Fine Motor Scores Research Articles

Early Life Exposure to Ambient Air Pollutants is Associated with Decreased Cognitive Development in Hispanic Infants from Southern California

BACKGROUND AND AIM: Previous research has established an association between postnatal ambient air pollution (AAP) exposure and cognitive development in preschoolers and school-aged children. However, this association has not been examined during infancy, a critical neurodevelopmental window. The purpose of this study was to explore relationships between postnatal AAP exposure and cognitive development in infants. METHODS: This study examined 118 Hispanic mother-infant pairs from the longitudinal Mother’s Milk Study in Southern California. Average individual residential exposure to AAP, including nitrogen dioxide (NO2) and particulate matter smaller than 2.5 and 10 microns in diameter (PM2.5 and PM10 respectively), in the first month of life was estimated from central site monitors. Infant cognitive outcomes at 24-months were measured using the Bailey-III Scales of Infant and Toddler Development. Multivariate linear regression was used to examine relationships between postnatal AAP exposure and age scaled cognitive scores, adjusting for socioeconomic status, breastfeeding frequency, time of delivery (early/late/on-time) as a proxy for gestational age, pre-pregnancy BMI, birthweight, and sex. Effects are reported for each standard deviation increase in exposure. RESULTS:NO2 was negatively associated with fine motor score (β=-0.55, p=0.006), motor score (β=-0.90, p =0.007), and cognitive score (β=-0.55, p=0.01). PM2.5 and PM10 were negatively associated with social emotional scores (β=-0.77, p=0.009 and β=-0.66, p=0.01 respectively). The association between NO2 and cognitive score varied by infant sex (p-interaction = 0.046), where NO2 was negatively associated with cognitive score among females (β=-0.16, p=0.0006) but not males (β=-0.01, p=0.81). CONCLUSIONS:Higher postnatal exposure to AAP in the first month of life was inversely associated with scaled motor, cognitive, and social-emotional scores at 24-months of age. Sex-specific findings for scaled cognitive score may suggest differential impacts of AAP exposure among females. These results indicate that AAP may negatively impact neurodevelopment in early life. KEYWORDS: Air Pollution, Neurodevelopmental Outcomes, Multi-pollutant, Environmental Disparities, Short-term Exposure

Early motor outcomes in infants with critical congenital heart disease are related to neonatal brain development and brain injury.

AimTo assess the relationship between neonatal brain development and injury with early motor outcomes in infants with critical congenital heart disease (CCHD).MethodNeonatal brain magnetic resonance imaging was performed after open‐heart surgery with cardiopulmonary bypass. Cortical grey matter (CGM), unmyelinated white matter, and cerebellar volumes, as well as white matter motor tract fractional anisotropy and mean diffusivity were assessed. White matter injury (WMI) and arterial ischaemic stroke (AIS) with corticospinal tract (CST) involvement were scored. Associations with motor outcomes at 3, 9, and 18 months were corrected for repeated cardiac surgery.ResultsFifty‐one infants (31 males, 20 females) were included prospectively. Median age at neonatal surgery and postoperative brain magnetic resonance imaging was 7 days (interquartile range [IQR] 5–11d) and 15 days (IQR 12–21d) respectively. Smaller CGM and cerebellar volumes were associated with lower fine motor scores at 9 months (CGM regression coefficient=0.51, 95% confidence interval [CI]=0.15–0.86; cerebellum regression coefficient=3.08, 95% CI=1.07–5.09) and 18 months (cerebellum regression coefficient=2.08, 95% CI=0.47–5.12). The fractional anisotropy and mean diffusivity of white matter motor tracts were not related with motor scores. WMI was related to lower gross motor scores at 9 months (mean difference −0.8SD, 95% CI=−1.5 to −0.2). AIS with CST involvement increased the risk of gross motor problems and muscle tone abnormalities. Cerebral palsy (n=3) was preceded by severe ischaemic brain injury.InterpretationNeonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.

Maternal Sedentary Behavior and Physical Activity across Pregnancy and Early Childhood Motor Development.

Early childhood motor development is an important indicator of short- and long-term health. In utero exposures impact offspring health across the lifespan; however, whether maternal activity during pregnancy may impact early childhood motor development remains unknown. This prospective cohort study measured the motor development skills of n = 70 children born to mothers from a previously conducted cohort study which objectively measured activity profile, (sedentary behavior (SED) and moderate-to-vigorous intensity physical activity (MVPA), across pregnancy. Mothers reported the motor development of their child using the Early Motor Questionnaire (EMQ). Linear regression models examined associations between maternal activity profile and EMQ scores. Maternal SED and MVPA were analyzed in two ways: trimester-specific and across pregnancy using trajectory groups. Children were 12–30 months of age, majority white (82%), and 52% male. Maternal SED during pregnancy was not associated with any EMQ domains (gross motor, fine motor, and perception action). Higher maternal MVPA, across pregnancy by trajectory group and in the first and second trimesters, was significantly associated with moderate-sized effects of more advanced fine motor and perception action scores. Higher MVPA in early pregnancy appears to be related to more advanced early childhood motor development. Therefore, maternal MVPA may be a modifiable behavior by which short- and long-term offspring health may be impacted.

An Intervention Package Including Egg and Milk-Based Snack Improved Growth and Development of U-2 Children in Bangladesh: A Community-Based Randomized Controlled Trial

Abstract Objectives We aimed to compare the effect of a comprehensive intervention package focusing on the animal-source protein (egg and milk)-based snack in conjunction with feeding counseling, water sanitation and hygiene, and supplementation with multiple micronutrient powder on linear growth and development of 6‒12-month old children in rural Bangladesh. Primary and secondary outcomes were differences in length-for-age Z score and cognitive development. Methods A community-based cluster randomized controlled longitudinal trial included 412 mother-infant pairs from 13 unions (small-administrative-unit) of Harirampur sub-district, allocating to receive treatment (n = 206) or regular health messages (n = 206) as control. The treatment group received monthly food vouchers (30 eggs, 12 L milk, 500 g semolina, 500 mL oil, 500 g sugar) to prepare nutritious children's snacks, micronutrient powder, child feeding and handwashing counseling for 12 months. The Control group received routine health messages from the government. Anthropometry, feeding and morbidity data were collected at baseline, monthly and endpoint. Children's development was assessed only once at an endpoint using Extended Ages and Stages Questionnaire (EASQ), Bayley III and Wolke's behavior rating scales. We used generalized linear regression modelling to conduct intention to treat analysis. Results Children's mean weight and length were similar between groups at baseline. At endpoint, compared to the control, treatment children had higher mean length (83.52 and 80.89 cm; difference: 2.62, P < 0.001); higher LAZ score (β: 0.38, CI: 0.24, 0.51); 61% lower rate of stunting (IRR: 0.39, CI: 0.22, 0.67); higher cognitive (β: 4.01, CI: 2.08, 5.94), language (β: 2.94, CI: 0.94, 4.94) and motor (β: 4.53, CI: 1.87, 7.20) scores, all being statistically significant. The intervention also improved developmental EASQ outcomes of the treatment children (gross and fine motor, problem-solving, and socio-emotional scores). Conclusions A comprehensive intervention package focusing on egg and milk-based snacks improved child growth and development in poor households in Bangladesh. Reducing the intervention cost and scale-up to larger communities in resource-poor settings merit further research. Funding Sources Children Investment Fund Foundation funded the trial.

Maternal and neonatal factors associated with child development in Cear\xe1, Brazil: a population-based study

BackgroundThe first 1000 days of life are a critical period when the foundations of child development and growth are established. Few studies in Latin America have examined the relationship of birth outcomes and neonatal care factors with development outcomes in young children. We aimed to assess the association between pregnancy and neonatal factors with children’s developmental scores in a cross-sectional, population-based study of children in Ceará, Brazil.MethodsPopulation-based, cross-sectional study of children aged 0–66 months (0–5.5 years) living in Ceará, Brazil. We examined the relationship of pregnancy (iron and folic acid supplementation, smoking and alcohol consumption) and neonatal (low birth weight (LBW) gestational age, neonatal care interventions, and breastfeeding in the first hour) factors with child development. Children’s development was assessed with the Ages and Stages Questionnaire (ASQ-BR). We used multivariate generalized linear models that accounted for clustering sampling to evaluate the relationship of pregnancy and neonatal factors with development domain scores.FindingsA total of 3566 children were enrolled. Among pregnancy factors, children whose mothers did not receive folic acid supplementation during pregnancy had lower fine motor and problem-solving scores (p-values< 0.05). As for neonatal factors, LBW was associated with 0.14 standard deviations (SD) lower (CI 95% -0.26, − 0.02) communication, 0.24 SD lower (95% CI: − 0.44, − 0.04) fine motor and 0.31 SD lower (CI 95% -0.45, − 0.16) problem-solving domain scores as compared to non-LBW children (p values < 0.05). In terms of care, newborns that required resuscitation, antibiotics for infection, or extended in-patient stay after birth had lower development scores in selected domains. Further, not initiating breastfeeding within the first hour after birth was associated with lower gross motor and person-social development scores (p-values < 0.05).ConclusionPregnancy and neonatal care factors were associated with later child development outcomes. Infants at increased risk of suboptimal development, like LBW or newborns requiring extended in-patient care, may represent groups to target for supplemental intervention. Further, early integrated interventions to prevent adverse pregnancy and newborn outcomes may improve child development outcomes.

Early-life exposure to aluminum and fine motor performance in infants: a longitudinal study.

Aluminum (Al) is a well-established neurotoxicant. However, little is known about its effects on the neurodevelopment of infants. To examine early-life exposure to Al in relation to neurodevelopment in healthy infants. Nail Al concentrations were measured among 747 newborn babies within 6 months of delivery in the Shanghai Birth Cohort. Neurodevelopment was assessed using Ages and stages questionnaire (third edition, ASQ-3) at ages 6 and 12 months. General linear regression models were performed to estimate the associations between Al concentrations and ASQ-3 scores. After adjustment for potential confounders, early-life exposure to Al was not associated with any neurodevelopmental performance at age 6 months. However, Al level was associated with an increased risk of having a low fine motor score (quartile 4 vs. quartile 1, mean difference (MD): -1.63; 95% confidence interval (CI): -3.22, -0.05; P-trend < 0.01) at 12 months. No association was found for communication, gross motor, problem-solving, or personal-social score at 12 months. Early-life exposure to Al may be associated with poor fine motor skills in a dose-response manner among apparently healthy infants at age 12 months.

Cognitive, motor, and visual development in healthy children in the first 42 months of life.

The Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) is a tool for measuring the developmental status of children, including cognitive and motor functioning, in the first three years of life. This study aims to evaluate the correlation between grating visual acuity and visual functionality in healthy children using the Bayley-III. Binocular grating visual acuity was measured using Teller Acuity Cards followed by the Bayley-III in healthy children aged 1-42 months. Visual acuity (logMAR) and Bayley-III scores for both cognitive and motor (gross and fine) skills were compared. Forty children (20 boys) aged 1.2-42.1 months were tested. Their mean visual acuity was 0.39 ± 0.27 logMAR, which was within the normal age limits for all children. There was a strong and significant negative correlation between visual acuity and age (r=-0.83, p<0.001). The mean cognitive raw data score was 49.92 ± 18.93 points, with a strong and significant positive correlation between cognitive score and age (r=0.81, p<0.001). The mean gross motor score was 41.72 ± 16.23 points, with a strong and significant positive correlation between gross motor score and age (r=0.75, p<0.001). The mean fine motor score was 39.75 ± 14.63 points, with a strong and significant positive correlation between fine motor score and age (r=0.77, p<0.001). Multiple linear regression demonstrated that older age and better visual acuity were significantly associated with higher Bayley-III scores. This study found a high correlation between grating visual acuity measured using Teller Acuity Cards and cognitive and motor scores measured using the Bayley-III in healthy children, demonstrating that the Bayley-III might be a useful tool for assessing the repercussions of visual impairment on the cognitive and motor development of young children.

The relationship of motor development with sensory processing among infants born very preterm: a prospective case-control study.

Little is known about the relationship between sensory processing and motor development in very preterm infants. The purpose of this study was to explore the relationship of motor development with sensory processing among such infants with developmental delay and those who had typical development at the ages of 8 and 12 months. This prospective case-control study included 61 preterm infants (31 males, 30 females, mean gestational age: 29.1 weeks). The infants had a gestational age of 32 weeks or less and a current corrected age of 8 months, and they had spent at least 15 days in the neonatal intensive care unit. Motor development was assessed with the Neuro-sensory Motor Developmental Assessment (NSMDA), and sensory processing was evaluated with the Test of Sensory Functions in Infants (TSFI). There were very strong positive correlations between the gross and fine motor scores of the NSMDA and the TSFI`s subdomain scores and total scores (r=0.85-0.93, p < 0.001). There were also very strong negative correlations between the functional level according to the NSMDA and the subdomain scores and total scores of the TSFI (r=-0.89-0.94, p < 0.001). The results show that sensory processing and motor development are related parts of the development of very preterm infants. In the early rehabilitation process, therapists should comprehensively take motor and sensory development into consideration.

Do Infant Motor Skills Mediate the Association Between Positional Plagiocephaly/Brachycephaly and Cognition in School-Aged Children?

Positional plagiocephaly/brachycephaly (PPB) is associated with lower cognitive scores in school-aged children. This study tested the hypothesis that infant motor skills mediate this association. Children with a history of PPB (cases, n=187) and without PPB (controls, n=149) were followed from infancy through approximately 9years of age. Infant motor skills were assessed using the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3), and cognition was assessed using the Differential Ability Scales, 2nd edition (DAS-2). The Bayley-3 motor composite was examined as a mediator of the association between PPB and DAS-2 general cognitive ability (GCA) scores. In secondary analyses, mediation models were examined for the DAS-2 verbal ability, nonverbal ability, and working memory scores; models using the Bayley-3 fine versus gross motor scores also were examined. Cases scored lower than controls on the DAS-GCA (β=-4.6; 95% CI=-7.2 to -2.0), with an indirect (mediated) effect of β=-1.5 (95% CI=-2.6 to -0.4) and direct effect of β=-3.1 (95% CI=-5.7 to -0.5). Infant motor skills accounted for approximately 33% of the case-control difference in DAS-2 GCA scores. Results were similar for other DAS-2 outcomes. Evidence of mediation was greater for Bayley-3 gross motor versus fine motor scores. Infant motor skills partially mediate the association between PPB and cognition in school-aged children. Monitoring motor development and providing intervention as needed may help offset associated developmental concerns for children with PPB. To our knowledge, this study is the first longitudinal investigation of the development of children with and without PPB from infancy through the early school years and the first to examine motor skills as a mediator of cognitive outcomes in this population. The findings highlight the importance of early motor skills for other developmental outcomes. Infants' motor skills are related to the development of PPB and its association with later cognition. If your child has PPB, physical therapists may have an important role in assessing and providing treatment to promote motor development.

Neurobehaviour of very preterm infants at term equivalent age is related to early childhood outcomes.

To describe neurodevelopmental outcomes during early childhood among infants born very preterm and define the relationships between neurobehaviour of very preterm infants and neurodevelopmental outcomes at 4years. Forty-eight infants born ≤32weeks gestation had neurobehaviour assessed at term equivalent age using the NICU Network Neurobehavioral Scale (NNNS). Outcomes at 4years were assessed with the Ages and Stages Questionnaire (ASQ-3), the Sensory Profile-Short Form (SF) and the Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P). At 4years, 23 (48%) children had at least one below average score on the ASQ-3, 15 (31%) had a below average total score on the Sensory Profile-SF, and 3 (6%) had an abnormal total score on the BRIEF-P. Children with lower fine motor scores at 4years had poorer orientation (P=0.03) and self-regulation (P=0.03), hypertonia (P=0.01), and more sub-optimal reflexes (P=0.02) as neonates. Children with lower gross motor scores at 4years of age had more sub-optimal reflexes (P=0.03) and lethargy (P=0.046) as neonates. Children with tactile sensitivity at 4years of age had poorer orientation (P=0.01) and tolerance of handling (P=0.03) as neonates. Children with decreased responsiveness at 4years of age had low arousal (P=0.02) as neonates, and those with poor auditory filtering at age 4years had hypotonia (P=0.03) as neonates. Early neurobehaviour is related to neurodevelopmental outcome in early childhood.

The Impact of Hypernatremia in Preterm Infants on Neurodevelopmental Outcome at 18 Months of Corrected Age.

The study objective was to assess the correlation between hypernatremia during the first week of life and neurodevelopmental outcomes at 18 months of corrected age in premature infants. A retrospective observational study of preterm infants born at less than 32 weeks of gestation who had a neurodevelopmental assessment with the Bayley scales of infant and toddler development III at 18 ± 6 months of corrected age. Serum sodium levels from birth through 7 days of life were collected. The study cohort was divided into two groups: infants with a peak serum sodium of >145 mmol/L (hypernatremia group) and infants with a peak serum sodium level of <145 mmol/L (no hypernatremia group). Prenatal, intrapartum, and postnatal hospital course and neurodevelopmental data at 18 ± 6 months were collected. Logistic regression analysis was used to assess the correlation between neonatal hypernatremia and neurodevelopment with adjustment for selected population characteristics. Eighty-eight preterm infants with complete neurodevelopmental outcome data at 18 ± 6 months of corrected gestational age were included in the study. Thirty-five neonates were in the hypernatremia group and 53 were in the no hypernatremia group. Maternal and neonatal characteristics were similar between the two groups except that the hypernatremia group had a significantly lower average birth weight and gestational age. Comparison of the mean neurodevelopmental scores between the two groups showed that patients in the hypernatremia group as compared with those in the no hypernatremia group had significantly lower neurodevelopmental scaled scores in the fine motor domain (p = 0.01). This difference remained significant (p = 0.03, odds ratio [OR] = 0.8, 95% confidence interval [CI]: 0.6-0.97) when adjusted for birth weight and gestational age. Preterm infants born at less than 32 weeks of gestation with hypernatremia in the first week of life have lower fine motor scores at 18 months of corrected age. · Hypernatremia is a common electrolyte disturbance in preterm neonates.. · Hypernatremia may be associated with long-term neurodevelopmental outcomes in preterm infants.. · Hypernatremia is a potentially modifiable risk factor..

The Effect of Development Education on Fine Motor Skills of 18-Month-Old Children

Background The initial years of life particularly the first two years are regarded as the most important brain development period. The development of children is an important determinant of health throughout the whole of life. We aimed to evaluate an educational program to improve the fine motor skills of 18-month-old children. Materials and Methods: This randomized clinical trial was conducted in the city of Saqqez, Iran in 2015-2016. Seventy 18-month-old infants were randomly assigned to control (n=35), and intervention (n=35) groups. The training of fine motor skills was given to the mothers of the children of intervention group, including: painting, building a tower, stringing, tearing and crushing a piece of paper, targeting and dropping. Fine motor skills were measured before intervention and 4 and 8 weeks after the intervention using ASQ-II screening tool (Age and Stage Questionnaire, Second Edition). Data were analyzed using SPSS software version 20.0. Results: In the intervention and control group, 51.5% (n=17) were male and 48.5% (n=16) were female. Statistical test of Chi-square showed that there was no statistically significant difference in terms of gender (p=0.59). According to independent t-test, there was no significant difference in the mean of fine motor score before intervention in the two groups with (p = 0.13). The repeated measurement test showed that 4 and 8 weeks after training, the scores of fine movements with (p = 0.04) became significant. Conclusion Based on the results, developmental skills training compared with control group improved the fine motor skills of 18-month-old children in this study.

Endoscopic part-task training box scores correlate with endoscopic outcomes

Competency in endoscopy has traditionally been based on number of procedures performed. With movement towards milestone-based accreditation, new standards of establishing competency are required. The Thompson Endoscopic Skills Trainer (TEST) is a training device previously shown to differentiate between novice and expert endoscopists. This study aims to correlate TEST scores to other markers of performance in endoscopy. Trainees of a gastroenterology fellowship program were guided through the TEST. Their scores and sub-scores were correlated to their endoscopic metrics of performance, including adenoma detection rate, cecal intubation rate, cecal intubation time, withdrawal time, fentanyl usage, midazolam usage, pain score, overall procedure time, and performance on the ASGE Assessment of Competency in Endoscopy Tool (ACE Tool). The Overall Score positively correlated with the ACE Tool Total Score (r = 0.707, p = 0.010) and sub-scores (Cognitive Skills Score: r = 0.624, p = 0.030; Motor Skills Score: r = 0.756, p = 0.004), and negatively correlated with cecal intubation time (r = -0.591, p = 0.043). The Gross Motor Score positively correlated with cecal intubation rate (r = 0.593, p = 0.042), ACE Tool Total Score (r = 0.594, p = 0.042) and Motor Skills Score (r = 0.623, p = 0.031), and negatively correlated with cecal intubation time (r = -0.695, p = 0.012). The Fine Motor Score positively correlated with the ACE Tool Polypectomy Score (r = 0.601, p = 0.039), and negatively correlated with procedure time (r = -0.640, p = 0.025), cecal intubation time (r = -0.645, p = 0.024), and withdrawal time (r = -0.629, p = 0.028). This study demonstrates that performance on the TEST correlate to endoscopic measures. Given these results, the TEST may be used in conjunction with existing assessment tools for demonstrating competency in endoscopy.

Neurodevelopmental outcomes after moderate to severe neonatal hypoglycemia

The long-term consequences of transient neonatal hypoglycemia are sparsely studied. We performed a follow-up of a cohort of neonates with blood glucose recordings < 1.7 mmol/L (< 30 mg/dL), treated with > 2.5 mmol/L (> 45 mg/dL), compared with healthy siblings. Exclusion criteria were gestational age < 35 weeks, severe asphyxia, head injury, and other cerebral diseases. In 71 children with neonatal hypoglycemia and 32 control siblings, Wechsler IV cognitive test, Movement ABC-2 test, and Child Behavior Checklist were performed at mean age 7.75 and 9.17 years, respectively. No significant changes were detected for cognitive function by using Wechsler IV or for behavior by using Child Behavior Checklist. In univariate analysis, the hypoglycemia group had lower age-adjusted fine motor scores by using the Movement ABC-2 test compared with control siblings, 42.6 ± 31.2 vs. 57.2 ± 30.8 percentile (p = 0.03). In the sibling-paired analysis, the decrease in total motor score was highly significant, p = 0.009, driven by a decrease in fine motor score, p = 0.008. In the hypoglycemia group, adjusted analysis showed a lower fine motor function for boys, β = − 16.4, p = 0.048.Conclusion: Neonatal hypoglycemia treated with > 2.5 mmol/L was associated with lower fine motor scores within the normal range, particularly in boys. No associations with cognitive function or behavior were detected.What is Known:• Transient neonatal hypoglycemia is associated with acute neurologic dysfunction and long-term neurodevelopment impairment in 18 months of age.What is New:• Neonatal hypoglycemia treated with > 2.5 mmol/L is associated with lower fine motor function within the normal range, particularly in boys, but not to changes in cognitive function or behavior.

Effects of continued positioning pillow use until a corrected age of six months on cranial deformation and neurodevelopment in preterm infants: A prospective case-control study

BackgroundPreterm infants have a high risk of cranial deformity resulting from external pressures. Such deformity is associated with delayed neurodevelopment. AimsWe aimed to clarify the effects of continuous use of positioning pillows on cranial deformity and neurodevelopment in preterm infants. MethodsThis prospective case-control study was conducted between November 2018 and August 2019. The continuous use of a pillow was initiated after discharge from the neonatal intensive care unit, up to a corrected age of six months. Preterm infants weighing less than 1800 g without neurological abnormalities were included in the study. Patients were divided into two groups: non-pillow group (NP-group) and pillow group (P-group). The primary outcome was the Bayley Scales of Infant Development III (BSID-III) score. We compared asymmetrical cranial deformity and the BSID-III scores in the two groups at a corrected age of six months using the Fisher's exact test and unpaired t-test, respectively. ResultsThere were 19 preterm infants (mean gestational age 32.5 ± 1.9 weeks, birth weight 1461.3 ± 244.7) eligible during the study period. The P-group (n = 11) showed asymmetrical cranial deformity at six months less frequently than the NP-group (n = 8) (p = 0.001, Fisher's exact test). Infants in the P-group had significantly higher scores on the BSID-III cognitive scales (95.0 ± 8.4 vs. 86.9 ± 2.6; p = 0.02, unpaired t-test) and fine motor scores on the motor scales (8.6 ± 2.2 vs. 6.6 ± 0.7, p = 0.02, unpaired t-test). ConclusionsContinuous pillow use in preterm infants is effective in reducing cranial deformity and improved cognitive and fine motor skills. Trial registrationUMIN Clinical Trials Registry, trial no. UMIN000034400 (http://www.umin.ac.jp/ctr/index.htm).

Early child development in children who are HIV-exposed uninfected compared to children who are HIV-unexposed: observational sub-study of a cluster-randomized trial in rural Zimbabwe.

IntroductionExposure to maternal HIV may affect early child development (ECD), although previous studies have reported heterogeneous findings. We evaluated ECD among children who were HIV‐exposed uninfected (CHEU) and children who were HIV‐unexposed (CHU) recruited to the SHINE trial in rural Zimbabwe.MethodsSHINE was a community‐based cluster‐randomized trial of improved infant feeding and/or improved water, sanitation and hygiene. Pregnant women were enrolled between 2012 and 2015. We assessed ECD in a sub‐study at 24 months of age, between 2016 and 2017, using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social development); MacArthur‐Bates Communicative Development Inventory (CDI) (assessing vocabulary and grammar); A‐not‐B test (assessing object permanence); and a self‐control task. Mothers and infants were tested longitudinally for HIV. We used generalized estimating equations to compare ECD scores between CHEU and CHU, accounting for the cluster‐randomized design. Primary results were adjusted for trial‐related factors that could affect measurement reliability of ECD: study nurse, age of child, calendar month of birth, sex and randomized arm.ResultsA total of 205 CHEU and 1175 CHU were evaluated. Mean total MDAT score was 90.6 (SD 8.7) in CHEU compared to 92.4 (9.1) in CHU (adjusted mean difference −1.3, 95% CI: −2.3, −0.3), driven mostly by differences in gross motor (−0.5, 95% CI: −0.9, −0.2) and language scores (−0.6, 95% CI: −1.1, −0.1). There was evidence that fine motor scores were lower in CHEU (adjusted mean difference −0.4, 95% CI: −0.8, 0.0) but no evidence of a difference in social scores (0.1, 95% CI: −0.2, 0.4). Mean MacArthur‐Bates CDI vocabulary score was 57.9 (SD 19.2) in CHEU compared to 61.3 (18.8) in CHU (adjusted mean difference −2.9 words, 95% CI: −5.7, −0.1). Object permanence and self‐control scores were similar between groups.ConclusionsCHEU in rural Zimbabwe had total child development and vocabulary scores that were approximately 0.15 standard deviations lower than CHU at two years of age. More detailed and specific studies are now needed to unravel the reasons for developmental delay in CHEU and the likelihood that these delays persist in the longer term.

MP48-06 GENDER IMPACT ON BLADDER-RELATED OUTCOMES AND QUALITY OF LIFE AFTER PARAPLEGIC SPINAL CORD INJURY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-06 GENDER IMPACT ON BLADDER-RELATED OUTCOMES AND QUALITY OF LIFE AFTER PARAPLEGIC SPINAL CORD INJURY Sara Lenherr*, Jennifer S. Herrick, Sean P Elliott, Angela P. Presson, Odinachi Moghalu, John T Stoffel, Blayne Welk, and Jeremy B Myers Sara Lenherr*Sara Lenherr* More articles by this author , Jennifer S. HerrickJennifer S. Herrick More articles by this author , Sean P Elliott Sean P Elliott More articles by this author , Angela P. PressonAngela P. Presson More articles by this author , Odinachi MoghaluOdinachi Moghalu More articles by this author , John T StoffelJohn T Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , and Jeremy B MyersJeremy B Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Females with spinal cord injury (SCI) have been collectively analyzed along with males with SCI, despite the fact that women have fundamentally different genitourinary anatomy. We hypothesized that women have different patient reported outcomes and quality of life (QoL) related to their neurogenic bladder dysfunction. METHODS: The Neurogenic Bladder Research Group (NBRG) SCI Registry is a multicenter prospective observational study designed to assess bladder−related symptoms and QoL after SCI. Outcomes included the Neurogenic Bladder Symptom Score (NBSS) total score and a global satisfaction with urinary function question (NBSS-QoL). Bladder management was categorized as: clean intermittent catheterization without prior bladder surgery (CIC), indwelling catheter (urethral or suprapubic), surgical (bladder augmentation, catheterizable channel, urinary diversion), or voiding (condom catheter, involuntary leaking, volitional). Multivariate linear regression analysis was conducted controlling for age, obesity, years since injury, chronic pain, UTI burden (>4 per year), severe bowel dysfunction, SCI-QoL bladder management difficulties and SCI-FI fine motor score. RESULTS: 1479 participants (894 male and 585 female) were identified. Mean age of 44 ± 13 years and mean 16 ± 12 years since SCI. SCI level was: 57% paraplegia & 43% tetraplegia. Among paraplegic participants (470 male, 373 female), females who had a bladder surgery (n=71) reported a better total NBSS score (adjusted difference (AD) -3.35, 95% CI -5.85 to -0.85, p=0.009) and better bladder-related QoL (AD -0.71, 95% CI -1.03 to -0.39, p<0.0001) compared to those using intermittent catheterization (n=198). In contrast, males who had surgery (n=30) did not have a statistically different total NBSS total score (AD 1.77, 95% CI -2.01 to 5.55, p=0.36) compared to those using intermittent catheterization (n=327) but bladder-related QoL was improved (AD -0.59, 95% CI -1.11 to -0.07, p=0.03). CONCLUSIONS: There are differences in neurogenic bladder symptoms based on gender after spinal cord injury. Women with paraplegia experience worse bladder-related symptoms and have more opportunity for improvement with surgery. Educational efforts to improve bladder-related outcomes should be tailored to address gender-specific concerns. Source of Funding: PCORI CER14092138 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e696-e696 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sara Lenherr* More articles by this author Jennifer S. Herrick More articles by this author Sean P Elliott More articles by this author Angela P. Presson More articles by this author Odinachi Moghalu More articles by this author John T Stoffel More articles by this author Blayne Welk More articles by this author Jeremy B Myers More articles by this author Expand All Advertisement PDF downloadLoading ...

Motor skills and later communication development in early childhood: Results from a population‐based study

Motor milestones in infancy are important developmental markers, not only for later motor skills but also for more widespread social, cognitive, and communication development. The aim of the current study was to investigate the relationships between fine and gross motor development in infants at 6 and 12 months of age and communication skills at 24 months of age. The Ages & Stages Questionnaire (ASQ-II) was used to measure gross motor, fine motor, and communication skills in a large population-based sample of 1,555 infants, recruited from well-baby clinics in five municipalities in South-Eastern Norway. Of these, 557 children had valid values of gross and fine motor scores at 6 and 12 months and for communication score at 24 months. The relationships between motor skills at 6 and 12 months and communication skills at 24 months were analysed using a linear regression analysis. Gross motor skills at 6 months were positively associated with communication skills at 24 months (coefficients 0.09, p = 0.036) and fine motor skills at 12 months were positively associated with communication skills at 24 months (coefficient 0.23, p < 0.001). We did not find clear evidence for a relationship between gross motor skills at 12 months and communication skills at 24 months (coefficient 0.05, p = 0.126) or between fine motor skills at 6 months and communication skills at 24 months (coefficient 0.08, p = 0.098). The present study supports previous research showing associations between early motor development and later communication development in infancy. Targeted intervention should be considered with at-risk infants.

Erratum: "Prenatal Exposure to DDT and Pyrethroids for Malaria Control and Child Neurodevelopment: The VHEMBE Cohort, South Africa".

Erratum: "Prenatal Exposure to DDT and Pyrethroids for Malaria Control and Child Neurodevelopment: The VHEMBE Cohort, South Africa".

Thyroid function in preterm infants and neurodevelopment at 2 years

ObjectivesPostnatal thyroid dysfunction is common in preterm infants but the relationship between mild dysfunction and neurodevelopment is unclear. Our aim is to describe the relationship between thyroid function and neurodevelopment.DesignCohort...