Wechsler Preschool Research Articles

The stability of the Bayley scales in early childhood and its relationship with future intellectual abilities in a low to middle income country

BackgroundThe Bayley Scales of Infant and Toddler Development is widely used worldwide. The objective of the current study was to measure the stability of the Bayley Scales during early childhood and its relationship with intellectual abilities at four years in young Nepalese children. MethodsIn a prospective cohort we used the Bayley 3rd edition to measure early child development in 529 Nepalese children at 6–11, 18–23 and 30–35 months. At four years, we used the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) to measure intellectual abilities. We expressed the stability of the Bayley scores by intraclass correlation coefficients (ICCs) and concordance correlation coefficients (CCCs). The relationship between the Bayley scores and the WPPSI full-scale IQ (FSIQ) at four years was examined in regression models. ResultsThe ICCs between the Bayley scores across timepoints were 0.01 (95 % CI -0.06, 0.04), 0.19 (95 % CI 0.15, 0.26) and 0.22 (95 % CI 0.17, 0.28) for the Cognitive, Language and Motor composite scores. The CCC for the composite scores ranged from 0.05 to 0.20 between 6 and 11 and 30–35 months and from 0.20 to 0.36 between 18 and 23 and 30–35 months. The Bayley scores at 6–11, 18–23 and 30–35 months explained 3 %, 20 % and 36 % of the variation of the FSIQ. ConclusionThe stability of the Bayley scales is poor in early childhood, and its relationship with future intellectual abilities is poor in infancy but improves slightly with age in early childhood. Findings from this large community-based cohort of healthy at-risk children are relevant when measuring early child development worldwide.

Routines as a Protective Factor for Emerging Mental Health and Behavioral Problems in Children with Neurodevelopmental Delays.

Children with neurodevelopmental delays show higher levels of externalizing behavioral problems, resulting in increased parental stress. This study aims to determine if the frequency of family routines moderates children's externalizing problems and associated parental stress based on children's cognitive ability longitudinally. Children with neurodevelopmental delays and caregivers (N = 202) participated in assessments that included the Wechsler Preschool and Primary Scale of Intelligence-Forth Edition, Child Behavior Checklist, Parent Daily Report, and Family Routines Inventory. Child participants were 28 to 72 months old (M = 48.00, SD = 10.652) and predominantly male (69.3%). Frequency of family routines at baseline (b = - .375, SE = .112, p = .001) was associated with lower child externalizing behaviours at baseline (b = - .104, SE = .047, p = .031). Frequency of family routines moderated parental stress for children with average (i.e., at the mean; b = - .211, SE = .119, p = .08) and above average (i.e., 1SD above mean; b = - .436, SE = .177, p = .02) nonverbal skills. Longitudinally, increased frequency of family routines (b = - .193, SE = .092, p = .04) was associated with less child externalizing behaviors. Findings demonstrate that routines may reduce parental stress, but the use of routines alone may be less practical for children with lower verbal skills. Additionally, the importance of routines for minimizing behavioral problems in children was significant for children with average or higher nonverbal skills at baseline, suggesting that nonverbal skills are protective for these children.

Invited Perspective: HEPA Filters-An Effective Way to Prevent Adverse Air Pollution Effects on Neurodevelopment?

Invited Perspective: HEPA Filters-An Effective Way to Prevent Adverse Air Pollution Effects on Neurodevelopment?

Portable HEPA Filter Air Cleaner Use during Pregnancy and Children's Cognitive Performance at Four Years of Age: The UGAAR Randomized Controlled Trial.

Background:Developmental exposure to air pollution is associated with diminished cognitive abilities in observational studies, but no randomized controlled trial has examined the effect of reducing air pollution on cognition in children.Objectives:We sought to quantify the impact of reducing exposure to particulate matter (PM) during pregnancy on children’s cognitive performance at 4 y of age.Methods:In this single-blind, parallel-group, randomized controlled trial in Ulaanbaatar, Mongolia, we randomly assigned 540 nonsmoking pregnant women (268 intervention and 272 control) to receive 1–2 portable high-efficiency particulate air (HEPA) filter air cleaners or no air cleaners. The air cleaners were used from a median of 11 wk gestation until the end of pregnancy. The primary outcome was full-scale intelligence quotient (FSIQ) assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) when children were a median of 48 months old. We imputed missing outcome data using multiple imputation with chained equations, and our primary analysis was by intention to treat.Results:After excluding known miscarriages, stillbirths, neonatal deaths, and medical conditions that impeded cognitive testing and imputation, 475 (233 control and 242 intervention) children were included in our analyses. In an unadjusted analysis, the mean FSIQ of children who were randomly assigned to the intervention group was 2.5 points [95% confidence interval (CI): , 5.4 points] higher than that of children in the control group. After adjustment to account for an imbalance in preterm birth between groups, the effect estimate increased to 2.8 points (95% CI: , 5.7).Conclusions:Reducing PM air pollution during pregnancy may improve cognitive performance in childhood. https://doi.org/10.1289/EHP10302

Aberrant White Matter Organization Correlated With Neurodevelopment Outcomes in Tetralogy of Fallot: An Atlas-Based Diffusion Tensor Imaging Study

BackgroundWhite matter injury (WMI) and impaired neurodevelopment are common in children with congenital heart disease. However, the effect of WMI on neurodevelopmental outcomes is still rarely reported. In this study, we aimed to investigate microstructural changes in white matter (WM) and its relationship with neurodevelopmental outcomes and further explore the underlying neurophysiological mechanisms of neurocognitive impairments in the tetralogy of Fallot (ToF). MethodDiffusion tensor imaging (DTI) data were acquired in preschool-aged children with ToF (n = 29) and normal controls (NC, n = 19), and neurodevelopmental assessments were performed with the Wechsler Preschool and Primary Scale of Intelligence in ToF. The differences in DTI metrics including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were evaluated between ToF and NC. Correlations between WM microstructural changes and neurodevelopmental outcomes were further analyzed. ResultsSignificant WM differences were found in the uncinate fasciculus, cingulum hippocampus, superior longitudinal fasciculus, and corticospinal tract between children with ToF and NC. Impaired WM integrity was correlated with the verbal comprehension index and working memory index in ToF. ConclusionsThis study demonstrated WM microstructure injury, and this injury is related to worse language and working memory performance in preschool-aged children with ToF. These findings suggested that DTI metrics may be a potential biomarker of neurocognitive impairments in ToF and can be used to predict future neurodevelopmental outcomes, which also provide new insights into the underlying neurophysiological mechanisms of neurocognitive impairments in ToF.

Comparison of the Wechsler Preschool and Primary Scale of Intelligence-Third Edition and the Leiter-R Intellectual Assessments for Clinic-Referred Children.

A review of clinical records was conducted for children with developmental, emotional, and behavioral difficulties who were assessed with both the Wechsler preschool and primary scale of intelligence-third edition (WPPSI-IIICDN; Wechsler, 2004) and the Leiter international performance scale-revised (Leiter-R; Roid & Miller, 1997) within the same psychological evaluation. Forty children, ages 3–7, were included in this study. Pearson correlations showed that the IQ scores of the two instruments are strongly related (r > .70; p < .001). However, paired t-tests showed that overall Leiter-R scores (M = 99.03) were significantly higher than WPPSI-IIICDN scores (PIQ; M = 82.28, FSIQ; M = 75.24) (p < .001). The discrepancies between the instrument’s scores were clinically important as the use of only one of the two instruments could result in misclassification of child intellectual ability. These results should prompt professionals working with this clinical population to be cautious when using results from a single instrument in a child’s intellectual evaluation.

0490 Longitudinal associations between sleep and behavior and cognition in preschoolers from five European birth-cohorts

Abstract Introduction There has been little focus on sleep and its relation to behavior and cognition in preschool-aged children. We aimed to investigate the association between sleep duration in early preschoolers (» 3.5 years of age) and later behavioral and cognitive outcomes (» 5 years of age) in European children. Methods We used harmonized data from five cohorts from the EU Child Cohort Network, established by the LifeCycle Project (n=16.444 children): ALSPAC and SWS from UK, EDEN and ELFE from France and INMA from Spain. Within all cohorts, total sleep duration per day and behavioral and cognitive information were reported by parents. Internalizing and externalizing behaviors were measured with the Strengths and Difficulties Questionnaire and treated as percentile scores. Verbal and non-verbal intelligence were assessed by the Wechsler Preschool and Primary Scale of Intelligence or with the McCarthy Scales of Children’s Abilities depending on the cohort and treated as standardized scores. All scores were cohort specific. Associations between sleep duration during early preschool age and later behavior and/or cognition were estimated using linear regression and pooled with two-stage individual participant data meta-analysis adjusted for child, maternal and household information. Analyses were done in DataSHIELD. Results Global mean sleep duration was 11h54 ± 1h00 per day at mean age 3.5 years but differed by country, with children from France showing longer sleep duration than children from the UK or Spain. In multivariate meta-analysis, 1 hour of additional sleep duration per day at mean age 3.5 years was associated with reduced internalizing and externalizing behavior percentile scores at mean age 5.1 years (internalizing behavior: badjusted= -1.05, 95%-CI [-1.93, -0.18], I2: 30.3%; externalizing behavior: badjusted= -2.12, 95%-CI [-2.78, -1.47], I2: 0.0%). No association was observed between sleep duration and subsequent verbal or non-verbal intelligence Conclusion Longer sleep duration in early preschool age (» 3.5 years of age) was associated with subsequent lower internalizing and externalizing behavior scores (» 5 years of age), but not with verbal or non-verbal intelligence. Adequate sleep duration at an early age is important for children’s later mental health. Support (If Any) KG was granted a LifeCycle fellowship.

Gestational and childhood urinary iodine concentrations and children's cognitive function in a longitudinal mother-child cohort in rural Bangladesh.

Severe iodine deficiency adversely affects neurodevelopment; however, evidence regarding the association of non-severe deficiency and child cognitive functioning is inconclusive. This prospective mother-child cohort study was nested in a population-based nutritional supplementation trial in Bangladesh (Maternal and Infant Nutrition Interventions in Matlab [MINIMat]). Participants with data on cognitive abilities at 5 and 10 years of age (n = 1530) and at least one measurement of urinary iodine concentration (UIC) (gestational week 8, 5, and 10 years) were selected. Cognitive abilities were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and Wechsler Intelligence Scale for Children (WISC-IV). UICs were measured with inductively coupled plasma mass spectrometry and thereafter adjusted for specific gravity. Median UICs in our population: (282 μg/L [pregnancy]; 406 μg/L [5 years]; 294 μg/L [10 years]) indicated that iodine intake corresponded to above 'adequate' or even 'excessive', according to the WHO classification. Maternal 'UIC <150 μg/L' was associated with lower full-scale and verbal scores at 5 and 10 years, although the associations were weakened in the fully adjusted models. A tendency of decreased verbal scores was also observed for maternal 'UIC ≥500 μg/L' but not for the corresponding child iodine category (≥300 μg/L). Child 'UIC <100 μg/L' was associated with lower processing speed (B=-3.1, 95% CI [-6.2, -0.1]; P-value = 0.041) compared with the reference group (100 μg/L≤ UIC <300 μg/L). Current findings add to the growing evidence of a causal association of early-life iodine intake with cognitive development, indicating that low iodine intake during childhood isassociated with reduced processing speed andnon-optimal gestational iodine intake is weakly associated with slightly poorer verbal development outcomes.

The positive learning transfer from a musical play early-learning system® to young children’s linguistic and spatial skills

ABSTRACT The benefits of musical play in cognitive development have recently received an upsurge of interest in the field of early childhood music education research. This study examines the positive learning transfer from a musical play early-learning system® to cognitive development. Specifically, we investigated the effects of early musically enriched multicultural play activities on linguistic and spatial skills once the children have reached school age. Four subtests were selected from the Wechsler's Preschool and Primary Intelligence Scale to assess linguistic and spatial skills. A group of twenty children aged between 50 and 82 months who had been exposed daily to a musical play platform over a period of 24 months (4 or 5 days a week, 45min/day) in daycare centres was selected and compared to a matched group of twenty children aged between 48 and 79 months who had not been exposed to this programme. Results showed that the musical play group obtained significantly higher scores than the non- musical play group in linguistic but not in spatial skills, regardless of parental SES. Linear regression analysis revealed that spatial skills predicted linguistic skills in the musical play group. A broader implementation of this musical play early- learning system® in more daycare settings is suggested.

The Role of Cognitive Skills, Sex, and Parental Education for Social-Emotional Skills: A Cross-Sectional Study on the WPPSI-IV Performances of Children Aged 3 to 5 Years.

Background: Current research suggests that knowledge about the relationship between cognition and social–emotional skills in preschoolers is important to better understand child development. The present study investigated possible effects of cognitive skills measured by the Wechsler Primary and Preschool Scale—Fourth Edition (WPPSI-IV), children’s sex, and parental educational level on social–-emotional skills measured by the Developmental Test 6 Months to 6 Years—Revision (ET 6-6 R) for children aged 3 to 5. Methods: Statistical analyses were based on a sample of N = 93 children (47 females, 46 males). First, bivariate correlations among relevant WPPSI-IV index scores, the ET social–emotional quotient, children’s sex, and parental educational level were calculated to identify possible significant associations between the variables under investigation. Subsequently, two multiple regression analyses were conducted to test for the hypothesized main effects of cognitive skills, children’s sex, and parental educational level on social–emotional skills. Finally, a moderated multiple regression analysis was carried out to investigate whether possible effects of cognitive skills on social–emotional skills were moderated by children’s sex and parental educational level. Results: Regression analyses indicated that visual–spatial skills measured by the WPPSI-IV and children’s sex have both a small but significant main effect on social–emotional skills. The main effect of sex was due to the fact that, on average, females achieved higher scores on the measure of social–emotional skills than males. Conclusions: The present findings suggest that the WPPSI-IV represents a suitable test battery for the assessment of those cognitive skills, which might play a reasonable role in social–emotional development

Embryo morphologic quality in relation to the metabolic and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection: a matched cohort study

Embryos with higher morphologic quality grading may have a greater potential to achieve clinical pregnancy that leads to a live birth regardless of the type of cleavage-stage embryos or blastocysts. Few studies have investigated the impacts of embryo grading on the long-term health of the offspring. This pilot study aimed to examine the associations between embryo morphologic quality and the physical, metabolic, and cognitive development of singletons conceived by invitro fertilization and intracytoplasmic sperm injection at preschool age. This matched cohort study included singletons born to infertile couples who underwent fresh cleavage-stage embryo transfer cycles with good- or poor-quality embryos from 2014 to 2016 at the reproductive center of the Women's Hospital, School of Medicine, Zhejiang University. A total of 144 children, aged 4 to 6 years, participated in the follow-up assessment from 2020 to 2021, and the response rate of poor-quality embryo offspring was 39%. Singletons in the good-quality embryo group were matched with singletons in the poor-quality embryo group at a 2:1 ratio according to the fertilization method and the children's age (±1 year). We measured the offspring's height, weight, body mass index, blood pressure, thyroid hormone levels, and metabolic indicators. Neurodevelopmental assessments were performed using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition, and the Adaptive Behavior Assessment System, Second Edition. We also collected data from the medical records. A linear regression model was used to analyze the association between embryo morphologic quality and offspring health outcomes. A total of 48 singletons conceived with poor-quality embryo transfer and 96 matched singletons conceived with good-quality embryo transfer were included in the final analysis. Age, sex, height, weight, body mass index, blood pressure, thyroid function, and metabolic indicators were comparable between the 2 groups. After adjustment for potential risk factors by linear regression model 1 and model 2, poor-quality embryo offspring exhibited a tendency toward higher free thyroxine levels than offspring of good-quality embryo transfers (beta, 0.22; 95% confidence interval, 0.09-0.90; beta, 0.22; 95% confidence interval, 0.09-0.91, respectively), but this difference was not clinically significant. Regarding neurodevelopmental assessments, there was no difference in the full-scale intelligence quotient based on the Wechsler Preschool and Primary Scale of Intelligence (109.96±12.42 vs 109.60±14.46; P=.88) or the general adaptive index based on the Adaptive Behavior Assessment System (108.26±11.70 vs 108.08±13.44; P=.94) between the 2 groups. The subindices of the 2 tests were also comparable. These findings remained after linear regression analysis. At 4 to 6 years of age, singletons born from poor-quality embryo transfers have comparable metabolic and cognitive development as those born from good-quality embryo transfers using fresh cleavage-stage embryos. The results of this pilot study indicate that poor-quality embryos that can survive implantation and end in live birth are likely to have a developmental potential comparable to that of good-quality embryos.

Biomass fuel use for cooking in Nepalese families and child cognitive abilities, results from a community-based study

BackgroundBiomass fuel use for cooking is widespread in low to middle income countries. Studies on the association between biomass fuel use and cognitive abilities in children are limited. ObjectiveTo examine the association between biomass fuel use for cooking and cognitive abilities in Nepalese children at 4 years of age. MethodsIn a cohort design we have information on biomass fuel use in the households of 533 children in infancy and cognitive abilities when they were 4 years old from a community-based sample. Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and the NEPSY-II. We examined the associations between biomass fuel use and scores on the WPPSI-IV Full-Scale IQ (FSIQ) (primary outcome), and WPPSI index and NEPSY-II subtest scores in multiple linear regression models. The associations were also examined in predefined subgroups. ResultsNinety-nine (18.6%) of the families used biomass fuel for cooking. Children in these families had lower mean FSIQ than children in families with no biomass use (83.3 (95%CI 81.7, 85.0) vs. 85.3 (95%CI 84.5, 86.0)), with a mean difference of −2.2 (95%CI -3.9, −0.5) adjusting for demographics and socio-economic status. The association between biomass fuel use and cognitive abilities was strongest in subgroups of children from households with more than three rooms, with separate kitchen and bedroom, and with higher wealth-score. These interactions were significant for number of rooms in the home (p = 0.04), if the household had separate bedroom and kitchen (p = 0.05), and for the wealth-score (p = 0.03). ConclusionBiomass fuel use for cooking in Nepalese families was associated with lower overall cognitive abilities at 4 years. Uncertainties include exposure misclassification and unmeasured confounding. The associations between biomass fuel use and neurodevelopment in children needs further investigation with more precise measurements of the exposure.

Cognitive Profiles of Children with Low Motor Performance: A Contribution to the Validation of the WPPSI-IV

(1) Background: Developmental Coordination Disorder (DCD) is a common developmental disorder of preschool age. Children often show cognitive deficits in addition to motor problems. Various studies point in particular to problems in visual perception, working memory and processing speed. In this context, it is investigated whether the Wechsler Preschool and Primary Scale-IV (WPPSI-IV) is a suitable instrument for mapping these deficits in a valid and economical way. (2) Methods: The WPPSI-IV profiles of children with DCD (n = 12), below-average motor performance (n = 22) and a control group (n = 32) were compared. (3) Results: Children with DCD achieved significantly poorer test performance in the primary indices Verbal Comprehension, Visual Spatial, Processing Speed and Full Scale compared to a control group. Children with below-average motor skills, on the other hand, do not differ from the children in the control group. (4) Conclusions: The WPPSI-IV is a suitable instrument for diagnosing cognitive deficits in the context of DCD. The Fluid Reasoning and Verbal Comprehension indices should be used as a supplement to assess cognitive performance levels.

Cardiovascular Health at Age 5 Years: Distribution, Determinants, and Association With Neurodevelopment.

BackgroundEarly childhood may represent an opportune time to commence primordial prevention of cardiovascular disease (CVD, i.e., prevention of risk factors onset), but epidemiological evidence is scarce. We aimed to examine the distribution and parental and early life determinants of ideal cardiovascular health (CVH) in children up to 5 years and to compare the level of cognitive development between children with and without ideal CVH at age 5 years.MethodsUsing data from the Etude sur les déterminants pré et post natals précoces du Développement psychomoteur et de la santé de l'Enfant (EDEN) study, a French population-based mother–child cohort study, CVH was examined in children at 5 years of age based on the American Heart Association CVH metrics (ideal body mass index, physical activity, diet, blood pressure, cholesterol and glucose levels, and passive smoking, considered in sensitivity analysis only). Children were categorized as having ideal (five to six ideal metrics) or non-ideal CVH (<5 ideal metrics). Intelligence quotient (IQ) at age 5 years was assessed using the French version of the Wechsler Preschool and Primary Scale of Intelligence.ResultsAmong the 566 children (55% boys), only 34% had ideal CVH. In fully adjusted logistic regression, boys compared to girls (OR = 1.77, 95% CI 1.13–2.78), children with intermediate (1.77, 1.05–2.98) or ideal (2.58, 1.38–4.82) behavioral CVH at age 3 years and children who spent < 30 min/day watching television (1.91, 1.09–3.34) at age 3 years were more likely to have ideal CVH at age 5 years. At age 5 years, there was a significant 2.98-point difference (95% CI 0.64–5.32) in IQ between children with and without ideal biological CVH after adjusting for confounders.ConclusionThis study highlights that only a third of children aged 5 years had ideal CVH and identified modifiable determinants of ideal CVH and is suggestive of an association between CVH and neurodevelopment at a young age.

Latent class growth analysis identified different trajectories in cognitive development of extremely low birthweight children

BackgroundRecent longitudinal studies suggest stable cognitive development in preterm children, although with great individual variation. This prospective neurocognitive follow-up study of extremely low birthweight (ELBW, <1000 g) children aimed to...

Neurocognitive development in isolated Robin sequence treated with the Tuebingen palatal plate

ObjectivesWe aimed to determine the neurocognitive development of cleft palate patients with and without Robin sequence (RS).Materials and methodsChildren with isolated RS with cleft palate and children with cleft palate only (CPO) were contacted at the age of 5–6 years. All RS children had undergone initial polygraphic sleep study (PG) with a mixed-obstructive apnea index (MOAI) of ≥ 3/h and were consequently treated with the Tuebingen palatal plate. A standardized clinical examination as well as a neuropediatric and neuropsychological examination included the Wechsler Pre-school and Primary Scale of Intelligence (WPPSI-III), Kaufman Assessment Battery for Children (K-ABC), and an assessment of developmental milestones.ResultsIn total, 44 children (22RS, 22CPO) were included. RS children were younger at study (70.5 ± 7.3 and 75.2 ± 7.5 months; P = .035). Both groups achieved the evaluated milestones within the normed time frame. WPPSI-III and K-ABC results showed no group differences. Mean values for Verbal IQ (101.8 ± 11.1 vs. 97.1 ± 15.7), Performance IQ (102.9 ± 12.1 vs. 99.6 ± 14.5), Processing Speed Quotient (98.9 ± 15.6 vs. 94.5 ± 15.7), Full-Scale IQ (103.2 ± 12.1 vs. 98.4 ± 15.3), and Sequential Processing Scale (102.1 ± 13.1 vs. 94.2 ± 17.3) were within the reference range (IQ 85–115) for RS and CPO children, respectively, indicating average performance of both groups.ConclusionNo neurocognitive, physical, or mental impairments were detected suggesting that RS children having upper airway obstruction (UAO) treated early and effectively may use their potential for an age-appropriate neurocognitive development.Clinical relevanceTuebingen palatal plate treatment successfully releases UAO. Thus, isolated RS does not necessarily result in developmental delay or an impaired neurocognitive outcome.Trial registrationDeutsches Register Klinischer Studien, DRKS00006831, https://www.drks.de/drks_web/

Relation between nighttime sleep duration and executive functioning in a nonclinical sample of preschool children.

Sleep is a support for cognitive development in childhood. Most of the studies in the field have focused on school-age children and sleep problems, but less research focuses on the relation between the normative course of sleep and executive functions in preschoolers. Thus, the aim of the present study was to analyze the association between nighttime sleep duration and executive functioning in a 158 non-clinical sample of Spanish participants (Mage = 56.35 months, SD = 11.24; ages 38-78 months; 48.1% girls). Sleep habits were measured by parents' self-reports; Shape School task was applied to assess inhibition and cognitive flexibility; Word Span task was used to assess working memory; and Vocabulary subtest from the Wechsler Preschool and Primary Scale of Intelligence-III was used to assess verbal ability. The findings revealed that the relationbetween sleep and executive functioning was only significant in the cases of inhibition and working memory. Further, age and verbal ability were related and were predictors of inhibition, working memory, and cognitive flexibility. We consider it necessary to continue researchingin this area given the importance of forming a correct sleep habit during the preschool age and its impact on health, cognition, and well-being in childhood. In short, our results represent the first approach to the subject under study, which should be completed with objective sleep measures.

Fentanyl Exposure in Preterm Infants: Five-Year Neurodevelopmental and Socioemotional Assessment.

ObjectiveTo evaluate the association between cumulative fentanyl dose during neonatal intensive care and 5-year neurodevelopmental and socioemotional outcomes in very preterm infants.Materials and MethodsPatient demographics and clinical factors during the perinatal and neonatal course were collected in 84 patients born between 23- and 30-weeks gestational age (GA). Cumulative fentanyl dose during neonatal intensive care was calculated. Developmental testing at age 5 years included the Wechsler Preschool and Primary Scale of Intelligence Full-Scale Intelligence Quotient, Third Edition, Clinical Evaluation of Language Fundamentals-Preschool, Second Edition, Movement Assessment Battery for Children, Second Edition (MABC-2), and Shape School Assessment. Socioemotional outcomes were assessed via caregiver's responses on the Child Behavior Checklist/1.5-5 (CBCL/1.5-5.5) and Social Responsiveness Scale, Second Edition (SRS-2). Covariates were identified on bivariate analysis (p < 0.1). Linear regression models related outcome measures to the log of cumulative fentanyl dose adjusted for covariates.ResultsHigher cumulative fentanyl dose was associated with lower composite motor scores on bivariate analysis (p < 0.01). Cumulative fentanyl dose did not correlate with composite intelligence quotient, language, or executive function. The Clinical Risk Index for Babies score, log of mechanical ventilation, inotrope, and anesthesia duration, and log of cumulative midazolam and hydrocortisone dose were also associated with MABC-2 scores (p < 0.1). Cumulative fentanyl dose was not associated with composite MABC-2 scores on multiple linear regression. Higher cumulative fentanyl dose was associated with decreased socioemotional problems based on caregiver's response on CBCL/1.5-5.5 t-scores driven by fewer symptoms of depression. The McMaster Family Assessment Device general functioning scale score, maternal age, GA, log of total parenteral nutrition days, patent ductus arteriosus requiring treatment, and log of inotrope hours were also associated with CBCL/1.5-5.5 t-scores (p < 0.1). Cumulative fentanyl dose (p = 0.039) and family dysfunction score (p = 0.002) remained significant after controlling for covariates on multiple linear regression.ConclusionCumulative fentanyl dose during neonatal intensive care did not correlate with 5-year motor, cognitive, or language outcomes after controlling for other variables. Fentanyl dose was associated with caregiver reported total socioemotional problems on the CBCL/1.5-5.5 on multivariate modeling. Additional long-term studies are needed to fully elucidate the safety of fentanyl in very preterm neonates.

Altered brain structure in preschool-aged children with tetralogy of Fallot.

Neurodevelopmental abnormalities are prevalent in children with tetralogy of Fallot. Our aim was to investigate the structural brain alterations of preschool-aged children with tetralogy of Fallot and its correlation with neurodevelopmental outcome. T1-weighted structural images were obtained from 25 children with tetralogy of Fallot who had undergone cardiopulmonary bypass surgery and from 24 normal controls. Cortical morphological indices including gray matter volume, cortical thickness, sulcal depth, gyrification, and cortical surface complexity were compared between the two groups. Neurodevelopmental assessments of the children with tetralogy of Fallot were performed with the Wechsler Preschool and Primary Scale of Intelligence. Cortical morphological differences between groups were distributed throughout the right caudal middle frontal gyrus, right fusiform gyrus, right lateral occipital gyrus, right precuneus, and left inferior parietal lobule. Among children with tetralogy of Fallot, altered cortical structures were correlated with the visual spatial index, working memory index, and perioperative variables. Our results suggested that abnormal cortical structure in preschool-aged children with tetralogy of Fallot may be the persistent consequence of delayed cortical development in fetuses and cortical morphology can be used as an early potential biomarker to capture regional brain abnormalities that are relevant to neurodevelopmental outcomes. Altered cortical structures in preschool-aged children with ToF were correlated with both neurodevelopmental outcomes and clinical risk factors. Cortical morphology can be used as an effective tool to evaluate neuroanatomical changes and detect underlying neural mechanisms in ToF patients. Abnormal cortical structure may be the continuous consequence of delayed fetal brain development in children with ToF.

Perinatal, neonatal, developmental and demographic predictors of intelligence at 4\xa0years of age among low birth weight children: a panel study with a 2-year follow-up

IntoductionChildhood intelligence is an important predictor of later outcomes in life such as socioeconomic status or health. Hence, a deeper understanding of predictors of child intelligence should suggest points of intervention for children facing adversities.ObjectivesThe purpose of this study is to examine the predictive value of demographic, perinatal and neonatal variables after birth and developmental characteristics at age 2 for 4-year intelligence as outcome among low birth weight children.MethodsWe designed a panel study with a 2-year follow-up with 114 child-mother pairs. The outcome variable was IQ intelligence quotient at 4 years of age of LBW low birth weight children measured by the Wechsler Primary and Preschool Scales of Intelligence. Potential predictors were maternal education, family wealth, ethnic identity; sex, twin pregnancy, gestational age, birth weight, Apgar scores, maternal smoking during pregnancy; diagnosis of intravetricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia after birth and cognitive, language and motor development at age 2 measured by one composite score of the three Bayley Scales of Infant and Toddler Development aggregated.ResultsStepwise backward regression was carried out including significant variables from the bivariate analysis. The best model included 4 predictors which accounted for 57% of the variance of the full IQ intelligence at 4-years of age. Maternal higher education was significant positive, below average family wealth and neonatal diagnosis of bronchopulmonary dysplasia were significant negative predictors in the model after birth. 2-year developmental characteristics such as cognitive, motor and language skills were positive predictors of the IQ intelligence at age 4.ConclusionSociodemographic assessment at birth and developmental assessment at two years of age are of crucial importance to recognize children at high risk for delayed cognitive development. High-risk children should be directed to supportive interventions and their development should be regulary monitored.