Developmental Outcomes (developmental + outcome)

Distribution by Scientific Domains

Kinds of Developmental Outcomes

  • poor developmental outcome

  • Selected Abstracts

    360 Degree Feedback and Developmental Outcomes: The Role of Feedback Characteristics, Self-Efficacy and Importance of Feedback Dimensions to Focal Managers' Current Role

    Caroline Bailey
    This longitudinal study investigates whether developmental changes following 360 degree feedback are predicted by the favourability of ratings received, and moderated by focal individuals' self-efficacy and perceived importance of feedback. Five developmental criteria are investigated longitudinally: (i) self-assessments, (ii) line managers' ratings, (iii) amount of developmental activity, (iv) global self-efficacy and (iv) self-efficacy for development. Feedback ratings from certain rater groups predicted changes in ratings, but not changes in self-efficacy or amount of developmental activity. Self-efficacy significantly moderated the feedback,performance association for certain rater groups, but feedback importance did not. Contrary to expectations, the focal individual's initial self-assessment predicted changes in self-efficacy, over the favourability of ratings received. The implications of these findings for organizations using 360 degree feedback for developmental purposes are discussed. [source]

    A Framework for Understanding the Association Between Food Insecurity and Children's Developmental Outcomes

    Godwin S. Ashiabi
    ABSTRACT,Food insecurity, defined as limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways, is still a problem in the United States. It is associated with poor parenting practices, poor health, and socioemotional and cognitive/academic difficulties in children. This review synthesizes some of these findings and suggest links among these outcomes. In this endeavor, it describes the concept of food insecurity and propose a mediational framework to anchor our discussions. Finally, it examines the implications of the review for research and policy. [source]

    Developmental outcome and types of chronic-stage EEG abnormalities in preterm infants

    Akihisa Okumura MD
    The aims of this study were to determine the types of chronic-stage EEG abnormalities that exist and to clarify their relation to neurodevelopmental outcome in preterm infants. We evaluated 183 preterm infants with gestational ages of less than 33 weeks (mean age 29.2 weeks) and weighing less than 2000g (mean weight 1275g). The first EEG was performed within 72 hours of life; thereafter, EEG was performed once every 1 to 4 weeks until the infant reached a post-conceptional age of 40 to 42 weeks. Two kinds of EEG abnormalities, acute- and chronic-stage abnormalities, were evaluated and we assessed mainly the latter. Chronic-stage EEG abnormalities were divided into two patterns: disorganized and dysmature. Periventricular leukomalacia (PVL) and intraventricular haemorrhage (IVH) were diagnosed on the basis of ultrasound findings. Psychomotor development was examined every 3 months after discharge until at least 18 months of the infants'corrected age. Disorganized and dysmature patterns were observed in 52 and 28 infants respectively. Among the 52 infants with disorganized patterns, PVL was observed in 31 and IVH in seven infants. Thirty-nine infants had cerebral palsy (CP). Twenty-six achieved normal cognitive development. Of the 28 infants with dysmature patterns, PVL was seen in one and IVH in 11 infants. CP was seen in five infants. Only eight infants achieved normal cognitive development. Gestational age and birth weight were significantly lower in infants with dysmature patterns than in those with disorganized ones. Results indicate that types of chronic-stage EEG abnormalities are related to types of neurological sequelae and are useful for assessing the mode of brain injury in preterm infants. [source]

    Development and growth in very preterm infants in relation to NIDCAP in a Dutch NICU: two years of follow-up

    ACTA PAEDIATRICA, Issue 2 2009
    JM Wielenga
    Abstract Aim: To study development and growth in relation to newborn individualized developmental and assessment program (NIDCAP®) for infants born with a gestational age of less than 30 weeks. Methods: Developmental outcome of surviving infants, 25 in the NIDCAP group and 24 in the conventional care group, in a prospective phase-lag cohort study performed in a Dutch level III neonatal intensive care unit (NICU) was compared. Main outcome measure was the Bayley scales of infant development-II (BSID-II) at 24 months corrected age. Secondary outcomes were neurobehavioral and developmental outcome and growth at term, 6, 12 and 24 months. Results: Accounting for group differences and known outcome predictors no significant differences were seen between both care groups in BSID-II at 24 months. At term age NIDCAP infants scored statistically significant lower on neurobehavioral competence; motor system (median [IQR] 4.8 [2.9,5.0] vs. 5.2 [4.3,5.7], p = 0.021) and autonomic stability (median [IQR] 5.7 [4.8,6.7] vs. 7.0 [6.0,7.7], p = 0.001). No differences were seen in other developmental outcomes. After adjustment for background differences, growth parameters were comparable between groups during the first 24 months of life. Conclusion: At present, the strength of conclusions to be drawn about the effect of NIDCAP on developmental outcome or growth at 24 months of age is restricted. Further studies employing standardized assessment approaches including choice of measurement instruments and time points are needed. [source]

    Developmental outcomes of infants with bronchopulmonary dysplasia: Comparison with other medically fragile infants

    Diane Holditch-Davis
    Abstract The purpose of this study was to compare the developmental outcomes and mother,infant interactions of infants with bronchopulmonary dysplasia (BPD) and those of other medically fragile infants. One-hour behavioral observations were made of the interactions of mothers with two groups of infants (23 with BPD, 39 medically fragile without BPD or neurological problems) at enrollment, every 2 months during hospitalization, 1 month after discharge, and at 6 months' and 12 months' corrected age. Assessment of the home environment also was done at 6 and 12 months. Multiple regressions were calculated separately for child mental, adaptive, language, and motor outcomes. Predictors were: home environment assessment, measures of maternal interactive behaviors (positive attention, expression of negative affect, medicalized caregiving), infant group membership, and presence of intraventricular hemorrhage (IVH) in the infant. There were no significant differences between the two groups in any of the developmental outcomes or interactive variables, and the presence of IVH had no effect on these variables. Maternal positive attention and the home environment were correlated with mental development, and mother negative affect was related to adaptive behavior for both groups. Differences in developmental and interactive behaviors between infants with BPD and other prematurely born infants found in other studies appear to be a result of chronic health problems and, thus, are not unique to infants with BPD. © 2001 John Wiley & Sons, Inc. Res Nurs Health 24: 181,193, 2001 [source]

    Developmental outcomes in early compared with delayed surgery for glue ear up to age 7 years: a randomised controlled trial

    A.J. Hall
    Objectives:, To investigate whether early versus delayed surgery for children severely affected by otitis media with effusion (OME) results in improved performance on developmental tests up to age 7 years. Design:, Follow-up of a randomised controlled trial. Setting:, University of Bristol. Participants:, One hundred and eighty-two children (mean age 35 months) with persistent OME, hearing loss and speech, language or behaviour problems who were originally eligible and randomised to either early surgery or delayed surgery after a period of watchful waiting were followed-up as part of the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 4½ and 7,8 years. Main outcome measures:, Measures included behaviour, language, educational attainment tests, hearing, reading, cognition and coordination. Results:, Of the original randomised trial, 88 of 92 of the early surgery and 74 of 90 of the watchful waiting group were still participating in ALSPAC. Analysis was by intention to treat. At age 4 ½ years there were significant differences in teacher assessment of language (adj OR 3.45, 95% CI: 1.42,8.39) and writing (adj OR 3.74, 95% CI: 1.51,9.27), in favour of early surgery. At age 7,8 years, there was a significant difference on teacher report of emotional problems (adj OR 4.11, 95% CI: 1.15,14.64) in favour of early surgery. There were no other significant differences. Conclusions:, Early surgery for the child severely affected by OME may be associated with subtle benefits at age 4½ years. This may continue to 7,8 years but the small study size makes it difficult to distinguish these effects from chance. A larger study is recommended. [source]

    How does early developmental assessment predict academic and attentional,behavioural skills at group and individual levels?

    The main aim of the study was to explore the ability of a brief developmental assessment to predict teacher-rated learning and attentional and behavioural skills in the first grade of school at both the group and individual levels. A sample of 394 children (181 males, 213 females) aged 4 years were followed to the age of 6 years, and 283 of the children (145 males, 138 females; mean age 7y 11 mo) were followed further to the first grade (age 7y) at school. The children were administered a brief but comprehensive developmental assessment (Lene , a neurodevelopmental screening method) at their local child health-care centres at ages 4 and 6 years. In the first grade, teachers completed a detailed questionnaire (JLD Teacher Questionnaire) on the children's (mean age 7y 11mo, SD 3.1mo, range 7y 3mo,8y 4mo) performance and behaviour. Structural equation modelling showed that no single developmental area predicted development during the follow-up. Instead, a comprehensive developmental outcome at age 4 years significantly predicted skills in the first grade at the group level. Developmental status at age 4 and 6 years together explained 66% of the variance of academic skills and 40% of the variance of attentional and behavioural skills in the first grade. Age-specific logistic regression analyses were constructed to produce the risk indices. At the individual level it was possible to reach acceptable levels of sensitivity and specificity for academic skills at age 4 and age 6 years. Identification of attentional and behavioural problems at the individual level was possible at age 6 years, but the number of false positives was high. [source]

    Bronchopulmonary dysplasia predicts adverse developmental and clinical outcomes in very-low-birthweight infants

    Suh-Fang Jeng PT ScD
    This study examined the developmental and clinical outcomes in very-low-birthweight (VLBW; ,1500g) infants with and without bronchopulmonary dysplasia (BPD) throughout infancy, and assessed if BPD predicted poor developmental outcome beyond the effects of other risk factors. One hundred and three VLBW infants (53 males, 50 females; mean gestational age 28wks [SD 2] birthweight 1041g [SD 261]) were graded for severity of BPD according to the American National Institutes of Health (NIH) consensus definition. Neuro-development was assessed using the Neonatal Neurobehavioral Examination-Chinese version, at 36 and 39 weeks' postmenstrual age, and the 2nd edition of the Bayley Scales of Infant Development at 6 and 12 months' corrected age. Clinical outcome was measured by means of rehospitalization for pulmonary causes and treatment with pulmonary medications. Compared with infants without BPD, infants with BPD had higher rates of clinical morbidity, and those with severe BPD further exhibited higher incidences of developmental delay throughout infancy. BPD predicts poor 1-year developmental and clinical outcomes in VLBW infants for which effects are well correlated to the NIH consensus definition. [source]

    Corrected head circumference centiles as a possible predictor of developmental performance in high-risk neonatal intensive care unit survivors

    François V Bolduc MD FRCPC
    The aim of this study was to evaluate the predictive value of corrected head circumference (HC) centiles at 2 years of age with respect to developmental performance in a series of high-risk neonatal intensive care unit (NICU) survivors with microcephaly. The study used a retrospective review of the clinical files of children seen in a clinic devoted to the follow-up of all high-risk survivors of a hospital's level III NICU. All children with microcephaly (occipital-frontal circumference below the 2nd centile for sex) at 2 years of age were identified. The HC obtained at 2 years was corrected to the ages for which the absolute HC corresponded to either the 50th or 2nd centile for the child's sex. Of 312 high-risk patients followed, 38 (12.2%) were microcephalic. Fifteen performed below the 50th age-corrected HC centile (severe developmental delay), 12 performed between the 50th and 2nd age-corrected HC centile (moderate developmental delay), and 11 performed above the 2nd age-corrected HC centile (mild developmental delay). The absolute value of HC measurement was not a predictor of developmental performance. Of all clinical factors evaluated, only coexisting epilepsy was found to be a significant predictor of less than the 50th age-corrected HC centile developmental performance (Chi2=6.134, p=0.01). We conclude that in a high-risk population, the presence of microcephaly implies developmental impairment, though neither the absolute HC measurement nor the corrected HC centile is predictive. Coexisting epilepsy in this context appears to worsen developmental outcome. [source]

    Elevated corticosterone levels in stomach milk, serum, and brain of male and female offspring after maternal corticosterone treatment in the rat

    Susanne Brummelte
    Abstract Early influences such as maternal stress affect the developmental outcome of the offspring. We created an animal model of postpartum depression/stress based on giving high levels of corticosterone (CORT) to the rat dam, which resulted in behavioral and neural changes in the offspring. This study investigated whether highly elevated levels of maternal CORT during pregnancy or the postpartum result in higher levels of CORT in the stomach milk, serum, and brain of offspring. Dams received daily injections of CORT (40 mg/kg) or oil (control) either during pregnancy (gestational days 10,20) or the postpartum (Days 2,21). Pups that were exposed to high gestational maternal CORT had higher CORT levels in serum, but not in stomach milk or brain, on postnatal day (PND) 1. However, on PND7, pups that were exposed to high postpartum maternal CORT had higher CORT levels in stomach milk and brain, but not in serum. Conversely on PND18, pups that were exposed to high postpartum maternal CORT had higher CORT levels in serum, but not in brain (prefrontal cortex, hypothalamus, or hippocampus). Moreover, 24 h after weaning, there were no significant differences in serum CORT levels between the groups. Thus, CORT given to the dam during pregnancy or the postpartum results in elevated levels of CORT in the offspring, but in an age- and tissue-dependent manner. Developmental exposure to high CORT could reprogram the HPA axis and contribute to the behavioral and neural changes seen in adult offspring. © 2010 Wiley Periodicals, Inc. Develop Neurobiol 70: 714,725, 2010 [source]

    Migrating Partial Seizures in Infancy: Expanding the Phenotype of a Rare Seizure Syndrome

    EPILEPSIA, Issue 4 2005
    Eric Marsh
    Summary:,Purpose: The constellation of early-onset, unprovoked, alternating electroclinical seizures and neurodevelopmental devastation was first described by Coppola et al. We report six new patients and the prospect of a more optimistic developmental outcome. Methods: Retrospective chart reviews were performed on six infants evaluated at the Children's Hospital of Philadelphia (five patients) and at Hershey Medical Center (one patient) who had electroclinically alternating seizures before age 6 months of age. Electroclinical characteristics and long-term follow-up were recorded. Results: All had unprovoked, early-onset (range, 1 day to 3 months; mean, 25 days) intractable electroclinical seizures that alternated between the two hemispheres. Each patient underwent comprehensive brain imaging and neurometabolic workups, which were unrevealing. In all patients, subsequently intractable partial seizures developed and often a progressive decline of head circumference percentile occurred with age. Three demonstrated severe developmental delay and hypotonia. All survived, and 7-year follow-up on one patient was quite favorable. Conclusions: Our patients satisfied the seven major diagnostic criteria first described by Coppola et al. The prognosis of this rare neonatal-onset epilepsy syndrome from the original description and subsequent case reports was very poor, with 28% mortality, and the majority of survivors were profoundly retarded and nonambulatory. Our patient data validate the diagnostic criteria of this syndrome and further quantify a previously described observation of progressive decline of head circumference percentiles with age. Our data also suggest that the prognosis of this syndrome, although poor, is not as uniformly grim as the cases reported previously in the literature. [source]

    Clinical and Electrographic Features of Epileptic Spasms Persisting Beyond the Second Year of Life

    EPILEPSIA, Issue 6 2002
    Márcio A. Sotero De Menezes
    Summary: ,Purpose: Few reports detailing the electroclinical features of epileptic spasms persisting beyond infancy have been published. We sought to characterize this unique population further. Methods: We retrospectively reviewed the clinical and video-EEG data on 26 patients (4,17 years; mean, 93 months) with a confirmed diagnosis of epileptic spasms and who were evaluated at our tertiary referral center between 1993 and 2000. Results: In half of our cases, epileptic spasms were associated with disorders of neuronal migration, severe perinatal asphyxia, and genetic anomalies. Interictal EEGs showed generalized slowing in the majority of patients, and a slow-wave transient followed by an attenuation of the background amplitude was the most common ictal EEG pattern associated with an epileptic spasm (19 cases). Other seizure types (number of cases in parentheses) included tonic seizures with or without a preceding spasm (13), partial seizures (11), myoclonic seizures (11), generalized tonic,clonic seizures (six), atypical absence seizures (two), and atonic seizures (one). Cases with a more organized EEG background (especially with frequencies ,7 Hz) were more likely to have better cognition. Continued disorganization of the EEG background and persistence of hypsarrhythmia were associated with poor developmental outcome. Conclusions: Patients with epileptic spasms persisting beyond age 2 years constitute a truly refractory population, one that should be better recognized by clinicians. Interestingly, although many therapies resulted in a >50% reduction in seizures, neither neurocognitive function nor quality of life was substantially improved with intervention. The interictal EEG background is the most helpful in predicting neurologic outcome. [source]

    Early Recognition of Benign Partial Epilepsy in Infancy

    EPILEPSIA, Issue 6 2000
    Akihisa Okumura
    Summary: Purpose: The aim of this study is to determine how precisely we can recognize the outcome in infants with epilepsy beginning in the first year of life. Methods: We performed a prospective 5-year follow-up study on 63 patients who developed epilepsy in the first year of life. We first judged that patients met the criteria of "possible benign partial epilepsy in infancy (BPEI)" on enrollment in this study. At 2 years of age, we reevaluated the seizure and developmental outcome in the patients who were diagnosed as having "possible BPEI." We finally judged that patients met the criteria of "definite BPEI" at age 5 years. "Possible BPEI" was defined as epilepsy meeting all the following conditions: (a) complex partial seizures and/or secondarily generalized seizures; (b) normal psychomotor development and neurologic findings before onset; (c) normal interictal electroencephalograms; (d) normal cranial computed tomography (CT) and magnetic resonance imaging (MRI) findings; and (e) no seizures during the first 4 weeks of life. "Definite BPEI" was defined as epilepsy meeting all the following criteria in addition to those of "possible BPEI": (a) normal psychomotor development beyond age 5 years, and (b) no seizures beyond age 2 years. Results: Thirty-two of the 63 patients met the inclusion criteria completely and were included in the "possible BPEI" group. Twenty-five of the 32 patients completed the 5-year follow-up. At age 2 years, four patients were excluded from the "possible BPEI" group because of seizure recurrence and/or delayed development. By age 5 years, one had a recurrence of seizures, and another exhibited mildly delayed psychomotor development. We finally diagnosed 19 patients as having "definite BPEI.""Definite BPEI" accounted for 76% of the patients diagnosed as having "possible BPEI" at the first presentation and 90% of those who met the conditions on reevaluation at age 2 years. Conclusions: Recognition of BPEI is possible, to some extent, at the first presentation, and reevaluation at age 2 years is useful for a more precise diagnosis. [source]

    Early life modulators and predictors of adult synaptic plasticity

    Katherine G. Akers
    Abstract Early life experience can induce long-lasting changes in brain and behaviour that are opposite in direction, such as enhancement or impairment in regulation of stress response, structural and functional integrity of the hippocampus, and learning and memory. To explore how multiple early life events jointly determine developmental outcome, we investigated the combined effects of neonatal trauma (anoxia on postnatal day 1, P1) and neonatal novelty exposure (P2,21) on adult social recognition memory (3 months of age) and synaptic plasticity in the CA1 of the rat hippocampus (4.5,8 months of age). While neonatal anoxia selectively reduced post-tetanic potentiation (PTP), neonatal novel exposure selectively increased long-term potentiation (LTP). No interaction between anoxia and novelty exposure was found on either PTP or LTP. These findings suggest that the two contrasting neonatal events have selective and distinct effects on two different forms of synaptic plasticity. At the level of behaviour, the effect of novelty exposure on LTP was associated with increased social memory, and the effect of anoxia on PTP was not accompanied by changes in social memory. Such a finding suggests a bias toward the involvement of LTP over PTP in social memory. Finally, we report a surprising finding that an early behavioural measure of emotional response to a novel environment obtained at 25 days of age can predict adult LTP measured several months later. Therefore, individual differences in emotional responses present during the juvenile stage may contribute to adult individual differences in cellular mechanisms that underlie learning and memory. [source]

    Precursors of cardiorespiratory events in infants detected by home memory monitor,

    Carl E. Hunt MD
    Abstract In 1,079 infants monitored for >700,000 hr at home for apnea or bradycardia, we found an association between infants having multiple events exceeding conventional or a priori defined more extreme thresholds and less favorable developmental outcome at 1 year of age than infants with few or no events. If it is necessary to prevent such events to minimize risk for developmental morbidity, there is reason to determine whether there are disturbances in advance of the apnea or bradycardia that herald their onset. In the 85 infants with at least 1 extreme event and 1 conventional event, we hypothesized that apnea and bradycardia do not occur de novo but rather are preceded by cardiorespiratory and hemoglobin O2 saturation changes. We compared recorded time intervals preceding these events, and we analyzed three preceding time intervals for each conventional and extreme event, and each non-event recording: Time-2 hr: up to 2 hr before; Time-1 hr: up to 1 hr before; and Time-75 sec: the 75 sec immediately preceding each event. O2 saturation progressively decreased preceding both conventional and extreme events, and progressive increases occurred in heart and breathing rate variability. Duration of respiratory pauses and of periodic breathing progressively increased preceding conventional events, respiratory rate variability increased immediately preceding conventional events and at 1 hr preceding extreme events, and O2 saturation decreased immediately preceding both conventional and extreme events. Thus, conventional and extreme events do not occur de novo but rather are preceded by autonomic instability of the cardiorespiratory system. Pediatr Pulmonol. 2008; 43:87,98. © 2007 Wiley-Liss, Inc. [source]

    Gender-associated differences in the psychosocial and developmental outcome in patients affected with the bladder exstrophy-epispadias complex

    BJU INTERNATIONAL, Issue 2 2006
    OBJECTIVE To identify problems in the long-term psychosocial and developmental outcome specific to patients with the bladder exstrophy-epispadias complex (BEEC), using a self-developed semi-structured questionnaire, as there are various techniques of reconstruction to repair BEEC but to date neither patients nor surgeons have a clear answer about which type gives the most acceptable long-term results. PATIENTS AND METHODS Increasingly many patients with BEEC reach adulthood and wish to have sexual relationships and families. To date, no studies have used disease-specific psychological instruments to measure the psychosocial status of patients with BEEC. Thus we contacted 208 patients with BEEC, and 122 were enrolled, covering the complete spectrum of the BEEC. The data assessed included the surgical reconstruction, subjective assessment of continence, developmental milestones, school performance and career, overall satisfaction in life, disease-specific fears and partnership experiences in patients aged >18 years. We compared affected females and males to assess gender-associated differences in quality of life. RESULTS Affected females had more close friendships, fewer disadvantages in relation to healthy female peers and more partnerships than the males. Family planning seemed to be less of a problem in affected females. There were no gender differences in the adjustments within school and professional career, which was very good in general. CONCLUSION Future studies are needed to assess the disease-specific anxieties, considering gender-specific differences. [source]

    Five-year follow-up of prematurely born children with postnatally developing caudothalamic cysts

    ACTA PAEDIATRICA, Issue 2 2010
    A Lind
    Abstract Aim:, To assess the long-term developmental outcome of very low birth weight children with postnatally developing caudothalamic cysts. Methods:, Five very low birth weight children with postnatal caudothalamic cysts were examined using cranial ultrasound and brain Magnetic Resonance Imaging as neonates, the Bayley Scales of Infant Development, 2nd edition, and the Hammersmith Infant Neurological Examination at 2 years of corrected age, and with the Wechsler Preschool and Primary Scale of Intelligence-Revised and the standardization version of NEPSY II at 5 years of age. The Magnetic Resonance Imaging of the brain was repeated at 5 years of age. The developmental outcome at 5 years of age was compared with that of 23 very low birth weight children with normal brain structure. Results:, A cognitive level below normal and/or neuropsychological impairments was seen in all the children with caudothalamic cysts as well as in those with normal brain structure. Conclusion:, Very low birth weight children with postnatally developing caudothalamic cysts had cognitive and neuropsychological impairments similar to very low birth weight children without such cysts. [source]

    Methadone-exposed newborn infants: outcome after alterations to a service for mothers and infants

    J. Miles
    Abstract Objective, To evaluate the impact of a shared care approach in clinical management with a drug liaison midwife (DLM) service for mothers and infants established in 1995,1996 in an inner city area and to address the problem of congenital abnormality and microcephaly with fetal drug exposure. Methods, Descriptive analysis of data in live births of women enrolled in a methadone maintenance programme in 1991,1994 (n = 78) and 1997,2001 (n = 98), including time spent in hospital, treatment for neonatal abstinence syndrome (NAS), admission to the neonatal medical unit (NMU) and follow-up for child health checks. Results, In 1997,2001 compared with 1991,1994, the mothers used more methadone in the last week of pregnancy (median 40.0 mg/day vs. 21.5 mg/day, P = 0.0006) and there were more preterm deliveries (36% vs. 21%, P = 0.03). The infants spent less time in hospital (median 5 days vs. 28 days, P < 0.0001), a smaller proportion had treatment for NAS (14% vs. 79%, P < 0.0001), and NMU admission was reduced (median 14 days vs. 26 days, P < 0.0003). Neonatal convulsions (P = 0.0001) and jaundice (P < 0.001) occurred less frequently, and more infants were breastfed (P = 0.001). One infant in each study group had a cleft palate and none had microcephaly. Child health checks for 18,24 months showed a favourable outcome in 1997,2001. Conclusions, We altered antenatal care and modified neonatal management, subsequently infants spent less time in hospital and NMU admissions were reduced with less NAS treatment. Congenital abnormalities and microcephaly were not common and as regular child health checks were possible, the impact of the DLM service in shared management merits further investigation, for mother,infant bonding and developmental outcome. [source]

    Development and growth in very preterm infants in relation to NIDCAP in a Dutch NICU: two years of follow-up

    ACTA PAEDIATRICA, Issue 2 2009
    JM Wielenga
    Abstract Aim: To study development and growth in relation to newborn individualized developmental and assessment program (NIDCAP®) for infants born with a gestational age of less than 30 weeks. Methods: Developmental outcome of surviving infants, 25 in the NIDCAP group and 24 in the conventional care group, in a prospective phase-lag cohort study performed in a Dutch level III neonatal intensive care unit (NICU) was compared. Main outcome measure was the Bayley scales of infant development-II (BSID-II) at 24 months corrected age. Secondary outcomes were neurobehavioral and developmental outcome and growth at term, 6, 12 and 24 months. Results: Accounting for group differences and known outcome predictors no significant differences were seen between both care groups in BSID-II at 24 months. At term age NIDCAP infants scored statistically significant lower on neurobehavioral competence; motor system (median [IQR] 4.8 [2.9,5.0] vs. 5.2 [4.3,5.7], p = 0.021) and autonomic stability (median [IQR] 5.7 [4.8,6.7] vs. 7.0 [6.0,7.7], p = 0.001). No differences were seen in other developmental outcomes. After adjustment for background differences, growth parameters were comparable between groups during the first 24 months of life. Conclusion: At present, the strength of conclusions to be drawn about the effect of NIDCAP on developmental outcome or growth at 24 months of age is restricted. Further studies employing standardized assessment approaches including choice of measurement instruments and time points are needed. [source]

    Severe hypothyroidism due to atrophic thyroiditis from second year of life influenced developmental outcome

    ACTA PAEDIATRICA, Issue 8 2005
    JV Joergensen
    Abstract From the second year of life a girl showed an insidious development of clinical hypothyroidism due to a non-goitrous lymphocytic thyroiditis without traceable circulating levels of thyroid antibodies measured by routine immunoassays. The diagnostic delay of this rare variant of atrophic thyroiditis caused persistent neuropsychological deficits. Conclusion: Her difficulties with speed of processing and working memory in particular could suggest a frontal deficit, possibly in the dorsolateral prefrontal circuit. This contrasts with findings in congenital hypothyroidism, suggesting a relatively preserved frontal function, and could illustrate different neuropsychological deficits of hypothyroidism at different ages in early childhood. [source]

    "Natural restoration" can generate biological complexity

    COMPLEXITY, Issue 2 2005
    Emile ZuckerkandlArticle first published online: 16 DEC 200
    Abstract Factor complexes engaged in transcriptional regulation of gene expression and their cognate DNA elements recurrently suffer mutational damage that can result in deadaptations in the mutual fit of interacting macromolecules. Such mutations can spread in populations by drift if their functional consequences are not severe. Mutational restorations of the damaged complexes may ensue and can take many forms. One of these forms would represent spontaneous increases in gene interaction complexity and correlated aspects of organismic complexity. In this particular mode of restoration, restabilization of a factor/factor/DNA complex occurs through the binding of an additional factor. Factors added under such circumstances to regulatory kits of individual genes are thought to be at the origin of a slow but persistent "complexity drive." This drive seems to be resisted in many forms whose developmental outcome has reached a finish line difficult to pass, but imposes itself along other lines of phylogenetic descent. In the process of restoration by an additional factor, the chances are significant that the original regulatory control of a target gene is not recovered exactly and that the restored gene expression has novel spatial, temporal, or quantitative characteristics. These new characteristics, which represent a functional transfer of the gene to a new domain of activity, may be selectable, even when the physicochemical properties of the gene product have remained largely unchanged. As a consequence of such activity transfers under quasi-constancy of the molecular properties of the protein encoded by the regulation's target gene, the activity domain originally covered by that target gene may be left at least in part functionally vacant. At that point, an unmodified duplicate of the target gene and of its original regulatory dependencies probably becomes in turn selectable. A causal link is therefore predicted between the regulatory specialization and selection of one of two duplicates and the regulatory maintenance and selection of the other. A conserved increase in gene number would result indirectly from the regulatory shift in paralogs, and the organism's complexity would be increased in this sense also, complexity as number of genes in addition to complexity as number of regulatory factors per gene. It is thus proposed that increased biological complexity, innovation in the gene regulatory network, and the development of a novel evolutionary potential can be the result, counterintuitively, of conservative forces that intervene when mutations play a survivable form of havoc with the system of gene regulation. Increasing complexity, then, could be seen as one of the side effects of "natural restoration." This phrase designates the mutational re-establishment in the gene whose regulation has been damaged of a functionally effective activity pattern, albeit, perhaps, with changes in its mode of expression in regard to location, time, and rate. The higher complexity, innovation in the gene regulatory network, of higher organisms,their very character of higher organisms,would to a significant extent be a side effect of episodes of natural selection aimed at functional restoration, not at complexity itself. Regulatory impairment, the point of departure of the process outlined, represents a controller gene disease. It thus may well be the case that molecular diseases, the effects on the individual of inheritable structural decay, are among the conditions of the evolution of higher organisms. © 2005 Wiley Periodicals, Inc. Complexity 11: 14,27, 2005 [source]

    Churchill and Sip1a repress fibroblast growth factor signaling during zebrafish somitogenesis

    Fatma O. Kok
    Abstract Cell-type specific regulation of a small number of growth factor signal transduction pathways generates diverse developmental outcomes. The zinc finger protein Churchill (ChCh) is a key effector of fibroblast growth factor (FGF) signaling during gastrulation. ChCh is largely thought to act by inducing expression of the multifunctional Sip1 (Smad Interacting Protein 1). We investigated the function of ChCh and Sip1a during zebrafish somitogenesis. Knockdown of ChCh or Sip1a results in misshapen somites that are short and narrow. As in wild-type embryos, cycling gene expression occurs in the developing somites in ChCh and Sip1a compromised embryos, but expression of her1 and her7 is maintained in formed somites. In addition, tail bud fgf8 expression is expanded anteriorly in these embryos. Finally, we found that blocking FGF8 restores somite morphology in ChCh and Sip1a compromised embryos. These results demonstrate a novel role for ChCh and Sip1a in repression of FGF activity. Developmental Dynamics 239:548,558, 2010. © 2009 Wiley-Liss, Inc. [source]


    FAMILY COURT REVIEW, Issue 4 2001
    William G. Austin
    How to integrate the problem of partner violence into a child custody evaluation is analyzed within a risk-assessment approach. The research literature on partner violence is reviewed to examine the issues of establishing a base rate for partner violence and its relative frequencies for both genders. Theoretical typologies of partner violence are reviewed and a new typology presented that is more suitable to the predictive task in the custody evaluation. A model of how the evaluator should approach partner violence is described, with an integration of a risk-assessment approach to child developmental outcomes as associated with custody and parenting time arrangements and a violence risk assessment of a perpetrator/parent. [source]

    Emotional vitality in infancy as a predictor of cognitive and language abilities in toddlerhood

    Amanda J. Moreno
    Abstract Previous work by our group has shown that infant emotional vitality (EV), the lively expression of shared emotion both positive and negative, predicts cognitive and language abilities in toddlerhood. Specifically, infants who demonstrated a pattern of high emotional expression combined with high bids to their caregivers, fared significantly better on the Bayley II and Preschool Language Scales (PLS-3) at 2 years of age than infants who showed both low expression and low bids to mother. That study was conducted on a large, low-income, ethnically diverse sample. The current study was undertaken with a smaller but demographically similar sample as an effort to demonstrate the value of EV as a construct and to provide additional information about its links with later developmental outcomes. Replication that included a variation in the age at which EV was assessed provides support for the generalizability of the construct. In addition, this study examined EV's effects further into childhood than did the original study in order to insure they are not limited to a brief window in toddlerhood. The results indicate that over and above maternal psychological resources, EV expressed during positive/joyful and frustrating circumstances in 8-month-olds accounted for significant portions of variance in expressive language at 30 months and cognitive-developmental assessments at 24 and 36 months. This study supports EV as an important relational-emotional behaviour that increases experiences that optimize developmental outcomes. Successful replication suggests that EV holds promise as a construct with clinical utility for early interventions attempting to improve developmental outcomes in children from poor families. Copyright © 2005 John Wiley & Sons, Ltd. [source]

    Maternal sensitivity in interactions with three- and 12-month-old infants: Stability, structural composition, and developmental consequences

    Arnold Lohaus
    This study addresses three topics related to the structural components of maternal sensitivity: (a) The stability of sensitivity over a nine-month period, (b) the predictability of maternal sensitivity assessed at 12 months from early parameters of parenting and (c) the relation between maternal sensitivity and developmental outcomes assessed at 12 months. Maternal sensitivity and its components (signal perception, correct interpretation, prompt, and appropriate reaction) were evaluated for 60 mother,infant-dyads when their infants were aged three and 12 months. Additional parameters of early parenting were maternal emotional warmth and behavioural contingency. Developmental outcome measures were the amount of infant crying and the quality of attachment at twelve months. The results showed close correlations between the sensitivity components suggesting a unidimensional structure for maternal sensitivity. The sensitivity assessments were significantly related to measures of maternal warmth. Stability of maternal sensitivity over time was, however, quite low. There was no relation between the early sensitivity assessments and later developmental outcomes, whereas there was a significant relation between the sensitivity parameters assessed at twelve months and developmental outcomes. The results indicate changes in the meaning of maternal sensitivity during infants' development. Copyright © 2004 John Wiley & Sons, Ltd. [source]

    The role of maternal responsiveness in predicting infant affect during the still face paradigm with infants born very low birth weight

    Sarah J. Erickson
    There is limited empirical literature addressing infants' response to a standardized stressor with infants born very low birth weight (VLBW). The purpose of this study was to assess the relative strength of maternal responsiveness in predicting infant affect in response to the Still Face (SF) paradigm in a cross-sectional cohort of ethnically diverse infants born VLBW and their mothers (N = 50; infants 6,8 months old). Infant affect and maternal responsiveness were coded in 1-s intervals while dyads participated in the SF. In addition, perinatal medical status, developmental status, and infant temperament were assessed. Findings revealed that positive infant affect during and after the SF stressor were strongly associated with baseline infant positive affect and maternal responsiveness at the reunion episode, respectively. In contrast, when predicting negative infant affect during and after the SF stressor, prior infant negative affect was strongly and uniquely significant. Infant positive affect, negative affect, and maternal responsiveness were not significantly associated with gender, infant perinatal medical history, developmental status, or temperament. Future research is warranted to determine how these findings relate to infants' stress reactions in naturalistic settings and if relationship-focused interventions may reverse infant negative emotionality, enhance positive emotionality, and thereby improve self-regulation and longer term social and cognitive developmental outcomes in medically at-risk infants. [source]

    Symptoms of attention-deficit/hyperactivity disorder in first-time expectant women: Relations with parenting cognitions and behaviors

    Jerilyn E. Ninowski
    The relationship between maternal symptoms of attention-deficit/hyperactivity disorder (ADHD) and parenting cognitions and behaviors was studied in 86 first-time expectant women. Women high on ADHD symptoms were less likely to be married, less likely to have obtained at least some university education, and less likely to report that they wanted to get pregnant at the time they became pregnant. As predicted, ADHD symptoms were positively correlated with symptoms of anxiety and depression, and predicted less positive prenatal expectations regarding the infant and the future maternal role and lower maternal self-efficacy. Contrary to predictions, ADHD did not predict any incremental variance in maternal stressful life events or social support. Symptoms of ADHD were negatively correlated with attendance at recommended prenatal checkups, but were unrelated to other behaviors during pregnancy. Findings suggest that even prior to any contact with their infant, women with ADHD symptoms have maladaptive cognitions regarding their expectations of motherhood and parenting abilities. As a result, they may benefit from early interventions that focus on attenuating the potential negative effects that these maladaptive cognitions might have on the mother-infant relationship and later developmental outcomes for their children. [source]

    Nursing and midwifery management of hypoglycaemia in healthy term neonates

    Vivien Hewitt BSc(Hons) GradDipLib
    Executive summary Objectives The primary objective of this review was to determine the best available evidence for maintenance of euglycaemia, in healthy term neonates, and the management of asymptomatic hypoglycaemia in otherwise healthy term neonates. Inclusion criteria Types of studies The review included any relevant published or unpublished studies undertaken between 1995 and 2004. Studies that focus on the diagnostic accuracy of point-of-care devices for blood glucose screening and/or monitoring in the neonate were initially included as a subgroup of this review. However, the technical nature and complexity of the statistical information published in diagnostic studies retrieved during the literature search stage, as well as the considerable volume of published research in this area, suggested that it would be more feasible to analyse diagnostic studies in a separate systematic review. Types of participants The review focused on studies that included healthy term (37- to 42-week gestation) appropriate size for gestational age neonates in the first 72 h after birth. Exclusions ,,preterm or small for gestational age newborns; ,,term neonates with a diagnosed medical or surgical condition, congenital or otherwise; ,,babies of diabetic mothers; ,,neonates with symptomatic hypoglycaemia; ,,large for gestational age neonates (as significant proportion are of diabetic mothers). Types of intervention All interventions that fell within the scope of practice of a midwife/nurse were included: ,,type (breast or breast milk substitutes), amount and/or timing of feeds, for example, initiation of feeding, and frequency; ,,regulation of body temperature; ,,monitoring (including screening) of neonates, including blood or plasma glucose levels and signs and symptoms of hypoglycaemia. Interventions that required initiation by a medical practitioner were excluded from the review. Types of outcome measures Outcomes that were of interest included: ,,occurrence of hypoglycaemia; ,,re-establishment and maintenance of blood or plasma glucose levels at or above set threshold (as defined by the particular study); ,,successful breast-feeding; ,,developmental outcomes. Types of research designs The review initially focused on randomised controlled trials reported from 1995 to 2004. Insufficient randomised controlled trials were identified and the review was expanded to include additional cohort and cross-sectional studies for possible inclusion in a narrative summary. Search strategy The major electronic databases, including MEDLINE/PubMed, CINAHL, EMBASE, LILACS, Cochrane Library, etc., were searched using accepted search techniques to identify relevant published and unpublished studies undertaken between 1995 and 2004. Efforts were made to locate any relevant unpublished materials, such as conference papers, research reports and dissertations. Printed journals were hand-searched and reference lists checked for potentially useful research. The year 1995 was selected as the starting point in order to identify any research that had not been included in the World Health Organisation review, which covered literature published up to 1996. The search was not limited to English language studies. Assessment of quality Three primary reviewers conducted the review assisted by a review panel. The review panel was comprised of nine nurses with expertise in neonatal care drawn from senior staff in several metropolitan neonatal units and education programs. Authorship of journal articles was not concealed from the reviewers. Methodological quality of each study that met the inclusion criteria was assessed by two reviewers, using a quality assessment checklist developed for the review. Disagreements between reviewers were resolved through discussion or with the assistance of a third reviewer. Data extraction and analysis Two reviewers used a data extraction form to independently extract data relating to the study design, setting and participants; study focus and intervention(s); and measurements and outcomes. As only one relevant randomised controlled trial was found, a meta-analysis could not be conducted nor tables constructed to illustrate comparisons between studies. Instead, the findings were summarised by a narrative identifying any relevant findings that emerged from the data. Results Seven studies met the inclusion criteria for the objective of this systematic review. The review provided information on the effectiveness of three categories of intervention , type of feeds, timing of feeds and thermoregulation on two of the outcome measures identified in the review protocol , prevention of hypoglycaemia, and re-establishment and maintenance of blood or plasma glucose levels above the set threshold (as determined by the particular study). There was no evidence available on which to base conclusions for effectiveness of monitoring or developmental outcomes, and insufficient evidence for breast-feeding success. Given that only a narrative review was possible, the findings of this review should be interpreted with caution. The findings suggest that the incidence of hypoglycaemia in healthy, breast-fed term infants of appropriate size for gestational age is uncommon and routine screening of these infants is not indicated. The method and timing of early feeding has little or no influence on the neonatal blood glucose measurement at 1 h in normal term babies. In healthy, breast-fed term infants the initiation and timing of feeds in the first 6 h of life has no significant influence on plasma glucose levels. The colostrum of primiparous mothers provides sufficient nutrition for the infant in the first 24 h after birth, and supplemental feeds or extra water is unnecessary. Skin-to-skin contact appears to provide an optimal environment for fetal to neonatal adaptation after birth and can help to maintain body temperature and adequate blood glucose levels in healthy term newborn infants, as well as providing an ideal opportunity to establish early bonding behaviours. Implications for practice The seven studies analysed in this review confirm the World Health Organisation's first three recommendations for prevention and management of asymptomatic hypoglycaemia, namely: 1Early and exclusive breast-feeding is safe to meet the nutritional needs of healthy term newborns worldwide. 2Healthy term newborns that are breast-fed on demand need not have their blood glucose routinely checked and need no supplementary foods or fluids. 3Healthy term newborns do not develop ,symptomatic' hypoglycaemia as a result of simple underfeeding. If an infant develops signs suggesting hypoglycaemia, look for an underlying condition. Detection and treatment of the cause are as important as correction of the blood glucose level. If there are any concerns that the newborn infant might be hypoglycaemic it should be given another feed. Given the importance of thermoregulation, skin-to-skin contact should be promoted and ,kangaroo care' encouraged in the first 24 h after birth. While it is important to main the infant's body temperature care should be taken to ensure that the child does not become overheated. [source]

    Metabolomics in the assessment of chemical-induced reproductive and developmental outcomes using non-invasive biological fluids: application to the study of butylbenzyl phthalate

    Susan Sumner
    Abstract This study was conducted to evaluate the use of metabolomics for improving our ability to draw correlations between early life exposures and reproductive and/or developmental outcomes. Pregnant CD rats were exposed by gavage daily during gestation to vehicle or to butylbenzyl phthalate (BBP) in vehicle at a level known to induce effects in the offspring and at a level previously not shown to induce effects. Urine was collected for 24,h (on dry ice using all glass metabolism chambers) from dams on gestational day 18 (during exposure) and on post natal day (pnd) 21, and from pnd 25 pups. Traditional phenotypic anchors were measured in pups (between pnd 0 and pnd 26). Metabolomics of urine collected from dams exposed to vehicle or BBP exhibited different patterns for endogenous metabolites. Even three weeks after gestational exposure, metabolic profiles of endogenous compounds in urine could differentiate dams that received the vehicle, low dose or high dose of BBP. Metabolic profiles could differentiate male from female pups, pups born to dams receiving the vehicle, low or high BBP dose, and pups with observable adverse reproductive effects from pups with no observed effects. Metabolites significant to the separation of dose groups and their relationship with effects measured in the study were mapped to biochemical pathways for determining mechanistic relevance. The application of metabolomics to understanding the mechanistic link between low levels of environmental exposure and disease/dysfunction holds huge promise, because this technology is ideal for the analysis of biological fluids in human populations. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Parabens, oestrogenicity, underarm cosmetics and breast cancer: a perspective on a hypothesis

    Philip W. Harvey
    Abstract A recent review by Darbre (2003) published in this journal (J. Appi. Toxicol. 23: 89,95) has attracted public and scienti,c interest that requires perspective, particularly on the use of esters of p -hydroxybenzoic acid (parabens) as preservatives in underarm cosmetics. Although parabens are generally regarded as safe, recent reports suggest that they are oestrogenic in a variety of in vitro (including MCF7 and ZR-75-1 human breast cancer cell lines) and in vivo tests for oestrogenicity (uterotrophic assays in both rat and mouse). There are also recent reports of adverse reproductive and developmental outcomes in rodent toxicity studies. Of interest is the lack of activity by the oral route but clear activity by the subcutaneous and topical routes, which is of some relevance to the use of underarm cosmetics. There would seem to be a case now to supplement these emerging toxicity data with longer term regulatory standard tests examining other oestrogenic endpoints and at least to consider these ,ndings in more up-to-date risk assessments speci,c for cosmetic use. Further, there are few data on the use of underarm cosmetics and the risk of breast cancer, and although one recent retrospective interview-based study found no association there is a need for more thorough investigation taking into account the type of chemicals used. Darbre has forwarded a hypothesis and called for further work to establish whether or not the use of underarm cosmetics (particularly containing oestrogenic formulants) contributes to the rising incidence of breast cancer. It would seem prudent to conduct this work because the current database is sparse and the effects of long-term low-level exposures to weakly oestrogenic chemicals on human health, particularly their application to the underarm and the risks of breast cancer, are unknown. The role of oestrogens in breast cancer, however, is undisputed. Copyright © 2003 John Wiley & Sons, Ltd. [source]