Developmental Assessment Scale For Indian Infants Research Articles

A Study of General Movement Assessment and Its Association With Neurodevelopmental Outcome at Age 12 to 15 Months Among Term Neonates With Hyperbilirubinemia

BackgroundTo determine the association between optimality score at term age and age three to five months and neurodevelopmental outcome among neonates with hyperbilirubinemia. MethodsFifty infants with and without hyperbilirubinemia were enrolled. The motor repertoires of the infants were evaluated through general movement assessment (GMA) at term age and three to five months post-term. The association between the General Movement Optimality Score (GMOS), Motor Optimality Score (MOS), and Development Assessment Scale for Indian Infants (DASII) at age 12 to 15 months was also assessed. ResultsDuring term age, the median GMOS was significantly lower among infants in the study group when compared with the control group (40 [29 to 42] vs 42 [42 to 42], P < 0.001). However, at age three to five months, there was no significant difference between the groups. Significantly higher number of neonates had abnormal motor repertoire at term age and age three to five months in the study group when compared with the control group (18 [36%] vs 2 [4%], P = 0.001, at term age and 6 [12.2%] vs 1 [2%], P =0.04, at age three to five months). Among neonates with hyperbilirubinemia, the median GMOS and MOS were significantly lower at term age and age three to five months in infants with motor and mental developmental quotient scores <85 when compared with ≥85. ConclusionsGMA including GMOS and MOS performed in neonates with hyperbilirubinemia during the neonatal period and early infancy is associated with neurodevelopmental outcomes in the first year of life. GMA can help initiate early intervention in such neonates.

Nutritional vitamin B12 deficiency-associated Infantile epileptic spasms syndrome: Clinico-neurophysiological presentation, response to treatment, and neurodevelopmental outcome

IntroductionNutritional vitamin B12 deficiency has been shown to cause Infantile epileptic spasms syndrome (IESS) in infants in anecdotal studies. MethodsIn this retrospective cohort study, we intended to study the clinical presentation, neurophysiological, laboratory abnormalities, treatment, and neurodevelopmental outcome at 6-months in infants presenting with IESS secondary to nutritional vitamin B12 deficiency (NVBD) and to compare these variables from the rest of the infants with IESS without vitamin B12 deficiency. We included only spasm-free cases or those who showed at least a 50% reduction in spasm frequency on D7 after starting oral/parenteral vitamin B12. We used well-validated measurement tools like the Developmental Assessment Scale for Indian Infants (DASII), Child Feeding Index (CFI), Burden of amplitudes and epileptiform discharges (BASED) score, countable Hypsarrhythmia paroxysm index (cHPI), durational Hypsarrhythmia paroxysm index (dHPI), and Early childhood epilepsy severity scale (E-CHESS) score for documenting these variables. ResultsData from 162 infants with IESS (21 caused by NVBD) were included in our study. The NVBD group had more patients residing in the rural region, with lower socioeconomic status, vegetarian mothers and poor complementary feeding index (p<0.001 for all). The NVBD group also had less number of patients requiring antiseizure medications (ASMs) and hormonal therapy(p<0.001), remained seizure free at six months (p=0.008), lower number of clusters per day (p=0.02) and the number of spasms per clusters at presentation (p=0.03), lower BASED score (p=0.03) and cHPI, dHPI at presentation (p<0.001). All of them remained spasm-free, with normal electroencephalogram at 6-months. Development quotient at baseline, at 6-months, and improvement in development quotient between these two-time points were more in the vitamin B12 deficiency group (p<0.001). All of them had clinical features of pre-ITS (infantile tremor syndrome) or ITS and it was found to be the only independent predictor of NVBD in infants with IESS. Mothers of all these infants had low serum vitamin B12 levels (<200 pg/ml). ConclusionsNutritional vitamin B12 deficiency may cause IESS in infants. Hence, vitamin B12 deficiency needs to be ruled out in patients with IESS without any definite etiology.

Comparison of Neurodevelopmental Status in Early Infancy of Infants of Women With and Without Gestational Diabetes Mellitus.

To study the neurodevelopmental status of offsprings of mothers with gestational diabetes (OGDM) aged 3½ mo. This cross-sectional study was conducted at a tertiary hospital, New Delhi which included infants aged 3½ mo (+1 wk) who were either offsprings of women with gestational diabetes (cases) or infants of mothers without gestational diabetes mellitus presenting to tertiary care public hospital in India from January, 2018 through March, 2019, with enrollment of infants done between 10 April, 2018 and 30 March, 2019. The development quotient (DQ) using Developmental Assessment Scales for Indian Infants (DASII) was calculated as Motor DQ, Mental DQ and a composite DQ. The mean motor DQ of the enrolled infants was 101.7 (12.02); it was significantly lower for OGDM than controls [101 (1.41) vs. 109.5 (10.6); P <0.001]. The mean mental DQ of the enrolled infants was 88.9 (12.0); it was significantly lower for OGDM than the control group [84 (9.89 vs. 88 (8.48); P = 0.03]. The total development quotient for the enrolled infants was 95.3 (11.3). The total development quotient for study group was significantly lower than the control group [92.5 (5.65) vs. 98.75 (9.54); P = 0.001]. The mean motor, mental total DQ of offsprings of mothers with GDM were significantly lower than those born to mothers without GDM. Hence follow up, early intervention should be considered for this high risk group.

Assessment of neurodevelopmental status using Development Assessment Scale for Indian Infants in children 6-24 months of age with congenital heart disease

ABSTRACT Context: With improved awareness, early screening and diagnosis, and better postoperative care, the survival rate and life expectancy of congenital heart disease (CHD) population is on rise, and hence there is the uttermost need to study morbidities like neurodevelopment delay, which significantly affect quality of life in long term. Aim: Assessment of Neurodevelopmental Status Using Development Assessment Scale for Indian Infants (DASII) in children 6-24 months of age with CHD. Settings and Design: This was a descriptive, cross-sectional, hospital-based study, conducted in a tertiary care hospital of Central India. Subjects and Methods: The study included children 6–24 months of age with CHD confirmed by echocardiography. Their mental development quotient (DMeQ) and motor development quotient (DMoQ) was calculated using DASII. Developmental delay is defined as DQ &lt;70% (&lt;2 standard deviation) in either mental or motor domain. Statistical Analysis Used: Data entered in Excel spreadsheets and analyzed using SPSS 25.0. Results: Motor delay was found in 28% children and 26% children had mental delay (P = 0.0001). Among children with cyanotic CHD, both motor and mental development was seen in 80%, while in children with acyanotic CHD 18.8% children had motor delay and 16.5% children had mental delay (P = 0.0001). The mean DMoQ and mean DMeQ was significantly lower in the cyanotic group than in acyanotic group. The mean DMoQ and mean DMeQ was found to be significantly lower in the children with severe disease as compared to children with mild disease, as well as in the high-risk group as compared to low-risk group (P = 0.0001). Conclusions: We found high rates of motor and mental delay in children with cyanotic CHD, severe cardiac lesions, and high-risk category groups. Still, there is a need to find other associated factors, which can contribute to developmental delay, identified at the time of diagnosis through appropriate screening methods. Routine follow-up of these high-risk children with neurodevelopment assessment using DASII scale and early intervention will allow maximum growth and development of pediatric population with CHD and will have a positive impact on their quality of life.

Neurodevelopment outcome of late prematurity: a retrospective cohort study from a developing country.

The late preterm infants (34 0/7 to 36 6/7weeks of gestation) account for at least 70% of all preterm birth. Our aim was to detect growth and neurodevelopment outcome, incidence of neurodevelopmental disability, and its association with maternal and neonatal risk factors among sick late preterm population. Two hundred and ninety-nine late preterm infants were followed up till corrected 2years of age in this retrospective cohort study. Assessment was done by anthropometry and Developmental Assessment Scale for Indian Infants (DASII) scale at corrected 2years of age. Presence of visual and hearing impairment, cerebral palsy, and overall neurodevelopmental impairment were also recorded. At 2years of corrected age, average motor development quotient (DMoQ) was 93.55 (95% CI 90.9 to 96.20) and average mental development quotient (DMeQ) was 89.59 (95% CI 87.13 to 92.04). The incidence of bilateral severe to profound hearing loss and visual loss were found in 6 (2%) and 4 (1.33%) infants, respectively. Severe neurodevelopmental impairment was found in 19 (6.35%) infants. Central nervous system disease and sepsis were found as independent predictors of moderate to severe neurodevelopmental disability. Conclusion: Late preterm infants admitted in neonatal units were at risk of growth and neurodevelopmental impairment requiring close neurodevelopmental follow-up. In a resource limited setting, this may best be achieved by using DASII in follow-up clinic. What is Known: • Late preterm infants are at a high risk of prematurity-related morbidities. • There is increased risk of cognitive defect, learning difficulties, and behavior problems found at school age for sick late preterm infants. What is New: • Central nervous system disease and sepsis were found as independent predictors of early moderate to severe neurodevelopmental impairment for sick late preterm infants in developing countries like India.

General Movement Assessment in Babies Born Preterm: Motor Optimality Score–Revised (MOS-R), Trajectory, and Neurodevelopmental Outcomes at 1 Year

To assess the association between the General Movement Assessment (GMA) findings, including Motor Optimality Scores-Revised (MOS-R) at 16weeks, and neuromotor outcome assessed by the Amiel-Tison Neurological Assessment at 9months of corrected age and the Developmental Assessment Scales for Indian Infants (DASII) at 1year of corrected age in preterm ≤32weeks. Serial GMA videos of infants born preterm ≤32weeks were recorded on day 7, 35weeks of postmenstrual age, 40weeks of postmenstrual age, and 16weeks of corrected age. The association between GMA findings, including MOS-R scores and GM trajectory between 35 to 40weeks and the Amiel-Tison Neurological Assessment and DASII scores, was assessed by Spearman correlation, Fisher exact tests, and ordinal regression. Moderate correlations were observed between MOS-R and the DASII motor DQ (Spearman r=0.70, P<.001) and between MOS-R and DASII Mental DQ (r=0.65, P<.001). The GMA trajectory at 35-40weeks was associated with DASII motor DQ (Fisher exact, P=.002), and also with the Amiel-Tison Neurological Assessment at 9months of corrected age (P<.01 by the Fisher exact test). On analysis by performing ordinal regression of predictive values of the general movements (GM)at 7days of age, GM at 35weeks, GM at 40weeks, GM at 16weeks, and MOS-R at 16weeks, MOS-R alone was a statistically significant predictor of motor DQ at 1year of age (OR -0.59; 95% CI -0.97 to -0.22; Wald statistics, P<.02). Consistent with findings in high-income countries, GMA including MOS-R scores performed in Indian infants born preterm during the neonatal period and early infancy is associated with neurodevelopmental outcomes in the first year of life. GMA can help initiate focused early intervention in low- and middle-income settings, where resources may be limited.

Survival and Neurodevelopmental Outcome of Extremely-Low-Birth-Weight Infants at One Year of Age-A Prospective, Descriptive Study.

To study the survivalrates at discharge and neurodevelopmental outcome at 1 y of corrected age (CA) of extremely-low-birth-weight ELBW neonates. This prospective, descriptive study was conducted in a tertiary care level III extramural NICU of a teaching hospital. Forty-nine extremely-low-birth-weight (ELBW) neonates were enrolled in the study from July 2017 to June 2018. Baseline demographic data, morbidities during NICU stay, and survival at discharge for the enrolled neonates were recorded. The enrolled infants were followed up to 1 y of CA at three-monthly intervals. During the follow-up, anthropometry, developmental screening by Denver Developmental Screening Test (DDST), and tone assessment by Amiel-Tison scale were done. Developmental Assessment Scale for Indian Infants (DASII) was administered at CA of 12 mo. Thirty-seven (75.5%) neonates survived to discharge. Survival rate of neonates with birth weight > 750g and with gestational age ≥ 26 wk was 90.2% and 85.7%, respectively. Amongst those < 750g or < 26 wk (n = 8), none survived. Abnormal developmental quotient (DQ < 70%) was seen in 6 infants out of 33 infants (18.1%) followed at 1 y of CA. Overall, 3/4th of ELBW infants survived to discharge and 80% of those who were followed up at 1 y of CA had normal neurodevelopmental outcome. However, survival rates of neonates born at < 26 wk and/or with birth weight < 750g were less and needs to be improved.

Neurodevelopmental outcomes in children with cyanotic congenital heart disease following open heart surgery.

ABSTRACTBackground:Neurodevelopmental abnormalities are common in congenital heart disease (CHD), more so in cyanotic CHDs. Perioperative factors have been known to affect neurodevelopmental outcomes.Aim:We aimed to determine the neurodevelopmental outcomes following open-heart surgery in cyanotic CHD.Methods:In this prospective observational study, eligible infants and children ≤21 months with cyanotic CHD planned for open-heart surgery underwent preoperative neurodevelopmental assessment using Developmental Assessment Scale for Indian Infants (DASII) to look for any motor and/or mental delay. A second neurodevelopmental assessment was performed after 9 months ± 2 weeks of cardiac surgery. Follow-up DASII was conducted through interactive video conferencing in 23 of 60 patients due to COVID-19 pandemic. The univentricular and biventricular repair groups were compared in terms of their neurodevelopmental outcomes. Perioperative factors were compared between neurodevelopmental “delay” and “no delay” groups.Results:Of the 89 children enrolled, preoperative motor and mental delay were present in 29 and 24 children, respectively. Follow-up DASII could be performed in 60 children. At follow-up, motor delay was present in seven and mental delay in four children. Overall, there was a significant improvement in both motor and mental developmental quotient at follow-up. There was no significant difference in either motor or mental domains between univentricular and biventricular groups. Among the perioperative variables, only the postoperative length of stay in intensive care unit was significantly different between neurodevelopmental “delay” and “no delay” groups (P = 0.04).Conclusion:Neurodevelopmental delay occurred substantially among unoperated children with cyanotic CHD. The neurodevelopmental status improved significantly following open-heart surgery among the survivors. Delay was associated with length of stay in intensive care following cardiac surgery.

Diagnostic Accuracy of Parents' Evaluation of Developmental Status (PEDS), PEDS Developmental Milestones, and PEDS Combined in Indian Children Aged Less than 2Years.

To assess the diagnostic accuracy of Parent's Evaluation of Developmental Status (PEDS), PEDS Developmental Milestones (PEDS:DM) and PEDS Combined for developmental screening of Indian children aged less than 2 y. A hospital-based study of diagnostic accuracy was conducted over 17 mo. Children under 24 mo (n = 180) were enrolled after exclusion of severe illnesses or known neurodevelopment disorders. The index tools included standardized Hindi translations of PEDS and PEDS:DM. The reference tool was Developmental Assessment Scale for Indian Infants (DASII). Both were administered by blinded researchers. Parameters of diagnostic accuracy were computed. There were 13 (7.2%) failures in PEDS, 119 (66.1%) in PEDS:DM and 119 (66.1%) in PEDS Combined. DASII identified 3 children with developmental delay. Sensitivity (Sn) [95% CI] of PEDS was 33.3 [0.8-90.6] and Specificity (Sp) 93.2 [88.5-96.5]. The Sn and Sp of both PEDS:DM and PEDS Combined were 100 [29.2-100] and 34.5 [27.5-42.0], respectively. Hindi translations of PEDS, PEDS:DM and PEDS Combined are not suitable for developmental screening of children less than 2 y due to suboptimal diagnostic accuracy.

Development Assessment Scale for Indian Infants: A Systematic Review and Perspective on Dwindling Cutoffs

The Developmental Assessment Scale for Indian Infants (DASII) remains the mainstay in India for diagnostic confirmation and validation of upcoming screening tools for developmentin infants and toddlers. This is an Indian adaptation of Bayley Scales of Infant Development which is the globally accepted gold standard. However, the DASII cutoff points used for categorizing development and distinguishing normal from abnormal development are not in agreement across different studies conducted over the last two decades in India. This is probably due to a lack of mention of cutoff points in the DASII manual and existing literature. The current systematic review summarizes the heterogeneity in literature for interpretation of DASII and its cutoff points. Also, a perspective on the ideal cutoff points is presented.

Effectiveness of Ayurveda intervention on growth and development in Indian infants

Background: Ayurveda is a traditional system of medicine. This system of medicine is having many practices to promote and preserve health. There are certain folklore practices that are promoting for healthy living of the children. The ingredients of Kumarabharana prasha (Bhasmas Swarna, Rajata, Pravala and Choorna of Yastimadhu, Amalaki, Ashwagandha, Shunti, Pippali, Harithaki, Vacha) has been collected from one such folklore practice called Uramarunnu/ Suttumadhu. Aim: To assess, whether 300 mg once daily administration of Kumarabharana Prasha from birth to 6 months has a role in growth and development in healthy infants. Materials and methods: Total 44 healthy infants from birth to 1 week fulfilling the inclusion criteria were recruited. The subjects were randomized into two groups. 21 received 300 mg of Madhu and Ghrita once daily and 23 received 300 mg of Kumarabharana Prasha once daily served as control and study group respectively. Subjects in both the groups were assessed for anthropometrical/growth parameters (length, weight, head circumference, chest circumference) and development (motor age, development quotient of motor age, mental age and development quotient of metal age). Development was assessed using Development Assessment Scale for Indian infants (DASII). Result: The mean growth and development both were found significantly higher in study group as compared to control group. Conclusion: Kumarabharana Prasha can be considered as a positive health care initiative in infants, which may enhance the growth and development in infants.

Global DNA Methylation in Cord Blood and Neurodevelopmental Outcome at 18 Months of Age among Intrauterine Growth Restricted and Appropriate for Gestational Age Infants.

Intrauterine growth restriction (IUGR) is associated with faltered growth and development later in life. Alteration in DNA methylation may occur among IUGR babies and it can have bearing on the outcome. To compare the DNA methylation in the cord blood among IUGR and appropriate for gestational age (AGA) babies and find it is association with their neurodevelopmental outcome at 18 months of age. Genomic DNA methylation among 40 IUGR and equal number of AGA neonates was estimated by using 5-mC ELISA kit in the cord blood. Infants were assessed at birth and their anthropometric measurements were taken. They were regularly followed up and assessed for neurodevelopment outcome till 18 months of age using DASII (Developmental Assessment Scale for Indian Infants). DNA methylation was correlated with neurodevelopmental outcome. Numbers and percentages were used for categorical data. Mean and SD were used for continuous variables. The significant mean difference between IUGR and AGA was determined by independent Student t-test. To study the association between the DNA methylation and outcome, Spearman correlation was used. A p < 0.05 was considered as statistically significant. Significant difference in DNA methylation was observed between IUGR and AGA infants (IUGR: 3.12 ± 1.24; AGA: 4.40 ± 2.03; p < 0.001). Anthropometry (weight, length and head circumference) at birth was significantly decreased among IUGR infants. Hospital stay was significantly longer for IUGR infants. Motor (IUGR: 89.98 ± 18.77; AGA: 101.75 ± 9.62; p < 0.001), and mental (IUGR: 90.81 ± 11.13; AGA: 105.71 ± 7.20; p < 0.001) scores were significantly decreased among IUGR compared with AGA neonates at 18 months of follow-up. Global DNA methylation had a significant positive correlation with mental score but not with motor developmental score. IUGR babies had lower motor and mental score compared with AGA babies. Cord blood global DNA methylation significantly correlated with mental development score but not with motor development at 18 months of age.

Neurodevelopmental Outcome of Preterm Newborns with Abnormal Umbilical Artery Doppler - A Prospective Cohort Study.

To assess the neurodevelopmental outcome of preterm neonates with absent/reversed end diastolic flow (A/REDF) in umbilical artery Doppler at 1year of corrected age. A cohort of 70 preterm newborns with fetal growth restriction (FGR), defined as estimated fetal weight (EFW) <10th centile, confirmed by birthweight <10th centile, along with A/REDF in the umbilical artery Doppler was followed up till 1year of corrected age (CA). An equal number of gestation and gender matched preterm newborns with birthweight >10th centile [appropriate for gestational age (AGA)] and normal antenatal ultrasound were taken as controls. Primary outcome was a composite of death or major neurodevelopmental disability (NDD) at 1year of corrected age. Matched analysis was performed. A total of 140 newborns were enrolled, of which, 20 expired and 8 were lost to follow-up. The primary outcome (death/major NDD) occurred in 26.8% of the FGR (A/REDF) newborns as compared to 9.3% of their AGA counterparts (RR-2.83, p = 0.02, 95% CI:1.11-7.18). Mean motor quotient in Development Assessment Scale for Indian Infants (DASII) at 1year of corrected age was significantly lower in FGR (A/REDF) infants (91 ± 13.6 vs. 96.3 ± 7.1, p < 0.05). Multiple other co-morbidities were also significantly more among these newborns. Preterm newborns with FGR and A/REDF are at significantly increased risk of death/major NDD at 1year of corrected age.

Outcome of Inherited Metabolic Disorders Presenting in the Neonatal Period.

To assess the outcome of infants who were diagnosed to have Inborn errors of metabolism (IEM) during neonatal period from a single center in South India. This retrospective cohort study included consecutive neonates diagnosed to have IEM by biochemical testing or those detected using newborn screening (NBS) between November 2014 and July 2018. Disorders were categorized into intoxication and non-intoxication groups. Their presentation and outcome were described. Development at 12 mo was assessed objectively using DASII (Developmental assessment scale for Indian infants). Developmental quotient <70 was considered as delay. Mortality was analyzed using Kaplan Meier survival analysis. Among the total of 33 (14 intoxication and 19 non-intoxication groups), 7 died in neonatal period, 3 were lost to follow-up, 9 expired during varying period leaving 14 under regular follow-up. NBS detected 3 of them, others presented symptomatically unwell during neonatal period. Median survival was 18 mo (95% CI 3.7 to 32.2). Kaplan Meier survival analysis revealed a significant difference in mortality in intoxication compared to non-intoxication group. Among 14 survivors, 7 (50%) had developmental delay; 5 (35%) had seizures; 6 (43%) had growth failure. Infants with encephalopathy as initial presentation had poorer prognosis. NBS detection rate was 1 in 1060 live births (3 positives out of 3180 NBS samples). Those detected by NBS remained well. Morbidity and mortality remain high in those diagnosed as IEM during neonatal period. Despite the small sample size, this study calls attention to implement NBS wherever feasible.

Effect of Maternal Docosahexaenoic Acid (DHA) Supplementation on Offspring Neurodevelopment at 12 Months in India: A Randomized Controlled Trial.

Intake of dietary docosahexaenoic acid (DHA 22:6n-3) is very low among Indian pregnant women. Maternal supplementation during pregnancy and lactation may benefit offspring neurodevelopment. We conducted a double-blind, randomized, placebo-controlled trial to test the effectiveness of supplementing pregnant Indian women (singleton gestation) from ≤20 weeks through 6 months postpartum with 400 mg/d algal DHA compared to placebo on neurodevelopment of their offspring at 12 months. Of 3379 women screened, 1131 were found eligible; 957 were randomized. The primary outcome was infant neurodevelopment at 12 months, assessed using the Development Assessment Scale for Indian Infants (DASII). Both groups were well balanced on sociodemographic variables at baseline. More than 72% of women took >90% of their assigned treatment. Twenty-five serious adverse events (SAEs), none related to the intervention, (DHA group = 16; placebo = 9) were noted. Of 902 live births, 878 were followed up to 12 months; the DASII was administered to 863 infants. At 12 months, the mean development quotient (DQ) scores in the DHA and placebo groups were not statistically significant (96.6 ± 12.2 vs. 97.1 ± 13.0, p = 0.60). Supplementing mothers through pregnancy and lactation with 400 mg/d DHA did not impact offspring neurodevelopment at 12 months of age in this setting.

Assessment of Physical Growth and Motor Development of Preterm Babies Based on Developmental Assessment Scale For Indian Infants (DASII)

Background: The rate of preterm births ranges from 5% to 18% across 184 countries. Almost 12% births are preterm in low-income countries compared with 9% in high-income countries. Almost 1 million children die each year due to complications of preterm birth. Of those who survive, suffer from face developmental disabilities and undernourishment.Aims and Objectives: To assess the physical growth and its relation with the development of babies taken into study.Materials and Methods: A prospective study was conducted on 159 preterm babies of gestational age 32 to 36 weeks. All the treatments given during hospitalization, course of stay, and special procedures done were recorded. Baby’s weight, length, and head circumference were again noted at the time of discharge. Anthropometric measurements were done at every follow-up visit. Neurodevelopmental screening was performed at each follow-up. At the end of 12 months the risk factors contributing to the delayed development were analyzed.Results: 95.5% infants born as preterm had a length of more than 58 cm (– 3SD) and weight 5.6 kg at 1 year and 50% infants had a head circumference of more than 39 cm (– 3SD).Conclusion: Preterm babies when followed-up for 1 year of age did attain appropriate weight and length of their corrected age. Microcephaly was observed in 30% of babies at 1 year of age, of which 15.7% were found with developmental delay.

Maternal Docosahexaenoic Acid (DHA) Supplementation and Offspring Neurodevelopment in India (DHANI)

Abstract Objectives Evidence suggests that low maternal levels of docosahexaenoic acid (DHA; 22:6n-3), a long-chain omega-3 fatty acid, are associated with suboptimal offspring brain development. Indian diets are low in DHA. We assessed the impact of maternal DHA supplementation on Neuro-development of Indian infants (DHANI) at 12 months (mo). Methods Healthy pregnant women (£20 weeks of singleton gestation; n = 957; mean age = 23.5 y) were randomized to receive either 400 mg/d of DHA or a placebo from enrolment till 6 months postpartum. The mother-child dyads were followed through infant age 1 year. Development Quotient (DQ) scores were assessed at ages 6- and 12-mo using the validated Development Assessment Scale for Indian Infants (DASII). Results The two groups were well-balanced at baseline. 72.6% of women took &amp;gt;90% of their assigned treatment. 25 serious adverse events, found unrelated to intervention, were reported (DHA group = 16; placebo = 9). Of the 902 live births, 878 were followed to 12 mo; the DASII was administered to 863 infants. Intent-to-treat 12 mo mean DQ scores (SD) (DHA, control) and difference (DHA-control) were: 96.6 (12.2), 97.1 (13.0) and −0.46 (95% CI −1.23, 2.14; P = 0.6), respectively. Similarly, at the end of the supplementation period at 6 mo postpartum, there were no differences in mean DQ scores by intervention (difference 1.15 (95% CI −2.64, 0.35; P = 0.13). Conclusions Supplementing mothers through pregnancy and lactation with 400 mg/d DHA did not impact offspring neurodevelopment at 6 or 12 mo of age in this Indian setting. Deeper insights into maternal dietary patterns, young child feeding practices, home environment, and the interactions amongst these factors are warranted to understand what shapes early neurodevelopment. Funding Sources Funded by Wellcome Trust-DBT India Alliance (Dec 2015-Dec 2020). The Young Scientist Award by DST SERB India (2013–16) helped us establish DHANI trial partially.

Neuronal Biomarkers in Predicting Neurodevelopmental Outcome in Term Babies with Perinatal Asphyxia.

To assess whether serum levels of neuronal biomarkers (S100 calcium-binding protein B and Neuron specific enolase) correlate with the neurodevelopmental outcome of term neonates at 18 mo who had hypoxic ischemic encephalopathy and underwent therapeutic hypothermia. This randomized controlled trial was conducted in a tertiary care teaching hospital, south India. There were 162 term infants with moderate to severe hypoxic ischemic encephalopathy who were randomized into 2 groups (Group A and B). Neonates in Group A and B received normothermia and therapeutic hypothermia respectively. Serum levels of neuronal biomarkers were estimated at 0, 24 (±1) and 72 (±1) h after birth using sandwich ELISA in both groups. All neonates were carefully monitored till discharge. Infants who survived the neonatal period were followed up in the high risk clinic for 18 mo and neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Neurodevelopmental outcomes between the two groups were compared using Chi square test and neuronal biomarker levels between the groups were compared using Mann Whitney test. The baseline maternal and neonatal characteristics in both groups were comparable. There was statistically insignificant lesser mortality in therapeutic hypothermia group compared to normothermia group with Risk Ratio (RR):0.82 (28.2% vs. 34.5%, 95% CI: 0.52-1.29, p = 0.38). Among the survivors, children in therapeutic hypothermia group had better motor and mental scores compared to those in normothermia group at 18 mo. There was no significant correlation between S100B and Neuron specific enolase levels and neurodevelopmental outcome. Serum levels of neuronal biomarkers (S100B and Neuron specific enolase) do not correlate with the long term neurodevelopmental outcome among these infants.

Developmental Outcomes in Children with Infantile Tremor Syndrome.

In this prospective, study, children with Infantile tremor syndrome (ITS) were assessed at diagnosis and at follow-up using the Developmental Assessment Scale for Indian Infants (DASII). Of the 53 children enrolled (25 children had tremor, mean age: 13.1 ± 4.9 mo), 45 (84.9%) had developmental delay and 17 (32.8%) had development regression. The mean Motor-Developmental quotient (DQ) at baseline was 39.1 ± 15.6 (no-tremors group) and 22.2 ± 12.6 (tremor group) and mean Mental-DQ at diagnosis was 29.9 ± 15.2 (no-tremors group) and 14.5 ± 10.6 (tremor group) respectively. Forty-four children were assessed at follow-up (median- 216 d). The mean Motor-DQ on follow-up was 66.2 ± 22.1 (no tremors) and 55.9 ± 15.6 (tremors); and the mean Mental-DQ was 54.3 ± 23.0 (no tremors) and 45.6 ± 11.6 (tremors) respectively. Only seven (16%) children had a follow-up mental DQ more than 70. Mental abilities are more affected than motor abilities in children with ITS and those with tremors fare poorly. Despite gains, very few children have abilities in normal range at follow-up.

Relationship between home environment and psychomotor development in Urban and Rural children: A cross-sectional study

Background and Purpose: Development of children has shown to be influenced by various factors, one of them being the environment. There are diverse cultural practices across different settlements that play a role in conditioning the child's pattern of development. A home serves to be the primary environment in which every child grows in, which influences development. This study intends to determine the relationship between home environment and psychomotor development in children and to compare the psychomotor development in children of urban and rural areas. Materials and Methods: A door-to-door survey was conducted for the recruitment of participants from urban and rural areas as per inclusion criteria. Two hundred children were evaluated, 100 each from urban and rural areas. Home environment assessment made using Affordances in the Home Environment for Motor Development (AHEMD) scale versions as per the age of the child. The developmental assessment was done using the Developmental Assessment Scales for Indian Infants (DASII). Results: A significant positive correlation was found between AHEMD and motor quotient (MoQ) (r = 0.2892) and mental quotient (MeQ) (r = 0.3940) on DASII. There was a significant difference in the AHEMD scores of urban and rural participants (P = 0.0038). The MoQ was between urban and rural participants which was statistically significant. A significant difference (P = 0.0006) was found in MeQ scores between urban and rural participants. Conclusion: The present study concludes that there is a positive correlation between the environment at home and psychomotor development in children. The urban children had better mental and motor development scores than the rural children, although both the urban and rural children showed average development.