Caffrey, Aoife

Cassidy, T

Dornan, James

McNulty, Helene

Pentieva, Kristina

Prasad, Girijesh

Rollins, Mark

English

Background:Peri-conceptional folic acid (FA) supplementation is known to prevent neural tube defects. It remains uncertain whether continuing FA after the first trimester has benefits for offspring neurodevelopment. A previously published follow up study of Mothers who had participated in a randomized trialof FA Supplementation in the Second and Third Trimesters (FASSTT) in pregnancy and who had received 400 micrograms/day FA or placebo from the 14th gestational week until the end of pregnancy showed their offspring at both 3 and 7 years scored significantly higher than the placebo group in word reasoning and cognition.Objectives: Follow up investigation of 11 year old children, whose Mothers had participated in a randomized trial of FA Supplementation in the Second and Third Trimesters (FASSTT) in pregnancy and received 400 micrograms/day FA or placebo from the 14th gestational week to determine if previous improvement in Cognitive performance and brain functionpersists in this age group.Methods:Mother - child pairs who undertook the FASSTT trial (healthy pregnant women aged 18–35 years with singleton pregnancy) and who had taken 400 micrograms/day of FAin the first trimester were randomized to receive FA supplements or placebo until the end of pregnancy. When the child was 11 years old Mother-child pairs were recruited by invitation to undergo assessment of the child`s Cognitive performance by the Wechsler Intelligence Scale for Children (WISCIV). Assessors were blinded to the treatment allocation of theMother during the FASSTT trial. In a sub sample of participants, magnetoencephalographic(MEG)brain imaging was performed to assess brain functioning through estimating neuronal activity in relation to semantic processing of language. Related covariates including general health and lifestyle measures, socioeconomic status, anthropometry including BMI status, B-vitamin biomarkers and nutritional dietary analysis were evaluated. Statistical analysis was performed using the Statistical package for the Social Services software.Results:Of the 119 mother-child pairs in the FASSTT trial, 68 children were assessed for neurocognitive performance at 11- year follow up (Dec 2017 to Nov 2018). Children of mothers randomized to FA compared with placebo scored significantly higher in two Processing Speed tests i.e. symbol search (mean difference 2.9 points, 95% CI 0.3 to 5.5,p=0.03) and cancellation (11.3 points,2.5 to 20.1, p=0.04), whereas the positive effect on Verbal Comprehension was significant in girls only (6.5 points, 1.2 to 11.8, p=0.03). MEG assessment of neuronal responses to a language task showed increased power at the Beta (13–30 Hz, p=0.01) and High Gamma (49–70 Hz, P=0.04) bands in children from FA-supplemented mothers, suggesting more efficient semantic processing of language.Conclusions:Continued FA supplementation in pregnancy beyond the early period currently recommended to prevent NTD, can benefit neurocognitive development of the child. MEG provides a non-invasive tool in paediatric research to objectively assess functional brain activity in response to nutrition and other interventions. Our findings add considerably to the existing evidence that have linked maternal folate status in pregnancy with neurocognitive outcomes in the older child. This evidence reinforces our previous findings in these children and suggest that continued FA intervention in pregnancy beyond the early period is beneficial to future neurocognitive development.<br/

Ulster University's Research Portal

policies. We believe this information is valuable to local,regional and national service commissioning groups in theredirection of efforts and resources to target populationswhere more urgent intervention is required. Points can belearnt from the top performing regions to improve deliveryand establish uniformity of care. This project not only identi-fies the need for continued work in this domain, but also pro-vides a foundation and structure for further analysis of thecurrent services offered in secondary care.British Society of Paediatric Endocrinologyand Diabetes876 ENDOCRINE DYSFUNCTIONS IN TRANSFUSIONDEPENDENT THALASSEMIC CHILDREN: ANOBSERVATIONAL STUDYSakshi Gupta, Ayesha Ahmad, Zeeba zaka-ur-rab, Muhammed Saleeq, Nazish Malik.Jawaharlal Nehru Medical College, Aligarh Muslim University10.1136/archdischild-2021-rcpch.252Background Multiple transfusion therapy in Thalassemia Majorhas led to increased life expectancy but complications likeendocrine dysfunction can occur due to secondary iron depo-sition especially in the endocrine organs despite chelationtherapy.Objectives The objective of this study was to determine theprevalence of endocrine dysfunctions in Transfusion dependentThalassemic patients and correlation between serum ferritinlevels and specific endocrine dysfunction.Methods The study included Transfusion dependent Thalassemicpatients between the age group 5 to 18 years receiving at least ayear of chelation therapy with deferasirox in a tertiary carecentre. After proper consent/assent and clearance from the ethi-cal committee, patients’ characteristics and investigations wererecorded on a predesigned proforma. Patients were analysed forendocrine dysfunctions like Growth hormone deficiency, Hypo-thyroidism, Parathyroid dysfunction, dysglycemia and delayedpuberty. Assessment for parathyroid dysfunction, dysglycemiaand puberty was done in patients more than 10 years of ageonly.Data was expressed as Mean± S.D. with 95% confidenceIntervals. Correlation between endocrine dysfunctions and serumferritin levels was investigated using Pearson’s correlation and pvalue of <0.05 was considered significant.Results A total of 50 patients completed the study, out ofwhich 16 patients were more than 10 years of age. The meanage of the study participants was 8.3±2.70 years with a maleto female ratio of 2.8:1. The mean age of diagnosis was16.87±14.03months and mean duration of chelation was38.40±26.71 months. Endocrine dysfunction was observed in28 patients (56%). Evaluation for parathyroid dysfunction,dysglycemia and pubertal disorders was done in patients morethan 10 years of age only while short stature and thyroid dys-function was evaluated in all 50 patients completing the study.Maximum prevalence was of parathyroid dysfunction,observed in 10 patients (62.5%) followed by short stature in17 patients (34%), Impaired Fasting Glucose/Impaired GlucoseTolerance in 4 patients (25%) and subclinical hypothyroidismin 7 patients (14%). Pubertal delay and overt diabetes werenot detected in any of the patients. Growth hormone defi-ciency on provocative stimulation test was observed in 8patients out of 17 patients (47.05%) with short stature. Theserum ferritin levels did not show a significant correlationwith any of the endocrine dysfunctions.Conclusions This study showed that 56% of the Transfusiondependent Thalassemics had at least one endocrinopathy. Astatistically insignificant correlation of endocrinopathy withserum ferritin levels was observed in the study. Irrespective ofchelation therapy, patients with transfusion dependent thalasse-mia can have a considerably high prevalence of endocrinecomplications. Serum levels of ferritin cannot be utilised as apredictor of endocrine dysfunctions. Therefore, all patientswith Thalassemia requiring frequent transfusions shouldundergo regular monitoring for endocrinopathies.British Association of Perinatal Medicineand Neonatal society877 EFFECTS OF CONTINUED FOLIC ACIDSUPPLEMENTATION DURING THE SECOND AND THIRDTRIMESTERS OF PREGNANCY ON CHILDREN`SNEUROCOGNITIVE DEVELOPMENT AT 11 YEARS1Mark Rollins, 2Aoife Caffrey, 2Helene McNulty, 2Kristina Pentieva, 3Tony Cassidy,4Girijesh Prasad, 5James Dornan. 1Paediatric Department Causeway Hospital; 2NICHE,School of Biomedical Sciences, Ulster University; 3Psychology Research Institute, UlsterUniversity; 4Intelligent Systems Research Centre, Ulster University; 5Royal Jubilee Maternity,Belfast, UK10.1136/archdischild-2021-rcpch.253Background Peri-conceptional folic acid (FA) supplementationis known to prevent neural tube defects. It remains uncertainwhether continuing FA after the first trimester has benefits foroffspring neurodevelopment. A previously published follow upstudy of Mothers who had participated in a randomized trialof FA Supplementation in the Second and Third Trimesters(FASSTT) in pregnancy and who had received 400 micro-grams/day FA or placebo from the 14th gestational week untilthe end of pregnancy showed their offspring at both 3 and 7years scored significantly higher than the placebo group inword reasoning and cognition.Objectives Follow up investigation of 11 year old children,whose Mothers had participated in a randomized trial of FASupplementation in the Second and Third Trimesters (FASSTT)in pregnancy and received 400 micrograms/day FA or placebofrom the 14th gestational week to determine if previousimprovement in Cognitive performance and brain functionpersists in this age group.Methods Mother - child pairs who undertook the FASSTTtrial (healthy pregnant women aged 18–35 years with single-ton pregnancy) and who had taken 400 micrograms/day of FAin the first trimester were randomized to receive FA supple-ments or placebo until the end of pregnancy. When the childwas 11 years old Mother-child pairs were recruited by invita-tion to undergo assessment of the child`s Cognitive perform-ance by the Wechsler Intelligence Scale for Children (WISC-IV). Assessors were blinded to the treatment allocation of theAbstractsArch Dis Child 2021;106(Suppl 1):A1–A514 A145copyright. on September 30, 2021 by guest. Protected byhttp://adc.bmj.com/Arch Dis Child: first published as 10.1136/archdischild-2021-rcpch.253 on 30 September 2021. Downloaded from Mother during the FASSTT trial. In a sub sample of partici-pants, magnetoencephalographic(MEG)brain imaging was per-formed to assess brain functioning through estimatingneuronal activity in relation to semantic processing of lan-guage. Related covariates including general health and lifestylemeasures, socioeconomic status, anthropometry including BMIstatus, B-vitamin biomarkers and nutritional dietary analysiswere evaluated. Statistical analysis was performed using theStatistical package for the Social Services software.Results Of the 119 mother-child pairs in the FASSTT trial, 68children were assessed for neurocognitive performance at 11-year follow up (Dec 2017 to Nov 2018). Children of mothersrandomized to FA compared with placebo scored significantlyhigher in two Processing Speed tests i.e. symbol search (meandifference 2.9 points, 95% CI 0.3 to 5.5,p=0.03) and cancel-lation (11.3 points,2.5 to 20.1, p=0.04), whereas the positiveeffect on Verbal Comprehension was significant in girls only(6.5 points, 1.2 to 11.8, p=0.03).MEG assessment of neuronal responses to a language taskshowed increased power at the Beta (13–30 Hz, p=0.01) andHigh Gamma (49–70 Hz, P=0.04) bands in children fromFA-supplemented mothers, suggesting more efficient semanticprocessing of language.Conclusions Continued FA supplementation in pregnancybeyond the early period currently recommended to preventNTD, can benefit neurocognitive development of the child.MEG provides a non-invasive tool in paediatric research toobjectively assess functional brain activity in response to nutri-tion and other interventions. Our findings add considerably tothe existing evidence that have linked maternal folate status inpregnancy with neurocognitive outcomes in the older child.This evidence reinforces our previous findings in these chil-dren and suggest that continued FA intervention in pregnancybeyond the early period is beneficial to future neurocognitivedevelopment.Association of Paediatric EmergencyMedicine878 7IS APPROACH TO EVALUATING A NOVELEDUCATIONAL E-MODULE ON PAEDIATRIC ADVANCEDLIFE SUPPORTCarl Leith van Heyningen. Leicester Royal Infirmary10.1136/archdischild-2021-rcpch.254Background Storytelling is a powerful tool in education whereemotional investment rewards enhanced learning.We designeda ‘choose your own adventure’ story written in the secondperson where the participant assumes the role of a junior doc-tor taking decisions in the resuscitation of an infant. The deci-sions taken influence both the narrative and learner’s rolemaking it truly interactive. This breaks from traditional e-learning techniques with linear progression. Instead the learneris supported in a safe environment to make realistic clinicaldecisions. The purpose of such engagement is to stimulatesinterest, simulate real clinical practice and enables higher levellearning whilst also testing knowledge in a way that allowsdetailed personal feedback.In the current climate of the COVID-19 pandemic, the aimwas to produce an innovative e-module that engaged andentertained learners who most likely will have a degree ofonline burnout. Learning objectives are taken from theadvanced paediatric life support course. Retention of knowl-edge is paramount and through simulating auditory, visual andcognitive cues it is hoped translation into practice isimproved.Objectives In this study, we had the following two aims.Firstly to gather user feedback to determine areas forimprovement with subsequent versions. Secondly, to determinethe utility of digital simulation in healthcare education as atool to impact clinical practice.Methods Many approaches to evaluation exist. Using a frame-work described by Roland et al. we crafted a pre and post-questionnaire to assess more than simply user experience.Users including all clinical staff in our tertiary hospital emer-gency department via email. Hence sampling was not randomand instead was opportunistic. Beforehand, an anonymousonline survey firstly gathered demographic data about users(for example; age, sex, ethnicity, profession group and trainingexperience).Afterwards, a series of questions were asked, again via ananonymous online survey, to determine the utility of the digi-tal simulation with regards to the following; interactivity,interface, instruction, ideation (what you think you havelearned), integration (what you have shown you have learned),implementation and improvement. This 7Is framework allowspotential patient benefit to encapsulated in its outcome meas-ures as has an existing precedent for use as demonstrated in aprevious study examining outcomes of a separate e-learningpackage.Results Results include the following; 90% had high motiva-tion, 60% were able to easily access the module (desktopcomputer, smartphone etc), 100% wished to utilise the samestyle of learning again, 80% report gaining new knowledge orskills, mean time to complete module was 22 minutes, blankspace feedback included; ‘novel and engaging format, unclearat first how to select choices,’ ‘needs to include feedback ateach decision point, not at end,’ ‘learnt airway skills and stepsto expect in the resuscitation of a baby.’ The first one hun-dred staff to respond were included in this data set withgood representation across the different demographic groups.Conclusions This work represents preliminary stages of devel-opment for a novel elearning module.Results suggest with fur-ther improvement this is a format that has the potential toengage, educate and impact upon clinical practice.British Paediatric Respiratory Society880 THE MANAGEMENT OF EPISODES OF A SIGNIFICANTDROP IN LUNG FUNCTION IN PATIENTS WITH CYSTICFIBROSIS (CF) IN AN OUTPATIENT SETTING1Courteney Furzer, 2Jo Harrison. 1NHS; 2Royal Children’s Hospital Melbourne10.1136/archdischild-2021-rcpch.255AbstractsA146 Arch Dis Child 2021;106(Suppl 1):A1–A514copyright. on September 30, 2021 by guest. Protected byhttp://adc.bmj.com/Arch Dis Child: first published as 10.1136/archdischild-2021-rcpch.253 on 30 September 2021. Downloaded from 

Effects of continued folic acid supplementation during the second and third trimesters of pregnancy on children’s neurocognitive development at 11 years

https://pure.ulster.ac.uk/files/92429615/Rollins_et_al_2021_RCPCH_Abstract_145.pdf

Effects of continued folic acid supplementation during the second and third trimesters of pregnancy on children’s neurocognitive development at 11 years

Abstract

Similar works

Full text

Available Versions

Ulster University's Research Portal