Risk Of Developmental Delay Research Articles

Chlorpyrifos and other pesticide exposure and suspected developmental delay in children aged under 5 years: a case-control study in Phitsanulok, Thailand

Background: Developmental delay among children under 5 years of age is a serious global public health problem and much research has been carried out to find potential causes. Pesticides - especially organophosphates - are suspected to be one of the main causes of the problem. This study aimed to investigate the association between pesticide use by the mother during pregnancy and preschool children development using a case-control study.Methods: Data on prenatal and postnatal pesticide exposure of 442 children with suspected developmental delay, and 413 controls with normal development were included for analysis. The children were matched for gender, age, and residency. Data on pesticide exposure were collected via interview with the mother, and data on pregnancy outcomes abstracted from hospital records. Results: Chlorpyrifos exposure significantly increased the risk of developmental delay with an odds ratio (OR) of 3.71 (95% CI 1.03-13.36) for ever use of the pesticide, and an OR of 5.92 (95% CI 1.01-34.68) for postnatal exposure (p <0.05). Some other pesticides also had a positive association with developmental delay but none were statistically significant (p <0.05). Those pesticides were insecticide, fungicide, herbicide, and molluscicide. Individual pesticides with a positive association were glyphosate, paraquat, butachlor, methyl parathion (pholidon), savin, methomyl, endosulfan, carbosulfan, methamidophos, monochrotofos, mancozeb, and bordeaumixture.Conclusions: This case-control study found that chlorpyrifos and some other pesticides exposure during pregnancy were positively associated with developmental delay in children aged under 5 years. Further research should be conducted to better understand this potential effects of pesticides on child neurodevelopment, and the public - especially those who plan to have families - should be informed.

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.

Chlorpyrifos and other pesticide exposure and suspected developmental delay in children aged under 5 years: a case-control study in Phitsanulok, Thailand

Background: Developmental delay among children under 5 years of age is a serious global public health problem and much research has been carried out to find potential causes. Pesticides - especially organophosphates - are suspected to be one of the main causes of the problem. This study aimed to investigate the association between pesticide use by the mother during pregnancy and preschool children development using a case-control study.Methods: Data on prenatal and postnatal pesticide exposure of 442 children with suspected developmental delay, and 413 controls with normal development were included for analysis. The children were matched for gender, age, and residency. Data on pesticide exposure were collected via interview with the mother, and data on pregnancy outcomes abstracted from hospital records. Results: Chlorpyrifos exposure significantly increased the risk of developmental delay with an odds ratio (OR) of 3.71 (95% CI 1.03-13.36) for ever use of the pesticide, and an OR of 5.92 (95% CI 1.01-34.68) for postnatal exposure (p &lt;0.05). Some other pesticides also had a positive association with developmental delay but none were statistically significant (p &lt;0.05). Those pesticides were insecticide, fungicide, herbicide, and molluscicide. Individual pesticides with a positive association were glyphosate, paraquat, butachlor, methyl parathion (pholidon), savin, methomyl, endosulfan, carbosulfan, methamidophos, monochrotofos, mancozeb, and bordeaumixture.Conclusions: This case-control study found that chlorpyrifos and some other pesticide exposure during pregnancy was positively associated with developmental delay in children aged under 5 years. Further research should be conducted to better understand this potential effect of pesticides on child neurodevelopment, and the public - especially those who plan to have families - should be informed.

Ambient Air Pollution Exposure and Risk of Developmental Delay in Children and Teenagers in Taiwan

(1) Background: Studies on the association between air pollution and developmental delay in children are limited. Therefore, we evaluated the risk of developmental delay in Taiwanese children exposed to air pollution. (2) Methods: We merged the two nationwide databases, and the annual average pollutant concentrations were grouped into tertiles to evaluate the risk of developmental delay (ICD-9 code 315.9). We identified the patients’ active residential locations based on the location of the clinic or hospital in which they sought treatment for acute upper respiratory infections (ICD 9 code 460). The two nationwide databases were linked for analysis based on the active residential locations of each participant and the locations of the 74 ambient air quality monitoring stations. (3) Results: We observed an increased risk of developmental delay in children and teenagers exposed to SO2, CO, and NO2. The adjusted odds ratios (ORs) of developmental delay for comparison among the tertiles with respect to SO2, CO, and NO2 exposures were 1.12 (95% confidence interval [CI], 1.01–1.24), 1.21 (95% CI, 1.09–1.34), and 1.40 (95% CI, 1.261.55), respectively. (4) Conclusions: The present findings suggest that air pollution exposure increases the risk of developmental delay in children and teenagers in Taiwan.

Utility of the Ages and Stages Questionnaires 3rd Edition for Developmental Screening in Children with Surgically Repaired Congenital Heart Disease

ABSTRACT Aim: This study sought to evaluate the accuracy of the Ages and Stages Questionnaires 3rd Edition (ASQ-3) in identifying developmental delay (DD) in children with congenital heart disease (CHD) born at term who underwent surgical repair. Methods: Participants had to complete ASQ-3 and Bayley Scales of Infant and Toddler Development 3rd Edition (BSID-III) at 12 and 24 months. A child was considered at risk of DD for a ASQ-3 domain when he scored below the cutoff (≤-1SD or ≤-2SD). A child had a DD in a BSID-III domain when the score was ≤-1SD. The validity for each ASQ-3 domain and for overall ASQ-3 was measured. Results: At 12 months (n = 64), overall ASQ-3 (≤-2SD) sensitivity was 88%, specificity 74%. At 24 months (n = 82), overall ASQ-3 (≤-2SD) sensitivity was 74%, specificity 88%. Conclusion: The results support the utility of the ASQ-3 for screening the overall risk of DD in children with CHD.

P–788 Health outcomes at birth, 12 and 24 months of 747 children conceived after Preimplantation Genetic Testing: a single centre experience

Abstract Study question Does conception by Preimplantation Genetic Testing (PGT-M, PGT-SR) adversely affect health outcomes in children born through this assisted reproductive technique? Summary answer No significant difference was noted in the rate of congenital malformations in children born after PGT-M and PGT-SR compared with IVF-ICSI children. What is known already It is already known that the risk of congenital anomalies in IVF-ICSI pregnancies is higher when compared with pregnancies conceived naturally. Study design, size, duration This is a prospective study on 747 children born between December 1999 and July 2016 after a cycle of PGT-M or PGT-SR (IVF +/- ICSI + embryo biopsy) performed at a single London reproductive centre. PGT-A is not performed in the Centre, so pregnancy outcomes in this group are not relevant. The children were examined at birth, at 12 and 24 months of age and the data collected in three questionnaires. Participants/materials, setting, methods 747 PGT-M and PGT-SR children were enrolled in the study. 742/747 were examined at birth, 444/747 at 12 months and 168/747 at 24 months. The assessment consisted of three separate questionnaires completed at birth, 12 months and two years of age. The first questionnaire focused on the detection of congenital anomalies in newborn babies. The questionnaire at follow up recorded growth data and examination of the baby’s health and development. Main results and the role of chance We found no evidence that PGT-M and PGT-SR increased the risk of an adverse perinatal outcome when compared with children born after IVF-ICSI. The overall malformation rate in our group of live born after PGT-M and PGT-SR was 3.9% and of major malformations was 2%. These values are comparable with literature data on malformation risk in children born after IVF-ICSI. In terms of misdiagnosis, we had one misdiagnosis of SMA type 1 in 658 pregnancies obtained. This was very early on in the centre’s experience of offering PGT-M. Follow-up visits in our cohort allowed us to evaluate their development. Unfortunately, the low participation rate at 24 months (23%) significantly reduced the size of our cohort. We observed a cumulative value of 10% at 24 months of babies with developmental delay which is comparable with the value of 10% given by the WHO, but is twice the incidence Global Research on Developmental Disabilities Collaborators described in the UK in 2016 (4.6%). To our knowledge, no large studies have assessed the risk of developmental delay in children born after PGT. We cannot draw conclusions on this from our small cohort at 24 months and recommend further studies. Limitations, reasons for caution Although our sample is one of the largest reported, it is too small to generalise results due to the heterogeneity of the conditions for which PGT was being offered and the rarity of these conditions. There were multiple confounding factors including couple’s fertility background, varying fertility treatments and embryological techniques. Wider implications of the findings: Our results support published literature highlighting the safety of PGT-M and PGT-SR techniques. We followed up at birth, 12 months and 24 months a large cohort of children, in one of the largest datasets published so far. Trial registration number Not applicable

Motor performance evaluation of newborns with gastroschisis after surgical correction

Introduction: Gastroschisis is a congenital malformation that has risk factors for delayed neuropsychomotor development. That is why it is important to recognize early developmental changes in these newborns during hospitalization in the Neonatal Intensive Care Unit. Objective: To evaluate the motor performance of newborns with gastroschisis after surgical correction. Methods: An observational and retrospective study was carried out with newborns with gastroschisis, assessed by the Test of Infant Motor Performance at the Neonatal Intensive Care Center 2 of the Instituto da Criança e do Adolescente. The test allows the classification of the risk for developmental delay in 4 categories: within the average for age, low average, below average, and well below average. Maternal, neonatal, surgical, and motor assessment data were collected through electronic medical records. Results: Motor assessment was performed on 17 newborns, where 88.23% were classified as “below average” for age. The mean maternal age was 20 years, and the average gestational age and birth weight were 36.38 weeks and 2343.9 grams, respectively, with the majority being female. Simple gastroschisis accounted for 64.71%, and primary closure was possible in 82.35%. The average hospital stay of 53.24 days, and sepsis was the most frequent complication (64.71%). Conclusion: Newborns with gastroschisis remain hospitalized for a long time and are susceptible to complications. It was possible to identify the delay in the development of these newborns early during hospitalization, which allows intervention by physiotherapy before the delay worsens.

The Association Between Nutritional Status and Risk of Developmental Disorder in Children in Denpasar Bali Indonesia

BACKGROUND: Preschool age is an important period for growth and development. Malnutrition that occurs during this period can have negative impacts on growth, cognitive development, and academic performance in children. AIM: The objective of the study is to know the association between nutritional status and the risk of developmental disorder in preschool children in Denpasar. METHODS: An observational analytic study with a cross-sectional design and cluster sampling method was conducted on children under 5 years old who attended Early Childhood Education in Denpasar Bali in 2019. RESULTS: From 468 samples, the median age was 5 years old (range, 1–5), the majority of children were well-nourished (52.6%), and caretaken by parents (82.9%). Child development was prescreened using an Indonesian child development pre-screening questionnaire/Kuesioner Pra Skrining Perkembangan (KPSP) that had 75% sensitivity, 99.16% specificity, 85.71% positive predictive value,and 98.33% negative predictive value compared to Capute Scale test as a gold standard. It showed that the majority of participants had an appropriate developmental stage (91.3%), followed by doubtful (5.3%) and possible deviations (3.4%). The results of the bivariate analysis showed that malnutrition was significantly related to the risk of developmental delay (PR 2; confidence interval [CI] 95%, 1.05-3.97). The result of multivariate analysis for variables that were considered to be significant as a risk for developmental disorder showed that malnutrition was related to the possibility of developmental disorder (PR 2; CI 95%, 1.04–3.95). Caretakers other than parents and lack of physical activity were not significantly related to the risk of developmental disorder. CONCLUSION: Malnutrition was found to be significantly associated with the risk of developmental disorder in preschool children. Further prospective study by standard assessment tools is required to evaluate the association between nutritional status and developmental level in children.

Association between Early Life Child Development and Family Dog Ownership: A Prospective Birth Cohort Study of the Japan Environment and Children’s Study

Pets may play a role in the social-emotional development of children. In particular, some studies have suggested that family dog ownership is associated with better health outcomes. To date, no study has assessed child development in association with dog ownership of different time points. The purpose of the current study was primary to investigate whether “ever” family dog ownership was associated with early child development, and secondary to further examine whether associations between family dog ownership and early child development differ among family dog ownership of status, including “past only”, “current only”, and “always” groups, using the data of family dog ownership obtained at multiple time points. Associations between family dog ownership and infant development at 3 years of age were examined using data from a nationwide prospective birth cohort study, the Japan Environment and Children’s Study (n = 78,941). “Ever” family dog ownership was categorized to “past only”, “current only”, and “always”. We observed that children with “ever” family dog ownership showed a significantly decreased risk of developmental delay in the communication (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.78, 0.96), gross motor (OR = 0.83; 95% CI: 0.76, 0.92), problem-solving (OR = 0.89; 95% CI: 0.83, 0.96) and personal-social (OR = 0.86; 95% CI: 0.72, 0.92) domains compared to children with “never” family dog ownership. Furthermore, a significantly decreased risk of developmental delay in gross motor function was observed in association with living with dogs in the “past only” (OR = 0.83; 95% CI: 0.73, 0.95) and “always” (OR = 0.86; 95% CI: 0.75, 0.98). In addition, a decreased risk of developmental delay in the problem-solving domain was associated with “past” family dog ownership (OR = 0.87; 95% CI: 0.79, 0.97) and in the personal-social domain was associated with “always” family dog ownership (OR = 0.81; 95% CI = 0.68, 0.95). Given the possible positive association between early life child development and family dog ownership, living with dogs may be an important factor to be considered when assessing child development.

An Ecological Model to Frame the Delivery of Pediatric Preventive Care.

* Abbreviation: FV — : fluoride varnish Screening and surveillance are integral aspects of child health promotion and disease prevention. The American Academy of Pediatrics recommends that primary care clinicians screen children and adolescents for a broad array of conditions, conduct surveillance of growth and development, and identify social determinants of health and protective and risk factors that might impact health over time. However, access to and outcomes of preventive services vary on the basis of the features of children’s social ecology, including family and community contexts. The proposed five-stage socio-ecological model considers multiple contextual dimensions of pediatric screening: (1) individual, (2) interpersonal, (3) organizational, (4) community/population, and (5) public policy. Incorporating this model into routine care might improve outcomes at the individual and population level. Future endeavors should focus on integration of this model with validated risk screening tools as part of a supportive electronic health record, culture, and incentive structure. Further research assessing the contributors and outcomes of differences in beliefs, resources, practices, and opportunities among individuals, families, providers, primary care organizations, communities, health systems, and policy partners will be essential in advancing knowledge and policies to improve preventive services delivery. Screening and surveillance are important activities in child health promotion and disease prevention.1–5 The American Academy of Pediatrics recommends a wide range of specific preventive services to allow for early implementation of effective interventions to maximize development and quality of life.3 The need is clear; >17% of children are at risk for developmental delay,6 and screening can facilitate entry into critical services. Unfortunately, nearly 40% of pediatricians do not routinely screen … Address correspondence to Corina Graif, Department of Sociology and Criminology, Population Research Institute, Pennsylvania State University, 816 Oswald Tower, University Park, PA 16802. E-mail: corina.graif{at}psu.edu

Developmental service referrals for foster children with delays

In this volume of The Journal, Greiner et al focus on young children who have entered the foster care system in Ohio, starting to parse out some of the differences in outcomes between non-relative foster family placements and kinship foster placements. These children's experience of abuse and neglect places them at higher risk for developmental delay, with Early Intervention services often indicated. This study identifies gaps in referrals for children who are delayed, but also frequent lack of completion of referrals that were placed, with more kinship caregivers declining services.

Children Exposed to IPV: Impact of Multiple Father Figures.

Exposure to intimate partner violence (IPV) has been associated with adverse infant developmental outcomes; however, the influence of the number of father-figures (abusive vs non-abusive) has on young infants' risk for neurodevelopmental delays has not been examined. A secondary data analysis was conducted from the Domestic Violence Enhanced Perinatal Home Visits (DOVE) study of abused pregnant women (N = 239) and their infants' neurodevelopment from baseline through 12-months postpartum. Although all women reported decreased violence from baseline to 12months postpartum, there was a significant main effect between baseline IPV scores and infant risk for developmental delay at 12months (β = .19; p < .05) and a significant interaction between baseline IPV scores and multiple partner categories (β = .89; p < .01). Women in the single abusive partner category demonstrated a negative association between baseline IPV and 12-month infant risk scores (β = -.56; p < .01). Whereas women in the mixed and multiple abusive partner groups demonstrated a positive association between IPV and infant risk scores (β = .32; p < .05). This study provides evidence that an infant's neurodevelopment is impacted by exposure to violence in the home. Additional research is needed to examine the full impact, not only the effects of single and/or abusive partners on child development, but also the possible effect of multiple non-abusive partners on development.

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.

Fruit and vegetable consumption before and during pregnancy and developmental delays in offspring aged 2 years in Japan.

The association between fruit and vegetable consumption before and during pregnancy and offspring's physical growth has been well reported, but no study has focused on offspring's neurological development. We aimed to explore the association between maternal fruit and vegetable consumption before and during pregnancy and developmental delays in their offspring aged 2 years. Between July 2013 and March 2017, 23406 women were recruited for the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Fruit and vegetable consumption was calculated using FFQ, and offspring's developmental delays were evaluated by the Ages & Stages Questionnaires, Third Edition (ASQ-3) for infants aged 2 years. Finally, 10420 women and 10543 infants were included in the analysis. Totally, 14·9 % of children had developmental delay when screened using the ASQ-3. Women in the highest quartile of vegetable consumption from pre-pregnancy to early pregnancy and from early to mid-pregnancy had lower odds of offspring's developmental delays (OR 0·74; 95 % CI 0·63, 0·89 and OR 0·70; 95 % CI 0·59, 0·84, respectively) than women in the lowest quartile. Women in the highest quartile of fruit consumption from early to mid-pregnancy had lower odds of offspring's developmental delays (OR 0·78; 95 % CI 0·66, 0·92) than women in the lowest quartile. In conclusion, high fruit and vegetable consumption before and during pregnancy was associated with a lower risk of developmental delays in offspring aged 2 years.

Exposure to Domestic Violence During the COVID-19 Pandemic: A Potent Threat to the Mental Well-being of Children

The unprecedented scale of the coronavirus disease 2019 (COVID-19) pandemic has indeed brought about tremendous ramifications on the state of mental health for children. One notable aspect deserving emphasis however, is the psychological impact in children as a result of the purported surge of domestic violence (DV) in many of the countries that imposed stay-at-home requirement. The imposition of movement restriction policy led to isolation and overcrowding, made worse by loss of income in some instances, causing high levels of stress and anxiety, thereby increasing the risk of DV and child abuse particularly those already living within violent or dysfunctional families. Children exposed to DV have higher risk of developmental delay and behavioural problems, more likely to suffer from post-traumatic symptoms, depression and anxiety, reduced cognitive functioning and social competence. Additionally, these children tend to have poorer academic performance and are more likely to engage in violent or abusive relationship later in life. Health care providers need to be vigilant and actively screen and identify children or families that are affected by DV to protect their physical and mental health well-being.

Household food insecurity and early childhood development in Brazil: an analysis of children under 2 years of age.

To determine if household food insecurity (HFI) is associated with the risk of developmental delays. Cross-sectional study of a representative sample of children under 2 years old. Risk of developmental delays was assessed with the Denver Developmental Screening Test II. HFI was measured with the Brazilian Food Insecurity Measurement Scale. Multivariable logistic regression was used to test the association between HFI (food secure/insecure) and risk of developmental delays, adjusting for household, maternal and child variables. Community Health Centers in the Federal District, Brazil. 1004 children under 2 years old. Among participants, 15 % were at risk of developmental delays and about 40 % of children lived in food-insecure households. HFI was associated with the risk of developmental delays (adjusted OR 2·61; 95 % CI 1·42, 4·80) compared with food-secure households after adjusting for key confounders. HFI was strongly associated with the risk of developmental delays in children under 2 years. Investments that prevent or mitigate HFI are likely to be key for improved human and national development.

Chlorpyrifos and other pesticide exposure and suspected developmental delay in children aged under 5 years: a case-control study in Phitsanulok, Thailand

Background: Developmental delay among children under 5 years of age is a serious global public health problem and much research has been carried out to find potential causes. Pesticides - especially organophosphates - are suspected to be one of the main causes of the problem. This study aimed to investigate the association between pesticide use by the mother during pregnancy and preschool children development using a case-control study.Methods: Data on prenatal and postnatal pesticide exposure of 442 children with suspected developmental delay, and 413 controls with normal development were included for analysis. The children were matched for gender, age, and residency. Data on pesticide exposure were collected via interview with the mother, and data on pregnancy outcomes abstracted from hospital records. Results: Chlorpyrifos exposure significantly increased the risk of developmental delay with an odds ratio (OR) of 3.71 (95% CI 1.03-13.36) for ever use of the pesticide, and an OR of 5.92 (95% CI 1.01-34.68) for postnatal exposure (p &lt;0.05). Some other pesticides also had a positive association with developmental delay but none were statistically significant (p &lt;0.05). Those pesticides were insecticide, fungicide, herbicide, and molluscicide. Individual pesticides with a positive association were glyphosate, paraquat, butachlor, methyl parathion (pholidon), savin, methomyl, endosulfan, carbosulfan, methamidophos, monochrotofos, mancozeb, and bordeaumixture.Conclusions: This case-control study found that chlorpyrifos and some other pesticide exposure during pregnancy was positively associated with developmental delay in children aged under 5 years. Further research should be conducted to better understand this potential effect of pesticides on child neurodevelopment, and the public - especially those who plan to have families - should be informed.

Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls.

ObjectiveInfants with Congenital Heart Disease (CHD) are at risk for developmental delays, though the mechanisms of brain injury that impair development are unknown. Potential causes could include cerebral hypoxia and cerebrovascular instability. We hypothesized that we would detect significantly reduced cerebral oxygen saturation and greater cerebrovascular instability in CHD infants compared to the healthy controls.MethodsWe performed a secondary analysis on a sample of 43 term infants (28 CHD, 15 healthy controls) that assessed prospectively in temporal cross-section before or at 12 days of age. CHD infants were assessed prior to open-heart surgery. Cerebral oxygen saturation levels were estimated using Near-Infrared Spectroscopy, and cerebrovascular stability was assessed with the response of cerebral oxygen saturation after a postural change (supine to sitting).ResultsCerebral oxygen saturation was 9 points lower in CHD than control infants in both postures (β = -9.3; 95%CI = -17.68, -1.00; p = 0.028), even after controlling for differences in peripheral oxygen saturation. Cerebrovascular stability was significantly impaired in CHD compared to healthy infants (β = -2.4; 95%CI = -4.12, -.61; p = 0.008), and in CHD infants with single ventricle compared with biventricular defects (β = -1.5; 95%CI = -2.95, -0.05; p = 0.04).ConclusionCHD infants had cerebral hypoxia and decreased cerebral oxygen saturation values following a postural change, suggesting cerebrovascular instability. Future longitudinal studies should assess the associations of cerebral hypoxia and cerebrovascular instability with long-term neurodevelopmental outcomes in CHD infants.

Small Group-Delivered Literacy Based Behavioral Interventions for Young Children

Many differences exist between preschool and kindergarten classrooms, including the type and time spent on fine motor activities. Children at risk for developmental delays and learning challenges as they transition to kindergarten often require direct support during preschool to learn new skills needed for kindergarten. This study expanded the storybook literacy based behavioral intervention (LBBI) research by exploring the effect of small group-delivered, electronic LBBIs on preschool students considered at-risk by their teachers. Using a multiple probe design across skills, we delivered LBBIs in a small group to teach common fine motor classroom skills (cutting with scissors, using liquid glue, and matching using one-to-one correspondence). Children acquired and maintained the new skills, then generalized the motor skills to novel materials.

605 Sleep problems are associated with behavioral problems and decreased quality of life in children with Fontan circulation

Abstract Introduction Children with congenital heart disease who undergo a Fontan procedure are at higher risk of behavior and attention problems as well as reduced quality of life compared to age-matched peers. While sleep problems are associated with behavior and attention problems in children without Fontan circulation, this relationship has never been examined in children with Fontan circulation. We hypothesized that sleep problems in this population may increase the risk of behavior problems and also reduce health related quality of life (HRQOL). Methods We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent-reported diagnosis of a sleep problem with reported behavioral concerns and HRQOL as measured by the child health questionnaire (CHQ) in 558 children with Fontan circulation. Analysis was performed using logistic regression or Wilcoxon sum rank test, as appropriate, with Bonferroni correction for multiple comparisons. Results Parent-reported sleep problems were present in 10% of participants. Sleep problems were associated with a 4.6x higher risk of attention problems, 10.2x higher risk of anxiety problems, 3.9x higher risk of behavioral problems, 9.5x higher risk of depression, 5.0x higher risk of developmental delay, 6.9x higher risk of learning problems and 2.2x higher risk of speech problems (p=0.04 for speech problems, p&amp;lt;0.001 for all others). Parent report of a sleep problem was associated with decreased physical HRQOL (z-score -1.3 [interquartile range-2.2, -0.2] vs 0.0 [-0.8, 0.4], p&amp;lt;0.001) and psychosocial HRQOL (-0.9 [-1.9, 0.0] vs 0.0 [-0.8, 0.7], p&amp;lt;0.001) compared to children without a reported sleep problem. Report of a sleep problem was associated with significantly lower HRQOL across all subdomains of the CHQ (p&amp;lt;0.05 for all subdomains). Conclusion Children with Fontan circulation with sleep problems have an increased risk of behavioral and developmental problems as well as reduced HRQOL. Better understanding of sleep problems is needed in children with Fontan circulation, as sleep disorders may represent a reversible cause of behavioral problems and decreased HRQOL in this population. Support (if any) Funding to DC from the American Heart Association, University of Arizona Health Sciences Center, and NIH-NHLBI. Fontan study data obtained from the Pediatric Heart Network.