Psychomotor Development Index Scores Research Articles

Sensory profiles obtained from parental reports correlate with independent assessments of development in very preterm children at 2 years of age

BackgroundVery preterm (VPT) children have different sensory profiles than term-born controls, but how the sensory profiles in VPT children relate to development has not been reported. AimThe aim of this study was to examine the relationship between VPT infant sensory profiles and concurrent developmental outcomes at 2years' corrected age. Study designCohort study. Subjects243 children <30weeks' gestation. Outcome measuresPrimary caregivers completed the Infant/Toddler Sensory Profile Questionnaire to obtain information on sensory processing at 2years of age. Independent observers assessed the child's neurodevelopment with either the Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development version 2 (Bayley 2) or the Cognition, Language and Motor Composites of the Bayley Scales of Infant and Toddler Development version 3 (Bayley 3). ResultsA stronger Low Registration pattern correlated with lower MDI and PDI scores and a stronger Sensation Avoiding pattern correlated with a lower PDI score. A stronger Low Registration pattern correlated with a lower Language Composite score. More frequent visual and oral sensory processing behaviours were associated with higher performance on the MDI and PDI, with more frequent auditory sensory processing behaviours also associated with higher PDI scores. More frequent auditory, touch and oral sensory processing behaviours were associated with improved outcomes on the Language Composite and more frequent auditory, touch and vestibular processing behaviours correlated with improved outcomes on the Cognition Composite. A secondary analysis using a computed MDI score derived from the Bayley 3 scores did not substantially alter any conclusions. Conclusion(s)Different sensory profile patterns obtained from parental reports of VPT children are associated with various aspects of neurodevelopment at 2years of age, obtained from independent assessment.

Comparison of Bayley‐2 and Bayley‐3 scores at 18 months in term infants following neonatal encephalopathy and therapeutic hypothermia

AimNeuroprotection trials for neonatal encephalopathy use moderate or severe disability as an outcome, with the Bayley Scales of Infant Development, Second Edition (Bayley-2) Index scores of <70 as part of the criteria. The Bayley Scales of Infant and Toddler, 3rd Development, Third Edition (Bayley-3) have superseded Bayley-2 and yield higher than expected scores in typically developing and high-risk infants. The aim of this study, therefore, was to compare Bayley-2 scores and Bayley-3 scores in term-born infants surviving neonatal encephalopathy treated with hypothermia.MethodSixty-one term-born infants (37 males, 24 females; median gestational age at birth 40wks, range 36–42wks; median birthweight 3280g, range 2295–5050) following neonatal encephalopathy and hypothermia had contemporaneous assessment at 18 months using the Bayley-2 and Bayley-3.ResultsThe median Bayley-3 Cognitive Composite score was 7 points higher than the median Bayley-2 Mental Developmental Index (MDI) score and the median Bayley-3 Motor Composite score was 18 points higher than the median Bayley-2 Psychomotor Developmental Index (PDI) score. Ten children had a Bayley-2 MDI of <70; only three children had Bayley-3 combined Cognitive/Language scores of <70. Eleven children had Bayley-2 PDI scores of <70 and four had modified Bayley-3 Motor Composite scores of <70. Applying regression equations to Bayley-3 scores adjusted rates of severe delay to similar proportions found using Bayley-2 scores.InterpretationFewer children were classified with severe delay using the Bayley-3 than the Bayley-2, which prohibits direct comparison of scores. Increased Bayley-3 cut-off thresholds for classifying severe disability are recommended when comparing studies in this clinical group using Bayley-2 scores.

Effect of zinc intake on mental and motor development in infants: a meta-analysis.

A systematic review and meta-analysis of available randomized controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on mental and motor development in infants. Out of 5500 studies identified through electronic searches and reference lists, 5 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on mental and motor development was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional situation, and risk of bias. Indices of mental and motor development assessed were the Mental Development Index (MDI) and Psychomotor Development Index (PDI). Additionally we carried out a sensitivity analysis. The pooled β was -0.01 (95 %CI -0.02, 0) for MDI and 0 (95 %CI -0.03, 0.02) for PDI, with a substantial heterogeneity in both analyses. When we performed a meta-regression, the effect of Zn supplementation on MDI changed depending on the dose of supplementation. Regarding PDI, there was a differential effect of Zn intake depending on intervention duration, dose of supplementation, nutritional situation, and risk of bias. Zn supplementation showed a negative, weak and significant effect on PDI score in those studies with a length of 4 to 20 weeks (β= -0.05; CI 95 % -0.06 to -0.04). In conclusion, no association was found between Zn intake and mental and motor development in infants. Further standardized research is urgently needed to clarify the role of Zn supplementation upon infant mental and motor development, particularly in Europe.

Behavioral and socioemotional competence problems of extremely low birth weight children.

To examine behavioral and social-emotional problems in extremely low birth weight (ELBW) children and to assess factors associated with behavioral and social competency outcomes at 30 to 36 months adjusted age. A total of 696 ELBW (401 to 1000 g) children from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were included. Behavioral and social-emotional problems were assessed using the Brief Infant-Toddler Social and Emotional Assessment administered to parents. Unadjusted comparisons were performed between children with or without behavioral or social-emotional problems. Logistic regression was used to examine factors associated with behavioral outcomes. Parents reported behavioral problems in 46.8%, deficits in social-emotional competence in 20.4% and having both behavioral and social-emotional competence problems in 15.4% of ELBW children. Characteristics associated with behavioral problems in logistic regression included female gender, lower household income and a Bayley Psychomotor Developmental Index (PDI)<70. Deficits in social competence were associated with Bayley Mental Developmental Index (MDI) and PDI scores<70 and Hispanic or Other races compared with White non-Hispanic. Half of the (51.9%) ELBW children showed behavioral or social-emotional competence problems at 30 months. Low socioeconomic status and low Bayley MDI and PDI scores were associated with behavioral and socioemotional difficulties.

Comparing Two Motor Assessment Tools to Evaluate Neurobehavioral Intervention Effects in Infants With Very Low Birth Weight at 1 Year

Infants with very low birth weight (VLBW) are at increased risk for motor deficits, which may be reduced by early intervention programs. For detection of motor deficits and to monitor intervention, different assessment tools are available. It is important to choose tools that are sensitive to evaluate the efficacy of intervention on motor outcome. The purpose of this study was to compare the Alberta Infant Motor Scale (AIMS) and the Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development-Dutch Second Edition (BSID-II-NL) in their ability to evaluate effects of an early intervention, provided by pediatric physical therapists, on motor development in infants with VLBW at 12 months corrected age (CA). This was a secondary study in which data collected from a randomized controlled trial (RCT) were used. At 12 months CA, 116 of 176 infants with VLBW participating in an RCT on the effect of the Infant Behavioral Assessment and Intervention Program were assessed with both the AIMS and the PDI. Intervention effects on the AIMS and PDI were compared. Corrected for baseline differences, significant intervention effects were found for AIMS and PDI scores. The highest effect size was for the AIMS subscale sit. A significant reduction of abnormal motor development in the intervention group was found only with the AIMS. No Dutch norms are available for the AIMS. The responsiveness of the AIMS to detect intervention effects was better than that of the PDI. Therefore, caution is recommended in monitoring infants with VLBW only with the PDI, and the use of both the AIMS and the Bayley Scales of Infant Development is advised when evaluating intervention effects on motor development at 12 months CA.

Psychosocial Stimulation Benefits Development in Nonanemic Children but Not in Anemic, Iron-Deficient Children

Young children with iron deficiency anemia (IDA) usually have poor development, but there is limited information on their response to psychosocial intervention. We aimed to compare the effects of psychosocial stimulation on the development of children with IDA and children who were neither anemic nor iron deficient (NANI). NANI (n = 209) and IDA (n = 225) children, aged 6–24 mo, from 30 Bangladeshi villages were enrolled in the study. The villages were then randomized to stimulation or control, and all children with IDA received 30 mg iron daily for 6 mo. Stimulation comprised 9 mo weekly play sessions at home. We assessed children's development at baseline and after 9 mo by using the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development–II, and rated their behavior during the test. When we controlled for socioeconomic background, the IDA and NANI groups did not differ in their Bayley scores and behavior at baseline. After 9 mo, the IDA group had improved in iron status compared with baseline but had lower PDI scores and were less responsive to the examiner than the NANI group. Random-effects multilevel regressions of the final Bayley scores of the IDA and NANI groups showed that stimulation improved children's MDI [B ± SE = 5.7 ± 1.9 (95% CI: 2.0, 9.4), P = 0.003], and the interaction between iron status and stimulation showed a suggestive trend (P = 0.10), indicating that children with IDA and NANI responded differently to stimulation, with the NANI group improving more than the IDA group. In addition to iron treatment, children with IDA may require more intense or longer interventions than NANI children.

Effects of Fat Mass on Motor Development During the First 2 Years of Life

This study characterized total body fat mass (FM) and motor development during the first 2 years of life in healthy infants. Participants (n = 469) from the Beginnings Study cohort, a prospective, longitudinal study of early infant feeding, were assessed at 3, 6, 9, 12, and 24 months of age for a total of 2231 observations. Growth was evaluated using standard anthropometric techniques, and body composition was assessed using dual-energy X-ray absorptiometry (DXA). Motor development was evaluated using Bayley Scales of Infant Development. Mixed-effects models adjusted for race, sex, gestational age, birth weight, birth length, and maternal education were used for data analyses. Greater weight-for-length Z-scores and overweight status were negatively associated with subsequent psychomotor development index (PDI) scores ( P &lt; .01), and total body FM was negatively associated with concurrent and subsequent PDI scores ( P &lt; .01). The relationship between total body FM and PDI scores was significant starting at 9 months ( −0.18, P = .01) until 24 months ( −0.39, P = .04). Infants with high total body FM ( ≥31%) scored 1.96 points lower on concurrent PDI and 3.05 points lower on subsequent PDI. However, neither anthropometric measures nor total body FM was associated with the clinical diagnosis of delayed motor development, defined by PDI scores below 85. Thus, greater FM and overweight status were significantly associated with lower motor development in early childhood, although average scores remained within the normal range.

Early developmental intervention for infants with birth asphyxia

This randomized controlled trial sought to determine if early, in-home, developmental intervention improves the neurodevelopmental outcomes in infants who received resuscitation at birth. In this Herculean effort, the investigators coordinated every-other-week home visits for nearly 300 babies born in India, Pakistan, and Zambia for the first 3 years of life. To assess the impact of this intervention, 36-month developmental testing was performed on four groups of infants: (1) control infants receiving every-other-week health and safety counseling; (2) those who were resuscitated and received every-other-week health and safety counseling; (3) those who did not need resuscitation and received early developmental intervention; and (4) those who were resuscitated and received early developmental intervention. Early developmental intervention improved 36-month Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) scores regardless of the need for resuscitation. Importantly, however, all groups had MDI and PDI mean scores within the normal range. This work demonstrates that infants benefit from early developmental interventions; identifying which babies may benefit the most remains an intriguing question. Article page 705▶ Randomized Trial of Early Developmental Intervention on Outcomes in Children after Birth Asphyxia in Developing CountriesThe Journal of PediatricsVol. 162Issue 4PreviewTo determine if early developmental intervention (EDI) improves developmental abilities in resuscitated children. Full-Text PDF

Tractography of white‐matter tracts in very preterm infants: a 2‐year follow‐up study

The aim of this study was to determine whether tractography of white-matter tracts can independently predict neurodevelopmental outcome in very preterm infants. Out of 84 very preterm infants admitted to a neonatal intensive care unit, 64 (41 males, 23 females; median gestational age 29.1 weeks [range 25.6-31.9]; birthweight 1163 g [range 585-1960]) underwent follow-up at 2 years. Diffusion tensor imaging (DTI) values obtained around term were associated with a neurological examination and mental and psychomotor developmental index scores at 2 years based on the Bayley Scales of Infant Development (version 3). Univariate and logistic regression analyses tested for associations between DTI values and follow-up parameters. Cut-off values predicting motor delay and cerebral palsy (CP) were determined for fractional anisotropy, apparent diffusion coefficient (ADC), and fibre lengths. Infants with psychomotor delay and CP had significantly lower fractional anisotropy values (p=0.002, p=0.04 respectively) and shorter fibre lengths (p=0.02, p=0.02 respectively) of the posterior limb of the internal capsule. Infants with psychomotor delay also had significantly higher ADC values (p=0.03) and shorter fibre lengths (p=0.002) of the callosal splenium. Fractional anisotropy values of the posterior limb of the internal capsule independently predicted motor delay and CP, with sensitivity between 80 and 100% and specificity between 66 and 69%. ADC values of the splenium independently predicted motor delay with sensitivity of 100% and specificity of 65%. Diffusion tensor imaging tractography at term-equivalent age independently predicts psychomotor delay at 2 years of age in preterm infants.

Stunting and Wasting Are Associated with Poorer Psychomotor and Mental Development in HIV-Exposed Tanzanian Infants

Infants born to HIV-infected women are at increased risk of impaired neurodevelopment, but little research has attempted to identify modifiable risk factors. The objective of this prospective cohort analysis was to identify maternal, socioeconomic, and child correlates of psychomotor and mental development in the first 18 mo of life among Tanzanian infants born to HIV-infected women. We hypothesized that child HIV infection, morbidity, and undernutrition would be associated with lower developmental status when taking into consideration maternal health and socioeconomic factors. Baseline maternal characteristics were recorded during pregnancy, birth characteristics were collected immediately after delivery, infant micronutrient status was measured at 6 wk and 6 mo, and anthropometric measurements and morbidity histories were performed at monthly follow-up visits. The Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development, 2nd edition (BSID-II) were used to assess developmental functioning at 6, 12, and 18 mo of age. Multivariate repeated regression models with time-varying covariates were used to estimate adjusted mean MDI and PDI scores for each level of the variables. A total of 311 infants contributed ≥1 BSID-II assessments for 657 PDI and 655 MDI measurements. Of infants, 51% were male, 23% were born preterm, 7% were low birth weight, and 10% were HIV-positive at 6 wk. Preterm birth, child HIV infection, stunting, and wasting were independently associated with lower PDI and MDI scores. Strategies to lower mother-to-child transmission of HIV, prevent preterm birth, and enhance child growth could contribute to improved child psychomotor and mental development.

Neurodevelopmental Outcome Among Multiples and Singletons: A Regional Neonatal Intensive Care Unit's Experience in Turkey

The aim of this study was to compare the neurodevelopmental outcome at 12-18 months' corrected age between multiples and singleton preterm infants. We designed a prospective study of preterm infants (≤32 weeks gestation) born and hospitalized in the neonatal intensive care unit between November 2008 and November 2009, whose assessments were performed at 12-18 months' corrected age. Neurodevelopmental impairment was defined as the presence of any one of the following: moderate or severe cerebral palsy, severe bilateral hearing loss or bilateral blindness, mental developmental index score, or psychomotor developmental index score less than 70. Results were compared for both multiples and singleton infants. One hundred and fifty-nine multiples and 211 singleton infants were assessed at 12-18 months' corrected age. The neurodevelopmental outcome including all parameters at 12-18 months' corrected age in multiples was not significantly different from singleton preterm infants. Multiple gestation in preterm infants is not associated with an increased risk of neurodevelopmental impairment at 12-18 months' corrected age compared with singleton preterm infants. For further information, long term and high participation in neurodevelopmental follow-up and evaluation at pre-school age will be needed.

Prenatal lead and cadmium co-exposure and infant neurodevelopment at 6 months of age: The Mothers and Children's Environmental Health (MOCEH) study

BackgroundThis study aimed to explore the developmental effects of prenatal exposure to Pb and Cd on infant cognitive development at 6 months of age. MethodsBetween 2006 and 2010, the blood levels of Pb and Cd were measured in 884 mothers during their early and late pregnancy. The mental (MDI) and psychomotor (PDI) development index scores of the infants were assessed using the Bayley Scales of Infant Development. The development index scores were adjusted for birth weight, maternal age, maternal education level, family income, breastfeeding status, and residential area. ResultsThe geometric mean of the maternal blood concentration was 1.36μg/dL (10th percentile=0.83; 90th percentile=2.13; range=0.26–9.10) for Pb and 1.42μg/L (10th percentile=1.01; 90th percentile=2.16; range=0.03–9.87) for Cd during the early pregnancy period and 1.27μg/dL (10th percentile=0.77; 90th percentile=2.10; range=0.12–4.28) for Pb and 1.52μg/L for Cd (10 percentile=1.07; 90th percentile=2.10; range=0.43–3.73) during the late pregnancy period. The prenatal Pb and Cd concentrations during the early pregnancy period showed no association with the adjusted MDI or PDI scores. The antagonistic interaction between the prenatal Pb and Cd levels during the early pregnancy period had a significant effect on the MDI score (B=−4.64, 95% CI=−8.17 to −1.12, p=0.01), but the effect of this interaction did not reach statistical significance for the PDI score (B=−3.69, 95% CI=−7.94 to 0.56, p=0.09). The Pb levels during the late pregnancy period were inversely associated with the MDI score (B=−1.94, 95% CI=−3.60 to −0.29, p=0.02) but not with the PDI score (B=−1.69, 95% CI=−3.65 to 0.27, p=0.09). The prenatal Cd levels during the late pregnancy period showed no association with the MDI or PDI score. However, the MDI score (B=−3.20, 95% CI=−5.35 to −1.06, p<0.01) and the PDI score (B=−2.86, 95% CI=−5.55 to −0.16, p=0.04) of infants with Cd levels >1.51μg/L were significantly associated with the Pb level, whereas there were no such associations for infants with Cd levels <1.51μg/L. These results suggest that there is a synergistic effect modification between Pb and Cd during the late pregnancy period. ConclusionsThese findings suggest that there is dose-dependent interaction between prenatal exposure to Pb and prenatal exposure to Cd. The results further demonstrate the biological complexities of examining the neurodevelopmental effects of co-exposure to multiple toxicants.

Randomized Trial of Early Developmental Intervention on Outcomes in Children after Birth Asphyxia in Developing Countries

To determine if early developmental intervention (EDI) improves developmental abilities in resuscitated children. This was a parallel group, randomized controlled trial of infants unresponsive to stimulation who received bag and mask ventilation as part of their resuscitation at birth and infants who did not require any resuscitation born in rural communities in India, Pakistan, and Zambia. Intervention infants received a parent-implemented EDI delivered with home visits by parent trainers every other week for 3 years starting the first month after birth. Parents in both intervention and control groups received health and safety counseling during home visits on the same schedule. The main outcome measure was the Mental Development Index (MDI) of the Bayley Scales of Infant Development, 2nd edition, assessed at 36 months by evaluators unaware of treatment group and resuscitation history. MDI was higher in the EDI (102.6±9.8) compared with the control resuscitated children (98.0±14.6, 1-sided P=.0202), but there was no difference between groups in the nonresuscitated children (100.1±10.7 vs 97.7±10.4, P=.1392). The Psychomotor Development Index was higher in the EDI group for both the resuscitated (P=.0430) and nonresuscitated children (P=.0164). This trial of home-based, parent provided EDI in children resuscitated at birth provides evidence oftreatment benefits on cognitive and psychomotor outcomes. MDI and Psychomotor Development Index scores of both nonresuscitated and resuscitated infants were within normal range, independent of early intervention.

1231 Neurodevelopmental Outcome Among Multiples and Singletons: A Regional Neonatal Intensive Care Unit’s Experience in Turkey

ObjectiveThe aim of this study was to compare the neurodevelopmental outcome at 12–18 months’ corrected age between multiples and singleton preterm infants.MethodsWe designed a prospective study of preterm infants (≤32...

1239 Neurodevelopmental Outcome One Year After Early Versus Late Selective Surfactant Treatment

AimTo investigate whether neurodevelopmental outcome at age one year might be different after early versus late rescue surfactant treatment in preterm infants.MethodsIn 54 preterm infants, having gestational age between 25–30...

Evaluation of Cognitive and Motor Development in Toddlers With Congenital Hypothyroidism Diagnosed by Neonatal Screening

The Dutch neonatal congenital hypothyroidism (CH) screening procedure and treatment modality has been adapted several times since its national institution in 1981. These changes enabled us to investigate whether earlier treatment has resulted in improved cognitive and motor outcomes. The present study examined whether the advancement of treatment modality has resulted in improved cognitive and motor outcomes. In 95 toddlers with thyroidal CH (CH-T), born in 2002 through 2004 and treated at a median age of 9 days, cognitive and motor outcomes were assessed with the Bayley Scales of Infant Development-II-NL at 1 and 2 years of age. This outcome was also analyzed in relation to treatment variables. The mean mental developmental index (MDI) scores of the severe (initial free thyroxine [FT4] ≤0.4 ng/dL (≤5 pmol/L), moderate (0.4 < initial FT4 ≤ 0.8 ng/dL (5.0 < initial FT4 ≤ 10.0 pmol/L), and mild (initial FT4 > 0.8 ng/dL (>10.0 pmol/l) CH-T groups at 1 year and the moderate and mild CH-T groups at 2 years were similar to the population mean. The mean MDI scores of the total CH-T group and severe CH-T group at 2 years were significantly lower than the population mean (p < .0001). In all 3 severity subgroups, significant lower psychomotor developmental index scores (p < .0001) were observed. No correlations were found between starting day of treatment and developmental outcome. Initial T4 concentration and initial T4 dose were weak predictors for developmental outcome. Essentially, comparable with our earlier findings, children with CH, especially those with severe CH, are still at risk for motor and cognitive problems, which are probably due to the consequence of the prenatal hypothyroid state or the thyroid hormone deficiency in early life.

Associations between maternal prepregnancy body mass index and child neurodevelopment at 2 years of age

Both underweight and obese mothers have an increased risk for adverse offspring outcomes. Few studies have examined the association between prepregnancy body mass index (BMI) and children's neurodevelopment. We used data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; n=6850). Children were classified according to their mother's prepregnancy BMI (kg m(-2)) status: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese class I (BMI 30.0-34.9), and obese class II and III (BMI ≥35.0). Children's age-adjusted mental development index (MDI) and psychomotor development index (PDI) T-scores (mean 50, s.d. 10) were obtained using a validated shortened version of the Bayley Scales of Infant Development-II at approximately 2 years of age. While adjusting for sociodemographics, we estimated the average MDI and PDI scores or the risk of delayed (<-1 s.d. vs >1 s.d.) mental or motor development, relative to children of normal weight mothers. Compared with children of normal weight mothers, MDI scores were lower among children of mothers of all other prepregnancy BMI categories, with the greatest adjusted difference among children of class II and III obese mothers (-2.13 (95% CI -3.32, -0.93)). The adjusted risk of delayed mental development was increased among children of underweight (risk ratio (RR) 1.36 (95% CI 1.04, 1.78)) and class II and III obese (RR 1.38 (95% CI 1.03, 1.84)) mothers. Children's PDI scores or motor delay did not differ by maternal prepregnancy BMI. In this nationally representative sample of 2-year-old US children, low and very-high maternal prepregnancy BMI were associated with increased risk of delayed mental development but not motor development.

Clinical outcome score predicts the need for neurodevelopmental intervention after infant heart surgery

Our goal was to determine if a clinical outcome score derived from early postoperative events is associated with 18- to 24-month Psychomotor Developmental Index (PDI) score among infants undergoing cardiopulmonary bypass surgery. We included infants aged ≤6 weeks who underwent surgery during 2002-2006, all of whom were referred for neurodevelopmental evaluation at age 18 to 24 months. We excluded children with chromosomal abnormalities, hearing loss, cerebral palsy, or a Bayley III assessment. The prespecified clinical outcome score had a range of 0 to 7. Lower scores indicated a more rapid postoperative recovery. Patients requiring extracorporeal membrane oxygenation were assigned a score of 7. Ninety-nine subjects were included. Surgical procedures were arterial switch (n=36), Norwood (n=26), repair of total anomalous pulmonary venous connection (n=16), and other (n=21). Four subjects had postoperative extracorporeal membrane oxygenation. Clinical outcome scores were highest in the Norwood group (mean 4.1 ± 1.4) compared with the arterial switch group (1.9 ± 1.6) (P<.001), total anomalous pulmonary venous connection group (1.6 ± 2.0) (P<.001), and other group (3.3 ± 1.6, P=not significant). A mean decrease in PDI of 10.9 points (95% confidence interval, 4.9-16.9; P=.0005) was observed among children who had a clinical outcome score ≥3, compared with those with a clinical outcome score <3. Time until lactate ≤2.0 mmol/L increased with increasing clinical outcome score (P=.0003), as did highest 24-hour inotrope score (P<.0001). Clinical outcome scores of ≥3 were associated with a significantly lower PDI at age 18 to 24months. This score may be valuable as an end point when evaluating novel potential therapies for this high-risk population.

Association of Impaired Linear Growth and Worse Neurodevelopmental Outcome in Infants with Single Ventricle Physiology: A Report from the Pediatric Heart Network Infant Single Ventricle Trial

To describe neurodevelopmental outcomes in infants with single ventricle (SV) physiology and determine factors associated with worse outcomes. Neurodevelopmental outcomes for infants with SV enrolled in a multicenter drug trial were assessed at 14 months of age using the Bayley Scales of Infant Development-II. Multivariable regression analysis was used to identify factors associated with worse outcomes. Neurodevelopmental testing was performed at 14 ± 1 months in 170/185 subjects in the trial. Hypoplastic left heart syndrome was present in 59% and 75% had undergone the Norwood operation. Mean Psychomotor Developmental Index (PDI) and mental developmental index (MDI) were 80 ± 18 and 96 ± 14, respectively, (normal 100 ± 15, P < .001 for each). Group-based trajectory analysis provided a 2-group model ("high" and "low") for height z-score trajectory and brain type natriuretic peptide (BNP) trajectory. The predicted PDI scores were 15 points higher in the "high" height z-score trajectory compared with the "low" cluster (P < .001). A higher number of serious adverse events during the trial was associated with lower PDI scores (P = .02). The predicted MDI scores were 13-17 points lower in "low height trajectory-high BNP trajectory" group compared with the other 3 groups (P < .001). MDI scores were also lower in subjects who required extracorporeal membrane oxygenation during the neonatal hospitalization (P = .01) or supplemental oxygen at discharge (P = .01). Neurodevelopmental outcome at 14 months of age is impaired in infants with SV physiology. Low height trajectory and high BNP trajectory were associated with worse neurodevelopmental outcomes. Efforts to improve nutritional status alone may not improve neurodevelopmental outcomes.

In Utero Antidepressant Exposure and Neurodevelopment in Preterm Infants

To investigate the impact of in utero selective serotonin reuptake inhibitor (SSRI) exposure on neurodevelopment in a cohort of preterm infants. Retrospective case control study of preterm infants ≤36(6/7) weeks gestation with in utero SSRI exposure. Subjects were matched to controls by gestational age, year of birth, birth weight, gender, and age at neurodevelopmental assessment. Neurodevelopment was assessed with the Bayley Infant Neurodevelopmental Screener and the Bayley Scales of Infant Development. The 19 infants with in utero SSRI exposure were similar to controls in demographic data, birth weight, and in-hospital morbidity. The mean ± standard deviation (SD) Mental Developmental Index score for study infants at 36 months was 94 ± 15 versus 91 ± 10 for controls (p = 0.46). The mean ± SD Psychomotor Developmental Index score was also similar between groups: 79 ± 21 for study infants versus 75 ± 20 for control infants (p = 0.72). Other neurodevelopmental outcomes were comparable. In this cohort of preterm infants, in utero SSRI exposure was not associated with adverse neurodevelopment above the baseline risk for this degree of prematurity. Larger studies are needed to obviate the risk of a type II error.