of in utero exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants might affect neonatal outcome and psychomotor development in infancy. Birth outcome was determined in the offspring of 55 women with major depressive disorder who used SSRI medication for different durations during their pregnancies. At an average age of 14months, children underwent a pediatric examination and an evaluation with the Bayley Scales of Infant Development (BSID-II). Duration of in utero exposure to SSRIs was negatively associated with total Apgar scores, specifically the activity subscale. Odds ratios for a low score (<2) on this scale were 3.8 and 6.0 at 1 and 5min, respectively. Newborns with longer exposure were more often admitted to the Neonatal Intensive Care Unit (p < .03). Mental Development Index scores of the infants were not associated with the length of gestational exposure to SSRIs. A longer duration of exposure increased the risk for lower Psychomotor Developmental Index and Behavioral Rating Scale scores in infancy (p = 0.012 and p = 0.007, respectively) on the BSID-II. The findings provide evidence that the length of prenatal SSRI antidepressant use can affect neonatal adjustment and can have an effect on psychomotor test scores in infancy. Importantly, the children's mental development and motor function by neurological examination were within the normal range. Timing of exposure to SSRIs during susceptible periods of fetal development and variations in the severity of maternal depression may have contributed to the associations.

Secondhand smoke exposure during pregnancy and infantile neurodevelopment

During prenatal development, the nervous system may be more susceptible to environmental toxicants, such as secondhand smoke. The authors assessed the effects of prenatal and postnatal secondhand smoke exposure on the neurodevelopment of 6-month infants. The subjects were 414 mother and infant pairs with no medical problems, taken from the Mothers' and Children's Environmental Health study. Prenatal and postnatal exposures to secondhand smoke were determined using maternal self-reports. Examiners, unaware of exposure history, assessed the infants at 6 months of age using the Bayley Scales of Infant Development. Bayley scores were compared for secondhand smoke exposed and unexposed groups after adjusting for potential confounders. Multiple logistic regression analysis was carried out to estimate the risk of developmental delay posed by SHS exposure. The multivariate model included residential area, maternal age, pre-pregnancy body mass index, education, income, infant sex, parity, birth weight, and type of feeding. After adjusting for covariates, secondhand smoke exposure during pregnancy was found to be related to a decrease in mental developmental index score, but not to a decrease in psychomotor developmental index score. In addition, secondhand smoke exposure during pregnancy was found to increase the risk of developmental delay (mental developmental index score ≤85) at 6 months. This study suggests that the infants of non-smoking women exposed to secondhand smoke are at risk of neurodevelopmental delay.

Neurodevelopmental Outcomes of Triplets or Higher-Order Extremely Low Birth Weight Infants

Extremely low birth weight twins have a higher rate of death or neurodevelopmental impairment than singletons. Higher-order extremely low birth weight multiple births may have an even higher rate of death or neurodevelopmental impairment. Extremely low birth weight (birth weight 401-1000 g) multiple births born in participating centers of the Neonatal Research Network between 1996 and 2005 were assessed for death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined by the presence of 1 or more of the following: moderate to severe cerebral palsy; mental developmental index score or psychomotor developmental index score less than 70; severe bilateral deafness; or blindness. Infants who died within 12 hours of birth were excluded. Maternal and infant demographic and clinical variables were compared among singleton, twin, and triplet or higher-order infants. Logistic regression analysis was performed to establish the association between singletons, twins, and triplet or higher-order multiples and death or neurodevelopmental impairment, controlling for confounding variables that may affect death or neurodevelopmental impairment. Our cohort consisted of 8296 singleton, 2164 twin, and 521 triplet or higher-order infants. The risk of death or neurodevelopmental impairment was increased in triplets or higher-order multiples when compared with singletons (adjusted odds ratio: 1.7 [95% confidence interval: 1.29-2.24]), and there was a trend toward an increased risk when compared with twins (adjusted odds ratio: 1.27 [95% confidence: 0.95-1.71]). Triplet or higher-order births are associated with an increased risk of death or neurodevelopmental impairment at 18 to 22 months' corrected age when compared with extremely low birth weight singleton infants, and there was a trend toward an increased risk when compared with twins.

Melatonin and Mental Capacities in Newborn Infants

To investigate the role of melatonin in the emergence of mental capacities in the newborn infant. Assessment of Preterm Infant Behavior examination was performed at 2 weeks post-term age for 39 (21 preterm and 18 term) infants. 6-Suphatoxymelatonin from nocturnal urine samples was analyzed by enzyme-linked immunosorbent assays, and the Mental Developmental Index, assessed by Bayley scales, was correlated at 4, 6, and 9 months' corrected age. Multivariate analysis of variance with repeated measures showed that improved autonomic function at 2 weeks of age was associated with higher Mental Developmental Index scores at 9 months when related to the amount of melatonin at 4, 6, and 9 months of age. Early compromised autonomic system function in preterm infants is associated with lower mental capacities and is related to lower melatonin levels at later ages.

Have school-age cognitive outcomes improved for preterm infants in the last decade of neonatal care?

Neurodevelopmental follow-up studies of very preterm infants over the years have shown a high prevalence of neurological, sensory, cognitive, and behavioural deficits. While there has been good evidence to show the reduction in neonatal mortality in these infants following the introduction of neonatal intensive care, the evidence for an improvement in disability rates in more recent cohorts is less compelling. There may be many reasons for the inconsistencies in the results published, but variation in definitions of deficits, cohort selection, individual exclusions, assessments used, and the age at which they are applied may all operate. Many reports look for associations between perinatal variables such as illness severity, brain scans or post-natal growth, and outcomes. Whilst significant relationships are often found, they are rarely useful as precise predictors of future disability. The widescale use of cranial imaging by ultrasound and magnetic resonance imaging in preterm infants in the past couple of decades have helped to explain the connections between neonatal illness in this high-risk population and subsequent neurological and cognitive deficits. White matter damage, whether from periventricular haemorrhage, periventricular leukomalacia, or simply diffusely poor myelination is common, and significantly associated with later function. Poor white matter development in early life is associated with lower grey matter volumes later. Early white matter damage is particularly related to inflammation in the preterm and chorioamnionitis, later sepsis, or necrotizing enterocolitis markedly increase the risk of it occurring. Antenatal steroid use is associated with fewer white matter lesions, and its use has been shown to equate with better developmental outcomes. Its wider use may have contributed to any improvements in outcome seen in the most recent years, as may better management of neonatal sepsis. Lind et al. describe a Finnish cohort of very low birthweight infants born in 2001 to 2003 and followed up at 5 years together with term controls. They found, as expected, lower scores in the preterm children compared with the term controls on most of the sub-sets of the NEPSY-II, but the mean IQ score for the preterm children was 100. They conclude that as the cohort was born in this century, these results represent evidence for improved outcomes for neonatal care in recent years. In 2007, Wilson-Costello reviewed the published evidence for improved outcomes after intensive care in preterm infants born from 1959 to 2002. For neurological impairment there was sufficient evidence to suggest that it had shown a significant decrease in the most recent periods reported. All studies reported poorer cognitive abilities in preterm infants, and no real evidence that these results were improving over time. The most recent longitudinal study of outcomes in preterm infants (<1000g) compared results at 20 months from 1982 to 1989, 1990 to 1999, and 2000 to 2002. The latter period showed significantly better neurodevelopmental outcomes than the previous period, including a small but significant increase in Psychomotor Developmental Index score (but not Mental Developmental Index score) on the Bayley-II scale. These improved results were accompanied by fewer lesions noted on cranial ultrasound scans in the neonatal period. Can the results from this paper be used as evidence that cognitive outcome for Finnish preterm children, and especially those of lowest gestation have improved in the last decade? I think not. The relatively good performance of the very low gestation infants can be attributed to the exclusion of untestable children instead of including them as having a nominal score of say less than 50. When the NEPSY-II scores were examined the preterm infants performed significantly less well than term-born children. The IQ test scores of the preterm infants were also significantly poorer than the controls. The difference was due to the high mean IQ scores of the term children, which were nearly 1 SD above the standardized test mean. It emphasizes the importance of controls in such studies. As the authors suggest, this is almost certainly an example of the Flynn effect where mean IQ scores appear to creep upwards over time. We will need to await larger and longitudinal studies to confirm whether neonatal care improves cognitive outcome as well as survival and cerebral palsy rates.

Impact of maternal subclinical hypothyroidism during the first trimester on brain development of the offspring： a prospective study

Objective To assess the effects of maternal subclinical hypothyroidism （SCH） during the first trimester on neuropsychological development of the offspring by 20-30 months. Methods In this study, 1 761 pregnant women from 10 hospitals with about 8 weeks of gestation were enrolled. Urinary iodine excretion and serum thyrotropin （ TSH ）, free thyroxine （ FT4 ）, and thyroid peroxidase antibody （ TPOAb ） levels were determined in all subjects. Pregnant women with SCH （TSH≥2.5 mIU/L） were divided into two subgroups using trimester-specific thyroid function reference： group A （2.5 mIU/L≤TSH〈3.93 mIU/L, 18 cases）, and group B （TSH ≥3.93 mIU/L, 20 eases）. Thirty euthyroid and TPOAb-negative women from the same cohort were selected as controls. Intellectual and motor development score evaluations were performed in the children by 20-30 months of age. Results Children of women with SCH and subgroups A and B had lower mean intelligence scores 6.55,3.39, and 9.40 points compared with those of the control group （P=0. 001, P=0. 125, and P〈0. 001 ）; the respective mean motor scores were 6.31,4.35, and 8.07 points being lower than that of the control （ P=0. 003,P=0. 070, and P=0. 001 ）. Intelligence scores and motor scores were negatively correlated with TSH levels （r=-0.425, P〈0. 001 and r=-0. 394, P=0. 001 ）. Multiple group comparisons revealed that differences of TSH affected intelligence and motor scores （F=9. 277, P〈0. 001 and F=5. 909, P=0. 004）. Ordinal logistic regression analysis showed that possibilities for the reduction of filial mental development index （ MDI ） and psychomotor development index （ PDI ） scores in SCH with maternal TSH levels≥3.93 mIU/L were 8.66 and 6.27 times that of controls （ OR = 8.66,95% CI 2.72-27.57, OR =6.27,95% CI 2.03-19.34 ）. Conclusion Maternal elevated TSH levels diagnosed by trimester-specific reference during early gestation are independently associated with lowered filial neurodevelopment scores by 20-30 months. Key words: Early, pregnancy; Subclinical hypothyroidism; Brain development

Contralateral MRI abnormalities affect seizure and cognitive outcome after hemispherectomy

To explore whether EEG and MRI abnormalities in the "healthy" hemisphere influence seizure and cognitive outcome after functional hemispherectomy. This is a retrospective consecutive cohort study of 43 children who underwent functional hemispherectomy between 1994 and 2008. Results of preoperative EEG recordings were reviewed for the existence of (inter)ictal epileptic or background abnormalities in the contralateral hemisphere. Preoperative MRIs were reexamined for the existence of unequivocal contralateral abnormalities. Postoperative seizure status was assessed, and of 34 children, IQ or mental developmental index (MDI) scores were obtained preoperatively and postoperatively. Seizure freedom was defined as Engel 1A. Contralateral EEG and MRI abnormalities were studied in relation to seizure and cognitive outcome. Thirty-three children achieved seizure freedom (77%). Of the 11 patients with contralateral MRI abnormalities, only 45% were seizure free, compared with 88% of the 32 patients without contralateral MRI lesions (p = 0.030). Children with contralateral MRI abnormalities more often were severely retarded after surgery (MDI/IQ <55; 90% vs 42%, p = 0.030). Postoperative MDI/IQ scores improved in none of the children with, but in 38% of those without contralateral MRI abnormalities (p = 0.034). Contralateral epileptic or background EEG abnormalities did not affect seizure outcome or postoperative cognitive performance. Four of 6 children with bilateral epileptic encephalopathy reached seizure freedom. Unambiguous contralateral MRI abnormalities are significantly associated with seizure recurrence, severe mental delay, and lack of cognitive improvement and may be considered a relative contraindication for hemispherectomy. Contralateral EEG abnormalities do not negatively influence postsurgical outcome.

Early Intervention Improves Cognitive Outcomes for Preterm Infants: Randomized Controlled Trial

The goal was to examine the effectiveness of an early intervention on cognitive and motor outcomes at corrected ages of 3 and 5 years for children with birth weights (BWs) of <2000 g. A randomized controlled trial of a modified version of the Mother-Infant Transaction Program was performed. Outcomes were assessed with the Bayley Scales of Infant Development II and the Wechsler Preschool and Primary Scale of Intelligence-Revised at 3 and 5 years, respectively. McCarthy Scales of Children's Abilities and the grooved pegboard test were used to test motor outcomes at 5 years. A total of 146 infants were assigned randomly (intervention group: 72 infants; control group: 74 infants). The mean BWs were 1396 ± 429 g for the intervention group and 1381 ± 436 g for the control group. After adjustment for maternal education, a nonsignificant difference in Mental Developmental Index scores at 3 years of 4.5 points (95% confidence interval: -0.3 to 9.3 points) in favor of the intervention group was found, whereas the intervention effect on full-scale IQ scores at 5 years was 6.4 points (95% confidence interval: 0.6-12.2 points). Significantly more children in the intervention group had IQ scores of ≥ 85 at 3 and 5 years. There were no differences between the groups with respect to motor outcomes. This modified version of the Mother-Infant Transaction Program improved cognitive outcomes at corrected age of 5 years for children with BWs of <2000 g.

Neurological and developmental disabilities in ELBW and VLBW: follow-up at 2 years of age

To establish the prevalence of neurodevelopmental disabilities among premature infants born in western Poland. From 1999 to 2003, 640 extremely low birth weight (ELBW) and 777 very low birth weight (VLBW) infants were admitted to the tertiary care center in Poland. Discharged home were 302 and 671 of them, respectively. At 2 years corrected age, 165 ELBW and 285 VLBW children were diagnosed with neurosensory abnormality including cerebral palsy (CP) and evaluated with Bayley Scales of Infant Development II. Mental developmental index (MDI) score <70 was recorded in 104 children (23.1%). There were 75 (16.7%) cases of CP, 8 (1.7%) deafness/hearing loss, 22 (4.8%) blindness and 14 (3.1%) of epilepsy. Patients with abnormal neurosensory status had significantly lower MDI compared with those with normal development (83.8±9 vs 54.7±10). Severe intraventricular haemorrhage, periventricular leucomalacia, ventricular dilatation and hydrocephalus were the most important risk factors for neurologic abnormality. Severe disability is more common among ELBW compared with VLBW infants and remains a major challenge for health-care providers.

Neurodevelopmental outcome of fetuses referred for ventriculomegaly.

To characterize the delivery and postnatal neurodevelopmental outcomes of fetuses referred for ventriculomegaly (VM). Under an internal review board-approved protocol, pregnant women were referred for magnetic resonance imaging (MRI) after sonographic diagnosis of VM and classified into one of four diagnostic groups: Group 1, normal central nervous system (CNS); Group 2, isolated mild VM (10-12 mm); Group 3, isolated VM > 12 mm; and Group 4, other CNS findings. Pregnancy outcome was obtained. Follow-up visits were offered with assessment of neurodevelopmental, adaptive and neurological functioning at 6 months and 1 year and/or 2 years of age. Atrial diameter and VM group differences in developmental outcomes were evaluated using repeated measures logistic regression and Fishers exact test, respectively. Of 314 fetuses, 253 (81%) were liveborn and survived the neonatal period. Fetuses in Groups 4 and 3 were less likely to progress to live delivery and to survive the neonatal period (60% and 84%, respectively) than were those in Groups 2 or 1 (93% and 100%, respectively, P < 0.001). Of the 143 fetuses followed postnatally, between 41% and 61% had a Bayley Scales of Infant Development (BSID-II) psychomotor developmental index score in the delayed range (< 85) at the follow-up visits, whereas the BSID-II mental developmental index and Vineland Adaptive Behavior composite scores were generally in line with normative expectations. Among those that were liveborn, neither VM group nor prenatal atrial diameter was related to postnatal developmental outcome. Diagnostic category and degree of fetal VM based on ultrasound and MRI measurements are associated with the incidence of live births and thus abnormal outcome. Among those undergoing formal postnatal testing, VM grade is not associated with postnatal developmental outcome, but motor functioning is more delayed than is cognitive or adaptive functioning.

Predicting school readiness from neurodevelopmental assessments at age 2 years after respiratory distress syndrome in infants born preterm

To determine whether neurodevelopmental outcomes at the age of 2 years accurately predict school readiness in children who survived respiratory distress syndrome after preterm birth. Our cohort included 121 preterm infants who received surfactant and ventilation and were enrolled in a randomized controlled study of inhaled nitric oxide for respiratory distress syndrome. Abnormal outcomes at the age of 2 years were defined as neurosensory disability (cerebral palsy, blindness, or bilateral hearing loss) or delay (no neurosensory disability but Bayley Scales of Infant Development mental or performance developmental index scores <70). School readiness (assessed at a mean age of 5y 6mo, SD 1y) was determined using neurodevelopmental assessments of motor, sensory, receptive vocabulary, perceptual, conceptual, and adaptive skills. The mean birthweight of the cohort (57 males, 64 females) was 987g (SD 374), and the mean gestational age was 27.3 weeks (SD 2.6). At the age of 2 years, the neurodevelopmental classification was 'disabled' in 11% and 'delayed' in 23%. At the age of 5 years 6 months, intensive special education was required for 11% and some special education for 21%. Disability and delay at the age of 2 years were 92% and 50% predictive of lack of school readiness respectively, whereas only 15% of children who were normal at the age of 2 years were not school ready at the later assessment. Children with delay at 2 years were more likely to need special education if they were socially disadvantaged. Without preschool developmental supports, preterm survivors living in poverty will require more special education services.

Neurodevelopment and in utero antiretroviral exposure of HIV-exposed uninfected infants.

Antiretroviral (ARV) drugs are routinely provided to HIV-infected pregnant women to prevent HIV mother-to-child transmission. Although ARV use has significantly reduced mother-to-child transmission to <2% in the United States, it remains crucial to monitor uninfected infants and children for adverse consequences of in utero ARV exposure. We studied neurodevelopmental function in HIV-exposed uninfected children who were enrolled in Pediatric AIDS Clinical Trials Group 219/219C, a multisite, prospective, cohort study. Mental and motor functioning were assessed with the Bayley Scales of Infant Development (BSID), first and second editions. ARV exposure information was collected during pregnancy or within the first years of life. Linear regression methods were used to evaluate the association of in utero ARV exposure on Mental Developmental Index and Psychomotor Developmental Index at 2 years of age, controlling for demographic factors (age, gender, and race/ethnicity) and potential confounders: test version, primary language, primary caregiver, caregiver education level, low birth weight, geographic and urban/rural location, birth year, and maternal illicit drug use. Among 1840 infants who were born between 1993 and 2006, 1694 (92%) were exposed to ARV in utero and 146 (8%) were not exposed. After controlling for confounders, children who were exposed in utero to any ARV did not have lower Mental Developmental Index and Psychomotor Developmental Index scores than unexposed children. Among low birth weight infants, significantly higher BSID scores were observed for prenatally ARV-exposed than unexposed children. Maternal illicit drug use was reported for 17% of mothers but was not associated with BSID scores. Mental and motor functioning scores were not lower for infants with in utero ARV exposure compared with no exposure. Although these results are reassuring, continued evaluation of uninfected children with in utero ARV exposure for long-term adverse outcomes is important.

Low Motor Assessment: A Comparative Pilot Study with Young Children With and Without Motor Impairment

Most of the developmental instruments that measure cognitive development in children rely heavily on fine motor skills, especially for young children whose language skills are not yet well developed. This is problematic when evaluating the cognitive development of young children with motor impairment. The purpose of this study is to assess the need for a Low Motor adapation of a standardized instrument when testing children with motor impairment. To accomplish this, we have adapted the procedures, item instructions and play material of a widely used and standardized instrument, the Bayley Scales of Infant Development-Second Edition (BSID-II, Bayley 1993). The Original and the Low Motor versions were administered to 20 children experiencing typical development and 19 children with motor impairment within a period of two weeks. Results showed that children with motor impairments scored significantly higher on the Low Motor version of the Bayley Mental Scale than on the Original version: a difference of between 5 and 10 points when the score is expressed in terms of a developmental index score. Results from children with typical development support the assumption that item content and difficulty remain unchanged in the Low Motor version.

Higher Cumulative Doses of Erythropoietin and Developmental Outcomes in Preterm Infants

We hypothesized that higher cumulative doses of recombinant erythropoietin (rEPO) for extremely preterm infants during the first 6 postnatal weeks would improve developmental outcomes, as evidenced in evaluations with the Bayley Scales of Infant Development-II Revised. This was a retrospective cohort study with a data set for a group (N = 366) of infants of <1500 g and < or =30 weeks of gestation that was created initially to examine the association between rEPO treatment and retinopathy of prematurity. Infants who underwent developmental follow-up evaluations at corrected age of >12 months were included. The associations between rEPO doses and higher Bayley Scales of Infant Development Psychomotor Developmental Index and Mental Developmental Index (MDI) scores were estimated in multivariate linear regression analyses. Eighty-two infants underwent developmental evaluations after 12 months. The median age of evaluation was 25 months. The median 6-week cumulative rEPO dose was 3750 U/kg. In multivariate analyses, Psychomotor Developmental Index (PDI) scores were associated with transfusions, female gender, birth weight, and 5-minute Apgar scores (R(2) = 0.39). MDI scores were associated with 6-week rEPO dose, female gender, prenatal steroid treatment for > or =48 hours, and breast milk feedings (R(2) = 0.40). These findings identify a dose-response relationship between rEPO treatment and improved MDI scores. They are consistent with findings of adult studies and animal brain injury models and await confirmation.

Delayed language development due to infantile thiamine deficiency

The aim of this study was to investigate the language development of 20 children who had been exposed to thiamine (vitamin B(1)) deficiency in infancy due to feeding with soy-based formula that was accidentally deficient of thiamine. In this case-control study, 20 children (12 males, eight females; mean age 31.8mo [SD 4.1], range 24-39mo) who were fed thiamine-deficient formula in infancy were compared with 20 children (12 males, eight females; mean age 32.2mo [SD 3.9], range 25-39mo) fed with other milk sources and matched for age, sex, and maternal education. Receptive and expressive language development was assessed with the Preschool Language Scale, 3rd edition. Other assessments included mental development (Bayley Scales of Infant Development, 2nd edition), evaluation for autistic spectrum disorders, and neurological examination. Motor development was compared by age at independent walking. The study and control groups differed significantly in the expressive communication (p<0.001) and auditory comprehension language subscales (p<0.001), the Mental Developmental Index score (p<0.001), and age at independent walking (p=0.001). A significant correlation was found between the receptive language score and age at independent walking, i.e. poorer language associated with later walking (r=-0.601, p=0.005). The conclusion was that thiamine deficiency in infancy could affect language development in childhood.

Assessment of general movements and 2.5 year developmental outcomes: Pilot results in a diverse preterm group

Background While the predictive value of general movements for later cerebral palsy is well known, its value to predict minor neurological and developmental impairments is less clear. Aim To analyze the results of the assessment of general movements in relation to the developmental outcome measured by the Bayley scales of infant development in a group of preterm infants. Methods Twenty-six preterm infants (gestational age from 23 weeks to 36 weeks) were included. The results of the assessment of general movements at term age and at 3 months corrected age were compared to the results of the mental and psychomotor developmental index of the Bayley scales assessed between two and three years of chronological age. Results Infants with normal writhing general movements achieved the highest scores on the mental and psychomotor developmental index, and those with cramped-synchronized general movements had the lowest scores. Infants with normal general movements during the fidgety period achieved the highest scores on both scales; those with an absence of fidgety movements achieved the lowest scores. We found the sensitivity of general movements to predict cognitive impairments to be 1.00 during the writhing period and 0.83 during the fidgety period; and 0.85 and 0.54, respectively, to predict motor impairments. The differences in the mental developmental index score between the groups with different qualities of general movements were significant in the writhing period and approached significance in the fidgety period, while for the psychomotor developmental index the differences between the groups with different qualities of general movements were not significant. Conclusion The quality of general movements may be predictive of later development.

Follow-up Outcomes at 1 and 2 Years of Infants Born Less Than 32 Weeks After Newborn Individualized Developmental Care and Assessment Program

This was a randomized, controlled trial to investigate the effect of Newborn Individualized Developmental Care and Assessment Program on growth, cognitive, psychomotor, and neuromotor development at 1 and 2 years in infants born at <32 weeks' gestational age. Infants were randomly assigned within 48 hours of birth to the newborn individualized developmental care and assessment program group (intervention) or basic developmental care group (control group [ie, incubator covers and nests]). At 1 and 2 years' corrected age, growth was measured and standardized neurologic examinations were administered. Mental and psychomotor development was assessed by using the Dutch version of the Bayley Scales of Infant Development II. Neurologic outcome, Psychomotor Developmental Index, and Mental Developmental Index scores were combined a total outcome measure. One hundred sixty-eight infants were recruited (intervention: 84; control: 84). Four infants (newborn intervention: 3; control: 1) were excluded because they were admitted less than or died within the first 5 days, leaving a total of 164 infants who met inclusion criteria. In-hospital mortality was 8 of 81 in the intervention group and 3 of 83 in the control group. At 1 year of age 148 children (intervention: 70; control: 78) and at 2 years of age 146 children (intervention: 68; control: 78) were assessed. There was no significant difference in growth at 1 and 2 years of age. There was no significant difference found in neurologic outcomes or mental and psychomotor development at 1 and 2 years of age. When neurologic outcome, Mental Developmental Index and Psychomotor Developmental Index scores were combined, there still remained no significant difference. Newborn individualized developmental care and assessment program developmental care showed no effect on growth or neurologic, mental, or psychomotor development at 1 and 2 years of age in infants born at <32 weeks. Duration of the intervention was not associated with neurologic and developmental outcome.