Risk Factors For Developmental Delay Research Articles

Risk factors of developmental delay in children from the age group of 6 months to 6 years

Background: Infants at risk for developmental delay (DD) have a history of one or more risk factors that occurred during pregnancy, the perinatal period, or after birth. Despite numerous studies on high-risk pregnancies and child development in advanced countries, there is scanty data from developing nations like India. Objectives: To determine the antenatal, natal and postnatal risk factors of DD in children aged 6 months to 6 years. Method: A case-control study comprising 61 infants with DD and 61 controls was carried out at Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe) in Maharashtra from December 2019 to May 2020. Children with DD were taken as cases and children without DD as controls. A questionnaire delivered to mothers was used to gather data. Data analysis was carried out using STATA, version 10 software. Results: Common risk factors were caesarean sections (55%), infections (58%), and chronic disorders during pregnancy (49%). Maternal infections, chronic diseases during pregnancy, caesarean section, failure to cry after birth and absence of breastfeeding were significantly more in cases compared to controls. Conclusions: In this case-control study, maternal infections, chronic diseases during pregnancy, caesarean section, failure to cry after birth and absence of breastfeeding were risk factors of DD in children aged 6 months to 6 years.

Screening of Early Developmental Delay and Its Risk Factors Among Children Seeking Health Care in India-exploring Missed Opportunities

Background and Objectives: Early years are considered to be critical for a child’s development. Lower middle-income countries report developmental delays late, resulting in limited access to early intervention and rehabilitation services. The opportunity to screen children during immunization and regular outpatient department (OPD) clinics is missed. To estimate the proportion of developmental delay and its risk factors among children under two years of age. Methods: A cross-sectional study was conducted among 169 children attending outpatient department (OPD) and immunization clinics of five health centers in Bengaluru City, India. A standardized developmental delay screening tool was used to screen for developmental delay among children under 2 years of age. After receiving informed written consent, a pretested questionnaire was administered, including the child’s socio-demographic details and risk factors responsible for the developmental delay. Proportions were calculated. The relationship between risk factors and developmental delay was assessed using a chi-square test. The odds ratio and adjusted odds ratio were calculated. Results: A total of 59 children (34.9%) were from rural primary health care (PHC), 79(46.7%) from urban primary health care (PHC), and 31(18.3%) from the hospital. A total of 111(65.7%) of them were females, mean age was 10.6±5.5 months. Developmental delay was reported among 30 children (17.8%). Developmental delay was significantly higher among children younger than 12 months of age and those screened in immunization clinics than compared to the other counterparts. Conclusion: The proportion of developmental delay and risk factors for developmental delay is high among children seeking health care. It is required to implement mandatory monitoring and opportunistic screening during immunization sessions to effectively identify developmental delays early in children.

Prevalence of developmental delay and associated risk factors among At Risk Surveillance System (ARSS) children at United Bulawayo Hospitals, Zimbabwe

Globally, 8.4% of children under five years of age have developmental disorders, with sub-Saharan Africa having the highest prevalence. In Zimbabwe, the At Risk Surveillance System (ARSS) follows up on babies with known developmental risk factors for early detection of developmental delay. This study aimed to determine the prevalence and severity of developmental delay in children under the ARSS at United Bulawayo Hospitals (UBH). A descriptive cross-sectional study systematically sampled 160 babies enrolled in the ARSS between 2019 and 2020. The Bayley Scales of Infant and Toddler Development Third Edition (BSID-III) tool was used to assess cognitive, motor, and language domains. Developmental delay risk factors were also noted from caregivers and patient files. A prevalence of 83.7% developmental delay was established in our sample, the majority of whom had mild developmental delay. The most important risk factors for developmental delay in all three domains were neonatal convulsions (Adjusted Odds Ratio, aOR, 5.6, p=0.03), Apgar scores of <5 (aOR 2.6, p=0.02), and being a boy (aOR 7.1, p<0.001). Developmental delay of 83.7% is higher than in previous findings because children included in this study had known risk factors for developmental delay. The risk factors were similar to those identified by other studies. Children with the most important risk factors need close monitoring as they have a high chance of developmental delay. Children with known risk factors should be closely monitored using the BSID-III, while the rest can be screened using cheaper and faster tools such as the Ages and Stages Questionnaire (ASQ).

FAKTOR RISIKO KEJADIAN STUNTING PADA BALITA USIA 24-36 BULAN DI PUSKESMAS DELI TUA KECAMATAN DELI TUA KABUPATEN DELI SERDANG

Stunting is a linear growth disorder characterized by a high z-score for age <10 years. It showed -2 ​​SD. Deritua's prevalence health center is 2.71% of him. This study addressed risk factors for stunting in infants aged 24 to 36 months in relation to family economic factors, nutritional status, exclusive breastfeeding, immunization status, and infectious disease status. increase. The aim of this study was to analyze risk factors for developmental delay in infants aged 24-36 months. This research method was descriptive in cross-sectional design. Sampling is done by simple random sampling with a sample size of 40 people. Stunting is measured based on age-specific z-scores and nutritional status as weight divided by height. Analysis using Sofwere World Health Organization (WHO) Anthro 2005. Data on economic status, immunization status, and infectious disease status were measured using questionnaires and maternal and child health handbooks. Infant height was measured with a microtooth and infant weight was measured with a scale. Data analysis with chi-square. The outcome of this study was a prevalence of growth retardation of up to 32.5%. The bivariate outcome was that risk factors for stunting in infants aged 24–36 months were family economic status < UMR p=0.00 (p<0.05), normal nutritional status p=0.00 (p<0.05). 0.05), indicating exclusive breastfeeding. Breast milk alone p=0.00 (p<0.05), full vaccination status p=0.05 (p<0.05). Infections have not been proven to be a risk factor for growth retardation in infants. The results of this study are that economic status, nutritional status, exclusive breastfeeding, and immunization status are risk factors for growth retardation in infants aged 24-36 months.

Identification of Preventable Risk Factors for Developmental Delay in Children: A Pilot Study

Purpose: Developmental delay (DD) is reported to be frequent in developing countries, such as India. Hence, this study was carried out to evaluate preventable risk factors that can predispose children to DD, through observations of pediatric neurology outpatients. Methods: This was a prospective, observational, and descriptive cross-sectional single-center hospital-based study for a period of 30 days, split into two separate time periods due to the impact of the coronavirus disease 2019 pandemic. Children who newly presented to the pediatric neurology outpatient department were considered. There were a total of 151 boys and girls, from 6 months to 14 years of age. Detailed demographic information on prenatal, natal and postnatal risk factors relevant to the neurological diagnosis was collected. Antenatal education for mothers about breastfeeding and newborn care, place of delivery, the availability of round-the-clock pediatric care during the delivery, gestational age, maternal fever, encephalitis, seizures, meningitis, blood pressure, gestational diabetes mellitus, infections, history of consanguinity, and genetic disorders were all considered. The data were analyzed with odds ratios and multivariable logistic regression. Results: Forty-three of the 151 enrolled children had DD. Significant associations were found between consanguinity and DD (adjusted odds ratio [AOR], 6.50; 95% confidence interval [CI], 1.96 to 21.51; P<0.002) and between prematurity and DD (AOR, 2.34; 95% CI, 1.07 to 5.13; P<0.033). Conclusion: This study shows that consanguineous marriages and prematurity predisposed children to DD when prenatal, natal, and postnatal risk factors were comprehensively considered.

Developmental assessment of infants with congenital heart disease: a cross-sectional study

BackgroundRecently, marked improvement of medical and surgical care for infants with congenital heart disease led to a growing population with a high risk of developmental delay. We aimed to identify developmental delay in these infants and its risk factors. So, we performed a cross-sectional study on 100 infants with congenital heart disease to assess their development by using Vineland Adaptive Behaviour Scale. We searched for risk factors for developmental delay in these infants. Correlations were conducted between the degree of developmental delay and the potential risk factors. To our knowledge, this study has not been conducted in developing countries before.ResultsThe median age of the study group is 12.5 months, but it is equivalent to 9.5 months by using Vineland Adaptive Behaviour Scale. There was a statistically significant developmental delay in infants who had risk factors such as prematurity, history of neonatal intensive care unit admission, anemia, stunted growth, underweight, central cyanosis, or abnormal electroencephalographic.ConclusionsDevelopmental delay is a common complication in infants with congenital heart disease. It has many risk factors; some of them could be modifiable as anemia, stunted growth, and underweight. Thus, early screening for developmental delay and its risk factors is of a great value. This could help in applying preventive measures and early intervention programs. Vineland Adaptive Behaviour Scale is a reliable tool in determination of developmental delay in infants with congenital heart disease.

A Prospective Observational Cross-Sectional Study on Developmental Delay and Associated Socioeconomic, Demographic and Clinical Factors among Apparently Neurologically Normal Children Aged 2 Months to 36 Months in Eastern India

INTRODUCTION: Prevalence estimates for developmental delay are scarce for eastern India. The main objective of the study was to estimate the prevalence of developmental delay amongst apparently neurologically normal children admitted to the general paediatrics ward. We also aimed to ascertain associations between developmental delay and known or suspected precedents and risk factors for developmental delay. METHODS: A prospective, cross-sectional and observational study was conducted on in-patients in the general paediatrics ward. A pretested and predesigned questionnaire was administered to the attendant on the day of the discharge. Information was gathered regarding patients’ demographics, parent’s socio-economic and educational status, relevant history that is known or suspected to cause developmental delay. Achievement of developmental milestones was assessed as per the Trivandrum Development Screening Chart (TDSC) for 0-3 years. Chi-square tests were done and p<0.05 was considered statistically significant. RESULT: The prevalence of developmental delay was 23.13% amongst 134 children. Developmental delay had a significant association with child’s age (p-value:0.0007), preterm delivery (p-value:0.0012), histories of birth asphyxia (p-value:0.0066) and neonatal seizure (p-value:0.0093). CONCLUSION: A significant proportion of apparently normal children have developmental delay. Measures to detect these cases can help to institute early intervention and prevent long-term sequelae.

Effects of preterm birth and birth weight on developmental delays of children aged 12-36 months

Background: Early childhood is a critical period for the development of cognitive, linguistic, social, and motor abilities. Due to the importance of early detection of developmental delays in children, this study aims to investigate the effect of preterm birth and birth weight on the developmental skills among children aged 12-36 months. Materials and Methods: In this cohort study, 125 children of 12 to 36 months of age from Khorramabad, Iran, were evaluated in three groups, i.e. preterm group (59 children), low birth weight group and term infants group (21 children), and finally children with average birth weight and term infants group (45 children). This evaluation was carried out using the Ages & Stages Questionnaires-Third Edition in five developmental areas. Five models of logistic regression were separately used for modeling the effect of the “age and birth weight of children”. The collected data were analyzed in SPSS v.22 software using logistic regression analysis, where the significance level was 0.05. Results: According to the findings related to child screening, the percentage of developmental delay in at least one area was 49.6%, where the highest and lowest rates of delay were 15.2% and 6.4% in fine motor and problem-solving skills, respectively. Moreover, 9.6% of the children were abnormal in communication skills, and 9.6% and 8.8% of the children were bnormal in gross motor skills and personal-social skills respectively. Based on the logistic regression method, the relationships between “the age and birth weight of children” and the state of communication skill development (P=0.235), fine motor skills (P=0.125) and personal-social skills (P=0.307) were insignificant but noticeable. Conclusion: Low birth weight in full-term infants is a risk factor for delayed communication and fine motor skills, while preterm birth is a risk factor for delayed personal-social skills. Preterm birth and low birth weight are risk factors for developmental delays in children, which require early screening to diagnose and prevent their future complications.

Health Literacy Profiles of Early Intervention Providers: Use of the Health Literacy Questionnaire.

Background:Early intervention (EI) providers work with parents of children with or who have risk factors of developmental delay or disability through Part C of the Individuals with Disabilities Education Act. Many parents in the United States have low health literacy; therefore, EI providers should be aware of and address families' health literacy needs. EI providers need to be health literate themselves to implement evidence-based recommended practices.Objective:This study aimed to measure health literacy levels of interdisciplinary EI providers and investigate associations between health literacy levels and demographic variables.Methods:A survey containing the Health Literacy Questionnaire (HLQ) was completed by EI providers working at 10 EI centers in Massachusetts. Scale scores were calculated and compared across demographic variables, including EI job role, age, years of EI experience, and highest education level.Key Results:Of 715 EI providers invited to participate, 376 surveys were completed (52.6% response rate). Most participants were women (92.6%, n = 348), reported race as White (85.4%, n = 321), had a mean age of 43.1 years (standard deviation [SD] 12.9) ranging from 20 to 74 years, and English as their primary language (89.6%, n = 337). EI providers scored the lowest on HLQ Scale 5 “Appraisal of health information” (mean [M] = 2.99 (SD 0.50) [confidence interval (CI) 2.93, 3.04]), and Scale 7 “Navigating the healthcare system” (M = 3.83 (SD 0.58) [CI 3.77, 3.89]). EI providers having stronger health literacy profiles were generally older, with a higher education level, were licensed providers, or had more years of EI work experience.Conclusions:EI providers require adequate health literacy to manage their health needs and to effectively provide services to EI families. Study results may inform future targeted professional development to support improvement of EI providers' health literacy skills, including appraisal of health information and navigation of the health care system. [HLRP: Health Literacy Research and Practice. 2022;6(2):e128–e136.]Plain Language Summary:EI providers' health literacy profiles have not been previously investigated. Study results reveal EI providers struggled with health literacy skills of appraising health information and navigating the health care system, which are vital for EI practice. Health Literacy Questionnaire results can inform targeted professional development to improve EI providers' health literacy levels and their clinical practice.

Neurodevelopmental Outcomes of Very-Low-Birth-Weight Infants without Severe Brain Lesions and Impact of Postnatal Steroid Use: A Single-Center Korean Study

Purpose: We used the Bayley Scales of Infant and Toddler Development (BSID)-III to analyze the incidence and risk factors of developmental delay in very-low-birth-weight infants without severe brain lesions. We further examined the correlation between the cumulative dexamethasone dose and developmental assessment results.Methods: We retrospectively analyzed data of preterm infants (birth weight <1,500 g) admitted to our neonatal intensive care unit between January 2014 to December 2020. The BSID-III scores obtained between the corrected ages of 12 and 24 months and after 24 months were analyzed. Developmental delay was defined as a composite score of <85 for the cognition, language, and motor domains. Univariate and multivariate analyses of developmental delay risk factors and developmental changes from the first to second BSID-III were performed. Correlations between the accumulated dexamethasone dose used for bronchopulmonary dysplasia (BPD) and the first and second test scores were analyzed.Results: Seventy-one and thirty-six infants completed the first and second tests, respectively. In both tests, developmental delay was most commonly observed in the language domain (26.8%, 47.2%). In multivariate analysis, mild BPD was identified as a developmental delay risk factor (<i>P</i><0.05), whereas prenatal steroid use reduced the developmental delay risk (<i>P</i><0.05). All domain scores were lower in the second test than in the first test. The cognition and language domain scores in the second test decreased with increasing cumulative dexamethasone doses.Conclusion: Very-low-birth-weight infants typically experience language delay, which can persist as they age.

Development of preschool refugee children living under temporary protection status.

The conflict in Syria following the anti-regime demonstrations that started in March 2011 created one of the greatest humanitarian crises. The United Nations High Commissioner for Refugees (UNHCR) reports that refugee and resettlement experiences can influence the critical stages of intellectual, social, emotional and physical development of children. There is a lack of sufficient information about the prevalence of developmental delay in forcibly displaced children. In this study, we aimed to describe the impact of the Syrian crisis on the development of children after resettlement, factors that are associated with developmental problems and domains in which developmental delays are more likely to occur. Refugee children (n=60) between the ages of 18-72 months admitted to the Yenimahalle Community Health Center Immigrant Health Unit to receive primary health care services between 1 November 2018- 1 March 2019 were included in this study. The control group included 60 Turkish children between 18-72 months admitted to the İsmail Ulucan Family Health Center which is in the same building. Developmental assessments were conducted by the researchers using the Denver II Developmental Screening Test (DDST-II). Sociodemographic characteristics of the child, family and caregivers as well as risk factors related to development were collected using a questionnaire. The interviews with refugee families were conducted with an interpreter. Developmental delay was more frequent in refugee children compared to Turkish children. The DDST-II were normal in 82.1%, questionable in 10.7% and abnormal in 7.1% of Turkish children; in the study group, 22.2% of the patients were found to be normal, 33.3% were questionable and 44.4% were abnormal. The differences were statistically significant (p < 0.05). Multiple logistic regression analysis revealed that, being a forcibly displaced refugee was the single significant risk factor for developmental delay alone. In the DDST II subdomain analysis, it was seen that high monthly income reduces the risk of caution-delay in personal-social domain. It was found that birth weight below 2500 g increased the risk of caution-delay in the fine-motor and gross-motor domain and being a forcibly displaced refugee and consanguinity increased the risk of caution -delay in the language domain. This study showed that being a forcibly displaced refugee was the most important risk factor for developmental delay. We emphasized the importance of surveillance and screening development in these highrisk children as well as early intervention services.

Abstract 10260: Risk Factors for Developmental Delay in Congenital Heart Disease Patients Following Surgery

Introduction: Children with congenital heart disease (CHD) receiving cardiac surgical intervention are at greater risk for developmental delays (DD). Identification of DD and early interventions may improve long term outcomes. The Ages and Stages Questionnaire (version 3) (ASQ3) is a DD screening tool. We hypothesized that clinical and perioperative risk factors are associated with DD in the early post-operative period. Methods: Patients who received an ASQ3 from 2019-2021 post CHD surgery were included. The ASQ3 was administered at outpatient surgical consultation or inpatient, if specific DD risk criteria were met. Those with incomplete operative data were excluded. DD was defined by an ASQ3 score for any domain below the at-risk cutoff. Associations between DD, patient characteristics, clinical factors, and perioperative factors were analyzed utilizing descriptive, univariate, and multivariable statistics. Results: A total of 57 patients were identified: median age at screening was 4 [IQR: 2-9] months, 22(39%) had a non-cardiac congenital abnormality (NCAA) and 17 (30%) a chromosomal abnormality (CA) (Table). Median cardiopulmonary bypass (CPB) time was 194 [IQR: 89-239] minutes. Forty-six (81%) patients had a DD. The median time between surgery and screening was 2 [IQR: 1-5] months. Patients with a NCAA (p = 0.037) and CA (p = 0.024) were more likely to have a DD. No other significant differences were found. In models adjusted for NCAA and CA, CPB times were not significant. Conclusions: The ASQ3 detected a high prevalence of DD among patients screened post CHD surgery. Despite known associations between CHD surgery and DD, few clinical factors, including CPB times, in our sample were associated with ASQ3 determined DD. More studies are needed to assess if the ASQ3 is sensitive and specific enough to serve as a screening tool in this population.

Long-term cognitive outcomes of prematurely born infants: A longitudinal follow-up of Denver II, Bayley III and WISC-IV Tests.

Prematurity constitutes a risk factor for developmental delay in infancy and childhood. This study aims to: (i) determine long-term cognitive outcomes in prematurely delivered children and compare them with term-delivered children using the WISC-IV and Stroop tests; (ii) examine the relation between Denver II, Bayley III and WISC-IV, Stroop tests. The study group consisted of children born prematurely who had been tested with Denver II and Bayley III in their first 2 years, and had been evaluated with WISC-IV and Stroop tests under follow up, 6-10 years later. The study group (n = 60, 25 F, 35 M) was 8.0 ± 2.4 (6-10.7) years old when given WISC-IV and Stroop tests. Gestational age in the study group was 34-37 weeks in 25%, 30-33 weeks in 48.3%, and <29 weeks in 26.7%. On WISC-IV, the verbal comprehension index, perceptual reasoning index, working memory index, and full-scale IQ scores were lower in the study group than the control group (P < 0.05). The study group took longer to complete the Stroop test (P < 0.05). Lower socioeconomic status (P = 0.005) and parental education level (P = 0.000) were associated with lower verbal comprehension index scores. Denver II and Bayley III test results were related to WISC-IV results (P < 0.05) but not to the Stroop test results (P > 0.05). Our results showed prematurity negatively influences the results of WISC-IV and Stroop tests at school age. Denver II and Bayley III tests applied at age 2 years likely predict WISC-IV results.

Developmental outcomes in small-for-gestational age twins using a singleton vs twin birthweight reference

Limited data exist about the potential developmental delays in appropriately grown twins; furthermore, twins may be at higher risk of developmental delay than singletons. Small-for-gestational age is a risk factor for developmental delay and is based on singleton birthweight references, which may misclassify small-for-gestational age in a subset of appropriately grown twins. This study aimed to evaluate the risk of developmental delay in twins classified as small-for-gestational age according to the twin and singleton birthweight references (<10th percentile). In a birth cohort (2008-2010) of twins (n=1790) and singletons (n=3829) where parents completed Ages & Stages Questionnaires for child development between 4 and 36 months, we used a US population-based birthweight reference to categorize singletons and twins as small-for-gestational age. Uncertain small-for-gestational age twins were defined as small-for-gestational age by a singleton reference (<10th percentile) and not by a twin reference, and twin-reference small-for-gestational age twins were defined as small-for-gestational age by a twin reference. Adjusted generalized linear mixed-effects models were used to estimate the odds of failure on any Ages & Stages Questionnaires domain and on each of the 5 domains (fine motor, gross motor, communication, personal-social, and problem-solving domains); random intercepts accounted for repeated measures and twin clustering. Compared with non-small-for-gestational age twins (>10th percentile), uncertain small-for-gestational age twins did not have higher odds of Ages & Stages Questionnaires failure (adjusted odds ratio, 1.28; 95% confidence interval, 0.91-1.80). Compared with non-small-for-gestational age singletons, both twin-reference and uncertain small-for-gestational age twins had higher odds of Ages & Stages Questionnaires failure, with the highest risk conferred to twin-reference small-for-gestational age twins (twin-reference adjusted odds ratio, 3.14 [95% confidence interval, 1.94-5.10]; uncertain adjusted odds ratio, 2.35 [95% confidence interval, 1.69-3.26]; P<.01 for trend). Results remained consistent when limiting analyses to term births (≥37 weeks' gestation). Although a singleton reference may overestimate small-for-gestational age in twins, the findings indicated that a singleton birthweight reference may be appropriate for twins because it identifies more twins at risk of developmental delay than a twin reference.

Comparative analysis of developmental profile between normal and severe acute malnourished under-five children in Pakistan: a multicentre cross-sectional study

ObjectivesThis study aims to compare the developmental profile of severe acute malnourished (SAM) and normal under-five children and to find sociodemographic determinants accountable for their developmental disabilities.SettingWe conducted a multi-centre...

Novel interstitial 2q12.3q13 microdeletion predisposes to developmental delay and behavioral problems.

Microarray-based comparative genomic hybridization (aCGH) is being increasingly applied to delineate novel genomic disorders and related syndromes in patients with developmental delay. In this study, detailed clinical and cytogenetic data of three unrelated patients with interstitial 2q12.3q13 microdeletion were described and compared with thirteen 2q12.3q13 microdeletion patients, gathered from the medical literature and public databases. 60K aCGH analysis revealed three overlapping 2q12.3q13 microdeletions measuring 1.88Mb in patient 1, 1.25Mb in patient 2, and 0.41Mb in patient 3, respectively. Confirmation and segregation studies were performed using fluorescence in situ hybridization (FISH) and quantitative real-time PCR. Variable clinical features of 2q12.3q13 microdeletion including microcephaly, prenatal growth retardation, developmental delay, short stature, behavioral problems, learning difficulties, skeletal anomalies, congenital heart defects, and features of ectodermal dysplasia were observed. The boundaries and sizes of the 2q12.3q13 deletions in the sixteen patients were different, but an overlapping region of 249kb in 2q12.3 was defined. The SRO (smallest region of overlap) encompasses four genes, including LIMS1, RANBP2, CCDC138, and EDAR. Among these genes, RANBP2 is a strong candidate gene for neurological phenotype and genetic susceptibility to viral infections. To our knowledge, this is the first published report of 2q12.3q13 microdeletion syndrome and our observations strongly suggest that these recurrent CNVs may be a novel risk factor for developmental delay with variable expressivity and incomplete penetrance.

Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease.

Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease.

Factors Affecting the Developmental Outcomes of High-Risk Newborns

Background: Newborns weighing less than 2,500 grams and those with birth asphyxia are particularly vulnerable to multiple complications. This study aimed to evaluate the prevalence and factors related to developmental delays in high-risk newborns. Methods: This study included the clinical data of infants with a birth weight of under 2500 grams or an Apgar score of less than 7 at 1 or 5 minutes after birth. Medical records from January 1, 2015 to December 31, 2020 were included. The actual age of the infants was corrected according to gestational age. Participants with genetic abnormalities (trisomy 21, 18, 13) and congenital brain anomalies (hydrocephalus, encephalocele) were excluded. The Developmental Assessment for Intervention Manual (DAIM) was used during follow-up visits. Multivariate logistic regression analysis was used to examine the data. Results: Of the 297 patients included, 110 completed the follow-up and 62 infants (56%) had developmental delays. Significant associations with delayed development included maternal age (adjusted odds ratio [AOR] 3.36, 95% confidence interval [CI] 1.19 - 9.46), male sex (AOR 3.23, 95% CI 1.24 - 8.44), gestational age below 32 weeks (AOR 33.35, 95% CI 1.39 - 799.87), and neonatal hypoglycemia (AOR 3.81, 95% CI 1.13 - 12.85). Conclusion: Maternal age, male sex, gestational age less than 32 weeks, and neonatal hypoglycemia were all associated risk factors for developmental delays in high-risk infants.

19.3 DEVELOPMENTAL EXPOSURE TO NEAR-ROADWAY POLLUTION PRODUCES BEHAVIORAL AND HISTOLOGICAL PHENOTYPES RELEVANT TO NEURODEVELOPMENTAL DISORDERS

Epidemiological studies consistently implicate traffic-related air pollution (TRAP) and/or proximity to heavily trafficked roads as risk factors for developmental delays and neurodevelopmental disorders (NDDs); however, there are limited preclinical data demonstrating a causal relationship. To test the effects of TRAP, pregnant rat dams were transported to a vivarium adjacent to a major freeway tunnel system in Northern California where they were exposed to TRAP drawn directly from the tunnel or filtered air (FA).

Predicting Autism Spectrum Disorder in Very Preterm Infants.

Children born preterm are known to be at higher risk for developing autism spectrum disorder (ASD) compared with their term-born counterparts, with an estimated 7% prevalence of ASD based on a recent large prospective study and a meta-analysis.1,2 This high prevalence is in contrast to the currently estimated prevalence of ASD in the United States of 1.8% in the general population.3 ASD has been shown to be associated with a variety of prenatal, perinatal, and neonatal risk factors, including a variety of maternal health risk factors and medications and neonatal risk factors such as seizures, birth asphyxia, and low birth weight.4 Previously identified perinatal risk factors for ASD specific to preterm infants include factors such as low birth gestational age and birth weight, intracranial hemorrhage, and acute and chronic lung disease (CLD).5The article by Chen et al6 in this issue of Pediatrics provides the first prospectively obtained data regarding whether there is an early developmental trajectory of prematurely born children that predicts who will develop ASD. The authors tested 319 preterm children prospectively with Bayley Scales of Infant Development examinations at 6, 12, and 24 months and used group-based trajectory modeling to assess whether early-life developmental trajectory predicted autism at 5 years of age. The approach of looking at developmental trajectory has been used in other high-risk populations, such as infant siblings of children with ASD7 or those with a specific genetic disorder (tuberous sclerosis complex) with a high prevalence of ASD.8The authors provide the first data revealing that although a small percentage of preterm infants who develop ASD have a similar early-life trajectory to that of term-born children, with decline in mental development from age 12 to 24 months,9,10 the highest-risk group was identified as having low cognitive scores at 6 months, with further decline over time, allowing for early identification and intervention. The converse finding that infants with low cognitive scores who improve to >85 and those with stably high cognitive scores are at lower risk of developing ASD enables the clinician to provide reassurance to families.Their analysis also illuminates risk factors for ASD related to preterm birth by comparing the 29 children who developed ASD with the 290 children without ASD. Notably, their study identified both nonmodifiable (eg, male sex, gestational age, and birth weight) and potentially modifiable risk factors (eg, CLD and duration of oxygen therapy) for the development of ASD. As the authors discussed, CLD is known to be a risk factor for developmental delay and cognitive impairment and/or disability, but it is unclear the extent to which the risk associated with CLD is related to brain injury and altered brain development.One acknowledged limitation of the study was the lack of neuroimaging data, so it is unknown whether there was a contribution of identifiable brain injury to the development of ASD in their subjects. It is likely that at least some of the infants in the low cognitive score group had easily detected brain injury, such as large cerebellar injury11 or cerebral injury and/or impaired brain development,12–14 both of which are associated with low IQ and are suspected to increase the risk of ASD. Additionally, there were no data regarding genetic risk factors for ASD, which could contribute a “second hit” to risk factors related to prematurity. Numerous genes have now been identified to be associated with ASD and/or intellectual disability and could have contributed to some cases of ASD in this study. Male sex remains a strong risk factor for ASD in both preterm and term-born children, and particularly in preterm children, male sex may contribute to inherent genetic risks related to sex as well as increased vulnerability to complications of preterm birth that also increase the risk of ASD. The importance of neuroimaging and genetic data relates in part to the observation that preterm and term-born children with ASD have been shown to have important phenotypic differences. In one study, boys with ASD born preterm had higher rates of seizures, attention-deficit/hyperactivity disorder, and sleep apnea,15 suggesting a potentially different neural substrate for ASD than term-born children.Perhaps most importantly, these findings provide an opportunity for initiating interventions in early life to mitigate ASD before the diagnosis of ASD can be definitively established. Identification of a constellation of prenatal and neonatal risk factors could help clinicians target infants at highest risk, while providing reassurance to parents whose infants are at low risk. Identification of high-risk infants with low cognitive scores at 6 months of age or those with declining scores over time could provide another opportunity to intensify early intervention services aimed at mitigating manifestations and/or symptoms of ASD. Importantly, identification of high-risk infants by neonatal discharge and/or 6 months of age could improve research into novel therapies to mitigate the manifestations of ASD, such as communication and social-emotional deficits or impairments.