Outcomes For Young Children Research Articles

Arcuate fasciculus and pre-reading language development in children with prenatal alcohol exposure.

Prenatal alcohol exposure (PAE) contributes to widespread neurodevelopmental challenges, including reading, and has been associated with altered white matter. Here, we aimed to investigate whether arcuate fasciculus (AF) development is associated with pre-reading language skills in young children with PAE. A total of 51 children with confirmed PAE (25 males; 5.6 ± 1.1 years) and 116 unexposed controls (57 males; 4.6 ± 1.2 years) underwent longitudinal diffusion tensor imaging (DTI), for a total of 111 scans from participants with PAE and 381 scans in the unexposed control group. We delineated the left and right AF and extracted mean fractional anisotropy (FA) and mean diffusivity (MD). Pre-reading language ability was assessed using age-standardized phonological processing (PP) and speeded naming (SN) scores of the NEPSY-II. Linear mixed effects models were run to determine the relationship between diffusion metrics and age, group, sex, and age-by-group interactions, with subject modeled as a random factor. A secondary mixed effect model analysis assessed the influence of white matter microstructure and PAE on pre-reading language ability using diffusion metric-by-age-by-group interactions, with 51 age- and sex-matched unexposed controls. Phonological processing (PP) and SN scores were significantly lower in the PAE group (p < 0.001). In the right AF, there were significant age-by-group interactions for FA (p < 0.001) and MD (p = 0.0173). In the left AF, there was a nominally significant age-by-group interaction for MD that failed to survive correction (p = 0.0418). For the pre-reading analysis, a significant diffusion-by-age-by-group interaction was found for left FA (p = 0.0029) in predicting SN scores, and for the right FA (p = 0.00691) in predicting PP scores. Children with PAE showed altered developmental trajectories for the AF, compared with unexposed controls. Children with PAE, regardless of age, showed altered brain-language relationships that resembled those seen in younger typically developing children. Our findings support the contention that altered developmental trajectories in the AF may be associated with functional outcomes in young children with PAE.

Exploring the Influence of Diction and Language Style in Children's Song Lyrics on Preschool Learning and Development

This research delves into the profound influence of diction and language style within children's song lyrics on the educational experiences of preschoolers. The study investigates the impact of diverse language styles, ranging from simpler, repetitive structures to more complex and varied compositions, on language development, cognitive engagement, emotional responses, and learning outcomes in young children. Through a mixed-methods approach encompassing quantitative analysis and qualitative observations, the research examines the implications of varied language styles on comprehension, engagement, and cognitive growth among preschoolers. Findings highlight the significance of diverse language styles in fostering comprehensive learning experiences, nurturing cognitive engagement, emotional responses, and social interactions among preschoolers. The research underscores the importance of a balanced approach to language styles in educational materials, offering immediate engagement while stimulating cognitive challenge for sustained educational growth. The practical application of these findings advocates for educators to curate a diverse repertoire of song lyrics, integrate multisensory experiences, and harness technology to enhance the learning environment for preschoolers, nurturing their language skills, cognitive abilities, and emotional development. The study's implications extend to educational practices, emphasizing the importance of embracing diverse language styles to create a dynamic and comprehensive educational journey for our youngest learners.

Association of Maternal Gestational Vitamin D Supplementation with Respiratory Health of Young Children.

This study aimed to evaluate the association between maternal gestational Vitamin D3 supplementation and early respiratory health in offspring. This was a population-based record-linkage study which used data from the French National Health Database System. Maternal Vitamin D3 supplementation consisted of a single high oral dose of cholecalciferol, (100,000 IU) from the seventh month of pregnancy, according to national guidelines. In total, 125,756 term-born singleton children were included, of which 37% had respiratory illness defined as hospital admission due to respiratory causes or inhalation treatment up to 24 months of age. Infants prenatally exposed to maternal Vitamin D3 supplementation (n = 54,596) were more likely to have a longer gestational age (GA) at birth (GA 36-38 weeks, 22% vs. 20%, p < 0.001 in exposed vs. non-exposed infants, respectively). After adjusting for the main risk factors (maternal age, socioeconomic level, mode of delivery, obstetrical and neonatal pathology, birth weight appropriateness, sex, and birth season), the risk of RD was found to be 3% lower than their counterparts (aOR [IC 95%], 0.97 [0.95-0.99], p = 0.01). In conclusion, this study provides evidence for the association between maternal gestational Vitamin D3 supplementation and improved early respiratory outcomes in young children.

Effect of mTOR Inhibitors in Epilepsy Treatment in Children with Tuberous Sclerosis Complex Under 2 Years of Age

Mechanistic target of rapamycin (mTOR) inhibitors sirolimus and everolimus are an effective therapy for subependymal giant cell astrocytomas, cardiac rhabdomyomas, renal angiomyolipomas, and lymphangioleiomyomatosis associated with tuberous sclerosis complex (TSC). Everolimus was recently approved in the EU and the USA for the treatment of refractory focal-onset seizures. Despite frequent use of mTOR inhibitors, there are only a few studies on their effect on epilepsy control in children under 2years of age. This study aims to assess the effect of adjunctive mTOR inhibitor treatment on seizure frequency in this age group. We performed retrospective data analysis of medical records of patients with TSC who initiated sirolimus or everolimus under the age of 2years. Participants' antiseizure medication was adjusted according to their epilepsy control independently from mTOR inhibitor administration. The data was assessed separately for patients treated with mTOR inhibitors before and after the onset of seizures. We also compared the treatment group with a matched control group. The follow-up duration was up to 24months. Twenty-one patients with TSC from two clinical centers were included in the study. Nine participants had no history of seizures before mTOR inhibitor initiation. Twelve reported active epilepsy in the month prior to treatment initiation. Most patients treated preventively with mTOR inhibitors did not report active epilepsy at the end of their follow-up. In the second group, the mean frequency of seizures decreased with time. According to the comparative analysis, seizure control was better in the groups treated with mTOR inhibitors. Patients with TSC treated with mTOR inhibitors demonstrated better seizure control than individuals without this treatment. Adjunctive pharmacotherapy with mTOR inhibitors appears to have a beneficial effect on epilepsy outcome in young children. Further prospective clinical trials should be conducted to determine the efficacy of mTOR inhibitors on epilepsy in patients with TSC under the age of 2years.

From terrible twos to sassy sixes: The development of vocabulary and executive functioning across early childhood.

Across the early childhood period of development, young children exhibit considerable growth in their executive functioning (EF) and vocabulary abilities. Understanding the developmental trajectory of these seemingly interrelated processes is important as both early vocabulary and EF have been shown to predict critical academic and socio-emotional outcomes later in childhood. Although previous research suggests that EF and vocabulary are correlated in early childhood, much of the existing longitudinal research has focused on unidirectional relations among preschool child samples. The current large-scale study, therefore, sought to examine whether children's vocabulary and EF abilities are bidirectionally related over time across four measurement waves in early childhood (i.e., at ages 2, 3, 4, and 6). At each timepoint, children's vocabulary skills were positively correlated with their concurrent EF abilities. After controlling for child sex and maternal education status, the best-fitting, cross-lagged panel model was a unidirectional model whereby children's early vocabulary scores predicted their later EF performance at each timepoint. Although age 2 EF significantly predicted age 3 vocabulary size, this association was no longer significant after accounting for maternal education status. Our results illustrate that vocabulary size plays an important role in predicting children's later EF performance across various timepoints in early childhood, even after controlling for children's initial EF scores. These findings have important implications for intervention research as fostering early vocabulary acquisition may serve as a possible avenue for improving EF outcomes in young children. RESEARCH HIGHLIGHTS: Children's vocabulary size is positively correlated with their concurrent executive functioning skill at ages 2, 3, 4, and 6 Young children's early vocabulary scores predict their later EF performance across measurement waves, even after controlling for initial EF skill There is stability in children's relative vocabulary size and executive functioning performance over time in early childhood.

Movement behavior policies in the early childhood education and care setting: An international scoping review.

Meeting 24-h movement behavior guidelines for the early years is associated with better health and development outcomes in young children. Early childhood education and care (ECEC) is a key intervention setting however little is known about the content and implementation of movement behavior polices in this context. To inform policy development this international scoping review examined the prevalence, content, development and implementation of ECEC-specific movement behavior policies. A systematic literature search of published and gray literature since 2010 was conducted. Academic databases (EMBASE, Cinahl, Web of Science, Proquest, Scopus, EBSCO, PubMed) were searched. A Google search was undertaken and limited to the first 200 results. The Comprehensive Analysis of Policy on Physical Activity framework informed data charting. Forty-three ECEC policy documents met inclusion criteria. Most policies originated in the United States, were subnational and developed with government, non-government organizations and ECEC end-users. Physical activity was specified in 59% (30-180 min/day), sedentary time in 51% (15-60 min/day) and sleep in 20% (30-120 min/day) of policies. Daily outdoor physical activity was recommended (30-160 min/day) in most policies. No policy permitted screen time for children <2 years, with 20-120 min/day for children >2 years. Most policies (80%) had accompanying resources but few provided evaluation tools (e.g., checklists; action plan templates). Many policies had not been reviewed since the publication of 24-h movement guidelines. Movement behavior policies in the ECEC setting are often vaguely worded, missing a comprehensive evidence base, siloed in development and often not tailored for the 'real world.' A focus on evidence informed ECEC-specific movement behavior policies proportionally aligned with national/international 24-h Movement Behaviors Guidelines for the Early Years is needed.

Protocol and biomarker strategy for a multi-site randomized controlled trial examining biological mechanisms and dosing of active music engagement in children with acute lymphoblastic leukemia and lymphoma and parents

BackgroundMusic therapy is a standard palliative care service in many pediatric and adult hospitals; however, most research has focused on the use of music to improve psychosocial dimensions of health, without considering biological dimensions. This study builds on prior work examining psychosocial mechanisms of action underlying an Active Music Engagement (AME) intervention, designed to help manage emotional distress and improve positive health outcomes in young children with cancer and parents (caregivers), by examining its effects on biomarkers of stress and immune function.MethodsThis two-group randomized controlled trial (R01NR019190) is designed to examine biological mechanisms of effect and dose-response relationships of AME on child/parent stress during the consolidation phase of Acute B- or T-cell Lymphoblastic Leukemia (ALL) and T-cell Lymphoblastic Lymphoma (TLyLy) treatment. Child/parent dyads (n = 228) are stratified (by age, site, risk level) and randomized in blocks of four to the AME or attention control condition. Each group receives one session (30-minutes AME; 20-minutes control) during weekly clinic visits (4 weeks standard risk B-cell ALL; 8 weeks high risk B-cell ALL/T-cell ALL/TLyLy). Parents complete questionnaires at baseline and post-intervention. Child/parent salivary cortisol samples are taken pre- and post-session (sessions 1–4). Child blood samples are reserved from routine draws before sessions 1 and 4 (all participants) and session 8 (high risk participants). We will use linear mixed models to estimate AME’s effect on child/parent cortisol. Examining child/parent cortisol as mediators of AME effects on child and parent outcomes will be performed in an ANCOVA setting, fitting the appropriate mediation models using MPlus and then testing indirect effects using the percentile bootstrap approach. Graphical plots and non-linear repeated measures models will be used to examine dose-response relationship of AME on child/parent cortisol.DiscussionDuring pediatric cancer treatment there are special challenges that must be considered when measuring cortisol and immune function. In this manuscript we discuss how we addressed three specific challenges through our trial design. Findings from this trial will increase mechanistic understanding of the effects of active music interventions on multiple biomarkers and understanding of dose-response effects, with direct implications for clinical practice.Trial RegistrationClinicalTrials.gov: NCT04400071.

Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes

BackgroundClosed-loop control systems of insulin delivery may improve glycemic outcomes in young children with type 1 diabetes. The efficacy and safety of initiating a closed-loop system virtually are unclear.MethodsIn this 13-week, multicenter trial, we randomly assigned, in a 2:1 ratio, children who were at least 2 years of age but younger than 6 years of age who had type 1 diabetes to receive treatment with a closed-loop system of insulin delivery or standard care that included either an insulin pump or multiple daily injections of insulin plus a continuous glucose monitor. The primary outcome was the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring. Secondary outcomes included the percentage of time that the glucose level was above 250 mg per deciliter or below 70 mg per deciliter, the mean glucose level, the glycated hemoglobin level, and safety outcomes.ResultsA total of 102 children underwent randomization (68 to the closed-loop group and 34 to the standard-care group); the glycated hemoglobin levels at baseline ranged from 5.2 to 11.5%. Initiation of the closed-loop system was virtual in 55 patients (81%). The mean (±SD) percentage of time that the glucose level was within the target range increased from 56.7±18.0% at baseline to 69.3±11.1% during the 13-week follow-up period in the closed-loop group and from 54.9±14.7% to 55.9±12.6% in the standard-care group (mean adjusted difference, 12.4 percentage points [equivalent to approximately 3 hours per day]; 95% confidence interval, 9.5 to 15.3; P<0.001). We observed similar treatment effects (favoring the closed-loop system) on the percentage of time that the glucose level was above 250 mg per deciliter, on the mean glucose level, and on the glycated hemoglobin level, with no significant between-group difference in the percentage of time that the glucose level was below 70 mg per deciliter. There were two cases of severe hypoglycemia in the closed-loop group and one case in the standard-care group. One case of diabetic ketoacidosis occurred in the closed-loop group.ConclusionsIn this trial involving young children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with a closed-loop system than with standard care. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; PEDAP ClinicalTrials.gov number, NCT04796779.)

Rehabilitation and Reintegration of Women and Children Returning from Violent Extremist Contexts: A Rapid Review to Inform Program and Policy Development

ABSTRACT This rapid review used a systematic approach to examine the available literature on rehabilitation and reintegration (R&R) programs for women and children returning from contexts of violent extremism, examining common assumptions, inputs, activities and outcomes across diverse settings. Fifty-one documents including peer reviewed articles and grey literature were included in the analysis. The most common program activities identified included mental health services, community level social programs, promoting school and vocational enrollment, regular health services, and parenting training & education, though there was a lack of consensus around core program components. The analysis points to the need for a robust set of inputs and resources to implement R&R programs including government officials, child welfare, mental health professionals, teachers, law enforcement, healthcare, community leaders, and extended family. The review also uncovered a number of gaps. This includes the need to create clear and analytically distinct definitions of rehabilitation and reintegration that are applicable and relevant to key stakeholders, delineating age-appropriate activities and outcomes for young children, youth, and adults, defining frameworks for service delivery and coordination of stakeholders, and placing R&R programs within existing domains of public safety and restorative justice.

Language development trajectories in young children with developmental disabilities in Taiwan

BackgroundLanguage development is critical to various outcomes in young children with developmental disabilities (DD), including autism spectrum disorder (ASD) and non-ASD delays. However, language development trajectories in young children with DD in non-Western populations remain unclear. AimsTo investigate the language development trajectories of young children with DD in Taiwan. We investigated the relationship between trajectory class assignment and diagnostic outcomes (ASD or non-ASD delays) at 3 years after enrollment in the study and the differences in early abilities among children in different trajectory classes. Methods and ProceduresThe participants were 101 young children with DD (mean age: 21.88 months; follow-up: 1.5 and 3 years after enrollment). Growth mixture modeling analyses were conducted to receptive language developmental quotients (RLDQ) and expressive language developmental quotients (ELDQ) on the basis of the Mullen Scales of Early Learning. Outcomes and ResultsThree RLDQ trajectories were identified, namely age expected, delayed catch-up, and delayed, and two ELDQ trajectories were identified, namely delayed improve and delayed. Trajectory class assignment was related to diagnostic outcomes. Children who demonstrated more proficient skills at the early time point, demonstrated improved language outcomes 3 years later. However, adaptive functioning did not differ between the two ELDQ trajectory classes. Conclusions and ImplicationsLanguage development in young children with DD in Taiwan is heterogeneous. Delayed receptive and expressive language development trajectories relate to later ASD diagnoses.

Surgical treatment of tethered cord syndrome showed promising outcome in young children with short duration.

Aside from the severity, surgical interventions for the treatment of neurological dysfunctions remain controversial. This study aimed to find factors predicting the benefits of tethered cord syndrome (TCS) surgery. 80 children with TCS were included and followed up for pre- and post-operative factors along with neurophysiological analysis. Outcomes were assessed by univariate and multivariate analysis. Surgical treatment not only improved preoperative signs and symptoms in 79% of TCS patients but it showed to be an efficient procedure for the occurrence of future neurological defects. Univariate analysis also revealed that surgical intervention in TCS children (age <1 year) can modulate filar lipoma location and cutaneous abnormalities three months after surgery. Neurophysiological assessment revealed only 5.0% of surgical complications in TCS patients. Two patients had cerebrospinal fluid leakage, and two cases of CNS infection were detected. Surgical intervention is highly recommended for the prevention of neurological deficits in children with TCS. Electrophysiological monitoring revealed rare complications following the surgery.

HSCT FOR HEMOGLOBINOPATHIES (2022 UPDATE)

In 2021 the Brazilian society of stem cell transplantation and cell therapy published the consensus guidelines regarding hematopoietic stem cell transplantation (HSCT) for hemoglobinopathies. No changes have been added for thalassemia. HSCT with a matched sibling donor (MSD) or a related cord blood is the treatment of choice for young patients with transfusion dependent thalassemia. Matched unrelated and haploidentical HSCT, using bone marrow graft, are a clinical option. For sickle cell disease (SCD), conditioning regimen should be myeloablative for patients &lt; 16 years old. For adults, fludarabine, busulfan and ATG is a safe and effective regimen. The chemo-free regimen with alemtuzumab and TBI, pioneered by the NIH group, was successfully reproduced by other centers and is a good option for adults and patients with established organ damage. Haploidentical HSCT with post-transplant cyclophosphamide showed high rejection rates in the beginning but improvements in the conditioning regimen were performed, including the use of pre-transplant immunosuppression, the increase in TBI dose from 2 cGy to 4 cGy and the addition of thiotepa, which significantly reduced rejection rates. We consider haploidentical transplant as a clinical option in children with significant neurological alteration and in adults with the established indications. The optimal timing for HSCT in SCD children with MSD is not well established. Previous international reports showed excellent outcomes in young children. The risk of grade 2-4 acute graft-versus-host disease (GVHD) and chronic GVHD is significantly higher in patients older than 15 years old. Despite potential complications of HSCT (GVHD, gonadal dysfunction), transplantation at an earlier age may prevent organ dysfunction, strokes, iron overload and improve patients’ quality of life. Therefore, an early referral to HSCT is strongly recommended. The medical dilemma in older SCD patients, will be the assessment of established organ damage and the risk of transplantation. The clinical course of SCD is extremely variable and no validated genetic risk score has been established so far. Most of the risk scores use phenotypic characteristics together with laboratory biomarkers and imaging parameters to define outcomes in SCD.

The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review.

Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.

671: HEAD INJURY DEPTH AND FUNCTIONAL OUTCOMES IN PEDIATRIC TRAUMATIC BRAIN INJURY

Introduction: The centripetal theory of traumatic brain injury (TBI) posits that an inertial mechanism (rotational acceleration and deceleration) injures the brain in an outward-in fashion, where mild injuries affect only the superficial brain and severe injuries affect the deep, subcortical structures of the brain. Neurologic symptoms progressively worsen as depth of injury increases. Depth of brain lesion has been proposed as a potential prediction tool for functional outcome in older children and adolescents, but there is a paucity of data connecting depth of injury and outcome in young children. We hypothesized that functional outcome at hospital discharge will worsen as greatest depth of injury increases in children < 3. Methods: Retrospective chart review including patients < 3 years of age admitted to a tertiary children’s hospital PICU or Intermediate Care Unit between 2015 - 2020 with acute TBI. Patients were divided into 4 cohorts based on greatest depth of injury visible on initial neuroimaging: scalp/skull/epidural vs. subdural/subarachnoid vs. cortical brain vs. subcortical brain injury. Baseline and hospital discharge Functional Status Score (FSS) (score 6-30) and Pediatric Cerebral Performance Category (PCPC) (score 1-5) were assigned. Results: A total of 170 patients were included (scalp/skull/epidural, n=54; subdural/subarachnoid, n=76; cortical brain, n=17; subcortical brain, n=23). Median age was 6 months. Sixty percent of patients were male. Nine patients died, 1 with a cortical injury and 8 with subcortical injuries. Total length of stay (LOS), PICU LOS, and ventilator days all increased as depth of injury increased (p< 0.001). All patients had a normal baseline FSS of 6 and a PCPC of 1. As depth of injury increased from superficial to deepest, patients were more likely to have functional deficits at discharge (FSS: 4% vs. 7% vs. 38% vs. 73%, p< 0.001; PCPC: 2% vs. 8% vs. 44% vs. 73%, p< 0.001). Patients with subcortical injuries had significantly higher median FSS (10, IQR 6.5-13, p< 0.001) and PCPC (2, IQR 1.5-3.5, p< 0.001) at discharge. Conclusions: Functional outcomes at hospital discharge worsen as greatest depth of injury increases in children < 3 with acute TBI, supporting the potential use of depth of brain injury as a prediction tool for functional outcome in this population.

Measuring the association between behavioural services and outcomes in young children with autism spectrum disorder

BackgroundChildren with autism spectrum disorder (ASD) receive a wide range of services. AimsTo examine the association between behavioural services received by children with ASD between ages 2 and 5 years and outcomes during primary school years. MethodsA total of 414 preschool-aged children diagnosed with ASD were enrolled at five Canadian sites and were assessed within four months of diagnosis (T1), six months later (T2), 12 months later (T3), at school entry (T4), and then annually (T5-T8) to 11 years of age. The association between the receipt of behavioural services during T1 to T3 and T8 outcomes related to adaptive behaviour and behavioural problems was modelled using linear regressions adjusted for immigrant status, family income, child’s age at diagnosis, site, sex assigned at birth, and baseline (T1) outcome. ResultsChildren who received behavioural services during at least one time period from T1 to T3 did not have significantly different outcomes at T8 than children who did not receive any behavioural services. ImplicationsPre-school use of behavioural services was not found to affect outcomes during later childhood. Numerous challenges accompany studies of the association between pre-school service use and later outcomes in a heterogeneous ASD sample. Recommendations for study design are provided.

The impact of Allied Health Professionals on the primary and secondary prevention of obesity in young children: A scoping review.

Allied Health Professionals (AHPs) have the capacity to promote healthy behaviours in young children through routine 'contact points', as well as structured weight management programmes. This scoping review aims to evaluate the impact of AHPs in the prevention of obesity in young children. Databases were searched for relevant evidence between 1st January 2000 and 17th January 2022. Eligibility criteria included primary evidence (including, but not limited to; randomized controlled trials, observational studies, service evaluations) evaluating the impact of AHPs on the primary and secondary prevention of obesity in young children (mean age under 5 years old). AHP-related interventions typically demonstrated improvements in outcomes such as nutritional behaviour (e.g. lower sweetened drink intake), with some reductions in screen time. However, changes in weight outcomes (e.g. body mass index (BMI) z-score, BMI) in response to an AHP intervention were inconsistent. There was insufficient data to determine moderating effects, however tentative evidence suggests that those with a lower socioeconomic status or living in an underprivileged area may be more likely to lose weight following an AHP intervention. There was no evidence identified evaluating how AHPs use routine 'contact points' in the prevention of obesity in young children. AHP interventions could be effective in optimizing weight and nutritional outcomes in young children. However, more research is required to determine how routine AHP contact points, across the range of professional groups may be used in the prevention of obesity in young children.

Abstract 10403: Residual Lesion Severity is Associated With Adverse Neurodevelopmental Outcomes in Young Children With Congenital Heart Disease

Introduction: There are few modifiable risk factors for adverse neurodevelopmental (ND) outcomes in congenital heart disease. We assessed the Residual Lesion Score (RLS), a quality improvement metric that assesses residual lesion severity following congenital heart surgery (CHS), as a predictor of ND delay. Hypothesis: We hypothesized that RLS would be independently associated with ND outcomes. Methods: This was a single center, retrospective review of patients who underwent CHS from 01/2011-12/2019 and received post-discharge ND evaluation between the ages of 12 and 42 months using the Bayley Scales of Infant Development, 3 rd ed. (BSID-3). RLS was assigned at discharge per previously published criteria: Class 1, no residua; Class 2, minor residua; Class 3, major residua or in-hospital unplanned reintervention. Associations between RLS and BSID-3 scores (at the first ND evaluation) were evaluated using linear regression, adjusting for baseline patient risk, the Childhood Opportunity Index, and maternal education level. Linear mixed effects models assessed trends in ND outcomes over time. Results: Of 477 patients with mean age at ND testing of 21.2 ± 6.1 months, 282 (59.1%), 132 (27.7%), and 63 (13.2%) patients had RLS 1, 2, and 3 lesions, respectively. Table 1A shows BSID-3 outcomes by RLS. On multivariable analysis, Class 3 patients had significantly lower cognitive, receptive and expressive communication, and fine and gross motor scaled scores, compared to Class 1 patients, with the largest difference observed in the cognitive domain ( Table 1B ). In a subset of 191 patients with more than one ND evaluation, Class 3 patients made fewer gains in skills from the first to the last evaluation in the cognitive and language domains, compared to Class 1 patients (both p&lt;0.05). Conclusions: Patients with major residua (RLS 3) are at increased risk for ND delay, warranting closer ND follow-up and greater developmental support for cognitive, communication, and motor skills.

Comparison of Injury Severity Score, Glasgow Coma Scale and Revised Trauma Score in Predicting the Outcome in Young Patients with Trauma Attending Emergency Department of Suez Canal University Hospitals

Background: Easy-to-use trauma scoring systems can be used for making good clinical decision before the patient reaches the hospital and at emergency department. These scoring systems can also be used for timely delivering medical support and preparing the patient for surgery in early stage. The objective of this study was to assess the ability of trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries.&#x0D; Methods: This was a potential cross-sectional study that was conducted in the emergency department of Suez Canal University Hospitals. We included 86 children patients younger than 6 years of age who were presented to hospital via the emergency department with any traumatic injury and compared the trauma outcomes for GCS, ISS, and RTS on patient outcomes.&#x0D; Results: The main type of accident encountered in our study was fall from height (33.7%) followed by road traffic accidents (29.1%). Mortality rate in our study was 4.7%. The mean trauma scores of ISS, GCS, and RTS in our studied population were 11.47, 14.21, and 7.79, respectively. All trauma scores differed with statistical significance (p&lt;0.001, &lt;0.001, &lt;0.030, respectively) between the survivors and mortality groups. We found a mean ISS of 10.30 ± 5.84 in survived children and 35.25 ± 25.97 in those who died. Mean GCS was 14.62 ± 1.10in survivors and 5.75 ± 1.50 in non-survivors. RTS means were7.96 ± 0.33in survived children and 4.25 ± 0.50 in those who died, respectively. ROC curve analysis of the three scores regarding mortality prediction revealed close results; all showed a modest ability to predict mortality. The highest AUC was for RTS and GCS; 0.998 and 0.997, respectively. ISS had a slightly lower AUC of 0.0816. In the current study, RTS and GCS showed the best sensitivity and specificity to predict mortality of 100% and 98.78%, respectively. A slight lower ability was found for ISS with a sensitivity of75%. The desired cut-offs to predict mortality were ≤7 for the GCS, ≤5 for the RTS and ≥17 for the ISS with the previously mentioned sensitivity and specificity. Regarding the need for surgery, among survived patients, those who had surgery had statistically significant higher ISS compared to those who did not have surgery (14.69 ± 9.98 Vs 7.39 ± 6.04) (p&lt;0.001). On the other hand, there was no statistically significant difference between the two groups in regard to GCS (p=0.053) and RTS (p=0.251). Conclusion: In conclusion, we found that worse trauma scores of ISS, GCS, and RTS were associated with increased mortality and prolonged hospital stays among young children’s injuries. Among these three trauma scores, we found RTS and GCS to have the best predictive value. The cutoff values of ISS, GCS, and RTS for predicting mortality were &gt;17, ≤7, and ≤5, respectively.

Inequitable Experiences and Outcomes in Young Children: Addressing Racial and Social-Economic Disparities in Physical and Mental Health

Given the high rates of child poverty in the United States, socioeconomic disparities exist regarding children's physical and mental health. These disparities are particularly pronounced for children of color, who are more likely to experience poverty compounded by the vestiges of historical and systemic racism. Physical health disparities include higher rates of mortality, growth impairments, allergies, respiratory difficulties, tooth decay, and injuries. Disparities have also been found in the mental health arena, including a higher likelihood of internalizing and externalizing disorders, as well as trauma symptoms, and differences in the timing of diagnosis of, types of, and treatments for mental health disorders. Familial, neighborhood, service, and systemic contextual factors further solidify these disparities. It is critical to address the structural causes of these disparities and their consequences to promote more positive outcomes in affected children. A system of care that integrates economic programs, child care and education supports, parenting interventions, and appropriate physical and mental health care is essential to meet the health needs of children from impoverished backgrounds.

Early Developmental Trends in High-Risk Neonates Later Diagnosed With Autism Spectrum Disorder.

We hypothesized that clinical data from a neonatal intensive care unit (NICU) infant developmental follow-up clinic would identify early manifestations of autism spectrum disorder (ASD). One hundred forty-four infants were identified; 72 later diagnosed with ASD and 72 controls. Retrospective chart review provided data from the Test of Infant Motor Performance (TIMP) and the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), between 8 and 26 months of age. Between-group comparisons indicated no significant group difference in TIMP scores; however, Bayley-III scaled scores differed between the groups at 2 administration times. The within-group Bayley-III change scores declined significantly more for the ASD group in cognitive and communication subtests. High-risk neonates, due to prematurity or morbidity, later diagnosed with ASD demonstrated statistically significant differences, including a more precipitous drop in Bayley-III scores over time. Early, longitudinal developmental surveillance for neonates at risk of ASD is critical. What this adds to the evidence: Early identification of ASD is critical to optimize developmental outcomes in young children, including infants born prematurely or with neonatal morbidity, who are perceived to have an increased risk for ASD. Despite these findings, minimal research has been conducted to evaluate the utility of commonly administered norm-referenced developmental surveillance instruments to identify possible early signs of ASD in this high-risk population due to prematurity or neonatal morbidity and not familial association. The present study analyzed retrospectively collected clinical data from a NICU developmental follow-up clinic for 144 infants, 72 of which were later diagnosed with ASD and 72 sex- and gestational age-matched controls. Results demonstrated statistically significant poorer Bayley-III outcomes for the ASD group compared with controls at 2 different study time points, including a more precipitous drop in Bayley-III scaled scores over time. This study highlights the importance of early and longitudinal developmental surveillance for high-risk neonates at risk of ASD.