High Risk For Developmental Problems Research Articles

Predictive validity of the Lacey Assessment of Preterm Infants for motor outcome at 2 years corrected age

IntroductionThe Lacey Assessment of Preterm Infants (LAPI) is a clinical tool used to assess neuromotor development in preterm infants at high risk of developmental problems. The aim of this study was to determine its predictive validity for estimating later motor outcome at 2 years of age, to ensure appropriate referral to early intervention and thus optimise the infant's outcome. MethodLAPI outcomes (usual or monitor) for preterm infants born between January 2012–2017 at a single tertiary level neonatal intensive care unit in London, UK were retrospectively reviewed. Predictive validity for later “moderate/severe” motor delay was determined by comparing LAPI outcomes with locomotor scores estimated using the Griffiths Mental Development Scales-Extended Revised (GMDS-ER) or Griffiths III at 2 years corrected age. Results118 infants were included (GMDS-ER = 87, Griffiths III = 31). Infants classified as usual on the LAPI showed significantly less motor delay on the GMDS-ER locomotor subset at 2 years, compared to infants in the monitor group (usual = 2.00 months, monitor = 6.00 months; p = 0.001). Sensitivity was found to be only 47.37%, with higher specificity of 84.85%. ConclusionThe LAPI shows high specificity but low sensitivity for prediction of later motor delay. It may therefore be useful for screening lower-risk infants, however on-going monitoring would be advised. Further studies investigating the reliability of the LAPI and use in conjunction with other predictive tools to improve sensitivity are recommended.

Children who face development risks due to maternal addiction during pregnancy require extra medical and psychosocial resources.

This study examined medical and psychosocial risk factors in children born to women with addiction problems during pregnancy and the children's needs for extra medical and psychosocial resources. Swedish midwives routinely screen pregnant women for drugs and alcohol and refer women with addictions to the Maternity and Child Healthcare Resource Team. We investigated the medical records of 127 children (51% girls) whose mothers were referred to the Resource Team from 2009 to 2015. Additional data were obtained from local child healthcare services (CHS), which provide routine paediatric care. More than three-quarters (76%) of the children had prenatal exposure to alcohol and drugs, and 17% were born with withdrawal symptoms. The mothers had a high rate of psychiatric diagnoses (38%) and were more likely to smoke after delivery and less likely to breastfeed than the general population. However, adherence to the CHS programme was generally high. Additional visits to the nurse, referrals to specialists, collaboration meetings and reports of concerns to social services decreased when the children began attending ordinary CHS centres. Children born to women with addictions during pregnancy faced a high risk of developmental problems and should be offered additional CHS resources to minimise negative long-term consequences.

Infant development in a family with multiple problems

Supporting families with multiple problems involves the close cooperation of various disciplines. The babies from these families must be considered as individuals potentially at high risk of developmental problems, who need to be surrounded and protected. Observation enables professionals to get to know these babies and rapidly spot any signs of suffering. Child health nurses have an essential preventive and nursing role.

Prevention of Recurrent Preterm Birth: Role of the Neonatal Follow-up Program

Preterm birth (PTB) is a public health crisis in need of effective preventative strategies. Multi-disciplinary Neonatal Follow-up Programs (NFPs) provide health services to preterm infants at high risk for developmental problems after discharge from US newborn intensive care units. We aimed to determine whether NFPs are a potentially effective venue for specialized maternal counseling and intervention aimed at reducing the high rate of recurrent PTB in this population. This prospective case series enrolled women with preterm children evaluated in the Utah Department of Health NFP, 2010-2012. Women were interviewed, received Maternal Fetal Medicine (MFM) counseling services, and maternal and neonatal records were abstracted. We assessed maternal demographics, medical history, and characteristics of the index pregnancy. We calculated the proportion of women with knowledge of PTB recurrence risk and available prevention strategies, and assessed current contraceptive use and reproductive plans. Ninety-six women with a history of early PTB (≤26 weeks and/or birth weight < 1,250 g) were evaluated. Nearly 1 in 5 women (19.8 %) evaluated reported sexual activity, desire to avoid pregnancy, and no current contraceptive use, and were therefore at imminent risk of unintended pregnancy. Of women without permanent contraception, only 24.3 % were aware of their individual PTB recurrence risk. Of women with a history of spontaneous PTB, only 4 % were aware of effective pharmacologic preventative strategies. Introduction of MFM consultation as part NFP multi-disciplinary services is a novel approach with the potential to reduce recurrent PTB in an exceptionally high-risk population.

Maternal and infant predictors of attendance at Neonatal Follow‐Up programmes

Neonatal Follow-Up (NFU) programmes provide health services for families of infants at high risk of developmental problems following difficult or extremely premature birth: yet, up to 30% of families do not attend these programmes with their infants. The study objective was to determine maternal and infant factors that predicted attendance at NFU programmes. Utilizing Andersen's Behavioural Model of Health Services Use, a prospective two-phase multi-site descriptive cohort study was conducted in three Canadian Neonatal Intensive Care Units (NICU) that refer to two affiliated NFU programmes. In Phase 1, 357 mothers completed standardized questionnaires that addressed maternal and infant factors, prior to their infants' NICU discharge. In Phase 2, attendance at NFU was followed at three time points over a 12-month period. Factors of interest included predisposing factors (e.g. demographic characteristics and social context); enabling factors (e.g. social support, travel distance, and income); and infant illness severity (i.e. needs factors). Multivariate logistic regression was used to estimate the odds ratio for each independent factor. Mothers parenting alone, experiencing higher levels of worry about maternal alcohol or drug use, or at greater distances from NFU were less likely to attend. Mothers experiencing higher maternal stress at the time of the infant's NICU hospitalization were more likely to attend NFU. No infant factors were predictive of NFU attendance. Mothers at risk of not attending NFU programmes with their infants require better identification, triage, referral and additional support to promote engagement with NFU programmes and improved quality of life for their high-risk infants.

Individual development of preschool children-prevalences and determinants of delays in Germany: a cross-sectional study in Southern Bavaria

BackgroundEven minor abnormalities of early child development may have dramatic long term consequences. Accurate prevalence rates for a range of developmental impairments have been difficult to establish. Since related studies have used different methodological approaches, direct comparisons of the prevalence of developmental delays are difficult. The understanding of the key factors affecting child development, especially in preschool aged children remains limited. We used data from school entry examinations in Bavaria to measure the prevalence of developmental impairments in pre-school children beginning primary school in 1997–2009.MethodsThe developmental impairments of all school beginners in the district of Dingolfing- Landau, Bavaria were assessed using modified “Bavarian School Entry Model” examination from 1997 to 2009 (N=13,182). The children were assessed for motor, cognitive, language and psychosocial impairments using a standardised medical protocol. Prevalence rates of impairments in twelve domains of development were estimated. Using uni- and multivariable logistic regression models, association between selected factors and development delays were assessed.ResultsThe highest prevalence existed for impairments of pronunciation (13.8%) followed by fine motor impairments (12.2%), and impairments of memory and concentration (11.3%) and the lowest for impairments of rhythm of speech (3.1%). Younger children displayed more developmental delays. Male gender was strongly associated with all developmental impairments (highest risk for fine motor impairments = OR 3.22, 95% confidence interval 2.86-3.63). Preschool children with siblings (vs. children without any siblings) were at higher risk of having impairments in pronunciation (OR 1.31, 1.14-1.50). The influence of the non-German nationality was strong, with a maximum risk increase for the subareas of grammar and psychosocial development. Although children with non-German nationality had a reduced risk of disorders for the rhythm of speech and pronunciation, in all other 10 subareas their risk was increased.ConclusionsIn preschool children, most common were delays of pronunciation, memory and concentration. Age effects suggest that delays can spontaneously resolve, but providing support at school entry might be helpful. Boys and migrant children appear at high risk of developmental problems, which may warrant tailored intervention strategies.

Transition to Neonatal Follow-up Programs

Neonatal follow-up (NFU) programs provide health services for infants at high risk for developmental problems after they transition home from the neonatal intensive care unit (NICU). The purpose of the study was to assess current patterns of NFU attendance and explore time points when mothers and infants withdrew from NFU programs during the infant's first year of life. The study was conducted in 3 Canadian tertiary-level NICUs that referred to 2 affiliated, regional NFU programs. A total of 357 mothers and 400 infants were consecutively recruited during NICU hospitalization. Attendance at NFU programs was tracked at each of the 3 scheduled appointments from existing NFU databases. Attendance at NFU decreased over time from 84% at the first appointment to 74% by 12 months, with the highest withdrawal from NFU after NICU discharge, followed by withdrawal after the first NFU appointment. Nonattendance at NFU results in less access to required services and underreporting of the developmental outcomes of these infants. Given these findings, mothers should be screened earlier in the NICU to identify those at greatest risk of not attending NFU. Strategies should be implemented to address potential barriers and provide effective transition and access to the NFU program.

SP6-51 Effects of maternal history of abuse on child development at age 3

IntroductionA community sample of pregnant women participated in a randomised controlled trial of prenatal care in Calgary, Alberta between 2001 and 2004. These women were followed-up when the child was...

Maternal well-being and its association to risk of developmental problems in children at school entry.

BackgroundChildren at highest risk of developmental problems benefit from early identification and intervention. Investigating factors affecting child development at the time of transition to school may reveal opportunities to tailor early intervention programs for the greatest effectiveness, social benefit and economic gain. The primary objective of this study was to identify child and maternal factors associated with children who screened at risk of developmental problems at school entry.MethodsAn existing cohort of 791 mothers who had been followed since early pregnancy was mailed a questionnaire when the children were aged four to six years. The questionnaire included a screening tool for developmental problems, an assessment of the child's social competence, health care utilization and referrals, and maternal factors, including physical health, mental health, social support, parenting morale and sense of competence, and parenting support/resources.ResultsOf the 491 mothers (62%) who responded, 15% had children who were screened at high risk of developmental problems. Based on a logistic regression model, independent predictors of screening at high risk for developmental problems at age 5 were male gender (OR: 2.3; 95% CI: 1.3, 4.1), maternal history of abuse at pregnancy (OR: 2.4; 95% CI: 1.3, 4.4), and poor parenting morale when the child was 3 years old (OR: 3.9; 95% CI: 2.1, 7.3). A child with all of these risk factors had a 35% predicted probability of screening at high risk of developmental problems, which was reduced to 13% if maternal factors were favourable.ConclusionsRisk factors for developmental problems at school entry are related to maternal well being and history of abuse, which can be identified in the prenatal period or when children are preschool age.

Child Care Problems and Employment Among Families With Preschool-Aged Children With Autism in the United States

The impact of childhood autism on parental employment is largely unknown. The purpose of this work was to describe the child care arrangements of children with autism and to determine whether families of preschool-aged children with autism are more likely to report that child care arrangements affected employment compared with typically developing children and children at high risk for developmental problems. METHODS. Parents of 16282 preschool-aged children were surveyed by the National Survey of Children's Health. An autism spectrum disorder was defined as an affirmative response to the question, "Has a doctor or health professional ever told you that [child] has any of the following conditions? Autism?" There were 82 children with autism spectrum disorder in the sample, and 1955 children at high risk on the basis of the Parent's Evaluation of Developmental Status. We used chi(2) and multivariate logistic regression analyses. Ninety-seven percent of preschool-aged children diagnosed with autism spectrum disorder were cared for in community settings, particularly preschool and Head Start, with only 3% in exclusive parental care. Thirty-nine percent of the parents of children with autism spectrum disorder reported that child care problems had greatly affected their employment decisions, compared with 16% of the children at high risk and 9% of those who were typically developing. In multivariate analyses, families with a child with autism spectrum disorder were 7 times more likely to state that child care problems affected employment than other families, after controlling for household and child covariates. This effect was 3 times larger than the effect of poverty. Developmental problems and autism spectrum disorder are associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant evaluation of the community resources available to families with children with special needs.

Maternal mental health predicts risk of developmental problems at 3 years of age: follow up of a community based trial

BackgroundUndetected and untreated developmental problems can have a significant economic and social impact on society. Intervention to ameliorate potential developmental problems requires early identification of children at risk of future learning and behaviour difficulties. The objective of this study was to estimate the prevalence of risk for developmental problems among preschool children born to medically low risk women and identify factors that influence outcomes.MethodsMothers who had participated in a prenatal trial were followed up three years post partum to answer a telephone questionnaire. Questions were related to child health and development, child care, medical care, mother's lifestyle, well-being, and parenting style. The main outcome measure was risk for developmental problems using the Parents' Evaluation of Developmental Status (PEDS).ResultsOf 791 children, 11% were screened by the PEDS to be at high risk for developmental problems at age three. Of these, 43% had previously been referred for assessment. Children most likely to have been referred were those born preterm. Risk factors for delay included: male gender, history of ear infections, a low income environment, and a mother with poor emotional health and a history of abuse. A child with these risk factors was predicted to have a 53% chance of screening at high risk for developmental problems. This predicted probability was reduced to 19% if the child had a mother with good emotional health and no history of abuse.ConclusionOver 10% of children were identified as high risk for developmental problems by the screening, and more than half of those had not received a specialist referral. Risk factors for problems included prenatal and perinatal maternal and child factors. Assessment of maternal health and effective screening of child development may increase detection of children at high risk who would benefit from early intervention.Trial registrationCurrent Controlled Trials ISRCTN64070727

Validity of the Social Communication Questionnaire in Assessing Risk of Autism in Preschool Children with Developmental Problems

This study estimates the sensitivity and specificity of the social communication questionnaire (SCQ) for autistic spectrum disorders in preschool children at high risk for developmental problems referred to a tertiary centre and compares the predictions of the SCQ and the referrer. The SCQ was completed by 81 parents prior to multidisciplinary assessment and compared with the final diagnosis. The sensitivity and specificity were 93% and 58% for children aged 2-6, and 100 and 62% for children aged 3-5 years, with a cut-off score of 11. The SCQ performed better than referrers. Low-specificity means the SCQ is not suitable as a diagnostic tool but will assist clinicians and tertiary services in selecting children with developmental problems who require autism-specific assessment.

Rural African-American Mothers Parenting Prematurely Born Infants: An Ecological Systems Perspective

This qualitative descriptive study describes the concerns and issues of rural African-American mothers with prematurely born infants. Mothers were part of a larger nurse-parent support intervention. The 18 mothers lived in rural areas in the Southeast, and their infants were younger than 35 weeks gestational age at birth and at high risk for developmental problems because they either weighed less than 1500 grams at birth or required mechanical ventilation. Field notes written by the intervention nurses providing support to the mothers after discharge from the hospital were analyzed using methods of content analysis. Concerns of the mothers related to the infant's health and development, the maternal role in parenting the infant, personal aspects of their lives, and relationship issues particularly with the fathers. Findings support the importance of an ecological systems perspective when designing research and caring for rural African-American mothers with prematurely born children.

Sleeping and waking state development in preterm infants

Background Most studies of sleep–wake states of preterm infants have been cross-sectional. Thus, the extent to which sleep–wake development occurs within individuals and how environmental factors affect the development of sleeping and waking is unclear. Aims This study examined the development of sleeping and waking during the preterm and early post-term periods and the effects of infant health and environmental characteristics. Design Longitudinal, descriptive design. Participants 134 preterm infants at high risk for developmental problems because of birthweights under 1500 g or mechanical ventilation. Outcome measures Weekly 2-h behavioral observations were conducted from the time infants were no longer critically ill until 43 weeks post-conceptional age or discharge. A single follow-up observation was conducted 1–3 months later. Results Active sleep, large body movements and the percent of no REM during active sleep decreased with age, and quiet waking, active waking, quiet sleep and regularity of respiration in active sleep and quiet sleep increased. The state of sleep–wake transition increased until 40 weeks and then decreased after 43 weeks CA. Negative facial expressions showed a quadratic decrease over age. Active waking, active sleep, negative facial expressions and quiet sleep regularity showed a change of development after term. Infant characteristics, illness severity and medical treatments, the handling due to performing an EEG and hospital had only minor effects. Conclusions Significant development of sleeping and waking occurs over the preterm period. Additional research is needed to determine how the change from the hospital to the home environment affects on these developmental trajectories.

The impact of intrauterine exposure versus postnatal environment in neurodevelopmental toxicity: long-term neurobehavioral studies in children at risk for developmental disorders

Various investigators have shown that enriched environment may positively affect the early brain development of experimental animals. Environment was also shown to positively affect the development of young children born to mothers of low socio-economic class (low SES). It is unknown, however, to what extent can an enriched environment improve the developmental outcome of children born with slight brain damage. We studied the development of preschool and early school age children born to heroin dependent parents raised at home or adopted in comparison to children suffering only from environmental deprivation (low parental SES) and to controls. They were examined by several professionals, using standard, age appropriate, neurological and psychological tests. Similar evaluations were performed on a group of early school age children born to mothers with pregestational or with gestational diabetes and on a group of children born prematurely, with a birth weight of less than 1500 g using various developmental tests. Young children born to heroin dependent mothers and fathers raised at home and children of low SES had, in comparison to controls, lower intellectual skills and a higher rate of inattention. This persisted at school age, too. Children born to heroin dependent mothers adopted at a young age and hence being raised in a good environment had normal intellectual function but a high rate of inattention and behavioral problems. We also examined the school age children for possible presence of ADHD and found a high rate of ADHD among all children born to heroin dependent parents including those adopted, as well as in the children with low parental SES. Similar findings regarding the strong positive influence of an enriched environment were observed in children born to diabetic mothers, where the intellectual abilities of the children were directly related with parental education. The cognitive abilities of the children born prematurely were also strongly associated with parental education and not with the degree of perinatal complications. In conclusion, in all groups of children at high risk for developmental problems was found that the environment has a strong influence on their intellectual abilities but not on motor skills or attention span. A good environment (high parental SES) may significantly improve the outcome.

Developmental Well-Being among Low and Normal Birth Weight U.S. Puerto Rican Children

Low birth weight is a more common occurrence among Puerto Rican children than among children from most other racial and ethnic groups in the United States, and they are more likely to experience the added risk of living in poverty. This study addresses what is protective for the development 602 normal birth weight and 554 low birth weight children from the Puerto Rican Maternal and Infant Health Study. The results presented in the current analysis identify several protective influences for development (particularly maternal social support, medical insurance, and paternal employment) among low birth weight children (who are at a high risk for developmental problems), and almost none for normal birth weight children. The results largely support the contention that protective factors emerge, or increase in strength, only in the presence of risk, indicating the use of targeted child health programs based on birth weight are an effective and efficient way to improve the developmental well-being of young Puerto Rican children in the United States.

Adolescent parenting programs: Assessing parent-infant interaction

With the increasing awareness that the offspring of adolescent parents are at high risk for developmental problems, programs serving adolescent parents are introducing services designed to improve the quality of interaction between adolescent mothers and their infants. Since most program planners and evaluation researchers have had little training or experience in the highly specialized field of parent-infant interaction, this paper will provide orientation to some academic and applied issues in this area. First we will give evidence documenting the key role that the parent-infant relationship plays as a foundation for the child's later development—and in particular the evidence suggesting that adolescent parent-infant relationships place the child at risk. Second, by drawing upon experiences with the Ounce of Prevention Fund adolescent parenting programs, we will describe some of the challenges in selecting a parent-infant interaction assessment instrument for use in community-based programs.

Growth and Development of Preterm Infants With Respiratory Distress Syndrome and Bronchopulmonary Dysplasia

This study examines the growth and development of 37 preterm infants, 20 with respiratory distress syndrome and 17 with bronchopulmonary dysplasia. The groups were balanced by sex, parity, family configuration, and socioeconomic status and were studied at either 12 or 18 months after hospital discharge. Findings indicate that infants with bronchopulmonary dysplasia are at greater risk for growth retardation in their second year than infants with respiratory distress syndrome. Furthermore, results from cognitive, sensorimotor, and language measures (the Bayley, Uzgiris-Hunt, and Receptive-Expressive Emergent Language scales) demonstrate that infants with bronchopulmonary dysplasia perform significantly less well than infants with respiratory distress syndrome. The group performance of the infants with respiratory distress syndrome suggests that their developmental scores are comparable to those of average, healthy full-term infants of the same age. In contrast, the group of infants with bronchopulmonary dysplasia performed in the low-average to delayed range. Moreover, regression analyses show that type of respiratory illness explains more of the variance in cognitive outcomes than such neonatal factors as birth weight or gestational age. Thus, this study demonstrates that infants with bronchopulmonary dysplasia are at high risk for developmental problems in their second year, and that the contribution of bronchopulmonary dysplasia to explanations of differential cognitive outcomes cannot be reduced to between-group differences in perinatal status.

53 CHILDREN WITH CHRONIC LUNG DISEASE: A TWO-YEAR FOLLOW-UP

The two year developmental findings on 9 children with diagnosed chronic lung disease at discharge from the nursery are reported. The children had birthweights of 709-1270 grams, gestational ages of 25-30 weeks and were appropriate for gestational age. The 1270 gram child had the Mickity-Wilson Syndrome. The other children had bronchopulmonary dysplasia and birthweights below 1100 grams. There was no clinical evidence of intracerebral hemorrhage. The Bayley Scales of Infant Development and an Occupational/Physical Therapy (OT/PT) assessment were administered at 2 years of age. Four of the 6 less than 1001 gram infants had Bayley scores below 78 and pathologic OT/PT findings. They had moderate-severe lung disease at discharge from the nursery. The 2 other children had Bayley scores above 78 but had suspicious OT/PT findings. They had mild-moderate lung disease. Of the 2 children with birthweights 1001-1250 grams one had advanced lung disease with Bayley scores below 78 and pathologic OT/PT findings. The other child had mild disease with normal Bayley scores, but with suspicious OT/PT findings. The 1270 gram child had mild lung disease, normal Bayley scores, but had suspicious OT/PT findings. In summary, the data suggest that children with very low birthweights, with moderate-severe lung disease at discharge from the nursery are at high risk for developmental problems. It is recommended that such children be followed closely.