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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. 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The Infant Behavioral Assessment and Intervention Program for very low birth weight infants at 6 months corrected age. Long‐chain polyunsaturated fatty acids and neurological developmental outcome at 18 months in healthy term infants
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 The effects of dietary docosahexaenoic acid ( DHA ) supply during infancy on later cognitive development of healthy term infants were evaluated in a r and omized clinical trial of infant formula milk supplemented with 0.35 % DHA or with 0.36 % DHA and 0.72 % arachidonic acid ( AA ) , or control formula which provided no DHA or AA .  Fifty-six 18-month-old children ( 26 male , 30 female ) who were enrolled in the trial within the first 5 days of life and fed the assigned diet to 17 weeks of age were tested using the Bayley Scales of Infant Development , 2nd edition ( BSID-II ) ( Bayley 1993 ) at the Retina Foundation of the Southwest , Dallas , TX . These children had also been assessed at 4 months and 12 months of age for blood fatty-acid composition , sweep visual evoked potential ( VEP ) acuity , and forced-choice preferential looking ( FPL ) acuity ( Birch et al. 1998 ) . Supplementation of infant formula with DHA+AA was associated with a mean increase of 7 points on the Mental Development Index ( MDI ) of the BSID-II . Both the cognitive and motor subscales of the MDI showed a significant developmental age advantage for DHA- and DHA+AA-supplemented groups over the control group . While a similar trend was found for the language subscale , it did not reach statistical significance . Neither the Psychomotor Development Index nor the Behavior Rating Scale of the BSID-II showed significant differences among diet groups , consistent with a specific advantage of DHA supplementation on mental development . Significant correlations between plasma and RBC-DHA at 4 months of age but not at 12 months of age and MDI at 18 months of age suggest that early dietary supply of DHA was a major dietary determinant of improved performance on the MDI BACKGROUND It is not known whether developmental and neurological outcomes in the preschool period differ depending on whether the predominant vital organ support strategy used in infant heart surgery was total circulatory arrest ( CA ) or low-flow cardiopulmonary bypass . METHODS AND RESULTS Infants with D-transposition of the great arteries who underwent an arterial-switch operation were r and omly assigned to a support method consisting predominantly of CA or low-flow cardiopulmonary bypass .  Developmental and neurological status were evaluated blindly at 4 years of age in 158 of 163 eligible children ( 97 % ) . Neither IQ scores nor overall neurological status were significantly associated with either treatment group or duration of CA . The CA group scored lower on tests of motor function ( gross motor , P=0.01 ; fine motor , P=0.03 ) and had more severe speech abnormalities ( oromotor apraxia , P=0.007 ) . Seizures in the perioperative period , detected either clinical ly or by continuous electroencephalographic monitoring , were associated with lower mean IQ scores ( 12.6 and 7.7 points , respectively ) and increased risk of neurological abnormalities ( odds ratios , 8.4 and 5.6 , respectively ) . The performance of the full cohort was below expectations in several domains , including IQ , expressive language , visual-motor integration , motor function , and oromotor control . CONCLUSIONS Use of CA to support vital organs during open heart surgery in infancy is associated , at the age of 4 years , with worse motor coordination and planning but not with lower IQ or with worse overall neurological status OBJECTIVES / AIM To determine whether sedation/analgesia drugs used before , during , and after infant cardiac surgery are associated with neurocognitive and functional outcomes . BACKGROUND Some animal models suggest neurotoxic effects of anesthetic drugs on the developing brain ; however , potential human effects are unknown . Whether these results can be extrapolated to humans is unknown . METHODS / MATERIAL S Prospect i ve follow-up project of all infants ≤6 weeks old having surgery for congenital heart disease between 04/03 and 12/06 . Demographic , perioperative , and sedation/analgesia variables were collected . Outcomes at kindergarten age were Wechsler Preschool and Primary Scale of Intelligence-III , Beery-Buktenica Developmental Test of Visual Motor Integration ( VMI-V ) , and General Adaptive Composite ( GAC ) of the Adaptive Behavior Assessment System-II .  Multivariable linear regression was used to identify predictor variables . RESULTS From 135 infants who underwent heart surgery , 19 died , 17 were excluded , 8 were lost to follow-up , leaving 91 children for analysis . Multiple linear regression found days on chloral hydrate [ 3.5 ( 3.7 ) days ] was associated with lower performance intelligence quotient ( PIQ ) ( Effect size -1.03 ; 95 % CI -1.96 , -0.10 ; P = 0.03 ) , and cumulative dose [ 54.2 ( 60.3 ) mg·kg(-1 ) ] of benzodiazepines was associated with lower VMI scores ( Effect size -0.07 ; 95 % CI -0.12 , -0.01 ; P = 0.026 ) . No other associations were found between sedation/analgesia variables and full-scale IQ , PIQ , Verbal IQ , VMI , or GAC . CONCLUSION Assessment of this cohort at kindergarten age found a small statistically significant association between days on chloral hydrate and PIQ , and benzodiazepine cumulative dose and lower VMI . No other association between sedation/analgesia drugs and outcomes was found In a double-blind , placebo-control prospect i ve cohort study of 196 infants from birth to 15 months of age , assessment was made at 12 months of age of the relationship between iron status and psychomotor development , the effect of a short-term ( 10-day ) trial of oral iron vs placebo , and the effect of long-term ( 3 months ) oral iron therapy . Development was assessed with the mental and psychomotor indices and the infant behavior record of the Bayley Scales of Infant Development in 39 anemic , 30 control , and 127 nonanemic iron-deficient children . Anemic infants had significantly lower Mental and Psychomotor Developmental Index scores than control infants or nonanemic iron-deficient infants ( one-way analysis of variance , P less than .0001 ) . Control infants and nonanemic iron-deficient infants performed comparably . No difference was noted between the effect of oral administration of iron or placebo after 10 days or after 3 months of iron therapy . Among anemic infants a hemoglobin concentration less than 10.5 g/dL and duration of anemia of greater than 3 months were correlated with significantly lower motor and mental scores ( P less than .05 ) . Anemic infants failed specifically in language capabilities and body balance-coordination skills when compared with controls . These results , in a design in which intervening variables were closely controlled , suggest that when iron deficiency progresses to anemia , but not before , adverse influences in the performance of developmental tests appear and persist for at least 3 months despite correction of anemia with iron therapy . If these impairments prove to be long st and ing , prevention of iron deficiency anemia in early infancy becomes the only way to avoid them OBJECTIVE The purpose of this study was to describe social-emotional outcomes and the relationship with neurodevelopmental outcomes in a cohort of 2-year-old children who underwent surgery for congenital heart disease ( CHD ) in infancy , and explore the relationship between the outcomes and parental and surgical factors . DESIGN A two-center prospect i ve cross-sectional cohort study . PATIENTS A cohort of 105 2-year-olds who underwent surgery in infancy for severe CHD MEASURES : Social-emotional and neurodevelopment was evaluated with the  Infant and Toddler Social and Emotional Assessment tool ( ITSEA ) , and the Bayley Scales of Infant Toddler Development , Third Edition . RESULTS Neurodevelopment was delayed in the CHD cohort with significantly worse results compared to published Australian-based norms in all domains ( P < .001 ) and in the Cognitive ( P < .001 ) and Language ( P < .001 ) domains with respect to the reported American norms . Social-emotional outcome was similar to Australian norms in all domains but better than the American based norms in the Internalizing domain ( P < .05 ) . Higher maternal education was associated to better neurodevelopmental outcome in all domains and better scores in the internalizing and externalizing domains of the ITSEA . There was a moderate correlation ( r = 0.43 , P < .001 ) between Language and social-emotional competence . Motor development was influenced by the need for a significant cardiac reoperation . CONCLUSIONS The influences of social factors may be underestimated in the outcome of children with CHD .  Language development in those with CHD may be improved with intervention targeting social-emotional competence ; further research is needed in this area OBJECTIVE To assess the utility of a telephone-based interview system in providing ongoing monitoring of the developmental and functional status of children with both positive newborn screens for Krabbe disease and low galactocerebrosidase activity on confirmatory testing , and to determine whether this approach provides improved compliance with follow-up compared with formal neuropsychological testing . STUDY DESIGN Infants with low galactocerebrosidase activity ( as detected by the New York State newborn screening program ) were eligible for this longitudinal prospect i ve cohort study . Consenting families were interviewed by telephone  at infant ages of 4 , 8 , 12 , 18 , and 24 months . Design ated instruments were the Ages and Stages Question naires , the Clinical Linguistic and Auditory Milestone Scale , the Gross Motor Quotient , the Warner Initial Developmental Evaluation of Adaptive and Functional Skills 50 , and the WeeFIM II 0 - 3 instrument . Assessment s with the Bayley Scales of Infant and Toddler Development , Third Edition ( Bayley III ) were scheduled at age 12 and 24 months . RESULTS Seventeen patients were enrolled ; 16 were assessed at age 12 and 18 months , and 15 were assessed at age 24 months . Scores were within the normal range on all tests of developmental and functional status , with the exception of expressive language . Only 7 patients completed the Bayley Scales of Infant and Toddler Development , Third Edition assessment s ; all their scores were in the normal range . CONCLUSION This telephone-based technique allows close monitoring of the developmental and functional status of children with a positive newborn screen for this neurometabolic disease , with special attention to detecting plateauing or regression of developmental milestones . Compliance is improved compared with formal neuropsychological testing Objective Historical cohort studies have reported adverse neurodevelopment following cardiac surgery during early infancy . Advances in surgical techniques and perioperative care have coincided with updating of neurodevelopmental assessment tools . We aim ed to determine perioperative risk factors for impaired neurodevelopment at 2 years following surgery for congenital heart disease ( CHD ) in early infancy . Design and patients We undertook a prospect i ve longitudinal study of 153 full-term infants undergoing surgery for CHD before 2 months of age . Infants were excluded if they had a genetic syndrome associated with neurodevelopmental impairment . Outcome measures Predefined perioperative parameters were recorded and infants were classified according to cardiac anatomy . At 2 years , survivors were assessed using the Bayley Scales of Infant Development-III . Results At 2 years , 130 children ( 98 % of survivors ) were assessed . Mean cognitive , language and motor scores were 93.4±13.6 , 93.6±16.1 and 96.8±12.5 respectively ( 100±15 norm ) . Twenty ( 13 % ) died and 12 ( 9 % ) survivors had severe impairment ( score < 70 ) , mostly language ( 8 % ) . The lowest scores were in infants born with single ventricle physiology with obstruction to the pulmonary circulation who required a neonatal systemic-to-pulmonary artery shunt . Additional risk factors for impairment included reduced gestational age , postoperative elevation of lactate or S100B and repeat cardiac surgery . Conclusions In the modern era of infant cardiac surgery and perioperative care , children continue to demonstrate neurodevelopmental delays . The use of up date d assessment tools has revealed early language dysfunction and relative sparing of motor function . Ongoing follow-up is critical in this high-risk population BACKGROUND Intracytoplasmic sperm injection ( ICSI ) was introduced as a new form of in-vitro fertilisation ( IVF ) in 1993 and is now accepted as the treatment of choice for severe male infertility in many centres around the world . However , there is little information about the long-term outcome of children conceived by ICSI .  We aim ed to find out the medical and developmental outcome of children conceived by ICSI  at age 1 year . METHODS In this prospect i ve study , we compared the medical and developmental outcome at 1 year of 89 children conceived by ICSI with 84 children conceived by routine IVF , and with 80 children conceived naturally .  Formal developmental assessment was done with Bayley Scales of Infant Development ( 2nd edition ) from which a mental development index ( MDI ) was derived . FINDINGS There was no significant difference in the incidence of major congenital malformations or major health problems in the first year of life . However , the mean Bayley MDI was significantly lower for the children conceived by ICSI than for the children conceived by routine IVF or naturally ( 95.9 [ SD 10.7 ] , 101.8 [ 8.5 ] , and 102.5 [ 7.6 ] , respectively , p < 0.0001 ) . 15 ( 17 % ) of 89 children conceived by ICSI experienced mildly or significantly delayed development ( MDI < 85 ) at 1 year compared with two ( 2 % ) of the 84 children conceived by IVF and one ( 1 % ) of the 80 children conceived by natural conception ( p < 0.0001 ) . INTERPRETATION Although most children conceived by ICSI are healthy and develop normally , there is an increased risk of mild delays in development at 1 year when compared with children conceived by routine IVF or conceived naturally . These findings support the need for ongoing developmental follow-up of children conceived by ICSI to see whether they are at increased risk of intellectual impairment or learning difficulties at school age BACKGROUND The outcome of infants who have transient seizures after open heart surgery has not been studied . Using the data base of the Boston Circulatory Arrest Study involving 171 children with D-transposition of the great arteries , we explored the relationship between early postoperative clinical and EEG seizures and neurodevelopmental outcomes at ages 1 and 2 1/2 years . METHODS AND RESULTS At 1 year , children returned for developmental and neurological evaluations  and MRI . Parent-completed developmental question naires were collected at 2 1/2 years of age . At 1 year , children with early postoperative seizures had lower Psychomotor Development Index ( motor function ) scores ( clinical seizures : 12.9 mean difference [ MD ] ; 95 % confidence interval [ CI ] , 2.2 to 23.6 ; P=.02 ; EEG seizures : 13.3 MD ; 95 % CI , 6.8 to 19.7 ; P<.001 ) . Mental Developmental Index scores of children with clinical or EEG seizures were also lower , but the differences were not statistically significant . Infants with seizures were more likely to have an abnormal neurological examination ( clinical seizures : 78 % versus 31 % ; P=.008 ; EEG seizures : 58 % versus 34 % ; P=.04 ) . Children with EEG seizures were more likely to have MRI abnormalities ( 43 % versus 13 % , P=.002 ) . At age 2 1/2 , children with EEG seizures had lower scores in several areas of function . CONCLUSIONS In infants undergoing the arterial switch operation for correction of D-transposition of the great arteries , transient postoperative clinical and EEG seizures were associated with worse neurodevelopmental outcomes at ages 1 and 2 1/2 years as well as neurological and MRI abnormalities at 1 year of age . The occurrence of such seizures may provide an early sign of brain injury with neurological and developmental sequelae OBJECTIVE . Beneficial effects of breast milk on cognitive skills and behavior ratings have been demonstrated previously in term and very low birth weight infants . Extremely low birth weight infants are known to be at increased risk for developmental and behavior morbidities . The benefits of breast milk that is ingested in the NICU by extremely low birth weight infants on development and behavior have not been evaluated previously . METHODS . Nutrition data including enteral and parenteral feeds were collected prospect ively , and follow-up assessment s of 1035 extremely low birth weight infants at 18 months ’ corrected age were completed at 15 sites that were participants in the National Institute of Child Health and Human Development Neonatal Research Network Glutamine Trial between October 14 , 1999 , and June 25 , 2001 .  Total volume of  breast milk feeds  ( mL/kg per day ) during hospitalization was calculated . Neonatal characteristics and morbidities , interim history , and neurodevelopmental and growth outcomes at 18 to 22 months ’ corrected age were assessed . RESULTS . There were 775 ( 74.9 % ) infants in the breast milk and 260 ( 25.1 % ) infants in the no breast milk group . Infants in the breast milk group were similar to those in the no breast milk group in every neonatal characteristic and morbidity , including number of days of hospitalization . Mean age of first day of breast milk for the breast milk infants was 9.3 ± 9 days . Infants in the breast milk group began to ingest non – breast milk formula  later ( 22.8 vs 7.3 days ) compared with the non – breast milk group . Age at achieving full enteral feeds was similar between the breast milk and non – breast milk groups ( 29.0 ± 18 vs 27.4 ± 15 ) . Energy intakes of 107.5 kg/day and 105.9 kg/day during the hospitalization did not differ between the breast milk and non – breast milk groups , respectively . At discharge , 30.6 % of infants in the breast milk group still were receiving breast milk . Mothers in the breast milk group were significantly more likely to be white ( 42 % vs 27 % ) , be married ( 50 % vs 30 % ) , have a college degree ( 22 % vs 6 % ) , and have private health insurance ( 34 % vs 18 % ) compared with the no breast milk group . Mothers who were black , had a low household income ( ≤$20000 ) , or had higher parity were less likely to provide breast milk feeds . The analysis of outcomes between the any human milk and no human milk groups were adjusted for maternal age , maternal education , marital status , race/ethnicity , and the other st and ard covariates . Children in the breast milk group were more likely to have a Bayley Mental Development Index ≥85 , higher mean Bayley Psychomotor Development Index , and higher Bayley Behavior Rating Scale percentile scores for orientation/engagement , motor regulation , and total score . There were no differences in the rates of moderate to severe cerebral palsy or blindness or hearing impairment between the 2 study groups . There were no differences in the mean weight ( 10.4 kg vs 10.4 kg ) , length ( 80.5 cm vs 80.5 cm ) , or head circumference ( 46.8 cm vs 46.6 cm ) for the breast milk and no breast milk groups , respectively , at 18 months . Multivariate analyses , adjusting for confounders , confirmed a significant independent association of breast milk on all 4 primary outcomes : the mean Bayley ( Mental Development Index , Psychomotor Development Index , Behavior Rating Scale , and incidence of rehospitalization ) . For every 10-mL/kg per day increase in breast milk ingestion , the Mental Development Index increased by 0.53 points , the Psychomotor Development Index increased by 0.63 points , the Behavior Rating Scale percentile score increased by 0.82 points , and the likelihood of rehospitalization decreased by 6 % . In an effort to identify a threshold effect of breast milk on Bayley Mental Development Index and Psychomotor Development Index scores and Behavior Rating Scale percentile scores , the mean volume of breast milk per kilogram per day during the hospitalization was calculated , and infants in the breast milk group were divided into quintiles of breast milk ingestion adjusted for confounders . Overall , the differences across the feeding quintiles of Mental Development Index and Psychomotor Development Index were significant . There was a 14.0 % difference in Behavior Rating Scale scores between the lowest and highest quintiles . For the outcomes ( Mental Development Index , Psychomotor Development Index , Behavior Rating Scale , and Rehospitalization < 1 year ) , only the values for the > 80th percentile quintile of breast milk feeding were significantly different from the no breast milk values . In our adjusted regression analyses , every 10 mL/kg per day breast milk contributed 0.53 points to the Bayley Mental Development Index ; therefore , the impact of breast milk ingestion during the hospitalization for infants in the highest quintile ( 110 mL/kg per day ) on the Bayley Mental Development Index would be 10 × 0.53 , or 5.3 points . CONCLUSIONS . An increase of 5 points potentially would optimize outcomes and decrease costs by decreasing the number of very low birth weight children who require special education services . The societal implication s of a 5-point potential difference ( one third of an SD ) in IQ are substantial . The potential long-term benefit of receiving breast milk in the NICU for extremely low birth weight infants may be to optimize cognitive potential and reduce the need for early intervention and special education services OBJECTIVES The purpose s of this study were to report the neurodevelopmental , neurosensory , and functional outcomes of 1151 extremely low birth weight ( 401 - 1000 g ) survivors cared for in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network , and to identify medical , social , and environmental factors associated with these outcomes . STUDY DESIGN A multicenter cohort study in which surviving extremely low birth weight infants born in 1993 and 1994 underwent neurodevelopmental , neurosensory , and functional assessment  at 18 to 22 months ' corrected age . Data regarding pregnancy and neonatal outcome were collected prospect ively . Socioeconomic status and a detailed interim medical history were obtained at the time of the assessment . Logistic regression models were used to identify maternal and neonatal risk factors for poor neurodevelopmental outcome . RESULTS Of the 1480 infants alive at 18 months of age , 1151 ( 78 % ) were evaluated . Study characteristics included a mean birth weight of 796 + /- 135 g , mean gestation ( best obstetric date s ) 26 + /- 2 weeks , and 47 % male . Birth weight distributions of infants included 15 infants at 401 to 500 g ; 94 at 501 to 600 g ; 208 at 601 to 700 g ; 237 at 701 to 800 g ; 290 at 801 to 900 g ; and 307 at 901 to 1000 g. Twenty-five percent of the children had an abnormal neurologic examination , 37 % had a Bayley II Mental Developmental Index < 70 , 29 % had a Psychomotor Developmental Index < 70 , 9 % had vision impairment , and 11 % had hearing impairment . Neurologic , developmental , neurosensory , and functional morbidities increased with decreasing birth weight . Factors significantly associated with increased neurodevelopmental morbidity included chronic lung disease , grade s 3 to 4 intraventricular hemorrhage/periventricular leukomalacia , steroids for chronic lung disease , necrotizing enterocolitis , and male gender . Factors significantly associated with decreased morbidity included increased birth weight , female gender , higher maternal education , and white race . CONCLUSION ELBW infants are at significant risk of neurologic abnormalities , developmental delays , and functional delays at 18 to 22 months ' corrected age The aim of this prospect i ve pilot study was to evaluate the predictive value of discrimination and habituation , which was measured by mismatch negativity in 17 healthy very preterm ( mean gestational age 27.4 weeks ; range 25.0 - 31.3 ) and 16 term ( mean gestational age 40.3 weeks ; range 37.9 - 41.7 ) born infants at term equivalent age .  Developmental outcome was measured by Bayley Scales of Infant Development – I in 13 preterm and 13 term-born children at a mean age of 21.7 months ( ±2.18 ) and 18.5 months ( ±1.9 ) , respectively . No differences in amplitude and latency of the mismatch negativity were found between both groups at term equivalent age . Within the preterm group habituation capacity was positively correlated with the Mental Developmental Index ( r = .654 , P = .008 ) and Performance Developmental Index ( r = .482 , P = .048 ) at 21 months . Early learning capability , as measured by habituation , may be associated with a better prognosis for early mental development in healthy preterm infants OBJECTIVE : The goal was to examine the effectiveness of an early intervention on cognitive and motor outcomes at corrected ages of 3 and 5 years for children with birth weights ( BWs ) of < 2000 g. METHODS : A r and omized controlled trial of a modified version of the Mother-Infant Transaction Program was performed . Outcomes were assessed with the Bayley Scales of Infant Development II and the Wechsler Preschool and Primary Scale of Intelligence-Revised at 3 and 5 years , respectively . McCarthy Scales of Children 's Abilities and the grooved pegboard test were used to test motor outcomes at 5 years . RESULTS : A total of 146 infants were assigned r and omly ( intervention group : 72 infants ; control group : 74 infants ) . The mean  BWs were 1396 ± 429 g for the intervention group and 1381 ± 436 g for the control group . After adjustment for maternal education , a nonsignificant difference in Mental Developmental Index scores at 3 years of 4.5 points ( 95 % confidence interval : −0.3 to 9.3 points ) in favor of the intervention group was found , whereas the intervention effect on full-scale IQ scores at 5 years was 6.4 points ( 95 % confidence interval : 0.6–12.2 points ) . Significantly more children in the intervention group had IQ scores of ≥85 at 3 and 5 years . There were no differences between the groups with respect to motor outcomes . CONCLUSION : This modified version of the Mother-Infant Transaction Program  improved cognitive outcomes at corrected age of 5 years for children with BWs of < 2000 Objective . To determine whether dietary long-chain polyunsaturated fatty acids ( LCPUFA ) , such as docosahexaenoic acid ( DHA ) and arachidonic acid , affect visual evoked potential ( VEP ) acuity of formula-fed infants , relative to breastfed infants . A secondary objective was to assess the effect of LCPUFA on Bayley 's mental developmental index ( MDI ) and psychomotor developmental index ( PDI ) . Methods . Formula-fed infants were r and omly allocated , in a double-blind manner , to either a placebo ( no LCPUFA;n = 21 ) , DHA supplemented ( n = 23 ) , or DHA+arachidonic acid supplemented formula ( n = 24 ) . Infants were fed their assigned formula from the first week of life until 1 year of age . A parallel reference group of breastfed infants was recruited and followed ( n = 46 ) . Infant VEP acuity was assessed at 16 and 34 weeks , and Bayley 's MDI and PDI were assessed at 1 and 2 years of age . Results . There were no differences among the r and omized formula groups for VEP acuity at either 16 or 34 weeks of age . Breastfed infants had better VEP acuity at 34 weeks of age , but not at 16 weeks , compared with all formula-fed infants . Bayley 's MDI and PDI were similar in the 3 formula-fed groups at 1 and 2 years . Breastfed infants had higher MDI scores than formula-fed infants at 2 years of age even after adjusting for environmental variables . Conclusions . LCPUFA supplementation did not influence VEP acuity development in these well-nourished , formula-fed infants PURPOSE To determine the influence of breastmilk consumption , as a dose response , in very low-birth-weight ( VLBW ) infants ( < 1,500 g ) on neurodevelopmental outcomes at 6 and 12 months corrected age , and to determine the influence of selected sociodemographic and infant variables on neurodevelopmental outcomes . SUBJECTSVLBW infants ( n = 148 ) who were fed mother 's milk or formula by parental choice . DESIGN Prospect i ve cohort with longitudinal follow-up at 6 and 12 months corrected age . METHODS Self-administered question naires given to mothers at study entry , before discharge , and at 3- , 6- , and 12-month follow-up visits . During hospitalization , mothers recorded the 24-hour volume of expressed milk once per week . At each follow-up visit , the volume of a  single feeding was assessed by pre- and postbreastfeeding test weights of infants measured on an electronic scale accurate to 1.0 g. The amount of breastfeeding was also assessed by feeding records and mother 's report . MAIN OUTCOME MEASURES The Bayley Scales of Infant Development ( 2nd Edition ) , the Mental Development Index ( MDI ) , and the Psychomotor Development Index ( PDI ) . PRINCIPAL RESULTS After controlling for specific sociodemographic and infant variables , this study of VLBW infants showed no statistically significant effect of predominantly breastfeeding compared with predominantly formula feeding on neurodevelopmental outcomes to 12 months corrected age . The most significant predictor of MDI scores at 6 and 12 months corrected age was birth weight , in which higher birth weights predicted higher MDI scores . CONCLUSIONS Despite the lack of statistically significant differences , the findings suggest a small but consistent advantage in developmental scores in infants who were fed their mother 's milk compared with those who were predominantly formula fed . Supporting parents to breastfeed preterm infants may maximize the potential advantages of early nutrition in the neurodevelopmental outcome of VLBW infants BACKGROUND Premature infants who have transient hypothyroxinemia in the first weeks of life may have developmental delay and neurologic dysfunction . Whether thyroxine treatment during this period results in improved developmental outcomes is not known . METHODS We carried out a r and omized , placebo-controlled , double-blind trial of thyroxine supplementation in 200 infants born at less than 30 weeks ' gestation .  Thyroxine ( 8 microg per kilogram of birth weight ) or placebo was administered daily , starting 12 to 24 hours after birth , for six weeks . Plasma free thyroxine concentrations were measured weekly for the first eight weeks after birth . Scores on the Bayley Mental and Psychomotor Development Indexes and neurologic function were assessed at 6 , 12 , and 24 months of age ( corrected for prematurity ) . RESULTS Mortality and morbidity up to the time of discharge from the hospital were similar in the study groups . At 24 months of age , 157 infants were evaluated . Overall , neither mental nor psychomotor scores differed significantly between the study groups at any time , nor was the frequency of abnormal neurologic outcome significantly different . In thyroxine-treated infants born at gestational ages of less than 27 weeks , the score on the Bayley Mental Development Index at 24 months of age was 18 points higher than the score for the infants with similar gestational ages at birth in the placebo group ( P=0.01 ) ; for thyroxine-treated infants born at 27 weeks or later , the mental-development score was 10 points lower than that of their counterparts in the placebo group ( P=0.03 ) . There was no relation between the initial plasma free thyroxine concentration and the effect of treatment . CONCLUSIONS In infants born before 30 weeks ' gestation , thyroxine supplementation does not improve the developmental outcome at 24 months INTRODUCTION There is debate about the type and intensity of early childhood intervention that is most helpful for children with developmental problems . The aim of the study was to determine whether a home-based programme provided over 12 months result ed in sustained improvement in development and behaviour 12 months after the intervention ceased . The characteristics of the children and families who benefited most from the intervention were also studied . METHOD R and omized controlled trial . Participants A total of 59 children , aged 3 - 5 years , attending two early childhood intervention centres in Melbourne , Australia . Intervention  Half of the subjects received an additional home-based programme consisting of 40 weekly visits . MAIN OUTCOME MEASURES Bayley Scales of Infant Development and Wechsler Preschool and Primary Scale of Intelligence Revised , Preschool Behaviour Checklist , Bayley Behaviour Rating Scale and Behaviour Screening Question naire . All tests administered pre-intervention , following the intervention and 12 months later . Secondary outcome measures Family stress , support and empowerment . RESULTS Fifty-four children completed the assessment s 12 months after conclusion of the intervention . Compared with the control group , improvement in aspects of cognitive development in the children who received the extra intervention was sustained 1 year later ( P= 0.007 ) while significant behavioural differences post intervention were not . Analyses of the data by the Reliable Change Index indicated improvement of clinical significance occurred in non-verbal areas . In contrast to the control group who deteriorated , language skills in the intervention group remained stable . Improvements were significantly associated with higher stress in the families . CONCLUSION Improvements following the provision of a home-based programme to preschool children with developmental disabilities were sustained 1 year later . Children from highly stressed families appeared to benefit most , reinforcing the importance of involving families in early childhood intervention programmes This article provides an overview of a longitudinal study on a cohort of 131 newborns and young infants with congenital heart defects who required open heart surgery .  The rationale for the study design is provided as well as a summary of the procedures used to evaluate these children prior to surgery , at discharge after surgery , 12 - 18 months later , and at 5 years of age . Results demonstrate that a substantial proportion of these infants had neurologic and developmental abnormalities prior to surgical repair . Developmental delays were common in children with both cyanotic and acyanotic heart defects , and these deficits persisted to school entry . A number of medical , surgical , demographic and environmental factors were significantly associated with developmental outcomes suggesting a multifactorial etiology to brain injury . Limited educational and rehabilitation re sources for this cohort at early school age suggests that service needs may need to be more carefully planned for this high-risk population . Lessons learnt from this prospect i ve study are highlighted as well as future directions for research and clinical practice Background — The Norwood procedure for stage 1 palliation of hypoplastic left heart syndrome is performed with either the modified Blalock-Taussig ( MBTS ) or the right ventricle – to – pulmonary artery ( RVPA ) shunt . In our institution , surgical practice changed from use of the MBTS to use of the RVPA shunt in 2002 . We analyzed survival and mental and psychomotor outcomes of the 2 consecutive surgical eras . Methods and Results — Between September 1996 and July 2005 , 94 neonates with hypoplastic left heart syndrome underwent the Norwood procedure .  Patients were recruited as neonates and followed up prospect ively . Health , mental , and psychomotor outcomes ( Bayley Scales of Infant Development-II ) were assessed at 2 years . The study subjects were from the Norwood-MBTS era ( n=62 ; 1996 to 2002 ) or the Norwood-RVPA era ( n=32 ; 2002 to 2005 ) . In the MBTS era , early and 2-year mortality rates were 23 % ( 14/62 ) and 52 % ( 32/62 ) ; the mean ( SD ) mental and psychomotor developmental indices were 79 ( 18 ) and 67 ( 19 ) . In the RVPA era , early and 2-year mortality rates were 6 % ( 2/32 ) and 19 % ( 6/32 ) ; the mean ( SD ) mental and psychomotor developmental indices were 85 ( 18 ) and 78 ( 18 ) . The 2-year mortality rate ( P=0.002 ) and the psychomotor developmental index ( P=0.029 ) were improved in the more recent surgical era . On multivariable Cox regression analysis , postoperative highest serum lactate independently predicted 2-year mortality in the MBTS and RVPA eras . Conclusions — Analysis of 2 consecutive surgical eras of hypoplastic left heart syndrome patients undergoing the Norwood procedure showed a significant improvement in 2-year survival and psychomotor development in the more recent era . Adverse neurodevelopmental outcome in this patient population remains a concern OBJECTIVE We tested the hypothesis that balanced addition of long-chain polyunsaturated fatty acid ( LCPUFA ) to preterm formula during the first weeks of life would confer long-term neurodevelopmental advantage in a double-blind , r and omized , controlled trial of preterm formula with and without preformed LCPUFA . METHODS The participants were 195 formula-fed preterm infants ( birth weight < 1750 g , gestation < 37 weeks ) from 2 UK neonatal units and 88 breast milk-fed infants . Main outcome measures were Bayley Mental Developmental Index ( MDI ) and Psychomotor Developmental Index ( PDI ) at 18 months and Knobloch , Passamanick and Sherrard 's Developmental Screening Inventory at 9 months ' corrected age . Safety outcome measures were anthropometry at 9 and 18 months , tolerance , infection , necrotizing enterocolitis , and death . RESULTS There were no significant differences in developmental scores between r and omized groups , although infants who were fed LCPUFA-supplemented formula showed a nonsignificant 2.6-point ( 0.25 st and ard deviation ) advantage in MDI and PDI at 18 months , with a greater ( nonsignificant ) advantage ( MDI : 4.5 points ; PDI : 5.8 points ) in infants below 30 weeks ' gestation . LCPUFA-supplemented infants were shorter than control infants at 18 months ( difference in length st and ard deviation score : 0.44 ; 95 % confidence interval : 0.08 - 0.8 ) . No other significant short- or long-term differences in safety outcomes were observed . Breastfed infants had significantly higher developmental scores at 9 and 18 months than both formula groups and were significantly heavier and longer at 18 months than LCPUFA-supplemented but not control infants . CONCLUSIONS With the dose , duration , and preparation of LCPUFA used , efficacy was not demonstrated , although an advantage in later neurodevelopment can not be excluded by global tests of development up to 18 months , particularly in infants below 30 weeks ' gestation . The surprising effect of LCPUFA-supplemented formula on growth 18 months beyond the intervention period needs to be confirmed in other studies using similar supplementation strategies . Additional follow-up of this cohort is critical at an age when more specific tests of cognitive function are possible OBJECTIVE To determine the relationship between type of  infant feeding and mental and psychomotor development  at age 18 months . METHOD A follow-up study of children born to primigravidae living in Dundee and booked into antenatal clinics in the City of Dundee ( Local Authority District ) from 1 May 1985 to 30 April 1986 . The study population was 846 first born singletons , of whom 592 attended for developmental assessment at age 18 months . The main outcome measures were the Bayley Scales of Infant Mental and Motor Development . RESULTS Higher mental development was significantly related to breast feeding on discharge from hospital and according to the health visitors ' notes at about 2 weeks after discharge after allowing for partner 's social class , mother 's education , height , alcohol and cigarette consumption ; placental weight and the child 's sex , birth weight and gestational age at birth . After adjustment for statistically significant variables , the difference in Bayley mental development index between breast and bottle fed infants was between 3.7 and 5.7 units depending on the source of feeding data . No differences were found for psychomotor development or behaviour . CONCLUSION The study provides further evidence of a robust statistical association between type of feeding and child intelligence . However , the literature is replete with suggestions for potential confounding variables which offer alternative causal explanations . To unravel what is an important clinical and public health question , further research should concentrate on r and omized trials of supplemented formula feeds for children of mothers opting for bottle feeding and on epidemiological studies design ed to disentangle the relation between method of feeding , parental intelligence and social environment The aims of the study were to examine the relationship between long-chain polyunsaturated fatty acid ( LCPUFA ) status at diagnosis of phenylketonuria ( PKU ) and neurodevelopment through the first 12 months of life , and to assess whether any difference exists between infants breastfed and bottlefed in the first days of life on the basis of LCPUFA status . Twenty infants with PKU were prospect ively examined through the first year of life .  Plasma fatty acids  were measured in infants at diagnosis . Plasma phenylalanine levels were determined monthly . Main outcome measures were the Bayley Mental Developmental Index ( MDI ) and Psychomotor Developmental Index ( PDI ) at 5 and 12 months of age , and the visual function at 12 months , evaluated by P100 wave latencies with visual evoked potentials . A higher PDI score was associated with higher plasma arachidonic acid at diagnosis ( adjusted correlation coefficient of PDI at 5 months , r=0.38 , p=0.05 ) . P100 wave latency at 15 minutes of arc ( 15 ' ) was associated with the early plasma arachidonic acid ( adjusted r=-0.56 , p=0.02 ) and phenylalanine levels at 12 months ( adjusted r=0.22 , p=0.05 ) . No association was found between MDI score and any essential fatty acids . Breastfed infants exhibited higher plasma arachidonic acid ( mean difference , delta , = 3.4 % ; 95 % confidence interval [CI]=1.2 - 5.6 % ) and shorter P100 wave latency at 15 ' ( delta=-21 ms , 95%CI=-30 to -12 ) than bottlefed infants . Within the population of this study , a weak positive association has been found between plasma LCPUFAs at diagnosis ( higher in breastfed infants ) and neurodevelopmental indices through the first year of life BACKGROUND . We previously reported beneficial effects of breast milk ingestion by infants with extremely low birth weight in the NICU on developmental outcomes at 18 months ’ corrected age . The objective of this study was to determine whether these effects of breast milk in infants with extremely low birth weight persisted at 30 months ’ corrected age . METHODS . Nutrition data , including enteral and parenteral feeds , were prospect ively collected , and 30 months ’ corrected age follow-up assessment s were completed on 773 infants with extremely low birth weight who participated in the National Institute of Child Health and Human Development Neonatal Research Network Glutamine Trial . A total of 593 ingested some breast milk during the neonatal hospitalization , and 180 ingested none . Neonatal feeding characteristics and morbidities and 30-month interim history , neurodevelopmental outcomes , and growth parameters were analyzed . Children were divided into quintiles of breast milk volume to evaluate the effects of volume of human milk ingested during the NICU hospitalization . RESULTS . At 30 months , increased ingestion of breast milk was associated with higher Bayley Mental Developmental Index scores , higher Bayley behavior score percentiles for emotional regulation , and fewer rehospitalizations between discharge and 30 months . There were no differences in growth parameters or cerebral palsy . For every 10 mL/kg per day increase in breast milk , the Mental Developmental Index increased by 0.59 points , the Psychomotor Developmental Index by 0.56 points , and the total behavior percentile score by 0.99 points , and the risk of rehospitalization between discharge and 30 months decreased by 5 % . CONCLUSIONS . Beneficial effects of ingestion of breast milk in the NICU persist at 30 months ’ corrected age in this vulnerable extremely low birth weight population . Continued efforts must be made to offer breast milk to all extremely low birth weight infants both in the NICU and after discharge OBJECTIVE To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants . DESIGN R and omized controlled trial . SETTING Newborn intensive care unit . PATIENTS Thirty-eight singleton preterm infants , free of known congenital abnormalities , weighing less than 1250 g , born before 30 weeks ' gestation , mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours , r and omly assigned to a control or an experimental group . INTERVENTION Caregiving by nurses specifically trained in individualized developmental care ; observation and documentation of the infants ' behavior within 12 hours of admission , and subsequently every 10th day ; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists ; and the availability of special caregiving accessories . MAIN OUTCOME MEASURES Medical outcome , including average daily weight gain ; number of days the infant required mechanical ventilation , oxygen , gavage tube feeding , and hospitalization ; severity of retinopathy of prematurity , bronchopulmonary dysplasia , pneumothorax , and intraventricular hemorrhage ; pediatric complications ; age at discharge ; and hospital charges . Neurodevelopmental outcome , including Assessment of Preterm Infants ' Behavior scale and quantified electroencephalography ( 2 weeks after due date ) ; and Bayley Scales of Infant Development and Kangaroo Box Paradigm ( 9 months after due date ) . RESULTS The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support ; earlier oral feeding ; reduced incidence of intraventricular hemorrhage , pneumothorax , and severe bronchopulmonary dysplasia ; improved daily weight gain ; shorter hospital stays ; younger ages at hospital discharge ; and reduced hospital charges compared with the infants in the control group . At 2 weeks after their due date s , these infants also showed improved autonomic regulation , motor system functioning , self-regulatory abilities , and visual evoked potential measures ; and at 9 months , they had improved Bayley Mental and Psychomotor Developmental Index scores , as well as Kangaroo Box Paradigm scores . CONCLUSION Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome A prospect i ve observational study was performed in pregnant women with known thyroid disease . We studied the effect of maternal thyroid function in the first half of pregnancy on the neurologic development of the infant in the first 2 y of life . Clinical and thyroid function data were collected from 20 pregnant women with known thyroid disease and their newborn children . Infants were divided into three groups according to their maternal thyroid function within the first half of pregnancy : Group A ( n = 7 ) : maternal sub clinical hypothyroidism , Group B ( n = 6 ) : maternal euthyroidism , and Group C ( n = 7 ) : maternal hyperthyroidism or sub clinical hyperthyroidism .  Neurophysiologic , i.e. motor nerve conduction velocity and somatosensory evoked potentials and neurologic and developmental ( Bayley scales ) assessment s were done . One infant , born to a mother with Graves ' disease , developed transient hyperthyroidism . At the age of 6 and 12 mo , the mean mental developmental index ( MDI ) score was 16 points lower for infants in Group A than for those in Group B ( p = 0.03 and 0.02 , respectively ) . At the age of 24 mo , the mean MDI score was 6 points lower , which was not statistically significant . Neurophysiologic and neurologic assessment s and the mean Psychomotor Developmental scores did not differ among the three groups . In conclusion , maternal sub clinical hypothyroidism in the first half of pregnancy was associated with a lower mean MDI score in their infants during the first year of life OBJECTIVES Although most infants born prematurely do not have major developmental problems , those with perinatal medical problems and lengthy stays in the neonatal intensive care unit are at risk for sensory modulation problems and developmental sequelae . This study compared sensory responsiveness in preterm and full-term infants and examined the relationship of sensory responsiveness to temperament and developmental function . METHOD Caregivers of infants with ( n = 45 ) and without ( n = 22 ) prematurity were asked to complete the  Sensory Rating Scale .  The preterm infants were also evaluated with the Bayley Scales of Infant Development , Second Edition ( BSID-II ) . RESULTS The preterm infants exhibited more frequent behaviors indicating tactile defensiveness and difficult temperament than did the full-term infants . When specific items were examined , the preterm infants displayed sensory-seeking behaviors and high activity levels . As measured by caregivers ' report , sensory responsiveness was significantly related to temperament . It was not related to BSID-II Mental and Psychomotor scale scores . CONCLUSION This study supports the findings of others that preterm infants have mild problems in sensory responsiveness and temperament . Correlational results do not support a definitive relationship between parents ' reports of their infants ' sensory responsiveness and developmental function OBJECTIVE To determine whether the Infant Behavioral Assessment and Intervention Program ( IBAIP ) , design ed to support and enhance infants ' self-regulatory competence , improved developmental and neurobehavioral outcomes in very low birth weight ( VLBW ) infants . STUDY DESIGN We r and omized 86 infants to 1 intervention before discharge and to 6 to 8 home interventions until 6 months corrected age , and 90 control infants received st and ard care .  Developmental and behavioral outcomes were evaluated at 6 months corrected age with the Bayley Scales of Infant Development-II ( BSID-II ) . Neurobehavioral functioning was evaluated with the  Infant Behavioral Assessment ( IBA ) at baseline and at 6 months corrected age . RESULTS Despite r and omization , some differences in neonatal characteristics were found between the intervention and control infants . After adjustment , intervention effects of 7.2 points ( + /- st and ard error 3.1 ) on the Mental Developmental Index and 6.4 + /- 2.4 points on the Psychomotor Developmental Index favored the intervention infants . The Behavioral Rating Scale of the BSID-II ( P = .000 ) and the  IBA  ( more approach [ P = .003 ] and less stress [ P = .001 ] over time ) also favored the intervention infants . CONCLUSIONS The IBAIP improved the mental , motor , and behavioral outcomes  of VLBW infants at 6 months corrected age Aim : Previously , we found a beneficial effect of 2 mo supplementation of infant formula with long‐chain polyunsaturated fatty acids ( LC‐PUFA ) on neurological condition at 3 mo in healthy term infants . The aim of the present follow‐up study was to evaluate whether the effect on neurological condition persists until 18 mo . Methods : A prospect i ve , double‐blind , r and omized control study was conducted . Three groups were formed : a control ( CF ; n=169 ) , an LC‐PUFA‐supplemented ( LF ; n=146 ) and a breastfed ( BF ; n=159 ) group . Information on potential confounders was collected at enrolment . At the age of 18 mo , neurodevelopmental condition was assessed by the age‐specific neurological examination of Hempel and the Bayley scales . The Hempel assessment result ed in a clinical neurological diagnosis , a total optimality score and a score on the fluency of motility . The Bayley scales result ed in mental and psychomotor developmental indices . Attrition at 18 mo was 5.5 % and non‐selective . Multivariate regression analyses were carried out to evaluate the effect of type of feeding while adjusting for confounders . Results : None of the children had developed cerebral palsy and 23 ( CF : n=8 ; LF : n=10 ; BF : n=5 )  showed minor neurological dysfunction . The groups did not show statistically significant differences in clinical neurological condition , neurological optimality score , fluency score , and the psychomotor and mental development indices . Multivariate analysis confirmed that there was no effect of type of feeding on neurological condition
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 .