Predictor Of Developmental Outcomes Research Articles

Predictors of Developmental Outcome in 4- to 6-Year-Olds With Developmental Disability.

Objective Studies on the early trajectories of developmental disability (DD) are limited. This study aimed to evaluate the diagnostic stability and developmental trajectories of autism spectrum disorder (ASD) and intellectual disability (ID), and to determine baseline clinical characteristics that affect future diagnosis. Methods We analyzed 192 children who were referred for possible DD through retrospective chart review. Clinical diagnosis was assessed once at baseline, aged 2–4, and at follow-up, aged 4–6. The participants’ developmental profiles were measured by Psychoeducational Profile-Revised (PEP-R), Vineland Social Maturity Scale (VSMS), Beery-Buktenica Developmental Test of Visual Motor Integration (VMI), and Childhood Autism Rating Scale (CARS). Results On comparing the diagnostic change, 5% of children were no longer diagnosed as ASD, and 13% of children were no longer diagnosed as ID at follow-up. Trajectories of developmental profiles were compared between children with and without ID at follow-up, and significant time-by-group interaction were observed in PEP-R (p<0.001), VSMS (p<0.001), and VMI (p=0.003) scores, indicating that children without ID at follow-up showed significant improvement over time compared to children with ID. ASD diagnosis (p<0.001) and CARS score (p=0.007) at baseline were significantly associated with ASD at follow-up, while VSMS score (p=0.004) and VMI score (p=0.019) at baseline were significantly associated with ID at follow-up. Conclusion A subset of children lost their diagnosis at follow-up, and such diagnostic change was significantly more common in ID compared to ASD. Baseline autism symptomatology was related to ASD at follow-up, and baseline adaptive and visuo-motor function was related to ID at follow-up.

Quantitative assessment of viral load in the blood and urine of patients with congenital cytomegalovirus infection using droplet digital PCR.

Congenital cytomegalovirus infection (cCMV) is a common cause of congenital infections, leading to neurodevelopmental sequelae. Real-time quantitative polymerase chain reaction (qPCR) has been widely used for the diagnosis and assessment of cCMV; however, the correlation between CMV DNA load and the severity of cCMV symptoms has been inconclusive. Droplet digital PCR (ddPCR) offers an improvement over the current qPCR methods through the absolute quantification of viral loads. We compared ddPCR and qPCR results for the quantification of CMV DNA in blood and urine specimens from 39 neonates with cCMV (21 symptomatic and 18 asymptomatic). There was no significant difference in blood CMV DNA loads measured by ddPCR and qPCR, with or without any clinical findings. However, developmental delays at 36 months were significantly more frequently observed in patients with high CMV DNA loads (≥2950 copies/ml), as measured by ddPCR at diagnosis, than in those with lower CMV DNA loads. The association of urine CMV DNA load with symptoms and developmental delay was not observed. CMV DNA loads in the blood might be used as a predictor of developmental outcomes in cCMV patients, and absolute quantitation of viral loads by ddPCR assay could contribute to the standardization of CMV load measurement.

Combined prenatal exposure to mercury and LCPUFA on newborn's brain measures and neurodevelopment at the age of 18 months

ObjectivesPrenatal exposure of long chain polyunsaturated fatty acids (LCPUFA) are essential for normal fetal growth and neurodevelopment. Availability of LCPUFA depends mostly on maternal fish consumption. Fish consumption also exposes the fetus to mercury which is well known neurotoxicant. We analyzed the associations of combined LCPUFA and mercury from fish consumption during pregnancy on newborn's brain measures and child neurodevelopment in a northern Adriatic coastal area. Patients and methodsThe prospective cohort study included 257 mother – infant pairs enrolled in a susceptible population of the Public Health Impact on long-term, low-level, Mixed Element exposure (PHIME) EU Sixth Framework Programme from 2 recruitment areas of the northern part of the Adriatic coast. Umbilical cord blood taken at delivery was used for measuring concentration of total mercury (THg) and specific LCPUFA - docosahexaenoic acid (DHA) and arachidonic acid (ARA). Neonatal cranial sonography was performed at the age of 3 days in 57 newborns. Neurodevelopmental assessment of cognitive, motor and language skills were conducted at 257 children at the age of 18 months using the Bayley Scales of Infant and Toddler Development, Third Edition. The participants were divided into two groups depending on the THg concentration in the umbilical cord blood (exposed > 5.8 μg/L and unexposed < 5.8 μg/L). Dietary habits and exposures to environmental and social factors were assessed through questionnaires. ResultsThere is a statistically significant difference in the cerebellum length (p = 0.032) and the superior frontal gyrus width (p = 0.023) between the exposed and the unexposed group. In combined analysis, including possible protective variables as DHA and ARA (R2 = 0.22, p = 0.001), the negative contribution of THg on cerebellum length (beta = −0.16, p = 0.001) persisted. We found no correlation between THg concentration in umbilical cord blood and child neurodevelopment scores at the age of 18 months. Language score with receptive and expressive subscores was significantly associated with fish consumption (p < 0.05). ConclusionThis analysis demonstrates the existence of morphological brain changes in newborns that are prenatally exposed at mercury concentrations what was diminished in combined analyse including LCPUFA. Our results emphasizes the importance of LCPUFA's and mercury common influence as a predictor of developmental outcome. Fish consumption, not solely LCPUFA contributes to better language development of children at the age of 18 months.

Neurocognitive and functional outcomes at 5years of age after renal transplant in early childhood.

Clinicians often use information about developmental outcomes in decision-making around offering complex, life-saving interventions in children such as dialysis and renal transplant. This information in children with end-stage renal disease (ESRD) is limited, particularly when ESRD onset is in infancy or early childhood. Using data from an ongoing prospective, longitudinal, inception cohort study of children with renal transplant before 5years of age, we evaluated (1) the risk of adverse neurocognitive and functional outcomes at 5years of age and (2) predictors of developmental outcomes. We found evidence of neurocognitive sequelae of ESRD in very young children; however, developmental outcomes appear remarkably better when compared with findings of two or three decades ago. Less time on dialysis predicted higher developmental scores, and hemodialysis was associated with poorer developmental outcomes. Our data suggest that renal replacement therapies in young children are associated with acceptable developmental outcome. Programs to identify those with developmental delays and provide early intervention may allow achievement of the child's full potential.

Approach temperament across cultures: Validity of the Infant Temperament Scale in MAL-ED

ABSTRACTCharacteristics of temperament have been shown to predict aspects of personality and psychopathology. Approach temperament (i.e., sensitivity, reactivity, and behavioral disposition toward reward stimuli) may be a particularly salient predictor of developmental outcomes (e.g., Nigg, 2006; Shiner & Caspi, 2003). However, there is little research on approach temperament among children from low- and middle-income nations. This study examined the validity of an adapted version of the Infant Temperament Scale across eight international sites with a focus on approach temperament. Our sample included 1,933 infants from eight study sites in low- and middle-income nations: Bangladesh, Brazil, India, Nepal, Peru, Pakistan, South Africa, and Tanzania. The Infant Temperament Scale was translated and administered as a structured interview to caregivers at each site. Exploratory and confirmatory factor analyses were used to examine the factor structure of the scale, and multiple indicator multiple cause (MIMIC) modeling was used to examine invariance of scores across sites. The findings supported the validity of an approach temperament factor. Although the findings did not support the cross-cultural use of the entire Infant Temperament Scale among individuals from low- and middle-income nations in our sample, the supported approach temperament factor is a theoretically important subconstruct. Moreover, the inability to measure other aspects of temperament across cultures may have important implications for researchers interested in the nature of temperament. Implications and future directions are discussed.

Predicting the effectiveness of Test of Infant Motor Performance as an early marker of motor development delay in preterm infants

Objectives: The purpose of this study was to determine the effectiveness of Test of Infant Motor Performance (TIMP) in detecting motor developmental delay in preterm infants. Material and methods: The present study was conducted on 30 infants born preterm with corrected age of 2 months and follow up of TIMP at 4 months corrected age and Alberta Infant Motor Scale (AIMS) at 2, 4 and 6 months corrected age. Study period was January 2012 to December 2015. Results: Pearson product moment correlation coefficient used to assess the relationship between the raw scores of TIMP and AIMS percentilerank at corrected age of 2 and 4 months, was 0.757 (p<0.0001) and 0.874 (p<0.0001) respectively. An analysis of the sensitivity, specificity, positive predictive value and negative predictive value of various TIMP cutoff scores for comparison with AIMS scores above and below the 10th percentile revealed the best TIMP score with a cutoff of -1 standard deviation below the mean. The results for comparison of 2, 4, 6 months corrected age AIMS data using Pearson chi square test was highly significant with p 0.001 at 2months CA AIMS data with 4 months CA AIMS data. Conclusion and Interpretation: TIMP and AIMS are equally useful in the assessment of infant motor performance at 4 months of corrected age. A cutoff score of -1 SD from the mean on TIMP was a better predictor of developmental outcome in this study.

Early prediction of developmental outcomes at 3 years following cardiac surgery

Early prediction of developmental outcomes at 3 years following cardiac surgery

Adolescent Ethnic Identity in Social Context: A Commentary.

Key findings from the various studies of this special section of Child Development are that ethnic identity is embedded in a positive proximal interpersonal context in adolescence and that the links between ethnic identity and the interpersonal context seem to become stronger from the beginning of early adolescence on. Remarkably, the (longitudinal) studies do not show that ethnic identity is a better predictor of developmental outcomes or that it can be better predicted in minority groups than in majority groups. I use one of the articles to demonstate that a longitudinal prediction model is different from a developmental sequence model. Finally, an extension of the present measures of ethnic identity is proposed. This extension would allow for a thorough investigation of the saliency of ethnic identity and its interplay with other identity domains during adolescent development.

Neurological Outcome in Fetuses with Mild and Moderate Ventriculomegaly.

Introduction Ventriculomegaly (VM) is one the most frequent anomalies detected on prenatal ultrasound. Magnetic resonance imaging (MRI) may enhance diagnostic accuracy and prediction of developmental outcome in newborns. Purpose The aim of this study was to assess the correlation between ultrasound and MRI in fetuses with isolated mild and moderate VM. The secondary aim was to report the neurodevelopmental outcome at 4 years of age. Methods Fetuses with a prenatal ultrasound (brain scan) diagnosis of VM were identified over a 4-year period. Ventriculomegaly was defined as an atrial width of 10-15 mm that was further divided as mild (10.1-12.0 mm) and moderate (12.1-15.0 mm). Fetuses with VM underwent antenatal as well as postnatal follow-ups by brain scan and MRI. Neurodevelopmental outcome was performed using the Griffiths Mental Development Scales and conducted, where indicated, until 4 years into the postnatal period. Results Sixty-two fetuses were identified. Ventriculomegaly was bilateral in 58% of cases. A stable dilatation was seen in 45% of cases, progression was seen in 13%, and regression of VM was seen in 4.5% respectively. Fetal MRI was performed in 54 fetuses and was concordant with brain scan findings in 85% of cases. Abnormal neurodevelopmental outcomes were seen in 9.6% of cases. Conclusion Fetuses in whom a progression of VM is seen are at a higher risk of developing an abnormal neurodevelopmental outcome. Although brain scan and MRI are substantially in agreement in defining the grade of ventricular dilatation, a low correlation was seen in the evaluation of VM associated with central nervous system (CNS) or non-CNS abnormalities.

Can We Predict Functional Outcome in Neonates with Hypoxic Ischemic Encephalopathy by the Combination of Neuroimaging and Electroencephalography?

Neonatal hypoxic ischemic encephalopathy (HIE) is a major cause of mortality, morbidity, and long-term neurological deficits. Despite the availability of neuroimaging and neurophysiological testing, tools for accurate early diagnosis and prediction of developmental outcome are still lacking. The goal of this study was to determine if combined use of magnetic resonance imaging (MRI) and electroencephalography (EEG) findings could support outcome prediction. We retrospectively reviewed records of 17 HIE neonates, classified brain MRI and EEG findings based on severity, and assessed clinical outcome up to 48 months. We determined the relation between MRI/EEG findings and clinical outcome. We demonstrated a significant relationship between MRI findings and clinical outcome (Fisher's exact test, p=0.017). EEG provided no additional information about the outcome beyond that contained in the MRI score. The statistical model for outcome prediction based on random forests suggested that EEG readings at 24 hours and 72 hours could be important variables for outcome prediction, but this needs to be investigated further. Caution should be used when discussing prognosis for neonates with mild-to-moderate HIE based on early MR imaging and EEG findings. A robust, quantitative marker of HIE severity that allows for accurate prediction of long-term outcome, particularly for mild-to-moderate cases, is still needed.

How Dravet syndrome became a model for studying childhood genetic epilepsies

In this issue of Brain , Brunklaus et al. report a study of 241 patients with Dravet syndrome carrying a SCN1A mutation, with the aim of identifying predictors of developmental outcome and determining specific clinical and demographic characteristics. The electroclinical features of a large cohort were collected and analysed prior to genetic testing. A total of 355 patients were diagnosed with Dravet syndrome, but the authors selected only the 241 (68%) who were positive for a mutation of SCN1A . Patients who were excluded had not been tested for mutations in other genes that could potentially cause overlapping phenotypes, such as protocadherin 19 (Depienne et al ., 2009). Dravet syndrome was first described briefly in French as severe myoclonic epilepsy in infancy (Dravet, 1978). In 1981, the same series was presented at the XIIIth Epilepsy International Congress and published 1 year later. Over the last 20 years, numerous series of patients have been reported, confirming the initial description, but also underlining variability of the clinical picture. The classic syndrome is defined by onset in an otherwise healthy infant during the first year of life, presenting febrile or afebrile and generalized or unilateral clonic or tonic clonic seizures, often long lasting, later associated with myoclonic, atypical absence and focal seizures. These are all resistant to drug treatment, and accompanied by slowing of developmental skills, as well as motor and behavioural disturbances. The EEG shows generalized and multifocal abnormalities whereas neuroimaging is normal. It quickly became apparent that a number of patients do not present with the complete semiology, mainly because the myoclonic component may be missing, and typical and atypical or ‘borderline’ forms are recognized, also showing an unfavourable prognosis. With time, the syndrome …

Prognostic, clinical and demographic features in SCN1A mutation-positive Dravet syndrome

Dravet syndrome is a severe infantile onset epileptic encephalopathy associated with mutations in the sodium channel alpha 1 subunit gene SCN1A. To date no large studies have systematically examined the prognostic, clinical and demographic features of the disease. We prospectively collected data on a UK cohort of individuals with Dravet syndrome during a 5-year study period and analysed demographic information based on UK population and birth figures. From structured referral data we examined a range of clinical characteristics including epilepsy phenotype, seizure precipitants, electroencephalography data, imaging studies, mutation class and response to medication. Predictors of developmental outcome were determined by logistic regression. We identified 241 cases with SCN1A mutation-positive Dravet syndrome, 207 of which were UK-based. The incidence of mutation-positive Dravet syndrome is at least 1:40 900 UK births. Clinical features predicting a worse developmental outcome included status epilepticus (odds ratio = 3.1; confidence interval = 1.5-6.3; P = 0.003), interictal electroencephalography abnormalities in the first year of life (odds ratio = 5.7; confidence interval = 1.9-16.8; P = 0.002) and motor disorder (odds ratio = 3.3; confidence interval = 1.7-6.4; P < 0.001). No significant effect was seen for seizure precipitants, magnetic resonance imaging abnormalities or mutation class (truncating versus missense). Abnormal magnetic resonance imaging was documented in 11% of cases, principally with findings of non-specific brain atrophy or hippocampal changes. Sodium valproate, benzodiazepines and topiramate were reported as being the most helpful medications at the time of referral. Aggravation of seizures was reported for carbamazepine and lamotrigine. The identification of factors influencing prognosis both aids counselling and encourages early, syndrome-specific therapy. Prevention of status epilepticus with regular medication and emergency protocols is important and may influence developmental outcome.

1FC1.5 Interstitial radiosurgery for gelastic epilepsy due to hypothalamic hamartomas: tolerability and efficacy in childhood and adolescence

Study aim: Our objective was to examine the demography, clinical features and prognostic factors predicting developmental outcome in a United Kingdom cohort of children with Dravet Syndrome. Methods: In the study period, 12/2005 to 2/2010, we prospectively collected data on individuals with Dravet syndrome referred to the only UK centre offering genetic testing. We analysed demographic information based on UK population and birth data. From structured referral data we examined a range of clinical characteristics including epilepsy phenotype, seizure precipitants, EEG data, imaging studies, mutation class and response to medication. Predictors of developmental outcome were determined by logistic regression. Results: We identified 241 SCN1A mutation-positive Dravet syndrome cases of which 207 are UK-based. The incidence of Dravet Syndrome is at least one in every 40,900 UK births. Clinical features predicting a worse developmental outcome included status epilepticus (OR=3.1; CI=1.5−6.3; p = 0.003), interictal EEG abnormalities in the first year of life (OR=5.7; CI=1.9 16.8; p = 0.002) and motor disorder (OR=3.3; CI=1.7−6.4; p<0.001). No significant effect was seen for seizure precipitants, MRI abnormalities or mutation class (truncating vs. missense). Abnormal MRI imaging was documented in 11% of cases, principally with findings of non-specific brain atrophy or hippocampal changes. Valproate, benzodiazepines and topiramate were reported the most helpful medications at time of referral. Aggravation of seizures was reported for carbamazepine (60%) and lamotrigine (43%). Conclusions: Identification of factors influencing prognosis both aids counselling and encourages early, syndrome specific therapy. Prevention of status epilepticus with regular medication and emergency protocols is important and may influence developmental outcome.

Sucking Behavior of Preterm Neonates As a Predictor of Developmental Outcomes

The relationship between the pattern of sucking behavior of preterm infants during the early weeks of life and neurodevelopmental outcomes during the first year of life was evaluated. The study sample consisted of 105 preterm infants (postmenstrual age [PMA] at birth = 30.5 +/- 2.8 weeks [mean +/- SD]; birth weight = 1476 +/- 460 g; mean length of hospital stay = 41.6 +/- 31.4 days). All infants received a 5-minute sucking test at 34 and at 40 weeks PMA, with outcomes evaluated at 6 and/or 12 months corrected gestational age via the Bayley Scales of Infant Development. As expected, 6- and 12-month values for the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development were significantly below the normative levels established for infants delivered at term. A significant association between neonatal sucking pattern at 40 weeks PMA and developmental outcome at 12 months corrected gestational age was obtained. Each of the 3 simple sucking parameters evaluated (number of sucks, mean number of sucks per bursts and mean sucking pressure peaks), as well as a composite parameter (average of the respective parameter z-scores), was significantly related to both PDI and MDI at 12 months. Multivariable models, adjusting for PMA at birth, length of hospital stay, and other predictors, affirmed that sucking performance at 40 weeks PMA was a significant, independent predictor of developmental status 1 year later. Standardization of an instrument for neonatal sucking assessment may offer a cost-effective early screening strategy for preterm infants at greatest risk for developmental delay.

Repetitive and stereotyped behaviors in children with autism spectrum disorders in the second year of life.

This study examined repetitive and stereotyped behaviors (RSB) in children with autism spectrum disorders (ASD, n = 50), developmental delays without ASD (DD; n = 25) and typical development (TD, n = 50) between 18 and 24 months of age. Children with ASD demonstrated significantly higher frequency and longer duration of RSB with objects, body, and sensory behaviors during a systematic behavior sample than both the DD and TD groups. RSB with objects were related to concurrent measures of symbolic capacity and social competence in the second year and predicted developmental outcomes as well as severity of autism symptoms at 3 years in children with communication delays. RSB in the second year appear to be important for early identification and prediction of developmental outcomes.

Validation of an Instrumented Sleep-Wake Assessment Against a Biobehavioral Assessment

Because of the vulnerability of preterm infants and the important functions of sleep to health and recovery, researchers have used the assessment of sleep-wake states extensively in research with preterm infants. Sleep-wake states have been used to evaluate the safety and effectiveness of interventions, as an outcome measure of interventions to promote sleep-wake state development and as a predictor of developmental outcome. The usual observations of infant behavior and polysomnography methods of sleep-wake state assessment are very resource-intensive, therefore limiting their widespread use. The purpose of this study was to examine the validity of a new, less resource-intensive, instrumented measure of infant sleep-wake states using infant respiration, body movements, and rapid eye movements against an accepted behavioral observation measure. The instrumented measure demonstrated significant reliability for assessing sleep states but was less reliable for waking states.

The Conundrum of Prediction

The study by Hack et al1 in this issue of Pediatrics underscores the complexities inherent in prediction of developmental outcome. More specifically, in this study many children who scored >2 SDs below average on the Bayley Scales of Infant Development-II (BSID-II)2 at 20 months' corrected age subsequently did better on the Kaufman Assessment Battery for Children (K-ABC)3 given at 8 years. Greater stability in scores was found in those children with Mental Developmental Index (MDI) scores of 70 also did well on the later assessment. As a result, high negative predictive values, but low positive predictive values, were found. There are numerous advantages to the study: large sample size, consideration of environmental and biomedical variables, long-term serial evaluation, analyses with and without … Reprint requests to (G.P.A.) Division of Developmental and Behavioral Pediatrics, Southern Illinois University School of Medicine, PO Box 19658, Springfield, IL 62794-9658. E-mail: gaylward{at}siumed.edu

Predictive Validity of the Test of Infant Motor Performance as Measured by the Bruininks-Oseretsky Test of Motor Proficiency at School Age

As the survival rate of infants who are born prematurely increases, the need for accuracy in early identification and prediction of developmental outcome in these infants is imperative. This study examined the predictive validity of the Test of Infant Motor Performance (TIMP) and the relationship between perinatal risk and motor performance in children who are of school age. A stratified, random sample of 35 children was selected from subjects who had been examined using the TIMP and the Problem-Oriented Perinatal Risk Assessment System (POPRAS). The subjects were between 32 weeks gestational age and 4 months postterm (mean age=10 days postterm). The stratification was based on age at the time of TIMP administration (AGE) and on POPRAS scores. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was administered to the children at a mean age of 5.75 years. Predictive values were calculated and correlation and regression analyses were conducted to examine the relationship between the TIMP and POPRAS scores and the BOTMP score. Using the receiver operating characteristic curve and a cutoff z score of -1.6, the TIMP's sensitivity, specificity, and positive and negative predictive values were.50, 1.00, 1.00, and.87, respectively. The correlation between TIMP and BOTMP scores, with AGE controlled, was.36, and the correlation between POPRAS and BOTMP scores was -.55. Thirty-seven percent of BOTMP variance was accounted for collectively by POPRAS scores, TIMP scores, and AGE. The TIMP and POPRAS may be viable instruments that can be used together to identify infants who are at risk for poor long-term motor performance.

Predictors of Developmental Outcome in Very Low Birth Weight Infants

Sociodemographic and biomedical predictors of development in very low birth weight (VLBW, #lt 1500 g) infants were examined in 85 VLBW infants (between the ages of 6 and 24 months) from racially and socioeconomically diverse backgrounds. Development was evaluated by the Bayley Infant Neurodevelopmental Screener (BINS), the Clinical Adaptive Test#shClinical Linguistic Auditory Milestone Scale (CAT#shCLAMS) and the Bayley Scales of Infant Development‐ll (BSID‐ll). Low Income and greater frequency of medical problems predicted developmental risk on the BSID‐ll. In two‐parent households, paternal education predicted developmental scores. Several individual biomedical factors (e.g., gender, IVH, and low Apgar score) distinguished infants rated as high vs. low risk on the BINS. Even In severely compromised children, both demographic and biomedical risk factors affect development Sample characteristics and instrumentation may influence results even in same data sets.

Cumulative risk and early cognitive development: a comparison of statistical risk models.

Although it is generally accepted that social risk factors predict delays in early cognitive and language development, there is less agreement about how to represent such associations statistically. Using data collected prospectively on 87 African American children during their first 4 years, this study examined 3 analytic methods for describing a child's level of social risk: (a) individual risk variables, (b) factor scores derived from those risk variables, and (c) a risk index computed by tallying the number of risk conditions present. Comparisons indicated that the individual-risk-variables approach provides better overall prediction of developmental outcomes at a particular age but is less useful in predicting developmental patterns. The risk-factor approach provides good prediction of developmental trajectories when sample sizes are moderate to large. Finally, the risk-index approach is useful for relating social risk to developmental patterns when a large number of risk variables are assessed with a small sample or when other constructs are of primary interest.