Infants Born Research Articles

High Incidence Rates of Early-onset Bacterial Sepsis in Infants Born in Two Brazilian Maternities: A 15-Year Retrospective Analysis.

Data on the burden and etiology of neonatal early-onset bacterial sepsis (EOBS) in low-to-middle-income countries are scarce. Surveillance is critical for optimizing prevention and treatment strategies. We aimed to estimate the incidence of EOBS in 2 large Brazilian cohorts of neonates. Data were retrospectively obtained from 33,794 neonates born between 2009 and 2017 at low-risk (n = 17,981) and high-risk maternity centers (n = 15,813). Blood cultures were taken within 72 hours of life from neonates with perinatal risk factors for EOBS or suspected EOBS. A positive blood culture for a pathogenic microorganism and a compatible clinical evolution confirmed the diagnosis of EOBS. One-third of the infants born from high-risk and 18.5% from low-risk maternities were investigated for EOBS. Overall, EOBS was more incident in neonates born in the high-risk facilities [66 cases or 4.2/1000 (95% CI: 3.2-5.3)] than in the low-risk facilities [24 cases or 1.3/1000 (95% CI: 0.9-2.0)]. The incidence rate of EOBS increased with decreasing gestational age (<32 weeks: 20.5/1000; 32-36 weeks: 5.6/1000; ≥37 weeks: 1.5/1000). Group B Streptococcus (GBS) was the agent more frequently identified in high-risk and low-risk maternities: 1.8/1000 (95% CI: 1.1-2.4) and 0.4/1000 (95% CI: 0.2-0.9), respectively. EOBS's overall case fatality rate was 17.8% for all the agents and 22% for GBS. EOBS remains unacceptably high and is frequently fatal in preterm and term infants cared for in high- or low-risk maternities. Because GBS has emerged as the most frequent causative agent, preventive strategies are urgently needed.

Prenatal Opioid Exposure and Risk for Adverse Brain and Motor Outcomes in Infants Born Premature

ObjectiveTo compare brain MRI biomarkers and neurodevelopmental test scores in infants born preterm with and without prenatal opioid exposure (POE). Study designWe examined 395 preterm infants (≤ 32 weeks gestational age[GA]) who had term-equivalent brain MRIs, composite scores from the Bayley Scales of Infant and Toddler Development-III(BSID-III) at 2 years corrected age, and POE data. MRI parameters included total/regional brain volumes and severe punctate white matter lesions (PWMLs). We conducted bivariable analysis and multivariable logistic regression analyses. ResultsThe mean(SD) gestational age was 29.3(2.5) weeks; 35(8.9%) had POE and 20(5.1%) had severe PWML. Compared with unexposed infants, those with POE exhibited higher rates of severe PWML (17.1% vs. 3.9%, respectively; p=0.002); findings remained significant with OR 4.16 (95% CI:1.26, 13.68) after adjusting for confounders. On mediation analysis, the significant relationship between POE and severe PWML was not indirectly mediated through preterm birth/GA (OR:0.93; 95% CI:0.78,1.10), thus suggesting the association was largely driven by a direct adverse effect of POE on white matter. In multivariable analyses, POE was associated with a significantly lower score by -6.2 (95%CI: -11.8,-0.6) points on BSID-III Motor subscale compared with unexposed infants. ConclusionsPOE was associated with severe PWML; this outcome may be a direct effect of POE rather than being mediated by premature birth. POE was also associated with worse motor development. Continued follow-up to understand the long-term effects of POE is warranted.

Commentary on "Parental Beliefs About the Motor Development of Dutch Infants Born Very Preterm: A Cohort Study".

Commentary on "Parental Beliefs About the Motor Development of Dutch Infants Born Very Preterm: A Cohort Study".

Echocardiographic Evaluation of Infants Born to Mothers with Gestational Diabetes Mellitus: A Cross-sectional Analytical Study

Introduction: Gestational Diabetes Mellitus (GDM) is a chronic and progressive disease characterised by changes in the metabolism of carbohydrates, lipids, and proteins, leading to glucose intolerance. The foetal heart in GDM is affected throughout the gestational period, which may result in hyperplasia and hypertrophy of myocardial cells. Aim: To determine the cardiac function and structural changes in infants of gestational diabetic mothers using Dopplerechocardiographic data. Materials and Methods: A cross-sectional analytical study was conducted on 30 infants of mothers with GDM and 30 infants of non diabetic mothers at the Department of Physiology, R.G. Kar Medical College and Hospital, in collaboration with the Departments of Paediatric Medicine and Cardiology from January 2023 to August 2023. Neonatal screening echocardiography was performed by a cardiologist using a Philips Echocardiograph machine, Model: EPIQ 7C, Software Version: 4.0.2, with a linear convex probe of S8-3 MHz frequency to assess cardiac structure and function using 2D, M mode, and Conventional Doppler. The parameters studied included aortic root diameter (mm), left atrial diameter (mm), Interventricular Septal (IVS) in diastole (mm), left ventricular posterior wall thickness in diastole (mm), left ventricular internal diameter in diastole (mm), left ventricular internal diameter in end systole (mm), left ventricular fractional shortening (%), and left ventricular ejection fraction (%). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version-20.0 with an Independent Student’s t-test. Results: The mean gestational age for the cases was 38.50±2.57 weeks and 39.30±1.97 weeks for controls. The mean maternal age for cases was 25±4.37 years and for controls was 27±5.03 years. The left atrial diameter in cases (12.83±2.14 mm) was significantly smaller than that of the control (14.20±0.55 mm). The left ventricular posterior wall diameter in diastole was significantly increased in cases (4.53±0.50 mm) compared to controls (3.87±0.35 mm). Significant differences were observed in the interventricular septum in diastole {cases: 4.73±0.45 mm, control: 3.97±0.32 mm} and in the left ventricular internal diameter in end systole {cases: 12.30±1.84 mm, control: 13.83±1.02 mm} between cases and controls. Aortic root diameter was increased in 13.3% of cases. The percentage of left ventricular fractional shortening (cases: 35.47±3.74 %, Control: 38.53±2.43 %), Left Ventricular Ejection fraction (cases: 67.63±4.52 %, control: 72.17±4.89 %) were significantly decreased in cases compared to control. Conclusion: The present study demonstrated the development of ventricular hypertrophy and compromised myocardial contractility in infants of diabetic mothers.

Knowledge and attitude of Down syndrome and prenatal screening among women in Hail, Saudi Arabia

Background and Aims: Down syndrome is the most common chromosomal abnormality occurring in live born infants. In Saudi Arabia termination of pregnancy is considered illegal and both religiously and culturally unacceptable. Our aim was to explore views, attitudes, and knowledge about Down syndrome, prenatal screening, integrating Down syndrome individuals in the community, willingness to terminate preg¬nancy. Methods: This cross-sectional study was conducted using a pre-validated questionnaire and carried out through face-to-face interviews, in Hail, Saudi Arabia from July-August 2019. Results: A total of 337 married women participated in this study, about Half were college graduates 157\\337(46.6%). Participants expressed opposition as “extremely opposed” to Down syndrome individuals to be involved in the community in schools, have jobs and attend public places 108\\337 (32.0%), 140\\337(41.5%) and 139\\337(41.2%) respectively. Illiterate participants were more willing to continue a pregnancy with Down syndrome fetus (AOR 9.7,95%CI: 2.2 – 42.8, p=0.003). In comparison, participants with college education were more willing to terminate (OR 1.6 95% CI: 1.0- 2.4, P=0.038). Moreover, awareness about prenatal tests were of no significant association with the willingness to terminate. Conclusions: This study has shown lack of knowledge about Down syndrome and most Saudi women in Hail are willing to undergo NIPT to prepare mentally for the child, but not go as far as TOP. This study also highlights the opinions of women towards the integration of DS individuals in the community. Further research on these questions would be useful to explore the reasons for the stigma surrounding the inclusion of DS individuals.

Feeding and Swallowing Trends in Infants Born via Exit Procedure for Giant Head and Neck Masses

Feeding and Swallowing Trends in Infants Born via Exit Procedure for Giant Head and Neck Masses

The Effect of Exposure to Carbon Monoxide (Co) Gas in Pregnant Women on The Incident of Weight Infants Born in Makassar City

Exposure to vehicle emissions, particularly carbon monoxide (CO), during pregnancy has been identified as a potential factor contributing to low birth weight in infants. The mechanism of CO's impact on the body involves its binding with hemoglobin (Hb) in red blood cells, leading to placental dysfunction and alterations in oxygen flow efficiency to the uteroplacental. Such disruptions can adversely affect fetal growth. This study focuses on Makassar City, a rapidly developing urban area experiencing substantial growth in infrastructure and transportation. This research aims to assess the impact of carbon monoxide exposure on birth weight in pregnant women residing in Makassar City. The method of this study is a quantitative approach employing a descriptive cross-sectional design was adopted for this study. The research sample consisted of 120 pregnant women categorized based on their CO exposure levels—30 with low exposure, 60 with moderate exposure, and 30 with high exposure. Simple random sampling was utilized for participant selection. CO levels were measured using the Adalog 7000 multi-gas monitor. Data analysis included One Sample ANOVA and Linear Regression. The results show that data analysis indicated that pregnant women with low CO exposure had an average birth weight of 3110.83 grams. In contrast, those with moderate and high CO exposure exhibited average birth weights of 2840.33 grams and 2667.33 grams, respectively. The regression coefficient for CO exposure was -221,750, indicating that a 1 µm increase in carbon monoxide gas correlated with a decrease in birth weight by -221,750. The conclusion is pregnant women who are exposed to high and moderate carbon monoxide gas during pregnancy had an effect on birth weight than mothers who are exposed to low carbon monoxide gas. Future research is needed to measure CO levels in the blood of pregnant women in relation to birth weight.

Secular Trends in Patent Ductus Arteriosus Management in Infants Born Preterm in the National Institute of Child Health and Human Development Neonatal Research Network

We evaluated changes in patent ductus arteriosus (PDA) diagnosis and treatment from 2012 through 2021 in a network of US academic hospitals. PDA treatment decreased among infants born at 26-28weeks but not among infants born at 22-25weeks. Rates of indomethacin use and PDA ligation decreased while acetaminophen use and transcatheter PDA closure increased.

Unbound Bilirubin and Acute Bilirubin Encephalopathy in Infants Born Late Preterm and Term with Significant Hyperbilirubinemia

To compare the association of unbound bilirubin (UB), total serum bilirubin (TSB), and bilirubin:albumin molar ratio (BAMR) with acute bilirubin encephalopathy (ABE), as assessed by bilirubin-induced neurologic dysfunction (BIND) score, in infants with significant hyperbilirubinemia (TSB ≥20mg/dL or underwent exchange transfusion). In this prospective cohort study, infants ≥34weeks of gestational age with significant hyperbilirubinemia during the first 2 postnatal weeks were eligible, unless they had craniofacial malformations, chromosomal disorders, TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus and herpes simplex) infections, surgery, or a family history of congenital deafness. TSB, serum albumin, and UB were measured at hospital admission using the colorimetric, bromocresol green, and modified peroxidase method, respectively. Infants were evaluated on admission for ABE using a standardized neurologic examination and assigned a BIND score by trained physicians. Infants with a total BIND score of 0 were deemed to not have ABE, whereas those with a score ≥1 were deemed to have ABE. A total of 151 infants were studied, among whom 37 (24.5%) had ABE. Of these, 19 had mild ABE (BIND score 1-3) and 18 had moderate-to-severe ABE (BIND score 4-9). On logistic regression, UB, but not TSB or BAMR, was associated with ABE (aOR 1.64; 95% CI 1.17-2.3). On ordered logistic regression, UB, but not TSB or BAMR, was associated with severity of ABE (aOR 1.76; 95% CI 1.28-2.4). Our findings of the association between UB and ABE indicate that BIND scoring may be useful for evaluation of ABE in infants ≥34weeksof gestational age.

Maternal Migration Background and Mortality Among Infants Born Extremely Preterm

Extremely preterm infants require care provided in neonatal intensive care units (NICUs) to survive. In the Netherlands, a decision is made regarding active treatment between 24 weeks 0 days and 25 weeks 6 days after consultation with the parents. To investigate the association between maternal migration background and admissions to NICUs and mortality within the first year among extremely preterm infants. This cross-sectional study linked data of registered births in the Netherlands with household-level income tax records and municipality and mortality registers. Eligible participants were households with live births at 24 weeks 0 days to 25 weeks 6 days gestation between January 1, 2010, and December 31, 2017. Data linkage and analysis was performed from March 1, 2020, to June 30, 2023. Maternal migration background, defined as no migration background vs first- or second-generation migrant mother. Admissions to NICUs and mortality within the first week, month, and year of life. Logistic regressions were estimated adjusted for year of birth, maternal age, parity, household income, sex, gestational age, multiple births, and small for gestational age. NICU-specific fixed effects were also included. Among 1405 live births (768 male [54.7%], 546 [38.9%] with maternal migration background), 1243 (88.5%) were admitted to the NICU; 490 of 546 infants (89.7%) born to mothers with a migration background vs 753 of 859 infants (87.7%) born to mothers with no migration background were admitted to NICU (fully adjusted RR, 1.03; 95% CI, 0.99-1.08). A total of 652 live-born infants (46.4%) died within the first year of life. In the fully adjusted model, infants born to mothers with a migration background had lower risk of mortality within the first week (RR, 0.81; 95% CI, 0.66-0.99), month (RR, 0.84; 95% CI, 0.72-0.97), and year of life (RR, 0.85; 95% CI, 0.75-0.96) compared with infants born to mothers with no migration background. In this nationally representative cross-sectional study, infants born to mothers with a migration background at 24 weeks 0 days to 25 weeks 6 days of gestation in the Netherlands had lower risk of mortality within the first year of life than those born to mothers with no migration background, a result that was unlikely to be explained by mothers from different migration backgrounds attending different NICUs or differential preferences for active obstetric management across migration backgrounds. Further research is needed to understand the underlying mechanisms driving these disparities, including parental preferences for active care of extremely preterm infants.

Trends in Mortality and Morbidities for Infants Born 24 to 28 Weeks in the US: 1997-2021.

Mortality and morbidity for very preterm infants in the United States decreased for years. The current study describes recent changes to assess whether the pace of improvement has changed. Vermont Oxford Network members contributed data on infants born at 24 to 28 weeks' gestation from 1997 to 2021. We modeled mortality, late-onset sepsis, necrotizing enterocolitis, chronic lung disease, severe intraventricular hemorrhage, severe retinopathy of prematurity, and death or morbidity by year of birth using segmented relative risk regression, reporting risk-adjusted annual percentage changes with 95% confidence intervals overall and by gestational age week. Analyses of data for 447 396 infants at 888 hospitals identified 3 time point segments for mortality, late onset sepsis, chronic lung disease, severe intraventricular hemorrhage, severe retinopathy of prematurity, and death or morbidity, and 4 for necrotizing enterocolitis. Mortality decreased from 2005 to 2021, but more slowly since 2012. Late-onset sepsis decreased from 1997 to 2021, but more slowly since 2012. Severe retinopathy of prematurity decreased from 2002 to 2021, but more slowly since 2011. Necrotizing enterocolitis, severe intraventricular hemorrhage, and death or morbidity were stable since 2015. Chronic lung disease has increased since 2012. Trends by gestational age generally mirror those for the overall cohort. Improvements in mortality and morbidity have slowed, stalled, or reversed in recent years. We propose a 3-part strategy to regain the pace of improvement: research; quality improvement; and follow through, practicing social as well as technical medicine to improve the health and well-being of infants and families.

Updated Clinical Practice Guidelines for Management of Hyperbilirubinemia in Infants Born at 35 Weeks or More Gestation.

Given the prevalence of jaundice in newborns, and the consequences of untreated hyperbilirubinemia, the long-awaited revised clinical practice guidelines for hyperbilirubinemia were finally released in August 2022 by the American Academy of Pediatrics as an update to the 2004 guidelines on the same topic. As new evidence and data become available, it is important for pediatricians and neonatologists to re-assess their clinical decision-making over time to ensure that patients are receiving the best care possible. With improvements in medical equipment and medical technology, and growing concerns about the overtreatment of hyperbilirubinemia, the newest clinical practice guidelines attempt to tackle the prevention, risk assessment, monitoring, and treatment of hyperbilirubinemia with these things in mind. [Pediatr Ann. 2023;52(12):e436-e439.].

EE542 Assessment of the Cost-Effectiveness of Risk Factor Guided Prophylaxis with Palivizumab for the Prevention of Severe Respiratory Syncytial Virus Infection in Colombian Infants Born at 32–35 Weeks’ Gestational Age

EE542 Assessment of the Cost-Effectiveness of Risk Factor Guided Prophylaxis with Palivizumab for the Prevention of Severe Respiratory Syncytial Virus Infection in Colombian Infants Born at 32–35 Weeks’ Gestational Age

Accuracy of Reticulocyte Hemoglobin for Diagnosing Iron Deficiency in Very Preterm Infants: A Population-Based Cohort Study

Background: Preterm born infants are at an increased risk of developing iron deficiency (ID) despite preventative iron supplementation, which can lead to long-term negative neurodevelopmental and behavioral outcomes. Serum ferritin (SF) is the commonly used test for diagnosing ID. However, SF is influenced by infection and inflammation, making it an unreliable marker in such situations. An alternative, reticulocyte hemoglobin equivalent (Ret-He), measures the iron content in newly produced red blood cells, providing an immediate assessment of iron availability. Unlike SF, Ret-He tests are automated, can be performed on the same blood sample as a complete blood count, and is not influenced by infection or inflammation like SF. However, there is limited literature on the reliability of Ret-He as an ID marker in very preterm infants (VPI) during their first year of life. This study aims to evaluate the diagnostic accuracy of Ret-He as an ID indicator in VPI at 4-6 months of corrected age (CA) compared to SF levels. Objective: To investigate the accuracy of Ret-He in detecting ID in VPI at 4-6 months CA Methods: A retrospective population-based cohort study was conducted using a population-based Provincial Perinatal Follow-Up (PFUP) database on all live VPIs born in Nova Scotia between 2012 and 2018. Infants with hematological disorders, chromosomal abnormalities, or major congenital anomalies were excluded. Prophylactic iron supplementation (2-3 mg/kg/day) starting at 2-4 weeks of chronological age was a standard of care for all included infants. Iron supplementation was recommended until 9-12 months CA. All infants underwent SF and CBC testing at either 4- or 6-months CA to assess iron stores and guide supplementation. In 2012, Ret-He was added as an additional marker of ID for clinical decision-making. Two definitions of ID were used. Definition one defined ID as SF level &amp;lt;20 mcg/L. Definition two defined ID as SF level &amp;lt;20 mcg/L at 4 months and &amp;lt;12 mcg/L at 6 months CA. Receiver operating characteristic curves were performed and the areas under the curves (AUC) were calculated to assess the accuracy of Ret-He in classifying patients with ID. The optimal cut-off point for Ret-He was determined using Youden's index, from which sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The Spearman correlation coefficient was calculated between SF and Ret-He. Statistical significance was set at a two-sided P value of &amp;lt; 0.05. Results: A total of 156 patients were included. Under definition one, 62 (39.7%) met the criteria for ID. Under definition two, 39 (25.0%) patients had ID. Baseline characteristics are provided in Table 1. The Spearman correlation coefficient between SF and Ret-He was 0.23 (p=0.004). Under definition one, the AUC of Ret-He for diagnosing ID was 0.64 (p=0.002) and 0.69 (p&amp;lt;0.001) under definition two (Figure 1). The optimal cut-off value for Ret-He in ID diagnosis was 29.4 pg irrespective of the definition. Sensitivity, specificity, PPV, and NPV for both definitions are reported in Table 1. Conclusion: Regardless of the ID definition used, the AUCs indicated a weak discriminatory ability of Ret-He for ID diagnosis. The study indicated a weak positive relationship between SF and Ret-He. Ret-He's low diagnostic accuracy in this study is comparable to other studies involving healthy pediatric populations but lower than studies involving children with chronic health conditions. Clinicians should use caution when relying on Ret-He alone to diagnose ID in VPI. Further research is needed to determine the optimal diagnostic approach for identifying ID in VPI as well as explore the clinical utility of Ret-He in combination with other ID biomarkers such as SF and transferrin saturation.

499. Level of Cord Blood Anti-SARs-CoV-2 Antibodies in Infants Born During 2021-2023 to The Mothers Who Had Received COVID-19 Vaccination During Pregnancy

Abstract Background Maternal antibodies against SARS-CoV-2 actively transfer across placenta providing passive immunity to neonates. However, levels of cord blood anti-SARS-CoV2 antibodies and protective effects are still unclear. The objectives of the study was to investigate level of cord blood SARs-CoV-2 antibody of infants born to the mothers who received at least 1 dose of COVID-19 vaccine during pregnancy or within 3 months before pregnancy, as well as having SARS-CoV-2 infection during pregnancy. Methods Prospective observational study was conducted in Bangkok between March 2022 to March 2023. Cord blood samples were tested for anti-receptor binding protein IgG (anti-RBD IgG). Medical records were review for history of SARS-CoV-2 infections in the mothers. Results A total of 154 neonates were enrolled. The highest cord blood geometric mean concentration (GMC) of anti-RBD IgG was observed in infants who was born from the mother who received COVID-19 vaccine and were diagnosed with COVID-19 during pregnancy (n= 28; anti-RBD IgG: 7684.8 [95% confidential interval (CI) 4215.9-14007.8] AU/ml), while the lowest GMC was found in the infants born from mothers who received COVID-19 vaccination before pregnancy and did not have COVID-19 during pregnancy (n=18, anti-RBD IgG 1453.5 [95% CI 648.1-3259.6 AU/ml]. Maternal SARs-CoV-2 infection during pregnancy had a significant association with anti-RBD IgG levels (P=0.03). Figure of Anti-RBD IgG comparison at birth Conclusion Vaccinating and having SARs-CoV-2 infection during pregnancy induced several folds higher antibody level in cord blood that could effectively provide protection in infants. Disclosures All Authors: No reported disclosures

1397. What were the Birth Outcomes of Infants Born to Zika Positive Mothers in Developing Countries?

Abstract Background Zika Virus became an emerging health threat in the early 21st century. Epidemics in the Pacific Islands noted flu-like symptoms and complications following human ZIKV infection. However, after a severe outbreak in 2015, Latin American studies reported fetal birth defects with maternal infection but reports in other developing countries where outbreaks occurred were not fully characterized. This study aims to review current reports on birth outcomes associated with maternal ZIKV infection . Methods This narrative review evaluated birth outcomes of Zika positive pregnant women. Research articles were found using Google Scholar, PubMed, and MEDLINE. The inclusion criteria were publication between 2012 to 2022, availability as full text in English, categorization as original research, meta-analyses or case reports. Exclusion criteria were studies that were part of a book chapter or encyclopedia and studies that cited results from developed nations. The articles were studied and 20 methodologically sound studies were selected for review, and the data was classified in themes based on birth outcomes. Results 18 studies reported that infants born to some laboratory-confirmed zika-positive mothers had abnormal birth outcomes after delivery including microcephaly, stillbirth, neurological abnormalities and hearing loss. Maternal ZIKV infection is associated with an increased risk of abnormal birth outcomes in newborns in developing countries. In the countries of studies that did not report abnormal outcomes there may have been a protective factor from previous maternal Dengue Virus (DENV) infection adding protection for their infants. Conclusion Overall, there appears a difference in birth outcomes of infants born to mothers infected with ZIKV, however more research is needed on environmental factors and prior arboviral infection as additional factors contributing to these outcomes. Disclosures All Authors: No reported disclosures

Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24–26 weeks’ gestational age: the EPI-DAF study

ObjectiveAfter lowering the Dutch threshold for active treatment from 25 to 24 completed weeks’ gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this...

Risk Factors for Admission Hyperthermia and Associated Outcomes in Infants Born Preterm

Maternal, placental, and neonatal factors were compared between infants born at ≤29weeks of gestational age with admission hyperthermia (>37.5○C) and euthermia (36.5-37.5○C). Admission hyperthermia was associated with longer duration of face-mask positive-pressure ventilation and infant's temperature ≥37.5○C in the delivery room. Infants born preterm with admission hyperthermia had greater odds of developing necrotizing enterocolitis and neurodevelopmental impairment.

Myelination of preterm brain networks at adolescence

Prematurity and preterm stressors severely affect the development of infants born before 37 weeks of gestation, with increasing effects seen at earlier gestations. Although preterm mortality rates have declined due to the advances in neonatal care, disability rates, especially in middle-income settings, continue to grow. With the advances in MR imaging technology, there has been a focus on safely imaging the preterm brain to better understand its development and discover the brain regions and networks affected by prematurity. Such studies aim to support interventions and improve the neurodevelopment of preterm infants and deliver accurate prognoses. Few studies, however, have focused on the fully developed brain of preterm born infants, especially in extremely preterm subjects. To assess the long-term effect of prematurity on the adult brain, myelin related biomarkers such as myelin water fraction and g-ratio are measured for a cohort of 19-year-old extremely preterm born subjects. Using multi-modal imaging techniques that combine T2 relaxometry and neurite density information, the results show that specific brain regions associated with white matter injuries due to preterm birth, such as the posterior limb of the internal capsule and corpus callosum, are still less myelinated in adulthood. Furthermore, a weak positive relationship between myelin water fraction values and Full-Scale Intelligence Quotient (FSIQ) scores was found in multiple brain regions previously defined as less myelinated in the Extremely Preterm (EPT) cohort. These findings might suggest altered connectivity in the adult preterm brain and explain differences in cognitive outcomes.

5 PediaTracTM: A Novel Measure for Screening Early Motor Development in Infants Born Preterm and Other At-Risk Populations

AbstractObjective:Infant motor development is a robust predictor of long-term developmental outcomes, especially in infants at high risk for neurodevelopmental impairments, such as those born preterm (PT, gestational age [GA] &lt;37 weeks). Although direct assessments of motor development are available, they are infrequently applied by pediatricians in routine screening of the broader population of infants born preterm. Parent ratings, such as the Ages and Stages Questionnaire, 3rd Ed., can be used to screen for motor delays. However, this and other existing screening measures focus on whether children have reached milestones based on pre-established cutoffs, rather than on assessing development along a continuum of ability. The present study examined the validity of the Motor domain of the recently developed caregiver report screening tool, PediaTracTM, in distinguishing infants born PT from infants born full term (FT, GA ^37 weeks) across the first 6 months of life. The reliability and factor structure of this motor scale were also evaluated.Participants and Methods:PediaTracTM is a web-based caregiver report assessing infant development across multiple domains, including motor functioning. This study reports on results from the PediaTracTM Motor domain for the study sample of 571 caregiver-infant dyads (240 PT, 331 FT). Caregivers rated their infants on age-targeted motor skills during the newborn period (NB, defined as term equivalent for the PT group) and at 2-, 4-, and 6-months after the NB period. Item Response Theory (IRT) methods were applied to assess the reliability (i.e., information) of caregiver-reported motor skills at each age. Using the IRT item parameters of discrimination and difficulty, items were selected for inclusion and to estimate theta, an index of the latent trait, motor ability, for each infant. Analyses conducted at each age assessed the effects of group, sex, and group x sex on the motor trait. Scale reliabilities and factor structure were also examined.Results:The PT group had significantly higher scores than the FT group on the motor trait at the NB period but significantly lower scores by 4 and 6 months, suggesting slower development of motor skills in the PT group. Means (SD) theta scores (similar to z scores) for the PT and FT groups, respectively, were .14 (.88) and -.05 (.91) for the NB period, -.01 (.90) and .01 (.91) for 2 months, .20 (.90) and .36 (88) for 4 months, and .46 (78) and .66 (.89) for 6 months. Effects for sex and group x sex interactions were not significant. Reliabilities, estimated at a point close to mean theta, were .94, .93, .96, and .98 at the NB, 2-, 4-, and 6-month periods, respectively. Exploratory factor analyses revealed evidence for a single primary motor factor and multiple second-order factors at each age.Conclusions:Findings provide strong support for applications of the caregiver reported PediaTracTM motor scales in screening infants born PT and other at-risk populations for early delays or abnormalities in motor development. Advantages of this method include its ease of administration, sensitivity to developmental change, and promise in assessing subdomains of motor skill.