MDI Scores Research Articles

Human milk intake in preterm infants and neurodevelopment at 18 months corrected age.

The effect of human milk intake on neurodevelopment in preterm infants is uncertain. We analyzed data from 611 participants in the DHA for Improvement of Neurodevelopmental Outcomes study, enrolled at ≤33 wk gestation from five Australian perinatal centers. The main exposures were (i) average daily human milk intake during the neonatal hospitalization and (ii) total duration of human milk intake before and after discharge. Outcomes were Bayley Scales of Infant Development, 2nd Edition Mental (MDI), and Psychomotor (PDI) Development Indexes. Adjusting for confounders in linear regression, human milk intake was not associated with higher MDI (0.2 points per 25 ml/kg/d; 95% confidence interval (CI): -0.6, 1.0) or PDI (-0.3 points; 95% CI: -1.1, 0.4). Longer duration of human milk intake was also not associated with MDI (0.1 points per month; 95% CI: -0.2, 0.3) or PDI (-0.2 points per month; 95% CI: -0.5, 0.01) scores, except in infants born 29-33 wk gestation (n = 364, MDI 0.3 points higher per additional month, 95% CI: 0.1, 0.6). We found no associations of human milk intake during the neonatal hospitalization with neurodevelopment at 18 mo corrected age.

Prenatal exposure to perfluorinated chemicals and neurodevelopment in early infancy: The Hokkaido Study

Perfluorinated chemicals (PFCs) are ubiquitous and persistent pollutants widely detected in blood samples of animals and humans across the globe. Although animal studies have shown the potential neurotoxicity of PFCs, there are few epidemiological studies regarding neurological effects of PFCs in humans, and those studies have had inconclusive results. In this study, we conducted a hospital-based prospective birth cohort study between 2002 and 2005 (n=514) to examine the associations between prenatal perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) exposures and the neurodevelopment of infants at 6 (n=173) and 18 (n=133) months of age. Using the second edition of the Bayley Scales of Infant Development (BSID II), the Mental and Psychomotor Developmental Indices (MDI and PDI, respectively) were assessed. PFOS and PFOA were measured in maternal serum samples by liquid chromatography–tandem mass spectrometry. After controlling for confounders, prenatal PFOA concentrations were associated with the MDI of female (but not male) infants at 6months of age (β=−0.296; 95% confidence interval (CI): −11.96, −0.682). Furthermore, females born to mothers with prenatal concentrations of PFOA in the fourth quartile had MDI scores −5.05 (95% CI: −10.66 to 0.55) lower than females born to mothers with concentrations of PFOA in the first quartile (p for trend=0.045). However, PFOA concentrations were not significantly associated with neurodevelopmental indices at 18months of age. In addition, we did not observe any significant association between PFOS concentrations and neurodevelopmental outcomes in early infancy. In conclusion, our results suggest that prenatal PFOA exposure may affect female mental scales of neurodevelopment at 6months of age. Further studies with larger sample sizes and longer observation periods are required to clarify sex difference of the neurodevelopmental effects.

Randomized controlled trial of a home-visiting intervention on infant cognitive development in peri-urban South Africa.

To determine whether, in an impoverished South African community, an intervention that benefitted infant attachment also benefitted cognitive development. Pregnant females were randomized to intervention (n=220) and no-treatment control groups (n=229). The intervention was home-based parenting support for attachment, delivered until 6 months postpartum. At 18 months, infants were assessed on attachment and cognitive development (Bayley Scales Mental Development Index [MDI]) (n=127 intervention, n=136 control participants). Infant MDI was examined in relation to intervention, socio-economic risk, antenatal depression, and infant sex and attachment. Overall, there was little effect of the intervention on MDI (p=0.094, d=0.20), but there was an interaction between intervention and risk (p=0.03, ηp2=0.02). MDI scores of infants of lower risk intervention group mothers were, on average, 4.84 points higher than those of other infants (p=0.002, d=0.41). Antenatal depression was not significant once intervention and risk were controlled (p=0.08); there was no association between infant MDI and either sex (p=0.41) or attachment (p=0.56). Parenting interventions for infant cognitive development may benefit from inclusion of specific components to support infant cognition beyond those that support attachment, and may be most effective for infants over 6 months. They may need augmentation with other input where adversity is extreme.

Association of cord blood levels of lead, arsenic, and zinc and home environment with children neurodevelopment at 36 months living in Chitwan Valley, Nepal.

BackgroundInconsistent results continue to be reported from studies linking low-level prenatal lead exposure and child development. Because of limited earlier epidemiological studies with birth cohort follow up design, it still remains inconclusive that either the associations of cord blood level of toxic, and essential elements, and postnatal raising environment on neurodevelopment of children remains constant throughout childhood or change over time.AimsThis study aims to investigate the influence of in utero toxic [lead (Pb) and arsenic (As)] and essential elements [zinc (Zn)] levels on neurodevelopment of 36 months children in Chitwan valley, Nepal taking the postnatal environment into account.Study Designs and SubjectsIn this birth cohort study, participants (N=100 mother-infants’ pairs) were recruited in Chitwan district, Nepal. We measured Pb, As and Zn concentrations in cord blood. Postnatal raising environment (i.e., Home score or home environment hereafter) was evaluated using Home Observation for Measurement of Environment (HOME) scale. Neurodevelopment of children at 36 months of age (n=70) were assessed using Bayley Scale of Infant Development, Second Edition (BSID II). Multivariate regression was performed (n=70) to see the association of in utero toxic and essential elements level and home environment with neurodevelopment score adjusted for covariates.ResultsCord blood levels of Pb, As and Zn were not associated with any BSID II cluster scores of 36 months children. The children with relatively superior HOME score and concurrent nutritional status (weight at 36 months) showed better cognitive development (i.e., MDI scores) and motor functions than their counterparts, respectively.ConclusionIn this general population in Nepal, prenatal Pb, As and Zn levels are not important determinants of the neurodevelopment of 36- month-old children while a consistent beneficial effect of a stimulating home environment on neurodevelopmental indicators is continued.

Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010.

OBJECT Intraventicular hemorrhage (IVH) is a common complication of preterm birth, and the prognosis of IVH is incompletely characterized. The objective of this study was to describe the outcomes of IVH in a population-based cohort with minimal selection bias. METHODS All very preterm (≥ 30 completed weeks) patients born in the province of Nova Scotia were included in a comprehensive database. This database was screened for infants born to residents of Nova Scotia from January 1, 1993, to December 31, 2010. Among very preterm infants successfully resuscitated at birth, the numbers of infants who died, were disabled, developed cerebral palsy, developed hydrocephalus, were blind, were deaf, or had cognitive/language scores assessed were analyzed by IVH grade. The relative risk of each outcome was calculated (relative to the risk for infants without IVH). RESULTS Grades 2, 3, and 4 IVH were significantly associated with an increased overall mortality, primarily in the neonatal period, and the risk increased with increasing grade of IVH. Grade 4 IVH was significantly associated with an increased risk of disability (RR 2.00, p < 0.001), and the disability appeared to be primarily due to cerebral palsy (RR 6.07, p < 0.001) and cognitive impairment (difference in mean MDI scores between Grade 4 IVH and no IVH: -19.7, p < 0.001). No infants with Grade 1 or 2 IVH developed hydrocephalus, and hydrocephalus and CSF shunting were not associated with poorer outcomes when controlling for IVH grade. CONCLUSIONS Grades 1 and 2 IVH have much better outcomes than Grades 3 or 4, including a 0% risk of hydrocephalus in the Grade 1 and 2 IVH cohort. Given the low risk of selection bias, the results of this study may be helpful in discussing prognosis with families of very preterm infants diagnosed with IVH.

Satisfaction with daily occupations amongst asylum seekers in Denmark

Aim: The aim of this study was to describe asylum seekers’ satisfaction with daily occupations and activity level while in a Danish asylum centre, and whether this changed over time. Another aim was to describe whether exposure to torture, self-rated health measures, and ADL ability were related to their satisfaction with daily occupations and activity level. Methods: A total of 43 asylum seekers at baseline and 17 at follow-up were included. The questionnaires Satisfaction with Daily Occupations, Major Depression Inventory, WHO-5 Wellbeing, Pain Detect, a questionnaire covering torture, and basic social information were used as well as Assessment of Motor and Process Skills. Results: The results showed a low level of satisfaction with daily occupations at both baseline and follow-up. There was no statistically significant change in satisfaction or activity level between baseline and the follow-up. Associations between AMPS process skills – education, worst pain and activity level – were present at baseline, as was a relationship between AMPS process skills and satisfaction. At follow-up, associations between WHO-5 and satisfaction and activity level and between MDI scores and activity level were found. Conclusion: Asylum seekers experience a low level of satisfaction with daily occupations, both at arrival and after 10 months in an asylum centre. There is a need for further research and development of occupation-focused rehabilitation methods for the asylum seeker population.

A meta-analysis of the protective effect of recombinant human erythropoietin (rhEPO) for neurodevelopment in preterm infants.

The purpose of this study is to assess the efficacy and safety of recombinant human erythropoietin (rhEPO) for improving neurodevelopment outcomes in preterm infants. According to the requirements of Cochrane systematic review, a literature search was performed among PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Wan Fang Data, and VIP INFORMATION from the establishment of the database from January 1999 to December 2011. Quality assessments of clinical trials were carried out. Randomized controlled trials (RCTs) or quasi-RCTs with rhEPO in preterm infants were enrolled, and RevMan5.0 software was used for meta-analysis. Data extraction, quality assessment, and meta-analysis for the results of homogeneous studies were done by two reviewers. The trials were analyzed using weighted mean difference (WMD) for continuous data and odds ratio (OR) for dichotomous data, both kinds of data were expressed by 95 % CI. For homogenous data (P ≥ 0.10), fixed effect model was calculated. Two RCTs and 3 quasi-RCTs including 233 preterm infants (119 of treatment group and 114 of control group) were included in the analysis. The results of quality assessment were that 1 study was A, 1 was B, and 3 were C. There was evidence of a significant effect of therapeutic rhEPO on the outcomes of MDI scores [WMD = 7.77, 95 % CI (3.49-12.06), P = 0.0004], PDI scores [WMD = 3.85, 95 % CI (0.62-7.09), P = 0.02] at 18-22 months and NBNA scores [WMD = 1.96, 95 % CI (1.56-2.37), P < 0.00001] at 40 weeks of corrected gestational age. However, rhEPO had no effect on MDI <70 (OR = 0.70, 95 % CI 0.31-1.61), PDI <70 (OR = 2. 46, 95 % CI 0.94-6.45), cerebral palsy (OR = 1.08, 95 % CI 0.39-2.99), blindness (OR = 0.34, 95 % CI 0.01-8.56), and hearing loss (OR = 1.04, 95 % CI 0.06-17.15). There were no differences between groups with respect to the percentage of preterm infants with severe retinopathy of prematurity of stage III or above (OR = 1.30, 95 % CI 0.50-3.43), severe intraventricular hemorrhage of stage III or above (OR = 2. 91, 95 % CI 0.64-13.23), necrotizing enterocolitis (OR = 0.57, 95 % CI 0.13-2.54), and borderline personality disorder (OR = 1. 06, 95 % CI 0.50-2.26). The rhEPO treatment has beneficial effect on the neurodevelopment outcomes without severe adverse side effect in preterm infants.

PO-0454 Impact Of Systematic Pain And Sedation Management On Outcome Of Very Low Birth Weight Infants

<h3>Background and objectives</h3> We retrospectively compared short-term and neurodevelopmental outcome of very low birth weight infants (VLBWI) before (n = 84) and after implementation (n = 69) of a protocol for the management of neonatal pain and sedation. <h3>Methods</h3> Opiate exposure, time on mechanical ventilation, inotropic support, details on nutritional aspects, and growth were compared between baseline and after protocol implementation. Infants were evaluated at 12 months corrected age using standardised neurologic examination and Bayley Scales of Infant Development-II. <h3>Results</h3> Cumulative mean ± SD opiate dose (baseline dose of 14 ± 39 mg/kg vs. intervention group dose of 84 ± 222 mg/kg morphine equivalents; p &lt; 0. 0001) increased after implementation. Time on mechanical ventilation, inotropic support, time on parenteral nutrition, growth, and length of stay were similar before and after implementation. There were no differences in neurodevelopmental outcome variables before and after intervention (MDI: 85 ± 14 vs. 84 ± 16, p = 0.6; PDI: 87 ± 19 vs. 83 ± 19, p = 0.2; BRS: 74 ± 27 vs. 68 ± 32, p = 0.2). Multiple linear regression analysis identified opiate exposure as a possible risk factor for lower MDI (estimate = -0.15; p = 0.004) and Behaviour Rating Scale (BRS) scores (estimate = -0.39; p = 0.012). <h3>Conclusions</h3> Implementation of a neonatal pain and sedation protocol results in an increase in opiate prescription without affecting short-term outcome and neurodevelopmental performance of VLBWI at 12 months corrected age.

PS-114 Prognostic Performance Of Proton Magnetic Resonance Spectroscopy (hmrs) Metabolite Ratios In The First 96 Hours Of Life In Asphyxiated Neonates

<h3>Background and aims</h3> Neonatal hypoxic-ischaemic encephalopathy (HIE) can lead to neurodevelopmental impairment, raising a need for early prognostic tools to guide therapy. The prognostic value of HMRS performed between 5–30 days of life has been extensively studied, although few studies focus on earlier periods. Therefore, we investigated the prognostic performance of HMRS during the first 96 h of life. <h3>Methods</h3> 55 consecutive hypothermia-treated HIE neonates were examined by HMRS at three echo-times (TE = 35 ms, 144 ms, 288 ms) between 6–96 h of age, depending of clinical stability. Patients were divided into favourable (n = 38) and unfavourable (n = 17) outcome groups based on Bayley II MDI and PDI scores (≥70 vs &lt;70 or death, respectively) assessed at 18–26 months of age. Associations between 36 routinely measured metabolite ratios (MROs) and outcome were studied. The prognostic performance of MROs was evaluated by ROC analysis. Time-dependent changes of MROs in whole patient population were also assessed. <h3>Results</h3> 6 MROs showed significant difference between outcome groups after correction for multiple testing (p &lt; 0.0014). ROC analysis revealed that Myo-inositol/N-Acetyl-Aspartate (TE = 35) gives best prediction for outcome with 85.71% sensitivity and 91.30% specificity. Assessment of time-dependency showed that 4 of 6 MROs stay constant during the first 96 h of life, all containing Myo-inositol. <h3>Conclusions</h3> Our findings suggest that during the first 96 h of life HMRS could be a useful early prognostic tool in predicting the outcome of asphyxiated neonates. Myo-inositol/N-Acetyl-Aspartate ratio was found to be the best and time-independent predictor.

Prenatal and postnatal lead exposure and cognitive development of infants followed over the first three years of life: A prospective birth study in the Pearl River Delta region, China

PurposeOur pilot studies showed that there was a significant relationship between low cord blood levels and scores of neonatal behavioral neurological assessment. The study was further to probe the adverse cognitive effects induced by low-level lead exposure during prenatal and postnatal period. MethodTotally 362 mothers with their infants located the PRD, Guangdong, China participated in the study during their stay in these center: 141 in the high lead group [umbilical-cord blood lead levels (UCBLLs)≥3.92μg/dl] and 102 in the low lead group (UCBLLs≤1.89μg/dl). The other 137 subjects failed to complete the study for a variety of reasons. Blood Lead levels (BLLs) were measured by atomic absorption spectrophotometry, equipped with a graphite furnace. The developmental functioning of infants and children was assessed with BSID-II. The children's birth outcome and the rest of information were obtained from their medical records or a comprehensive questionnaire from their parents, which contained demographic characteristics, lifestyle, mother's IQ and environmental lead sources, etc. ResultsOf 380, 243 newborns (63.95%) had complete data collection for all variables included at 6, 12, 24 and 36 months of age. The mean UCBLLs for high and low lead group were 5.63±0.32μg/dl and 1.35±0.26μg/dl, respectively. Significant inverse associations have been found between the UCBLLs and the MDI and the PDI. The associations might attenuate over subsequent years. BLLs at 24 months were significantly associated, in an inverse direction, with MDI at 24 and 36 months. The observed trend of cognitive deficit beginning at 6 months of life might persist, and even develop over the coming years. A positive significant effect of home nurture environment was observed on MDI scores at 12, 24, 36 months of age and PDI scores at 24 and 36 months of age. ConclusionOur study demonstrates that prenatal and postnatal lead exposure as low as 5μg/dl has an adverse effect on neurodevelopment, best arrested by measuring UCBLLs and BLLs at 24 months of age, and suggest a reference for a blood lead critical value below 5μg/dL. The collective evidence indicate that low lead exposure must be addressed appropriately by health policy makers and argues for an improvement of home nurture environment, i.e., reduce the burden of Pb on children and, strengthen the training of cognitive ability.

Preterm cerebral microcirculation assessed with color Doppler: A pilot study

Background and aims Neonatal hypoxic-ischaemic encephalopathy (HIE) can lead to neurodevelopmental impairment, raising a need for early prognostic tools to guide therapy. The prognostic value of HMRS performed between 5–30 days of life has been extensively studied, although few studies focus on earlier periods. Therefore, we investigated the prognostic performance of HMRS during the first 96 h of life. Methods 55 consecutive hypothermia-treated HIE neonates were examined by HMRS at three echo-times (TE = 35 ms, 144 ms, 288 ms) between 6–96 h of age, depending of clinical stability. Patients were divided into favourable (n = 38) and unfavourable (n = 17) outcome groups based on Bayley II MDI and PDI scores (≥70 vs <70 or death, respectively) assessed at 18–26 months of age. Associations between 36 routinely measured metabolite ratios (MROs) and outcome were studied. The prognostic performance of MROs was evaluated by ROC analysis. Time-dependent changes of MROs in whole patient population were also assessed. Results 6 MROs showed significant difference between outcome groups after correction for multiple testing (p < 0.0014). ROC analysis revealed that Myo-inositol/N-Acetyl-Aspartate (TE = 35) gives best prediction for outcome with 85.71% sensitivity and 91.30% specificity. Assessment of time-dependency showed that 4 of 6 MROs stay constant during the first 96 h of life, all containing Myo-inositol. Conclusions Our findings suggest that during the first 96 h of life HMRS could be a useful early prognostic tool in predicting the outcome of asphyxiated neonates. Myo-inositol/N-Acetyl-Aspartate ratio was found to be the best and time-independent predictor.

Theories of change and outcomes in home-based Early Head Start programs

Programs to promote children's early development are based on a set of assumptions, explicit or implicit, about intended outcomes and how the program will effect change. The “theories of change” were examined in ten home-based programs in the Early Head Start Research and Evaluation Project (EHSREP), using data collected through multiple interviews with program staff. All home-based programs indicated that parenting outcomes were among their highest three priorities, while only 4 of 10 programs said that child outcomes were in their top priorities. The pattern of outcome differences between randomly-assigned program and control group participants reflected the programs’ theories of change in several ways. Early Head Start home-based programs showed positive impacts on 9 of 9 parenting outcomes, including parental supportiveness, home language and learning supports, emotional responsiveness, and family conflict when children were 24 months of age. Significant program impacts on child cognitive skills (Bayley MDI scores) and social behavior (observed child engagement of parent during play) were found when children were 36 months of age. Mediation analyses showed that the 54% of the program impact on 36-month child cognitive scores was mediated by 24-month program impacts on parental supportiveness, language and learning support, emotional responsiveness, and family conflict, and 47% of the program impact on 36-month child engagement of parent was mediated by 24-month impacts on parental supportiveness, language and cognitive stimulation, and emotional responsiveness. Results from mediation analyses were consistent with these home-based programs’ theories of change, supporting the efficacy of focusing on parent change as a mechanism for child outcomes in home visiting programs.

Social–emotional delays at 2 years in extremely low gestational age survivors: Correlates of impaired orientation/engagement and emotional regulation

BackgroundPremature infants are less socially and emotionally competent at school age than infants born at term. AimsTo evaluate the correlates of social and emotional delays at 2years of age among prematurely born children. Study designThis is a prospective cohort study. Subjects904 children born at <28weeks gestation during 2002–2004 and enrolled in the ELGAN study who survived until age 2years and returned for a developmental assessment. Outcome measuresThe Bayley Behavior Rating Scale (BRS), a neurological examination, and the Bayley Scales of Infant Development II (BSID-II). ResultsFully 31% of children had a non-optimal (14%) or questionable (17%) (NO/Q) BRS score for Emotional Regulation (ER), and 27% had a non-optimal (13%) or questionable (14%) score for Orientation/Engagement (O/E). Children with NO/Q scores on ER and O/E were more likely than others to have MDI and PDI scores <70 and be unable to walk. Antecedents of NO/Q OE scores included multi-fetal pregnancy, while antecedents of NO/Q scores for both ER and O/E included indicators of socioeconomic disadvantage, and male sex. ConclusionsOver 25% of children born extremely premature exhibit socio-emotional delays during developmental assessment at age 2years. Antecedents of these delays include sociodemographic characteristics, as well as those common antecedents of other impairments commonly observed among extremely preterm infants.

P.2.b.056 Time course of psychomotor performances, fatigue and cognitive function in stable in-patients with treatment resistant depression

as well as the average night sleep duration (ANSD) during this time period. Suicidal intent was recorded with the 15-item Beck’s Suicide Intent Scale (BSIS). BSIS score was sequentially regressed on AIS total score, specific AIS items, self-reported insomnia and ANSD after adjusting for gender, age and current depression or MDI score. Results: 102 subjects (63.7% females), aged 16−87 (43.8± 18.1) years were included. Assessments took place 4.2±4.4 days after the suicide attempt. 55.9% reported previous attempts. 50% had regular psychiatric consultations for mental health problems and had been previously diagnosed with affective disorder (26.5%), schizophrenia (7.8%), personality disorders (2.9%) or alcohol abuse (2%). 48% received psychotropic medication during the month preceding the attempt. Methods employed in the most recent suicide attempt included drug-overdose (80.4%), selfpoisoning (6.9%) and self-injury (12.7%). 38.2% of participants fulfilled DSM-IV-TR criteria of current major depressive episode. During the two-week time period before the attempt, 55.9% reported suffering from insomnia while 41.2% slept less than 5 hours per night on average. 35.3% of attempters scored high on BSIS (>=14) while 44.1% had intermediate scores (5−13). After adjusting for covariates in multiple regressions, BSIS was independently associated with AIS total score (p = 0.007), ANSD (p = 0.037) and ANSD 5hr (p = 0.025). Interactions of gender, age and current depression with sleep measures (AIS score, ANSD) tested non-significant. Out of specific AIS items, items 2 (night-time awakenings) (p = 0.007), 3 (late insomnia) (p = 0.001) and 4 (inadequate sleep duration) (p = 0.004) were significantly associated with BSIS, while item 8 (somnolence) was associated at a trend level (p = 0.08). Conclusions: In conclusion, suicide intent was found to be associated with the severity of insomnia and short self-reported sleep duration (less than 5 hours per night on average) during a two-week time period preceding the suicide attempt independently of the presence of a current major depressive episode. In specific, night-time awakenings (middle insomnia) and early arousal (late insomnia) were strongly associated with suicide intent.

Prenatal lead and cadmium co-exposure and infant neurodevelopment at 6 months of age: The Mothers and Children's Environmental Health (MOCEH) study

BackgroundThis study aimed to explore the developmental effects of prenatal exposure to Pb and Cd on infant cognitive development at 6 months of age. MethodsBetween 2006 and 2010, the blood levels of Pb and Cd were measured in 884 mothers during their early and late pregnancy. The mental (MDI) and psychomotor (PDI) development index scores of the infants were assessed using the Bayley Scales of Infant Development. The development index scores were adjusted for birth weight, maternal age, maternal education level, family income, breastfeeding status, and residential area. ResultsThe geometric mean of the maternal blood concentration was 1.36μg/dL (10th percentile=0.83; 90th percentile=2.13; range=0.26–9.10) for Pb and 1.42μg/L (10th percentile=1.01; 90th percentile=2.16; range=0.03–9.87) for Cd during the early pregnancy period and 1.27μg/dL (10th percentile=0.77; 90th percentile=2.10; range=0.12–4.28) for Pb and 1.52μg/L for Cd (10 percentile=1.07; 90th percentile=2.10; range=0.43–3.73) during the late pregnancy period. The prenatal Pb and Cd concentrations during the early pregnancy period showed no association with the adjusted MDI or PDI scores. The antagonistic interaction between the prenatal Pb and Cd levels during the early pregnancy period had a significant effect on the MDI score (B=−4.64, 95% CI=−8.17 to −1.12, p=0.01), but the effect of this interaction did not reach statistical significance for the PDI score (B=−3.69, 95% CI=−7.94 to 0.56, p=0.09). The Pb levels during the late pregnancy period were inversely associated with the MDI score (B=−1.94, 95% CI=−3.60 to −0.29, p=0.02) but not with the PDI score (B=−1.69, 95% CI=−3.65 to 0.27, p=0.09). The prenatal Cd levels during the late pregnancy period showed no association with the MDI or PDI score. However, the MDI score (B=−3.20, 95% CI=−5.35 to −1.06, p<0.01) and the PDI score (B=−2.86, 95% CI=−5.55 to −0.16, p=0.04) of infants with Cd levels >1.51μg/L were significantly associated with the Pb level, whereas there were no such associations for infants with Cd levels <1.51μg/L. These results suggest that there is a synergistic effect modification between Pb and Cd during the late pregnancy period. ConclusionsThese findings suggest that there is dose-dependent interaction between prenatal exposure to Pb and prenatal exposure to Cd. The results further demonstrate the biological complexities of examining the neurodevelopmental effects of co-exposure to multiple toxicants.

Neonatal exposure to Thimerosal from vaccines and child development in the first 3 years of life

BackgroundDespite the common use of Thimerosal as a preservative in childhood vaccines since the 1930s, there are not many studies on ethylmercury toxicokinetics and toxicodynamics in infants. The knowledge of ethylmercury's potential adverse effects is derived mostly from parallel methylmercury research or from animal and theoretical models. Aim of the studyThis study was designed to examine the relationship between neonatal exposure to Thimerosal-containing vaccine (TCV) and child development. Material and methodsThe study sample consisted of 196 infants born between January 2001 and March 2003 to mothers attending ambulatory prenatal clinics in the first and second trimesters of pregnancy in Krakow. Vaccination history (date and the type of the vaccine) was extracted from physicians' records. Child development was assessed using the Bayley Scales of Infant Development (BSID-II) measured in one-year intervals over 3years. General Linear Model (GLM) and Generalized Estimating Equation (GEE) models adjusted for potential confounders were used to assess the association. ResultsAn adverse effect of neonatal TCV exposure was observed for the psychomotor development index (PDI) only in the 12th and 24th months of life (β=−6.44, p<0.001 and β=−5.89, p<0.001). No significant effect of neonatal TCV exposure was found in the 36th month. The overall deficit in the PDI attributable to neonatal TCV exposure measured over the course of the three-year follow-up (GEE) was significantly higher in TCV group (β=−4.42, p=0.001). MDI scores did not show the adverse association with neonatal TCV exposure.

Prenatal exposure to dental amalgam in the Seychelles Child Development Nutrition Study: Associations with neurodevelopmental outcomes at 9 and 30 months

BackgroundDental amalgam is approximately 50% metallic mercury and releases mercury vapor into the oral cavity, where it is inhaled and absorbed. Maternal amalgams expose the developing fetus to mercury vapor. Mercury vapor can be toxic, but uncertainty remains whether prenatal amalgam exposure is associated with neurodevelopmental consequences in offspring. ObjectiveTo determine if prenatal mercury vapor exposure from maternal dental amalgam is associated with adverse effects to cognition and development in children. MethodsWe prospectively determined dental amalgam status in a cohort of 300 pregnant women recruited in 2001 in the Republic of Seychelles to study the risks and benefits of fish consumption. The primary exposure measure was maternal amalgam surfaces present during gestation. Maternal occlusal points were a secondary measure. Outcomes were the child's mental (MDI) and psychomotor (PDI) developmental indices of the Bayley Scales of Infant Development-II (BSID-II) administered at 9 and 30 months. Complete exposure, outcome, and covariate data were available on a subset of 242 mother–child pairs. ResultsThe number of amalgam surfaces was not significantly (p>0.05) associated with either PDI or MDI scores. Similarly, secondary analysis with occlusal points showed no effect on the PDI or MDI scores for boys and girls combined. However, secondary analysis of the 9-month MDI was suggestive of an adverse association present only in girls. ConclusionWe found no evidence of an association between our primary exposure metric, amalgam surfaces, and neurodevelopmental endpoints. Secondary analyses using occlusal points supported these findings, but suggested the possibility of an adverse association with the MDI for girls at 9 months. Given the continued widespread use of dental amalgam, we believe additional prospective studies to clarify this issue are a priority.

409 Predictive Value of the Bayley Scales of Infant Development on Development of Very Preterm/Very Low Birth Weight Children: a Meta-Analysis

Background and AimsThe Bayley Scales of Infant Development (BSID) is the most widely used measure to assess neurodevelopment of very preterm (gestational age ≤32 weeks) and very low birth weight...

1221 Late Preterms How Do They Manage Their Psychomotor Development During The First Two Years?

Background and AimThe neurodevelopmental pace of late preterms during the first 2 years has hardly been investigated. Our aim was to assess longitudional neurodevelopmental status of babies of gestational ages...

1272 Survival and Neurodevelopmental Outcome of Preterm Infants with a Gestational Age of 22 to 26 Weeks in a Regional Centre

Background and AimsCounselling parents of extremely preterm infants requires knowledge on results of large population-based cohorts and contemporaneous local data.MethodsWe assessed the outcome of all live-born infants 2006 to 2009...