Evaluation of the Neurodevelopmental Outcome of Toddlers with Spinal Dysraphism after Surgical Repair Using ASQ-3™ Scores

Background: Spinal dysraphism represents a wide spectrum of congenital abnormalities of the spine. Myelomeningocele is considered the most common malformation and the most common we saw in our community, with its morbidity problems seen commonly in the postoperative period. ASQ-3TM Scores are the ages and stages questionnaire, third edition, and represent a tool to assess the development progress, especially in toddlers. Objectives: Evaluation of neurodevelopmental outcome among Sudanese toddlers with spinal dysraphism after surgical closure with or without a VP shunt using ASQ-3TM Scores. Methodology: This is a retrospective hospital-based study of 84 patients who underwent myelomeningocele repair at the National Center for Neurological Sciences (NCNS) during the period from 2017 up to 2019. Data were collected through a constructed questionnaire, including ASQ-3TM Scores. Data were processed and analyzed using the Statistical Package for Social Science (SPSS) computer program. Version 25. Results: 84 patients were included in this study;all patients were diagnosed with spinal dysraphism. Out of them, 51 (60.7%) were 2 years old, 33 (39.3%) were 3 years old, 45 (53.6%) were male, 45 (53.6%) of patients mothers attended ANC irregularly, and 54 (64.3%) their mothers didn’t receive folate supplements. 44 (52.3%) of patients underwent MMC repair only, while 40 (47.7%) underwent MMC repair and VP shunt. The commonest postoperative complication was infection, reported in 12 (14.3%) of patients, followed by VP shunt revision in 9 (10.7%) of patients. Neurological assessment showed that the majority of patients need further assessment with a professional, 57 (67.9%) of children don’t walk, run, or climb like other toddlers as their parent’s state;also, half of patients (42, 50%) had medical problems, and 27 (32.1%) of their parent’s state that they do not talk like other toddlers their age. There was a statistically significant association between post-operative complications and communication development, problem-solving development, and personal social development (P value = 0.05), and a statistically significant association was found between age at repair and neurological development (P value = 0.05). Conclusion: The majority of patients had motor deficiency (particularly gross motor) and poor personal and social skills. Age at repair and postoperative complications significantly influenced the neurological development.

Neurodevelopmental Outcomes of Extremely Premature Infants with Extremely Low and Very Low Birth Weight at Three Years of Age: A Retrospective Study

Introduction: The purpose of this retrospective study is to identify medical conditions impacting neurodevelopmental outcomes of extremely low birth weight and very low birth weight preterm infants at three years of age. Methods: Infants born in Banner Diamond Children’s University Medical Center, receiving services in the Newborn Intensive Care Unit, and attending Neonatal Developmental Follow-Up Clinic were identified. Participants received developmental assessment and follow-up from August 2012 through December 2018. Relevant clinical conditions during initial hospital stay and up to three years of age were obtained by reviewing medical and developmental records. Bayley Scales of Infant Toddler Development (Bayley III) was used to evaluate skill development at 6, 9, 12, 18, 24, 30, 36 months. Results: Data analysis did not reveal significant p-values;it did demonstrate that some predictor variables impact neurodevelopmental outcomes in cognitive, language and motor skill development. Conclusion: This retrospective study reports significant association between birth weight and low cognitive scores. Correlations were also found between gestational age and Total Language, and the longer an infant stayed in the NICU, the poorer the Total Language Scaled Scores at 8 to 12 months, 15 to 18 months, and 24 to 36 months. Birth weight was found to be the greatest predictor of poor motor scores.

Preterm nutrition and neurodevelopmental outcomes

Survival of preterm infants has been steadily improving in recent years because of many recent advances in perinatal and neonatal medicine.Despite these advances,the growth of survivors does not reach the ideal target level of the normal fetus of the same gestational age.Postnatal weight gain is often not achieved because extrauterine growth has higher energy requirements than intrauterine growth,due to the intensive care environment,illness and inadequate nutrition.Although many other factors influence infant brain development,including family socioeconomic and educational background,the role of nutrition is considerable and fortunately,amenable to intervention.In the preterm neonate,the brain is the most metabolically demanding organ,consuming the largest proportions of energy and nutrient intake for its function and programmed growth and maturation.Weight gain,linear and head circumference growth are all markers of nutritional status and are independently associated with long-term neurodevelopment.Brain development is not only the result of nutrients intake,but in addition,of the interaction with growth factors which depend on adequate nutrient supply and overall health status.This explains why conditions such as sepsis,necrotizing enterocolitis and chronic lung disease alter the distribution and accretion of nutrients thereby suppressing growth factor synthesis.In this review,we will focus on the direct role of nutrition on neurodevelopment,emphasizing why it should be started without delay.The nutritional requirements of the preterm infant will be discussed,followed by the effects of general nutritional interventions and specific nutrients,as well as the role of nutritional supplements on neurodevelopment.The primordial role of human breast milk,breast milk fortifiers and human milk oligosaccharides will be discussed in detail.We will also examine the role of nutrition in preventing neonatal complications which can affect neurodevelopment in their own right.

Neurodevelopmental Outcome After Fetoscopic Laser Surgery for Twin-twin Transfusion Syndrome:A Systematic Review of Follow-up Studies from the Last Decade

Objective:To review the literature on long-term neurodevelopmental outcome after fetoscopic laser surgery for twin-twin transfusion syndrome(TTTS).Methods:A literature search in PubMed,Embase,Emcare,Web of Science,Cochrane library,and Academic Search Premier was performed.Inclusion criteria were studies between 2009 and 2019 in TTTS-survivors treated with fetoscopic laser surgery and followed-up after the neonatal period with cognitive developmental tests and neurologic exams.Exclusion criteria were non-English articles and reviews,case reports,letters,and guidelines.Results:Nineteen articles were included.Long-term severe neurodevelopmental impairment(NDI)was reported by seven and ranged from 4.0%to 18.0%with a mean of 9.7%(95%confidence interval(CI):7.8-11.5).The prevalence of cerebral palsy ranged from 1.6%to 18.2%,with a mean of 5.1%(95%CI:4.1-6.2).The mean prevalence of minor impairment was 13.7%(95%CI:11.4-16.0).However,only 78.9%(15/19)studies used a validated neurodevelopmental test.As studies lack uniform definitions of primary outcome,timing of follow-up,inclusion criteria,and methods,adequate comparison is hampered.Conclusion:The prevalence of severe NDI and cerebral palsy after fetoscopic laser surgery for TTTS in the last decade remains stable around 9.7%and 5.1%,respectively.International agreements on primary outcomes,methods,and follow-up are necessary to improve the knowledge of NDI in TTTS-survivors.

Mortality and Long-Term Outcome of Neonates with Congenital Heart Disease and Acute Perinatal Stroke:A Population-Based Case-Control Study

Objective:Neonates with congenital heart disease(CHD)and perinatal stroke have high mortality and survivors are at risk for poor long-term neurodevelopmental outcome.The aim of this study was to assess the risk factors and outcome of neonates with both CHD and MRI-confirmed perinatal stroke(Study Group)and compare those to the risk factors and outcome of infants matched for CHD without stroke(Control-1)and of infants matched for MRI-confirmed stroke without CHD(Control-2).Methods:We conducted a population-based case-control study enrolling 28 term neonates with CHD and MRI-confirmed acute perinatal stroke born between 2007–2017 in the Central-Hungarian Region.Each of the control groups included 56 infants.The Bayley Scales of Infant Development-II,the Brunet-Lézine test and the Binet Intelligence scales-V were used for neurodevelopmental follow-up at a median age of 61 months.Results:Mortality was highest in the Study Group(25%compared to 5%and 2%,respectively,p=0.001).Adverse neurodevelopmental outcome was prevalent in the Study(53%)and Control-2 Groups(52%,p=0.03).Significantly different parameters among the three groups included Apgar scores,mode of delivery,gestational age at birth,cardiac interventions and twin pregnancy.In a multivariable regression analysis adjusted for clinically relevant parameters,patients in the Study Group had significantly higher odds for mortality compared to patients in the Control-1 Group(OR:6.595%CI:1.1–39.4).Conclusions:Neonates with perinatal stroke and CHD are at a higher risk for dying compared to neonates with CHD without stroke.In addition,the stroke-associated direct insult to the brain likely plays an important role in the development of neurodevelopmental morbidity in these patients.

Neurodevelopmental in Relation to Breastfeeding–Experiences among Hungarian Preterm Infants at 12 Months of Corrected Age:Empirical Study

Preterm and low birth weight infants are at higher risk of neurodevelopmental outcomes;breastfeeding offers sev-eral beneficial aspects for them.This study aimed to describe the average neurodevelopmental outcomes of pre-term infants and examine the associations between neurodevelopment and breastfeeding among Hungarian preterm infants at 12 months of corrected age.154 preterm infants with low birth weight(<2500 g)and their mothers were participated in this study.Bayley-III Screening Test(Bayley Scales of Infant and Toddler Develop-ment Screening Test,Third Edition)was administered to measure the cognitive,language and motor skills of infants;breastfeeding data was obtained through parental anamnesis.To analyze data,independent sample t-test or the Welch t-test,Mann-Whitney tests,Chi-square tests of independence and Spearman’s rank correlation test were used to.Concerning the risk of developmental delay,Receptive and Expressive language and Fine motor subscales were the lowest.Examination of the associations between breastfeeding and neurodevelopmental per-formance identified significantly higher cognitive(U=2047.5;P=0.023)andfine motor(U=2096.0;P=0.037)skills in infants who were breastfed.We found significant positive correlations between the duration of breastfeeding and cognitive,expressive language andfine motor skills.The study draws the attention to the importance of breastfeeding and early screening.Further research is required to examine the casual relationship between neurodevelopmental outcomes and breastfeeding.

Factors Affecting the Developmental Outcomes of High-Risk Newborns

Background: Newborns weighing less than 2,500 grams and those with birth asphyxia are particularly vulnerable to multiple complications. This study aimed to evaluate the prevalence and factors related to developmental delays in high-risk newborns. Methods: This study included the clinical data of infants with a birth weight of under 2500 grams or an Apgar score of less than 7 at 1 or 5 minutes after birth. Medical records from January 1, 2015 to December 31, 2020 were included. The actual age of the infants was corrected according to gestational age. Participants with genetic abnormalities (trisomy 21, 18, 13) and congenital brain anomalies (hydrocephalus, encephalocele) were excluded. The Developmental Assessment for Intervention Manual (DAIM) was used during follow-up visits. Multivariate logistic regression analysis was used to examine the data. Results: Of the 297 patients included, 110 completed the follow-up and 62 infants (56%) had developmental delays. Significant associations with delayed development included maternal age (adjusted odds ratio [AOR] 3.36, 95% confidence interval [CI] 1.19 - 9.46), male sex (AOR 3.23, 95% CI 1.24 - 8.44), gestational age below 32 weeks (AOR 33.35, 95% CI 1.39 - 799.87), and neonatal hypoglycemia (AOR 3.81, 95% CI 1.13 - 12.85). Conclusion: Maternal age, male sex, gestational age less than 32 weeks, and neonatal hypoglycemia were all associated risk factors for developmental delays in high-risk infants.

Psychotropic drug abuse in pregnancy and its impact on child neurodevelopment:A review

Substance abuse by women of child-bearing age and fetal in utero drug exposure has increased in the number of infants born with health issues.Prenatal exposure to psychoactive substances can lead to neurological and neurodevelopmental deficits later in life.Useful data concerning the effects of psychoactive drugs on fetal neurodevelopmental status are sparse.Understanding the neurodevelopmental consequences of prenatally drug-exposed children has become a pressing global concern.The aim of this review is to gather current evidence and information on neurodevelopmental outcomes of in utero drug exposure.A literature search was performed on the PubMed,Scopus,and Google Scholar databases using the terms“psychotropic drugs”,“neurodevelopmental consequences”,“prenatal drug exposure”,and“pregnancy”.Available studies on in utero drug exposure were reviewed and found to support the idea that some degree of health issues are present in fetuses and children.Different psychoactive substances have profound neurodevelopmental consequences,such as structural brain changes,poor attention span,Down syndrome,attention deficit hyperactivity disorder,autism spectrum disorder,imbalances in neurotransmitter levels,and many structural deficits.The pervasive use of psychoactive drugs in women of child-bearing age is an important health concern.Further scientific efforts are needed to investigate the effect of prenatal exposure to psychoactive drugs on children.

No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years

Background:To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants(≤1500 g)born by cesarean with those by vaginal delivery.Methods:In this retrospective,case-control study,we evaluated neonatal mortality,medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight(VLBW)infants born between January 2005 and December 2010.Of the 710 infants,351 were born by the cesarean and 359/710 by vaginal route.Results:There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group[56/351(15.9%)vs.71/359(19.8%),P=0.20].VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route[221/351(63.0%)vs.178/359(49.6%),P<0.001].There were no differences in other neonatal morbidities,including intraventricular hemorrhage[126/351(35.9%)vs.134/359(37.3%),P=0.69],bronchopulmonary dysplasia[39/351(11%)vs.31/359(8.6%),P=0.38]and necrotising enterocolitis[40/351(11.4%)vs.32/359(8.9%),P=0.32]between the two groups.The incidence of poor neurodevelopment after cesarean delivery was similar to that after vaginal delivery[105/351(29.9)vs.104/359(29.0%),P=0.78].Conclusions:In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants.Moreover,the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants.The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.