Mental Development Scores Research Articles

Polybrominated Diphenyl Ethers (PBDEs) in Breast Milk and Neuropsychological Development in Infants

Background: There is increasing interest in the potential effects of polybrominated diphenyl ethers (PBDEs) on children’s neuropsychological development, but only a few small studies have evaluated such effects.Objectives: Our goal was to examine the association between PBDE concentrations in colostrum and infant neuropsychological development and to assess the influence of other persistent organic pollutants (POPs) on such association.Methods: We measured concentrations of PBDEs and other POPs in colostrum samples of 290 women recruited in a Spanish birth cohort. We tested children for mental and psychomotor development with the Bayley Scales of Infant Development at 12–18 months of age. We analyzed the sum of the seven most common PBDE congeners (BDEs 47, 99, 100, 153, 154, 183, 209) and each congener separately.Results: Increasing Σ7PBDEs concentrations showed an association of borderline statistical significance with decreasing mental development scores (β per log ng/g lipid = –2.25; 95% CI: –4.75, 0.26). BDE-209, the congener present in highest concentrations, appeared to be the main congener responsible for this association (β = –2.40, 95% CI: –4.79, –0.01). There was little evidence for an association with psychomotor development. After adjustment for other POPs, the BDE-209 association with mental development score became slightly weaker (β = –2.10, 95% CI: –4.66, 0.46).Conclusions: Our findings suggest an association between increasing PBDE concentrations in colostrum and a worse infant mental development, particularly for BDE-209, but require confirmation in larger studies. The association, if causal, may be due to unmeasured BDE-209 metabolites, including OH-PBDEs (hydroxylated PBDEs), which are more toxic, more stable, and more likely to cross the placenta and to easily reach the brain than BDE-209.

In-Utero Exposure to Dichlorodiphenyltrichloroethane and Cognitive Development Among Infants and School-aged Children

Dichlorodiphenyltrichloroethane (DDT) continues to be used for control of infectious diseases in several countries. In-utero exposure to DDT and dichlorodiphenyldichloroethylene (DDE) has been associated with developmental and cognitive impairment among children. We examined this association in an historical cohort in which the level of exposure was greater than in previous studies. The association of in-utero DDT and DDE exposure with infant and child neurodevelopment was examined in 1100 subjects in the Collaborative Perinatal Project, a prospective birth cohort enrolling pregnant women from 12 study centers in the United States from 1959 to 1965. Maternal DDT and DDE concentrations were measured in archived serum specimens. Infant mental and motor development was assessed at age 8 months using the Bayley Scales of Infant Development, and child cognitive development was assessed at age 7 years, using the Wechsler Intelligence Scale for Children. Although levels of DDT and DDE were relatively high in this population (median DDT concentration, 8.9 μg/L; DDE, 24.5 μg/L), neither were related to Mental or Psychomotor Development scores on the Bayley Scales nor to Full-Scale Intelligence Quotient at 7 years of age. Categorical analyses showed no evidence of dose- response for either maternal DDT or DDE, and estimates of the association between continuous measures of exposure and neurodevelopment were indistinguishable from 0. Adverse associations were not observed between maternal serum DDT and DDE concentrations and offspring neurodevelopment at 8 months or 7 years in this cohort.

Cluster‐randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers

Inadequate feeding and care may contribute to high rates of stunting and underweight among children in rural families in India. This cluster-randomized trial tested the hypothesis that teaching caregivers appropriate complementary feeding and strategies for how to feed and play responsively through home-visits would increase children's dietary intake, growth and development compared with home-visit-complementary feeding education alone or routine care. Sixty villages in Andhra Pradesh were randomized into three groups of 20 villages with 200 mother-infant dyads in each group. The control group (CG) received routine Integrated Child Development Services (ICDS); the complementary feeding group (CFG) received the ICDS plus the World Health Organization recommendations on breastfeeding and complementary foods; and the responsive complementary feeding and play group (RCF&PG) received the same intervention as the CFG plus skills for responsive feeding and psychosocial stimulation. Both intervention groups received bi-weekly visits by trained village women. The groups did not differ at 3 months on socioeconomic status, maternal and child nutritional indices, and maternal depression. After controlling for potential confounding factors using the mixed models approach, the 12-month intervention to the CFG and RCF&PG significantly (P < 0.05) increased median intakes of energy, protein, Vitamin A, calcium (CFG), iron and zinc, reduced stunting [0.19, confidence interval (CI): 0.0-0.4] in the CFG (but not RCF&PG) and increased (P < 0.01) Bayley Mental Development scores (mean = 3.1, CI: 0.8-5.3) in the RCF&PG (but not CFG) compared with CG. Community-based educational interventions can improve dietary intake, length (CFG) and mental development (RCF&PG) for children under 2 years in food-secure rural Indian families.

Indoor Air Pollution From Gas Cooking and Infant Neurodevelopment

Gas cooking is a main source of indoor air pollutants, including nitrogen dioxide and particles. Because concerns are emerging for neurodevelopmental effects of air pollutants, we examined the relationship between indoor gas cooking during pregnancy and infant neurodevelopment. Pregnant mothers were recruited between 2004 and 2008 to a prospective birth cohort study (INfancia y Medio Ambiente) in Spain during the first trimester of pregnancy. Third-trimester questionnaires collected information about the use of gas appliances at home. At age 11 to 22 months, children were assessed for mental development using the Bayley Scales of Infant Development. Linear regression models examined the association of gas cooking and standardized mental development scores (n = 1887 mother-child pairs). Gas cookers were present in 44% of homes. Gas cooking was related to a small decrease in the mental development score compared with use of other cookers (-2.5 points [95% confidence interval = -4.0 to -0.9]) independent of social class, maternal education, and other measured potential confounders. This decrease was strongest in children tested after the age of 14 months (-3.1 points [-5.1 to -1.1]) and when gas cooking was combined with less frequent use of an extractor fan. The negative association with gas cooking was relatively consistent across strata defined by social class, education, and other covariates. This study suggests a small adverse effect of indoor air pollution from gas cookers on the mental development of young children.

Mixed Metals Toxicity: More than the Sum of Its Parts?

Most toxicologic studies focus on one chemical or toxicant at a time, although in the real world people are exposed to multiple substances at once. Metals, for example, are commonly found in combinations in air, water, and food. Now researchers have conducted a prospective epidemiologic study to examine neurodevelopmental effects of manganese–lead coexposure [EHP 120(1):126–131; Claus Henn et al.]. The study included 455 children enrolled at birth in a Mexico City longitudinal cohort study, who were followed until 36 months of age. The researchers measured blood levels of lead and manganese at 12 and 24 months of age. Cognitive, motor, and language development were assessed every 6 months from 12 to 36 months of age using the Bayley Scales of Infant Development–II. Both lead and manganese exert their toxic effects on child development primarily through the central nervous system. Exposure to manganese and lead simultaneously was associated with greater deficits in both mental and psychomotor development than expected based on the estimated effects of exposure to either metal alone; this is consistent with a synergistic effect on neurodevelopment. Associations were greatest at 12 months, where Mental Development Index scores were 2.16 points lower per 1-unit increase in blood lead among children with high manganese compared with children with midrange manganese. Psychomotor Development Index scores at 12 months were 0.97 points lower per 1-unit increase in blood lead among children with high manganese compared with children with midrange manganese. The authors suggest that the developmental period up to 12 months may be particularly sensitive to this interaction. The differences in mental and psychomotor development scores were small for individuals, but the authors write that these differences may have population-level consequences if they cause the entire distribution of neurodevelopment scores to shift. This would increase the number of children eligible for diagnosis with neurodevelopmental problems (who would then require treatment) as well as decrease the average IQ. The study’s strengths include a stable study population with little attrition as well as the repeated measurements of neurodevelopment between 12 and 36 months, which allowed the researchers to evaluate associations over time and offered greater statistical power than cross-sectional analyses. Weaknesses of the study included the lack of formal exposure assessment, which means the sources of metal exposure were unknown. In addition, the neurodevelopment test instruments used in the study were not normalized to the Mexican population, so the resulting scores are relatively low compared with the expected mean score of 100 in a U.S. population and cannot be generalized to other populations.

PRENATAL PHTHALATE EXPOSURE AND NEURODEVELOPMENT AT 3 YEARS OF AGE (PILOT STUDY)

Background and Aims: Prenatal exposure to phthalates has been negatively associated with neurodevelopment in the limited studies conducted to date, possibly due to their connection with altered thyroid signaling or other mechanisms. Different associations have been reported between boys and girls. The aim of this pilot study is to investigate the relationship between maternal urinary phthalate concentrations during pregnancy and children’s neurodevelopment at 36 months of age. Methods: Urinary phthalate metabolites (MEHP, MBzP, MEP, MBP, MCPP, DEHP) and bisphenol a (BPA) were measured in 45 pregnant women at the third trimester of pregnancy; children’s neurodevelopment was assessed using the mental development scores (MDI) from the Bayley Scales of Infant Development-II at 36 months of age (20 boys and 25 girls). The relationship between specific gravity-corrected prenatal phthalate concentrations and MDI was estimated using adjusted linear regression models stratified by sex. Results: After the correction for urinary dilution and adjustment for potential confounders, an increase in loge concentrations of MEHP and MBzP were associated with lower MDI scores in girls: MEHP: -5.53 (95%CI: -10.35, -0.71), MBzP:, -5.11 (95%CI: -9.38,-0.84). The remaining phthalate metabolites and BPA were inversely associated with MDI but not statistically significant. There were no statistically significant associations between MDI and prenatal phthalate concentrations among boys. Conclusions: A differential effect of prenatal phthalates exposure by gender was documented in this study in relation to neurodevelopment. MEHP and MBzP, high-molecular weight phthalates, were associated with a lower MDI in girls at 36 months of life. Further studies are needed with larger sample sizes to confirm these results.

Associations of Early Childhood Manganese and Lead Coexposure with Neurodevelopment

Background: Most toxicologic studies focus on a single agent, although this does not reflect real-world scenarios in which humans are exposed to multiple chemicals.Objectives: We prospectively studied manganese–lead interactions in early childhood to examine whether manganese–lead coexposure is associated with neurodevelopmental deficiencies that are more severe than expected based on effects of exposure to each metal alone.Methods: Four hundred fifty-five children were enrolled at birth in an longitudinal cohort study in Mexico City, provided blood samples, and were followed until 36 months of age. We measured lead and manganese at 12 and 24 months and assessed neurodevelopment at 6-month intervals from 12 to 36 months of age using Bayley Scales of Infant Development–II.Results: Mean (± SD) blood concentrations at 12 and 24 months were, respectively, 24.7 ± 5.9 μg/L and 21.5 ± 7.4 μg/L for manganese and 5.1 ± 2.6 μg/dL and 5.0 ± 2.9 μg/dL for lead. Mixed-effects models, including Bayley scores at five time points, showed a significant interaction over time: highest manganese quintile × continuous lead; mental development score, β = –1.27 [95% confidence interval (CI): –2.18, –0.37]; psychomotor development score, β = –0.92 (95% CI: –1.76, –0.09). Slopes for the estimated 12-month lead effect on 18-month mental development and 24- through 36-month psychomotor development scores were steeper for children with high manganese than for children with midrange manganese levels.Conclusions: We observed evidence of synergism between lead and manganese, whereby lead toxicity was increased among children with high manganese coexposure. Findings highlight the importance of understanding health effects of mixed exposures, particularly during potentially sensitive developmental stages such as early childhood.

Prenatal Exposure to Polycyclic Aromatic Hydrocarbons, Bisphenol A, and Phthalates and Growth and Neurodevelopment in Infants and Children

S-29B5-3 Background/Aims: To examine the potential health effects of growth and neurodevelopment in infants and children associated with prenatal exposure to polycyclic aromatic hydrocarbons (PAHs), bisphenol A (BPA), and phthalates. Methods: Study subjects were mothers and children (n = 200–600 pairs) who were enrolled in the mothers and children's environmental health (MOCEH) study, a multicenter cohort of pregnant women. We measured maternal urinary levels of 1-hydroxypyrene and 2-naphthol (2-NA) as metabolites of PAHs, BPA, and 3 phthalates as environmental endocrine disruptors during early pregnancy and at delivery. Fetal growth was assessed by ultrasonogram measuring biparietal diameter, abdomen circumference, and femur length. Birth weight and the Ponderal index were measured at delivery. At 6 and 12 months of children, neurodevelopment was assessed using Bayley test. We analyzed the association between prenatal urinary levels of these chemicals in mothers and fetal growth, birth weight, and neurodevelopment in children using multiple regression, logistic regression, and mixed model adjusted for possible confounding factors. Results: The fetal abdominal circumference showed a positive association with urinary phthalate level (MBP) at early pregnancy (P = 0.02), while any indices of fetal growth having no association with the other chemicals. The birth weight increased significantly according to increasing maternal BPA level at delivery (P trend = 0.04), but it decreased according to increasing 1-hydroxypyrene (P = 0.06) and 2-NA (P = 0.07). The psychomotor developmental score assessed by Bayley test at 6 months of infant was significantly decreased according to increasing maternal urinary BPA level at delivery (P = 0.04). The mental developmental score at 12 months of infants was significantly decreased by increasing 2-NA level at delivery (P trend = 0.01). Conclusion: The prenatal PAHs exposure seems to decrease birthweight and mental development of infant, while prenatal exposure to endocrine disruptors increase fetal growth and birth weight, but decrease the psychomotor development of infant.

598 Vlbw Infants: Accelerated Cognitive Development at Two Years

There is a paucity of literature concentrating on the VLBW infant whose development is accelerated. This study addresses a cohort of Infants BW ≤ 1500g who had high Bayley Mental Developmental scores (≥115).Methods: VLBW ≤1500g born in a tertiary 3 Unit were followed up at 2 years corrected age. The Bayley Scales of Infant Development - 11 were used to measure Mental, Psychomotor and Emotional development during the period 1997- 2004.Results: Of 460 infants assessed 73 (15.7%) infants demonstrated Accelerated Mental Performance (MDI ≥ 115). 70% were girls; 30% boys. Linguistic acquisition was a strong feature. Birthweight and Gestational age did not influence outcome. A subtask analysis was performed. 25 tasks consisting of cognitive, language and visual spatial skills were identified. Of these 25 tasks, 56% (14 tasks) of the Accelerated group demonstrated >90% success whereas only 8% (2 tasks) of the Normal Outcome group demonstrated >90% success. Tasks that were most discriminatory in showing a difference between the Accelerated group and the Normal Outcome group were shape discrimination, use of 3 word and contingent utterances, picture naming, picture discrimination, and tower building. Attention skills, task planning and prompt performance were strong features in the Accelerated group.Conclusion: 16% of our cohort of VLBW infants achieved accelerated performance on the Bayley scale when tested at 2 years. We identified specific tasks that discriminated the performance of the Accelerated group from the Normal group and noted favourable behavioural characteristics that were integral to higher level of task performance.

Developmental and Neurophysiologic Deficits in Iron Deficiency in Children

Several studies in animals and humans have clearly demonstrated the effect of ID on development, cognition, behavior and neurophysiology. The effect of ID have been shown: on brain metabolism, neurotransmitter function, and myelination. Changes in brain iron content caused by early ID in animals are not reversible by iron therapy, inspite of correction of anemia and other tissue deficits and result in changes in behavior which continue into adulthood. ID has repercussions in the perinatal period, infancy and childhood. Some effects are irreversible while other defects may be corrected: timing of ID in a child may be critical. Children (6-23 months) with moderate to severe anemia (ID) or chronic anemia (>3 months) had lower mental and psychomotor development scores than the nonanemic, and except for some continued to have lower scores in spite of iron therapy for 3 months although anemia was corrected. The deficits persisted on re-evaluation at 5, 11-14, and at 19 years. Scholastic achievement is lower and ID children are twice more likely to have problems with mathematics. Ten year follow-up indicated special educational assistance was required for initially anemic children. ID affects WICS items of information, comprehension and verbal performance and full scale IQ. EEG power spectrum had a slower activity suggesting developmental lag compared to iron sufficient children. Treatment with iron improved IQ scores significantly; other studies found differential effects: improvement in cognition and mental scores in older but not in younger children. IQ levels are affected by ID: IQ at 4 years may be predicted by hemoglobin at 5 and 36 months. Abnormal Evoked Response Potentials (ERPs):ABRs and VEPs are seen in ID, which persist in children who were anemic in infancy on retesting at 4 years. Differences have been consistently found in ID infants and in older children. Iron supplementation may significantly reduce latencies of some ERPs. ID affects newborn temperament, ERPs and recognition memory. Iron supplementation in infants (<1,301 g) improved neurocognitive and psychomotor development by 5.3 years (median age). Preventive iron supplementation in well nourished infants also show a positive effect on motor development. The changes are usually subtle, however, with prevalence of anemia of 79.2% in children 6-35 months and 57.9% in pregnant women (NFHS-3, 2005-06), the adverse effects of cognitive, development and behavioral defects should not be underestimated.

Early postnatal blood manganese levels and children's neurodevelopment.

Recent evidence suggests that low-level environmental exposure to manganese adversely affects child growth and neurodevelopment. Previous studies have addressed the effects of prenatal exposure, but little is known about developmental effects of early postnatal exposure. We studied 448 children born in Mexico City from 1997 through 2000, using a longitudinal study to investigate neurotoxic effects of early-life manganese exposure. Archived blood samples, collected from children at 12 and 24 months of age, were analyzed for manganese levels using inductively coupled plasma mass spectrometry. Mental and psychomotor development were scored using Bayley Scales of Infant Development at 6-month intervals between 12 and 36 months of age. At 12 months of age, the mean (SD) blood manganese level was 24.3 (4.5)microg/L and the median was 23.7 microg/L; at 24 months, these values were 21.1 (6.2) microg/L and 20.3 microg/L, respectively. Twelve- and 24-month manganese concentrations were correlated (Spearman correlation = 0.55) and levels declined over time ([beta] = -5.7 [95% CI = -6.2 to -5.1]). We observed an inverted U-shaped association between 12-month blood manganese and concurrent mental development scores (compared with the middle 3 manganese quintiles, for the lowest manganese quintile, [beta] = -3.3 [-6.0 to -0.7] and for the highest manganese quintile, [beta] = -2.8 [-5.5 to -0.2]). This 12-month manganese effect was apparent but diminished with mental development scores at later ages. The 24-month manganese levels were not associated with neurodevelopment. These results suggest a possible biphasic dose-response relationship between early-life manganese exposure at lower exposure levels and infant neurodevelopment. The data are consistent with manganese as both an essential nutrient and a toxicant.

Prenatal Exposure to Cell Phone Use and Neurodevelopment at 14 Months

Recently, an association was reported between prenatal and postnatal exposure to cell phones and neurobehavioral problems in children at the age of 7 years. A birth cohort was established in Sabadell, Spain between 2004 and 2006. Mothers completed questions about cell phone use in week 32 of the pregnancy (n = 587). Neurodevelopment of their children was tested at age 14 months using the Bayley Scales of Infant Development (n = 530). We observed only small differences in neurodevelopment scores between the offspring of cell phone users and nonusers. Those of users had higher mental development scores and lower psychomotor development scores, which may be due to unmeasured confounding. There was no trend with amount of cell phone use within users. This study gives little evidence for an adverse effect of maternal cell phone use during pregnancy on the early neurodevelopment of offspring.

The Timing of Prenatal Exposure to Maternal Cortisol and Psychosocial Stress Is Associated With Human Infant Cognitive Development

The consequences of prenatal maternal stress for development were examined in 125 full-term infants at 3, 6, and 12 months of age. Maternal cortisol and psychological state were evaluated 5 times during pregnancy. Exposure to elevated concentrations of cortisol early in gestation was associated with a slower rate of development over the 1st year and lower mental development scores at 12 months. Elevated levels of maternal cortisol late in gestation, however, were associated with accelerated cognitive development and higher scores at 12 months. Elevated levels of maternal pregnancy-specific anxiety early in pregnancy were independently associated with lower 12-month mental development scores. These data suggest that maternal cortisol and pregnancy-specific anxiety have programming influences on the developing fetus.

Long-Term Breastfeeding and Neurodevelopment at 14 Months: Which Factors Could Explain This Relationship?

ISEE-0740 Background and Objective: Although breastfeeding increases organochlorine transfer to infants, it has been found to be beneficial for the neurodevelopment of the child. Several mechanisms have been proposed to explain these benefits. This study aims to assess the role of three possible mediators: long-chain polyunsaturated fatty acids (LC-PUFAs) levels in colostrum, mother-child attachment, and maternal factors such as intelligence quotient (IQ), education level, and social class in the link between breastfeeding and children’s neurodevelopment at 14 months. Methods: In the Spanish INMA (Environment and Childhood)-Sabadell birth cohort, 657 women were recruited during the 1st trimester of pregnancy. At 14 months, mental and psychomotor development with Bayley Scales of Infant Development was assessed in 561 children, as well as mother-child attachment and maternal IQ. Full breastfeeding was defined as exclusive breastfeeding in addition to infrequent feeds of water or juice. Information about maternal education level and social class were obtained by questionnaire. Maternal organochlorine levels during the 1st trimester of pregnancy were measured by GC-MS and LC-PUFAs in 352 colostrum samples by fast gas chromatography. Multivariable linear regression models were performed. Results: Only very long-term full breastfeeding (> 6 months) was associated with higher infant mental score (6.44 points, 95% confidence interval 1.79–11.08). At smaller durations there was no trend. No relationship was found with psychomotor development scores, although α-linolenic/linoleic acid ratio, maternal education, IQ, and social class were associated with mental development scores (P-value < 0.02). Adjustment for these variables did not confound the association between long-term full breastfeeding and mental development score. Mother-child attachment score and maternal organochlorine levels were not associated with development scores. Conclusion: Both the lack of any association for breastfeeding less than 6 months and the lack of any confounding in the effect of long breastfeeders suggest that non measured social or environmental variables may explain higher mental development among very long breastfeeders rather than breastfeeding itself.

Correlates and Consequences of Spanking and Verbal Punishment for Low‐Income White, African American, and Mexican American Toddlers

This study examined the prevalence, predictors, and outcomes of spanking and verbal punishment in 2,573 low-income White, African American, and Mexican American toddlers at ages 1, 2, and 3. Both spanking and verbal punishment varied by maternal race/ethnicity. Child fussiness at age 1 predicted spanking and verbal punishment at all 3 ages. Cross-lagged path analyses indicated that spanking (but not verbal punishment) at age 1 predicted child aggressive behavior problems at age 2 and lower Bayley mental development scores at age 3. Neither child aggressive behavior problems nor Bayley scores predicted later spanking or verbal punishment. In some instances, maternal race/ethnicity and/or emotional responsiveness moderated the effects of spanking and verbal punishment on child outcomes.

Long-term outcome following pediatric liver transplantation for metabolic disorders

In order to determine long-term outcome, including survival, growth and development, following liver transplantation in children with metabolic disorders, we retrospectively reviewed charts of 54 children with metabolic disorders evaluated from 1989-2005 for presenting symptoms, transplantation timing and indications, survival, metabolic parameters, growth, and development. Thirty-three patients underwent liver transplantation (12 received combined liver-kidney transplants) at a median age of 21 months. At a median follow-up of 3.6 yr, patient survival was 100%, and liver and kidney allograft survival was 92%, and 100%, respectively. For the group as a whole, weight Z scores improved and body mass index at follow-up was in the normal range. Two yr post-transplantation, psychomotor development improved significantly (p < 0.01), but mental skills did not; however, both indices were in the low-normal range of development. When compared to patients with biliary atresia, children with metabolic disorders showed significantly lower mental developmental scores at one and two yr post-transplantation (p < 0.05), but psychomotor developmental scores were not significantly different. We conclude that, in patients with metabolic disorders meeting indications for transplantation, liver transplantation or combined liver-kidney transplantation (for those with accompanying renal failure) is associated with excellent long-term survival, improved growth, and improved psychomotor development.

Effects of Maternal Multimicronutrient Supplementation on the Mental Development of Infants in Rural Western China: Follow-up Evaluation of a Double-Blind, Randomized, Controlled Trial

We investigated the benefits of maternal multimicronutrient supplementation during gestation on the mental and psychomotor development of infants. In a double-blind, randomized, controlled trial, pregnant women (N = 5828) in 2 rural counties in western China were assigned randomly to receive multimicronutrient (5 minerals and 10 vitamins at levels approximating the recommended daily allowance), folic acid plus iron, or folic acid supplementation daily from approximately 14 weeks of gestation until delivery. We assessed a subset of the newborns (N = 1305) from the 3 supplementation groups by measuring their mental and psychomotor development with the Bayley Scales of Infant Development, at 3, 6, and 12 months of age. Multilevel analyses were used to compare the mental development and psychomotor development raw scores at 3, 6, and 12 months. Multimicronutrient supplementation was associated with mean increases in mental development raw scores for infants at 1 year of age of 1.00 and 1.22 points, compared with folic acid only and folic acid plus iron supplementation, respectively. However, supplementation did not increase significantly the psychomotor development raw scores up to 1 year of age. Compared with iron and folic acid supplementation, the administration of multimicronutrients to pregnant women improved the mental development of their children at 1 year of age.

Birth weight effects on children's mental, motor, and physical development: evidence from twins data.

To determine the effect of very low birth weight (VLBW; <1500 g) and moderately low birth weight (MLBW; 1500-2499 g) on children's mental and motor development and physical growth during the first 2 years of life and whether VLBW and MLBW babies catch up to normal birth weight (NBW; > or =2500 g) children by age 2. We use data on dizygotic (DZ) and monozygotic (MZ) twins and singleton births from the first two waves of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative dataset of children born in the US in 2001. We estimate the effects of VLBW and MLBW on children's mental and motor development scores, weight-for-age, weight-for-length, weight-for-height, and length-for-age z-scores at 9 months and 2 years. We examine whether differences in outcomes within twin pairs are related to differences in their birth weights. The within-twins analysis is conducted on samples of DZ and MZ twins. For comparison, we also estimate birth weight effects on child outcomes from multivariate linear regression models using the full singleton and twins' sample. We also estimate the effect of being small-for-gestational age (SGA; birth weight <10th percentile for gestation) using the same set of models in order to separate out the effects of fetal growth restriction from prematurity. Evaluation of all births showed that VLBW and MLBW have large negative effects on mental development, motor development, and growth at 9 months and 2 years of age. However, results from within-twin models with DZ twins that control for shared maternal and environmental factors showed much less effect of birth weight on mental or motor development, but continued large effects on growth for the VLBW group. Within-twin models with MZ twins that control for shared maternal, environmental, and genetic factors showed statistically insignificant effects of birth weight on mental and motor development, but continued effects on growth. Similar patterns were found when examining the effects of SGA. After controlling for the influence of maternal, environmental, and genetic factors, low birth weight has at most a small negative effect on children's mental and motor development in their first 2 years of life. However, low birth weight is a major risk factor for children's physical growth in the early years and there is no evidence of catch-up by age 2.

Nutrition in Brain Development and Aging: Role of Essential Fatty Acids

The essential fatty acids (EFAs), particularly the n-3 long-chain polyunsaturated fatty acids (LCPs), are important for brain development during both the fetal and postnatal period. They are also increasingly seen to be of value in limiting the cognitive decline during aging. EFA deficiency was first shown over 75 years ago, but the more subtle effects of the n-3 fatty acids in terms of skin changes, a poor response to linoleic acid supplementation, abnormal visual function, and peripheral neuropathy were only discovered later. Both n-3 and n-6 LCPs play important roles in neuronal growth, development of synaptic processing of neural cell interaction, and expression of genes regulating cell differentiation and growth. The fetus and placenta are dependent on maternal EFA supply for their growth and development, with docosahexaenomic acid (DHA)-supplemented infants showing significantly greater mental and psychomotor development scores (breast-fed children do even better). Dietary DHA is needed for the optimum functional maturation of the retina and visual cortex, with visual acuity and mental development seemingly improved by extra DHA. Aging is also associated with decreased brain levels of DHA: fish consumption is associated with decreased risk of dementia and Alzheimer's disease, and the reported daily use of fish-oil supplements has been linked to improved cognitive function scores, but confirmation of these effects is needed.

A randomized clinical trial of regional cerebral perfusion versus deep hypothermic circulatory arrest: Outcomes for infants with functional single ventricle

Regional cerebral perfusion has been adopted as a means to improve neuroprotection during aortic arch reconstruction. The purpose of this study was to determine whether a strategy of regional cerebral perfusion rather than one of deep hypothermic circulatory arrest during aortic arch reconstruction would improve neurodevelopment without increasing morbidity or mortality for patients undergoing the Norwood operation. A randomized trial was performed in infants with single ventricle anatomy undergoing the Norwood operation. Participants were randomized to deep hypothermic circulatory arrest or regional cerebral perfusion. Neurodevelopment was measured before second-stage surgery and at 1 year by the Bayley Scales of Infant Development-II, Psychomotor Development Index and Mental Development Index. Intent-to-treat analysis was performed. Seventy-seven patients were enrolled. Survival to hospital discharge was 88% and to 1-year follow-up, 75%, without a significant difference between groups. For the entire cohort, the mean (SD) psychomotor development index score was 77 (20) and the mean mental development index score was 92 (21), with psychomotor development index lower than mental development index both before second-stage surgery (P < .0001) and at 1 year (P < .0001). There were no statistical differences in mental development or psychomotor development scores between the groups at pre-second-stage operation or 1-year follow-up, although the point estimates were consistently lower for the regional cerebral perfusion group. Infant development is delayed after the Norwood operation. Pilot data do not suggest that regional cerebral perfusion improves infant development. Further study with a multicenter clinical trial is imperative to address this important question.