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The effects of early and late preterm birth on brainstem and middle-latency auditory evoked responses in children with normal neurodevelopment.

In preterm and term infants, brainstem and middle latency auditory evoked responses (ABR and MLR) were obtained at 40 and 52 weeks conceptional age (CA) and at 5 years of age. A neurological and neuropsychological evaluation was performed at 5 years of age. To study the effect of preterm birth on the maturation of the ABR and MLR, the preterm infants were divided into early and late preterm groups. Only children with a normal neurodevelopmental outcome at 5 years of age were entered into the study. For ABR, the late preterm group showed significantly longer mean latencies IIc, III, V, and Vc when compared with the term group at 52 weeks CA. There was a trend to longer ABR latencies I in the early preterm group compared with the term group. At 52 weeks CA, the late preterm group showed longer mean interpeak latencies III-I and V-I when compared with the term as well as the early preterm group. At 5 years, the late preterm group showed significantly longer mean ABR latencies IIc and III when compared to the early preterm group. For MLR, the early preterm group showed significantly longer mean latencies of MLR component PO when compared with the term group at 40 weeks CA. At 52 weeks, the late preterm group also had longer mean MLR latencies P0 than the term group. At 5 years of age, the term group showed higher mean peak-to-peak amplitudes Na-P0 than the early as well as the late preterm group. To a large extent, the ABR results support the hypothesis that middle ear effusions in combination with retarded myelination of the central auditory pathway are responsible for the ABR differences found between term and preterm infants with a normal neurodevelopmental outcome at 5 years of age. The longer latencies and interpeak latencies found in late preterm infants when compared with early preterm infants might be explained by an augmented vulnerability of the auditory pathway between 30 and 34 weeks CA. The MLR differences found between term and preterm infants might be explained by a difference in the maturation of primary and nonprimary MLR components.

Auditory Cortex↗

The clinical stigmata of aberrant neurodevelopment in schizophrenia.

The neurodevelopmental hypothesis of schizophrenia is currently a primary etiopathological model for schizophrenia. Its tenets derive from observations of epidemiological, postmortem, and brain imaging evidence of neurodevelopmental deviance. Clinical stigmata of neurodevelopmental arrest include the presence of obstetric complications, minor physical anomalies, abnormal dermatoglyphics, and childhood neuromotor precursors of adult schizophrenic illness. The relative importance of these stigmata and their relationship to brain imaging findings in schizophrenia are discussed.

Adult↗

Timing of perinatal human immunodeficiency virus type 1 infection and rate of neurodevelopment. The Women and Infant Transmission Study Group.

BACKGROUND: Identifying HIV-1-infected children who are at greatest risk for disease-related morbidities is critical for optimal therapeutic as well as preventive care. Several factors have been implicated in HIV-1 disease onset and severity, including maternal and infant host characteristics, viral phenotype and timing of HIV-1 infection. Early HIV-1 culture positivity, i.e. intrauterine infection, has been associated with poor immunologic, virologic and clinical outcomes in children of HIV-infected women. However, a direct effect of timing of infection on neurodevelopmental outcome in infancy has not yet been identified. METHODS: Serial neurodevelopmental assessments were performed with 114 infants vertically infected with HIV-1 in a multicenter natural history, longitudinal study. Median mental and motor scores were compared at three time points. Longitudinal regression analyses were used to evaluate the neurodevelopmental functioning of children with early positive cultures and those with late positive cultures. RESULTS: Early infected infants scored significantly lower than late infected infants by 24 months of age and beyond on both mental (P = 0.05) and motor (P = 0.03) measures. Early HIV-1 infection was associated with a decline in estimated motor scores of 1 standard score point per month compared with 0.28 point in the late infected group (P < 0.02). Estimated mental scores of the early infected group declined 0.72 point/ month, whereas the average decline of the late infected group was 0.30 point/month (P < 0.13). CONCLUSION: Early HIV-1 infection increases a child's risk for poor neurodevelopmental functioning within the first 30 months of life.

Child Development↗

Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis.

The objective of this study was to determine whether children with nonsyndromic craniosynostosis and plagiocephaly without synostosis demonstrated cognitive and psychomotor delays when compared with a standardized population sample. This was the initial assessment of a larger prospective study, which involved 21 subjects with nonsyndromic craniosynostosis (mean age, 10.9 months) and 42 subjects with plagiocephaly without synostosis (mean age, 8.4 months). Each child was assessed using the Bayley Scales of Infant Development-II (BSID-II) for cognitive and psychomotor development before therapeutic intervention (surgery for craniosynostosis and molding-helmet therapy for plagiocephaly without synostosis). The distribution of the scores was divided into four groups: accelerated, normal, mild delay, and significant delay. The distributions of the mental developmental index (MDI) and the psychomotor developmental index (PDI) were then compared with a standardized Bayley's age-matched population, using Fisher's exact chi-square test. Within the craniosynostosis group, the PDI scores were significantly different from the standardized distribution (p < 0.001). With regard to the PDI scores, 0 percent of the subjects in the craniosynostosis group were accelerated, 43 percent were normal, 48 percent had mild delay, and 9 percent had significant delay. In contrast, the MDI scores were not statistically different (p = 0.08). Within the group with plagiocephaly without synostosis, both the PDI and MDI scores were significantly different from the normal curve distribution (p < 0.001). With regard to the PDI scores, 0 percent of the subjects in the group with plagiocephaly without synostosis were accelerated, 67 percent were normal, 20 percent had mild delay, and 13 percent had significant delay. With regard to the MDI scores, 0 percent of the subjects in this group were accelerated, 83 percent were normal, 8 percent had mild delay and 9 percent had significant delay. This study indicates that before any intervention, subjects with single-suture syndromic craniosynostosis and plagiocephaly without synostosis demonstrate delays in cognitive and psychomotor development. Continued postintervention assessments are needed to determine whether these developmental delays can be ameliorated with treatment.

Child Development↗

In utero exposure to organic solvents and human neurodevelopment.

Recent reports of growth and mental retardation in infants whose mothers abused solvent-containing substances, and of an association between central nervous system malformations and solvent exposure, have suggested that in utero exposure to organic solvents may have a profound effect on the development of the human brain. The present investigation compared the neurobehavioral development of 41 children whose mothers worked with organic solvents during pregnancy with a group of matched, unexposed children. The children were compared on a variety of measures, including the McCarthy Scales of General Abilities, growth (weight, height and head circumference) and mother's report of developmental milestones, behavior and personality. Potential confounders were controlled for in multiple regression analyses. Despite adequate power, no differences could be found between the two groups on any of the measures of neurobehavioral development or growth. This study suggests that in utero exposure to relatively low levels of organic solvent is not associated with adverse neurodevelopmental outcome.

Brain↗

Cerebral blood-flow velocity during the first week of life of preterm infants and neurodevelopment at two years.

Disturbances in perinatal cerebral perfusion appear to be associated with unfavourable neurodevelopmental outcome. Using transcutaneous Doppler technique, the authors investigated cerebral blood-flow velocity patterns in the anterior cerebral artery (ACA) of an intensive care-unit population of preterm infants during the first week of life. The results were correlated with neurodevelopmental outcome at two years of age. Children with major disability at two years of age had significantly higher pulsatility index (PI) values, mainly increased peak systolic flow velocity (PSFV), compared with children with normal or more favourable outcome. End diastolic flow velocity and area under the velocity curve values of the ACA did not differ between the groups, indicating that cerebrovascular resistance and cerebral blood-flow were not different. It is thought that the higher PI and PSFV values were caused by increased compliance of the vascular bed supplied by the ACA, possibly induced by congestion and oedema of the periventricular white-matter due to ischaemic lesions, which also cause periventricular leukomalacia.

Blood Flow Velocity↗

Community health nursing assessment of neurodevelopment in high-risk infants.

All infants discharged from designated perinatal center neonatal intensive care units in Illinois are referred for follow-up home visits by community health nurses. These visits provide parental support, teaching, and anticipatory guidance plus physical and developmental assessment of the infant. The maternal and child nursing consultants who coordinate this follow-up program are frequently called upon to assist the community health nurses in physical/developmental assessment techniques. The neurodevelopmental component of the assessment, including areas of alertness, tone, head circumference, vision and hearing screening, plus primitive reflexes, is described.

Attention↗

Transient dystonia in non-handicapped low-birthweight infants and later neurodevelopment.

The aim of the present study was to evaluate the long-term prognostic significance of transient increase in muscle tone during infancy (dystonia) in very low-birthweight (VLBW) infants without cerebral palsy. Motor (Peabody Developmental Motor Scales), cognitive (Wechsler Preschool and Primary scale of Intelligence) and behavioural (Personality Inventory for Children, Yale Children's Inventory) development was assessed at 5 years of age. In a population-based sample of 50 VLBW children, transient dystonia was present in 14. In explorative analyses, transient dystonia was associated with low 1 min Apgar scores, neonatal bacterial infection, and lack of breast-milk in the neonatal period. Cognitive, neuromotor and behavioural development at 5 years of age was comparable in those with and without transient dystonia, although there was a statistically non-significant tendency towards more neuromotor problems in the dystonic children.

Apgar Score↗

Babies, brains and culture: optimizing neurodevelopment on the savanna.

Cross-cultural child development research has demonstrated the influence of infant experience as well as constitutional, neurodevelopmental influences in infant outcomes. African infant precocity found in a number of studies is examined in the light of developmental models and in the context of the enriched child-rearing environment of pre-industrial societies. Examples are drawn from fieldwork in East Africa that demonstrate the different contributions of pregnancy, nutrition, early learning and cultural factors on developmental outcomes. The multiple enhancing infant rearing and nutritional factors are postulated to optimize the rate of neuro-development thereby contributing to psychomotor precocity.

Africa↗

Visual function in term infants with hypoxic-ischaemic insults: correlation with neurodevelopment at 2 years of age.

AIMS: To determine if there is any association between the findings of visual assessment performed at the age of 5 months and neurodevelopmental outcome at the age of 2 years in children who have sustained hypoxic-ischaemic insults. METHODS: Twenty nine term infants with hypoxic-ischaemic encephalopathy and/or brain lesions on neonatal magnetic resonance imaging (MRI) were prospectively evaluated. At 5 months of age all the infants had their visual function assessed using the Atkinson Battery of Child Development for Examining Functional Vision, which includes the assessments of optokinetic nystagmus (OKN), acuity, visual fields, fixation shift and phase and orientation reversal visual evoked potentials. At 2 years of age the children had a structured neurological evaluation and a Griffiths developmental assessment. RESULTS: There was good correlation between the extent of the early detected visual impairment and both neuromotor and global development. Children with more than three out of five abnormal visual tests at 5 months of age tended to have abnormal neurological examination results and abnormal developmental quotients. Children with three or fewer abnormalities tended to have developmental quotients in the normal range; the level of their performance, however, was still related to the number of visual tests passed. CONCLUSIONS: Individual visual tests can provide important prognostic information. While abnormal OKN and acuity were always associated with abnormal outcome, normal results on visual evoked potentials and fixation shift tended to be associated with normal outcome.

Brain↗

Effects of tapering neonatal dexamethasone on rat growth, neurodevelopment, and stress response.

Dexamethasone is commonly used to lessen the morbidity of chronic lung disease in premature infants, but little is known regarding neurological consequences of its prolonged use. To study neurological effects of dexamethasone, we have developed a rat model in which newborn pups are exposed to tapering doses of dexamethasone at a time corresponding neurodevelopmentally to human exposure in the neonatal intensive care unit. On postnatal day (PD) 2, litters were divided into three groups: 1) handled controls, 2) saline-injected animals, and 3) animals injected with tapering doses of intramuscular dexamethasone between PD 3 and 6. Somatic growth and brain weight were decreased in dexamethasone-treated animals. Dexamethasone-treated animals demonstrated delays in gross neurological development on PD 7 and 14 but not PD 20. In late adolescence (PD 33), dexamethasone-treated animals were less active in light and dark environments, while demonstrating a blunted serum corticosterone response to a novel stress. The dissociation between behavioral and hormonal stress responsiveness suggests that neonatal dexamethasone exposure permanently alters central nervous system function, particularly within the neuroendocrine stress axis. This may lead to increased risk for learning impairment and maladaptive responses to the environment.

Animals↗

Neurodevelopment in pediatric HIV infection. The use of CAT/CLAMS. Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale.

Pediatric neuro-AIDS may be the first clinical manifestation of HIV infection in children born to HIV-infected mothers. As part of the neurodevelopmental examination of children, the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was investigated as a tool for pediatricians to use to monitor the development of children at risk for HIV infection. The CAT/CLAMS was found to detect neurodevelopmental differences between HIV-infected and uninfected children at 12 and 18 months of age. Good correlations were found between the CAT/CLAMS and concurrently administered Bayley Scales of Infant Development. These findings suggest that the CAT/CLAMS should be considered as a part of the neurodevelopmental examination of children at risk for pediatric neuro-AIDS.

Acquired Immunodeficiency Syndrome↗

Regional differences in the critical period neurodevelopment in the mouse: implications for neonatal seizures.

The voltage-sensitive calcium channel probe 125I-omega-GVIA conotoxin has been shown to be a developmental marker in whole brain preparations of Swiss Webster mice. The present study looks more carefully at regional dissections of the mouse brain (cerebrum, cerebellum, and brain stem) at postnatal day 8 and postnatal day 16. 125I-omega-GVIA conotoxin binding, thought to be presynaptic, showed a dramatic increase between postnatal days 8 and 16 in the cerebral cortex, a decrease in the cerebellum, and no change in the brain stem. The dramatic cerebral cortex increases indicated by these binding data correspond to a critical period between postnatal day 11 and postnatal day 14 in Swiss Webster mice; during this critical period, dendrites exhibit rapid outgrowth, sensory modalities come on line, electroencephalographic patterns mature, and the cortex reaches adult proportions. This period parallels a similar initiation of electrical maturation in the 28- to 32-week neonatal human brain. We conclude from these data that the unusual clinical presentation of neonatal seizures is not just the result of immature myelin formation. It includes incomplete synapse formation linking the cortex to the brain stem.

Animals↗

Sodium supplementation strategies in preterm infants: effects on growth, electrolyte balance, and exploratory evidence on neurodevelopment - a systematic review and meta-analysis.

This study evaluated the effects of sodium supplementation on growth, electrolyte balance, and neurodevelopmental outcomes in preterm infants. A systematic review and meta-analysis of published studies were conducted using data from PubMed, Embase, Scopus, and Google Scholar, including randomized controlled trials and observational studies involving infants born before 37&#xa0;weeks of gestation. Twelve studies comprising more than 2,800 participants were analysed using random-effects models. Sodium supplementation was associated with improved weight gain and a significant reduction in the risk of hyponatremia (RR&#x2009;=&#x2009;0.28, 95% CI: 0.08-0.96). Pooled incidence estimates indicated hypernatremia (32%) and intraventricular hemorrhage (29%) among supplemented cohorts; however, substantial heterogeneity was observed, and comparative risk estimates were limited. Only one study reported long-term neurodevelopmental follow-up, suggesting potential benefit; however, the available evidence remains limited and hypothesis-generating.These findings suggest that sodium supplementation may support growth and is associated with a lower risk of hyponatremia in preterm infants; however, hypernatremia and other morbidity estimates reported here are largely descriptive frequencies within supplemented cohorts rather than comparative treatment effects, and careful, individualized therapy with close monitoring is needed to minimize potential risks.

Growth outcomes↗