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Methodological issues in modeling the relationship between low-level lead exposure and infant development: examples from the Boston Lead Study.

This paper addresses several methodological issues relevant to an assessment of the association between low-level lead exposure and early development. In particular, we discuss methods for choosing, from a large pool of candidates, the covariates to control when estimating this association. We examine the issue of confounding and explain why adjusting increased, rather than decreased, the estimate of the association between blood lead level and development at 6 months of age in our sample. A step-by-step description of our strategy for model building is presented. Finally, we demonstrate the robustness of the findings by showing that the magnitude and standard error of the estimated lead effect is not affected appreciably by the method of selecting covariates to be controlled for or by the characterization of lead as a continuous, ordinal, or dichotomous variable. Although these issues arose in the course of analyses of data collected by the Boston lead study (D. Bellinger, H. Needleman, A. Leviton, C. Waternaux, M. Rabinowitz, and M. Nichols (1984), Neurobehav. Tox. Teratol., 6, 387-402), they apply to other current prospective lead studies as well.

Analysis of Variance

Vitamin A and E status in very low birth weight infants: development of an improved parenteral delivery system.

Plasma vitamin A and E levels were inadequate in very low birth weight infants receiving a continuous infusion of a parenteral multivitamin preparation, 1.5 ml/kg per day, in dextrose-amino acid solution. A new delivery system using 2 ml/kg per day, infused for 6 hours from the first day of life, avoided loss during infusion and significantly improved plasma vitamin A and E levels during the first 28 days of life in very low birth weight infants.

Avitaminosis

Effects of maternal nutrition on fetal growth and infant development.

The results of a food supplementation study conducted in four chronically malnourished rural villages in Guatemala were analyzed to determine possible effects on the study children's early mental and physical development. One of two food supplements, atole and fresco, were given to pregnant and lactating mothers and the infants born to them up to three years of age. The level of supplement received was noted and the subsequent course of the children's development observed. Food supplementation of pregnant mothers was found to correlate with higher weights of their babies at birth. No other major maternal variables--home diet, body height and/or weight, morbidity, obstetric characteristics, or socioeconomic status--could account for this association. At 36 months of age the children who had received a large amount of food supplementation showed a far lower prevalence of growth retardation than did those who received smaller quantities. Again, this correlation could not be attributed to any other major maternal variables. In regard to mental development, food supplementation was found to correlate with better performance in psychological tests beginning at six months of age. At 36 months the correlations were significant in five different tests. The results of this analysis have wide-ranging implications for public health. Given the recognized association between low birthweight and infant mortality, they point especially to the importance of maternal nutrition during pregnancy in programs aimed at reducing this serious problem.

Child, Preschool

Toxicity to bilirubin in neonates: infant development during first year in relation to maximum neonatal serum bilirubin concentration.

Neurologic and developmental performance during the first year of life was correlated with maximum neonatal serum bilirubin levels for 27,000 infants in the Collaborative Perinatal Project. The infants were grouped by race and by five birth weight/gestational age categories to control for the effect of these factors on hyperbilirubinemia and developmental outcome. Low mean eight-month motor scores and delayed one-year motor development were associated with serum bilirubin levels in the range of 10 to 14 mg/dl and above. This relationship was strongest for low-birth-weight/short-gestational-period infants. A persistent association of developmental outcome with hyperbilirubinemia was found over and above the variation of maturity within the birth weight/gestational age categories.

Bilirubin

Relationships between prenatal medical and nutritional measures, pregnancy outcome, and early infant development in an urban poverty setting. I. The role of nutritional intake.

Repeated nutritional assessments were made on 118 low-income women who registered at an urban hospital clinic prior to the twenty-eighth week of pregnancy and then on 122 comparable women who were provided with protein-mineral supplementation. Demographic and background information were obtained. Medical assessments were carried out throughout pregnancy, labor, delivery, and the postpartum period. The infants were assessed both medically and with Brazelton Neonatal Behavioral Assessment Scales. In spite of their low-income status, the subjects did not appear nutritionally deprived. Few significant relationships were obtained between maternal nutritional intake and measures of maternal or infant medical status or infant psychological status. A limited number of consistent relationships were obtained when the supplemented and nonsupplemented groups were compared. Although consistent infant medical and psychological benefits were not noted, mothers in the supplemented group developed fewer parameters of pre-eclampsia and had fewer complications during labor and delivery.

Adolescent

Maternal expectations of their infants' development: some cultural differences.

A total of 124 mothers from three cultural groups living in the same British city were asked to give the ages at which they expected their one-month-old infants to achieve three motor milestones. Jamaican mothers expected their infants to sit and walk much earlier than their English and Indian counterparts. The Indian mothers gave later estimates for crawling than those of the other two groups. The actual ages at which the abilities were attained closely reflected the cultural differences in expectations between the Jamaican and English mothers. Jamaican mothers were particularly accurate in predicting sitting age. These results are discussed in relation to cultural theories of child development, together with their implications for child health in multicultural societies.

Child Development