Wechsler Preschool Research Articles

Neuroanatomical Correlates Underlying the Association Between Maternal Interleukin 6 Concentration During Pregnancy and Offspring Fluid Reasoning Performance in Early Childhood

BackgroundMaternal inflammation during pregnancy can alter offspring brain development and influence risk for disorders commonly accompanied by deficits in cognitive functioning. We therefore examined associations between maternal interleukin 6 (IL-6) concentrations during pregnancy and offspring cognitive ability and concurrent magnetic resonance imaging–based measures of brain anatomy in early childhood. We further examined newborn brain anatomy in secondary analyses to consider whether effects are evident soon after birth and to increase capacity to differentiate effects of pre- versus postnatal exposures. MethodsIL-6 concentrations were quantified in early (12.6 ± 2.8 weeks), mid (20.4 ± 1.5 weeks), and late (30.3 ± 1.3 weeks) pregnancy. Offspring nonverbal fluid intelligence (Gf) was assessed at 5.2 ± 0.6 years using a spatial reasoning task (Wechsler Preschool and Primary Scale of Intelligence–Matrix) (n = 49). T1-weighted magnetic resonance imaging scans were acquired at birth (n = 89, postmenstrual age = 42.9 ± 2.0 weeks) and in early childhood (n = 42, scan age = 5.1 ± 1.0 years). Regional cortical volumes were examined for a joint association between maternal IL-6 and offspring Gf performance. ResultsAverage maternal IL-6 concentration during pregnancy was inversely associated with offspring Gf performance after adjusting for socioeconomic status and the quality of the caregiving and learning environment (R2 = 13%; p = .02). Early-childhood pars triangularis volume was jointly associated with maternal IL-6 and childhood Gf (pcorrected < .001). An association also was observed between maternal IL-6 and newborn pars triangularis volume (R2 = 6%; p = .02). ConclusionsThese findings suggest that the origins of variation in child cognitive ability can, in part, trace back to maternal conditions during the intrauterine period of life and support the role of inflammation as an important component of this putative biological pathway.

Chemical mixture exposures during pregnancy and cognitive abilities in school-aged children

IntroductionGestational exposure to chemical mixtures, which is prevalent among pregnant women, may be associated with adverse childhood neurodevelopment. However, few studies have examined relations between gestational chemical mixture exposure and children's cognitive abilities. MethodsIn a cohort of 253 pregnant women and their children from Cincinnati, OH (enrolled 2003–2006), we quantified biomarker concentrations of 43 metals, phthalates, phenols, polybrominated diphenyl ethers, organophosphate and organochlorine pesticides, polychlorinated biphenyls, perfluoroalkyl substances, and environmental tobacco smoke in blood or urine. Using k-means clustering and principal component (PC) analysis, we characterized chemical mixtures among pregnant women. We assessed children's cognitive abilities using the Wechsler Preschool and Primary Scale of Intelligence-III and Wechsler Intelligence Scale for Children-IV at ages 5 and 8 years, respectively. We estimated covariate-adjusted differences in children's cognitive ability scores ]=cross clusters, and with increasing PC scores and individual biomarker concentrations. ResultsGeometric mean biomarker concentrations were generally highest, intermediate, and lowest among women in clusters 1, 2, and 3, respectively. Children born to women in clusters 1 and 2 had 5.1 (95% CI: 9.4,-0.8) and 2.0 (95% CI: 5.5, 1,4) lower performance IQ scores compared to children in cluster 3, respectively. PC scores and individual chemical biomarker concentrations were not associated with cognitive abilities. ConclusionsIn this cohort, combined prenatal exposure to phenols, certain phthalates, pesticides, and perfluoroalkyl substances was inversely associated with children's cognition, but some individual chemical biomarker concentrations were not. Additional studies should determine if the aggregate impact of these chemicals on cognition is different from their individual effects.

Association of Breastfeeding and Child IQ Score at Age 5 Years.

To evaluate whether breastfeeding and its duration are associated with a reduced risk of low IQ scores or other neurodevelopmental problems. We conducted a secondary analysis of two parallel multicenter, double-blinded randomized controlled trials in which participants with a singleton pregnancy and either subclinical hypothyroidism or hypothyroxinemia were treated with thyroxine or placebo. Our primary outcome was a low IQ score (less than 85 on the WPPSI-III [Wechsler Preschool and Primary Scale of Intelligence III] at age 5 years). Secondary outcomes included performance measures on other validated neurodevelopmental tests. Univariable and multivariable analyses were performed to evaluate the association between breastfeeding and neurodevelopmental outcomes. Stepwise backward proceeding linear and logistic regression models were used to develop the final adjusted models. Of the 772 participants studied, 614 (80%) reported breastfeeding. Of these, 31% reported breastfeeding for less than 4 months, 19% for 4-6 months, 11% for 7-9 months, 15% for 10-12 months and 23% for more than 12 months. IQ scores were available for 756 children; mean age-5 scores were higher with any breastfeeding (96.7±15.1) than without (91.2±15.0, mean difference 5.5, 95% CI 2.8-8.2), and low IQ scores were less frequent with any breastfeeding (21.5%) than with no breastfeeding (36.2%, odds ratio 0.48, 95% CI 0.33-0.71). In adjusted analyses, breastfeeding remained associated with reduced odds of low IQ score (adjusted odds ratio [aOR] 0.62, 95% CI 0.41-0.93), and each additional month of breastfeeding was associated with lower odds of a low IQ scores (aOR 0.97, 95% CI 0.939-0.996). No significant associations between breastfeeding and other neurodevelopmental outcomes were identified in adjusted analyses. Breastfeeding and its duration are associated with lower odds of low IQ score at age 5 years.

Stimulation and cognitive function in short-stature preschoolers

Background Normal-height children generally have better cognitive function than growth-stunted, short-stature children. Children’s cognitive function reportedly improves with stimulation. However, a correlation between stimulation and cognitive function in children with a history of short stature remains unclear.&#x0D; Objective To assess correlation between stimulation and cognitive function in normal-height vs. short-stature preschool children.&#x0D; Methods A cross-sectional study with consecutive sampling was performed in four sub-district areas in Jakarta. Preschool-aged children and their primary caregivers from previous studies on short stature were eligible for inclusion. An Indonesian version of a questionnaire was used to assess stimulation. A psychologist assessed verbal IQ (VIQ), performance IQ (PIQ), and full-scale IQ (FSIQ) with the Indonesian version of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Data were analyzed using Pearson’s correlation and Chi-square tests, and P values &lt;0.05 were considered to be significant.&#x0D; Results Of 62 subjects, 64.5% had normal height and 35.5% had short stature. Both normal-height and short-stature children had similar IQ outcome and history of stimulation. The stimulation was significantly correlated with FSIQ in normal-height children (r= 0.316; P=0.047), but not short-stature children (r=0.049; P=0.828). However, the percentage differences in VIQ, PIQ, and FSIQ between normal-height and short-stature children were not significant (P=0.409, 0.119 and 0.877, respectively).&#x0D; Conclusion There is a significant correlation between stimulation and IQ in normal-height children. Short-stature preschoolers were not worse in terms of IQ than normal-height preschoolers. Parents and caregivers should be encouraged to provide regular and adequate stimulation to their young children.

Academic school readiness in children born very preterm and associated risk factors

Background and aimsAlthough the intelligence quotient (IQ) test is useful to assess general cognitive function, it may miss more specific and subtle deficits of learning, working memory, attention and executive function. This study aims to evaluate cognitive performance and academic school readiness (SR) concepts in preterm very low birth weight (PT/VLBW) children, compared to typically developing term controls and to evaluate factors affecting basic (SR) concepts in children with IQ>85. MethodsA prospective cohort study of 123 PT/VLBW survivors with birth weights ≤1250 g and 74 term controls born between 2007 and 2009 in Singapore were assessed for school readiness using Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), Bracken School Readiness Assessment (BSRA-3) and Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) at age 5.5 years. Social risk composite score (SRCS) was calculated based on ethnicity, parental education and family income and marital status. Uni- and multi-variable regressions were conducted to evaluate risk factors associated with poor academic SR in the entire cohort and in those with IQ >85. ResultsMean gestational age and birth weight of the 123 PT/VLBW children were 27.8 (2.3) weeks and 939 (194) grams while that of the 74 term controls were 38.8 (1.2) weeks and 3165 (402) grams.PT/VLBW survivors had statistically significant lower full composite scores on WPPSI-III (97.0 vs 114), BSRA-3 (98.5 vs 112.3) and VMI (107.2 vs 112.9) compared to controls. The differences remained significant in preterm and children with higher SRCS even after adjustment. ConclusionsPrematurity and high social composite risk scores were risk factors affecting academic SR and this difference persisted in PT/VLBW children with normal cognitive scores with IQ >85.

Association between head circumference at two years and second and fifth year cognition

BackgroundHead circumference (HC) measurement is routinely not performed in early childhood and there is conflicting information about its utility in literature. The current study analyses the association between HC at two years of age and cognition at two and five years of age.MethodsA community based birth-cohort recruited between 2010 and 2012 was followed up till five years of age in an urban slum in Vellore, India. Children were recruited at birth after informed parental consent by consecutive sampling using eligibility criteria of healthy new-born, singleton pregnancy and family’s availability in the study area during follow-up. HC measured at two years of age was used as the exposure variable to calculate association with cognition at both two and five years of age. Cognitive domain of Bayley scale of infant development was used at two years of age and Wechsler Preschool Primary Scales of Intelligence at five years.ResultsOf the 251 enrolled children, 138 (55%) were girls and 71 (30%) belonged to lower socioeconomic status. At 2 years, 8.81% of children had HC < − 3SD. Compared to children with HC z-scores ≥ − 2 SD, those with measurements < − 3 SD had a lower cognition scores by − 2.21 [95% CI: − 3.87 - -0.56] at 2 years. Also, children with HC < − 3 SD at two years scored significantly lower scores in cognitive domains of verbal, − 7.35 [95% CI: − 11.78 - -2.92] and performance, − 7.07 [95% CI: − 11.77 - -2.36] intelligence at five years.ConclusionsThis study showed that smaller HC at 2 years of age was negatively associated with cognition at both 2 and 5 years of age. Early childhood HC measurements can be utilised as a cheaper screening tool to identify children at risk in LMIC settings. Further studies can confirm these findings in diverse settings.

Protocol for assessing whether cognition of preterm infants

IntroductionDocosahexaenoic acid (DHA) is an omega-3 (n-3) fatty acid that accumulates into neural tissue during the last trimester of pregnancy, as the fetal brain is undergoing a growth spurt. Infants...

The performance of children with intellectual giftedness and intellectual disability on the WPPSI-IVA&NZ

ABSTRACT Objective The Wechsler Preschool and Primary Scale of Intelligence – Fourth Edition Australian and New Zealand Standardised Edition (WPPSI-IVA&NZ) is one of the most widely used intelligence assessments for children aged 2 years 6 months to 7 years 7 months. Given the impact of clinical and placement decisions that are supported by WPPSI-IVA&NZ results, it is important to provide evidence of criterion-related validity. Criterion-related validity refers to the degree to which test scores are associated with an external criterion (e.g., pre-existing diagnosis or classification). Method Two studies of children with intellectual giftedness (n = 19) and intellectual disability (n = 15) were conducted to determine if the constructs measured by the WPPSI-IVA&NZ perform as expected in criterion groups with known characteristics. Results Independent sample t-tests revealed mean composite scores for intellectually gifted children were significantly higher than matched controls, with the exception of the Processing Speed Index and Cognitive Proficiency Index. Children with intellectual disability on average obtained significantly lower mean scores on all composites relative to matched controls. Conclusion Results indicated that the WPPSI-IVA&NZ can provide valid estimates of intellectual ability for children with intellectual giftedness and intellectual disability that align with their previous diagnosis or classification.

Sex Differences in Intelligence in Young Children: Some Evidence from Taiwan

In the standardization sample of the Wechsler Preschool and Primary Scale of Intelligence – Fourth Edition (WPPSI-IV) in Taiwan, girls at the age of 2:5-3:11 years generally had higher average cognitive abilities than boys but this advantage was not present at the age of 4:0-7:0 years. These results are consistent with other studies reporting that among young children, girls have higher average cognitive abilities than boys. Girls had greater variability than boys in the majority of measures. Key Words: Taiwan; Wechsler tests; Sex differences; Intelligence; Young children; Variability

Sex Differences in Intelligence in Children Aged 2:6–7:7: Analysis of the Factor Structure and Measurement Invariance of the German Wechsler Primary and Preschool Scale of Intelligence–Fourth Edition

The present study investigated gender differences in cognitive abilities for children aged 2–7 years on the German Wechsler Primary and Preschool Scale of Intelligence–Fourth Edition (WPPSI-IV). WPPSI-IV data of 1,042 children (517 girls and 525 boys) were selected from the extended dataset of the German WPPSI-IV standardization sample. First of all, confirmatory factor analyses (CFAs) were used to verify the factor structure of the WPPSI-IV, which was proposed by the test developers. Then, multiple-group confirmatory factor models were implemented to explore measurement invariance across gender. Finally, mean differences in the subtests, index scores, as well as full scale IQ (FSIQ) were analyzed. The second-order three-factor model for age group 2:6–3:11 as well as the second-order five-factor model for age group 4:0–7:7 could be verified. For age group 2:6–3:11, full scalar invariance could be accepted, whereas partial scalar invariance could be established by freeing five nonequivalent subtest intercepts for age group 4:0–7:7. These findings support interpretable comparisons of the WPPSI-IV scores between girls and boys. For age group 4:0–7:7, partial invariance should be taken into account in these comparisons. Furthermore, girls aged 4:0–7:7 showed an advantage in processing speed (PS). Mean scores in any of the other cognitive abilities did not differ between girls and boys in both age groups. These results indicated measurement invariance across gender on the WPPSI-IV, so that the tests measure cognitive abilities in the same way for girls and boys. The current findings showed that gender differences in PS may emerge in early childhood, which might lead to gender differences in later educational skills.

Prenatal exposure to polybrominated diphenyl ethers (PBDEs) and cognitive ability in early childhood

BackgroundPrenatal exposure to polybrominated diphenyl ethers (PBDEs) has been associated with adverse neurodevelopmental outcomes in children, but evidence remains mixed regarding sex differences in this association. ObjectiveTo examine the prospective association between prenatal PBDE exposure and cognitive ability in young children, as well as potential sex differences. MethodsThe study was conducted in a multi-site Canadian pregnancy cohort recruited in 2008–11. PBDEs were measured in maternal plasma samples collected early in pregnancy. Cognitive ability was assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) in children at age 3 years (mean = 3.4). Multiple linear regression was used to analyze the association between maternal PBDE plasma concentrations (lipid-standardized and log10-transformed) and Verbal, Performance, and Full Scale IQ scores on the whole sample and stratified by sex, adjusting for confounders. ResultsThe sample was composed of 592 children (291 boys and 301 girls). A tenfold increase in maternal blood PBDE concentration (sum of BDE-47, −99, −100, and −153) was associated with lower Full Scale scores in boys (−3.4 points; 95% CI: −7.0, 0.1), after adjusting for confounders. BDE-47 was the congener with the highest concentrations in maternal blood and a tenfold increase in exposure was associated with significantly lower Full Scale IQ scores in boys (−4.4 points; 95% CI: −7.9, −0.9), after adjusting for confounders. Verbal and Performance IQ scores were similarly associated with PBDE exposure. Maternal blood PBDE concentrations were not associated with IQ scores in girls. ConclusionsPrenatal exposure to background levels of PBDEs, especially BDE-47, was associated with lower IQ scores in boys, but not in girls. Our results support that exposure to PBDEs during early development may be sex-dependent and detrimental to a child’s neurodevelopmental trajectory.

Long-Term Neurodevelopmental Outcome of Children after in Utero Exposure to Chemotherapy

Simple SummaryFacing cancer diagnosis during pregnancy constitutes a truly complex and challenging situation for both the patients and the physicians. Cancer diagnosis in a period of hope and joy is an unendurable situation that may affect the psychosocial functioning of the mother, causing depression, anxiety, self-blame, and social isolation. At the same time, a moral dilemma evolves among medical professionals; what is best for the mother in terms of immediate chemotherapy may have detrimental effects on the fetus, and conversely, delaying therapy and protecting the fetus may have a negative impact on the mother as the tumor progresses. Solid data on the safety profile or risks of anti-cancer agents and on the long-term neurodevelopmental outcome of children after in utero exposure to chemotherapy may provide both the patients and the physicians the information necessary for shared decision making when cancer is diagnosed during pregnancy.Pregnancy-related cancer management represents a real challenge for both the patients and the physicians. The long-term neurodevelopmental outcome of children in utero exposed to chemotherapeutic agents has only recently been addressed. This review aims to systematically integrate and highlight all existing data from the literature regarding the effect of prenatal exposure to chemotherapy on fetal brain growth and child development. All eligible studies are based on validated neurodevelopmental testing scales (e.g., Bayley Scales of Infant Development, Wechsler Preschool and Primary Scale of Intelligence) and/or well-defined questionnaires. Our systematic review including 17 studies demonstrates that no major consequences on the neurodevelopment of children after in utero exposure to anti-cancer drugs have been reported; nevertheless, longer and more thorough follow-up with large-scale multicenter prospective studies is certainly required in order to draw firm conclusions.

Effect of long-chain polyunsaturated fatty acids in infant formula on long-term cognitive function in childhood: A systematic review and meta-analysis of randomised controlled trials.

PROSPERO registration numbers CRD42018105196 and CRD42018088868.

Maternal Cadmium Exposure and Neurobehavior in Children up to Age 8 Years: The HOME Study

Background: It is unclear whether cadmium (Cd) exposure during fetal brain development is associated with child neurobehavior. This study examined the potential associations between Cd exposure during pregnancy and neurobehavior among children. Methods: We used data from 276 children in the Health Outcomes and Measures of the Environment (HOME) Study, a well-established prospective pregnancy and birth cohort. We measured maternal urinary Cd concentrations at 26 weeks of gestation. For cognitive function, we assessed Mental Development Index (MDI) and Full-Scale Intelligence Quotient (FSIQ) using the Bayley Scales of Infant Development-II, the Wechsler Preschool and Primary Scales of Intelligence-III, or the Wechsler Intelligence Scales for Children-IV at ages 1, 2, 3, 5, and 8 years. We assessed child behaviors using the Behavior Assessment System for Children-2 at ages 2, 3, 4, 5, and 8 years, yielding four composite measures: Externalizing Problems, Internalizing Problems, Behavioral Symptoms Index, and Adaptive Skills. We used linear mixed models with covariate adjustment to estimate the associations between maternal urinary Cd concentrations and child neurobehavior. Results: We categorized study participants into three groups based on maternal urinary Cd concentrations (Group 1: &lt; limit of detection (LOD), Group 2: 0.06-0.22 μg/g creatinine, Group 3: &gt;0.22-1.73 μg/g creatinine). In linear mixed models adjusting for maternal and child characteristics, maternal urinary Cd levels were not significantly associated with cognitive function at ages 1, 2, 3, 5, and 8 years or with behavioral composite measures at 2, 3, 4, 5, and 8 years. Conclusions: No significant associations were observed between maternal urinary Cd and cognitive or behavioral measures in children at 1 to 8 years of age in this study.

Identifying Critical Periods of Neurotoxicity to Fluoride Exposure in Canadian Children

Background: Fluoride is associated with IQ deficits during early brain development, but the period in which children are most vulnerable has not been established. We assessed sex-specific effects of fluoride on IQ across prenatal, infancy, and early childhood windows. Methods: Repeated exposures from 596 mother-child pairs in the Maternal-Infant Research on Environmental Chemicals cohort were analyzed using GEE to explore associations between fluoride exposures and IQ after adjustment for covariates and multiple comparisons. Fluoride was measured in urine spot samples collected during pregnancy trimesters and when children were between 1.9 and 4.4 years. Infant fluoride exposure was estimated from water fluoride concentration and duration of formula-feeding over the first year of life. The Wechsler Preschool and Primary Scale of Intelligence-III was administered at 3 to 4 years. Results: Among boys and girls, the association between fluoride and performance IQ (PIQ) significantly differed across exposure windows (p = .01). Among boys, prenatal exposure to fluoride was most strongly associated with adverse deficits on PIQ, B = -8.45 (95% CI: -12.90, -3.99), followed by infancy, B = -2.81 (95% CI: -6.59, 0.98), but not childhood, B = 0.20 (95% CI: -2.58, 2.99), respectively. Among girls, infancy exposure to fluoride was most strongly associated with adverse deficits on PIQ, B= -5.19 (95% CI: -8.84, -1.53), followed by prenatal and childhood exposures, B = -3.50 (95% CI: -9.51, 2.51), B = -2.05 (95% CI: -2.58, 2.99), respectively. Estimates for full-scale IQ were weaker but showed strongest effects for boys in the prenatal exposure period. Effects across all windows were nonsignificant among girls. We found no significant sex-specific associations between fluoride and verbal IQ. Conclusion: Adverse associations between fluoride exposures and cognitive outcomes may depend on timing and biological sex, with the prenatal window potentially critical for boys, while infancy is potentially critical for girls. Keywords: Fluoride, critical windows, water quality, children’s neuropsychology, epidemiology, toxicology.

Prenatal Exposure to organophosphate and pyrethroid pesticides and children’s cognitive development at five years in an Urban Cohort of Pregnant Women

Background/aim: Pyrethroids and Organophosphate pesticides are used to protect crops and reduce the transmission of insect-borne diseases. Previous studies have found an inverse association between exposure to these pesticides and children’s cognitive development. We aimed to investigate the effect of five urinary metabolites of pesticides, including pyrethroids, organophosphates, and 2,4-D herbicide among healthy pregnant women aged 18-43 living in New York City on the cognitive development of the children at five years old.Methods: Urinary biomarkers of exposure from 149 women in the Thyroid disruption and infant development cohort were measured. Values &lt;LOD were assigned the value of LOD/(√2). The metabolites were divided by urinary creatinine to adjust for specific gravity. Linear regression models were used to evaluate the association between the log of the pesticide concentration adjusted for specific gravity and the child IQ measured by the third version of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-3) at five years old. We adjusted for race/ethnicity, maternal education, marital status, and household income during the prenatal period and maternal IQ, maternal education, and household income at age five. Associations were assessed for boys and girls separately. Results: We included 109 children with available WPPSI-3 IQ test measures at age five years in the analysis. We did not find association between prenatal exposure to any of the five pesticides and children's IQ at age five, with and without covariate adjustment in linear models. Conclusions: Our results indicated that the children’s IQ at age five years may not be associated with prenatal exposure to a group of five organophosphate, pyrethroid pesticides, and 2,4-D herbicide.

The Impact of Reducing Air Pollution during Pregnancy on Cognitive Abilities at Four Years of Age: The UGAAR Randomized Controlled Trial of HEPA Air Cleaners

Background Air pollution is a leading contributor to the global burden of disease. Observational evidence indicates that exposure can affect cognitive abilities, but the influence of gestational exposure on cognitive development in childhood is poorly understood. The Ulaanbaatar Gestation and Air Pollution Research (UGAAR) study is a randomized controlled trial of portable (High-Efficiency Particulate Air) HEPA air cleaners use during pregnancy and childhood development. Ulaanbaatar, Mongolia’s capital, is among the most polluted cities due primarily from coal combustion for home heating. We investigated the effect of air cleaners use during pregnancy on cognitive development in 4-year old children. Methods We enrolled 540 non-smoking, apartment-dwelling pregnant women in 2014 and 2015 and randomly assigned them to an intervention (use of 1-2 HEPA air cleaners from enrollment to childbirth) or control (no air cleaners) group. There were 464 live births. We administered the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI) to 390 children (187 control and 203 intervention) at a mean age of 48.2 months. Our primary outcome was full-scale IQ. Results The mean maternal age at birth was 29 (26 - 33) years. We previously reported 29% reduction in particulate matter (PM) concentration. The intervention was associated with a 3.3 point (95% CI: 0.39, 6.25) increase in full-scale IQ. The mean verbal comprehension score was also higher (3.8 points, 95% CI: 0.5 - 7.1 points) among children in the intervention group. Intervention participants had higher mean scores across all 10 of the WPPSI indices, although confidence intervals spanned the null.Conclusion Our findings indicate that reducing PM exposure during pregnancy led to an improvement in children’s neurocognitive performance at four years of age. The use of portable air cleaners during pregnancy may mitigate some of the adverse neurodevelopmental impacts of air pollution.

Variations in practice in cardiac neurodevelopmental follow-up programs.

Over the last two decades, heart centres have developed strategies to meet the neurodevelopmental needs of children with congenital heart disease. Since the publication of guidelines in 2012, cardiac neurodevelopmental follow-up programmes have become more widespread. Local neurodevelopmental programmes, however, have been developed independently in widely varying environments. We sought to characterise variation in structure and personnel in cardiac neurodevelopmental programmes. A 31-item survey was sent to all member institutions of the Cardiac Neurodevelopmental Outcome Collaborative. Multidisciplinary teams at each centre completed the survey. Responses were compiled in a descriptive fashion. Of the 29 invited centres, 23 responded to the survey (79%). Centres reported more anticipated neurodevelopment visits between birth and 5 years of age (median 5, range 2-8) than 5-18 years (median 2, range 0-10) with 53% of centres lacking any standard for routine neurodevelopment evaluations after 5 years of age. Estimated annual neurodevelopment clinic volume ranged from 85 to 428 visits with a median of 16% of visits involving children >5 years of age. Among responding centres, the Bayley Scales of Infant and Toddler Development and Wechsler Preschool and Primary Scale of Intelligence were the most routinely used tests. Neonatal clinical assessment was more common (64%) than routine neonatal brain imaging (23%) during hospitalisation. In response to clinical need and published guidelines, centres have established formal cardiac neurodevelopment follow-up programmes. Centres vary considerably in their approaches to routine screening and objective testing, with many centres currently focussing their resources on evaluating younger patients.

Weight, length, and head circumference at 36 weeks are not predictive of later cognitive impairment in very preterm infants.

To assess diagnostic accuracy of 36-week anthropometric weight, length, and head circumference <10th and <3rd percentiles to predict preterm infant cognitive impairment. Cohort study of 898 preterm <30-week very-low-birth weight (<1500 g) infants. Anthropometric measures' accuracy to predict cognitive impairment (Bayley-III Cognitive Composite score) <80, 21-months corrected age (CA) and Wechsler Preschool and Primary Scale of Intelligence Quotient (intellectual outcomes) <70, 36-months CA, were determined using receiver operating characteristic (ROC) curves. Thirty-six-week weight, length or head circumference <10th or <3rd percentile did not predict cognitive impairment; areas under ROC curves were <0.6. Sensitivities and specificities for 10th and 3rd percentile cut points were all poor, with most not exceeding 70%, whether the Fenton 2013 or INTERGROWTH 2015 growth charts were used. Brain injury and low maternal education were better predictors of cognitive impairment. Preterm infant 36-week anthropometric measurements are not accurate predictors of cognitive impairment.

Location and Size of Preterm Cerebellar Hemorrhage and Childhood Development

To examine the association between cerebellar hemorrhage (CBH) size and location and preschool-age neurodevelopment in very preterm neonates. Preterm magnetic resonance images of 221 very preterm neonates (median gestational age = 27.9 weeks) were manually segmented for CBH quantification and location. Neurodevelopmental assessments at chronological age 4.5 years included motor (Movement Assessment Battery for Children, 2nd Edition [MABC-2]), visuomotor integration (Beery-Buktenica Developmental Test of Visual-Motor Integration, 6th Edition), cognitive (Wechsler Primary and Preschool Scale of Intelligence, 3rd Edition), and behavioral (Child Behavior Checklist) outcomes. Multivariable linear regression models examined the association between CBH size and 4.5-year outcomes accounting for sex, gestational age, and supratentorial injury. Probabilistic maps assessed CBH location and likelihood of a lesion to predict adverse outcome. Thirty-six neonates had CBH: 14 (6%) with only punctate CBH and 22 (10%) with ≥1 larger CBH. CBH occurred mostly in the inferior aspect of the posterior lobes. CBH total volume was independently associated with MABC-2 motor scores at 4.5 years (β = -0.095, 95% confidence interval = -0.184 to -0.005), with a standardized β coefficient (-0.16) that was similar to that of white matter injury volume (standardized β = -0.22). CBH size was similarly associated with visuomotor integration and externalizing behavior but not cognition. Voxelwise odds ratio and lesion-symptom maps demonstrated that CBH extending more deeply into the cerebellum predicted adverse motor, visuomotor, and behavioral outcomes. CBH size and location on preterm magnetic resonance imaging were associated with reduced preschool motor and visuomotor function and more externalizing behavior independent of supratentorial brain injury in a dose-dependent fashion. The volumetric quantification and localization of CBH, even when punctate, may allow opportunity to improve motor and behavioral outcomes by providing targeted intervention. ANN NEUROL 2020;88:1095-1108.