Griffiths Developmental Scales Research Articles

Influence of a single osteopathic procedure on the regulatory processes of the body of premature infants (pilot study)

Introduction. The number of children born early in gestation and with low body weight and associated health disorders require the search for effective methods of rehabilitation treatment. The development of new effective non-invasive methods of rehabilitation/rehabilitation of premature infants is one of the priority tasks of national health care.Aims — to evaluate the effect of a single osteopathic procedure on the regulatory processes of the body (an indicator of the activity of regulatory systems and an index of nervous system tension) in premature infants.Materials and methods. In the clinic 30 premature infants with a gestation period of 24 to 37 weeks were monitored on the terms of voluntary written informed consent (the average gestation period was 31,35±0,45 weeks). The children were aged from 2 to 12 months (the average age was 4,93±0,45 months), of which 53,3 % (16 people) were boys and 46,6 % (14 people) were girls. On admission, parents most often complained about sleep disorders: sleep is not long, the child often wakes up at night or cries in his sleep, often sleeps only in the arms of his mother. It is difficult to feed the child, he does not eat the daily norm of food. During wakefulness, the child is restless, and when crying, calms down only in the arms. Osteopathic examination and correction were performed according to the clinical recommendations «Somatic Dysfunctions» and patent № 2739128 «Method of treatment of pain syndrome on the background of somatic dysfunctions in newborns». The procedures are carried out, as a rule, in the first half of the day, lasting 20 minutes. A methodical technique in the form of a single osteopathic procedure was used, when first the patient is examined, immediately after that the procedure and again the examination. The state of nervous system tension was assessed using cardiointervalography, the index of activity of the body′s regulatory systems and the index of tension of the autonomic nervous system were evaluated. The FLACC-SS pain assessment scale for infants, which we modified, was used to assess pain. Psychomotor development was assessed using the Griffiths developmental scale. The Statistica-10 software package was used for statistical analysis of the obtained data.Results. Upon admission, the pain level on the FLACC-SS scale was 2,35±1,35 points, which indicates, on average, moderate pain intensity in children. The Griffiths score was 31,64±3,57 points, which indicates a delay in psychomotor development in children. In the study of CIG before osteopathic correction, the IN was 597,77±89,99 units, and the PARS was 5,10±0,85 points. This is a pronounced functional stress of the body and is characterized by a decrease in its functional reserves and an inadequate response to environmental factors. During the initial osteopathic examination, somatic dysfunctions were detected mainly at the global level (changes in skeletal muscle tone, changes in cranial, cardiac and respiratory rhythms). After a single osteopathic correction procedure, the tension index decreased statistically significantly, and there was also a tendency to decrease the level of tension of regulatory systems. The pain level in children decreased to 0,16 points, which means.Conclusion. Somatic dysfunctions play an important role in the development of disorders of body regulation and pain syndrome. Correction of somatic dysfunctions in premature infants by osteopathy methods helps to reduce pain syndrome and improve the adaptive mechanisms of the body. Thus helps to prevent energy-consuming increased work of regulatory mechanisms, to adjust sleep and wakefulness, to improve appetite and, ultimately, the quality of life of the infant and the whole family. Restoring the energy balance of the child′s body, optimizing the work of regulatory systems, reducing the intensity of pain syndrome makes it possible to start early rehabilitation of premature infants.

Identification of functional domains in developmental measures: An ICF-CY analysis of Griffiths developmental scales and Schedule of Growing Skills II

Objective: This study aims to identify functioning categories of the International Classification of Functionality, Disability and Health for Children and Youth covered by the Griffiths developmental scales and the Schedule of Growing Skills II (SGS-II), as well as to analyse levels of agreement between coders when assigning its items to the ICF-CY classification system. Methods: Items were linked to the ICF-CY following a content analysis procedure and the published linking rules. Agreement was calculated with Cohen’s Kappa Coefficient. Results: All SGS items assess mostly Activities and Participation, alike most of the Griffiths’ scales except for the Language and Eye-hand coordination scales, which assess mostly Body Functions. Consistently with previous studies, agreement levels between coders vary considerably, thus being highly dependent on the nature of the concept analysed. Conclusion: Although necessary from a capacity-driven approach to assessment, information collected with these instruments should be complemented with other assessments in order to cover all aspects of the child’s life, in line with a systemic approach.

G.P.174: Behavioral and neurocognitive profile in Duchenne Muscular Dystrophy

Non progressive cognitive impairment and increased rates psychosocial disorders, ADHD and Autism are reported in DMD patients. Through structured and validated questionnaire (Wechsler scales or Griffiths developmental scale, CBCL, Youth Self Report, Strengths and Difficulties Questionnaire, ADOS and DAWBA) we explored the possible role of cognitive impairment on the neuropsychiatric comorbidity in 32 boys with DMD (4–18years). Our preliminary analysis shows a mean Full Intelligence Quotient of the whole group of 83.90±16.68, lower in the patients with deletions in the distal portion of the gene (78.28±16.72) than in the ones with proximal deletions (88.52±15.62), with a very high frequency of Autism (about 20%) particularly in children with lower IQ level, and a high frequency of internalizing problems at CBCL, in boys with FIQ within the normal range, suggesting a role of cognitive capabilities in DMD children psychopathology.

Enhancing Emotional and Social Competence in a Group of South-African School Beginners: A Preliminary Study

This study piloted the efficacy of a short-term intervention program for socio-emotional development in pre-schoolers.in a South African setting. Participants were 48 learners, aged between 5 and 6 years (22 boys, 26 girls). A proportion of the participants (n=26) took the socio-emotional competence development intervention. Programme effects were measured using the Social Competence and Behavioural Evaluation, Preschool Edition (SCBE) and the Griffiths Developmental Scales—Extended Revised (GMDS-ER). Between group comparisons showed significant gains in internalization and social competence skills in favour of the intervention group as compared to the control group.

Desenvolvimento, psicopatologia e apego: estudo exploratório com crianças institucionalizadas e suas cuidadoras

O presente estudo exploratorio examinou o desenvolvimento mental e a qualidade do funcionamento socio-emocional de 16 criancas entre os 3 e os 6 anos, institucionalizadas em Centros de Acolhimento Temporario, relacionando-os com a qualidade das narrativas sobre o apego das suas cuidadoras. Foram utilizadas a Escala de Desenvolvimento Mental de Griffiths, o Questionario de Comportamentos, as Narrativas sobre o Apego e o Attachment Q-Sort. Os resultados revelaram que o nivel de desenvolvimento das criancas foi inferior aos valores normativos. Alem disso, os valores apresentados ao nivel da psicopatologia, em termos de sintomas de internalizacao e de externalizacao, aproximaram-se dos valores clinicos. Nao obstante e, em contraste com o esperado, a maioria das criancas apresentou valores proximos da seguranca (base segura), os quais nao estao associados com a qualidade das narrativas sobre o apego das suas cuidadoras. Os resultados sao discutidos com base no impacto da privacao em meio institucional para o desenvolvimento na infância.

Early Development of Epileptic Infants with Pre- or Perinatal Brain Injuries: Role of the Epileptic Disorder

To try to understand the causative role of epilepsy PER SE in the developmental deterioration of brain injured infants, twenty-eight infants affected with early acquired, pre- and perinatal brain injuries were enrolled and divided into three groups, a) those with West syndrome, b) those with other non-West epilepsies, and c) those without epilepsy. Developmental monitoring consisted of a full clinical assessment, including examination of visual function, Griffiths developmental scales, standard EEG, long-term monitoring when necessary, and MRI, from the seizure onset or the first observation to the end of follow-up. Patients with epilepsy showed at study onset abnormal clinical features (neurological and developmental) distinct from those of non-epileptic patients, partially due to the varying severity of their brain injuries. A definite differentiation between groups was observed in the clinical evolution that showed among the epileptic patients, mostly in West syndrome, a significant deterioration. Moreover, impaired visual function at seizure onset was possibly associated with a bad developmental evolution. A developmental deterioration, mostly in West syndrome, accounts for a causative role of the epileptic disorder PER SE, but in few cases it was also observed in infants with only a brain injury, suggesting other aetiopathogenic mechanisms. The predictive value of early visual function seems to be confirmed.

Prospective follow-up study of children with univentricular heart: Neurodevelopmental outcome at age 12 months

Despite recent advances in the treatment of children with univentricular heart, their neurodevelopmental outcome remains a major concern. This prospective follow-up study evaluated the neurodevelopmental outcome of 23 patients with hypoplastic left heart syndrome, 14 with other forms of univentricular heart, and 46 healthy control subjects at a median age of 12.2 months. The Griffiths Developmental Scale and Alberta Infant Motor Scale served for developmental evaluation. The mean Griffiths developmental quotient of children with hypoplastic left heart syndrome was significantly less (91.6) than that of control children (106.8, P < .001). Patients with univentricular heart scored significantly lower than control subjects only in the gross motor domain (P = .001) but not in overall development (100.6). Alberta Infant Motor Scale scores were significantly lower in children with hypoplastic left heart syndrome (37.5, P < .001) and univentricular heart (43.5, P = .011) than in control subjects (53.3). In linear regression a diagnosis of hypoplastic left heart syndrome (P = .016), a clinical history of seizure (P = .002), and the highest plasma lactate level after the bidirectional Glenn operation (P = .045) were significantly associated with the developmental quotient. At age 1 year, the level of development of children with univentricular heart was significantly lower than for control subjects only in motor skills, whereas children with hypoplastic left heart syndrome had a more widespread developmental delay. The diagnosis, a clinical seizure history, and increased plasma lactate levels after the bidirectional Glenn operation emerged as risk factors.

Antenatal Post-hemorrhagic Ventriculomegaly: A Prospective Follow-up Study

The aim of this study was to evaluate the presence and the severity of neurological and cognitive impairment at 2 years of age in 16 infants (9 term born, 7 preterm of mean gestation 33.6 weeks) with cerebral ventriculomegaly of antenatal onset associated with intraventricular haemorrhage. Ventricular dilatation, with or without associated lesions, was, with one exception, not identified on the antenatal routine scan at approximately 22 weeks but was obvious on the scans performed between weeks 27 and 33. In 8 of the 16 cases there were signs of parenchymal involvement or of abnormalities of the corpus callosum or cerebellum. In all patients the diagnosis of antenatal IVH was confirmed by early neonatal imaging. Outcome was measured using the Hammersmith infant neurological examination and the Griffiths developmental scales at 2 years. At 2 years, 8 infants had normal motor outcome and 8 had cerebral palsy. The presence and severity of cerebral palsy or neurodevelopmental delay was not always related to the magnitude or symmetry of the ventricular dilatation per se. The presence of associated lesions was a negative prognostic marker. The early development of epilepsy was also associated with an abnormal outcome.

Comparative Development of Surviving Co-Twins of Vanishing Twin Conceptions, Twins and Singletons

Early loss of one fetus in a multiple gestation as a 'vanishing' twin is a well recognized phenomenon. It is uncertain whether this has an impact on the development of the surviving co-twin. The aim of this study is to compare the development of singletons, twins and the surviving co-twins of a vanishing twin. The 324 children born to 229 women who were recruited into the study between 1999 and 2001 formed the study population. Children were assessed at 1 year of age with Griffiths Mental and Developmental Scales. A neurological examination was performed using an optimality score to exclude those with severe neurodisability. Three hundred and five children (92 singletons, 180 twins and 33 survivors with a vanishing twin) were included. The sub- and general quotient scores in singletons and surviving co-twins of a vanishing twin did not differ significantly. Twins had significantly lower scores than singletons in all areas of development and were more likely to be born early with lower birthweights. Following adjustment for gestation and birthweight, the difference between the two groups was nullified suggesting that the slower development of twins is related to their prematurity and lower birthweight.

Vanishing Twin: A Possible Cause of Cerebral Impairment

Fetal death in a twin conception during second and third trimester is associated with increased risk of cerebral injury in the surviving twin. The aim of this study is to test the hypothesis that even early fetal losses as a 'vanishing' twin may be associated with an increased risk of cerebral impairment in the surviving twin. The study population comprised 362 pregnant women attending Liverpool Women's Hospital recruited between 1999 and 2001. Women were classified according to the first ultrasound scan into 3 groups: vanishing twin, twin and singleton. The vanishing twin group was further subdivided into 'definite' and 'probable'. Children from these pregnancies were assessed at 1 year of age for their development and neurological function using the Griffiths Mental and Developmental Scales and Optimality score. Children from 229 pregnancies (63.2%) attended the assessment. Information on children from a further 21 (5.8%) pregnancies was obtained through a review of hospital records. Cerebral impairment was found in 2 children from the vanishing twin group, 2 from the twin group and none from the singleton group. When cases with definite vanishing twin are considered there is a significant difference between the vanishing twin and singleton group (relative risk 6.1; 95% confidence interval 1.5-8.3; p = .03). An additional study with an increased sample size would enable a more robust conclusion.

White matter lesions in term infants with neonatal encephalopathy: Correlation with later scans and neurodevelopmental outcome

Background: The commonest brain abnormality after perinatal hypoxic–ischaemia and neonatal encephalopathy (NE) is damage to the basal ganglia (BGT). However there are infants who escape this damage but have abnormally appearing white matter (WM). The long-term outcome of these children has not been well defined. Aim: To evaluate, in term infants with NE and abnormally appearing WM but normal BGT on neonatal MRI scan, the evolution of the scans in the first 1–2 years and the relation of the imaging findings to neurodevelopmental outcome at 2–4 years. Subjects/Methods: From a cohort of 270 term infants with perinatal asphyxia and NE (without evidence of systemic infection, a metabolic, or a congenital disorder), born at or referred to the Hammersmith Hospital, London (1991–2000) 46 infants had normally appearing BGT but abnormal WM on neonatal scans; 18 infants had normal scans. Follow-up scans were obtained in 57 infants. Griffiths developmental scales, standardized neurological examination and HC, evidence of cerebral palsy (CP), visual, hearing, language, feeding and behavioural problems) was obtained in all infants. Parental and ethical permission from the Hammersmith Hospital REC was obtained. Results: Median (range) of gestation was 40.1 weeks (36– 42 weeks), birth weight 3.26 kg (2.0–4.82 kg), head circumference (HC) 35.0 cm (31–39.1 cm), Apgar scores at 1/5 min was 2 (0–9)/6 (0–10), pH 6.97 (6.56–7.37). 38 infants (59%) were male; 26 had Sarnat stage I and 38 had stage II NE. WM abnormality on neonatal scans was mild in 20, moderate in 14, severe in 9 and severe with haemorrhage in 3; 18 infants had normal scans. Follow up scans were normal in 18, mildly abnormal in 18, moderate in 9, severe in 8 and severe with marked tissue loss in 4. Neonatal and later grading of scans remained the same 67%; improved in 12% and deteriorated in 21% by one grade. There was no difference in the perinatal data bar HIE staging between the infants in the different WM groupings at birth or follow-up. Mean (range) DQ at a median age of 3 years in children with normal WM was 109 (88–125), with mild WM 106 (85–124), moderate WM 88 (40–126), severe WM 71 (45–95) severe with haemorrhage 50 (40–60). In contrast, the neurological exam score was only low in the severe WM group. Six children had CP but only two were not independently ambulant. Followup scan abnormalities included a PVL-like appearance, reduced thalamic size and cortical abnormality. The more severe follow up scans were associated with CP, poor head growth, early feeding problems, language delay, squint and behavioural difficulties. Discussion: Follow-up scans of infants with NE show that neonatal WM abnormality may lead to significant long-term problems. Early and late scans correlate but the change in grading in 33% suggests that external factors may influence outcome. Outcome at 2–4 years can be significantly abnormal in those with moderate and severe scan abnormality. Despite few major motor problems these infants require prolonged follow up and considerable support [1]. Reference [1] Marlow N, et al. Arch Dis Child 2005;90:F380–7.

Correlation of hearing screening with developmental outcomes in infants over a 2-year period

Conclusion: Evoked otoacoustic emission (OAE) and auditory brainstem response (ABR) results for hearing screening among infants have good concordance. However, good correlation with the Griffiths Developmental Scales remains to be desired. Objective: To correlate hearing screening outcomes of a cohort of infants with developmental outcomes at 6 and 12 months. Subjects and methods: A cohort of pregnant women was identified in several communities in a rural area (Bulacan province) from April 2002 to February 2003 as part of a population-based study determining maternal exposure to pollutants and infant outcomes, with a total follow-up of 2 years. Pregnant mothers were identified and followed up until delivery at a secondary, provincial hospital. Hearing screening was performed with OAEs and ABR. Mental development of infants was assessed at 6 and 12 months using Griffiths Mental Developmental Scales – locomotor, personal-social, hearing and speech, hand and eye coordination, performance tests. Results: Among the 1086 babies recruited, there were 724 with hearing assessment. Of these 724 babies, 565 had both OAE testing and ABR. Overall in 1130 ears, OAE and ABR testing showed an observed agreement of 99%, agreement due to chance of 96%, and kappa agreement of 79% (p=0.00) in diagnosing bilateral hearing losses. OAEs had a sensitivity of 86.4% (95% CI 64–96.4%) and a specificity of 99.4% (95% CI 98.6–99.7%). At the end of the study, there were 708/724 (97.8%) infants with normal hearing, 7/724 (1.0%) with unilateral hearing loss, 8/724 (1.1%) with bilateral mild hearing loss, and 1/724 (0.1%) with bilateral profound hearing loss, who demonstrated consistent mental delay throughout. Follow-up rates for developmental examinations at 6 and 12 months were 98% and 81.25%, respectively. In these groups, there were 8 (1%) infants at 6 months and 18 (2.4%) at 12 months with developmental delay (Griffiths Mental Developmental Scales).

Events at early development: Are they associated with early word production and neurodevelopmental abilities at the preschool age?

Background Obstetrical and neonatal complications and/or an adverse parenting environment are risk factors for language impairment, but little is known about their effects on early word production (late talking). Aims To determine obstetrical and neonatal risk factors in children with delayed word production; to assess the influence of the parenting environment on word production; to determine whether the toddler's vocabulary competence is related to his/her social competence; to document the neurodevelopmental outcome at the late preschool age. Study design Prospective follow-up study. Based on word production at 18 months, children were retrospectively classified into consistent or transient late talkers and controls. Subjects Full-term infants, N = 30 (mean GA 40.3 ± 1.1 weeks, mean birth weight 3577 ± 267 g) were assessed at 18 and 24 months; and 5 years and 7 months. Methods Austrian Communicative Development Inventories; Bayley Scales of Infant Development; Griffiths Developmental Scales. Outcome measures Peabody Picture Vocabulary Test; Kaufman Assessment Battery for Children; Touwen's neurological examination. Results and Conclusions Lower Apgar scores and the need for neonatal intensive care were associated with delayed word production. The parents' educational and vocational levels were lower in late talkers. Early vocabulary competence correlated with social competence. With regard to the prediction of lexical and cognitive outcomes, late talkers did not differ from controls. Minor neurological dysfunctions (MND) were seen in nearly half of the late talkers and indicate the necessity to follow these children into school age, when MND might become more obvious and literacy can be assessed.

Early Dyadic Patterns of Mother–Infant Interactions and Outcomes of Prematurity at 18 Months

With the increased survival of very preterm infants, there is a growing concern for their developmental and socioemotional outcomes. The quality of the early mother-infant relationship has been noted as 1 of the factors that may exacerbate or soften the potentially adverse impact of preterm birth, particularly concerning the infant's later competencies and development. The first purpose of the study was to identify at 6 months of corrected age whether there were specific dyadic mother-infant patterns of interaction in preterm as compared with term mother-infant dyads. The second purpose was to examine the potential impact of these dyadic patterns on the infant's behavioral and developmental outcomes at 18 months of corrected age. During a 12-month period (January-December 1998), all preterm infants who were <34 weeks of gestational age and hospitalized at the NICU of the Lausanne University Hospital were considered for inclusion in this longitudinal prospective follow-up study. Control healthy term infants were recruited during the same period from the maternity ward of our hospital. Mother-infant dyads with preterm infants (n = 47) and term infants (n = 25) were assessed at 6 months of corrected age during a mother-infant play interaction and coded according to the Care Index. This instrument evaluates the mother's interactional behavior according to 3 scales (sensitivity, control, and unresponsiveness) and the child's interactional behavior according to 4 scales (cooperation, compliance, difficult, and passivity). At 18 months, behavioral outcomes of the children were assessed on the basis of a semistructured interview of the mother, the Symptom Check List. The Symptom Check List explores 4 groups of behavioral symptoms: sleeping problems, eating problems, psychosomatic symptoms, and behavioral and emotional disorders. At the same age, developmental outcomes were evaluated using the Griffiths Developmental Scales. Five areas were evaluated: locomotor, personal-social, hearing and speech, eye-hand coordination, and performance. Among the possible dyadic patterns of interaction, 2 patterns emerge recurrently in mother-infant preterm dyads: a "cooperative pattern" with a sensitive mother and a cooperative-responsive infant (28%) and a "controlling pattern" with a controlling mother and a compulsive-compliant infant (28%). The remaining 44% form a heterogeneous group that gathers all of the other preterm dyads and is composed of 1 sensitive mother-passive infant; 10 controlling mothers with a cooperative, difficult, or passive infant; and 10 unresponsive mothers with a cooperative, difficult, or passive infant. Among the term control subjects, 68% of the dyads are categorized as cooperative pattern dyads, 12% as controlling pattern dyads, and the 20% remaining as heterogeneous dyads. At 18 months, preterm infants of cooperative pattern dyads have similar outcomes as the term control infants. Preterm infants of controlling pattern dyads have significantly fewer positive outcomes as compared with preterm infants of cooperative pattern dyads, as well as compared with term control infants. They display significantly more behavioral symptoms than term infants, including more eating problems than term infants as well as infants from cooperative preterm dyads. Infants of the controlling preterm dyads do not differ significantly for the total development quotient but have worse personal-social development than term infants and worse hearing-speech development than infants from cooperative preterm dyads. The preterm infants of the heterogeneous group have outcomes that can be considered as intermediate with no significant differences compared with preterm infants from the cooperative pattern or the controlling pattern dyads. Among mother-preterm infant dyads, we identified 2 specific patterns of interaction that could play either a protective (cooperative pattern) or a risk-precipitating (controlling pattern) role on developmental and behavioral outcome, independent of perinatal risk factors and of the family's socioeconomic background. The controlling pattern is much more prevalent among preterm than term dyads and is related to a less favorable infant outcome. However, the cooperative pattern still represents almost 30% of the preterm dyads, with infants' outcome comparable to the ones of term infants. These results point out the impact of the quality of mother-infant relationship on the infant's outcome. The most important clinical implication should be to support a healthy parent-infant relationship already in the NICU but also in the first months of the infant's life. Early individualized family-based interventions during neonatal hospitalization and transition to home have been shown to reduce maternal stress and depression and increase maternal self-esteem and to improve positive early parent-preterm infant interactions.

106 Cortical Growth and Neurocognitive Impairment in Preterm Infants

Background. Neurocognitive impairment after preterm birth is common and directly related to increasing prematurity. The neural substrate for this dysfunction is unknown, but cannot be wholly accounted for by major destructive brain lesions.Aims. To test the hypothesis that the timing of premature delivery is associated with a dose-dependent reduction in the rate of growth of the cerebral cortex which parallels the increase in neurocognitive impairment.Methods. MR images were obtained from a consecutive cohort of extremely preterm infants serially from soon after delivery until term corrected age and neurodevelopment was assessed using the Griffiths Developmental Scales at median 24 months corrected age. Total cerebral volume and cortical surface area were measured semi-interactively, and their rate of growth found to be related by a power law, the scaling exponent of which gives a direct measure of the growth rate of cortical surface area relative to cerebral volume. A generalized least squares random effects regression model was constructed to test the effect of gestational age at birth and potential confounding variables on the scaling exponent, and the relation to neurodevelopmental outcome was tested.Results. 113 infants born at 23–29 weeks gestation were imaged providing 274 images without major destructive lesions for analysis. Complete neurodevelopmental data are available on 63 infants. Increasing prematurity was associated with a reduced rate of cortical growth (p<0.0001) which was independent of intrauterine or postnatal somatic growth. There was a significant relation between reduced cortical growth and the Griffiths Developmental Quotient (p<0.05), seen with all subscales except the locomotor.Conclusions. Reduced rate of growth of the cerebral cortex parallels the dose-dependent effect of prematurity on neurodevelopmental function. Cortical growth failure may be a neural substrate for the high rate of non-locomotor neurocognitive impairment seen in preterm infants.

Learning disabilities in a population‐based group of children with hydrocephalus

To assess cognitive functions in a population-based group of children with hydrocephalus and to analyse differences between children with and without myelomeningocoele (MMC); with hydrocephalus already present at birth and those who developed it later; children born at full term and those born preterm. Of 103 children with hydrocephalus born in the western-Swedish region in 1989-1993, 73 were assessed using the Wechsler Intelligence Scales or the Griffith Developmental Scales. One-third of the children were normally gifted (IQ >85), another 30% had a low average IQ of 70-84 and 37% had learning disabilities with an IQ of <70. The median IQ was 75, verbal IQ 90 and performance IQ 76 (p<0.001). An IQ of <70 was found in 19 of 45 (42%) children without MMC and in 8 of 28 (29%) of those with MMC. Children born preterm had a lower IQ of 68 than those born at full term with an IQ of 76, while children with hydrocephalus present at birth but without MMC had a lower IQ of 60 than the others with an IQ of 77. Children with cerebral palsy and/or epilepsy (n=22) had a lower IQ of 66 than the IQ of 78 in those without these impairments (p<0.01). Cognitive functions in children with hydrocephalus need to be carefully assessed before school age to ensure adequate support and education. Even the one-third near normally gifted children with an IQ of 70-85 require special attention, due to the profile of relatively well-preserved verbal functions but greatly impaired perceptual and non-verbal abilities.

Variation in the Interleukin-6 Gene Is Associated with Impaired Cognitive Development in Children Born Prematurely: A Preliminary Study

The pro-inflammatory cytokine IL-6 may be neurocytopathogenic, and elevated levels are associated with impaired neurological outcome among children born prematurely. However, the precise mechanisms underlying this association remain unclear. The rare C (rather than G) variant at position -572 in the IL-6 gene is associated with an increased IL-6 synthetic response. If IL-6 mediates cerebral injury, we would anticipate the -572 C allele to be associated with impaired childhood development. We have examined this hypothesis, studying 113 Caucasian children born at < or =32 wk gestation. Cognitive and motor functions were assessed using the Griffiths Developmental Scales at 2 y and British Ability Scales (2nd Ed.) and the ABC Movement Score at 51/2 y. Performance (median, interquartile range) in all three scales was worse in the 10 carriers of the C allele than for those with GG genotype: Griffiths Developmental Quotient: C allele, 92.4 (89.9-96.6) versus CG 100.9 (96.7-104.8), p = 0.002; General Cognitive Ability: C allele, 88.0 (80.3-102.8) versus GG 103.0 (92.0-112.0), p = 0.037; Movement ABC score: C allele 8.3 (6.6-20.3) versus GG 4.0 (1.0-9.5), p = 0.081. The presence of the rare (> or =1) IL-6 -572 C-allele (CC+GC genotypes) is associated with impaired cognitive development among children born before 32 wk gestation. These data support a role for IL-6 in the genesis of neurologic impairment in such children.

Low cerebral blood flow resistance in nonventilated preterm infants predicts poor neurologic outcome.

To examine whether cerebral blood flow variables during the first critical day of life can predict the 1-yr neurologic outcome in ventilated and nonventilated preterm infants. Prospective follow-up study. Neonatal intensive care unit of university central hospital. Forty-nine preterm infants <33 wks of gestation. Doppler ultrasound investigations of the brain circulation, heart rate, and systemic blood pressure were performed in ventilated (n = 35) and nonventilated (n = 14) preterm infants during the first day of life. The neurologic development was evaluated using Griffith's subscales at 12 months of corrected age. Cerebral blood flow velocity measurements were obtained from the anterior cerebral artery and internal carotid artery. Cerebral blood flow, cerebral blood flow resistance, and cerebral perfusion pressure subsequently were derived. These derived cerebral perfusion variables were associated with the sum of Griffith's developmental scales (p <.02). However, the slopes of regression lines between cerebral blood flow or cerebral blood flow resistance and the sum of Griffith's psychomotor developmental scales tended to be different in the ventilated and nonventilated infants (p =.06, p =.003, respectively). The correlations between these variables and the sum of Griffith's psychomotor developmental scales were significant only in nonventilated preterm infants (r =.69, p =.007, and r = -.85, p =.001, respectively). Our data suggest that lowered cerebral blood flow resistance reflecting lowered cerebral blood flow during early circulatory transition is associated with adverse outcome in nonventilated preterm infants, but no connection in ventilated infants was found.

Non-anaemic iron deficiency identified by ZPP test in extremely premature infants: prevalence, dietary risk factors, and association with neurodevelopmental problems.

The aims of this study were to determine, in a cohort of extremely premature infants, the prevalence of iron deficiency identified by zinc protoporphyrin/heme ratio (ZPP) testing, and its association with neurodevelopmental problems and dietary risk factors for iron deficiency. Infants of less than 29 weeks' gestation or less than 1000 g birth weight were studied prospectively at a multidisciplinary follow-up clinic. Assessments were made at a corrected age of either 12 months (n=72) or 2 years (n=69). Physical examination, Griffiths Developmental Scale, and neurosensory-motor assessment were administered, information on diet and behaviour was obtained by questionnaire, and a fingerprick ZPP ratio was performed to identify iron deficiency. 18.4% of infants had positive ZPP tests. There was no significant association between a positive ZPP test result and dietary risk factors, or symptoms of lethargy, irritability or poor attention. In children without cerebral palsy, there was no difference on Griffiths scores or neurosensory-motor assessment between ZPP-positive and ZPP-negative groups. The diagnosis of cerebral palsy (n=12) was significantly associated with both a positive ZPP test and a lower Griffiths general quotient (GQ) score. Iron deficiency occurs commonly in extremely low birth weight (ELBW) children in early childhood, and is not predicted by dietary risk factors. The prevalence of iron deficiency is increased in ELBW children with cerebral palsy. Non-anaemic iron deficiency (NAID) does not impair development or significantly affect behaviour of ELBW subjects who do not have cerebral palsy.

A new approach for neurological evaluation of infants in resource-poor settings

Research assessing the neurological development of infants in developing countries is scanty as no suitable standardised tests are available for field-use in constrained circumstances. We describe the development and application of two simple assessments. Firstly, we aimed to develop a test suitable for assessing acute neurological disturbances caused by such diverse effects as infections, drugs or toxins. This test (Shoklo Neurological Test) is aimed at infants between 9 and 36 months. The second test (Shoklo Developmental Test) is aimed not only to follow the evolution of the signs tested initially in the acute phase but also to evaluate later neurodevelopmental sequelae which might be caused by the same events. The latter test is suitable for infants aged from 3 to 12 months. Both tests can be performed easily in non-optimal conditions. The examinations were tested in a cohort of infants from a Karen refugee camp and administered in a rural setting by health workers, after appropriate training. In order to validate the tests we also applied them to a cohort of London infants. The Griffiths Developmental Scales were applied in the same infants and both the Shoklo Neurological and the Shoklo Developmental Tests showed good correlation with this standardised neurodevelopmental assessment.