Diagnosis Of Developmental Delay Research Articles

Successful Routine Cervical Cancer Screening Facilitated by Pelvic Floor Physical Therapy for a Woman With Developmental Disability and a History of Trauma: Case Report

Background: Women with intellectual and developmental disabilities (I/DD) are not getting routine cervical cancer screens at the recommended frequency, limiting opportunities for early detection and treatment of cervical cancer. Pelvic floor physical therapy plans of care can be used to successfully address this health care disparity. Case Description: This is the case of a patient who had diagnoses of developmental delay, oppositional defiant disorder, attention-deficit disorder, unilateral hearing loss, and a history of trauma. The patient was referred by her primary care physician after a halted first pelvic examination due to tension of the patient's pelvic floor and her overall discomfort and dissociation from the session. Clinical findings revealed pelvic floor tension. Interventions were employed over the course of 18 sessions. Outcomes: Sessions focused on education, positioning, relaxation, and graded vaginal dilator insertion while keeping the patient engaged to prevent dissociation. The patient showed minimal clinically important differences on the Patient-Specific Functional Scale, met the short- and long-term goals including undergoing a pain-free pelvic examination, and had a significantly decreased pelvic floor resting tone. Discussion: For patients with I/DD, pelvic floor physical therapy can be a valuable tool to help them undergo a successful and pain-free routine cervical cancer screen. It may take longer than typical plans of care, but the outcomes justify the length of the intervention. Practices that promote self-determination are a key to success. Informed consent was obtained and signed by the patient's medical guardian. Video Abstract: Supplemental Digital Content available at: http://links.lww.com/JWHPT/A128

Adverse Childhood Experiences and Developmental Delay in Young US Children.

Adverse childhood experiences (ACEs) are common and have been associated with poor developmental outcomes. We aimed to investigate the relationship between early ACE exposure, subsequent diagnosis of developmental delay, and receipt of developmental delay services by young children. In addition, we aimed to assess the impact of health-promoting behaviors such as breastfeeding and daily reading on these relationships. In this cross-sectional analysis of nationally-representative data from the 2017-2018 National Survey of Children's Health, we examined the relationship between ACEs, prior breastfeeding, daily reading, and developmental delay diagnosis among 7837 children aged 3-5 years, using multivariate logistic regression to adjust for family, personal, and sociodemographic characteristics. We found a dose-dependent relationship between ACEs and developmental delay diagnosis; compared to those without ACEs, developmental delay was more common among those with either one ACE (aOR = 2.03, 95% CI 1.17-3.52) or two or more ACEs (aOR = 2.34, 95% CI 1.25-4.37). Neither breastfeeding (exclusively breastfed for 6 months vs. never breastfed aOR = 0.70, 95% CI 0.33-1.46) nor daily reading (no reading versus daily reading aOR = 1.15, CI 0.57-2.33) were associated with incidence of developmental delay among study participants. There was no significant difference in receipt of services intended to meet developmental needs between children with and without ACEs. Children with very early ACE exposure are at increased risk for diagnosis of developmental delay. Early screening for ACEs and developmental delay may mitigate the early developmental manifestations of ACE exposure in vulnerable children.

Plasma neuron specific enolase (NSE), tumour necrosis factor-alpha (TNF-α) and soluble IL-2 receptor alpha (sIL-2Rα) levels in children with developmental delay (DD): Use of combined ROC curves to increase their diagnostic value

BackgroundDevelopmental delay (DD) occurs when children fail to reach developmental milestones in comparison to peers of the same age range. However, there are no valuable biomarkers for the early diagnosis of DD. Since there is no specific marker for screening the disease, we evaluated plasma NSE, TNF-α and sIL2-Rα as potential markers for this purpose. MethodsIn this cross-sectional randomized case-control study, a total of 174 DD patients and 49 matched elderly controls aged between 2 months and 60 months were recruited. A sensitive enzyme-linked immunosorbent assay and an immunoradiometric assay were used to evaluate the levels of plasma IL-1, IL-6, IL-8, IL-10, sIL2-Rα, TNF-α, and NSE. Statistical analyses using t test, χ2, ANOVA, ROC curves and binary logistic regression models were performed. ResultsIn comparison to the control group, the DD group had greater levels of NSE, TNF-α, and sIL2-Rα(p < 0.05). In the binary logistic regression analysis of DD, NSE had an odds ratio (OR) of 1.783 (95 % CI 1.297 to 2.451, p = 0.000), indicating that NSE was an independent risk factor for DD. The plasma TNF-α level was positively correlated with plasma NSE and sIL2-Rα levels in the DD group (r = 0.366 and 0.433, respectively), and the DQ score and plasma sIL2-Rα level in the DD group were positively correlated. The ROC curve revealed that the respective areas under the NSE, TNF-α, and sIL2-Rα ROC curves were 0.9797, 0.9365, and 0.8533, respectively. Moreover, a significant increase in AUC was observed using combined ROC curve analysis. ConclusionsChildren with DD have significantly altered plasma concentrations of sIL2-Rα, NSE, and TNF-α. NSE, TNF-α and sIL2-Rα can be used as DD blood biomarkers. This information may be helpful in early diagnosis and intervention.

Developmental and epileptic encephalopathy 44 due to compound heterozygous variants in the UBA5 gene: a case report

BackgroundDevelopmental and epileptic encephalopathy (DEE) is a group of rare inherited disorders characterized by intellectual disability, delayed development, epileptic seizures, and other related symptoms. DEE44 is caused by mutations in the UBA5 gene, which encodes a ubiquitin-like protein involved in protein degradation and cell signaling. However, there is limited information on the genotype–phenotype correlation of DEE44, and its clinical features remain to be fully characterized.Case presentationWe report a 12-month-old infant who presented with epileptic spastic seizures beginning at 4 months of age, accompanied by overall developmental delay, short stature, microcephaly, inability to hold his head upright, chasing vision, and high muscle tone in the extremities. Genetic findings showed compound heterozygous mutations of the UBA5 gene: NM_024818 c.562C > T(p.R188X) from the mother and NM_024818 c.214C > T(p.R72C) from the father.ConclusionsThis case report expands the clinical spectrum of DEE44 and highlights the importance of considering DEE44 in the differential diagnosis of developmental delay and epilepsy, even in the absence of classical symptoms suggestive of the condition. We hope that this case report will advance the understanding of DEE44 and improve the expertise of clinicians and early diagnose of this disease.

Reduced Cortical Complexity in Children with Developmental Delay in Saudi Arabia.

Developmental delay (DD) is a neurodevelopmental disorder characterized by delays in multiple domains. The investigation of brain structure in DD has been enhanced by advanced neuroimaging techniques that can identify regional surface deformities. Neuroimaging studies have identified structural brain abnormalities in individuals with DD, but research specific to the Saudi Arabian population is limited. In this study, we examine the neuroanatomical abnormalities in the cortical and subcortical regions of Saudi Arabian children with DD. A T1-weighted, 1-mm-thick MRI was used to acquire structural brain images of 29 children with DD and age-matched healthy controls. Analysis of the MRI data revealed significant differences in several cortical and subcortical structures of gray matter (GM) and white matter (WM) in several brain regions of the DD group. Specifically, significant deformities were observed in the caudate nucleus, globus pallidus, frontal gyrus, pars opercularis, pars orbitalis, cingulate gyrus, and subcallosal gyrus. These findings suggest disrupted neurodevelopment in these regions, which may contribute to the cognitive, motor, and behavioral impairments commonly observed in individuals with DD. The present study provides valuable insights into the neuroanatomical differences in Saudi Arabian children with DD. Our results provide evidence for cortical and subcortical abnormalities in DD. Deformities in the observed regions may contribute to cognitive impairment, emotional dysregulation, mood disorders, and language deficits commonly observed in DD. The structural analysis may enable the identification of neuroanatomical biomarkers to facilitate the early diagnosis or progression of DD. These results suggest that lower cortical complexity in DD children due to alterations in networks may play a critical role in early brain development.

Neonatal outcomes of early preterm births according to the delivery indications

ObjectiveTo compare the neonatal outcomes of early preterm births according to delivery indications and determine the obstetric risk factors associated with adverse outcomes. MethodsWe retrospectively studied pregnancies delivered between 22 + 0 and 26 + 6 weeks at the tertiary center between April 2013 and April 2022. Stillbirths, elective termination of pregnancy, and multifetal pregnancies were excluded. Patients were classified into two groups according to delivery indications: spontaneous preterm birth (sPTB) due to premature rupture of membranes (PROM), preterm labor, or acute cervical insufficiency; and indicated preterm birth (iPTB). Obstetric and neonatal outcomes were compared between the groups. ResultsOf the 121 neonates, 73 % (88/121) underwent sPTB. The overall survival rates were 73 % and 49 % in the sPTB and iPTB groups, respectively (p = 0.017). Multivariate logistic regression analysis was performed with adjustment for gestational age at delivery, fetal growth restriction, cesarean section, histological chorioamnionitis, and funisitis. Moreover, in the 1-year follow-up, the proportion of body mass below the third percentile was significantly higher in the iPTB-group than in the sPTB-group (53 % vs. 20 %, p = 0.019). Furthermore, diagnoses of developmental delay and cerebral palsy were slightly higher in the iPTB-group (33 % and 20 %, respectively) than in the sPTB-group (27 % and 9 %, respectively); however, this difference was not statistically significant. ConclusionsIn early preterm births, iPTB was associated with a higher neonatal mortality than sPTB.

Construction and validation of ShaMaq developmental screening tool.

The diagnosis of developmental delay and early intervention ameliorates long-term sequelae. There is a need for an appropriate, regionally adapted and reliable developmental screening tool to be used in low and middle-income countries with scarce resources. The aim of this research is to construct and validate a screening tool for identifying developmental delay in Pakistani children. ShaMaq developmental screening tool (SDST) was developed consisting of five proformas to be administered at different age groups: 6-8weeks (Group 1), 6-10months (Group 2), 18-24 months (Group 3), 3-3.5years (Group 4), and 4.5-5.5years (Group 5). On an average, Groups 1-3 took 10-15 min, whereas Groups 4 and 5 took 20-25 min. We sampled children between the ages of 6weeks to 5.5years and tested them all within their designated age groups. Internal consistency was assessed by Cronbach's alpha. Interobserver testing was done for reliability and concurrent validity was undertaken by using the senior consultant developmental paediatrician's final diagnosis as the gold standard. Out of 550 healthy children, 8-19% in the five groups were found to have some form of developmental delay using SDST. Approximately 50% of the families were in the low-to-moderate income bracket, and nearly 93% lived in a joint family system. Internal consistency of items in the five groups ranged from 0.784 to 0.940, whereas both interobserver reliability and concurrent validity ranged from 0.737 to 1.0. SDST showed 94.4% sensitivity and 92.9% specificity. SDST is an effective tool for identifying delay in healthy children with good internal consistency, reliability, and validity.

Assessing the need for a standardised paediatric assessment tool for podiatrists in South Africa

There is no literature to support the existence of an effective standardised assessment tool in South Africa that aids the podiatrist in the early diagnosis of developmental delay in the paediatric patient from age one to five. Podiatrists in South Africa (SA) need a suitable assessment tool to evaluate child development. A potential proforma that could be used by South African podiatrists is the Gait and Lower Limb Observation Proforma (GALLOP) Assessment Tool. AimThe aim of this research was to evaluate the “ease of use” and “usefulness” of the GALLOP Assessment Tool for podiatrists to effectively assess the paediatric patient from age one to age five. MethodsThe study was of a mixed methods descriptive design type, targeting all Health Professions Council of South Africa (HPCSA) registered podiatrists in the Johannesburg Metropolitan Municipal area. After allowing the participants to use the GALLOP Assessment Tool for a period of time, a survey was conducted to establish the “ease of use” and “usefulness” of the GALLOP Assessment Tool. ResultsAll participants agreed that the GALLOP Assessment Tool would be beneficial to South African podiatrists and that the assessment tool does not need to be improved upon.

Pregnancy intentions' relationship with infant, pregnancy, maternal, and early childhood outcomes: Evidence from births in Alaska, Missouri, and Oklahoma

Much of reproductive health care policy in the United States focuses on enabling women to have intended pregnancies. Investigating whether the association between pregnancy intention and adverse outcomes for mothers and children in the immediate and longer term is due to intention or a mother's demographics provides valuable context for policy makers aiming to improve maternal and child outcomes. We investigated relationships between pregnancy intention and pregnancy, infant, early childhood, and maternal outcomes using data from the Pregnancy Risk Assessment Monitoring System survey, conducted 2-8months after the child's birth, and follow-up surveys from three states (Alaska, Missouri, and Oklahoma), administered at age 2-3 years old. We used logistic regressions with inverse propensity weights to measure associations, accounting for potential confounding factors. After inverse propensity weighting, pregnancy intention was associated with adverse maternal pregnancy behaviors but not most infant outcomes. Mothers who reported an unwanted pregnancy were associated with increased odds of the child receiving a developmental delay diagnosis. Among those who did not report depression prior to pregnancy, mothers with unwanted pregnancies were more likely to experience persistent depression, and mothers with pregnancies mistimed by two or more years had a higher likelihood of experiencing depression postpartum or in the follow up period. Our findings suggest that pregnancy intention is less consequential for maternal and child well-being than socio-economic disadvantage, suggesting that re-orienting policy toward social conditions and reproductive autonomy will serve betterindividual and population health.

Role of magnetic resonance imaging brain in children with developmental delay

Background: Developmental delay is one of the most common conditions encountered by paediatricians. It is defined as significant delay in one or more of the developmental domains. Evaluation of such children with neuroimaging is important to come to a specific diagnosis. Early identification and diagnosis have implications for better treatment and parental counselling regarding the outcome. This study aims to observe the various findings in magnetic resonance imaging (MRI) brain and to depict the aetiology in children with developmental delay. Methods: A hospital based retrospective observational study, was carried out in Kamineni institute of medical sciences, Narketpally among 40 children aged between 6 months to 12 years, with features of developmental delay. MRI brain was done and findings were later classified into various etiological subgroups. Results: Normal morphological MRI findings were seen in only 12.5% of children with developmental delay. Abnormal morphological findings in MRI were seen in 87.5%, out of which 40% showed metabolic and degenerative disorders, 37.5% of the findings depicted congenital malformations, 10% of them were of infectious aetiology. The white matter was the most commonly involved anatomical structures i.e., (52.5%), followed by ventricles (20%). Conclusions: MRI can easily detect many specific etiological and pathophysiological conditions thus; clinical diagnosis of developmental delay must be aided with neuroimaging for better understanding of the aetiology.

Prevalence of Developmental Delay in 12-month-old Infants, Urban Health Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2018 - 2019

Background: Developmental delay (DD) in children is a crucial issue in pediatric health. The most practical evaluation way for early detection of developmental delay is parent-completed tool by the Ages and Stages Questionnaire (ASQ). Objectives: The aim of this study was to estimate the prevalence of developmental delay in 12-month-old infants. Methods: In this cross-sectional study, 5,025 ASQs of 12-month-old children who presented in urban health centers of Shahid Beheshti University of Medical Sciences from 23 August 2018 to 23 August 2019, were evaluated. Total scores in five main domains and six final questions were extracted. Results: Fifty-one-point-five percent were boys. Also, 243 cases (4.8%) had problem in at least one out of the five domains, 68 cases (1.35%) had DD in two domains, five cases (0.09%) in three domains, four cases (0.07%) in four domains, and two cases (0.03%) had an essential delay in all five domains. Developmental delay was seen more in gross motor (1.6%), followed by communication (1.5%), problem-solving (1%), fine motor (0.4%), and personal-social (0.3%), respectively. There were significant statistical differences in personal-social and problem-solving in boys. Among six questions in ASQ, the most common problem was in question 4 (1.4%), which is related to auditory problems. Conclusions: Developmental screening is a basic tool for developmental delay detection. Developmental delay diagnosis and early intervention may be possible through cost-effective screening tools.

Outcomes and considerations in children with developmental delay undergoing tonsillectomy.

Developmental delay (DD) affects one in six children and has been shown to require more health care than the average child [1-2]. Certain recent studies have suggested an increased rate of complications/costs in children with DD [3-5]. Our objective was to perform a retrospective study comparing DD children to non-DD controls in patients presenting for tonsillectomy over a 1-year period to further define the relationship between DD and post-operative complications. We conducted a retrospective chart review of children undergoing tonsillectomy over a one-year period. We collected demographic information, polysomnogram, comorbidities, complications, and length of stay. A diagnosis of developmental delay was considered if recorded prior to the tonsillectomy or workup was ongoing at the time of tonsillectomy. All data was analyzed using IBM SPSS Statistics 25. The final cohort included 400 patients. Our cohort had 56 patients with diagnosis of DD. We recorded 18 complications in the DD population (32.14%) compared to 30 complications in the control group (8.72%) (p<0.00001). Children with DD had higher incidence of comorbidities (p<0.00001), complication with comorbidities (p<0.00001), and incidence of prematurity (p<0.00001); whereas, they did not have increased length of stay (LOS) (p=0.33) or complications if premature (p=0.22). Pre-operative polysomnogram was associated with higher incidence of complication (p=0.035) in the total population but children with DD did not have higher pre-operative obstructive apnea-hypopnea index (oAHI)compared to the control patients (p=0.25). Children with DD were found to have a significantly higher complication rate compared to children without DD in our patient population. They did have higher incidence of additional comorbidities and prematurity. This elevated risk should at least be included in pre-operative counseling, but additionally has potential implications for pre-operative decision making and treatment plans in this high-risk population.

Rates of rare copy number variants in different circumstances among patients with genetic developmental and epileptic encephalopathy.

Most patients with developmental and epileptic encephalopathy (DEE) have genetic etiology, which has been uncovered with different methods. Although chromosomal microarray analysis (CMA) has been broadly used in patients with DEE, data is still limited. Among 560 children (<18 years) who underwent CMA in our hospital between January 2013 and June 2021, 146 patients with developmental delay and recurrent seizures were screened. Patients with major brain abnormalities, metabolic abnormalities, and specific syndromes were excluded. The rate of rare copy number variants (CNVs) was estimated in total and according to seizure-onset age, relation to first seizure with the diagnosis of developmental delay, epilepsy syndromes, and organ anomalies. Among the 110 patients enrolled, the rate of rare CNVs was 16.4%, varying by seizure-onset age: 33.3% in three neonates, 21.2% in 33 infants, 13.3% in 45 early childhood patients, 5.3% in 19 late childhood patients, and 30.0% in 10 adolescents. In relation to the first seizure with the diagnosis of developmental delay, the rates were 3.7%, 22.2%, and 12.5% in "before", "after", and "concurrent" subclasses, respectively. The rates of rare CNVs were 16.7% in "other predominantly focal or multifocal epilepsy", 28.6% in "other predominantly generalized epilepsy (PGE)", and 15.4% in West syndrome. The rates were 27.8% in minor brain anomalies, 37.5% in facial dysmorphism, and 22.2%, 20.0%, and 57.1% in endocrine, genitourinary and cardiovascular anomalies, respectively. The rate of rare CNVs in patients with genetic DEE was 16.4% in total, which was higher in seizures occurring below the infantile period or after the diagnosis of developmental delay, in PGE, and in the presence of facial dysmorphism or cardiovascular anomalies.

Dopaminergic Gene Dosage Reveals Distinct Biological Partitions between Autism and Developmental Delay as Revealed by Complex Network Analysis and Machine Learning Approaches.

The neurobiological mechanisms underlying Autism Spectrum Disorders (ASD) remains controversial. One factor contributing to this debate is the phenotypic heterogeneity observed in ASD, which suggests that multiple system disruptions may contribute to diverse patterns of impairment which have been reported between and within study samples. Here, we used SFARI data to address genetic imbalances affecting the dopaminergic system. Using complex network analysis, we investigated the relations between phenotypic profiles, gene dosage and gene ontology (GO) terms related to dopaminergic neurotransmission from a polygenic point-of-view. We observed that the degree of distribution of the networks matched a power-law distribution characterized by the presence of hubs, gene or GO nodes with a large number of interactions. Furthermore, we identified interesting patterns related to subnetworks of genes and GO terms, which suggested applicability to separation of clinical clusters (Developmental Delay (DD) versus ASD). This has the potential to improve our understanding of genetic variability issues and has implications for diagnostic categorization. In ASD, we identified the separability of four key dopaminergic mechanisms disrupted with regard to receptor binding, synaptic physiology and neural differentiation, each belonging to particular subgroups of ASD participants, whereas in DD a more unitary biological pattern was found. Finally, network analysis was fed into a machine learning binary classification framework to differentiate between the diagnosis of ASD and DD. Subsets of 1846 participants were used to train a Random Forest algorithm. Our best classifier achieved, on average, a diagnosis-predicting accuracy of 85.18% (sd 1.11%) on the test samples of 790 participants using 117 genes. The achieved accuracy surpassed results using genetic data and closely matched imaging approaches addressing binary diagnostic classification. Importantly, we observed a similar prediction accuracy when the classifier uses only 62 GO features. This result further corroborates the complex network analysis approach, suggesting that different genetic causes might converge to the dysregulation of the same set of biological mechanisms, leading to a similar disease phenotype. This new biology-driven ontological framework yields a less variable and more compact domain-related set of features with potential mechanistic generalization. The proposed network analysis, allowing for the determination of a clearcut biological distinction between ASD and DD (the latter presenting much lower modularity and heterogeneity), is amenable to machine learning approaches and provides an interesting avenue of research for the future.

Connecting to Early Intervention Services After Neonatal Intensive Care Unit Discharge in a Medicaid Sample.

To describe caregiver perspectives regarding connecting to early intervention (EI) services after neonatal intensive care unit discharge in a Medicaid sample. Open-ended semistructured interviews and focus groups were conducted with English- or Spanish-speaking families enrolled in Medicaid in an urban high-risk infant follow-up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. Thirty-two participants completed the study. The infant's median (interquartile range) birth weight was 1365 (969, 2800) grams; 50% were Hispanic; 31% reported living in a neighborhood with fourth quartile economic hardship. Eighty-one percent were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm and 63% had a diagnosis of developmental delay. A conceptual model was constructed and the analysis revealed major themes describing families' challenges and ideas to facilitate connection to EI. We identified subthemes related to the person in environment: health care environment/support and socio-economic resources, parent perspectives and built environment; provider level factors such as appointment scheduling, staff limitations, and parent suggestions to improve health care and service navigation, which included improved information sharing, the importance of patient advocates, video resources, early referrals to EI facilitated by the discharging hospital and system workarounds. The results from this study may provide a granular roadmap for providers to help facilitate referrals to EI services. We identified several ideas such as using advocates and providing transitional resources, including online media, that might improve the connection to EI services.

Neonatal chemokine markers predict subsequent diagnosis of autism spectrum disorder and delayed development

Immune dysregulation has been found to be related to a diagnosis of autism spectrum disorder (ASD). However, investigations in very early childhood examining immunological abnormalities such as altered neonatal cytokine/chemokine profiles in association with an aberrant developmental trajectory, are sparse. We assessed neonatal blood spots from 398 children, including 171 with ASD, which were subdivided according to severity (121 severe, 50 mild/moderate) and cognitive/adaptive levels (144 low-functioning, 27 typical to high-functioning). The remainder were 69 children with developmental delay (DD), and 158 with typical development (TD), who served as controls in the Childhood Autism Risks from Genetics and the Environment (CHARGE) study. Exploratory analysis suggested that, in comparisons with TD and DD, CTACK (CCL27) and MPIF-1 (CCL23), respectively, were independently associated with ASD. Higher neonatal levels of CTACK were associated with decreased odds of ASD compared to TD (odds ratio [OR] = 0.40, 95% confidence interval [Cl] 0.21, 0.77), whereas higher levels of MPIF-1 were associated with increased odds of ASD (OR = 2.38, 95% Cl 1.42, 3.98) compared to DD but not to TD. MPIF-1 was positively associated with better scores in several developmental domains. Dysregulation of chemokine levels in early life can impede normal immune and neurobehavioral development, which can lead to diagnosis of ASD or DD. This study collectively suggests that certain peripheral chemokines at birth are associated with ASD progression during childhood and that children with ASD and DD have distinct neonatal chemokine profiles that can differentiate their diagnoses.

Developmental Delay in Infants With Positional Skull Deformity

Research Article| July 01 2021 Developmental Delay in Infants With Positional Skull Deformity AAP Grand Rounds (2021) 46 (1): 4. https://doi.org/10.1542/gr.46-1-4 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Developmental Delay in Infants With Positional Skull Deformity. AAP Grand Rounds July 2021; 46 (1): 4. https://doi.org/10.1542/gr.46-1-4 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: developmental delay, plagiocephaly, skull malformation Source: Rohde JF, Goyal NK, Slovin SR, et al. Association of positional plagiocephaly and developmental delay within a primary care network. J Dev Behav Pediatr. 2021;42(2):128-134; doi: https://doi.org/10.1097/DBP.0000000000000860Google Scholar Investigators from Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, conducted a retrospective study to assess the association between plagiocephaly and developmental delay among a cohort of children seen in primary care offices and the relative timing of plagiocephaly and developmental delay. For the study, they reviewed data obtained from 45 primary care sites within a single health care system and abstracted data on patients <5 years old who had a first primary care office visit by the age of 12 months between 2000 and 2017. Children with a plagiocephaly diagnosis by 12 months were identified by ICD-9 and ICD-10 codes. Controls were patients seen by 12 months without a diagnosis of plagiocephaly. Data on demographics, history of prematurity, and diagnoses of abnormal tone and torticollis also were abstracted. The primary study outcome was a diagnosis of developmental delay, identified with ICD-9 and ICD-10 codes, assigned by a primary care provider. Secondary outcomes included diagnoses of specific types of developmental delay. The dates of first diagnosis of plagiocephaly and developmental delay were obtained. The association between demographic and clinical characteristics and plagiocephaly was assessed with chi-square or Fisher exact tests. Logistic regression was used to determine if plagiocephaly was independently associated with developmental delay and specific types of delay. Data were analyzed on 77,108 children, including 2,315 (3.0%) diagnosed with plagiocephaly by the age of 12 months. The median age of diagnosis was 3 months. Children diagnosed with plagiocephaly were significantly more likely to be male, white, have private insurance, and to have been born prematurely than controls (all P values <0.001). Diagnoses of abnormal tone (P <0.001) and torticollis (P <0.001) also were significantly associated with plagiocephaly. Developmental delay was diagnosed in 404 (17.5%) of those with plagiocephaly and 6,492 (8.7%) of controls. After controlling for confounding variables, plagiocephaly was independently associated with developmental delay (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.32, 1.70). Among specific types of developmental delay, plagiocephaly was associated with an increased odds for motor delay (OR, 1.67; 95% CI, 1.29, 2.16), language delay (OR, 1.35; 95% CI, 1.17, 1.56), and general delay (OR, 1.77; 95% CI, 1.39, 2.24), but not social delay (OR, 2.72; 95% CI, 0.87, 8.50) or cognitive delay (OR, 0.36; 95% CI, 0.11, 1.23). The diagnosis of plagiocephaly preceded that of developmental delay in 374 of 406 children (92.6%) with both conditions. The authors conclude that among a cohort of children seen in primary care offices there was an association between plagiocephaly and developmental delay. Dr Badawi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Deformational plagiocephaly and brachycephaly result from prolonged forces applied to the back... You do not currently have access to this content.

Racial Disparities in Developmental Delay Diagnosis and Services Received in Early Childhood.

Racial disparities in diagnosis and receipt of services for early childhood developmental delay (DD) are well known but studies have had difficulties distinguishing contributing patient, healthcare system, and physician factors from underlying prevalence. We examine rates of physician diagnoses of DD by preschool and kindergarten entry controlling for a child's objective development via scoring on validated developmental assessment along with other child characteristics. We used data from the preschool and kindergarten entry waves of the Early Childhood Longitudinal Study, Birth Cohort. Dependent variables included being diagnosed with DD by a medical provider and receipt of developmental services. Logistic regression models tested whether a child's race was associated with both outcomes during preschool and kindergarten while controlling for the developmental assessments, as well as other contextual factors. Among 7950 children, 6.6% of preschoolers and 7.5% of kindergarteners were diagnosed with DD. Of preschool children with DD, 66.5% were receiving developmental services, while 69.1% of kindergarten children with DD were receiving services. Children who were Black, Asian, spoke a primary language other than English and had no health insurance were less likely to be diagnosed with DD despite accounting for cognitive ability. Black and Latinx children were less likely to receive services. Racial minority children are less likely to be diagnosed by their pediatric provider with DD and less likely to receive services despite accounting for a child's objective developmental assessment. The pediatric primary care system is an important target for interventions to reduce these disparities.

Who to Test? A Retrospective Study of Lead Testing in High-Risk Children.

Nearly all pediatric patients in our setting meet high-risk criteria for lead exposure based on screening recommendations and guidelines. Implementation of screening and testing has been inconsistent. To assess the utility and efficacy of performing universal lead testing between ages 1 and 5 at an urban academic pediatric practice. Retrospective review of patients with routine lead testing between 2010 and 2015. Key variables included demographics, serum lead level, and behavioral diagnoses. A total of 6597 serum lead levels from 3274 patients were reviewed. Forty-seven samples (0.7%) from 24 patients (0.7%) were elevated. Of the 24 patients with elevated lead, 75% were identified at age 1 or 2. Sixty-seven percent of patients with first elevated lead level at age 3 or older had a diagnosis of developmental delay. Routine testing of high-risk patients yielded minimal specificity in identifying elevated lead levels, especially in patients older than 3 years and without developmental delay.

Rural and Racial/Ethnic Differences in Children Receiving Early Intervention Services.

We examined health care providers' (HCPs') responses to parents' developmental concerns about their children. We looked at the association with race, ethnicity, gender, rurality, and time to diagnosis. All data were secondary and derived from the Centers for Disease Control and Prevention's Survey of Pathways to Diagnosis and Services. Participants consisted of 1321 parents of children who had received early intervention services as reported by respondents' data collected in 2011. From a nationally representative sample of families receiving early intervention services, 76% were white, 10% were African American, 3% were Asian, 5% were Native American, and 9% were Hispanic. Families who were Hispanic were more likely to have received only a delaying response from HCPs. The average time to a developmental delay diagnosis was 5 months longer for families who received a delaying HCP response. Families who were Hispanic or who were from rural areas were most likely to receive a delayed HCP response; for parents who received a delayed HCP response, a developmental delay diagnosis took 5 months longer than for families from the other groups listed.