Neurodevelopmental Outcome Of Infants Research Articles

An antenatal marker of neurodevelopmental outcomes in infants with congenital heart disease

ObjectivePrenatal exposures are known to alter fetal neurodevelopment and autonomic control. We aimed to explore the correlation between fetal autonomic activity, measured by fetal heart rate variability, and 18-month developmental outcome in subjects with congenital heart disease.Study DesignFrom 2010–2013, 5 fetuses with hypoplastic left heart syndrome, 9 with transposition of the great arteries, and 9 with tetralogy of Fallot were included in this prospective cohort study. A maternal abdominal fetal electrocardiogram monitor recorded fetal heart rate at 34–38 weeks gestational age. We assessed associations between fetal heart rate parameters including interquartile range and standard deviation of the fetal RR intervals and 18-month Bayley Scales of Infant Development III scores using Pearson’s correlation coefficient. Multivariable regression modeling identified predictors of neurodevelopmental scores.ResultsFetal heart rate variability parameters at 34–38 weeks gestational age correlated with 18-month Cognition (r=0.47, p=0.03) and Motor scores (r=0.66, p=0.001). The interquartile range of the fetal RR intervals predicted Cognition (β=0.462, p=0.028, R2=0.282) and Motor (β=0.637, p<0.001, R2=0.542) scores.ConclusionsIn fetuses with congenital heart disease, low heart rate variability at 34–38 weeks gestational age predicts diminished 18-month cognitive and motor performance. Prenatal autonomic activity may serve as a marker of early childhood development in these high-risk patients.

Neurodevelopmental outcomes in infants undergoing general anesthesia

PurposePreclinical data strongly suggest that all agents used for general anesthesia (GA) have detrimental effects on the developing brain. However, clinical data are unclear. The purpose of this study was to use a cohort of infants who underwent GA and understand their neurodevelopmental outcomes. MethodsA cohort of infants who underwent GA was selected between 2010 and 2011, and a control group was created. Data regarding GA, procedures, and outcomes were collected in 2015. The cohort was divided into controls, GA without surgery, GA and surgery once, and multiple general anesthetics. Both univariate and multivariate analysis were performed, and a p value of less than 0.05 was considered significant. Results457 patients, 121 controls, and 336 cases were included. Median follow-up was 5.1years. While developmental delay and the need for speech therapy were higher with GA, this did not correlate with the duration of GA. Patients having GA for MRI had the poorest outcomes. Multivariate analysis using combined binary outcome measures for psychiatric and neurologic outcomes did not show any significant difference for duration of anesthesia, age at anesthesia, or induction and maintenance agents. ConclusionsThese data suggest that GA during the first year of life may have few significant neurodevelopmental effects compared to controls. Additionally, the duration of GA did not correlate with neurodevelopmental outcomes. Type of studyRetrospective Case Control Cohort Study. Level of evidence3 b (according to Oxford Center for EBM Levels of Evidence, March 2009, http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/).

MRI Patterns of brain injury and neurodevelopmental outcomes in neonates with severe anaemia at birth

AimsTo define patterns of brain injury and associated neurodevelopmental outcomes in infants with severe neonatal anaemia. MethodsWe studied 20 infants with severe anaemia at birth (haemoglobin<7g/dL). Clinical details were analysed for causes of anaemia and co-morbidities. All had early brain magnetic resonance imaging (MRI) scans, which were reviewed for injury pattern. Neurodevelopmental outcomes were assessed at a median age of 24months. ResultsThe aetiology of the anaemia was feto-maternal haemorrhage in 17 and antepartum haemorrhage in 3 infants. The predominant site of injury was the white matter, which was affected in all infants, with differing grades of severity and with cystic evolution in 45%. Only one infant showed an injury pattern typical of an acute severe hypoxic-ischaemic insult.Outcomes correlated closely to the severity of MRI findings. Cerebral palsy was seen only with the most severe neuroimaging patterns (n=6). Global developmental delay, learning or behavioural problems and seizures were common with moderate injury. Visual impairment occurred, particularly with posterior injury. Microcephaly developed in 45%. InterpretationSevere neonatal anaemia at birth was associated with a white matter predominant pattern of injury, the severity of which was related to neurodevelopmental outcomes. Early MRI and long-term follow-up are advisable following severe neonatal anaemia.

Bridging the gap between early corpus callosal growth and neurodevelopmental outcome in infants born very preterm.

This commentary is on the original article by Malavolti et al. on pages 433–440 of this issue.

Neurodevelopmental outcomes in infants exposed in utero to antipsychotics: a systematic review of published data.

The proportion of pregnancies exposed to either second-generation antipsychotics (SGAs) or first-generation antipsychotics (FGAs) varies between 0.3%-2% of all pregnancies, but, until now, little is known about the potential neurobehavioral teratogenicity of antipsychotics. Assessing this safety facet is the aim of this article. PubMed, Scopus, and Google Scholar were searched for eligible articles. PubMed (1954 to May 2016) was searched using several medical subject headings, variously combined. PubMed search results were also limited using the search filter for human studies published in English. Scopus and Google Scholar searches were filtered for article title (antipsychotics/neuroleptics, pregnancy). After excluding duplicates, 9,250 articles were identified and 29 met the following inclusion criteria: only articles that provided original/primary data on neurodevelopmental outcome in human offspring older than 4 months of age, independently of the study design, were selected for review. Indeed, some relevant neurodevelopmental milestones are achieved at this time. Length of study and neurodevelopmental assessment methodology did not influence the study selection. Unfortunately, published data on neurodevelopmental teratogenicity of SGAs mainly derive from case reports and small case-series studies. Even findings emerging from case-control and prospective/retrospective studies are of limited clinical relevance because of their small sample sizes. Limited data are also available on FGAs. Hence, we have to conclude that the long-term neurodevelopmental outcomes for children exposed in utero remain unclear. Low to very low quality evidence of retrieved data makes impossible to confirm or exclude potential long-lasting untoward effects on infant neurocognitive development associate with antenatal exposure to either SGAs or FGAs.

Early Cord Metabolite Index and Outcome in Perinatal Asphyxia and Hypoxic-Ischaemic Encephalopathy

Background: A ¹H-NMR-derived metabolomic index based on early umbilical cord blood alterations of succinate, glycerol, 3-hydroxybutyrate and O-phosphocholine has shown potential for the prediction of hypoxic-ischaemic encephalopathy (HIE) severity. Objective: To evaluate whether this metabolite score can predict 3-year neurodevelopmental outcome in infants with perinatal asphyxia and HIE, compared with current standard biochemical and clinical markers. Methods: From September 2009 to June 2011, infants at risk of perinatal asphyxia were recruited from a single maternity hospital. Cord blood was drawn and biobanked at delivery. Neonates were monitored for development of encephalopathy both clinically and electrographically. Neurodevelopmental outcome was assessed at 36-42 months using the Bayley Scales of Infant and Toddler Development, ed. III (BSID-III). Death and cerebral palsy were also considered as abnormal end points. Results: Thirty-one infants had both metabolomic analysis and neurodevelopmental outcome at 36-42 months. No child had a severely abnormal BSID-III result. The metabolite index significantly correlated with outcome (ρ² = 0.30, p < 0.01), which is robust to predict both severe outcome (area under the receiver operating characteristic curve: 0.92, p < 0.01) and intact survival (0.80, p = 0.01). There was no correlation between the index score and performance in the individual BSID-III subscales (cognitive, language, motor). Conclusions: The metabolite index outperformed other standard biochemical markers at birth for prediction of outcome at 3 years, but was not superior to EEG or the Sarnat score.

Role of EEG background activity, seizure burden and MRI in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischaemic encephalopathy in the era of therapeutic hypothermia.

To investigate the role of EEG background activity, electrographic seizure burden, and MRI in predicting neurodevelopmental outcome in infants with hypoxic-ischaemic encephalopathy (HIE) in the era of therapeutic hypothermia. Twenty-six full-term infants with HIE (September 2011-September 2012), who had video-EEG monitoring during the first 72h, an MRI performed within the first two weeks and neurodevelopmental assessment at two years were evaluated. EEG background activity at age 24, 36 and 48h, seizure burden, and severity of brain injury on MRI, were compared and related to neurodevelopmental outcome. EEG background activity was significantly associated with neurodevelopmental outcome at 36h (p=0.009) and 48h after birth (p=0.029) and with severity of brain injury on MRI at 36h (p=0.002) and 48h (p=0.018). All infants with a high seizure burden and moderate-severe injury on MRI had an abnormal outcome. The positive predictive value (PPV) of EEG for abnormal outcome was 100% at 36h and 48h and the negative predictive value (NPV) was 75% at 36h and 69% at 48h. The PPV of MRI was 100% and the NPV 85%. The PPV of seizure burden was 78% and the NPV 71%. Severely abnormal EEG background activity at 36h and 48h after birth was associated with severe injury on MRI and abnormal neurodevelopmental outcome. High seizure burden was only associated with abnormal outcome in combination with moderate-severe injury on MRI.

Assessing the Independent and Joint Effects of Unmedicated Prenatal Depressive Symptoms and Alcohol Consumption in Pregnancy and Infant Neurodevelopmental Outcomes

Prenatal alcohol exposure (PAE) is an established risk factor for neurodevelopmental deficits in the offspring. Prenatal depression has been associated with neurodevelopmental deficits in the offspring, although investigations into unmedicated prenatal depression have been inconsistent. We hypothesized that unmedicated prenatal depressive symptoms would independently and jointly with PAE predict neurodevelopmental outcomes in infant offspring. We studied 344 participants from a randomized clinical trial of multivitamin supplements in pregnant women in Ukraine. Women were recruited based upon periconceptional alcohol use and followed up to 12months postpartum. Prenatal depressive symptoms were assessed at approximately 32weeks of gestation using the Beck Depression Inventory score. Neurodevelopment was assessed with the Bayley Scales of Infant Development II Mental Development Index (MDI) and Psychomotor Development Index (PDI) at 6 and 12months postpartum. Generalized linear regression models were constructed to assess the independent and joint effects of prenatal depressive symptoms and PAE in models adjusted for sociodemographic and pregnancy characteristics. PAE was independently associated with deficits in neurodevelopmental outcomes at 6 and 12months, however, level of prenatal depressive symptoms was not. We found marginal evidence of synergism of depressive symptoms and PAE, with larger deficits in those with both exposures observed for the PDI-6months (p=0.05) and MDI-12months (p=0.09). Additionally, there was a suggestion of sexual dimorphism; females had stronger deficits from joint exposures than males (depressive symptom [MDI-6months] female: -8.28, 95% CI -13.06, -3.49; male: 0.68, 95% CI -4.58, 5.94; p for interaction 0.04). While not statistically significant for the MDI or PDI at 12months, the trend persisted. Infants exposed to PAE and prenatal depression may be at an increased risk of neurodevelopmental deficits. Healthcare providers should be aware of this possible synergism in their efforts to mitigate the neurodevelopmental effects of these co-occurring exposures.

Therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy had favourable outcomes at a referral hospital in a middle-income country.

This South African study documented the survival and neurodevelopmental outcomes of infants with hypoxic-ischaemic encephalopathy (HIE) after introducing cooling to a neonatal intensive care unit and identified early markers for neurodevelopmental outcome. We retrospectively reviewed infants that received cooling according to the Total Body Hypothermia trial protocol from 2008 to 2011. Infants were screened with the Bayley Scales of Infant and Toddler Development, Third Edition, at one year of age and underwent neurological and hearing assessments. Data on 99 infants with HIE showed that 45% of cases were moderate, 23% severe and 32% mild. An abnormal amplitude integrated electro-encephalogram (aEEG) background was documented in 45 cases within 24 hours. Magnetic resonance imaging (MRI) scans were consistent with HIE in all but one case. We reviewed 50 traceable survivors at one year. Development was significantly impaired in nine and 41 were normal or mildly impaired. A severely abnormal aEEG background, severe HIE and an abnormal MRI were associated with death and severe impairment. A good suck, mild HIE, primiparity and normal MRI were associated with good outcomes. Most infants with HIE survived without major impairment. Previously described predictors of neurodevelopmental outcome were good surrogate markers in this population.

Automated electroencephalographic discontinuity in cooled newborns predicts cerebral MRI and neurodevelopmental outcome

Background and hypothesisProlonged electroencephalographic (EEG) discontinuity has been associated with poor neurodevelopmental outcomes after perinatal asphyxia but its predictive value in the era of therapeutic hypothermia (TH) is unknown. In...

Defining the nature and implications of head turn preference in the preterm infant

AimTo determine the relationship of head turn preference in the preterm infant to: 1) perinatal medical factors, 2) neonatal neurobehavior, and/or 3) infant neurodevelopmental outcomes. MethodsSeventy preterm infants born ≤30weeks gestation were enrolled at birth. Detailed information regarding neonatal intensive care unit (NICU) medical course was compiled for each infant. Neurobehavioral testing was performed during NICU hospitalization. Head turn preference was quantified at term equivalent age using a newly developed scale. Infants returned at age two years for standardized developmental testing. ResultsAll infants demonstrated a head turning preference, with most preferring the right side (n=51, 77%). Fifty-five infants (79%) had moderate to severe head turn preference. Head turn preference was associated with 1) medical severity (hours of inotrope use, p=0.02; oxygen requirement at 36weeks postmenstrual age, p=0.03), 2) worse neurobehavioral performance (decreased self-regulation, p=0.007; more sub-optimal reflexes p=0.006), and 3) worse developmental outcome at age two years (poorer fine motor, p=0.02). InterpretationMedical factors in the NICU appear to be associated with the development of a head turn preference. Increased severity of head turn preference may be a marker for poor developmental outcome. Early identification may inform therapeutic interventions designed to minimize symptoms and optimize neurodevelopmental outcome.

Nutrition and neurodevelopmental outcomes in preterm infants: asystematic review.

A systematic review with meta-analysis was carried out to investigate the effects of increased nutritional intake, via either macronutrient or multinutrient intervention, during the neonatal period on neurodevelopmental outcomes in infants born at <32weeks of gestation or weighing <1501g at birth. Although the relationship remains unclear, increased early nutrition may reduce neurodevelopmental impairment in this group of infants. Future research should focus on using standardised nutritional interventions and an agreed neurodevelopmental assessment battery.

Neurodevelopmental Outcomes in Infants with Retinopathy of Prematurity and Bevacizumab Treatment.

PurposeThe current study aims to investigate the neurodevelopment of premature infants after intravitreal injections of bevacizumab (IVB) for the treatment of retinopathy of prematurity (ROP) up to the age of 2 years.MethodsThe study design was retrospective observational case series conducted at an institutional referral center. Infants with type 1 ROP were classified into 3 groups: laser only, IVB only, and a combination of IVB and laser treatment. Main Outcome Measures were neurodevelopmental outcomes of the patients after treatment were assessed by Bayley Scales for Infant Development.ResultsSixty-one patients who finished the neurodevelopmental survey were included. No detrimental effects on neurodevelopment were found in IVB group compared with the patients who received laser treatment only. The patients in the IVB + laser group had a higher incidence of significant mental (p = 0.028) and psychomotor (p = 0.002) impairment at 24 months than the patients in the laser group. The odds ratio of having severe psychomotor defects in the IVB + laser group was 5.3 compared with the laser group (p = 0.041). The causal source for the differences that were detected remained unknown due to lack of randomization in the study and accompanying bias in patient selection.ConclusionsTwo years after laser and/or intravitreal injections of bevacizumab for infants with retinopathy of prematurity, no difference on neurodevelopment for those who received only bevacizumab versus only laser treatment were found. Those infants who required rescue therapy with laser or bevacizumab injection after initial, unsuccessful treatment showed some detrimental, neurodevelopmental effects.

Risk Factor Analysis and Scoring System for Neurodevelopmental Outcomes after Neonatal Seizures

Background: The aims of this study were to determine prognostic factors and to devise a new scoring system for neurodevelopmental outcomes in infants with neonatal seizures. Methods: A retrospective review of medical records was performed for infants treated for neonatal seizures from March 2010 to December 2015 at the neonatal intensive care unit at Haeundae Paik Hospital. Neurologic outcomes were assessed at the post-conceptional age of 24 months. To assess the risk factors associated with poor neurologic outcomes, various factors including clinical characteristics, EEG findings, and the results from neuroimaging work-ups were analyzed with univariate and multiple logistic regression analyses (SPSS version 18.0). Results: Of the 174 enrolled infants, 57 (32.8%) showed abnormal neurologic outcomes. Seven potential predictors of adverse outcomes, selected by binary logistic regression analysis, were used to devise a scoring system. These included birth weight, time of onset, EEG findings, neuroimaging results, seizure type and severity and etiology. The variables were assigned binary scores with a total arithmetic composite score ranging from 0 to 7. A cutoff score of ≥ 3 provided the greatest sensitivity and specificity. Normalization or persistent normal findings at follow-up EEG within 3 months after seizure on-set were also associated with neurologic outcomes (p<0.05). Conclusion: We propose scoring system uses seven variables to provide early prognostic information on unfavorable neurodevelopmental outcomes in infants with neonatal seizures and reliably predicts long-term neurologic outcomes at the time of seizure onset.

Dose Brain MRI before Discharge at NICU Predict Neurodevelopmental Outcomes in Very Low Birth Weight Infants?

Dose Brain MRI before Discharge at NICU Predict Neurodevelopmental Outcomes in Very Low Birth Weight Infants?

Motor and cortico-striatal-thalamic connectivity alterations in intrauterine growth restriction

Intrauterine growth restriction is associated with short- and long-term neurodevelopmental problems. Structural brain changes underlying these alterations have been described with the use of different magnetic resonance-based methods that include changes in whole structural brain networks. However, evaluation of specific brain circuits and its correlation with related functions has not been investigated in intrauterine growth restriction. In this study, we aimed to investigate differences in tractography-related metrics in cortico-striatal-thalamic and motor networks in intrauterine growth restricted children and whether theseparameters were related with their specific function in order toexplore its potential use as an imaging biomarker of altered neurodevelopment. We included a group of 24 intrauterine growth restriction subjects and 27 control subjects that were scanned at 1 year old; we acquired T1-weighted and 30 directions diffusion magnetic resonance images. Each subject brain was segmented in 93 regions with the use of anatomical automatic labeling atlas, and deterministic tractography was performed. Brain regions included in motor and cortico-striatal-thalamic networks were defined based in functional and anatomic criteria. Within the streamlines that resulted from the whole brain tractography, those belonging to each specific circuit were selected and tractography-related metrics that included number of streamlines, fractional anisotropy, and integrity were calculated for each network. We evaluated differences between both groups and further explored the correlation of these parameters with the results of socioemotional, cognitive, and motor scales from Bayley Scale at 2 years of age. Reduced fractional anisotropy (cortico-striatal-thalamic, 0.319 ± 0.018 vs 0.315 ± 0.015; P= .010; motor, 0.322 ± 0.019 vs 0.319 ± 0.020; P= .019) and integrity cortico-striatal-thalamic (0.407 ± 0.040 vs0.399 ± 0.034; P= .018; motor, 0.417 ± 0.044 vs 0.409 ± 0.046; P=.016) in both networks were observed in the intrauterine growth restriction group, with no differences in number of streamlines. More importantly, strong specific correlation was found between tractography-related metrics and its relative function in both networks in intrauterine growth restricted children. Motor network metrics were correlated specifically with motor scale results (fractional anisotropy: rho= 0.857; integrity: rho= 0.740); cortico-striatal-thalamic network metrics werecorrelated with cognitive (fractional anisotropy: rho= 0.793; integrity, rho= 0.762) and socioemotional scale (fractional anisotropy: rho= 0.850; integrity: rho= 0.877). These results support the existence of altered brain connectivity in intrauterine growth restriction demonstrated by altered connectivity in motor and cortico-striatal-thalamic networks, with reduced fractional anisotropy and integrity. The specific correlation between tractography-related metrics and neurodevelopmental outcomes in intrauterine growth restriction shows the potential to use this approach to develop imaging biomarkers to predict specific neurodevelopmental outcome in infants who are at risk because of intrauterine growth restriction and other prenatal diseases.

Growth Asymmetry, Head Circumference, and Neurodevelopmental Outcomes in Infants with Single Ventricles

To assess the variability in asymmetric growth and its association with neurodevelopment in infants with single ventricle (SV). We analyzed weight-for-age z-score minus head circumference-for-age z-score (HCAZ), relative head growth (cm/kg), along with individual growth variables in subjects prospectively enrolled in the Infant Single Ventricle Trial. Associations between growth indices and scores on the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID-II) at 14months were assessed. Of the 230 subjects enrolled in the Infant Single Ventricle trial, complete growth data and BSID-II scores were available in 168 (73%). Across the cohort, indices of asymmetric growth varied widely at enrollment and before superior cavopulmonary connection (SCPC) surgery. BSID-II scores were not associated with these asymmetry indices. In bivariate analyses, greater pre-SCPC HCAZ correlated with higher MDI (r=0.21; P=.006) and PDI (r=0.38; P<.001) and a greater HCAZ increase from enrollment to pre-SCPC with higher PDI (r=0.15; P=.049). In multivariable modeling, pre-SCPC HCAZ was an independent predictor of PDI (P=.03), but not MDI. In infants with SV, growth asymmetry was not associated with neurodevelopment at 14months, but pre-SCPC HCAZ was associated with PDI. Asymmetric growth, important in other high-risk infants, is not a brain-sparing adaptation in infants with SV. Clinicaltrials.gov: NCT00113087.

Single rooms for preterm infants

Journal of Paediatrics and Child HealthVolume 51, Issue 10 p. 1044-1044 Heads UpFree Access Single rooms for preterm infants First published: 01 October 2015 https://doi.org/10.1111/jpc.13004_2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat The use of single-family rooms rather than open wards for neonates is controversial. Reported benefits in observational studies include more rapid achievement of full enteric feeds, fewer apnoeas, reduced mortality, reduced nosocomial sepsis and improvements in breastfeeding and parental satisfaction. Negative include increased staffing requirements, poorer parent–staff interaction and increased maternal stress. A US study compared medical and neurodevelopmental outcomes in infants <1500 g birthweight cared for in one neonatal unit from 2008 to 2012: 151 infants in an open-bay neonatal unit and 252 infants after transition to a single-family room unit.1 Infants from the single-family rooms achieved full enteric feeds at a lower gestational age, gained weight faster and were significantly heavier at discharge. They required fewer medical procedures and had less pain and less physiological stress. They were assessed as less hypertonic and less lethargic. As this was a longitudinal study it is open to ascertainment bias and some of the improvements may have been due to improved resources. The authors cited increased maternal involvement as causing the decreases in medical procedures, stress and pain. Other improvements were attributed to increased developmental support. Nurses reported a more positive work environment. Single-room neonatal units may be the future. Reference 1Lester BM, Hawes K, Abar B et al. Single-family room care and neurobehavioral and medical outcomes in preterm infants. Pediatrics 2014; 134: 754– 760. CrossrefPubMedWeb of Science®Google Scholar Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au, Children's Hospital at Westmead, Sydney Volume51, Issue10October 2015Pages 1044-1044 ReferencesRelatedInformation

Obstetric risk factors and time trends of neurodevelopmental outcome at 2years in very-low-birthweight infants: a single institution study.

To assess the time trends of neonatal survival and infant neurodevelopmental outcome in very-low-birthweight children at 24months corrected age over a 20-year period. The study cohort comprised 857 infants (439 males and 418 females) weighing less than 1500g at birth or delivered before 32weeks gestational age in the period 1989 to 2008. Neurological examination and cognitive assessment of the infants (Bayley Scales of Infant Development and Griffiths Mental Developmental Scale) were performed at 24months corrected age. The prevalence of neonatal survival with normal neurodevelopmental outcome increased from 55.3% (104/188) in 1989 to 1993, to 61.4% in 1994-1998 (116/189), 68.3% in 1999 to 2003 (138/202), and 84.5% in 2004 to 2008 (235/278) (annual increase=1%, 95% CI 2.1-4.1; p<0.001). In logistic models, the increase in the rate of normal neurodevelopmental outcome during the periods studied was consistent across the categories of birthweight (≤1000g as opposed to >1000g), gestational age (≤28wks as opposed to >28wks), and clinical characteristics (pre-eclampsia/growth restriction as opposed to spontaneous prematurity/rupture of membranes). The increased rate of normal neurodevelopmental outcome at 2years among very-low-birthweight infants is independent of obstetric risk factors.

Maternal PPARG Pro12Ala polymorphism is associated with infant's neurodevelopmental outcomes at 18 months of age

BackgroundPeroxisome proliferator activated receptors (PPARs) are ligand activated transcription factors with crucial functions in lipid homeostasis, glucose metabolism, anti-inflammatory processes, placental development, and are involved in cognitive functions and neurodegenerative diseases. Polymorphisms in PPAR genes are shown to influence the activity of these receptors. Aims1) To examine the association of PPARG Pro12Ala polymorphism in pregnant women and their offspring on infant's neurodevelopmental outcomes during the first 18months of life; 2) to determine the influence of Pro12Ala polymorphism on fatty acid concentrations in plasma phospholipids and placental tissue. Study design138 mother–infant pairs from the PREOBE observational study were genotyped for PPARG Pro12Ala. Plasma phospholipids and placental fatty acid concentrations were measured at delivery. Infants' neuropsychological assessment at 6 and 18months of age was performed using Bayley III. ResultsThe effect of Pro12Ala on infant's neurodevelopmental outcomes was detected at 18months, but not at 6months of age. 18months old infants born to mothers with wild-type Pro12 genotype had better cognitive (OR=5.11, 95% CI: 1.379–18.96, p=0.015), language (OR=3.41, 95% CI: 1.35–11.24, p=0.044), and motor development scores (OR=4.77, 95% CI: 1.243–18.33, p=0.023) than the Ala allele carriers. Pro12Ala variants did not seem to affect fatty acids concentrations in blood nor in placenta at delivery. ConclusionsInfants born to mothers with Pro12 genotype have better neurodevelopmental outcomes at 18months of age than Ala allele carriers, indicating a long-term transplacental action of PPARγ variants on foetal brain development.