Neonatal Behavioral Neurological Assessment Scores Research Articles

Efficacy of different treatment times of mild cerebral hypothermia on oxidative factors and neuroprotective effects in neonatal patients with moderate/severe hypoxic-ischemic encephalopathy.

ObjectiveTo investigate the efficacy of different treatment times of mild cerebral hypothermia for treating moderate/severe hypoxic–ischemic encephalopathy (HIE) in neonatal patients and its effects on oxidative factors.MethodsThis prospective, randomized, controlled study included 92 neonatal patients with moderate/severe HIE and 30 controls. The patients with HIE received routine treatment, 48 hours of hypothermia, or 72 hours of hypothermia.ResultsSuperoxide dismutase (SOD) values were significantly lower and malondialdehyde (MDA) and neuron-specific enolase (NSE) values were higher in patients with HIE than in controls before the study. After 24, 48, and 72 hours of treatment, SOD values in all patients with HIE gradually increased and MDA and NSE values gradually decreased. At 3, 7, and 10 days, the Neonatal Behavioral Neurological Assessment scores were highest in the mild hypothermia for 72 hours group than in the other groups. The Mental and Psychomotor Development Indices scores of the Bayley Scales were significantly higher in the mild hypothermia for 72 hours group than in the other groups.ConclusionHypothermia treatment of 72 hours is better than 48 hours for improving oxidative conditions, reducing NSE values, and improving neurological behavior and development for neonates with moderate/severe HIE.

Effect of combined pharmacological, behavioral, and physical interventions for procedural pain on salivary cortisol and neurobehavioral development in preterm infants: a randomized controlled trial.

Repeated procedural pain may lead to increased secretion of cortisol and future neurobehavioral development disorders in preterm infants. Changes in the cortisol level may mediate the effect of neonatal repetitive procedural pain on altered childhood neurobehavioral development in preterm infants. However, few studies have investigated the effect of combined pharmacological, behavioral, and physical interventions over repeated painful procedures on pain response, cortisol level, and neurobehavioral development. This study examined (1) the efficacy and safety of sucrose combined with massage, music, non-nutritive sucking, and gentle human touch to treat preterm infants with repeated procedural pain; (2) the cortisol level at discharge from the neonatal intensive care unit (NICU); (3) neurobehavioral development at 40 weeks' corrected gestational age; and (4) the potential mediating effect of the cortisol level in the combined interventions on neurobehavioral development. Stable preterm infants (n = 76) were randomized to receive routine care or combined interventions across repeated painful procedures throughout their NICU stay. The Premature Infant Pain Profile scores in the early, middle, and late periods of the NICU stay were measured, as were the basal salivary cortisol level at admission and discharge, the Neonatal Behavioral Neurological Assessment score at 40 weeks' corrected gestational age, and the incidence of adverse effects during the study period. Our findings indicated that the combined interventions remained efficacious and safe for reducing repeated procedural pain, decreased the cortisol level at discharge, and promoted early neurobehavioral development in preterm infants. This effect may have been mediated through decreased cortisol levels and reduced repeated procedural pain.

A clinical analysis of neurobehavioral development within one year after birth in preterm infants with bronchopulmonary dysplasia

To study the effect of bronchopulmonary dysplasia (BPD) on neurobehavioral development within one year after birth in preterm infants. A retrospective analysis was performed for the preterm infants with a gestational age of <34 weeks who were born from September 2017 to December 2019 and completed the follow-up assessments of neurobehavioral development at the corrected gestational ages of 40 weeks and 3, 6, and 12 months. According to their diagnosis, they were divided into a BPD group with 23 infants and a non-BPD group with 27 infants. The outcome of neurobehavioral development was compared between the two groups at different time points. There was no significant difference in the neonatal behavioral neurological assessment score between the BPD and non-BPD groups at the corrected gestational age of 40 weeks (P>0.05). Based on the Gesell Developmental Scale, compared with the non-BPD group, the BPD group had significantly lower global developmental quotient (DQ) and DQs of fine motor, adaptive behavior, and personal-social behavior at the corrected gestational ages of 3, 6, and 12 months (P<0.05). For both groups, the DQ of language at the corrected gestational age of 6 months was significantly higher than that at the corrected gestational age of 12 months (P<0.017), the DQ of personal-social behavior at the corrected gestational age of 6 months was significantly higher than that at the corrected gestational age of 3 months (P<0.017), and the DQ of adaptive behavior at the corrected gestational age of 12 months was significantly higher than that at the corrected gestational ages of 3 and 6 months (P<0.017). Based on the BSID-II scale, there were no significant differences in mental development index and psychomotor development index at each time point between the two groups (P>0.05). The mental development index at the corrected gestational age of 3 months was significantly higher than that at the corrected gestational ages of 6 and 12 months in both groups (P<0.001). Preterm infants with BPD have delayed neurodevelopment within one year after birth compared with those without BPD, which should be taken seriously in clinical practice.

Effect of Parenting Training on Neurobehavioral Development of Infants

BackgroundEarly interventions have been believed to have a positive influence on the neurodevelopment of infants. Our Child Health Center has carried out parenting training for parents of infants for several years to promote the neurobehavioral development of infants at an early stage.Material/MethodsWe enrolled 117 families with term infants age 0–3 months who had completed a parenting training class at the Child Health Center of the Department of Pediatrics, the Third Xiangya Hospital. Parenting training included 4 parts: nursing, intelligence, social contact, and physical ability. A nurse practitioner demonstrated procedures to parents, who then performed them at home for 1 month. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate infants before and 1 month after parenting training.ResultsIn the comparative analysis before and after parenting training, there was a significant increase in the NBNA scores. For the infants whose parents received parenting training, the NBNA scores in total score (33.74±0.19 before parenting training vs. 36.69±0.20 after 1 month), neonatal behavioral capacity (10.19±0.14 before parenting training vs. 11.26±0.10 after 1 month), passive muscle tension (7.28±0.07 before parenting training vs. 7.82±0.04 after 1 month), and initiative muscle tension (4.29±0.08 before the parenting training vs. 5.61±0.13 after 1 month) were significantly higher one month before (P<0.01).ConclusionsTerm infant neurobehavior was associated with participation in parenting training, suggesting that these practices of parenting training support better early neurobehavioral development of infants.

Sex-specific influence of prenatal air pollutant exposure on neonatal neurobehavioral development and the sensitive window

Increasing evidence indicates the adverse effect of air pollution exposure during pregnancy on neurologic development among children. However, the impact on neurobehavioral development in fetus remains unknown. In 2017, a total of 1193 mother–newborns pairs were enrolled in a birth cohort study in Changsha, China. Exposures to PM2.5, PM10, SO2, CO and NO2 were determined by using inverse distance weighted method based on local monitoring station data. Neurobehavioral measure was administered at 48–72 h postpartum by utilizing the neonatal behavioral neurological assessment (NBNA). Basic information and covariates were collected by face to face interview. Generalized linear regression and multivariable restricted cubic spline function were performed to explore the trimester-specific association and dose-response relationship of maternal air pollution exposure with NBNA score, respectively. In adjusted three-pollutant model, PM2.5 exposure in trimester 2 was negatively associated with behavior score (β, −0.003; 95% CI, −0.006, −0.001) and the inverse relation was more pronounced in male infants. In addition, PM2.5 level in the 2nd trimester was negatively related to activetone score (β, −0.012; 95% CI, −0.021, −0.002) in a dose-dependent manner for both genders. Collectively, our results demonstrated that prenatal exposure to PM2.5 was linked to poor neurobehavioral performance of newborns. The second trimester was the most sensitive time window for the developments of behavior and activetone, and male subject was more vulnerable as compared to females.

Comparison of the effects of caffeine citrate administering at different time on outcome and neuro-development of premature infants

Objective To investigate the effect of caffeine citrate administering at different time on outcome and neurodevelopment of premature infants. Methods A total of 113 preterm infants with gestational age less than 32 weeks and birth weight less than 1 500 g who were hospitalized and treated in the neonatal intensive care unit from January 2018 to June 2018 were enrolled.According to the time when caffeine citrate treatment was started, they were divided into early treatment group(≤1 days) with 53 infants and late treatment group(1 to 10 days) with 60 infants.A retrospective analysis was performed for their clinical data.The perinatal conditions, treatment process and clinical outcomes of the two groups were compared and the neurological development was followed up at 12 months old. Results Compared with the late treatment group, the early treatment group had a significantly shorter durations of mechanical ventilation time, oxygen therapy time, hospitalization days and a significantly lower incidence of bronchopulmonary dysplasia, patent ductus arteriosusand intraventricular hemorrhage or periventricular leukomalacia, and there were significant differences between two groups(P<0.05, respectively). The neonatal behavioral neurological assessment score in the early treatment group was higher than that in the late treatment group at 40 weeks of gestational age, and there was significant difference between two groups(P<0.05). The mental developmental index at 3 months of corrected age, the mental developmental index and psychomotor developmental index at 12 months were significantly better in the early treatment group than those in the late treatment group, and there were significant differences between two groups(P<0.05, respectively). Conclusion Early use of caffeine citrate can improve the outcome of premature infants and improve the prognosis of nervous system. Key words: Caffeine citrate; Premature infant; Very low birth weight infant; Neural development

Umbilical cord blood troponin I, myoglobin and CK-MB in neonatal hypoxic ischemic encephalopathy and the clinical significance.

Associations of serum S-100β, cystatin C (Cys-C) and C-reactive protein (CRP) with umbilical cord blood troponin I (TnI), myoglobin (Mb) and creatine kinase-MB (CK-MB) in neonatal hypoxic ischemic encephalopathy (NHIE) and the clinical significance were explored. A total of 40 patients with NHIE treated in the Binzhou Medical University Hospital were selected as observation group, while another 40 healthy neonates in the same period were selected as control group. The related data of all subjects were collected, and the levels of serum S-100β protein, CRP and Cys-C, and umbilical cord blood TnI, Mb and CK-MB were compared between the two groups. Associations of the neonatal behavioral neurological assessment (NBNA) score with the changes in serum S-100β protein, CRP and Cys-C and umbilical cord blood TnI, Mb and CK-MB were analyzed. The univariate and multivariate logistic regression analyses were performed to determine the risk factors for NHIE. In observation group, the levels of serum S-100β protein, CRP and Cys-C were significantly higher than those in control group, and the levels of umbilical cord blood TnI, Mb and CK-MB were also significantly higher than those in control group. The NBNA score was negatively correlated with the changes in serum S-100β protein, CRP and Cys-C as well as the umbilical cord blood TnI, Mb and CK-MB. The levels of serum S-100β protein, CRP and Cys-C, and umbilical cord blood TnI, Mb and CK-MB were related risk factors for NHIE. The increased levels of serum S-100β protein, CRP and Cys-C, and umbilical cord blood TnI, Mb and CK-MB were independent risk factors for NHIE. In NHIE patients, the levels of serum S-100β protein, CRP and Cys-C, and umbilical cord blood TnI, Mb and CK-MB all significantly increased, and they have negative correlation with the nervous system function after onset.

Prenatal exposure to arsenic and neurobehavioral development of newborns in China

TPS 731: Neurological effects in children, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: The link between arsenic exposure and deficits in children’s neurodevelopment has been well documented, but it remains unclear that whether prenatal arsenic exposure can affect early neurobehavioral development in infancy. Methods: To assess the associations of in utero arsenic exposure with neurobehavioral outcomes in newborns, we conducted a cross-sectional study of 892 mother-infant pairs from 10 hospitals in Shanghai, China. The concentrations of arsenic were determined in cord blood samples. Neurobehavioral measures were administered at 3 days postpartum in full-term newborns using the neonatal behavioral neurological assessment (NBNA). Logistic regression models were used to estimate odds ratios for dichotomous NBNA outcomes. Results: After adjusting for potential confounders, a natural log unit (ln-unit) increase in cord blood arsenic was associated with 90% increased odds of low NBNA score (95% confidence interval [CI]: 1.62, 2.23). As for clusters, each ln-unit arsenic increase was associated with 47% increased odds of low score for behavior (95% CI: 1.31, 1.66) and 36% increased odds of low score for passive muscle tone (95% CI: 1.23, 1.51). Odds ratios comparing extreme tertiles were 8.62 (95% CI: 4.19, 17.8) for total scale, 3.69 (95% CI: 2.35, 5.82) for behavior, and 3.32 (95% CI: 2.21, 4.97) for passive tone (all p-trend < 0.001). Stratified analyses showed more evident associations in newborns of mothers ≥ 29 versus < 29 years of age. Conclusions: Our results provide evidence for an inverse association between low-level prenatal arsenic exposure and neonatal neurobehavioral performance, particularly among newborns born to older mothers. Further studies are warranted to confirm arsenic-related neurodevelopmental deficits in early life.

Prognosis of fetuses with ventriculomegaly: An observational retrospective study.

To investigate the prognosis of fetuses with ventriculomegaly (VM). Clinical data were collected from 234 cases of fetal VM diagnosed by ultrasound between March 2010 and July 2016. VM progression was monitored, and karyotyping and infection screening performed. Magnetic resonance imaging (MRI) was performed where increasing ventricular diameter was noted. Neonatal behavioral neurological assessment (NBNA) was carried out after birth, and Bayley Scales of Infant Development assessment at 6 months. The in utero outcomes of Group A were better than Group B in 173 pregnancies. Isolated VM (IVM) was associated with better prognosis than nonisolated VM (NIVM); the regression rates were 74.6% (59/79) and 52.1% (49/94), respectively (χ2 = 10.222, .006). The NBNA scores were significantly higher in Group A than Group B (χ2 = 4.231, .004), but not significantly different between IVM and NIVM. The composition ratios of both the psychomotor and mental developmental index (PDI and MDI) scores were not significantly different between Groups A and B (Z = 1.869, .062 and Z = 0.826, .409, respectively). Significant differences in in utero outcomes were observed between IVM and NIVM cases in Groups A and B. Fetal VM prognosis is affected by the width of ventricle, chromosome abnormalities, coexisted abnormalities, and in utero progression.

Prenatal polycyclic aromatic hydrocarbons metabolites, cord blood telomere length, and neonatal neurobehavioral development

BackgroundPrenatal exposure to polycyclic aromatic hydrocarbon (PAH) is a potential risk factor for child neurobehavioral development. Telomere length (TL) has important implications for health over the life course. ObjectiveIn this study, we aimed to investigate whether prenatal urinary PAH metabolites were associated with adverse neonatal neurobehavioral development and altered cord blood TL and to explore whether the change of TL was a predictor of neonatal neurobehavioral development. MethodWe enrolled 283 nonsmoking pregnant women in Taiyuan city. Eleven PAH metabolites were measured in maternal urine samples. TL in cord blood was measured by real time quantitative polymerase chain reaction. Neonatal behavioral neurological assessment (NBNA) tests were conducted when the infants were three days old. Multiple linear regression models were used to analyze the associations of maternal urinary PAH metabolites with NBNA scores and cord blood TL, and restricted cubic spline models were further used to examine the shapes of dose-response relationships. A mediation analysis was also conducted. ResultWe observed dose-response associations of maternal urinary 2-hydroxyfluorene (2-OHFlu) and 2-hydroxyphenanthrene (2-OH Phe) with decreased active tone scores, sum of NBNA scores, and cord blood TL (P for trend<0.05). Each 1 unit increase in urinary levels of Ln (2-OH Flu) or Ln (2-OH Phe) was associated with a 0.092 or 0.135 decrease in the active tone scores and a 0.174 or 0.199 decrease in the sum of NBNA scores. Mediation analysis showed TL could explained 21.74% of the effect of sum of NBNA scores change related to prenatal exposure to 2-OH Phe (P for mediator = 0.047). ConclusionOur data indicates maternal urinary specific PAH metabolites are inversely associated with neonatal neurobehavioral development and cord blood TL. TL mediates the associations of 2-OH Phe with neonatal neurobehavioral development and partly explains the effect of 2-OH Phe on neonatal neurobehavioral development.

Relation of prenatal low-level mercury exposure with early child neurobehavioral development and exploration of the effects of sex and DHA on it

BackgroundThe extent to which low-level, in utero mercury exposure affects child neurobehavioral development during early childhood has been inconclusive. In addition, the effects of sex and docosahexaenoic acid (DHA) on these relationships remain unclear and controversial. ObjectivesThis study aimed to explore the associations between prenatal low-level mercury exposure and child neurobehavioral development during the neonatal and toddler periods and to examine the potential confounding or interactive effects of sex and DHA status on these relationships. MethodsThis longitudinal study included 286 mother-child pairs in Shanghai, China, whose cord blood samples were analyzed for total mercury, DHA, other nutrients and coexposure contaminants possibly due to maternal consumption of seafood. Children's neurobehavioral development was assessed with the Neonatal Behavioral Neurological Assessment (NBNA) three days after birth and the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) at 18 months of age. ResultsCord blood mercury concentration, with geometric mean of 2.00 μg/l, was related to poorer NBNA performance but unrelated to BSID-III scores with adjustment for DHA and other covariates. Cord serum DHA was positively associated with motor development assessed by the BSID-III. The interaction was found between mercury and DHA on the NBNA score, and the inverse relation of cord blood mercury with NBNA was significant only among the children with lower DHA levels (<45.54 μg/ml). Additional adjustment for DHA didn't change the associations between cord blood mercury and neurodevelopmental outcomes substantially. The mercury by sex interaction for language of BSID-III was borderline significant. ConclusionsOur research provides initial evidence for the negative effects of prenatal low-level mercury exposure on neonates' neurobehavioral development. Prenatal DHA status may modify the relationship between cord blood mercury level and neonatal neurobehavioral development, but the confounding effects of DHA were not observed. Further studies are warranted before the causality of the observed associations can be determined.

Efficacy and safety of selective brain hypothermia therapy on neonatal hypoxic-ischemic encephalopathy

To evaluate the efficacy and safety of selective brain hypothermia (SBH) in the treatment of neonates with moderate or severe neonatal hypoxic-ischemic encephalopathy (HIE), and the effect of SBH treatment on serum levels of neuron-specific enolase (NSE) and central nervous specific protein S100. A prospective randomized controlled trial was conducted. From January 2015 to June 2017, 42 children with moderate to severe HIE in the neonatal intensive care unit (NICU) of the First Affiliated Hospital of Bengbu Medical College were enrolled, and they were randomly divided into SBH treatment group and routine treatment group after obtaining the consent of the guardian of the children. The children in routine treatment group were given the traditional symptomatic supportive treatment, supplemented by drugs to promote nerve cell growth. On the basis of traditional treatment, the children in the SBH treatment group were given SBH treatment within 6 hours after birth. The nasopharyngeal temperature was maintained at 33.0-34.5 centigrade and the rectal temperature was maintained at 34.5-35.0 centigrade. The general clinical data of the two groups including gender, gestational age, birth weight, age, 5-minute neonatal asphyxia score (Apgar score), score for neonatal acute physiology perinatal extension version II (SNAPPE II) were collected. The primary outcomes were hospitalized death, severe disability at 15 months of age, neonatal behavioral neurological assessment (NBNA) score at 28 days of age, and Bayley scales of infant development (BSID) score [including mental development index (MDI) score and psychomotor development index (PDI) score] at 15 months of age at follow-up. The secondary outcomes were serum levels of NSE and S100 protein. The occurrences of adverse events in the two groups were recorded. Among 42 HIE children, 1 child of severe congenital malformation and 1 child of platelet count (PLT) < 50×109/L were excluded, and 40 children were enrolled in the study group. During the follow-up period, 2 children of SBH treatment group and 2 children of routine treatment group were lost or the outcome was unknown. Finally, 18 children of each group were enrolled in the analysis. There was no significant difference in the baseline data of gender, gestational age, birth weight, age, 5-minure Apgar score or SNAPPE II score between the two groups, indicating that the baseline data of the two groups were balanced and comparable. The incidence of severe disability in the SBH treatment group was significantly lower than that in the routine treatment group [5.6% (1/18) vs. 44.4% (8/18), P < 0.05]. There was 1 child death in the routine treatment group and no death in the SBH treatment group. Compared with the routine treatment group, the 28-day NBNA score of the SBH treatment group was increased by 2.9 [95% confidence interval (95%CI) = 1.0-4.8], BSID score at 15 months of age was improved significantly, MDI score was increased by 11.8 (95%CI = 4.3-19.3), and PDI score was increased by 12.4 (95%CI = 2.5-22.3), with significant differences between the two groups (all P < 0.05). After 3 days of treatment, the serum NSE and S100 protein levels in both groups were significantly decreased as compared with those before treatment [NSE (μg/L): 30.15±15.18 vs. 31.32±14.75, S100 (ng/L): 387.5 (273.3, 573.0) vs. 890.0 (590.5, 1 162.5) in routine treatment group; NSE (μg/L): 29.09±16.22 vs. 32.25±15.43, S100 (ng/L): 402.5 (302.2, 580.5) vs. 842.0 (462.3, 1 200.5) in SBH treatment group, all P < 0.05]. There was no significant difference in serum NSE or S100 protein level between the two groups (all P > 0.05). There was no serious adverse event such as arrhythmia, large vein thrombosis or irreducible hypotension in both groups, and there was no significant difference in the incidence of general adverse events such as sinus bradycardia, scleredema, blood glucose disorder, or systemic infection between the two groups [16.7% (3/18) vs. 11.1% (2/18), 5.6% (1/18) vs. 5.6% (1/18), 22.2% (4/18) vs. 11.1% (2/18), 5.6% (1/18) vs. 5.6% (1/18), all P > 0.05]. SBH treatment could significantly increase the NBNA score at 28 days of birth and BSID score at 15 months of age, reduce the incidence of severe disability in moderate and severe HIE children, but it was not be proved that SBH could reduce the mortality. Compared with routine treatment, SBH treatment had no significant superiority on improving the levels of serum NSE and S100 protein, suggesting that SBH could not protect the brain by inhibiting the apoptosis of nerve cells and promoting the repair of nerve cells.

Safety and early curative efficacy of lipocyte bioactive secretion in preventing white matter injury of premature infants

Objective To explore the safety and efficacy of intrathecal administration of adipose stem cells derived from bioactive secretome (ASCBS) in treatment of whiter matter injury (WMI) in the preterm infants. Methods Sixty-three cases of WMI were recruited according to the uniform standards from multiple medical centers and they were divided into 3 gestational age (GA) subgroups, which were 21 cases in group A (GA 24-28+ 6), 20 cases in group B (GA 29-32+ 6), and 22 cases in group C (GA 33-36+ 6). The patients were randomly divided into treatment groups and control groups by tossing coins.The treatment groups received lumbar puncture followed with ASCBS intra-thecal injection once daily for 3 consecutive days.Follow-up study included Neonatal Behavioral Neurological Assessment (NBNA) at term-equivalent age and neurodevelopment at corrected age of 6-month.Neurodevelopment was assessed by using the Bayley Scales of Infant Development and Peabody Developmental Motor Scale.The survival rates, NBNA scores, mental development index (MDI), psychomotor develop index (PDI), total motor development quotient, gross motor development quotient and fine motor development among each subgroup were compared. Results Sixty-three cases were recruited, including 31 in the treatment group and 32 in the control group.Only 1 case in the treatment groups lost in the follow-up.No clinical side effects were found in the treatment groups.There was no significant diffe-rence in the survival rate and complication in the preterms in all subgroups of the treatment group and control group (all P>0.05). The gross and total motor development quotient in the treatment group A was higher than that in the control group A(gross motor development quotient: 98.330±6.282 in treatment group A, 90.330±3.777 in control group A, P=0.040; total motor development quotient: 97.330±4.803 in treatment group A, 91.000±4.472 in control group A, P=0.023). The rest findings showed no significant difference between groups. Conclusion The treatment of WMI in preterm infants with ASCBS is safe and can promote the motor development of preterm infants with GA in 24 -28 weeks. Key words: Stem cells; Infant, premature; White matter injury; Lipid stem cells bioactive secretion

Prenatal exposure to arsenic and neurobehavioral development of newborns in China

The link between arsenic exposure and deficits in children's neurodevelopment has been suggested, but it remains unclear regarding the arsenic-related effects on the developing brain in early life. To investigate the associations of in utero arsenic exposure with neonatal neurobehavioral development, we conducted a cross-sectional study of 892 mother-infant pairs from 10 hospitals of different levels in Shanghai, China. The concentrations of arsenic were determined in cord blood samples. Neurobehavioral measures were administered at 3 days postpartum in full-term newborns using the neonatal behavioral neurological assessment (NBNA). Logistic regression models were used to estimate odds ratios for dichotomous NBNA outcomes. After adjusting for potential confounders, a natural log unit (ln-unit) increase in cord blood arsenic was associated with 90% increased odds of low NBNA score (95% confidence interval [CI]: 1.62, 2.23). As for clusters, each ln-unit arsenic increase was associated with 47% increased odds of low score for behavior (95% CI: 1.31, 1.66) and 36% increased odds of low score for passive muscle tone (95% CI: 1.23, 1.51). Odds ratios comparing extreme tertiles were 8.62 (95% CI: 4.19, 17.8) for total scale, 3.69 (95% CI: 2.35, 5.82) for behavior, and 3.32 (95% CI: 2.21, 4.97) for passive tone (all p-trend < 0.001). Stratified analyses showed that these associations were strengthened in newborns of mothers over 29 years of age. Our results provide evidence for an inverse association between low-level prenatal arsenic exposure and neurobehavioral performance of newborns, particularly among those born to older mothers. Further studies are warranted to confirm these findings and to determine whether such decrements in early neurodevelopment persist in later childhood.

First-trimester blood concentrations of drinking water trihalomethanes and neonatal neurobehavioral development in a Chinese birth cohort.

Toxicological evidence indicates that exposure to drinking water trihalomethanes (THMs) can impair neural development. However, no epidemiologic study to date has evaluated the relation of trihalomethanes exposure with neonatal neurobehavioral development. Here we aimed to evaluate if prenatal exposure to THMs during early pregnancy is associated with neonatal neurobehavioral development in 451 Chinese mother-child pairs. First trimester blood THMs [chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM)] were determined by solid phase micro-extraction gas chramatography. Neonatal neurobehavioral development was assessed using neonatal behavioral neurological assessment (NBNA) on the third day after birth. Multivariable linear regression models and restricted cubic spline models were constructed to evaluate the associations between blood THMs and neonatal neurological development scores. Blood concentrations of BDCM, whether modeled as continuous or categorical variables, were inversely associated with total NBNA score of newborns based on the multivariable linear regression. The association was further confirmed in the cubic spline model, and a linear dose-response relationship was observed. Stratified analysis showed that the inverse association between blood BDCM and total NBNA score was more evident in male infants than females. Our findings suggest that exposure to THMs during early pregnancy may be associated with impaired neonatal neurobehavioral development.

Study on the correlation of changes of IGF-1, GH, and NGB levels and NBNA score in neonates with hypoxic ischemic encephalopathy.

The aim of this work was to investigate the correlation between dynamic changes of serum insulin-like growth factor 1 (IGF-1), growth hormone (GH), neuroglobin (NGB), and neonatal behavioral neurological assessment (NBNA) scores in different periods in neonates with hypoxic ischemic encephalopathy (HIE). Sixty HIE patients in the Neonatal Department of our hospital were selected. They were divided into the mild group (35 cases), moderate group (19 cases), and severe group (six cases) according to the diagnostic criteria. During the same period, 18 neonatal patients born at term in our hospital were chosen as the control group. Data were analyzed by SPSS19.0 statistical software (SPSS Inc., Chicago, IL, USA). The dynamic changes of IGF-1, GH, and NGB in different periods, as well as NBNA scores in HIE patients and in the control group, were analyzed. Furthermore, we analyzed the degree of correlation of IGF-1, GH, and NGB in different periods as well as NBNA scores in HIE patients and in the control group. 1- IGF-1 levels between the three groups of HIE patients and control group had significant differences (p<0.05); 2- Comparing GH levels between the HIE experimental groups and control group, there was no statistical significance; 3-Comparing serum NGB levels between the three HIE experimental groups and control group, there were significant differences (p<0.05); 4- Comparing NBNA scores of the three groups of HIE patients and control group, there was a significant difference between the mild group and control group; 5- Serum IGF-1 and NBNA scores were positively correlated in the acute and recovery phase, while NGB level and NBNA scores were negatively correlated in the acute and recovery phase (p<0.05), which had statistical significance. In neonatal HIE, serum IGF-1, GH, and NGB levels change. IGF-1 and NGB levels correlate with the prognosis of HIE.

Effects of abnormal 75 g oral glucose tolerance test at different time points on neonatal complications and neurobehavioral development in the pregnant women with gestational diabetes mellitus (a STROBE-compliant article).

With the improvement of living standard, gestational diabetes mellitus (GDM) incidence is increasing every year. We observed the effects of abnormal 75 g oral glucose tolerance test (OGTT) at different time points on neonatal complications and neurobehavioral development in GDM.A total of 144 newborns whose mothers were diagnosed with GDM and received prenatal examination and childbirth in our hospital from October 2015 to April 2016, were observed in this study. Pregnant women underwent 75 g OGTT and the blood glucose level was recorded on an empty stomach, as well as postprandial 1 and 2 hours, respectively. Based on the frequency of 75 g OGTT-abnormal time points, the pregnant women were divided into group 1 (OGTT abnormality at 1 time point), group 2 (OGTT abnormality at 2 time points), and group 3 (OGTT abnormality at 3 time points). Neonatal behavioral neurological assessment (NBNA) was performed on the 3 groups, respectively.In the total score of NBNA, there was a significant difference among the 3 groups (F = 17.120, P = .000), and there were significant differences between the 3 groups (all P < .05). The incidence of neonatal hypoglycemia was significantly lower in groups 1 and 2 than in group 3, and the incidence of macrosomia was significantly lower in groups 1 than in groups 2 and 3 (all P < .05). In the 144 newborns, NBNA scoring was significantly lower in the newborns with hypoglycemia than in the newborns with normal blood glucose level, and in macrosomia than in the newborns with normal body weight (all P < .01).With the increase of OGTT-abnormal time points in the pregnant women with GDM, the incidences of neonatal hypoglycemia and macrosomia rise and neonatal NBNA score decreases. Therefore, reasonable measures should be adopted as early as possible to prevent poor prognosis in the pregnant women with GDM.

Application of family centered cognitive intervention in neonatal nursing

Objective To explore the role of family centered cognitive intervention in neonatal nursing. Methods According to the random number table method, 100 newborns were randomly divided into observation group and control group, 50 cases in each group.The two groups received routine health education, and the observation group received the family centered cognitive intervention.After the intervention, the neonatal physical development status (body weight, height, head circumference) and neonatal disease status of the two groups were analyzed.The active muscle tension, passive muscle tension, primitive reflexes, behavior ability, general evaluation and neonatal behavioral neurological assessment score(NBNA score) were evaluated and analyzed. Results The body weight[(4 753.88±434.59)g], length[(55.16±1.17)cm], head circumference[(37.34±0.51)cm]after 1 month discharge of the observation group were better than those of the control group[(4 295.78±344.63)g, (52.25±0.58)cm, (35.67±0.21)cm], the differences between the two groups were statistically significant(t=2.564, 6.235, 8.679, all P<0.05). The incidence rate of born disease of the observation group was 14.00%, which of the control group was 32.00%, there was statistically significant difference between the two groups(χ2=4.574, P<0.01). The active muscle tension, passive muscle tension, behavior ability, original reflection, the general evaluation and NBNA scores of the observation group were significantly higher than those of the control group, the differences were statistically significant(all P<0.01). Conclusion Family centered intervention can significantly improve the growth status of newborn infants, reduce the incidence of the disease, it is beneficial to improve the patients' neurological behavior, it is worthy of wide application. Key words: Home nursing; Cognition; Neonatal nursing; Child development

Role of magnetic resonance diffusion tensor imaging on prognostic evaluation of term neonates with asphyxia

Objective To discuss the prognostic evaluation of magnetic resonance diffusion tensor imaging (DTI)in term neonates with mild and severe asphyxia. Methods Eleven neonates with mild asphyxia, 14 neonates with severe asphyxia and 10 control neonates were studied.All the neonates were examined by conventional magnetic resonance imaging(MRI) and DTI.Fraction anisotropy (FA) values, apparent diffusion coefficient (ADC) values, voxel numbers and fiber numbers were calculated in seven regions of interest(ROI) and compared among the 3 groups.The correlation between FA values and neonatal behavioral neurological assessment(NBNA)scores were analyzed. Results (1) FA values in the left and the right thalamus were 0.54±0.08 and 0.56±0.15 in control group, 0.45±0.03 and 0.44±0.10 in mild group, and 0.21±0.11 and 0.25±0.13, respectively in severe group .FA values in posterior limbs of internal capsule were 0.49±0.09 and 0.48±0.08 in control group, 0.37±0.08 and 0.38±0.03 in mild group, and 0.20±0.04, 0.19±0.13 in severe group; FA values in thalamus and posterior limbs of internal capsule had statistical differences among the 3 groups(F=9.12, 9.11, 8.18, 8.55, all P<0.05). Voxel numbers in the left and the right superior longitudinal fasciculus were 1 094±112 and 1 123±113 in control group, 986±111 and 1 009±144 in mild group, 450±116 and 671±126 in severe group.Voxel numbers in anterior limbs of internal capsule were 947±104 and 1 237±184 in control group, 854±118 and 799±114 in mild group, 324±110 and 311±126 in severe group.Voxel numbers in posterior limbs of internal capsule were 2 047±129 and 2 137±238 in control group, 1 843±233 and 1 753±247 in mild group, 867±118 and 999±167 in severe group.Voxel numbers in superior longitudinal fasciculus, anterior and posterior limbs of internal capsule had statistical differences among the 3 groups(F=10.11, 9.45, 7.33, 8.45, 12.65, 11.23, all P<0.05); Fiber numbers in the left and the right cingulate gyrus were 245±72 and 405±94 in control group, 225±52 and 365±114 in mild group, 145±62 and 185±84 in severe group.Fiber numbers in inferior front-occipital fasciculus were 56±19 and 212±33 in control group, 49±22 and 197±33 in mild group , 33±12 and 156±39 in severe group.Fiber numbers in posterior limbs of internal capsule were 284±112 and 988±233 in control group, 234±67 and 678±234 in mild group, 114±67 and 188±84 in severe group.Fiber numbers in cingulate gyrus, inferior front-occipital fasciculus and posterior limbs of internal capsule had statistical differences among the 3 groups (F=3.11, 3.45, 9.88, 9.12, 7.45, 8.88, all P<0.05). (2)The correlation between FA value and NBNA scores was analyzed: the correlation coefficient in posterior limbs of internal capsule was 0.666 which was higher than those of the other areas.The area under the ROC curve of FA values in anterior limbs of internal capsule was 0.816 (P=0.005), used NBNA scores≥35 as a good outcome.FA values (≥0.375) in the posterior limbs of the internal capsules predicted a good outcome and the corresponding sensitivity and specificity was 73.1% and 77.8%, respectively. Conclusion In some ROIs, FA values, voxel numbers, and fiber numbers can quantitatively reflect the degree of white matter injury in neonates with asphyxia.Furthermore, the FA values in the posterior limbs of the internal capsules are closely correlated with NBNA scores, so it has more important clinical significance, and can accurately and objectively assess the prognosis in neonates with asphyxia. Key words: Infant, newborn; Asphyxia; Diffusion tensor imaging; Fraction anisotropy; White matter fiber tractography

Adjuvant treatment with monosialoganglioside may improve neurological outcomes in neonatal hypoxic-ischemic encephalopathy: A meta-analysis of randomized controlled trials.

BackgroundGanglioside has a neuroprotective role in neonatal hypoxic–ischemic encephalopathy (HIE). This study aimed to evaluate the neurological outcomes of monosialoganglioside as adjuvant treatment for neonatal HIE by conducting a meta-analysis.MethodsA comprehensive literature search was made in the Pubmed, EMBASE, Cochrane Library, Wanfang, CNKI, VIP databases through October 2016. Randomized controlled trials comparing monosialoganglioside with the usual treatment for newborns having HIE deemed eligible. Weighted mean difference (WMD) and risk ratio (RR) with 95% confidence interval (CI) were calculated for continuous and dichotomous data, respectively.ResultsTen trials consisting of 787 neonates were included. Adjuvant treatment with monosialoganglioside significantly reduced major neurodevelopmental disabilities (RR = 0.35; 95% CI = 0.21–0.57), cerebral palsy (RR = 0.32; 95% CI = 0.12–0.87), mental retardation (RR = 0.31; 95% CI = 0.11–0.88) as well as improved the mental (WMD = 14.95; 95% CI = 7.44–22.46) and psychomotive (WMD = 13.40; 95% CI = 6.69–20.11) development index during the follow-up. Also, monosialoganglioside significantly improved Neonatal Behavioral Neurological Assessment scores (WMD = 2.91; 95% CI = 2.05–3.78) compared with the usual treatment. However, adverse effects associated with monosialoganglioside were poorly reported in the included trials.ConclusionAdjuvant treatment with monosialoganglioside had beneficial effects in improving neurological outcomes in neonatal HIE. However, these findings should be interpreted with caution because of methodological flaws in the included trials. Furthermore, safety of monosialoganglioside use should also be further evaluated.