Longer duration of gestation in term singletons is associated with better infant neurodevelopment

Background: Longer gestation at term and post-term age is associated with increased perinatal mortality. Nonetheless, recent neuroimaging studies indicated that longer gestation is also associated with better functioning of the child's brain. Aims: to assess whether longer gestation in term and post-term (in short: term) singletons is associated with better infant neurodevelopment. Study design: cross-sectional observational study. Subjects: Participants were all singleton term infants (n = 1563) aged 2–18 months of the IMP-SINDA project that collected normative data for the Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). The group was representative of the Dutch population. Outcome measures: Total IMP score was the primary outcome. Secondary outcomes were atypical total IMP scores (scores &lt;15th percentile) and SINDA's neurological and developmental scores. Results: Duration of gestation had a quadratic relationship with IMP and SINDA developmental scores. IMP scores were lowest at a gestation of 38·5 weeks, SINDA developmental scores at 38·7 weeks. Next, both scores increased with increasing duration of gestation. Infants born at 41–42 weeks had significantly less often atypical IMP scores (adjusted OR [95 % CI]: 0·571 [0·341–0·957] and atypical SINDA developmental scores (adjusted OR: 0·366 [0·195–0·688]) than infants born at 39–40 weeks. Duration of gestation was not associated with SINDA's neurological score. Conclusions: In term singleton infants representative of the Dutch population longer gestation is associated with better infant neurodevelopment scores suggesting better neural network efficiency. Longer gestation in term infants is not associated with atypical neurological scores.</p

Developmental outcomes after early surgery for complex congenital heart disease:a systematic review and meta-analysis

AIM: (1) To systematically 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. METHOD: We searched pertinent literature (January 1990 to January 2019) in PubMed, Embase, CINAHL, and PsycINFO. Selection criteria included infants with complex CHD who had primary surgery within the first 9 weeks of life. Methodological quality, including risk of bias and internal validity, were assessed. RESULTS: In total, 185 papers met the inclusion criteria; the 100 with high to moderate methodological quality were analysed in detail. Substantial heterogeneity in the group with CHD and in methodology existed. The outcome of infants with single-ventricle CHD was inferior to those with two-ventricle CHD (respectively: average scores for PDI 77 and 88; intelligence scores 92 and 98). 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

Alberta Infant Motor Scale:Cross-cultural analysis of gross motor development in Dutch and Canadian infants and introduction of Dutch norms

Background: The Alberta Infant Motor Scale (AIMS) has been developed in Canada in the 90ies. The AIMS and its Canadian norms are frequently used across the world to monitor infants' gross motor development. Currently, it is disputed whether the Canadian norms are valid for non-Canadian infants. Aims: To compare scores on the AIMS of Dutch infants with that of the Canadian norms, to compare the sequence of motor milestones in Dutch and Canadian infants, and to establish Dutch AIMS norms. Study design: Cross-sectional study. Subjects: 1697 infants, aged 2-18 months, representative of the Dutch population (gestational age 39.7 weeks (27-42)). Outcome measure. AIMS assessments, based on standardized video. Perinatal and social information was obtained by questionnaire and medical records. To create Dutch reference values quantile regression with polynomial splines was used. Results: 1236 Dutch infants (73%) scored below the 50th (P50) percentile of the Canadian norms, 653 (38%) below the P10 and 469 (28%) below the P5. In infants aged 6 to 12 months these values were: 567 infants (81%) <P50, 288 infants (41%) <P10, 201 infants (29%) <P5. The sequence of achievement of motor milestones of Dutch and Canadian infants was similar. Dutch norm-reference values of the AIMS were calculated. Conclusions and implications: Gross motor development of Dutch infants is considerably slower than that of the Canadian AIMS norms sample. To prevent overdiagnosis of developmental delay and overreferral to paediatric physiotherapy Dutch AIMS norms are required. The paper introduces these norms, including percentile ranks

A comparison of statistical methods for age-specific reference values of discrete scales

Age-specific reference values are important in medical science to evaluate the normal ranges of subjects and to help physicians signal potential disorders as early as possible. They are applied to many types of measurements, including discrete measures obtained from questionnaires and clinical tests. These discrete measures are typically skewed to the left and bounded by a maximum score of one (or 100%). This article investigates the performances of various statistical methods, including quantile regression, the Lambda-Mu-Sigma (LMS) method and its extensions, and the generalized additive models for location, scale, and shape with zero and one-inflated distributions implemented with either fractional polynomials or splines, for age-specific reference values on discrete measures. Their large-sample performances were investigated using Monte-Carlo simulations, and the consistency of splines and fractional polynomials age profiles with quantile regression had been demonstrated as well. The advantages and disadvantages of these methods were illustrated with data on the Infant Motor Profile, a test score on motor behavior in children of 3–18 months. We concluded that quantile regression with fractional polynomials approach is a robust and computationally efficient method for setting age-specific reference values for discrete measures.</p

Infant motor behaviour and functional and cognitive outcome at school-age:A follow-up study in very high-risk children

BACKGROUND: The Infant Motor Profile (IMP) is an appropriate tool to assess and monitor infant motor behaviour over time. Infants at very high risk (VHR) due to a lesion of the brain generally show impaired motor development. They may grow into or out of their neurodevelopmental deficit. AIMS: Evaluate associations between IMP-trajectories, summarised by IMP-scores in early infancy and rates of change, and functional and cognitive outcome at school-age in VHR-children. STUDY DESIGN: Longitudinal study. SUBJECTS: 31 VHR-children, mainly due to a brain lesion, who had multiple IMP-assessments during infancy, were re-assessed at 7-10 years (school-age). OUTCOME MEASURES: Functional outcome was assessed with the Vineland-II, cognition with RAKIT 2. Associations between IMP-trajectories and outcome were tested by multivariable linear regression analyses. RESULTS: When corrected for sex, maternal education and follow-up age, initial scores of total IMP, variation and performance domains, as well as their rates of change were associated with better functional outcome (unstandardised coefficients [95% CI]): 36.44 [19.60-53.28], 33.46 [17.43-49.49], 16.52 [7.58-25.46], and 513.15 [262.51-763.79], 356.70 [148.24-565.15], and 269 [130.57-407.43], respectively. Positive rates of change in variation scores were associated with better cognition at school-age: 34.81 [16.58-53.03]. CONCLUSION: Our study indicated that in VHR-children IMP-trajectories were associated with functional outcome at school-age, and to a minor extent also with cognition. Initial IMP-scores presumably reflect the effect of an early brain lesion on brain functioning, whereas IMP rate of change reflects whether infants are able to grow into or out of their initial neurodevelopmental deficit

Dimensional changes of CAD/CAM polymer crowns after water aging - An in vitro experiment

Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) polymers can potentially replace traditional materials used for manufacturing indirect restorations. In 2012, Lava Ultimate (LU) was introduced as a highly suitable material for implant-supported single crowns. Three years after its introduction, the manufacturer issued a change in indication for the material, implying that they no longer considered the material to be suitable for crown indications due to debonding issues. A clinical trial with implant-borne Lava Ultimate crowns bonded to zirconia abutments revealed that 80 percent of the LU crowns showed debonding from the abutment within one year, whereas no debonding occurred when an alternative full-ceramic restoration material was used. These results suggest that the material itself had been the cause of the debonding. However, the exact reason for the debonding remained unclear. Water uptake in resin methacrylates like LU is known to cause dimensional changes resulting in mechanical stress on the RelyX Ultimate (RU) cement. The purpose of this study is to quantify the dimensional changes in LU caused by water uptake and relate these dimensional changes to the failure of the RU cement. Twenty-five identical LU-crowns were divided into three groups. 10 LU-crowns with abutment and 10 crowns without abutments were stored in water for 23 days and were only removed for measurement. Five crowns served as a control to calibrate the measurements. The internal diameter was measured eight times with a TS 460 Heidenhain touch probe. For visualization purposes, one crown was also 3D scanned before and after water treatment. The results showed that after 23 days in water the mean increase in diameter for the groups with and without abutment was 36.6 μm (SD = 35,1) and 36.7 μm (SD = 26,5) respectively. Mixed effects modelling indicated no significant between-group differences at any time point. Exposure of LU to water results in dimensional changes causing mechanical stress on the crown-abutment complex. It can be estimated that RU cement fails after an expansion of more than 4 μm. Within the limitations of this in vitro study, it can be concluded that the dimensional changes induced by water uptake can cause debonding issues. As more CAD/CAM polymers for restorative purposes are expected to be developed, the results of this study should stimulate manufacturers to quantify their products' dimensional changes in a wet environment before market release

Motor behaviour in infancy is associated with neurological, cognitive, and behavioural function of children born to parents with reduced fertility

AIM: To evaluate the associations between motor development in infancy and developmental outcomes at school age. METHOD: Participants were 195 children (99 males, 96 females; mean age [SD] 9y 3mo [3mo], range 8y 4mo-10y 11mo) born to couples whose reduced fertility was or was not treated with assisted reproductive technologies. Motor behaviour was assessed at 4, 10, and 18 months with the Infant Motor Profile (IMP). IQ, neurological optimality score (NOS), and behavioural problem scores were measured at 9 years with the Wechsler Abbreviated Scale of Intelligence, minor neurological dysfunction assessment, and the Child Behavior Checklist respectively. RESULTS: Children with a slow developmental trajectory in the IMP-domain adaptability had an IQ 12.6 points lower (95% confidence interval [CI] 4.7-20.4) and an NOS 3.4 points lower (95% CI 0.7-6.2) at 9 years of age than children with typical adaptability development. Children with a slow developmental trajectory in the IMP-domain performance had an IQ 5.0 points lower (95% CI 0.7-9.3) than children with typical performance development. A non-optimal trajectory in IMP-variation and a fluctuating trajectory in IMP-fluency were associated with higher internalizing scores of 3.6 and 5.8 points respectively, than infants with optimal IMP-domain trajectories. INTERPRETATION: In relatively low-risk children, motor behaviour in infancy was associated with neurological, cognitive, and behavioural function at school age