Developmental Assessment Scale Research Articles

Impact of maternal education on the development of severe acute malnourished children

Background: Severe acute malnutrition (SAM) is a grave form of undernutrition that has been recognized as a medical and social disorder. Various factors contribute to the development of SAM, but the impact of maternal education on the nutritional status and development of the child is of paramount importance since focused interventions in this aspect can yield promising results. Aims and Objectives: The aims and objectives of the study are to assess the impact of maternal education on the development of children with SAM. Materials and Methods: A total of 125 SAM children in the age group 12–30 months were enrolled in this prospective observational study from among those admitted to the nutritional rehabilitation center of a tertiary care center in central India. The developmental status of SAM children was assessed using the Developmental Assessment Scale of Indian Infants. The association of maternal education with the development of SAM children was analyzed. Results: Overall developmental delay was observed in 44.8% of SAM children, whereas motor and mental development delay was noted in 45.6% and 44% of SAM children. The maternal education level was significantly associated with the overall development of the SAM child. (P=0.043 for motor development, P=0.017 for mental development, P=0.023 for motor developmental delay). Conclusion: Maternal education plays a key role in improving the developmental status of SAM children, who are more prone to developmental delays across various domains. Efforts toward enhancing maternal education, especially knowledge regarding child nutrition and development, can reduce the incidence and improve the management of SAM in children.

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.

Differential features of early childhood motor skill development and working memory processing: evidence from fNIRS.

The study investigated the differential characteristics associated with motor skill development and working memory processing during early childhood, thereby providing insights for understanding motor learning and cognitive development in young children. In total, 101 preschool children (age: 4-6 years) were recruited for this study. The motor skill development level and the working memory capacity of the children were assessed using the MOBAK Motor Development Assessment Scale and a block task paradigm, respectively. Functional near-infrared spectroscopy brain imaging technology was used to monitor hemodynamic signals in the prefrontal cortex (PFC) of the children while they completed different memory tasks. MATLAB software and the Homer2 plugin were used to calculate the oxygenated hemoglobin (Oxy-Hb) concentration in relevant brain regions during the tasks. (1) The low motor skill group exhibited significantly lower accuracy during the three-memory load condition than during the two-memory load condition. Under both two-memory and three-memory load conditions, the high motor skill group exhibited significantly higher accuracy than the low motor skill group. (2) Significant differences in the Oxy-Hb concentration were observed in the left dorsolateral PFC (L-DLPFC), and right and left triangular part of the Broca's area (R-PTBA and L-PTBA, respectively) between the two memory difficulty levels for the high motor skill group. The Oxy-Hb concentration was significantly higher during the three-memory load condition than during the two-memory load condition. Under the two-memory load condition, the high motor skill group exhibited significantly higher Oxy-Hb concentration in the L-DLPFC and L-PTBA regions than in the low motor skill group. Under the three-memory load condition, the high motor skill group exhibited significantly higher Oxy-Hb concentration in the L-DLPFC, R-PTBA, and L-PTBA regions than the low motor skill group. A close association was observed between the motor skill levels and working memory in young children, with higher motor skill levels being associated with more pronounced brain activation patterns during working memory tasks.

The development of Early Childhood intellectual Capacities in the Child Development Centers of the Local Administrative Organizations, Chaiyaphum

Background and Aim: The early stage of childhood is a crucial period that significantly impacts a child's learning and growth trajectory. Research has shown a strong connection between cognitive ability, developmental milestones during this phase, and future outcomes in adolescence and adulthood. Therefore, it is imperative for preschool learning programs to prioritize age-appropriate and holistic development. To enhance the intellectual capabilities of preschoolers, an integrated learning activity program was implemented and analyzed for its effectiveness in improving young learners' intellectual and other developmental factors. Material and Methods: This study used pre- and post-test experimental designs. Through a multi-stage random sampling procedure, 113 preschoolers were chosen from five sub-district centers in Nai Faai, Nai Sineun, Ban Lao, Tha Hinong, and Huen. Developmental Assessment Scales, developed by the researcher, were used to compare cognitive abilities and development levels of children aged 24, 36, and 48 months before and after the 8-week Integrated learning program. The reliability of the scales was 0.85, 0.80, and 0.83, respectively. The t-test was employed for comparison analysis. Results: The results indicated that the motor skills, language, problem-solving, and personal-social awareness of preschoolers aged 24, 36, and 48 months significantly improved at the .01 level after participating in the integrated learning activities. Conclusions: Integrated learning activities could effectively support and enhance intellectual capacities and age-appropriate development.

Exploring the power of imagination: unravelling students’ self-perception of academic abilities in imaginative and traditional schools in Greece

ABSTRACT While contemporary trends in education emphasise the primacy of economic and technological competencies, imagination often finds itself under-valued. This is particularly true in Greece, where alternative schools encounter numerous challenges, some arising from discrimination. Imaginative teaching employs imagination-based teaching methods to support and enhance the development of children’s and adolescents’ physical, social, emotional and cognitive skills. This study explores the effects of imaginative teaching methods on students’ abilities by examining 103 Greek students’ self-perception of them. The abilities correspond to eight constructs, as described by Howard Gardner in his Multiple Intelligences (MI) theory. Prior research has hinted at the potential correlation between these imaginative teaching strategies and MI educational applications. The Multiple Intelligences Developmental Assessment Scale (MIDAS) was used to assess the 8 MI constructs and 24 associated skills. Statistically significant results show that students having imaginative-based education have a higher estimation of their language and intrapersonal skills. Further research is needed to move forward from assessing the self-perception of students’ abilities to assessing their actual skills.

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

Introduction Nutritional vitamin B12 deficiency has been shown to cause Infantile epileptic spasms syndrome (IESS) in infants in anecdotal studies. Methods In 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. Results Data 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). Conclusions Nutritional 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.

Bonding and Infants' Development and Quality of Life: A Study Among Mothers with Severe Mental Illnesses in Remission.

Maternal mental health has specific implications for bonding and infants' mental health. However, most of the evidence comes from mothers who are either symptomatic or did not have adequate mental health support. In this context, our objective was to explore if symptom status in mothers and bonding share any significant association with the infants' development and quality of life (QOL), in case of mothers with severe mental illnesses in remission. The study included 41 mother-infant dyads from the outpatient perinatal psychiatry services and the mother-baby unit of the current study center. Symptom status, self-reported bonding, mother-infant interactions, and infants' development and QOL were assessed with Clinical Global Impressions, Postpartum Bonding Questionnaire, Pediatric Infant-Parent Exam, Developmental Assessment Scales for Indian Infants, and Pediatric Quality of Life Scale, respectively. Most mothers had a complete recovery or minimal symptoms. Nine (22%) infants had a significant developmental delay. Atypical play-based interactions were observed in nine (22%) mothers. Self-reported bonding and bonding as evinced over play-based interactions did not significantly correlate with the QOL or development of the infants. Mothers who have recovered and are functioning well reported good bonding with their infants, though objective assessment revealed specific difficulties. Symptom severity correlated with poor physical QOL in infants. The association between mothers' bonding and infants' mental health is domain-specific and differential than linear and robust. Infants of mothers with severe mental illnesses postpartum should be routinely monitored for mother-infant bonding, development, and 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.

Neurodevelopmental outcome of children with severe acute malnutrition

Background: Severe acute malnutrition is known to be a major risk factor for impaired motor, cognitive, and socio-emotional development. Not much work has been done to study the neuro development of these patients. The aim of this study was to assess the neurodevelopment and outcome of children between 1 and 30 months with diagnosis of SAM Methods: The study was an observational prospective study conducted from November 2018 to April 2020. A total of 61 patients were enrolled in our study. Patients admitted in NRC with diagnosis of SAM were assessed for neurodevelopment after stabilization. Developmental assessment scale of Indian infants was used to calculate the motor developmental quotient and mental developmental quotient. Patients were followed till 6 months and after 6 months, they were again assessed by DASII to see the improvement in neurodevelopment status. Developmental quotient of less 70 was taken as delayed. Results: Mean DMeQ after stabilization and at 6 months after discharge was 53.672 and 72.591 respectively. Mean DMoQ after stabilization and at 6 months after discharge was 50.50 and 68.23 respectively. Mean DQ after stabilization and at 6 months after discharge was 52.186 and 70.4105 respectively. Conclusions: Severe acute malnutrition results in neurodevelopmental impairment in children but early and effective intervention results in significant improvement in neurodevelopment status.

Effectiveness of Educational Games Based on Social Constructivist Approach in Interaction with Learning Styles on Improving Multiple Intelligences of Elementary Students

Objective: The current study aimed to examine the effectiveness of educational games based on the social constructivist approach in interaction with learning styles on improving multiple intelligences of fifth-grade female elementary students. Methods and Materials: The research method was a quasi-experimental design with pre-test, post-test with control groups, accompanied by a 2-month follow-up phase. The statistical population included all fifth-grade female students enrolled in public schools in Hamedan during the 2023-2024 academic year. In the first phase, using simple random sampling, one school from the Hamedan city areas was selected, and 100 of them were chosen through screening and then randomly assigned into 2 experimental groups (25 students in the deep learning group and 25 in the surface learning group) and 2 control groups (25 students in the deep learning group and 25 in the surface learning group). The experimental groups underwent six 90-minute sessions of educational games based on the social constructivist approach; however, the control groups did not receive any intervention and remained on the waiting list. The two-factor Learning Process Questionnaire (R-LPQ-2F) by Biggs et al. (2001), and the Multiple Intelligences Developmental Assessment Scales (MIDAS) questionnaire by Shearer (1996) were used for data collection. Data analysis was performed using mixed ANOVA and Bonferroni post-hoc tests with SPSS version 24. Findings: The results showed that educational games based on the social constructivist approach were more effective in students with deep learning styles than those with surface learning styles in improving multiple intelligences (P&lt;0.05). Conclusion: It can be concluded that educational games based on the social constructivist approach can be used as an appropriate educational method for improving multiple intelligences, especially in elementary students with deep learning styles.

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

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. 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.

Early Electroencephalogram as Predictor of Neuromotor Outcome in a Term Newborn with Hypoxic Ischaemia Encephalopathy- A Prospective Cohort Study

Introduction: Birth asphyxia is the leading cause of neonatal morbidity and mortality globally. Early prediction of neuromotor problems in babies with Hypoxic Ischaemic Encephalopathy (HIE) allows parental counseling regarding treatment continuation, better utilisation of limited resources and prompt referral for early intervention services to so that the best possible outcomes can be achieved. Aim: To investigate the role of early Electroencephalogram (EEG) background activity in prediction of cerebral palsy, epilepsy and developmental delay in term newborn with HIE and also to check the association of EEG background activity with Hammersmith Neonatal Neurological Examination (HNNE), Hammersmith Infant Neurological Examination (HINE) score and various short-term and long-term outcome. Materials and Methods: This prospective clinical study was conducted in Neonatal Intensive Care Unit (NICU) of Department of Paediatrics, Shyam Shah Medical college and associated Gandhi Memorial Hospital, Rewa (MP) during April 2019 to June 2020. Total 81 term neonates with HIE underwent conventional EEG within six hours of birth using International 10-20 system, (modified for neonate) for electrode placement. At the time of discharge HNNE was performed. On follow-up (6 to 12 months), cerebral palsy was evaluated using HINE and modified Ashworth score, Developmental delay by Development Assessment Scale for Indian Infant (DASII) scale and for epilepsy by clinical history and EEG background activity. Association between EEG background activity, HNNE, HINE score and various short-term and long-term outcome was calculated using Chi-square test and Fisher’s-exact test. Results: In present study, out of 81 cases, 58 (71.6%) cases were male and 23 (28.4%) cases were female with mean Gestational Age (GA) of 39 weeks. A total of 57 neonates were discharged successfully after stay of mean duration 13.8 days in NICU. All neonates with normal/mildly abnormal EEG background activity had 100% survival rates whereas only 68.2% (15) and 37% (10) could be discharged from moderately abnormal and severely abnormal EEG background activity group. Out of discharged patients none with severely abnormal background had optimal HNNE whereas 75% (24) of mildly abnormal EEG had optimal HNNE score. Mean HNNE and HINE score was significantly lower in newborns with severely abnormal EEG (mean score 20.8) as compared to normal EEG group (mean score 30.3). Severely abnormal EEG at birth had significant association with cerebral palsy (p-value&lt;0.0001), epilepsy (p-value= 0.003) and developmental delay (p-value&lt;0.001) as compared to moderately and mildly abnormal EEG background activity in newborns with HIE. Conclusion: EEG within six hours of birth in term neonate with HIE has very high sensitivity and Negative Predictive Value (NPV) in predicting short-term outcome as death, poor neurological outcome and long-terms outcome as cerebral palsy, epilepsy and developmental delay.

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.

The relationship between motor development and social adaptability in autism spectrum disorder.

Autism spectrum disorders(ASD)describe a wide range of pervasive developmental disorders by core symptoms including deficits in social communication and interaction, as well as restricted, repetitive, and stereotyped behaviors. At the same time, some children with autism are accompanied by motor development disorder. Many studies have confirmed that the motor development impairment was significantly associated with the social problems associated with ASD. Thus, this study aimed to investigate how motor development affects social adaptability in children with ASD to provide references for early ASD intervention. The case data of children's health care were selected in 2021. Motor development was assessed with the Developmental Behavior Assessment Scale for Children Aged 0-6 years. Social adaptability was measured using the Japanese S-M Social Living Skills Scale. Statistical analysis was conducted with SPSS 22.0 software package. Data were analyzed using independent samples t-test and logistic regression. A total of 198 cases comprising 140 boys (70.71%) and 58 girls (29.29%) were included, and the average age of participants was 3.40 ± 1.06 years, with 3.33 ± 1.18 years in the typical development (TD) children group and 3.46 ± 0.95 years in the ASD group. The social adaptability of 107 ASD children was abnormal, including 37 children (34.5%) with marginal, 48 children (44.9%) with mild, 17 children (15.9%) with moderate, and 5 children (4.7%) with severe. In 91 TD children, there were 51 children (56.04%) with normal social adaptability, 38 children (41.75%) with marginal, 2 children (2.19%) with mild, and nobody with moderate or severe. The ASD children had lower levels of developmental behavior than those of TD children, and the difference was statistically significant. The results of logistic regression showed that fine motor increased by 1 unit, and the OR value of one level decreased in social adaptability was 2.24 times (OR = e0.807 = 2.24). In children with ASD, not only motor development is delayed, but also social adaptability is affected, and fine motor skill may be important for social adaptability.

Short-term neurodevelopment and growth outcomes of very and moderate preterm Indian infants.

To study the growth and neurodevelopmental outcome of very and moderate preterm infants (VMPT) compared to term appropriate-for-age (term AGA) infants at 18-months corrected age. This prospective cohort study enrolled consecutively born 212 VMPT infants and 250 term AGA controls delivered during study period. Major neurodevelopmental impairment (NDI) defined as any one of cerebral palsy, motor (MoDQ) or mental developmental quotient (MoDQ) <70 on Developmental Assessment Scale for Indian infants, visual or hearing impairment, or epilepsy, and growth outcomes. Among 195 VMPT and 240 term AGA infants who completed follow-up, the frequency of major NDI was 12.8% and 2.5% respectively (RR 5.1; 95% CI [2.13-12.19]). Major NDI was higher among infants <28 weeks gestation (39%) and birthweight <1000 grams (27%). A quarter of VMPT infants exhibited wasting and 18% stunting than 7% each among controls. VMPT infants had a higher frequency of major NDI and growth failure at 18-months.

Magnesium Sulfate as an Adjunct to Therapeutic Hypothermia in the Management of Term Infants with Hypoxic-Ischemic Encephalopathy: A Randomized, Parallel-Group, Controlled Trial.

To evaluate whether magnesium sulfate and therapeutic hypothermia in combination decreases mortality and/or major neurodevelopmental disability at 1 y of age among term neonates with hypoxic-ischemic encephalopathy. A total of 134 term neonates were randomized to receive intravenous magnesium sulfate at a dose of 250mg/kg (at 8mg/kg/min) once daily for 3 d starting within 6h after birth along with therapeutic hypothermia in the intervention group and therapeutic hypothermia alone in the comparator group. The primary outcome was the composite outcome of mortality and/or major neurodevelopmental disability (Developmental Assessment Scale for Indian Infants score < 70) at 1 y of age. A total of 115 infants were included in the primary analysis. The composite primary outcome occurred in 14 (24%) infants in the intervention group and 19 (33%) infants in the comparator group, and the difference was not statistically significant (p = 0.30; relative risk 0.72; 95% confidence interval 0.40-1.30). The secondary outcomes including neonatal mortality, major neurodevelopmental disability at 1 y of age, neurological status at discharge, level of oxidative stress markers, and adverse effects including hypotension and respiratory depression requiring support were also comparable between the groups. The combination of magnesium sulfate and therapeutic hypothermia did not improve the composite outcome of neonatal mortality and/or major neurodevelopmental disability at 1 y of age. Clinical Trials Registry of India (CTRI/2018/06/014594), prospectively registered.

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.

Differential impact of antenatal exposure to antiseizure medications on motor and mental development in infants of women with epilepsy.

We aimed to determine a possible association between motor and mental development in infants of women with epilepsy and antenatal exposure to antiseizure medication (ASM). Developmental paediatricians who were blinded to antenatal ASM exposure evaluated motor and mental development of infants (>12 months) using the Developmental Assessment Scale for Indian Infants (an Indian adaptation of the Bayley Scale of Infant Development). Motor (MODQ) and mental development quotients (MEDQ) were computed as ratios of respective developmental age to the chronological age of the child. We employed linear mixed models to study the relationship between antenatal exposure to ASM and the development quotients after adjustment for malformation status and age of the baby, maternal education and seizure type. We studied 1,357 infants with mean age of 15.3±4.0 months (71.2% of all eligible infants). Infants were classified as having monotherapy or polytherapy, or unexposed in 840, 407 and 110 participants, respectively. The MEDQ of the polytherapy (92.9±14.9) and monotherapy (96.9±13.9) groups was lower than that of unexposed infants (99.8 12.5). Similarly, the MODQ of polytherapy (91.1±19.3) and monotherapy (96.6±17.5) groups was lower than that of unexposed infants (97.6 16.6). The differences in adjusted mean MEDQ were -7.4 (-11.4 to -4.3, p=0.001), -9.6 (-11.3 to -6.0, p=0.001) and -6.4 (-9.2 to -3.7, p=0.001) for valproate monotherapy, polytherapy with valproate and polytherapy without valproate, respectively. The adjusted mean MODQ also showed a similar trend. Those exposed to levetiracetam (n=62) had higher or similar adjusted MODQ (110.4±14.3; p=0.001) and MEDQ (104.3±9.1; p=0.09), compared to unexposed infants. A dose-dependent decrease in developmental indicators was observed for valproate and phenobarbitone. Antenatal exposure to ASM, especially valproate and phenobarbitone, adversely affects motor and mental development of exposed infants. Early developmental screening of high-risk infants is desirable.

A Novel de Novo Variant in 5' UTR of the NIPBL Associated with Cornelia de Lange Syndrome.

Background: Cornelia de Lange syndrome (CdLS) is a genetic syndrome characterized by intellectual disability, special facial features, growth retardation, feeding difficulties, and multiple organ system abnormalities. NIPBL variants occur in approximately 80% of CdLS cases. Aims: We report a novel de novo heterozygous pathogenic variant in the NIPBL and its association with CdLS. We also examined the key regulatory sequences of the 5′ untranslated region in NIPBL mRNA. Few studies have reported mutation sites in the 5′ untranslated region (UTR) of the NIPBL that result in CdLS. Methods: The patient’s medical history, clinical manifestations, physical examination, laboratory examination, Griffiths development assessment scale—Chinese version, and cardiac B-ultrasound were examined. Mutation screening was conducted using trio whole exome sequencing (trio-WES) and Sanger sequencing. Quantitative PCR was performed to measure the NIPBL expression in peripheral blood mononuclear cells. A Dual-Luciferase reporter assay was conducted to evaluate the transcription of truncated mutants. Results: The proband showed characteristics of CdLS including thick eyebrows, a concave nasal ridge, long and smooth philtrum, downturned corners of the mouth, intellectual disability, postnatal growth retardation, and a short fifth toe. A novel de novo heterozygous pathogenic variant in the NIPBL (c.-467C > T) was identified. A Dual-Luciferase reporter gene assay showed that SPO1 (-490 bp to -360 bp) and SPO3 (-490 bp to -401 bp) induced the highest activity. Conclusions: We found a novel de novo heterozygous pathogenic variant (c.-467C > T) in the NIPBL resulting in CdLS. Our findings expand the spectrum of pathogenic mutations for CdLS. Our in vitro experiments elucidated important regulatory sequences in the 5′ UTR of the NIPBL.