MDI Scores Research Articles

The long-term neurodevelopmental outcomes of toddlers with SARS-CoV-2 infection in the neonatal period: a prospective observational study

BackgroundThe effect of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus in the neonatal period on developing brain is still unknown. This study aims to investigate the long-term neurodevelopmental outcomes of newborns exposed to SARS-CoV-2 & Delta variant.MethodsAt a tertiary referral center, a prospective observational cohort research was carried out. All babies who were equal to or more than 34 gestational weeks gestation and were admitted to the NICU between January 2021 and January 2022 due to SARS-CoV-2 infection (Delta - or Delta +) were included in the study. Infants who were hospitalized for non-SARS-CoV-2 reasons at similar dates and who had no history of invasive mechanical ventilation were incorporated as a control group using a 2:1 gender and gestational age match. Thirty infants were assigned to the study group and sixty newborns to the control group based on the sample size calculation. These toddlers’ neurodevelopment was evaluated between the ages of 18 and 24 months using the Bayley-II scale.ResultsWe enrolled 90 infants. SARS-CoV-2-positive infants had poorer psychomotor development index (PDI) scores and significantly greater mildly delayed performances (MDPs) at 18–24 months (PDI p = 0.05, MDPs p = 0.03, respectively). Delta variant showed statistically significant lower MDI and PDI scores (MDI p=0.03, PDI p=0.03, respectively). A smaller head circumference of SARS-CoV-2-positive toddlers was detected in the first year (p < 0.001), which improved at the second age.ConclusionSARS-CoV-2-positive neonates revealed lower PDI scores and greater MDPs at 18th-24th months. The effect is most noticeable in Delta variant. Longer-term examination of neurodevelopmental outcomes and reevaluation of these children between the ages of 5 and 12 are critical.

Differences in bacterial taxa between treatment-naive patients with major depressive disorder and non-affected controls may be related to a proinflammatory profile

BackgroundMajor depressive disorder (MDD) is characterized by sadness and anhedonia, but also physical symptoms such as changes in appetite and weight. Gut microbiota has been hypothesized to be involved in MDD through gut-brain axis signaling. Moreover, antidepressants display antibacterial properties in the gastrointestinal tract. The aim of this study was to compare the gut microbiota and systemic inflammatory profile of young patients with MDD before and after initiation of antidepressant treatment and/or psychotherapy in comparison with a non-depressed control group (nonMDD).MethodsFecal and blood samples were collected at baseline and at follow-up after four and twelve weeks, respectively. Patients started treatment immediately after collection of the baseline samples. The gut microbiota was characterized by 16 S rRNA gene sequencing targeting the hypervariable V4 region. Plasma levels of 49 unique immune markers were assessed using Mesoscale.ResultsIn total, 27 MDD patients and 32 nonMDD controls were included in the study. The gut microbiota in the baseline samples of MDD versus nonMDD participants did not differ regarding α- or β-diversity. However, there was a higher relative abundance of the genera Ruminococcus gnavus group, and a lower relative abundance of the genera Desulfovibrio, Tyzzerella, Megamonas, Olsenella, Gordonibacter, Allisonella and Rothia in the MDD group compared to the nonMDD group. In the MDD group, there was an increase in the genera Rothia, Desulfovibrio, Gordinobacteer and Lactobacillus, while genera belonging to the Firmicutes phylum were found depleted at twelve weeks follow-up compared to baseline. In the MDD group, IL-7, IL-8 and IL-17b levels were elevated compared to the nonMDD group at baseline. Furthermore, MDI score in the MDD group was found to correlate with Bray-Curtis dissimilarity at baseline, and several inflammatory markers at both baseline and after initiation of antidepressant treatment.ConclusionSeveral bacterial taxa differed between the MDD group and the nonMDD group at baseline and changed in relative abundance during antidepressant treatment and/or psychotherapy. The MDD group was furthermore found to have a pro-inflammatory profile compared to the nonMDD group at baseline. Further studies are required to investigate the gut microbiota and pro-inflammatory profile of patients with MDD.

A Potential Mechanism of Neurological Impairment in Children With Infantile Spasm: Based on Microanatomic Structure Analysis Employing Voxel-Based Morphometry and Surface-Based Morphometry

BackgroundInfantile epileptic spasms syndrome (IESS) would accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microwould accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microanatomic structure alteration. MethodsThe IESS group had 21 males and 13 females (mean age: 17.7 ± 15.6 months), whereas the healthy controls group had 22 males and 10 females (mean age: 29.4 ± 18.7 months). High-resolution 3D T1WI was performed. Computational Anatomy Toolbox implemented in Statistical Parametric Mapping 12 was used to measure the gray matter and white matter volume, and the cortical thickness separately. Independent sample t test was used to assess between-group differences. IESS group was assessed using the Bayley Scales of Infant Development. ResultsThe IESS group showed a significantly decreased volume of gray matter in right middle temporal gyrus, inferior temporal gyrus, superior temporal gyrus, right fusiform, and bilateral precuneus (P < 0.001). There were no significant between-group differences with respect to white matter volume or cortical thickness (P > 0.001). The results of Bayley Scales of Infant Development showed that the Mental Development Index (MDI) and Psychomotor Development Index scores of children with IESS were almost concentrated in the range of <70. MDI score showed a positive correlation with gray matter reduction area in IESS group. ConclusionChildren with IESS had impaired cognitive and delayed motor development. And the decreased gray matter in the right temporal lobe, fusiform, and bilateral precuneus could be the potential anatomic basis for impaired function, such as hearing, visual, and language.

Association between prenatal exposure to rare earth elements and the neurodevelopment of children at 24-months of age: A prospective cohort study

The increasing consumption of rare earth elements (REEs) has resulted in a considerable risk of environmental exposure. However, the adverse effects of prenatal REEs exposure on children's neurodevelopment are not yet fully recognized. Therefore, we investigated the individual and joint effects of prenatal exposure to 13 REEs on children's neurocognitive development based on 809 mother-child pairs from a large birth cohort in Wuhan, China. Maternal urinary concentrations of 13 REEs were repeatedly measured by inductively coupled plasma mass spectrometry. Children's neurodevelopment [e.g., mental and psychomotor development index (MDI/PDI)] at 24-months was assessed using Bayley Scales of Infant Development of Chinese Revision. GEE and BKMR models were applied to estimate the individual and joint effects of prenatal REE exposure on child neurodevelopment level. After controlling for typical confounders, we observed that exposure to 9 REEs during the first trimester were significantly associated with decreased MDI scores [βs and 95% confidence intervals (CIs) ranging from −2.24 (−3.86 ∼ −0.63) to −1.44 (−2.26∼ −0.26)], and 7 REEs during third trimester were significantly associated decreased PDI scores [β and 95% CIs ranging from −1.95 (−3.19 ∼ −0.71) to −1.25 (−2.34 ∼ −0.16)]. Higher quantiles of REE mixture in first and third trimester were associated with decreased MDI and PDI score. Thulium, erbium in the first trimester and cerium, lanthanum in the third trimester accounted most importance to joint effects on MDI and PDI, respectively. In conclusion, prenatal exposure to higher concentrations of REEs during the first and third trimester were negative associated with children's neurodevelopment.

Associations of maternal pre-pregnancy body mass index and gestational weight gain with risk of offspring neurodevelopment at 2years: A Chinese birth cohortstudy.

In recent decades, there has been a surge in both obesity and developmental impairments. Only a few research have looked at the relationship between gestational weight growth and pre-pregnancy BMI in mothers and the neurobehavioral development of their infants. The current research investigates the associations among maternal pre-pregnancy BMI, GWG, and the risk of child neural development at 2 years of age depending on a Chinese birth prospective study. The study population was 3,115 mother-infant pairs were registered in the Wuhan Health Baby cohort between September 2013 and October 2018, and data from this cohort was used in this investigation. The Chinese classification was used to group maternal BMI before conception. Based on the 2019 Life Cycle Project-Maternal Obesity and Childhood Outcomes Study Group, categories for GWG were created. The outcome was an assessment of child neural development at age 2 which was measured by employing a Chinese translation of the Bayley scales (BSID-CR). The multivariate regression models were used to calculate the beta (β) coefficients and 95% confidence intervals (CIs) for estimating the associations between continuous Bayley scores and maternal pre-pregnancy BMI categories, as same as in GWG categories. Infants of overweight and obese moms exhibited lower MDI scores than those of mothers with normal pre-pregnancy BMI (β = -2.510, 95%CI = -4.821 to -0.200) in the entire sample. Meanwhile, we find among the normal pre-pregnancy BMI mothers, infants of inadequate GWG mothers had lower MDI scores (β = -3.952, 95%CI = -7.809 to -0.094) compared with the referenced adequate GWG mothers, as well as the infants of excessive GWG mothers among the underweight pre-pregnancy BMI mothers (β = -5.173, 95%CI = -9.803 to -0.543). The PDI scores of the infants were not affected by the maternal pre-pregnancy BMI or GWG. For Chinese babies aged 2 in this nationally representative sample, aberrant pre-pregnancy BMI and GWG can impair infants' mental development, but not psychomotor development. Such results are significant given the incidence of overweight and obesity as well as the long-term effects of early brain development. In this study we found optimal GWG recommendations proposed by 2019 Life Cycle Project-Maternal Obesity and Childhood Outcomes Study Group were more suitable for Chinese women than 2009 Institute of Medicine(IOM) guidelines. Additionally, women should be given general advice on how to achieve their ideal pre-pregnancy BMI and GWG.

Neonatal outcomes and long-term neurodevelopmental evaluations of hospitalized early term infants: prospective case-control study.

It was intended to compare early term babies to term babies by reviewing short-term issues and long-term neurodevelopmental evaluations. It was planned as a prospective case-control study. Of the 4263 infants admitted to the neonatal intensive care unit, 109 infants born at early term by elective cesarean section and hospitalized within the first 10 postnatal days were included in the study. As the control group, 109 babies born at term were enrolled. Nutrition status of infants, reasons for hospitalization in the first postnatal week were recorded. When the babies were 18-24 months old, an appointment was made for neurodevelopmental evaluation. In the early term group, the time of breastfeeding was later than the control group, with a statistically significant difference. Similarly, breastfeeding difficulty, need for formula in the first week postpartum and hospitalization were found to be significantly higher in the early term group. Considering the short-term results; pathological weight loss, hyperbilirubinemia requiring phototherapy and feeding difficulties were statistically significantly higher in the early term group. Neurodevelopmental delay did not statistically differ across the groups, but the early term group's MDI and PDI scores were found to be statistically lower than those of the term group. Early term infants are thought to be like term infants in many ways. Although these babies are similar to term babies, they are still physiologically immature. The short and long-term negative consequences of early term birth are obvious, non-medical elective early term births should be prevented.

P005 0190Molecular-based classification of ulcerative colitis and its dynamic

Abstract Background A better characterization of inflammatory bowel disease is needed. We previously developed a molecular classification tool for Crohn’s disease, based on a combination of metagenomics (dysbiosis score - MDI), transcriptomics (barrier integrity score - BIS, autophagy score – ATS, unfolded protein response score - UPRS), serum proteomics (inflammation score - IPS) and genetics (polygenic risk score - GRS)1. We here investigated if this score could also apply for ulcerative colitis (UC) and how the individual components correlate with clinical outcomes. Methods For a total of 173 UC patients and 181 controls (CO), we collected faecal and blood samples, as well as colon biopsies (Table). Faecal microbiota 16S-sequencing, intestinal RNA-sequencing, and serum proteomics (OLINK inflammatory panel) were performed. Using proteomics and RNA expression data, IPS, ATS, UPRS and BIS were calculated. MDI was calculated as previously described1. Based on these findings, patients were categorized into quartiles, ranging from Q1 (the least dysfunctional state) to Q4 (the most dysfunctional state). The individual scores were correlated with time to first biological or biological switch, as well as correlations with C-reactive protein (CRP), faecal calprotectin (FC), and the Montreal classification. The therapeutic value of MDI score was studied in a small dietary intervention pilot study (n=8)2. Results None of the individual components of the score were associated with disease extent. Patients diagnosed at a later age had increased ATS and BIS levels. BIS and UPRS showed a positive correlation with disease duration (r=0.36, r=0.54 respectively, p&amp;lt;0.001) (Figure2). MDI (spearman r=0.27, r=0.44, r=0.46 respectively, all p&amp;lt;0.0001) and IPS (r=0.5, r=0.7, r=0.6 respectively, all p&amp;lt;0.0001) correlated with CRP and FC levels, and time to first biologic. UPRS, ATS, MDI, BIS, and IPS were considerably higher in patients who required a switch in biologic therapy (all p&amp;lt;0.001). Finally, we observed a decreasing trend in MDI in response to dietary modification (Figure3). Conclusion In UC patients, we created a multifaceted scoring system to molecularly describe disease by the degree of dysbiosis, dysregulation of the immune proteome, and intestinal barrier integrity. We also demonstrated the dynamic of MDI of this score in relation to dietary intervention. Therefore, molecular profiling of patients may represent a new, individualized strategy to the management of UC.

Hubungan Variasi Genetik Gen FADS pada Suku Sasak Terhadap Angka Kecukupan Gizi

One of the macronutrients needed by the human body is fat. Fatty acids are divided into two, namely saturated and unsaturated fatty acids. Based on the source of unsaturated fatty acids are divided into two, namely non-essential and essential. Essential fatty acids consist of omega-3 and omega-6 which are part of PUFAs. To determine the relationship of genetic variation of the FADS gene to the nutritional adequacy of long-chain polyunsaturated fatty acids (LC-PUFA) in children of the Sasak ethnic. Systematic reviews were carried out through scientific journals, government guidelines, online portals for journal publications such as Medscape, Google Scholar, PubMed, and Science Direct, with the keyword “Polyunsaturated Fatty Acid (PUFA)” There was a significant relationship between the FADS2 index (DHA: EPA ratio) and MDI score (r = 0.648, p &lt; 0.059) in AG but not in GG genotype. Two genotype models were found, namely homozygous major allele (GG) of rs 174468 which was dominant and heterozygous allele (AG) of Sasak ethnicity. The levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in infants in the Sasak ethnic were found to be higher than infants in other areas. Sasak ethnic children get EPA and DHA from breast milk which contains a lot of DHA. Sources of omega-3 and 6 on the island of Lombok are sea fish, seaweed, and full-blooded shellfish.

The patients\u2019 perspective on the burden of idiopathic intracranial hypertension

BackgroundIdiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure without evidence of a tumor or any other underlying cause. Headache and visual disturbances are frequent complaints of IIH patients, but little is known about other symptoms. In this study, we evaluated the patients’ perspective on the burden of IIH.MethodsFor this cross-sectional study, we developed an online survey for patients with IIH containing standardized evaluations of headache (HIT-6), sleep (PROMIS Sleep Disturbance Scale) and depression (MDI) in relation to BMI, lumbar puncture opening pressure (LP OP) and treatment.ResultsBetween December 2019 and February 2020, 306 patients completed the survey. 285 (93 %) were female, mean age was 36.6 years (± 10.8), mean BMI 34.2 (± 7.3) and mean LP OP at diagnosis was 37.8 cmH2O (± 9.5). 219 (72 %) of the participants were obese (BMI ≥ 30); 251 (82 %) reported severe impacting headaches, 140 (46 %) were suffering from sleep disturbances and 169 (56 %) from depression. Higher MDI scores correlated with higher BMI and increased sleep disturbances. Patients with a normalized LP opening pressure reported less headaches, less sleep disturbances and less depression than those with a constantly elevated opening pressure.ConclusionsIn addition to headaches and visual disturbances, sleep disturbances and depression are frequent symptoms in IIH and contribute to the patients’ burden. Structured questionnaires can help to identify IIH patients’ needs and can lead to personalized and better treatment.

Terapotik Hipotermide Nörogelişimsel Sonuçlar: Tek merkez deneyimi

Objective: Hypoxic-ischemic encephalopathy (HIE) is an acute and progressive encephalopathy resulting from perinatal asphyxia. Approximately 15% infants with neonatal HIE die, whereas 25% exhibit subsequent neurological disabilities. In this study, it was intended to compare effects of total body cooling treatment administered for hypoxic-ischemic encephalopathy on neurological and developmental findings obtained at 18-36 months. Material and Methods: Patients who have been hospitalized between 2013 and 2014 in Neonatal Intensive Care Unit with a diagnosis of hypoxic-ischemic encephalopathy and treated total body cooling were included. After discharge, neurological examinations of the patients were evaluated by developmental assessments with “Bayley Scales of Infant Development II” at 18-36 months. Results: Mean MDI score of 17 patients was 90.2±16.3, and mean PDI score was 93.8±17.3. MDI scores were < 70 in 11.8% (n = 2) of all cases, and PDI scores were < 70 in 5.9% (n=1) of all cases. In 5.9% (n=1) of all cases, deafness and cerebral palsy were detected. Developmental disorder were found in 17.6% (n=3) of all cases. Conclusion: The therapeutic hypothermia in newborns decreased mortality in moderate and severe HIE and improved neurodevelopmental outcomes at 18th month. In our study, early neurological and developmental problem rates after therapeutic hypothermia were found similar with the literature. However, long period follow-up is necessary to determine minor disorders in these patients.

Transient tone anomalies in very preterm infants: Association with term-equivalent brain magnetic resonance imaging and neurodevelopment at 18 months

BackgroundVery preterm (VPT) infants are at risk for neurodevelopmental impairments and early clinical findings such as transient tone anomalies (TTA) might represent potential predictive indicators. AimsThe aims of this study were to assess 1) the prevalence of TTA at 6 months corrected age in a population of VPT infants, 2) the association with term-equivalent age (TEA) brain MRI and 3) the neurodevelopmental outcome at 18 months corrected age. Study design and subjectsA prospective case-control cohort of 103 VPT infants (<29 weeks of gestation) was followed up at 6 months and classified into TTA+ or TTA−. TTA+ was defined by the presence of ≥2 criteria among anomalies of posture, anomalies of tone and hyperreflexia. Outcome measuresConventional and diffusion-weighted MRIs at TEA were analyzed according to a semi-quantitative MRI scoring system and apparent diffusion coefficients (ADC) and fractional anisotropy (FA) were measured in frontal, occipital white matter and posterior limb of the internal capsule (PLIC). Neurodevelopment was assessed at 18 months using Bayley-II scales (Psychomotor Developmental Index: PDI; Mental Developmental Index: MDI). ResultsTTA+ infants represented 29.1% of the total population. They had: 1) significantly higher ADC values in 3 regions of interest (p < 0.001), 2) significant lower FA in the PLIC (p < 0.001), and 3) significant lower PDI score (p < 0.05). No differences were observed regarding MDI scores. Interaction of TTA by cerebellum score was related to lower MDI scores. ConclusionsIn VPT infants, TTA at 6 months and/or structural brain abnormality at TEA are associated with poorer neurodevelopmental outcome at 18 months.

Early Neurodevelopmental Outcomes After Corrective Cardiac Surgery In Infants

To assess neurodevelopmental status in Indian infants undergoing corrective surgery for congenital heart disease (CHD) and to analyze factors associated with neurodevelopmental delay. Cross-sectional study. Tertiary-care pediatric cardiology facility. Consecutive infants undergoing corrective surgery for CHD (January 2013 -December 2014). Palliative procedures, and patients with known genetic syndromes were excluded. Neurodevelopmental evaluation 3 months, and one year after surgery using Developmental Assessment Scales for Indian Infants (DASII); scores were categorized as delayed if ≤70. Of the 162 children enrolled, delayed PDI and MDI scores were observed in 33.5% and 19.6% of patients at 3 months, respectively; this reduced to 14.5%on 1-year follow-up. On multivariate analysis, delayed PDI outcome at one year was predicted by early term birth and one-year postoperative head circumference Z-score <-2. Delayed MDI was associated with higher mean perfusion pressure on cardiopulmonary bypass. Cardiac diagnosis and peri-operative factors did not impact neurodevelopmental outcomes. Neurodevelopmental status is delayed in 14.5% of infants one year after corrective infant heart surgery.

Different vasodilatation characteristics among the main cerebral arteries in fetuses with congenital heart defects

To observe Doppler changes in the three main cerebral arteries in fetuses with congenital heart defects (CHDs). The pulsatility index (PI) values of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were prospectively compared in 78 CHD fetuses and 78 normal control fetuses. Correlations between the cerebral artery PIs and the neurodevelopment scores (psychomotor development index [PDI] and mental development index [MDI]) were assessed. The MCA-PI was decreased significantly in fetuses with hypoplastic left heart syndrome (HLHS). The ACA-PI was reduced significantly in fetuses with HLHS, fetuses with left-sided obstructive lesions (LSOLs) and fetuses with transposition of the great arteries. The PCA-PI was significantly smaller in fetuses with HLHS and fetuses with LSOLs. More fetuses presented signs of cerebral vasodilatation of the ACA than the MCA for certain types of CHD (P < 0.05). The ACA-PI was positively correlated with the PDI and MDI scores in fetuses with CHDs (r2 = 0.26, 0.20, P < 0.01). The MCA-PI was only positively correlated with the PDI scores (r2 = 0.15, P < 0.01). The ACA exhibited signs of vasodilatation more frequently and severely than the MCA. The ACA-PI appears to be more sensitive for predicting abnormal neurodevelopmental outcomes than the MCA-PI.

Prenatal mercury exposure, fish intake and neurocognitive development during first three years of life: Prospective cohort mothers and Children's environmental health (MOCEH) study

ObjectivesIn this prospective cohort study, the effects of prenatal Hg exposure on neurocognitive development during the first 3years of life were investigated. MethodsThe maternal blood levels of Hg were assessed during pregnancy and in cord blood. Maternal fish intake was assessed by interviewing the weekly frequency of fish intake during pregnancy. Maternal n-3 and n-6 fatty acid intake was estimated based on 24h recall food intake interview. The mental (MDI) and psychomotor (PDI) development index scores were assessed using the Bayley Scales of Infant Development at 6, 12, 24, 36months of age. ResultsThe geometric mean of the maternal blood Hg concentration was 3.3μg/L (10th percentile=1.81; 90th=5.91) during the early pregnancy, 3.0μg/L (10th=1.68; 90th=5.57) during late pregnancy, and 5.1μg/L (10th=2.94; 90th=8.93) in cord blood. After adjusting for weekly frequency of fish intake, the blood Hg concentrations during early pregnancy showed association with the adjusted MDI (β=−0.408, p=0.048) and PDI scores (β=−0.550, p=0.031) at 6months. After further adjusting for n-3 and n-6 fatty acids estimated based on 24h recall of food intake, the blood Hg concentrations during early pregnancy showed association with the MDI (β=−0.489, p=0.026) and PDI (β=−0.664, p=0.015) at 6months. ConclusionThese results show that prenatal Hg exposure during early pregnancy adversely associated with early neurodevelopment during infancy, after adjusting for fish and n-3, n-6 fatty acid intake. Consuming fish high in fatty acids and low in Hg during early pregnancy may be important to neurocognitive development at early infancy.

Implications of altered maternal cytokine concentrations on infant outcomes in children with prenatal alcohol exposure.

Excessive alcohol consumption has been shown to increase serum plasma levels of numerous immune cytokines. Maternal immune activation and elevated cytokines have been implicated in certain neurological disorders (e.g., autism and schizophrenia) in the offspring. We investigated the hypothesis that elevated cytokines during pregnancy are a risk factor in women who gave birth to a child with Fetal Alcohol Spectrum Disorder (FASD) or a child with neurobehavioral impairment, regardless of prenatal alcohol exposure. Moderate to heavy alcohol-exposed (AE) (N=149) and low or no alcohol-exposed (LNA) (N=92) women were recruited into the study during mid pregnancy (mean of 19.8±5.8 weeks' gestation) in two regions of Ukraine: Khmelnytsky and Rivne. Maternal blood samples were obtained at enrollment into the study at early to mid-pregnancy and during a third-trimester follow-up visit and analyzed for plasma cytokines. Children were examined at 6 and/or 12 months of age and were classified as having FASD if their mothers reported alcohol use and if they had at least one standardized score (Bayley Scales of Infant Development II Mental Development Index [MDI], or Psychomotor Development Index [PDI]) below 85 with the presence or absence of physical features of FASD. In multivariate analyses of maternal cytokine levels in relation to infant MDI and PDI scores in the entire sample, increases in the ratio of TNF-α/IL-10 and IL-6/IL-10 were negatively associated with PDI scores at 6 months (p=0.020 and p=0.036, respectively) and 12 months (p=0.043 and p=0.029, respectively), and with MDI scores at 12 months (p=0.013 and p=0.050, respectively). A reduction in the odds ratio of having an FASD child was observed with increasing levels of IL-1β, IL-2, IL-4, IL-6, and IL-10 in early to mid-pregnancy and IL-1β and IL-10 during late pregnancy. However, women that failed to increase IL-10 levels in the third trimester in order to maintain the balance of pro- and anti-inflammatory cytokines had an elevated risk of having an FASD child, specifically a significant increase in the odds ratio of FASD with every one-unit log increase in late pregnancy TNF-α/IL-10 levels (aOR: 1.654, CI: 1.096-2.495, p=0.017). These data support the concept that disruptions in the balance between pro- and anti-inflammatory cytokines may contribute to neurobehavioral impairment and alter the risk of FASD.

Study on the prognosis of premature infants with recurrent apnea treated with nasal intermittent positive pressure ventilation

Objective To investigate the effect of nasal intermittent positive pressure ventilation(NIPPV) on the prognosis of infants with recurrent apenea of premature(AOP) for 12 months of correcting gestational age, thus to provide reference for the treatment of AOP. Methods The premature infants with recurrent AOP of the neonatal intensive care unit were divided into observation group and control group according to the random number table method.The observation group was treated with NIPPV, the control group was treated with nasal continuous positive airway pressure(NCPAP). All living premature infants were followed up for early intervention, hearing, visual acuity, physical and mental development after hospital discharge.Neonatal behavioral neurological assessment(NBNA) was given to the premature infants at the corrected gestational age of 40 weeks and 42 weeks, CDCC was used to test of the corrected gestational age of 1 year old, and the mental retardation, cerebral palsy, hearing impairment, severe deafness, blindness were assessed and compared. Results 123 cases were selected, including 2 cases were abandoned in the treatment, 7 cases died(4 cases died during hospitalization, 3 cases died after hospital discharge), 5 cases were lost following up after hospital discharge, 12 cases were treated with poor compliance, the actual research subjects were 97 cases, 51 cases in NIPPV group, 46 cases in NCPAP group.In NIPPV group, the NBNA score more than 35 points of 40 weeks and 42 weeks were in 38 cases(74.5%), 47 cases(92.2%) respectively, which in NCPAP group were respectively in 28 cases(60.9%), 37 cases(80.4%). There were statistically significant differences between the two groups(t=14.786, 4.149, all P<0.05). In NIPPV group, MDI score<80 points, PDI score<80 points, mental retardation, cerebral palsy were respectively in 7 cases(13.7%), 6 cases(11.8%), 3 cases(5.9%), 1 case(2.0%), which in NCPAP group were respectively in 15 cases(32.6%), 14 cases(30.4%), 8 cases(17.4%), 5 cases(10.9%), there were statistically significant differences between the two groups(χ2=10.040, 9.765, 5.944, 6.663, all P<0.05). In NIPPV group, the hearing impairment, very severe deafness, blindness were respectively in 2 cases(3.9%), 0 cases(0.0%), 0 cases(0.0%), which in NCPAP group were respectively in 7 cases(15.2%), 2 cases(4.3%), 2 cases(4.3%), there were statistically significant differences between the two groups(χ2=7.037, 4.082, 4.082, all P<0.05). Conclusion NIPPV in the treatment of premature infants with recurrent AOP has a certain improvement in prognosis. Key words: Intermittent positive-pressure ventilationt; Infant, premature; Apnea; Prognosis

Neurodevelopmental Outcome of Children with Congenital Hypothyroidism Diagnosed in a National Screening Program in Turkey.

To study the factors affecting a neurodevelopmental status of children with congenital hypothyroidism, diagnosed on national screening program. The study was performed in the Pediatric Endocrinology Department of Dr. Behcet Uz Children's Hospital between May 2012 and May 2013. Children with congenital hypothyroidism, aged between 24 and 36 months, diagnosed by national screening program were included in the study group. Healthy subjects at the same age group consisted of the control group. For the neurodevelopmental evaluation, Bayley Scale of Infant Development- II (BSID-II) was used. Factors possibly effective on neurodevelopment were evaluated. 42 patients and 40 healthy children (mean (SD) age, 29.4 (3.7) and 29.2 (3.5), respectively were included in the study. The mean MDI score [92.6 (7.07) vs 97.1 (9.69), P=0.14)] and the mean PDI score [97.8 (15.68) vs 99.1 (10.57), P=0.66)] in the study group and control group were not significantly different. Among the patient, 4.6% and 4.7% children were moderately retarded as per the MDI scores and PPI scores, respectively. The sex, socioeconomic status, birth weight, screening levels of TSH, severity of the congenital hypothyroidism, initiation time and the dosage of thyroid hormone replacement, length of the normalization period of TSH, and adherence to treatment were not found to affect the MDI and PDI scores of the patients. Some children with congenital hypothyrodism may have mild to moderate neurodevelopmental retardation, despite the early diagnosis and treatment, and thus need to be under regular follow-up for neurodevelopmental status.

Abstract 13: The Effect of Circadian Light on Depressive Mood in Post Stroke Patient During Admission for Rehabilitation

Introduction: Stroke is a major cause of acquired cerebral disability among adults, frequently accompanied by depression. New ways of intervention to prevent post stroke depression is therefore needed. The blue light spectrum is the strongest zeitgeber (time-giver) and is known to stabilize the circadian rhythm. Patients admitted for rehabilitation are often lacking the blue light in daytime due to the long indoor admission; furthermore, they are often exposed to blue light in the evenings, as blue light is contained in standard lightning. Hypothesis: Circadian light will reduce depressive mood in stroke patients admitted for rehabilitation. Methods: The study is a prospective parallel longitudinal randomized controlled study (quasi randomization). Stroke patients in need of rehabilitation were included at the acute stroke unit and randomized to either the intervention unit (IU)(circadian lighting) or the control unit (CU)(standard lighting). The circadian light was installed in the entire IU (Cromaviso, Denmark). Examination was done in the acute unit and at discharge after at least 2 weeks in the IU/CU. Change in depressive mood was measured by the Hamilton Rating Scale for Depression (HAM-D 6 ) and The Major Depression Inventory scale (MDI). Results: Patients were included over a year (N=90), 6 did not reach randomization, 45 were randomized to the IU, and 39 to the CU. A sample of 59 and 62 patients were able to answer the HAM-D 6 (N=30IU;N=29CU) and MDI (N=30IU;N=29CU) score, respectively. Both scores were significantly lower in the intervention group at discharged compared with the control group (ANCOVA, antidepressants medicine was included as a confounder, HAM-D 6 , P=0.018, Estimate=-2.25;SEM=0.92, MDI, P=0.009, Estimate=-4.72;SEM=1.74). Conclusion: Our findings show for the first time circadian light as a beneficial intervention on depressive mood on long-term hospitalized patients in a real hospital setting. The circadian lightning should be considered as an integrated segment in the environment of rehabilitation units.

In utero exposure to fluoride and cognitive development delay in infants

The objective of this study was to evaluate the association between in utero exposure to fluoride (F) and Mental and Psychomotor Development (MDI and PDI) evaluated through the Bayley Scale of Infant Development II (BSDI-II) in infants. The sample included 65 mother-infant pairs. Environmental exposure to F was quantified in tap and bottled water samples and F in maternal urine was the biological exposure indicator; samples were collected during the 1st, 2nd and 3rd trimester of pregnancy. The mean values of F in tap water for the 1st, 2nd and 3rd trimester were 2.6±1.1mg/l, 3.1±1.1mg/l and 3.7±1.0mg/l respectively; above to 80% of the samples exceeded the reference value of 1.5mg/l (NOM-127-SSA1-1994). Regarding F in maternal urine, mean values were 1.9±1.0mg/l, 2.0±1.1mg/l and 2.7±1.1mg/l for the 1st, 2nd and 3rd trimester respectively. The infants with MDI and PDI scores less than 85 points were 38.5% and 20.9% respectively. After adjusting for potential confounding factors (gestational age, age of child, marginalization index and type of water for consumption), the MDI showed an inverse association with F levels in maternal urine for the first (β=−19.05, p=0.04) and second trimester (β=−19.34, p=0.01). Our data suggests that cognitive alterations in children born from exposed mothers to F could start in early prenatal stages of life.

Outcome of Infants at Risk of Brain Damage after Katona Neurohabilitation Therapy

Objective: To evaluate Katona’s neurorehabilitation therapy in preterm and term infants with risk factors for brain damage followed up to 24 months of age. Methods: 262 infants from 25 to 40 weeks of gestational age (GA) were treated with neurohabilitation beginning before 2 months of corrected age. Treatment was intensive, sustained for at least 12 months and required family participation. Neuropediatric examinations, MRI and Bayley-II scales were performed. Results: Abnormal MRI findings were observed in 80% of infants (increase in lateral ventricle volumes, decrease in corpus callosum volume, diffuse and cystic periventricular leukomalacia, diffuse white matter abnormalities, haemorrhages, infarcts). Outcome: Bayley-II scales showed that 20% of infants with a GA of less than 29 weeks and less than 15% of infants with a 30-40 week GA had significantly delayed MDI and PDI scores. Conclusion: Diagnosis and treatment using neurohabilitation in new-borns at risk of brain damage is recommended.