Performance of 2-year-old children after early surgery for congenital heart disease on the Bayley Scales of Infant and Toddler Development, Third Edition. Three‐Year Developmental Outcomes in Children with Prenatal Alcohol and Drug Exposure Early postoperative body temperature and developmental outcome after open heart surgery in infants. Chronic Lung Disease and Developmental Delay at 2 Years of Age in Children Born Before 28 Weeks' Gestation Prediction of IQ and Achievement at Age 8 Years From Neurodevelopmental Status at Age 1 Year in Children With D-Transposition of the Great Arteries Apolipoprotein E genotype and neurodevelopmental sequelae of infant cardiac surgery. Breast feeding and cognitive development at age 1 and 5 years Effect of Maternal Multivitamin Supplementation on the Mental and Psychomotor Development of Children Who Are Born to HIV-1–Infected Mothers in Tanzania Neurodevelopment and In Utero Antiretroviral Exposure of HIV-Exposed Uninfected Infants Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Randomized trial of early developmental intervention on outcomes in children after birth asphyxia in developing countries. Overestimating Neurodevelopment Using the Bayley-III After Early Complex Cardiac Surgery Early Cognitive and Motor Development Among Infants Born to Women Infected With Human Immunodeficiency Virus Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age. Follow-up Outcomes at 1 and 2 Years of Infants Born Less Than 32 Weeks After Newborn Individualized Developmental Care and Assessment Program Indications of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Neurodevelopmental outcome of premature infants after antenatal phenobarbital exposure. Rich micronutrient fortification of locally produced infant food does not improve mental and motor development of Zambian infants: a randomised controlled trial. No change in developmental outcome with incubator covers and nesting for very preterm infants in a randomised controlled trial Counterbalanced Comparison of the BSID-II and Bayley-III at Eighteen to Twenty-two Months Corrected Age The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: results of a randomized trial in infants. Pediatric Physical Therapy in Infancy: From Nightmare to Dream? A Two-Arm Randomized Trial Neurodevelopment in children with hypoplastic left heart syndrome.
BACKGROUND Previous research on developmental outcomes of infants with congenital heart disease ( CHD ) has shown delays in both cognitive and motor skills . AIMS To describe outcomes on the Bayley Scales of Infant and Toddler Development , 3rd edition ( Bayley-III ) for infants with CHD and to compare those findings to published results for similar sample s of infants assessed on the 2nd edition of the Bayley Scales ( BSID-II ) . STUDY DESIGN Prospect i ve cohort . PARTICIPANTS AND OUTCOME MEASURES Of 50 infants with CHD who participated in this longitudinal study ( 2006 - 2008 ) at the Royal Children 's Hospital in Melbourne , Australia , 47 were assessed on the Bayley-III ( median age=24.5 months ) ,  administered by a psychologist or neonatologist . Although neither assessor was blind to the CHD diagnosis , they were unaware of results of previous developmental assessment s conducted in this longitudinal study . RESULTS For the Bayley-III cognitive composite score , 17.0 % of infants showed mild delays ( 1 - 2 SD below the mean ) , 2.1 % had moderate delays ( 2 - 3 SD below the mean ) , and none had severe delays ( greater than 3 SD below the mean ) . Motor composite scores showed mild delays in 10.9 % of infants and moderate delays in 2.2 % ; none had severe motor delays . These findings differ from study results using the BSID-II in similar infants . CONCLUSIONS The Bayley-III may underestimate developmental delay in 2-year-old children with CHD when compared to results of similar children tested at 12 - 36 months of age on the BSID-II Purpose : The purpose of this study was to describe the performance of children whose mothers abused alcohol and drugs heavily during pregnancy , using the Bayley Scales of Infant Development Second Edition ( BSID‐II ) at three years , and to examine the effects of study group , prenatal binge alcohol exposure , and prematurity on developmental outcome . Methods : Children were born to mothers recruited from two large hospitals or through community referral . Hospital recruits were r and omly assigned to either a three‐year paraprofessional home visitation intervention program ( n = 30 ) or a control group ( n = 31 ) . Community recruits were enrolled in the intervention program ( n = 35 ) . Results : Among all children the mean BSID‐II Mental Developmental Index ( MDI ) was 84.4 ( SD = 14.4 ) and mean Psychomotor Developmental Index ( PDI ) was 84.1 ( SD = 16.9 ) . Box plots of the MDI and PDI scores by study group , maternal prenatal binge alcohol status , and a binary indicator of prematurity suggested an effect of maternal binge drinking on MDI and PDI scores :  children of mothers with a history of binge alcohol consumption have , on average , slightly lower scores . We saw no evidence of a systematic effect of the maternal intervention . Conclusions : Developmental performance of preschool children exposed to alcohol and drugs prenatally was , on average , substantially lower than expected for age regardless of study group . Although this home visitation intervention has been shown to be effective in helping mothers address a wide spectrum of needs , it is unlikely sufficient to overcome complex developmental risks of children exposed to alcohol and drugs prenatally . The effect of more comprehensive , multidimensional services specifically design ed for the children should be investigated within this context . ( Pediatr Phys Ther 2002;14:145‐153 BACKGROUND Experimental data have suggested that early postoperative temperature management after cerebral ischemia may alter neurologic outcome . We explored whether minor deviations in early postoperative body temperature after infant heart surgery  affects developmental outcome . METHODS In a study of infants undergoing repair of congenital heart disease , 95 % of whom had a period of deep hypothermic circulatory arrest , postoperative temperature data were collected following cardiac surgery . Subjects were infants who had been enrolled in one of two prospect i ve r and omized single-center trials . Development was tested at age one year ( the Bayley Scales of Infant Development ) and at four years ( Wechsler Preschool and Primary Scale of Intelligence , including Full Scale IQ , a Verbal IQ , and a Performance IQ ) . RESULTS Perioperative temperature  data were review ed in 329 patients , of whom 244 ( 74 % ) were evaluated at age one year and 156 ( 48 % ) were evaluated at four years . The temperature profile was recorded during the rewarming phase and for 36 hours postoperatively on the Intensive Care Unit . There were no significant associations between postoperative temperature and any of the neurodevelopmental tests at age one or four years . A further analysis assessing the percentage of time over specific temperature cutoff points of 37.5 degrees C , 38 degrees C , 38.5 degrees C , and 39 degrees C , revealed no significant effect . CONCLUSIONS Neurodevelopmental outcome at one and four years after repair of complex congenital heart disease was not significantly affected by the early postoperative body temperature profile of the infant when a management strategy aim ing for normothermia is employed INTRODUCTION : Extremely low gestational age newborns ( ELGANs ) are at increased risk of chronic lung disease ( CLD ) and of developmental delay . Some studies have suggested that CLD contributes to developmental delay . PATIENTS AND METHODS : We examined data collected prospect ively on 915 infants born before the 28th week of gestation in 2002–2004 who were assessed at 24 months of age with the Bayley Scales of Infant Development-2nd Edition or the Vinel and Adaptive Behavior Scales . We excluded infants who were not able to walk independently ( Gross Motor Function Classification System score < 1 ) and , therefore , more likely to have functionally important fine motor impairments . We defined CLD as receipt of oxygen at 36 weeks ' postmenstrual age and classified infants as either not receiving mechanical ventilation ( MV ) ( CLD without MV ) or receiving MV ( CLD with MV ) . RESULTS : Forty-nine percent of ELGANs had CLD ; of these , 14 % were receiving MV at 36 weeks ' postmenstrual age . ELGANs without CLD had the lowest risk of a Mental Developmental Index ( MDI ) or a Psychomotor Developmental Index ( PDI ) of < 55 , followed by ELGANs with CLD not receiving MV , and ELGANs with CLD receiving MV ( 9 % , 12 % , and 18 % for the MDI and 7 % , 10 % , and 20 % for the PDI , respectively ) . In time-oriented multivariate models , the risk of an MDI of < 55 was associated with the following variables : gestational age of < 25 weeks ; single mother ; late bacteremia ; pneumothorax ; and necrotizing enterocolitis . The risk of a PDI of < 55 was associated with variables such as single mother , a complete course of antenatal corticosteroids , early and persistent pulmonary dysfunction , pulmonary deterioration during the second postnatal week , pneumothorax , and pulmonary interstitial emphysema .  CLD , without or with MV , was not associated with the risk of either a low MDI or a low PDI .  However , CLD with MV approached , but did not achieve , nominal statistical significance ( odds ratio : 1.9 [ 95 % confidence interval : 0.97–3.9 ] ) for the association with a PDI of < 55 . CONCLUSIONS : Among children without severe gross motor delays , risk factors for CLD account for the association between CLD and developmental delay . Once those factors are considered in time-oriented risk models , CLD does not seem to increase the risk of either a low MDI or a low PDI . However , severe CLD might increase the risk of a low PDI Objective . Studies of developmental outcomes in children with congenital heart disease ( CHD ) frequently use assessment s conducted in infancy as primary endpoints . Whether test scores of CHD patients in infancy are predictive of status at school age has not been evaluated , however . Methods . In the Boston Circulatory Arrest Study , 135 children with D-transposition of the great arteries repaired by arterial switch operation  were administered the  Bayley Scales of Infant Development  and the Fagan Test of Infant Intelligence  at 1 year of age and the Wechsler Intelligence Scale for Children , Third Edition and the Wechsler Individual Achievement Test at 8 years . Results . Although most 1-year test scores were significantly associated with 8-year test scores , the amounts of shared variance were modest ( < 10 % ) . All 1-year test scores had poor sensitivity ( 16%–32 % ) and poor positive predictive value ( 35%–42 % ) but good specificity ( 80%–93 % ) and negative predictive value ( 78%–79 % ) . More than half of the children with low scores at 8 years ( ≤85 ) had had scores > 84 at 1 year . Conclusion . This pattern suggests that although test scores at 1 year are modestly associated with test scores at 8 years , many children who are at risk for poor late outcomes will not be identified on the basis of 1-year test scores . Long-term follow-up of children with CHD is necessary to draw inferences about the developmental sequelae of preoperative , intraoperative , and postoperative factors BACKGROUND There has been increasing recognition of adverse neurodevelopmental sequelae in some children after repair of congenital heart defects . Even among children with the same cardiac defect , significant interindividual variation exists in developmental outcome . Polymorphisms of apolipoprotein E have been identified as a risk factor for worse neurologic recovery after central nervous system injury . METHODS A single-institution prospect i ve study of patients < or=6 months of age undergoing cardiopulmonary bypass for repair of congenital heart defects was undertaken to evaluate the association between apolipoprotein E genotype and postoperative neurodevelopmental dysfunction . Developmental outcomes were evaluated at 1 year of age by using the Bayley Scales of Infant Development . RESULTS One-year evaluation was performed in 244 patients . After adjustment for preoperative and postoperative covariates-including gestational age , age at operation , sex , race , socioeconomic status , cardiac defect , and use of deep hypothermic circulatory arrest-the apolipoprotein E epsilon2 allele was associated with a worse neurologic outcome as assessed by the Psychomotor Developmental Index of the Bayley Scales of Infant Development ( P = .036 ) . Patients with the apolipoprotein E epsilon2 allele had approximately a 7-point decrease in the Psychomotor Developmental Index . CONCLUSIONS Apolipoprotein E epsilon2 allele carriers had significantly lower Psychomotor Development Index scores at 1 year of age after infant cardiac surgery . The effect was independent of ethnicity , socioeconomic status , cardiac defect , and use of deep hypothermic circulatory arrest . An effect of the apolipoprotein E epsilon4 allele was not detected . Genetic polymorphisms that decrease neuroresiliency and impair neuronal repair after central nervous system injury are important risk factors for neurodevelopmental dysfunction after infant cardiac surgery AIM To examine whether duration of breast feeding has any effect on a child 's cognitive or motor development in a population with favourable environmental conditions and a high prevalence of breast feeding . METHODS In 345 Sc and inavian children , data on breast feeding were prospect ively recorded during the first year of life , and neuromotor development was assessed at 1 and 5 years of age . Main outcome measures were Bayley 's Scales of Infant Development at age 13 months ( Mental Index , MDI ; Psychomotor Index , PDI ) , Wechsler Preschool and Primary Scales of Intelligence ( WPPSI-R ) , and Peabody Developmental Scales at age 5 . RESULTS Children breast fed for less than 3 months had an increased risk , compared to children breast fed for at least 6 months , of a test score below the median value of MDI at 13 months and of WPPSI-R at 5 years . Maternal age , maternal intelligence ( Raven score ) , maternal education , and smoking in pregnancy were significant confounders , but the increased risk of lower MDI and total IQ scores persisted after adjustment for each of these factors . We found no clear association between duration of breast feeding and motor development at 13 months or 5 years of age . CONCLUSION Our data suggest that a longer duration of breast feeding benefits cognitive development OBJECTIVES . To determine the association between maternal multivitamin supplementation and the mental and psychomotor development of children who are born to HIV-1–infected mothers in Tanzania , as secondary endpoints in a r and omized trial that investigated the effect of maternal multivitamin supplementation on HIV-1 vertical transmission and progression . METHODS . The Bayley Scales of Infant Development , 2nd Edition , were administered at 6 , 12 , and 18 months of age to a subset of children ( N = 327 ) . We assessed the effect of vitamin A and multivitamin ( vitamins B , C , and E ) supplementation using linear regression models and Cox proportional hazard models for the Mental Development Index , the Psychomotor Development Index , and raw scores separately . RESULTS . Multivitamin supplementation was associated significantly with a mean increase in Psychomotor Development Index score of 2.6 ( 95 % confidence interval : 0.1–5.1 ) . Multivitamins were also significantly protective against the risk for developmental delay on the motor scale ( relative risk : 0.4 ; 95 % confidence interval : 0.2–0.7 ) but not on the Mental Development Index .  Vitamin A supplementation had no significant effect on these outcomes . CONCLUSIONS . Maternal multivitamin supplements provide a low-cost intervention to reduce the risk for developmental delays among infants who are born to HIV-positive mothers in developing countries OBJECTIVE : Antiretroviral ( ARV ) drugs are routinely provided to HIV-infected pregnant women to prevent HIV mother-to-child transmission . Although ARV use has significantly reduced mother-to-child transmission to < 2 % in the United States , it remains crucial to monitor uninfected infants and children for adverse consequences of in utero ARV exposure . METHODS : We studied neurodevelopmental function in HIV-exposed uninfected children who were enrolled in Pediatric AIDS Clinical Trials Group 219/219C , a multisite , prospect i ve , cohort study .  Mental and motor functioning were assessed with the Bayley Scales of Infant Development ( BSID ) , first and second editions . ARV exposure information was collected during pregnancy or within the first years of life . Linear regression methods were used to evaluate the association of in utero ARV exposure on Mental Developmental Index and Psychomotor Developmental Index at 2 years of age , controlling for demographic factors ( age , gender , and race/ethnicity ) and potential confounders : test version , primary language , primary caregiver , caregiver education level , low birth weight , geographic and urban/rural location , birth year , and maternal illicit drug use . RESULTS : Among 1840 infants who were born between 1993 and 2006 , 1694 ( 92 % ) were exposed to ARV in utero and 146 ( 8 % ) were not exposed . After controlling for confounders , children who were exposed in utero to any ARV did not have lower Mental Developmental Index and Psychomotor Developmental Index scores than unexposed children . Among low birth weight infants , significantly higher BSID scores were observed for prenatally ARV-exposed than unexposed children . Maternal illicit drug use was reported for 17 % of mothers but was not associated with BSID scores . CONCLUSIONS : Mental and motor functioning scores were not lower for infants with in utero ARV exposure compared with no exposure . Although these results are reassuring , continued evaluation of uninfected children with in utero ARV exposure for long-term adverse outcomes is important BACKGROUND Deep hypothermia with either total circulatory arrest or low-flow cardiopulmonary bypass is used to support vital organs during heart surgery in infants . We compared the developmental and neurologic sequelae of these two strategies one year after surgery . METHODS Infants with D-transposition of the great arteries who underwent an arterial-switch operation were r and omly assigned to a method of support consisting predominantly of circulatory arrest or a method consisting predominantly of low-flow bypass . Developmental and neurologic evaluations and magnetic resonance imaging ( MRI ) were performed at one year of age . RESULTS Of the 171 patients enrolled in the study , 155 were evaluated . After adjustment for the presence or absence of a ventricular septal defect , the infants assigned to circulatory arrest , as compared with those assigned to low-flow bypass , had a lower mean score on the Psychomotor Development Index of the Bayley Scales of Infant Development ( a 6.5-point deficit , P = 0.01 ) and a higher proportion had scores < or = 80 ( i.e. , 2 SD or more below the population mean ) ( 27 percent vs. 12 percent , P = 0.02 ) . The score on the Psychomotor Development Index was inversely related to the duration of circulatory arrest ( P = 0.02 ) . The risk of neurologic abnormalities increased with the duration of circulatory arrest ( P = 0.04 ) . The method of support was not associated with the prevalence of abnormalities on MRI scans of the brain , scores on the Mental Development Index of the Bayley Scale , or scores on a test of visual-recognition memory . Perioperative electroencephalographic seizure activity was associated with lower scores on the Psychomotor Development Index ( P = 0.002 ) and an increased likelihood of abnormalities on MRI scans of the brain ( P < 0.001 ) . CONCLUSIONS Heart surgery performed with circulatory arrest as the predominant support strategy is associated with a higher risk of delayed motor development and neurologic abnormalities at the age of one year than is surgery with low-flow bypass as the predominant support strategy OBJECTIVE To determine if early developmental intervention ( EDI ) improves developmental abilities in resuscitated children . STUDY DESIGN This was a parallel group , r and omized controlled trial of infants unresponsive to stimulation who received bag and mask ventilation as part of their resuscitation at birth and infants who did not require any resuscitation born in rural communities in India , Pakistan , and Zambia . Intervention infants received a parent-implemented EDI delivered with home visits by parent trainers every other week for 3 years starting the first month after birth . Parents in both intervention and control groups received health and safety counseling during home visits on the same schedule . The main outcome measure was the Mental Development Index ( MDI ) of the Bayley Scales of Infant Development , 2nd edition , assessed at 36 months by evaluators unaware of treatment group and resuscitation history . RESULTS MDI was higher in the EDI ( 102.6 ± 9.8 ) compared with the control resuscitated children ( 98.0 ± 14.6 , 1-sided P = .0202 ) , but there was no difference between groups in the nonresuscitated children ( 100.1 ± 10.7 vs 97.7 ± 10.4 , P = .1392 ) . The Psychomotor Development Index was higher in the EDI group for both the resuscitated ( P = .0430 ) and nonresuscitated children ( P = .0164 ) . CONCLUSIONS This trial of home-based , parent provided EDI in children resuscitated at birth provides evidence of treatment benefits on cognitive and psychomotor outcomes . MDI and Psychomotor Development Index scores of both nonresuscitated and resuscitated infants were within normal range , independent of early intervention BACKGROUND : The newest measure of neurodevelopmental outcomes , the Bayley Scales of Infant and Toddler Development , 3rd Edition ( Bayley-III ) , gives higher-than-expected scores for preterm infants ; results after cardiac surgery are unknown . OBJECTIVES : The goal of this study was to report Bayley-III scores after cardiac surgery and compare the results with those of the Bayley Scales of Infant Development , 2nd Edition ( BSID-II ) on a subset of the same children . METHODS : In this prospect i ve , inception cohort , neurodevelopmental outcome study after complex cardiac surgery in infants from 2004 to 2007 , the Bayley-III was given to 110 survivors ( 68 % boys ) at a mean age of 21 months ( SD : 4 months ) . Analysis of variance was used to compare intergroup differences . Results for both test editions on the same 25 children were compared by using paired- sample s statistics . RESULTS : Mean ( SD ) Bayley-III mean composite scores ( CSs ) for 110 children were as follows : cognitive , 95.9 ( 14.1 ) ; language , 90.8 ( 18.1 ) ; and motor , 93.7 ( 14.2 ) , differentiating selected cardiac surgery groups . The average difference in mean CSs was 7.4 points higher than BSID-II scores for a previous cohort from this site and 7.2 points higher than a systematic review report . Direct comparison of BSID-II and Bayley-III revealed an average difference in mean CSs of 6.1 points , similar to normative results . Mean cognitive CSs increased by 10.0 ( P < .001 ) , language by 1.4 ( P = .526 ) , and motor by 6.9 points ( P = .009 ) . CONCLUSIONS : Research ers should be careful attributing higher Bayley-III scores to changes in acute care . At-risk children who previously qualified for early developmental intervention may no longer do so . School-age longitudinal studies are needed to determine the accuracy of early developmental estimates using the Bayley-III Objective . To examine the frequency , timing , and factors associated with abnormal cognitive and motor development during the first 30 months of life in infants born to women infected with human immunodeficiency virus type 1 ( HIV-1 ) . Methods . Serial neurodevelopmental assessment was performed with 595 infants born to women infected with HIV-1 in a multicenter , prospect i ve , natural history cohort study .  Survival analysis methods were used to evaluate 6 outcome events related to abnormal cognitive and motor growth ( time to confirmed drop of 1 SD , time to first score < 69 , and time to confirmed drop of 2 SD ) in Bayley Scales of Infant Development Mental Developmental Index ( MDI ) and Psychomotor Developmental Index ( PDI ) scores among infected ( n = 114 ) and uninfected ( n = 481 ) infants . Proportional hazards modeling was used to evaluate the effects of HIV infection status , prematurity , prenatal exposure to illicit drugs , maternal educational attainment , and primary language . Results . HIV-1 infection was significantly associated with increased risk for all outcome events related to abnormal mental and motor growth . Differences between infected and uninfected infants were apparent by 4 months of age . Prematurity was associated with increased risk for MDI < 69 and PDI < 69 . Maternal education of < 9 completed years was associated with increased risk for MDI < 69 . Neither prenatal exposure to illicit drugs nor primary language other than English was associated with abnormal development . Conclusion . A significant proportion of infants with HIV-1 infection show early and marked cognitive and motor delays or declines that may be important early indicators of HIV disease progression . These abnormalities are independent of other risk factors for developmental delay BACKGROUND To determine the effect of developmental care on neurodevelopmental outcome in formerly preterm infants at a corrected age of 2 years . METHODS A prospect i ve phase-lag study was performed at an Austrian neonatal intensive care unit ( NICU ) . From January 2003 to December 2005 ( study period of conventional care ) and January 2007 to December 2009 ( study period of developmental care ) , we enrolled all infants born in Tyrol at less than 32 weeks of gestation . During this period a total of 261 of 359 preterm infants ( participation rate 72.7 % ) completed the follow-up visit at 2 years of age ; there were 124 children in the conventional and 137 in the developmental care group . The association between developmental care and delayed motor or mental development ( Bayley Scales of Infant Development II ; psychomotor or mental developmental index < 85 ) was analyzed by means of logistic regression analysis at a corrected age of 24 months . RESULTS Children in the developmental care group showed less psychomotor delay than did those in the control group ( developmental care group : 16.1 % , conventional care group 27.4 % ; adjusted odds ratio 0.37 [ 95 % confidence interval : 0.19 - 0.74 ] , P=0.005 ) . Not smoking in pregnancy and higher gestational age were also significant predictors for a better psychomotor outcome at 2 years of age . Regarding cognitive outcome , no significant difference was observed between these two groups . CONCLUSION Our data implicate that developmental care may result in an improved 2-year psychomotor outcome in formerly preterm infants OBJECTIVE . This was a r and omized , controlled trial to investigate the effect of Newborn Individualized Developmental Care and Assessment Program on growth , cognitive , psychomotor , and neuromotor development at 1 and 2 years in infants born at < 32 weeks ’ gestational age . METHODS . Infants were r and omly assigned within 48 hours of birth to the  newborn individualized developmental care and assessment program group ( intervention ) or basic developmental care group ( control group [ ie , incubator covers and nests ] ) . At 1 and 2 years ’ corrected age , growth was measured and st and ardized neurologic examinations were administered . Mental and psychomotor development was assessed by using the Dutch version of the Bayley Scales of Infant Development II . Neurologic outcome , Psychomotor Developmental Index , and Mental Developmental Index scores were combined a total outcome measure . RESULTS . One hundred sixty-eight infants were recruited ( intervention : 84 ; control : 84 ) . Four infants ( newborn intervention : 3 ; control : 1 ) were excluded because they were admitted less than or died within the first 5 days , leaving a total of 164 infants who met inclusion criteria .  In-hospital mortality was 8 of 81 in the intervention group and 3 of 83 in the control group . At 1 year of age 148 children ( intervention : 70 ; control : 78 ) and at 2 years of age 146 children ( intervention : 68 ; control : 78 ) were assessed . There was no significant difference in growth at 1 and 2 years of age . There was no significant difference found in neurologic outcomes or mental and psychomotor development at 1 and 2 years of age . When neurologic outcome , Mental Developmental Index and Psychomotor Developmental Index scores were combined , there still remained no significant difference . CONCLUSIONS . Newborn individualized developmental care and assessment program developmental care showed no effect on growth or neurologic , mental , or psychomotor development at 1 and 2 years of age in infants born at < 32 weeks . Duration of the intervention was not associated with neurologic and developmental outcome BACKGROUND AND OBJECTIVE Care based on the Newborn Individualized Developmental Care and Assessment Program ( NIDCAP ) has been reported to exert a positive impact on the development of prematurely born infants . The aim of the present investigation was to determine the effect of such care on the 1-year development of infants born with a gestational age of less than 32 weeks . METHODS All surviving infants ( 11 in the NIDCAP group and 9 in the control group ) were assessed employing the Bayley Scales of Infant Development at 1 year of corrected age . RESULTS The Mental Developmental Index ( MDI ) of children who had received care according to NIDCAP was higher [ 88 ( 72 - 114 ) ] [ median ( range ) ] than the corresponding value for the control children [ 78 ( 50 - 82 ) ] ( p=0.01 ) . The odds ratio for being alive with an MDI>80 was 14 ( 95 % CI ; 1.4 - 141.5 ) in favour of the intervention group . However , the Psychomotor Developmental Indices ( PDI ) were not significantly different [ 85 ( 61 - 108 ) and 69 ( 50 - 114 ) , respectively ] ( p=0.23 ) . CONCLUSION Our findings indicate that care based on the NIDCAP might have a positive impact on the cognitive development of infants born very prematurely OBJECTIVE We previously demonstrated that antenatal phenobarbital does not decrease the risk of intracranial hemorrhage or early death in premature infants . The objective of the present study was to evaluate the impact of antenatal phenobarbital exposure on the neurodevelopmental outcome of premature infants born to women who were participating in the r and omized clinical trial of antenatal phenobarbital exposure . STUDY DESIGN Infants were evaluated at 18 to 22 months corrected age with a st and ard neurologic examination and the Bayley scales of infant development measuring the mental developmental index and the psychomotor developmental index . RESULTS Of the 578 infants < 34 weeks of gestational age who were born to women who were enrolled in the primary study , 7 infants died after discharge from the neonatal intensive care unit , and 135 infants were lost to follow-up . Infants who were lost to follow-up had a higher mean birth weight and gestational age and a lower maternal education , but the rates of intracranial hemorrhage were comparable to those infants who were evaluated . Among the infants who were evaluated ( n = 436 ; 76 % ) , the mean birth weight and gestational age , maternal education , and frequency and distribution of intracranial hemorrhage were similar in the antenatal phenobarbital exposed and placebo groups . Eighteen infants ( 8 % ) in the antenatal phenobarbital exposed group and 21 infants ( 11 % ) in the placebo group had cerebral palsy ( P = not significant ) . There was no difference between the 2 groups in either the median Bayley II mental developmental index ( 85 in the antenatal phenobarbital and 86 in the placebo group ) or the Psychomotor Developmental Index ( 91 in the antenatal phenobarbital and 91 in the placebo group ) . Infants with intracranial hemorrhage ( 23 % ) had significantly lower mental developmental index and psychomotor developmental index scores than infants with no intracranial hemorrhage , independent of antenatal phenobarbital exposure . In the total cohort of 436 infants , the presence of intracranial hemorrhage or periventricular leukomalacia was associated with lower mental developmental index and psychomotor developmental index scores ; the presence of increasing birth weight , maternal education , and a complete course of antenatal steroids was associated with a higher mental developmental index score . CONCLUSION Antenatal phenobarbital exposure did not favorably or adversely affect the neurodevelopmental outcome of premature infants at 18 to 22 months of age It is uncertain whether multiple micronutrients benefit the mental and psychomotor development of young children in developing countries . We conducted a r and omised double-blind controlled trial to evaluate the effect of a richly micronutrient-fortified v. a basal fortified porridge on mental and psychomotor development  in Zambian infants . Infants ( n 743 ) were r and omised at age 6 months to receive either the richly fortified or the basal fortified infant food and were followed up until 18 months of age . All the infants were evaluated monthly for achievement of a series of developmental milestones . The Bayley scales of infant development II were administered to a sub sample of 502 infants at 6 , 12 and 18 months . Rich micronutrient fortification had no significant benefit on the following : ( a ) number of developmental milestones achieved ( rate ratio at 12 months = 1·00 ; 95 % CI 0·96 , 1·05 ; P = 0·81 , adjusted for sex , socio-economic status and maternal education , with similar results at 15 and 18 months ) ; ( b ) ages of walking unsupported ( hazard ratio ( HR ) 1·04 ; 95 % CI 0·88 , 1·24 ; P = 0·63 , adjusted for the above covariates ) and of speaking three or four clear words ( HR 1·01 ; 95 % CI 0·84 , 1·20 ; P = 0·94 , adjusted for the above covariates ) ; ( c ) mental development index ( MDI ) and psychomotor development index ( PDI ) of the Bayley scales ( scores difference adjusted for baseline scores , age at the assessment , sex , socio-economic status , maternal education , language , age and HIV status : MDI 0·3 ( 95 % CI - 0·5 , 1·1 ) , P = 0·43 ; PDI - 0·1 ( 95 % CI - 0·9 , 0·7 ) , P = 0·78 ) . In conclusion , the results do not support the hypothesis that rich micronutrient fortification improves Zambian infants '  mental and motor development Objective : To investigate in a r and omised controlled trial the effect of basic elements of developmental care ( incubator covers and positioning aids ) on growth and neurodevelopment in infants born at < 32 weeks . Method : Infants were r and omised within 48 h of birth to a developmental care ( DC ) or st and ard care ( C ) group . Outcome measures at 1 and 2 years corrected age were growth , st and ardised neurological examinations , and mental ( MDI ) and psychomotor ( PDI ) development ( Dutch version of the Bayley Scales of Infant Development II ) . Results : 192 infants were recruited ( DC = 98 ; C = 94 ) . Thirteen infants ( DC = 7 , C = 6 ) were excluded because they were admitted for < 5 days or died within the first 5 days . In total , 179 infants met the inclusion criteria .  In-hospital mortality was 12/91 ( 13.2 % ) in the DC group and 8/88 ( 9.1 % ) in the C group . Assessment s were carried out on 147 children ( DC = 74 , C = 73 ) at 1 year and 142 children ( DC = 72 , C = 70 ) at 2 years . No significant difference in growth , neurological outcomes or MDI was found . A positive trend in PDI at 1 year ( p = 0.05 ) did not continue once the children reached 2 years . There was no difference found when neurological and developmental scores were combined . Conclusions : Basic developmental care has no positive effect on neurological and mental development or growth at 1 and 2 years of age in infants born at < 32 weeks . A positive effect on psychomotor development at 1 year did not continue at 2 years of age . Trial registration number : IS RCT N84995192 Objective : To evaluate differences in developmental assessment s using the current version of the Bayley Scales of Infant Development ( Bayley-III ) as compared to the older BSID-II . Previous studies suggest that average scores on the Bayley-III may be significantly higher than scores on the previous version , but the magnitude and potential impact of differences between these 2 assessment s are uncertain . Methods : We enrolled 77 former preterm infants ( born < 32 wk gestation and ⩽2000 g ) at 18 to 22 months corrected age in this r and omized crossover study . The Bayley-III was administered in follow-up clinic per st and ard of care . The BSID-II was administered during a separate study visit . The order of testing was r and omly assigned . The assessment s were performed 4 to 8 weeks apart by masked personnel . The main outcomes were mean difference between BSID-II Mental Development Index ( MDI ) and Bayley-III Cognitive Composite score , mean difference between BSID-II Psychomotor Development Index ( PDI ) and Bayley-III Motor Composite score , and difference in the proportion of infants classified as having “ developmental delay . ” Results : Bayley-III scores were significantly higher across the range of scores and in all domains . Mean Cognitive Composite scores were almost 1 SD higher than MDI scores ( 14.1 ± 12.9 points , p < .001 ) . Mean Motor Composite scores were 9.0 ± 11.9 points higher than PDI scores ( p < .001 ) . When severity of delay was classified using st and ardized cut-points for moderate and severe developmental delay ( 1 and 2 SDs below reference norm ) , 40 % of children ( n = 31/77 ) were classified as less severely delayed with the Bayley-III Cognitive Composite score than with the BSID-II MDI , whereas only 1 ( < 2 % ) was classified as more severely delayed with the Bayley-III ( p < .001 ) . Conclusion : These findings have critical implication s for both the interpretation of clinical research studies and determination of eligibility for services in high-risk children BACKGROUND We hypothesized that cognitive impairment and hemodynamic instability after infant cardiac surgery with cardiopulmonary bypass might be exacerbated by hemodilution . METHODS In a single-center r and omized trial with blinded assessment of outcomes , we compared use of 2 hemodilution protocol s during hypothermic cardiopulmonary bypass with infant cardiac surgery . The primary perioperative end point was lowest cardiac index in the first 24 hours postoperatively , and primary end points at age 1 year were scores on the Psychomotor Development Index and Mental Developmental Index of the Bayley Scales . RESULTS Among 147 subjects , 74 were assigned to the lower-hematocrit strategy ( 21.5 % + /- 2.9 % , mean + /- SD at onset of low-flow bypass ) and 73 to the higher-hematocrit strategy ( 27.8 % + /- 3.2 % ) . In intent-to-treat analyses the lower-hematocrit group had lower nadirs of cardiac index ( P = .02 ) , higher serum lactate levels 60 minutes after cardiopulmonary bypass ( P = .03 ) , and a greater percentage increase in total body water on the first postoperative day ( P = .006 ) . Blood product use and adverse events were similar in the 2 groups . At age 1 year ( 113 children ) , the lower-hematocrit group had worse scores on the Psychomotor Development Index ( 81.9 + /- 15.7 vs 89.7 + /- 14.7 , P = .008 ) , as well as more Psychomotor Development Index scores at least 2 SDs below the population mean ( 16/56 [ 29 % ] vs 5/53 [ 9 % ] , P = .01 ) . The groups had similar Mental Developmental Index scores and findings on neurologic examination . Inferences using hematocrit as a continuous variable were similar to those based on intent-to-treat analyses . CONCLUSIONS Hemodilution to a hematocrit level in wide use for cardiopulmonary bypass and thought to be safe is associated with adverse perioperative and developmental outcomes in infants Background Systematic review s have suggested that early intervention by means of specific motor training programs and general developmental programs in which parents learn how to promote infant development may be the most promising ways to promote infant motor and cognitive development of infants with or at high risk for developmental motor disorders . Objective The purpose of this study was to investigate the effects of a recently developed pediatric physical therapy intervention program ( “ Coping With and Caring for Infants With Special Needs ” [ COPCA ] ) on the development of infants at high risk for developmental disorders using a combined approach of a 2-arm r and omized trial and process evaluation . Setting The study was conducted at the University Medical Center Groningen in the Netherl and s. Participants and Intervention Forty-six infants at high risk for developmental disorders were r and omly assigned to receive  COPCA ( a family-centered program ) ( n=21 ) or traditional infant physical therapy ( TIP ) ( n=25 ) between 3 to 6 months corrected age ( CA ) . Developmental outcome was assessed by blinded assessors at 3 , 6 , and 18 months CA with a neurological examination , the Alberta Infant Motor Scales , the Pediatric Evaluation of Disability Inventory , and the Mental Developmental Index ( MDI ) of the Bayley Scales of Infant Development . Contents of the intervention were analyzed by a quantitative video analysis of therapy sessions . Quantified physical therapy actions were correlated to evaluate associations between intervention and developmental outcome components . Results The trial revealed that developmental outcome in both groups was largely identical . Process evaluation showed that typical COPCA actions—(1 ) family involvement and educational actions , ( 2 ) application of a wide variation in challenging the infant to produce motor behavior by himself or herself and allowing the infant to continue this activity , and ( 3 ) stimulation of motor behavior at the limit of the infant 's capabilities — had positive correlations with developmental outcome at 18 months CA . The use of h and ling techniques was negatively associated with the Pediatric Evaluation of Disability Inventory outcome at 18 months CA . Limitations Major limitations were the limited size of the groups studied and the differences between the groups in frequency and duration of physical therapy sessions . Conclusion Extending the r and omized trial with process evaluation was needed to obtain insight into associations between the components of intervention and developmental outcome . Specific therapist behaviors of parent coaching are associated with improved developmental outcome measures . Further studies are needed to examine whether these associations are caused by therapist behavior or whether therapist behavior is modified by children 's motor skills OBJECTIVE To assess neurodevelopment in children with hypoplastic left heart syndrome ( HLHS ) or other types of functionally single ventricle ( univentricular heart , UVH ) and to estimate the effect of possible clinical predictors on outcome . STUDY DESIGN A total of 22 patients with HLHS and 14 with UVH , surviving after palliative surgery performed in the same center , and 42 healthy control subjects were examined at a median age of 30.2 months neurologically and according to the Bayley Scales of Infant Development  in a population based prospect i ve neurodevelopmental follow-up study . RESULTS The mean Mental Developmental Index was significantly lower ( 89.9 ) in patients with HLHS than in control subjects ( 105.5 , P<.001 ) , whereas there was no difference between patients with UVH ( 98.5 ) and control subjects . The mean Psychomotor Developmental Index in patients with HLHS ( 80.7 , P<.001 ) as well as in those with UVH ( 94.5 , P=.016 ) was significantly inferior to that in control subjects ( 105.3 ) . CONCLUSIONS In patients with HLHS , mean Mental Developmental Index lags behind control subjects . Psychomotor Developmental Index is impaired in patients with both HLHS and UVH . Routine neurodevelopmental follow-up is recommended for this seriously ill patient group
Perioperative risk factors were inconsistently associated with developmental outcomes .
INTERPRETATION The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes .
WHAT THIS PAPER ADDS Children with complex congenital heart disease ( CHD ) are at increased risk of impaired developmental outcome .
Children with single-ventricle CHD have worse outcomes than children with two-ventricle CHD .
Children with two-ventricle CHD gradually grow out of their initial developmental impairment .
Perioperative factors are inconsistently associated with outcome
AIM ( 1 ) To systematic ally review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease ( CHD ) who underwent early surgery ; ( 2 ) to run a meta-regression analysis on the Bayley Scales of Infant Development , Second Edition Mental Developmental Index and Psychomotor Developmental Index ( PDI ) of infants up to 24 months and IQs of preschool-aged children to adolescents ; ( 3 ) to assess associations between perioperative risk factors and outcomes .