Neurodevelopmental Evaluation Research Articles

Abstract 4126358: Fetal cardiac physiology but not cerebrovascular resistance predicts neurodevelopmental outcomes in congenital heart disease

Introduction: Fetal “brain sparing” autoregulatory mechanisms respond to reduced cardiac output or substrate delivery by decreasing cerebrovascular resistance to maintain cerebral blood flow. In patients with congenital heart disease (CHD), data are conflicting on the association between fetal cerebral Doppler measures and postnatal neurodevelopment, possibly due to the heterogeneity of fetal cardiac physiology. Aim: To evaluate whether fetal cerebrovascular resistance estimated by middle cerebral artery pulsatility index (MCA PI) and cerebroplacental ratio (CPR; MCA PI divided by umbilical artery PI) predict neurodevelopment in patients with CHD. Methods: This retrospective analysis of a prospectively-enrolled cohort included cases with isolated CHD and healthy controls with a family history of CHD. Cases were classified by fetal cardiac physiology: single vs. biventricular circulation, outflow obstruction (none, systemic, pulmonary), and cerebral substrate delivery (normal, mixed, abnormal). Subjects underwent fetal echocardiography with cerebral and umbilical doppler measures (normalized for gestational age) as well as neurodevelopmental evaluation at two years of age with the Bayley Scales of Infant and Toddler Development III and IV. Results: Fetal echocardiograms and neurodevelopmental testing were obtained in 82 cases and 48 controls. There was no difference in MCA PI or CPR between cases and controls; however cases with mixed vs. normal substrate delivery had lower z-scores for MCA PI (-1.08 + 1.16 vs. -0.43 + 1.38, p=0.05) and CPR (-0.74 + 0.62 vs. -0.37 + 0.59, p=0.02). Cases had lower Bayley scores across all composite domains: cognitive (97.8 + 11.8 vs. 103.4 + 14.7, p=0.03), language (97.6 + 15.6 vs. 105.6 + 21.3, p=0.03), and motor (94.0 + 10.7 vs. 100.4 + 10.9, p=0.003). MCA PI and CPR were not associated with Bayley scores in cases or in sub-group analysis by fetal cardiac physiology. In multivariable analyses of Bayley scores adjusting for medical and demographic data, lower motor composite score was predicted by mixed vs. normal substrate delivery (partial R2=12.4%, p<0.001) and single ventricle physiology (partial R2=6.5%, p=0.008). Conclusions: In patients with CHD, fetal single ventricle physiology with mixed substrate delivery was associated with worse motor development. The lack of association of fetal cerebral dopplers with neurodevelopment may suggest that decreased cerebrovascular resistance is not necessarily an effective compensatory mechanism in CHD.

Is an Exclusive Human Milk Diet at the Time of Neonatal Intensive Care Unit Discharge Adequate to Maintain Growth and Neurodevelopment among Very Preterm Infants?

Background: An exclusive human milk (EHM) diet has numerous benefits. Formula supplementation may be recommended for former preterm infants at the time of neonatal intensive care unit (NICU) discharge to meet perceived metabolic demands and caloric goals. Recommendations addressing postdischarge nutrition for very preterm infants (VPTIs) are controversial, as the benefits of human milk supplementation regarding long-term growth, neurodevelopment, and chronic conditions are mixed. Objective: To compare growth and neurodevelopment of former VPTI fed an EHM diet to a supplemented/formula diet at NICU discharge. Materials and Methods: A retrospective cohort study of VPTI was followed at the Regional Neonatal Follow-up Program. Patients were categorized by diet at NICU discharge: EHM diet; mixed diet (EHM and formula); and exclusive formula diet. Growth percentile ranks at the first neonatal follow-up visit and 3 years of age were compared by diet type at NICU discharge. Neurodevelopmental outcomes as measured by the Bayley Scales of Infant Development 3rd Edition at 3 years of age were also compared. Results: Among 835 VPTIs, weight percentiles at the first neonatal follow-up visit were similar between the three NICU discharge diet types. One hundred fifty-eight subjects received neurodevelopmental evaluations at 3 years of age; anthropometrics and neurodevelopment were similar irrespective of diet at NICU discharge. Conclusion: An EHM diet at NICU discharge is appropriate to support growth in infancy as well as growth and neurodevelopment through 3 years of age. Thus, this raises the question of whether routine nutritional supplementation is necessary for VPTIs at NICU discharge.

Parental magnetic resonance imaging for the evaluation of fetuses with brain anomalies.

To evaluate the role of parental magnetic resonance imaging (MRI) in assessing fetuses with suspected brain anomalies and its use in prenatal counselling. A retrospective, multicentre chart review was conducted on fetuses who underwent brain MRI because of suspected brain abnormalities between January 2008 and December 2022, with one or both parents who underwent brain MRI (MRI-Trio) as part of prenatal counselling. Clinical and demographic data were collected, including fetal and parental MRI findings, prenatal counselling outcomes, genetic testing results, family and previous pregnancy history, neurological examinations of the born children up to 24 months of age, and autopsy reports of fetuses from terminated pregnancies. MRI-Trio concordance was defined as at least one abnormal brain feature identified with similarity in the fetus and the parents. The live-born children were assessed postnatally through either neurodevelopmental evaluations or telephone interviews. Sixty pregnancies were included (41.7% with concordant and 58.3% with discordant MRI-Trio). Forty-two children were born (70%) and 17 pregnancies were terminated (28.3%). One case of in utero fetal death (1.7%) was reported. The most common brain findings were multiple anomalies (n = 26, 43.3%), isolated disorders of the corpus callosum (n = 17, 28.3%), atypical periventricular pseudocysts (n = 6, 10%), and anomalies of the anterior complex (n = 4, 6.7%). MRI-Trio enabled better prognostication. When MRI-Trio was concordant, counselling was more favourable (n = 22, 36.6%) and the majority of live-born children exhibited typical development (p < 0.001). MRI-Trio is a valuable tool for identifying dominantly inherited brain anomalies that may not hold developmental significance or are associated with favourable outcomes, acknowledging the potential for variable penetrance, which may result in more severe presentations. Concordant MRI-Trio findings can enhance the accuracy of prenatal counselling, potentially reducing the incidence of termination of pregnancy.

Impaired motor and social skill development in infancy predict high autistic traits in toddlerhood

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. Early diagnosis in the critical period is important for ASD children. Recent studies of neurodevelopmental behavioral features and joint attention in high-risk infants showed there are some special cues which can distinguish ASD from typical development infant. But the findings of high-risk population may not be applicable to the general population. It is necessary to “analogically” study the potential warning traits of ASD in infancy in the general population. We did a nested case-control study from June 2019 to November 2022 in Tianjin, China, including 76 general infants whom completed the neurodevelopmental evaluation, the Checklist for Autism in Toddlers-23 (CHAT-23) screening, and eye tracking task. Social behavior quotient in infancy was negatively correlated to CHAT-23 total scores in toddlerhood. Social behavior quotient in infancy was positively correlated to initiating joint attention in toddlerhood. Regression model showed that high fine motor scale and social behaviour scale quotient in infancy were associated with an decreased risk of the total score of CHAT-23 ≥ 2 in toddlerhood. The Receiver operating characteristic curve showed the social behaviour in infancy alone and the combination of fine motor and social behaviour in infancy contributed to auxiliary diagnosis of higher level of autistic traits in toddlerhood. These findings suggest that Impaired development of fine motor and social behavior in infancy are potential warning features of high autistic traits in general population.

The impact of a biocellulose-based repair of fetal open spina bifida on the need to untether the cord: is it time to unify techniques for prenatal repair?

To report the need for cord untethering after prenatal repair of open spina bifida using a unique biocellulose-based technique performed at a later gestational age. An observational cohort study was conducted to determine the incidence of tethered cord syndrome. Between May 2013 and May 2022, we performed 172 procedures using the percutaneous fetoscopic approach in fetuses at 26-28 weeks of gestation. After placode dissection, a biocellulose patch was placed to cover the placode, a myofascial flap (when possible) was dissected, and the skin was closed. Owing to death or loss to follow-up, 23 cases were excluded. Cord tethering syndrome was defined as symptoms of medullary stretching, and the infants were evaluated and operated on by local neurosurgeons after an magnetic resonance imaging examination. Infants over 30-month had ambulation and neurodevelopment evaluations (PEDI scale). Among 172 cases operated at a median gestational age of 26.7 weeks and delivered at 33.2 weeks, 149 cases were available for postnatal follow-up, and cord untethering was needed in 4.4% of cases (6/136; excluding 13 cases younger than 12 months). Cerebrospinal fluid diversion and bladder catheterization were needed in 38% and 36% of cases, respectively. Of the 78 cases evaluated at 30 months, 49% were ambulating independently, and 94% had normal social function. The biocellulose-based technique was associated with a low rate of cord tethering, wich may be attributed to the lack of the duramater suture during prenatal repair, the formation of a neoduramater and/or later gestational age of surgery.

Exploring the neurological features of individuals with germline PTEN variants: A multicenter study.

PTEN, a known tumor suppressor gene, is a mediator of neurodevelopment. Individuals with germline pathogenic variants in the PTEN gene, molecularly defined as PTEN hamartoma tumor syndrome (PHTS), experience a variety of neurological and neuropsychiatric challenges during childhood, including autism spectrum disorder (ASD). However, the frequency and nature of seizures and the utilization of allied health services have not been described. Young patients with PHTS and sibling controls were recruited across five centers in the United States and followed every 6-12 months for a mean of 2.1 years. In addition to the history obtained from caregivers, neurodevelopmental evaluations and structured dysmorphology examinations were conducted, and brain MRI findings, received therapies, and epilepsy characteristics were reported. One hundred and seven patients with PHTS (median age 8.7 years; range 3-21 years) and 38 controls were enrolled. ASD and epilepsy were frequent among patients with PHTS (51% and 15%, respectively), with generalized epilepsy strongly associated with ASD. Patients with epilepsy often required two antiseizure medications. Neuroimaging revealed prominent perivascular spaces and decreased peritrigonal myelination in individuals with PHTS-ASD. Allied therapy use was frequent and involved physical, occupational, speech, and social skills therapies, with 89% of all patients with PHTS, regardless of ASD diagnosis, utilizing at least one service. This prospective, longitudinal study highlights the wide neurological spectrum seen in young individuals with PHTS. ASD is common in PHTS, comorbid with epilepsy, and allied health services are used universally. Our findings inform care discussions with families about neurological outcomes in PHTS.

Developmental outcomes of preschool children requiring craniosynostosis surgery in Manitoba: a cohort study.

Craniosynostosis is a congenital abnormality resulting in the premature fusion of one or more cranial sutures and usually requires surgical correction in the first year of life. While the majority of craniosynostosis cases represent isolated, nonsyndromic defects, approximately 25% are linked to a genetic diagnosis. Craniosynostosis has been associated with developmental delay. Therefore, historically in Manitoba, all children with surgically managed craniosynostosis were referred to the Child Development Clinic (CDC) for developmental assessment. There are currently prolonged wait times for neurodevelopmental assessments at CDC, leading to the need to better prioritize children who require neurodevelopmental assessment. The aim of the study was then to determine the developmental outcomes of preschool children requiring craniosynostosis surgery in Manitoba from July 1, 2016 through December 1, 2021. In this retrospective cohort study, clinical records were reviewed to evaluate the developmental outcomes of patients who were assessed at CDC for surgically managed craniosynostosis. Out of 67 children included in this study, 18% demonstrated global developmental delay, 24% demonstrated mild developmental delay, and 58% were developmentally appropriate across all levels. The presence of a genetic syndrome, multisutural craniosynostosis, and parental socioeconomic status were associated with risk of global developmental delay. The findings of this study suggest that while not all children with craniosynostosis present with developmental delay, those with suspected or confirmed syndromic involvement, multisutural cranyosinostosis, and/or low SES, should be referred for neurodevelopmental evaluation.

Therapeutic hypothermia after perinatal asphyxia in Vietnam: medium-term outcomes at 18 months – a prospective cohort study

AimTo determine neurodevelopmental outcome at 18 months after therapeutic hypothermia for hypoxic-ischaemic encephalopathy (HIE) infants in Vietnam, a low-middle-income country.MethodProspective cohort study investigating outcomes at 18 months in severely asphyxiated...

Neurodevelopmental evaluation of children who were operated due to congenital anomaly with the ‘Ages and Stages Questionnaire (ASQ)’ and ‘ASQ: Social–Emotional’

BackgroundThe purpose of surgeries performed for congenital anomalies in children is to increase the survival rates and provide a developmental comparison to that of their peers.AimThe objective of this study was to investigate the development of children following surgery for congenital anomalies and the risk factors affecting their development.MethodsOur study included 33 children who underwent surgery for gastrointestinal anomalies in our clinic between 2011 and 2016, and did not have any syndrome, chromosomal abnormality, or additional abnormality. Developmental levels were evaluated using the Ages and Stages Questionnaire (ASQ) and the ASQ: Social–Emotional (ASQ: SE) scales adapted for the use on Turkish children. Data on patient history were obtained retrospectively from patient files.ResultsThe study included 33 patients, including 11 with esophageal atresia, 6 with intestinal atresia, 11 with anorectal malformation, and 5 with Hirschsprung's disease. Developmental delay was found in the ASQ of 72.7% of the patients and the ASQ: SE tool was 27% of the patients. The rate of patients with scores below the threshold from each parameter of ASQ was higher than that of the normal population (p < 0.05). Development delay was detected using the ASQ scale in 100% of those with microcephaly at birth, in 91% of premature infants born between 1500 and 2500 g, and in 83.3% of those with low birth weight to gestational age.ConclusionsIn children who underwent surgery due to congenital anomalies, an evaluation through developmental tests, a post-surgical follow-up process, and a referral to the relevant disciplines when necessary may increase the success of surgery as well as increase the life quality of the patient.

Semi-Automatic Analysis of Specific Electroencephalographic Patterns during NREM2 Sleep in a Pediatric Population after SARS-CoV-2 Infection.

The post-COVID-19 condition is defined by the World Health Organization as the persistence of symptoms or development of new symptoms three months after the initial SARS-CoV-2 infection, lasting for at least two months without a clear explanation. Neuropsychiatric disorders associated with this condition include asthenia, memory and concentration problems, and sleep disturbances. Our study aims to investigate sleep patterns following SARS-CoV-2 infection using EEG findings and a sleep quality questionnaire completed by parents (Sleep Disturbance Scale for Children-SDSC). Notably, our investigation is based on a convenience sample. The patients in our sample, aged 1 to 14 years, are not currently taking any medications; rather, they are undergoing follow-up assessments at the Child Neuropsychiatry department of the University Hospital of Messina for neurodevelopmental evaluations. Specifically, we are analyzing amplitude and power spectrum data in the first five minutes of NREM2 sleep, calculated from EEG recordings obtained via bipolar leads within three months after the onset of the disease. These results will be compared with controls performed on the same subjects in the six months preceding the infection. The focus of the study was sleep spindles, which are generated by the thalamocortical systems and play a role in sleep modulation, memory, and learning. Preliminary analysis suggests a predominant increase in the slow component of the spindles in the right-frontal lead.

Preserved neonatal follow-up care during COVID-19: Use of neurodevelopmental evaluation via telehealth.

Preserved neonatal follow-up care during COVID-19: Use of neurodevelopmental evaluation via telehealth.

Neurodevelopmental evaluation of newborns who underwent hypothermia with a diagnosis of hypoxic ischemic encephalopathy based on the Bayley-III scale.

Hypoxic ischemic encephalopathy (HIE) is one of the common causes of mortality and morbidity in newborns. Despite therapeutic hypothermia, an important treatment with proven efficacy, the morbidity and mortality rates remain high. The aim of this study was to neurodevelopmentally evaluate patients who underwent therapeutic hypothermia. Included herein were patients who underwent hypothermia between 2018 and 2020. Their medical files were reviewed retrospectively, and their demographic and clinical information was recorded. Patients whose contact information was available were called to the developmental pediatrics outpatient clinic for a neurodevelopmental evaluation. The Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) was used as the evaluation tool. Laboratory values and clinical parameters of the patients were further analyzed. It was found that 42 patients underwent hypothermia in 3 years, of whom 14 (33.3%) had died. Of the 28 patients who were discharged, 20 children could be reached, and a neurodevelopmental evaluation was performed. Developmental delay in the cognitive area was detected in 11 (55%) patients, delay in the language area was found in 9 (45%) patients, and delay in the motor area was found in 11 (55%) patients. The correlation and regression analysis results determined that the time to start cooling was the most effective common factor in all 3 fields of scoring. The time to start cooling is related to the neurodevelopmental outcomes of patients with HIE. The earlier cooling is started, the better the neurodevelopmental results. Despite therapeutic hypothermia, the neurodevelopmental development of infants may be adversely affected. These patients should be followed-up neurodevelopmentally for a long time.

39 Neurodevelopmental Complexity of a Patient with Perinatal Right Middle Cerebral Artery Stroke and Infantile Spasms

Objective:A rich literature exists on cognitive changes related to focal injury in the adult brain. In contrast, the developing brains of children are less understood. In contrast to adult cases, 20% to 25% of perinatal strokes result in language disorder regardless of lesion lateralization. Existing literature suggests children with perinatal stroke may present with a range of executive functioning and visuospatial processing difficulties. Gross and fine motor challenges are also likely to occur. Furthermore, these children have an increased prevalence of autism spectrum disorder (ASD) and carry the highest risk for epilepsy. Despite growing research on neurodevelopmental profiles in patients with perinatal stroke, published literature is limited.Participants and Methods:Our study examines neurodevelopment of a 2-year-old, right-handed male with a history of perinatal ischemic right middle cerebral artery (MCA) stroke, infantile spasms, and left hemiparesis following right hemispherectomy for seizure management who underwent two neurodevelopmental evaluations at our medical center over approximately 3 years.Results:Findings from the patient’s evaluation with the Mullen Scales of Early Learning revealed overall cognitive ability in the low average range (SS = 89, 23rd percentile); however, notable variability was seen in his performance. His receptive language was average (SS = 98, 45th %tile) and consistent with previous evaluation results, and he has made gains in visual reception (from SS = 75, 5th %tile to SS = 91, 27th %tile) and expressive language (from SS = 55, 0.1st %tile to SS = 70, 2nd %tile). In addition, his gross motor was exceptionally low (SS = 55, 0.1st %tile) and consistent with previous evaluation results. Fine motor was low average (SS = 84, 14th %tile).Conclusions:Our patient showed cognitive gains in language and visual reception since his prior evaluation despite history of right MCA stroke and right hemispherectomy. Improvements are likely due to a combination of early brain plasticity and intensive therapies he has received. Consistent with published findings in this population, he experienced seizures associated with his stroke. Our results add to the limited literature on neurodevelopmental challenges associated with perinatal stroke and progress that can be made when appropriate supports are provided early and consistently.

H - 60 Navigating Cultural and Medical Factors in Pediatric Neuropsychological Assessment: a Case Study.

The current case study focuses on a neurodevelopmental evaluation for a child with a complex medical history, suspected genetic disorder, and significant developmental delays within the context of cultural diversity, linguistic barriers, and interpretation services. Patient is a 4-year-old male of Oromo decent who is exposed to both Oromo and English. Medical background is significant for congenital glaucoma and global developmental delay. He is nonverbal and uses few gestures to communicate. He presented with spastic motor movements and dysmorphic facial features. There is no history of genetic testing nor consults with neurology. Developmentally appropriate measure of neurocognitive functioning was administered with the use of an Oromo interpreter. Results revealed impaired performance within the areas of cognition, language, and motor functioning. Cognitive abilities measured similar to a 26-month-old. The patient's social communication and emotional reciprocity varied; there was consideration of an autism spectrum disorder. Diagnostic challenges included medical complexity (i.e., vision differences with eye contact and visual referencing, motor functioning), unanswered diagnostic questions (i.e., underlying genetic or neurological condition), and cultural considerations. The evaluation yielded diagnoses of a global developmental delay and unspecified neurodevelopmental disorder. Recommendations included referrals to neurology, genetics, care coordination, and outpatient therapies. Given the complexity of phenotypical behavioral manifestations of genetic disorders and cultural differences in terms of appropriate social behaviors convolute behaviors observed during the evaluation. The case study brings to light the consideration of cultural differences when interpreting behaviors as well as the value of a multidisciplinary approach to neuropsychological evaluation for diagnostic clarification.

20 Developmental Outcomes of a Cohort of Preschool Children Requiring Craniosynostosis Surgery in Manitoba

Abstract Background Historically in Manitoba, all children with craniosynostosis were referred to the Child Development Clinic (CDC) for neurodevelopmental evaluation, because craniosynostosis has been associated with developmental delay. However, due to heightened volume pressures, the CDC recently decided to limit the number of referrals accepted for evaluation of children with craniosynostosis. Objectives To inform best practices for neurodevelopmental screening, this study aims to describe the developmental outcomes of preschool children requiring craniosynostosis surgery in Manitoba. Design/Methods In this historical chart review of the CDC electronic medical record, the developmental outcomes of patients who were assessed at CDC for surgically managed craniosynostosis between July 1st, 2016 and December 1st, 2021 were described. Developmental quotients across Motor, Cognitive and Language domains were collected, and patients were categorized as Normal, Mild Delay in 1 Area or Delay in ≥2 Areas. Demographic and medical characteristics were collected, and descriptive statistics were used to describe and compare outcomes between groups. Results Out of a total of 67 children, 18% (n=12) demonstrated developmental delays in ≥2 areas, 23.9% (n=16) demonstrated mild developmental delays in one area, and 58.2% (n=39) were developmentally appropriate across all areas. Presence of genetic syndrome (p&amp;lt;0.001), suture type (p=0.011), and parental SES score (p=0.028) were significantly associated with developmental delay in ≥2 areas. Odds ratios for genetic syndrome and SES score were 218.352 (95% CI 6.843, 6967.766) and 0.857 (95% CI 0.766, 0.959) respectively. 11.9% (n=8) of children were referred to Children’s Disability Services, 5 of whom had syndrome involvement. Conclusion To target children at highest risk for developmental delay, we suggest that children with craniosynostosis be referred for neurodevelopmental evaluation if they have multisutural craniosynostosis, suspicion or confirmed genetic syndrome, or an identified developmental concern by primary care physician screening.

Trends in Preterm Body Composition and Neurodevelopmental Outcomes after Discharge

Introduction: Body composition, specifically fat-free mass (FFM), of preterm infants is associated with improved neurodevelopmental outcomes. Little is known about body composition of preterm infants after discharge. Preterm body composition was measured by air displacement plethysmography (ADP) at two time points, inpatient (35–40 weeks postmenstrual age [PMA]) and outpatient (48–58 weeks PMA), with neonatal factors and neurodevelopmental testing at 4–6 months corrected age. We hypothesized increased FFM is positively associated with neurodevelopment. Methods: From 2007 to 2011, 510 infants admitted to the Medical University of South Carolina’s neonatal intensive care unit underwent ADP. A total of 379 of 510 (74%) had anthropometrics at birth, an ADP scan with FFM, fat mass, fat percent z-scores, and an outpatient neurodevelopmental evaluation (CAT/CLAMS, Peabody Gross Motor). Variables were compared using multivariate analyses for body composition measurements. Results: The infants were 32 ± 4.8 weeks gestational age at birth with an average birth weight of 1,697 ± 932 g. Most (56%) infants received maternal milk at discharge. CAT, CLAMS, and gross motor scores had positive correlations with FFM z-scores at inpatient and outpatient ADP (p < 0.05). Receiving maternal milk at discharge was positively associated with cognitive (β = 0.22, p < 0.05) and language scores (β = 0.26, p < 0.05). Conclusion: Increased FFM is associated with improved cognitive, language, and gross motor testing. Maternal milk was positively associated with language and cognitive scores.

Predictors of poor neurodevelopmental outcomes of very preterm and very low birth weight infants.

Despite recent improvements, premature infants remain at high risk for long-term morbidity and poorer neurodevelopment, particularly very preterm (VP) and very low birth weight (VLBW). The aim of this study was to describe neurodevelopmental outcomes at two years and identify potential predictors of worse performance. In a retrospective cohort, a two-years' neurodevelopmental evaluation was analyzed. Multivariable regressions were used to study the association of perinatal history with neurodevelopmental outcomes. Subjects included VP and/or VLBW born at a Portuguese III-level perinatal center between 2011-2017. Milestones outcomes were assessed using the Griffiths' Mental Development Scales. One hundred seventy-seven infants were included. Two-years milestones were not achieved in 18.6% in language domain and 7.3% in motor function, 4.5% wore glasses and 1.1% auditory prosthesis/cochlear implant. Almost 30% needed intervention, 18.6% occupational therapy, 16.4% physiotherapy and 13.6% speech therapy. Griffiths' Mental Development Scales was performed in 139, with a mean global quotient of 98.3 and hearing/speech as the least quoted scale. Global development delay (GDD) was present in 14.8% and cerebral palsy in 2.8%. Multivariate analysis by logistic regression adjusted to gestational age, birth weight and confounding variables, revealed a statistically significant association between GDD and hydrocephalus with shunt/reservoir (OR:19.01), retinopathy of prematurity stage ≥2 (OR:7.86) and neonatal sepsis (OR:3.34). Consistent with recent studies, preterm are at increased risk of neurodevelopmental impairment, mainly due to GDD and language delay, rather than cerebral palsy. In this population, hydrocephalus, retinopathy of prematurity and neonatal sepsis were strongly associated with poorer outcomes. Insight into these factors is essential to refer patients for specific early intervention programs.

Impact of Residual Lesion Severity on Neurodevelopmental Outcomes Following Congenital Heart Surgery in Infancy and Childhood.

Children with congenital heart disease are at increased risk of neurodevelopmental delay throughout their lifespan. This risk is exacerbated following congenital heart surgery (CHS) in infancy. However, there are few modifiable risk factors for postoperative neurodevelopmental delay. In this study, weassessed the Residual Lesion Score (RLS), a quality assessment metric that evaluates residual lesion severity following CHS, as a predictor of neurodevelopmental delay. This was a single-center, retrospective review of patients who underwent CHS from 01/2011 to 03/2021 and post-discharge neurodevelopmental evaluation from 12 to 42months of age using the Bayley Scales of Infant Development, 3rd Edition (BSID-III). RLS was assigned per published criteria: RLS 1, no residua; RLS 2, minor residua; and RLS 3, major residua or pre-discharge reintervention. Associations between RLS and BSID-III scores, as well as trends in neurodevelopmental outcomes over time, were evaluated. Of 517 patients with median age at neurodevelopmental testing of 20.0 (IQR 18.0-22.7) months, 304 (58.8%), 146 (28.2%), and 67 (13.0%) were RLS 1, 2, and 3, respectively. RLS 3 patients had significantly lower scaled scores in the cognitive, receptive, and expressive communication, and fine and gross motor domains, compared with RLS 1 patients. Multivariable models accounted for 21.5%-31.5% of the variation in the scaled scores, with RLS explaining 1.4-7.3% of the variation. In a subgroup analysis, RLS 3 patients demonstrated relatively fewer gains in cognitive, expressive communication, and gross motor scores over time (all p < 0.05). In conclusion,RLS 3 patients are at increased risk for neurodevelopmental delay, warranting closer follow-up and greater developmental support for cognitive, language, and motor skills soon after surgery.

Treatment Approaches for Swallowing Disorders in Children.

A swallowing disorder or dysphagia is defined as a disorder in the sequence of swallowing, during the oral or pharyngeal phase, which compromises the safety and/or efficiency of transit of the food bolus to the esophagus. The evaluation of neurodevelopment, nutrition, and preventive medicine actions are as important as the clinical evaluation of dysphagia, so they must be included and systematized in all pediatric evaluations; This evaluation can be divided into different parts: bedside swallowing evaluation, instrumental swallowing evaluation, and additional studies. The management of swallowing disorders requires a multidisciplinary team approach, depending on the child's age, cognitive and physical abilities, and the specific swallowing and feeding disorder, ensuring adequate and safe nutrition and improving the patient's quality of life.

Assessment of Mastery Motivation and Neurodevelopment of Young Children at High Risk for Developmental Delays.

Young children's mastery motivation and neurodevelopmental evaluation can contribute to overall early assessment for early intervention evaluation. At present, children born preterm (<37 weeks gestation) and with a low birth weight (LBW; <2500 g) are at increased risk of experiencing developmental delays and more nuanced cognitive and language challenges. The main objective of this exploratory study was to examine the connection between preterm children's mastery motivation and their neurodevelopment, as well as to determine whether assessing mastery motivation can enhance assessment practices for early intervention (EI) programs. Parents of children born preterm completed the revised Dimensions of Mastery Motivation Questionnaire (DMQ18). Neurodevelopment was measured on the Bayley Scales of Infant and Toddler Development (BSID-III). Results revealed significant correlations between DMQ18 and BSID-III measures. Multivariate analysis showed that infants and toddlers born with a very low birth weight (VLBW; <1500 g) scored significantly lower on the infant DMQ18 and the BSID-III measures. Regression analyses revealed that birth weight and home environment were significant predictors of the children's eligibility for EI programs. Infants' social persistence with other children, gross motor persistence, and mastery pleasure, as well as toddlers' objective cognitive persistence, social persistence with adults, gross motor persistence, mastery pleasure, and negative reaction to frustration, were important markers for evidenced-based practices in EI programs. This study demonstrates the utility of the DMQ18 as a contributory assessment measure and the importance of birth weight and home environment in predicting EI enrollment.