Neonatal Behavioral Assessment Scale Research Articles

Neurobehavioural and cognitive development in infants born to mothers with eating disorders

Although recent research has focused on the effects of maternal eating disorders (EDs) on children, little is known about the effect of maternal EDs on neurobiological outcomes in newborns and infants. This study is the first to investigate neurobehavioural regulation and cognitive development in newborns and infants of mothers with EDs. Women with an active and past ED and healthy controls were recruited to a prospective longitudinal study during their first trimester or second trimester of pregnancy. Newborns and infants of mothers with ED were compared with newborns and infants of healthy controls on (a) neurobehavioural dysregulation using the Brazelton Neonatal Behavioural Assessment Scale at 8days postpartum (active ED, n=15; past ED, n=20; healthy controls, n=28); and (b) cognitive development using the Bayley Scales of Infant and Toddler Development at 1-year postpartum (active ED, n=18; past ED, n=19; healthy controls, n=28). In order to maintain the largest possible sample at each time point, sample size varied across time points. Newborns of mothers with an active ED had worse autonomic stability when compared with newborns of healthy controls [B=-0.34 (-1.81, -0.26)]. Infants of mothers with a past ED had poorer language [B=-0.33 (-13.6, -1.9)] and motor development [B=-0.32 (-18.4, -1.3)] compared with healthy controls. Children of mothers with ED display neurobehavioural dysregulation early after birth and poorer language and motor development at 1year. These characteristics suggest evidence of early neurobiological markers in children at risk. Differential outcomes in children of women with active versus past ED suggest that active symptomatology during pregnancy might have an effect on physiological reactivity while cognitive characteristics might be more stable markers of risk for ED.

Prolactin, a potential mediator of reduced social interactive behavior in newborn infants following maternal perinatal depressive symptoms

BackgroundThe hormone prolactin (PRL) plays a crucial role for the initiation and maintenance of maternal behavior, and is also associated with the etiology of mood disorders in women, especially for depression. The present study aimed to determine whether maternal peripheral prolactin would be associated with newborn behavior disorders following maternal perinatal depressive symptoms, and further to explore the efficacy of the Newborn Behavioral Observations (NBO) in improving newborn social interactive behavior. MethodsInterview and the 24-item Hamilton Rating Scale for Depression (HAMD) were used to assess the hospitalized pregnant women waiting for delivery at 37-42weeks of gestation. A total of 255 subjects were recruited, diagnosed with depression (n=135), and control group (n=120). Within 2 weeks postpartum, mothers were asked to fill with Maternal Attachment Inventory (MAI) to measure maternal care. Neonatal Behavioral Assessment Scale (NBAS) were used to evaluate newborn behavior. The depressed mother-newborns dyad was randomly assigned to NBO intervention and control group. Serum prolaction in mothers and cortisol in mothers and newborns were measured. ResultsThe newborns of mothers exposed to maternal perinatal depressive symptoms displayed the reduced newborn social interactive behavior accompanied by decreased maternal serum PRL as well as increased maternal and neonatal serum cortisol. The NBO could be an effective intervention tool. LimitationsOur study could not be double-blind. The mothers knew which group their infant were in. ConclusionsMaternal peripheral PRL had the potential to be a mediator in reduced social interactive behavior in newborn infants following maternal perinatal depressive symptoms.

Maternal prenatal cortisol predicts infant negative emotionality in a sex-dependent manner

ObjectivePrenatal stress influences fetal developmental trajectories, which may implicate glucocorticoid mechanisms. There is also emerging evidence that effects of prenatal stress on offspring development are sex-dependent. However, little is known about the prospective relationship between maternal prenatal cortisol levels and infant behaviour, and whether it may be different in male and female infants. We sought to address this question using data from a prospective longitudinal cohort, stratified by risk. MethodThe Wirral Child Health and Development Study (WCHADS) cohort (n=1233) included a stratified random sub-sample (n=216) who provided maternal saliva samples, assayed for cortisol, at home over two days at 32weeks of pregnancy (on waking, 30-min post-waking and during the evening) and a measure of infant negative emotionality from the Neonatal Behavioural Assessment Scale (NBAS) at five weeks-of-age. General population estimates of associations among measures were obtained using inverse probability weights. ResultsMaternal prenatal cortisol sampled on waking predicted infant negative emotionality in a sex-dependent manner (interaction term, p=0.005); female infants exposed to high levels of prenatal cortisol were more negative (Beta=0.440, p=0.042), whereas male infants were less negative (Beta=−0.407, p=0.045). There was no effect of the 30-min post-waking measure or evening cortisol. DiscussionOur findings add to an emerging body of work that has highlighted sex differences in fetal programming, whereby females become more reactive following prenatal stress, and males less reactive. A more complete understanding of sex-specific developmental trajectories in the context of prenatal stress is essential for the development of targeted prevention strategies.

182. Childhood Maltreatment, Postnatal Symptoms, and Neonatal Behavior in Postpartum Psychosis

Abstract Background: Individuals at risk of psychosis unrelated to gestation are reported to experience more childhood maltreatment, which has also been associated with more severe positive and affective symptoms (Thompson et al., 2009). Furthermore, maternal experience of childhood maltreatment is associated with increased risk of perinatal psychopathology (Lang et al., 2006; Mezey et al., 2005) and worse offspring outcomes (Roberts et al., 2004; Miranda et al., 2011). Therefore, it is particularly important to examine the relationship between maternal experience of childhood maltreatment and early postnatal psychopathology and offspring outcome in those women who are at high risk of developing postpartum psychosis (PP) after giving birth. Methods: We assessed pregnant women (n = 104) at 25 weeks gestation: 41 were at risk of PP because of a diagnosis of bipolar disorder (n = 35), schizoaffective disorder (n = 4) or a previous PP (n = 2), and 63 were healthy women. Maternal experience of childhood maltreatment was assessed using the Childhood Experience or Care and Abuse Questionnaire (CECA-Q). Maternal affective and psychotic postnatal symptoms were assessed at 6 days postpartum using standardized scales. Infant behavior was also assessed at 6 days postpartum using the Neonatal Behavioral Assessment Scale (NBAS). Results: Compared to healthy women, women at risk of PP experienced significantly more childhood maltreatment (17% vs. 49%, χ2(1) = 11.4, P < .01), particularly sexual abuse (3% vs. 28%, χ2(1) = 13.3, P < .01) and antipathy (7% vs. 24%, χ2(1) = 6, P = .03). Furthermore, women who experienced childhood maltreatment had significantly more postpartum psychotic symptoms than those who did not experience childhood maltreatment (31% vs. 5%, χ2(1) = 4.6, P = .05).Compared to the infants of healthy women, infants of women at risk of PP had worse social interactive (U = 761.5, Z =−2.0, P = 0.05) and autonomic stability (U = 719.0, Z = −2.3, P = .02) scores. However, maternal experience of childhood maltreatment was not associated with infant behavior. Conclusion: The results suggest that women at risk of PP experience more childhood maltreatment than women not at risk and that experience of childhood maltreatment is associated with more psychotic symptoms in the early postpartum. These findings are in line with the literature on psychosis unrelated to gestation and suggest that experience of childhood maltreatment might play a role in the risk for postpartum psychopathology in women at risk of PP. Infants of women at risk of PP had less optimal social interactive and autonomic stability scores on the NBAS, suggesting they were less alert, less able to attend to auditory and visual stimuli and less physiologically stable than infants born to healthy women. The fact that maternal experience of childhood maltreatment was not associated with infant behavior suggests this may not be the mechanism underlying these impairments.

Haemoconcentration risk at the end of pregnancy: effects on neonatal behaviour.

To determine the associations between haemoconcentration at the end of pregnancy (third trimester and delivery) and neonatal behaviour in healthy pregnant women supplemented with moderate doses of Fe. A prospective longitudinal study in which obstetric and clinical history, maternal toxic habits, maternal anxiety and Hb levels were recorded at the third trimester and delivery. Neonatal behaviour was assessed at 48-72 h of age using the Neonatal Behavioral Assessment Scale. Unit of Obstetrics and Gynaecology of the Sant Joan University Hospital in Reus, Tarragona (Spain). A total of 210 healthy and well-nourished pregnant women and their full-term, normal-weight newborns. The results showed that, after adjusting for confounders, in the third trimester the risk of haemoconcentration (6·2 % of pregnant women) was related to decreased neonatal state regulation (B=-1·273, P=0·006) and alertness (B=-1·848, P=0·006) scores. In addition, the risk of haemoconcentration at delivery (12·0 % of pregnant women) was also related to decreased neonatal state regulation (B=-0·796, P=0·021) and poor robustness and endurance (B=-0·921, P=0·005) scores. Our results show that the risk of haemoconcentration at the end of pregnancy is related to the neonate's neurodevelopment (and self-regulation capabilities), suggesting that Fe supplementation patterns and maternal Fe status during pregnancy are important factors for neurodevelopment which may be carefully controlled.

Wpływ modułu porodowego na stan emocjonalny matki, tworzenie więzi z dzieckiem i stan neurobehawioralny noworodka

Childbirth is an important event, both in a woman's, and in her family's lives, an event which carries a huge emotional charge and influences the functioning of a triad. Labour is a physiological process which may have health (somatic, psychological, mental) and economic consequences. Irrespective of the reasons why it is performed; caesarean section involves surgical, obstetric and anaesthesiological intervention, as well as the necessity for pharmacological agents. Bonding between parents and their children serves as a basis for optimal psychomotor development, and the first year is important for the rest of life. The aim of the study was to assess the influence of the labour mode on the mother's emotional state, mother-child bonding, and the infant's neurobehavioural state. The plan of this study was approved by the Bioethical Commission of the Pomeranian Medical University in Szczecin (BN-001/108/08). The research material comprised 200 women and their children. The following instruments were used in this study: an original questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), the Mother-Child Relationship FIRST score (MCR FIRST score), the Brazelton Scale, also known as the Neonatal Behavioural Assessment Scale (NBAS). The umbilical blood was used to determine the level of cortisol as a stress marker. Statistical analysis was performed using the Shapiro-Wilk test, the χ2 test, the Mann-Whitney U-test, the Fisher test, and the Spearman rank correlation coefficient. The accepted significance level (p) was equal to 0.05 (the acceptable type I error). Around 35% of the women took part in prenatal education, and 59% of them declared the intention to participate in postnatal education. The respondents wanted someone close to be with them during delivery (65.5%), although only 35% had such a possibility. Women giving birth naturally were more often accompanied by their partners (p = 0.00005). Less than half of the women (35%) had skin-to-skin contact with their babies, and there was a difference between delivery mode (p = 0.01). Attempts at breastfeeding were made by 81.5% of those surveyed. Women after c-section less often tried to breastfeed their babies than their counterparts after natural delivery (p = 0.003). The levels of cortisol in umbilical blood were significantly higher after natural labour than after caesarean section (p < 0.00001). The assessment of the risk of postnatal depression performed with the EPDS did not demonstrate significant differences between women in particular delivery modes (p = 0.82). The percentage of'crying' Children was similar in both modes (12% of naturally born babies and 13% of those born by c-section); the difference was not statistically significant (p = 1.0). Infant examination with the Brazelton Scale revealed differences in babies' behaviour in 30 parameters of the scale in favour of naturally born children. Children born through caesarean section had rarer contact with their mothers after delivery (p = 0.01). Naturally born babies obtained higher scores on the NBAS, which is an argument for the promotion of this delivery mode. Naturally born babies had significantly higher cortisol levels and more frequent direct contact with their mothers after delivery, which creates favourable conditions for forming bonds. Delivery mode had no influence on the occurrence of postpartum depression, according to the EPDS (p = 0.82).

Fetal heart rate variability mediates prenatal depression effects on neonatal neurobehavioral maturity

This study analyzed the mediating role of fetal heart rate variability (FHR) on prenatal depression and neonatal neurobehavioral maturity. A sample of 104 pregnant women was recruited and divided into two groups according to their Edinburgh Postnatal Depression Scale (EPDS) scores (depressed/non-depressed). FHR variability in response to speech stimuli was assessed at term (between 37 and 39 weeks gestation). The neonates were then assessed on the Neonatal Behavioral Assessment Scale (NBAS) during the first 5days after birth. The fetuses of non-depressed pregnant women showed higher HR variability than the fetuses of depressed pregnant women in response to speech stimuli, and later as neonates they performed more optimally on the NBAS (on autonomic stability and total scores). FHR variability mediated the relationship between the mother’s prenatal depression and the neonatés NBAS performance. Prenatal depression effects on neonatal behavior may be partially explained by its adverse effects on fetal neurobehavioral maturity.

The Relationship between Motor Function and Behavioral Function in Infants with Low Birth Weight.

Nowadays, the evaluation of all aspects of infant development is important. However, in practice, some of these assessments, especially those requiring more manipulation on high-risk infants, may impose additional stress on them. Therefore, sometimes it is essential to utilize the results of a developmental assessment for the prediction of some other aspects of development. This study evaluated the relationship between the scores of the behavioral tests and the motor function test. This cross-sectional study and was undertaken in the Neonatal Intensive Care Center and Clinic of Shahid Akbar Abadi Hospital, Tehran, Iran. A group of 50 infants with low birth weights was selected based on the easy non-contingency method and the inclusion criteria, and served as the participants. In order to assess the motor function and the behavioral performance, the motor function test (a test of infant motor performance (TIMP)) and the neonatal behavioral assessment scale (neonatal behavioral assessment scale (NBAS)) were used respectively. TIMP has both stimulation and observation sections. The items include habituation, social interaction, motor system, state organization, state regulation, autonomic system, smile, supplementary items, and the reflex. No significant association was found between the items of the habituation of behavioral testing and the observation of the movement test. There was no statistically significant relationship between the habituation and stimulation sections as well as between the system autonomous of the behavioral test and the observation section of the motor test (P>0.05). The relationship between other variables was statistically significant (P<0.05). The scores of some behavioral performance items could be a good predictor of the scores of the motor function items for low birth weight infants in the neonatal period.

Analysis of the Impact of Selected Anesthetic Agents on Neurobehavioral State of a Newborn

Introduction. An increasing percentage of children are born through C-sections. Both mother and child are exposed to potential obstetric, anesthesia and neonatal complications. Hypoxia associated with obstetric or anesthetic complications can lead to fetal hypoxia, and induce adaptation difficulties in the postpartum period or permanent developmental disorders. Knowledge of issues related to the perioperative care of the mother and child will minimize complications and provide high-quality care.Aim. The aim of the study was to analyze the impact of opioids in analgesia and hypotension during C-section on neonatal neurobehavioral state.Material and Methods. The study involved 102 mothers and their babies born by C-section. The study was approved by the Bioethics Committee of PUM. The inclusion criterion was the lack of systemic diseases in the mother and the gestational age over 36 weeks. All mothers were subarachnoidally anesthetized for the labor. Newborns after two days of life were assessed by NBAS (Neonatal Behavioral Assessment Scale).Results. Neonatal reflexes in the study group were normal. Newborns of mothers who were added fentanyl to anesthesia, did not differ in behavior from the others (p&gt;0.05). After adding Morphini Sulfas 0.1% Spinal to anesthesia there were observed statistically significant differences in the behavior of newborns, compared to infants whose mothers did not receive it, in terms of sound stimulus habituation (p=0.04) in favor of those whose mothers received MF Spinal intrathecally. Children of mothers anaesthetized without the addition of MF Spinal presented higher self-calming abilities than the others (p=0.03). The ability of calming down differed infants of mothers whose blood pressure declined during anesthesia (p=0.04).Conclusions. Subarachnoid anesthesia with opioid supplementation for C-section as well as an anesthesia-related decrease in blood pressure slightly affected neurobehavioral state of infants born by C-section comparing to those whose mothers had not received opioids intraspinally and had not experienced a blood pressure decrease. (JNNN 2016;5(3):92–98)

Neonatal behavior as biologically motivated behavior

Objectives: To discuss the possibility that neonatal behavior can be understood as biologically motivated behavior. Hypothesis: Human newborns present a behavioral repertoire which corresponds to the phylogenetic evolution and adaptation of the human species to environmental circumstances. Method: The behavioral repertoire of the human newborn is discussed at the light of the neurobehavioral evaluation of babies at the first moments of extra-uterine life, namely the NBAS (Neonatal Behavioral Assessment Scale) by T. Berry Brazelton. This description is articulated with several aspects of human experience: a) adequacy for survival after birth; b) sequence from prenatal behavior to postnatal behavior, c) similarity between prenatal sleep/awake states and postnatal sleep/awake states and d) postnatal behavioral competence as a result of prenatal training (the performance of prenatal behavior as an exercise towards the enhancement of postnatal behavioral performance). Conclusion: The articulation above described will be used to enlighten future research in the fields of neonatal behavior and prenatal behavior. It will also be used to deepen possibilities of psychological interventions based at presentations offered to mothers, fathers or families when assessing newborns’ behavior (Brazelton demonstrations).

The neonatal levels of TSB, NSE and CK-BB in autism spectrum disorder from Southern China.

A total of 80 patients with ASD (ASD group) were screened for this retrospective study. Among them, 34 were low-functioning ASD (L-ASD group) and 46 were high-functioning ASD (H-ASD group). Identification of the ASD cases was confirmed with a Revised Autism Diagnostic Inventory. For comparison with ASD cases, 80 normal neonates (control group) were selected from the same period. Biochemical parameters, including TSB, NSE and CK-BB in the neonatal period and medical records on neonatal behavior were collected. The levels of serum TSB, NSE and CK-BB in the ASD group were significantly higher when compared with those from the control group (P < 0.01, or P < 0.05). The amounts of serum TSB, NSE and CK-BB in the L-ASD group were significantly higher when compared with those in the H-ASD group (P < 0.01, or P < 0.05). The Neonatal Behavioral Assessment Scale (NBAS) scores in the ASD group were significantly lower than that in the control group (P < 0.05). Likewise, the NBAS scores in the L-ASD group were significantly lower than that in the H-ASD group (P < 0.05). There was no association between serum TSB, NSE, CK-BB and NBAS scores (P > 0.05) in the ASD group. The neonatal levels of TSB, NSE and CK-BB in ASD from Southern China were significantly higher than those of healthy controls. These findings need to be investigated thoroughly by future studies with large sample.

Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review

To review systematically the evidence on impact of cerebral redistribution, as assessed by fetal middle cerebral artery (MCA) Doppler, on neurological outcomes in small-for-gestational-age (SGA) or growth-restricted fetuses. For this systematic review, MEDLINE was searched for all controlled studies reporting neurological outcomes in SGA or growth-restricted babies with cerebral redistribution based on MCA Doppler indices, from inception to September 2013. We used relative risk or odds ratios, with 95% CI, to identify the association of cerebral redistribution with neurological outcomes. The search yielded 1180 possible citations, of which nine studies were included in the review, with a total of 1198 fetuses. Definitions of SGA and cerebral redistribution were variable, as was study quality. Data could not be synthesized in meta-analyses because of heterogeneity in outcome reporting. Cerebral redistribution was not associated with increased risk of intraventricular hemorrhage in neonates (five studies; n = 806). When present in preterm fetuses, cerebral redistribution was associated with normal Neonatal Behavioral Assessment Scale (NBAS) scores at 40 weeks (one study; n = 62) but abnormal psychomotor development at 1 year of age on the Bayley scale (one study; n = 172). When present in term SGA fetuses, cerebral redistribution was associated with increased risk of motor and state organizational problems on NBAS (two studies; n = 158), and lower mean percentile scores in communication and problem solving at 2 years of age on the Ages and Stages Questionnaire (one study; n = 125). SGA fetuses with cerebral redistribution may be at higher risk of neurodevelopmental problems. More data are needed from adequately controlled studies with long-term follow-up before conclusions can be drawn. If these findings are true, there is a need to re-evaluate timing of delivery in the management of SGA fetuses, particularly when cerebral redistribution is found at term gestation.

Neurobehavioral conditions and effects of gender, weight and severity in preterm infants according to the Neonatal Behavioral Assessment Scale

&lt;p&gt;The increasing number of preterm babies in recent years has raised interest in studying the consequences of prematurity as a risk factor. In the present paper, 30 preterm babies (at 40 weeks of gestational age (GA)) were assessed using the Neonatal Behavioral Assessment Scale and the results were compared with those of a control group of 28 full term babies. Moreover, the influence of weight, sex and GA was analyzed considering the Brazelton results in the preterm group.&lt;/p&gt;&lt;p&gt;The preterm group showed significantly lower scores than the control group for 9 of the 28 behavioral items in the Scale and for 2 of the 5 clusters. However, preterm babies performed better in habituation to disturbing stimuli (light and sound) during sleep. In relation to the influence of sex, premature girls performed better in the Social-Interactive cluster.&lt;/p&gt;The preterm group has lower neurobehavioral conditions than the full term group, probably due to the abrupt interruption of their intrauterine maturation. In contrast, they showed a better ability of habituation, maybe as a consequence of a learning effect due to earlier additional extrauterine exposition.

The Neonatal Behavioral Assessment Scale (NBAS) and Newborn Behavioral Observations system (NBO) for supporting caregivers and improving outcomes in caregivers and their infants

The Neonatal Behavioral Assessment Scale (NBAS) and Newborn Behavioral Observations system (NBO) for supporting caregivers and improving outcomes in caregivers and their infants

Attempting to prevent postnatal depression by targeting the mother-infant relationship: a randomised controlled trial.

The purpose of the study was to investigate whether an intervention which focused on enhancing the quality of the mother-infant relationship would prevent the development of postnatal depression (PND) and the associated impairments in parenting and adverse effects on child development. Recent meta-analyses indicate modest preventive effects of psychological treatments for women vulnerable to the development of PND. However, given the strong evidence for an impact of PND on the quality of the mother-infant relationship and child development, it is notable that there are limited data on the impact of preventive interventions on these outcomes. This is clearly a question that requires research attention. Accordingly, a randomised controlled trial (RCT) was conducted of such a preventive intervention. A large sample of pregnant women was screened to identify those at risk of PND. In an RCT 91 were randomly assigned to receive the index intervention from research health visitors, and 99 were assigned to a control group who received normal care. In an adjacent area 76 women at risk of PND received the index intervention from trained National Health Service (NHS) health visitors. The index intervention involved 11 home visits, two antenatally and nine postnatally. They were supportive in nature, with specific measures to enhance maternal sensitivity to infant communicative signals, including items from the Neonatal Behavioral Assessment Scale. Independent assessments were made at 8 weeks, 18 weeks, and 12 and 18 months postpartum. Assessments were made of maternal mood, maternal sensitivity in mother-infant engagement, and infant behaviour problems, attachment and cognition. The RCT revealed that the index intervention had no impact on maternal mood, the quality of the maternal parenting behaviours, or infant outcome, although there were suggestions, on some self-report measures, that those with a lower level of antenatal risk experienced benefit. This was also the case for the intervention delivered by trained NHS health visitors. The findings indicate that the approach investigated to preventing PND and its associated problems cannot be recommended.

OP25.05: Corpus callosum differences assessed by MRI in term small for gestational age fetuses and its association with neurobehaviour

To evaluate corpus callosum (CC) morphometry by MRI in term small for gestational age (SGA) fetuses compared to controls and its association with neurobehavioral outcome. 117 SGA and 73 control fetuses with normal umbilical Doppler were imaged using a 3T MRI scanner at 37 weeks of gestation, obtaining T2 HASTE anatomical acquisition in the three orthogonal planes. CC length, thickness, total area and the areas after a subdivision in 7 portions were blindly assessed by semi-automatic delineation. All measurements were corrected by the cephalic index. Neonatal neurobehaviour was evaluated with the Neonatal Behavioral Assessment Scale (NBAS) at 42 ± 1 week. Statistical analyses were performed by multivariate analysis of covariance adjusting for gender, smoking and body mass index. The association between CC measurements and NBAS scores in SGA was assessed by ordinal regression taking into account the same covariates plus age at NBAS test, considering the dependent variable the amount of NBAS test's clusters under the 5th centile. SGA fetuses showed significantly smaller total CC area (SGA: 1.3996 ± 0.26 vs. control: 1.664 ± 0.31; p < 0.01) and smaller genu, rostral body, anterior midbody, posterior midbody, isthmus and splenium areas. Overall, we found a significant association between smaller CC measures and worse neurobehavioral outcome in SGA newborns, particularly a smaller total area (p = 0.03), rostrum (p = 0.02), genu (p = 0.03), rostral body (p = 0.02), anterior midbody (p = 0.03) and splenium (p = 0.03) had a significant negative effect on the number of abnormal NBAS clusters. CC development was significantly altered in term SGA fetuses and correlated with worse neurobehavioral performance. CC could be further explored as a potential imaging biomarker to predict abnormal neurodevelopment in pregnancies at risk.

Fetal MRI insular cortical morphometry and its association with neurobehavior in late-onset small-for-gestational-age fetuses

To evaluate insular cortical morphometry assessed by magnetic resonance imaging (MRI) in late-onset small-for-gestational-age (SGA) fetuses compared with controls, and its association with neurobehavioral outcomes. MRI was performed in 65 late-onset SGA and 59 normally-grown fetuses at 37 weeks' gestation. T2-weighted half Fourier acquisition single-shot turbo spin echo (HASTE) anatomical and diffusion-weighted images were acquired. Insular cortical thickness, volume and fractional anisotropy values were assessed, and asymmetry indices were constructed. At 42 weeks of age, a Neonatal Behavioral Assessment Scale (NBAS) test was performed on the SGA neonates. Late-onset SGA fetuses had significantly thinner insular cortical thickness and smaller insular cortical volume than did controls. SGA fetuses also presented a more pronounced left asymmetry in the posterior cortex and significantly lower fractional anisotropy values in the left insula. Insular measurements in the SGA group were significantly correlated with neurobehavior as assessed by NBAS scores. Insular cortical morphometry was significantly different in late-onset SGA fetuses and correlated with poorer neurobehavioral performance. These data support the impact of growth restriction on brain development and the potential value of cortical assessment as a biomarker of neurodevelopment in at-risk fetuses.

Home environment and cord blood levels of lead, arsenic, and zinc on neurodevelopment of 24 months children living in Chitwan Valley, Nepal

In a birth cohort living in Chitwan Valley, lowland Nepal, we have previously reported inverse associations between in utero levels of lead (Pb), arsenic (As) and neurodevelopment at birth measured by the Brazelton Neonatal Behavioral Assessment Scale, third edition (NBAS III). In the present paper, a follow-up of the same cohort was made on 24-month-old infants regarding the neurodevelopmental effects of these metals, taking the postnatal environment into account. In total, the same100 mother-infant pairs as the previous study, whose Pb, As, and Zn concentrations in cord blood were known, were recruited. Postnatal raising environment was evaluated using the Home Observation for Measurement of Environment (HOME) scale. Neurodevelopment of children at 24 months of age (n=74) was assessed using the Bayley Scale of Infant Development, Second Edition (BSID II). Multivariable regression adjusting for covariates was performed to determine the associations of in utero levels of toxic and essential elements and the home environment with neurodevelopment scores. Unlike the NBAS III conducted for newborns, none of the BSID II cluster scores in 24-month-old infants were associated with cord blood levels of Pb, As, and Zn. The total HOME score was positively associated with the mental development scale (MDI) score (coefficient=0.67, at 95% CI=0.03 to 1.31). In this cohort, a detrimental effect of in utero Pb and As on neurodevelopmental indicators observed at birth disappeared at 24 months, while an association between neurodevelopment and home environment continued.

Correlation of Quantitative Texture Analysis of Cranial Ultrasound With Later Neurobehavior in Preterm Infants

The purpose of the study was to evaluate the association between a quantitative texture analysis of early neonatal brain ultrasound images and later neurobehavior in preterm infants. A prospective cohort study including 120 preterm (<33 wk of gestational age) infants was performed. Cranial ultrasound images taken early after birth were analyzed in six regions of interest using software based on texture analysis. The resulting texture scores were correlated with the Neonatal Behavioural Assessment Scale (NBAS) at term-equivalent age. The ability of texture scores, in combination with clinical data and standard ultrasound findings, to predict the NBAS results was evaluated. Texture scores were significantly associated with all but one NBAS domain and better predicted NBAS results than clinical data and standard ultrasound findings. The best predictive value was obtained by combining texture scores with clinical information and ultrasound standard findings (area under the curve = 0.94). We conclude that texture analysis of neonatal cranial ultrasound-extracted quantitative features that correlate with later neurobehavior has a higher predictive value than the combination of clinical data with abnormalities in conventional cranial ultrasound.

PFM.65 Impact of cerebral redistribution on neurological outcomes in small for gestational age babies: a systematic review

BackgroundCerebral redistribution (CR) in fetuses with growth restriction has been thought to be a protective, compensatory mechanism.Aimto systematically review the evidence on whether CR, as assessed by MCA Doppler, in...