Rate Of Developmental Delay Research Articles

Development of a culturally enhanced caregiver-facilitated language nutrition intervention "+Language is Medicine" to address developmental delay in Diné (Navajo) toddlers.

Developmental Delay (DD) is highly common in American Indian and Alaska Native (AI/AN; Indigenous) toddlers and leads to high numbers of AI/AN children who eventually need special education services. AI/AN children are 2.89 times more likely to receive special education compared to other children in the U.S., yet developmental disorders are more frequently under diagnosed and untreated in AI/AN infants and toddlers. DD, which can be identified as early as toddlerhood, can lead to negative impacts on developmental trajectories, school readiness, and long-term health. Signs of DD can be identified early with proper developmental screening and remediated with high quality early intervention that includes effective parent training. There are many evidence-based language facilitation interventions often used in Early Intervention programs. However, in communities in rural parts of the Navajo Nation where there are limited services and resources, infants and toddlers with early signs of DD are often missed and do not get the culturally responsive support and evidence-based intervention they deserve. The community-based +Language is Medicine (+LiM) study team partnered with tribal home visitors, community members, and a Diné linguist/elder using a collaborative virtual workgroup approach in 2021 and 2022 to present the +LiM pilot study aims and to discuss strategies for enhancing a language intervention for toddlers experiencing DD in their tribal community. This paper will detail the stages of community engagement, intervention enhancement and preparation for field testing of the +LiM intervention to address elevated rates of DD in toddlers in the Northern Agency of the Navajo Nation. Two major outcomes from this collaborative workgroup included: (1) a team-initiated redefining of language nutrition to align with Indigenous values that center cultural connectedness and native language use and (2) a five-lesson caregiver-facilitated curriculum titled +Language is Medicine which includes caregiver lessons on language nutrition, language facilitation, shared book reading, pretend play, and incorporation of native language into home routines. These two workgroup outcomes were leveraged to develop a pilot pre-/post-intervention study to test the effectiveness of the +LiM intervention with caregiver-toddler dyads living on the Navajo Nation. Delivering tailored child interventions through tribal home visiting are cost-effective and innovative methods for reaching reservation-based families who benefit from culturally responsive parent coaching and instruction. The +LiM team has applied a precision tribal home visiting approach to enhance methods of early intervention for children with DD. Our enhancement process was grounded in Indigenous community-based participatory research that centered culture and language.

Evaluating the Effect of Maternal Opioid Maintenance Dose on the NOWS-COS Outcome Criteria: A Pilot Study.

This retrospective cohort study included 77 mother-infant dyads that delivered term pregnancies at a single tertiary care institution. The primary objective was to investigate whether maternal dose of opioid maintenance therapy during pregnancy affects infant outcomes. All infants had prenatal exposure to opioid maintenance therapies. Maternal dose was converted into morphine milligram equivalents (MMEs) and stratified into high- (MME >1000 mg) and low-dose groups (MME ≤1000 mg). Associations between infant outcomes and MME dosage were examined using Wilcoxon rank-sum and Fisher's Exact tests. Days to symptom control were significantly higher in the high MME group (5 days vs 2.8 days, P = .016). Rates of developmental delay at 24 months were higher in the high MME group (21.2% vs 4.5%, P = .0335). Maternal MME did not predict need for NOWS treatment. Higher MME-exposed infants should have optimized nonpharmacologic interventions for consolation and be increasingly observed for signs of developmental delay.

Corrected Age at Bayley Assessment and Developmental Delay in Extreme Preterms.

Research on outcomes of prematurity frequently examines neurodevelopment in the toddler years as an end point, but the age range at examination varies. We aimed to evaluate whether the corrected age (CA) at Bayley-III assessment is associated with rates of developmental delay in extremely preterm children. This retrospective cohort study included children born at <29 weeks' gestation who were admitted in the Canadian Neonatal Network between 2009 and 2017. The primary outcomes were significant developmental delay (Bayley-III score <70 in any domain) and developmental delay (Bayley-III score <85 in any domain). To assess the association between CA at Bayley-III assessment and developmental delay, we compared outcomes between 2 groups of children: those assessed at 18 to 20 months' CA and 21-24 months. Overall, 3944 infants were assessed at 18-20 months' CA and 881 at 21-24 months. Compared with infants assessed at 18-20 months, those assessed at 21-24 months had higher odds of significant development delay (20.0% vs 12.5%; adjusted odds ratio, 1.75; 95% confidence interval [CI], 1.41-2.13) and development delays (48.9% vs 41.7%, adjusted odds ratio 1.33; 95% CI, 1.11-1.52). Bayley-III composite scores were on average 3 to 4 points lower in infants evaluated at 21-24 months' CA (for instance, adjusted mean difference and 95% CI for language: 3.49 [2.33-4.66]). Conversely, rates of cerebral palsy were comparable (4.6% vs 4.7%) between the groups. Bayley-III assessments performed at 21-24 months' CA were more likely to diagnose a significant developmental delay compared with 18- to 20-month assessments in extremely preterm children.

Developmental delay and its demographic and social predictors among preschool-age children in Palestine

PurposeThis study was designed to assess the developmental outcomes among preschool-aged children and its associated factors in Palestine. MethodsA cross-sectional, descriptive-correlational design involved a representative sample of preschool-aged children from kindergarten in Ramallah governorate. Data were collected using the Ages and Stages Questionnaire, Arabic version-3. Associations between developmental delay (DD), parent, child and family characteristics were analyzed utilizing SPSS-25 version. ResultsA total of 249 preschoolers participated in the study. The overall rate of children with Global Developmental Delay (GDD) was 23.7%. The most prevalent DD were in gross motor, personal social, and fine motor skills (25.3%, 17.7%, and 16.5%, respectively). Binary logistic regression analysis revealed that the male gender of a child (OR = 2.66, 95% CI [1.37, 5.19]), the mother's part-time work (OR = 6.01, 95% CI [1.68, 21.52]), low family income (OR = 3.67, 95% CI [1.05, 12.73]), and families with three or more children (OR = 1.43, 95% CI [1.15, 1.781]) were statistically significant independent predictors of GDD. ConclusionThe study findings revealed higher rate of DD among preschoolers in Palestine than regional areas, especially in gross motor, fine motor, and personal social skills, which has consequences for both national and global health. According to the results, factors related to the child, the mother and the family are associated with the cumulative risk of preschoolers having DD. ImplicationsIt is a crucial role for pediatric nurses to detect DD early and its related risk factors through screening programs to limit the burden of problems in childhood and later adulthood.

The home language environment and early childhood development: a LENA study from rural and peri-urban China

The home language environment is a significant correlate of early childhood development outcomes; however, less is known about this mechanism in rural and peri-urban China where rates of developmental delay are as high as 52%. This study examines associations between the home language environment and child development in a sample of 158 children (58% boys) aged 18–24 months (Mage = 21.5) from rural and peri-urban households in Western China. Results show a significant association between adult-child conversation count and language development, suggesting the home language environment may be a mechanism for child development in rural and peri-urban China. 22.5% of the sample were at risk of language delay. Mother’s employment and child’s age were significant factors in the home language environment.

Neurodevelopmental outcomes of preterm infants with very low birth weight conceived with the assistance of in vitro fertilization

To compare the neurodevelopmental outcomes at 18-24 months of corrected age between preterm (<32 weeks of gestational age) infants with very low birth weight (VLBW) conceived with and without the assistance of invitro fertilization (IVF). Prospective cohort study. Not applicable. In total, 4,940 infants with VLBW were born before 32 weeks of gestational age from January 2013 to December2015. Invitro fertilization. Neuromotor or sensory disability (primary outcome) and developmental delay assessed using the Bayley Scales of Infant and Toddler Development (secondary outcome) at 18-24 months of corrected age. Of the 4,940 infants with VLBW enrolled, 2,818 surviving infants who were followed up for neurodevelopmental assessment at 18-24 months of corrected age were included in the study. Of these 2,818 infants, 630 (22.4%) were conceived with the assistance of IVF, and 2,188 (77.6%) were not. After adjustment for potential confounders, no statistically significant differences were found in the rate of neuromotor or sensory disability at 18-24 months of corrected age between infants conceived with and without the assistance of IVF. After excluding infants with neuromotor or sensory disability, the rate of developmental delay was also comparable between those conceived with and without the assistance of IVF. This study showed comparable neurodevelopmental outcomes at 18-24 months of corrected age between preterm infants with VLBW conceived with and without the assistance of IVF.

Comparison of Parenting Styles in Parents of 3-5-Year-Old Kindergarten Children with and without Developmental Delay

Background Considering the effective role of the environment, family, and especially parents in the development of children, this study was conducted to compare parenting styles in parents of 3-5 year-old kindergarten children with and without developmental delay. Materials and Methods: This descriptive cross-sectional study was performed on 280 children aged 3 to 5 years and their parents by multi-stage-cluster sampling (based on the division of the Welfare Organization) in kindergartens in Tehran, Iran, in 2019. Parents completed the following questionnaires to collect the data: a demographic, Baumrind's parenting styles, and the Ages and Stages Questionnaires (ASQ). The data were analyzed using SPSS software version 19.0. Results: The mean age of children was 3.98+ 0.71 years, and the rate of developmental delay was observed in 9% (n=25). The highest frequency of developmental delay was observed in the age group of 3 years and in the field of problem-solving and the lowest developmental delay was observed in the age group of 5 years and the personal-social domain. 95.7% of mothers and 91.1% of fathers had an authoritative parenting style, 1.4% and 3.6% had permissive parenting style and 2.9%, and 5.4% had authoritarian style, respectively. Mothers of children without developmental delays had higher levels of education (p <0.05). In addition, fathers who had an authoritative parenting style had a higher level of education (p <0.05). The results showed no significant difference between parenting style in parent’s children with and without developmental delay. Conclusion According to the results of the present study, parenting styles show no differences between children with and without developmental delay. Further research is recommended.

Visual Perception, Fine Motor, and Visual-Motor Skills in Very Preterm and Term-Born Children before School Entry-Observational Cohort Study.

Very preterm children (<32 weeks gestation at birth; VP) are at risk of developmental difficulties. Specific functional difficulties and delays in visual perception, fine motor, and visual-motor skills have received little research attention, although they are critical for daily life and school readiness. Our aim was to assess these skills in a contemporary cohort of 60 VP and 60 matched term-born children before school entry. We administered the Movement Assessment Battery for Children (M-ABC-2) and the Developmental Test of Visual Perception (DTVP-2). Linear and logistic regressions were run to test group differences in performance and rates of developmental delay in visual perception, fine motor, and visual-motor skills. Very preterm children had lower scores than term-born children in visual perception (β = −0.25; p = 0.006), fine motor (β = −0.44; p < 0.001), and visual-motor tasks (β = −0.46; p < 0.001). The rate of developmental delay (<−1 SD) was higher among VP in visual perception (odds ratio (OR) = 3.4; 95% confidence interval (CI 1.1–10.6)), fine motor (OR = 6.2 (2.4–16.0)), and visual-motor skills (OR = 13.4 (4.1–43.9)) than in term-born controls. VP children are at increased risk for clinically relevant developmental delays in visual perception, fine motor, and visual-motor skills. Following up VP children until preschool age may facilitate early identification and timely intervention.

Prevalence and Factors Associated with Developmental Delays among Preschool Children in Saudi Arabia

Background: Developmental delays (DDs) are increasing in prevalence and necessitate routine screening of young children for early recognition and management. Objective(s): To estimate the prevalence of DDs among pre-school children and determine the risk factors associatedwith DDs in Makkah, Saudi Arabia. Methods: This cross-sectional study involved a total of 948 children at the ages 36, 48, and 60 months. Data were collected using a modified Arabic version of the Ages and Stages Questionnaires, Third Edition (ASQ-3) to assess five domains of development (Gross Motor, Fine Motor, Language and Communi­cation, Problem-Solving and Adaptive Behav­ior, and Personal and Social Performance). Parents’ characteristics and risk factors related to DDs were included. The p-value was set at 0.05. Results: Overall prevalence of children with DDs was 16.4%. The most prevailing DDs were the communication, problem solving, and personal/social skills (5.6%, 5.5% & 4.6% respectively). Lower rates of DDs were identified for fine motor, and gross motor milestones (1.9%, and 1.5% respectively). Binary logistic regression analysis revealed that artificial/complementary feeding before 6 months of age, narrow spacing between children (3),and lower level of maternal education were the most determining risk factors associated with DDs (OR=3.378; p=0.001, OR=2.554, p=0.018, OR=2.451; p=0.004, OR=2.074; p=0.037, and OR=1.832; p=0.016, respectively). Conclusion: The study recognized a high prevalence of DDs especially for communication, problem solving, and personal/social skills. It spotted a number of modifiable risk factors, and recommended early screening of preschool children for prompt recognition and timely intervention.

Early administration of vitamins B1 and B6 and l-carnitine prevents a second attack of acute encephalopathy with biphasic seizures and late reduced diffusion: A case control study

BackgroundAcute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most prevalent encephalopathy in Japanese children. AESD is characterized by a prolonged febrile seizure on day 1 followed by secondary seizures and MRI abnormality on days 4–6, resulting in high incidence of neurological sequelae. We aimed to clarify whether early administration of vitamins (vitamin B1, vitamin B6, and l-carnitine) would improve the clinical course of AESD. MethodsWe retrospectively reviewed 34 patients with acute encephalopathy who were admitted to our hospital between January 2009 and August 2016. Of the retrospectively registered 34 patients, 22 (65%) since 2011 were treated with the drug cocktail (prescription group) within 24 h of onset, whereas 12 (35%) before 2011 were not (non-prescription group). We compared clinical course, laboratory data, and MRI findings historically in both groups. ResultsThe two groups did not differ in terms of laboratory findings except for blood lactate values. There were no differences between the two groups regarding duration of ICU admission, intubation, or the duration of seizures. Among the prescription group, two patients developed AESD while 20 had mild encephalopathy (single phasic). In contrast, seven patients inthe non-prescription group developed AESD while five did not. The incidence of AESD was lower in the prescription group (P = 0.004). As for outcomes, the rate of developmental delay and epilepsy was significantly lower in the prescription group. ConclusionsOur data suggested that early administration of vitamins would improve the clinical course of acute encephalopathy. Mitochondrial rescue and neuroprotection are thought to be responsible for the favorable results.

Usability and Acceptability of a Text Message-Based Developmental Screening Tool for Young Children: Pilot Study.

BackgroundOnly 30% of parents of children aged 9-35 months report that their child received a developmental screening in the previous year. Screening rates are even lower in low-income households, where the rates of developmental delays are typically higher than those in high-income households. Seeking to evaluate ways to increase developmental screening, Text4baby, a national perinatal texting program, created an interactive text message-based version of a validated developmental screening tool for parents.ObjectiveThis study aimed to assess whether a text message-based developmental screening tool is usable and acceptable by low-income mothers.MethodsLow-income mothers of infants aged 8-10 months were recruited from the Women, Infants and Children Program clinics in Prince George’s County, MD. Once enrolled, participants used text messages to receive and respond to six developmental screening questions from the Parents’ Evaluation of Developmental Status: Developmental Milestones. After confirming their responses, participants received the results and feedback. Project staff conducted a follow-up phone survey and invited a subset of survey respondents to attend focus groups. A representative of the County’s Infants and Toddlers Program met with or called participants whose results indicated that their infants “may be behind.”ResultsEighty-one low-income mothers enrolled in the study, 93% of whom reported that their infants received Medicaid (75/81). In addition, 49% of the mothers were Hispanic/Latina (40/81) and 42% were African American (34/81). A total of 80% participated in follow-up surveys (65/81), and 14 mothers attended focus groups. All participants initiated the screening and responded to all six screening questions. Of the total, 79% immediately confirmed their responses (64/81), and 21% made one or more changes (17/81). Based on the final responses, 63% of participants received a text that the baby was “doing well” in all six developmental domains (51/81); furthermore, 37% received texts listing domains where their baby was “doing well” and one or more domains where their baby “may be behind” (30/81). All participants received a text with resources for follow-up. In a follow-up survey reaching 65 participants, all respondents said that they would like to answer screening questions again when their baby was older. All but one participant would recommend the tool to a friend and rated the experience of answering questions and receiving feedback by text as “very good” or “good.”ConclusionsA mobile text version of a validated developmental screening tool was both usable and acceptable by low-income mothers, including those whose infants “may be behind.” Our results may inform further research on the use of the tool at older ages and options for a scalable, text-based developmental screening tool such as that in Text4baby.

Maternal intelligence quotient and motor development in early childhood: The mediating role of mother's education.

To examine the association between maternal intelligence quotient (IQ) and early childhood motor development and whether maternal education mediates this relationship. Data were collected prospectively in the Ma'anshan Birth Cohort study. Maternal IQ was assessed using the Wechsler Adult Intelligence Scale-Revised by China (WAIS-RC). Information on baseline characteristics and maternal education was obtained from questionnaires and medical records. The study outcome was motor development evaluated at 18 months by the Third Edition of Ages and Stages Questionnaire. Logistic regression analyses and mediation analyses were used. Of 2739 valid subjects (84% follow-up), the rate of developmental delay was 3.1% in the gross motor domain and 6.2% in the fine motor domain. The mean value for maternal IQ was 96.2 (standard deviation 10.6). About 40.3% of the mothers had secondary education or less, while 59.7% had a college education. Mothers with higher IQ had a significantly higher educational level and had children with better motor development. Maternal education significantly mediated the association between maternal IQ and fine motor development. There was a direct effect of maternal IQ on gross motor development, but the mediation effect of maternal education was not found. Maternal IQ was associated with motor development. Maternal education played an important role in reducing the disparities in fine motor development among children of different maternal IQs.

Characteristics of young children with developmental delays and their trends over 14 years in Taiwan: a population-based nationwide study

ObjectivesTo describe the epidemiological characteristics of developmental delays (DD) at the national level and assess the changes over time.DesignWe calculated the incidence rates of DD from 2003 to 2016 and...

Long-term neurodevelopmental outcomes of infants born late preterm: a systematic review

Long-term neurodevelopmental outcomes of infants born late preterm: a systematic review Tanya Tripathi,1 Stacey C Dusing2,3 1Rehabilitation and Movement Science Program, Department of Physical Therapy, 2Department of Physical Therapy, 3Department of Pediatrics, Children&#39;s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA Purpose: Late preterm (LPT) births constitute a large proportion of the preterm births in the USA. Over the last few decades, there has been an increase in research focusing on the neurodevelopment of infants born LPT. The purpose of this research was to systematically review the long-term neurodevelopmental outcomes in LPT infants. Materials and methods: We identified studies by using PubMed, ERIC, CINAHL, and PsycINFO databases. The references of included papers were reviewed for additional papers that met the inclusion criteria. Included papers compared motor, cognitive, language development, or academic performance outcomes between individuals born LPT and a term control group assessed between 12 months and 18 years of age. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards for systematic reviews were utilized including a two-step, two-investigator review process. Results: Of the 4,720 studies found in the initial search, 20 studies met the inclusion criteria. Approximately 75% of the 16 studies that assessed cognitive outcomes reported cognitive delay in the LPT group when compared to their full-term counterparts. More than 50% of the seven studies that assessed motor outcomes suggested a delay in motor development in the LPT group in comparison to full-term. Fewer papers assessed academic performance and language in children born LPT; however, the majority identified borderline differences when LPT infants were compared to those born full-term. Conclusion: Evidence suggests that infants born LPT are at an increased risk of neurodevelopmental delay between 1 and 18 years of life when compared to those born at term. The delay is most evident in the cognitive domain of neurodevelopment. Children born LPT are also at a risk of delayed language development, motor development, and lower academic performance. The rate of developmental delay is reduced somewhat when controlling for social factors; however, group differences persist. Keywords: late preterm infants, developmental outcomes, motor development, cognitive development, language development and school performance

A psychometric study of the Bayley Scales of Infant and Toddler Development – 3rd Edition for term and preterm Taiwanese infants

The Bayley Scales of Infant and Toddler Development - 3rd Edition (Bayley-III) was updated to enhance its usefulness for contemporary child developmental assessment. However, recent data in Western countries have implicated the overestimation of child development by the new instrument. This study aimed to investigate the psychometric features of the Bayley-III for term and preterm infants in Taiwan. Forty-seven term infants and 167 preterm infants were prospectively examined with the Bayley Scales of Infant Development - 2nd Edition (BSID-II) and the Bayley-III at 6, 12, 18, and 24 months of age (corrected for prematurity). The psychometric properties examined included reliability, construct validity, and known-group validity. The intra- and inter-rater reliabilities of the Bayley-III were good to excellent. The correlations between the BSID-II and Bayley-III raw scores were good to excellent for the cognitive and motor items and low to excellent for the language items. Term infants achieved higher composite scores than preterm infants on all of the Bayley-III scales (p<0.05). However, their rates of developmental delay were lower than the previously established prevalence estimates. The Bayley-III cut-off composite score was adjusted 10-20, 1-13, and 12-24 points higher than 70 for optimal prediction of cognitive, language, and motor delay, respectively, as defined by the BSID-II index score<70. The Bayley-III is a reliable instrument that extends its previous edition, especially in early language assessment. However, the upward adjustment of its cut-off score is recommended for the accurate identification of developmental delay in term and preterm Taiwanese infants.

Computing Theoretical Rates of Part C Eligibility Based on Developmental Delays

Part C early intervention is a nationwide program that serves infants and toddlers who have developmental delays. This article presents a methodology for computing a theoretical estimate of the proportion of children who are likely to be eligible for Part C services based on delays in any of the 5 developmental domains (cognitive, motor, communication, social-emotional and adaptive) that are assessed to determine eligibility. Rates of developmental delays were estimated from a multivariate normal cumulative distribution function. This approach calculates theoretical rates of occurrence for conditions that are defined in terms of standard deviations from the mean on several variables that are approximately normally distributed. Evidence is presented to suggest that the procedures described produce accurate estimates of rates of child developmental delays. The methodology used in this study provides a useful tool for computing theoretical rates of occurrence of developmental delays that make children candidates for early intervention.

Sex‐specific associations between umbilical cord blood testosterone levels and language delay in early childhood

Preliminary evidence suggests that prenatal testosterone exposure may be associated with language delay. However, no study has examined a large sample of children at multiple time-points. Umbilical cord blood samples were obtained at 861 births and analysed for bioavailable testosterone (BioT) concentrations. When participating offspring were 1, 2 and 3 years of age, parents of 767 children (males = 395; females = 372) completed the Infant Monitoring Questionnaire (IMQ), which measures Communication, Gross Motor, Fine Motor, Adaptive and Personal-Social development. Cut-off scores are available for each scale at each age to identify children with 'clinically significant' developmental delays. Chi-square analyses and generalized estimating equations examined longitudinal associations between sex-specific quartiles of BioT concentrations and the rate of developmental delay. Significantly more males than females had language delay (Communication scale) at age 1, 2 and 3 years (p-values ≤. 01). Males were also more likely to be classified as delayed on the Fine-Motor (p = .04) and Personal-Social (p < .01) scales at age 3 years. Chi-square analyses found a significant difference between BioT quartiles in the rate of language delay (but not Fine-Motor and Personal-Social delay) for males (age 3) and females (age 1 and 3). Generalized estimating equations, incorporating a range of sociodemographic and obstetric variables, found that males in the highest BioT quartile were at increased risk for a clinically significant language delay during the first 3 years of life, with an odds ratio (OR) of 2.47 (95% CI: 1.12, 5.47). By contrast, increasing levels of BioT reduced the risk of language delay among females (Quartile 2: OR = 0.23, 95% CI: 0.09, 0.59; Quartile 4: 0.46, 95% CI: 0.21, 0.99). These data suggest that high prenatal testosterone levels are a risk factor for language delay in males, but may be a protective factor for females.

Lessons from SARS: A retrospective study of outpatient care during an infectious disease outbreak

BackgroundDuring severe acute respiratory syndrome (SARS) outbreak in Toronto, outpatient clinics at SickKids Hospital were closed to prevent further disease transmission. In response, a decision was made by the neonatal neuro-developmental follow up (NNFU) clinic staff to select patients with scheduled appointments to have a mail/telephone assessment using Ages and Stages Questionnaire (ASQ) or to postpone/skip their visit. The objective of this study was to compare the developmental assessment and its outcome in two groups of NNFU clinic patients, SARS versus non-SARS, over three standard clinic appointments.MethodsWe compared the diagnostic accuracy (identification of developmental delay), and patient management (referral for therapy or communication of a new diagnosis) of the strategies used during SARS, April/May 2003, to the standard assessment methods used for patients seen in April/May 2005 (non-SARS). In all cases data were obtained for 3 patient visits: before, during and after these 2 months and were compared using descriptive statistics.ResultsThere were 95 patients in the SARS group and 99 non-SARS patients. The gestational age, sex, entry diagnosis and age at the clinic visit was not different between the groups. The NNFU clinic staff mailed ASQ to 27 families during SARS, 17 (63%) were returned, and 8 of the 17 were then contacted by telephone. Criteria used to identify infants at risk selected for either mailed ASQ or phone interviews were not clearly defined in the patients' charts. There was a significant under identification of developmental delay during SARS (18% versus 45%). Of those who responded to the mailed questionnaire, referrals for therapy rates were similar to non-SARS group. The lost to follow up rate was 24% for the SARS group compared with 7% for non-SARS. There was no difference in the overall rate of developmental delay in the two groups as identified at the 'after' visit.ConclusionsPoor advanced planning led to a haphazard assessment of patients during this infectious disease outbreak. Future pandemic plans should consider planning for outpatient care as well as in hospital management of patients.

Morbidity of Overweight (≥85th Percentile) in the First 2 Years of Life

Our hypothesis was that morbidity related to overweight/obesity is already evident in infants and young toddlers. The major objectives of this study were (1) to assess the prevalence of overweight in a sample of hospitalized infants and (2) to assess the prevalence of morbidity in overweight infants in a community-based sample. The hospital admission study population included 2139 infants, <or=24 months of age, who were admitted for any reason to the pediatric department at the Bnai Zion Medical Center in 2004-2005. For the community-based sample, we identified overweight infants (>or=85th weight-for-height percentile in >or=2 measurements, >or=3 months apart), <or=24 months of age, in 8 mother and child health care facilities in the Haifa subdistrict of Israel. Parents of infants were interviewed by using a structured questionnaire. We found that overweight infants (85th to 94th percentiles) had fewer admissions and fewer repeated admissions than expected. Infants of >or=95th percentile had more admissions than expected, as well as a larger number of repeated admissions. In the second part of the study, we found that rates of developmental delays (mainly delayed gross motor skills) and snoring were significantly higher in infants of >or=85th percentile. In addition, although the results were not statistically significant, infants with overweight suffered more frequently from breathing problems, such as asthma and stridor. When the mothers were asked to assess whether their child was overweight, only 31.6% of mothers of overweight children thought that the child was overweight. The high admission rates for infants of >or=95th percentile and the high incidence rates of respiratory morbidity, snoring, and delayed gross motor skills in overweight infants support our hypothesis regarding early morbidity associated with overweight.

How Might Cocaine Interfere with Brain Development?

Women addicted to cocaine often continue drug use through pregnancy, despite risks to the fetuses they are carrying. Multiple studies have attempted to identify the effects of cocaine and other commonly abused drugs on fetal brain development and behavior in clinical populations. The attribution of risk to specific drugs remains challenging, however, because women addicted to cocaine often use other illegal drugs as well as alcohol and tobacco. Moreover, they tend to have poor nutrition, low levels of prenatal care, and other problems that confound analysis. Not surprisingly, as the outcomes of different cohorts of pregnant women who use drugs are examined, diverse findings have been reported. Overall, however, children exposed to cocaine prenatally appear to have neurological and cognitive deficits. For example, at six months of age children exposed to cocaine in utero have been observed to have abnormalities of tone and posture [1]. A longitudinal, prospective, comparison birth cohort study that measured drug levels in urine and meconium found that children exposed to cocaine showed significant cognitive deficits and a higher rate of developmental delay during the first two years of life [2]. Another cohort of children exposed to cocaine and other drugs had deficits in sustained attention and problems with impulsivity at age four [3].