Maternal and neonatal factors associated with poor cognitive outcomes at 11 years of age in a cohort of low birth weight infants in Jamaica

OBJECTIVE: To determine maternal and birth factors that are associated with poor cognitive outcome in a low-birth weight (LBW) cohort enrolled at birth and examined at 11 years of age. The identification of these factors will help to plan intervention strategies to improve cognitive outcomes in LBW infants. DESIGN AND METHODS: In September and October 1986, all Jamaican-born children were enrolled in the Jamaican Perinatal Mortality Survey. At that time, a Main Questionnaire, asking questions about maternal demographic, social, and medical conditions and reviewing aspects of the pregnancy, labour, and delivery, was administered. A geographical subset of children was examined for cognitive abilities at 11 years of age using the Peabody Picture Vocabulary Test and Ravens Progressive Matrices. Former LBW children were included in the testing even though they were outside of the geographical area. Of the 1569 children tested, 107 were former LBW infants. Linear regressiong models were developed associating variables from the Main Quesitionnaire with outcomes on the cognitive tests. Based on the regression models, a Nursery Checklist was developed that could be used to identify children for referral to early intervention programmes. RESULTS: Twenty-one (20 percent) of the 107 ex-LBW children performed two standard deviations below the mean of the entire cohort. Maternal and birth factors associated with poor outcome were: living in poor housing conditions, not taking prenatal iron, not working outside the home and the infant not crying at birth. The Nursery Checklist identified 90 percent of the infants with poor cognitive outcomes while only referring 56 percent of the LBW population to intervention services. CONCLUSION: The factors associated with poor cognitive outcome include two socio-economic factors, an indication of infant viability at birth, and a possible nutritional deficiency. These factors can be used to institute primary interventions to ameliorate these conditions and to identify children in need of secondary interventions in early childhood.(Au)

Seroprevalence of Toxocara infections in children in Trinidad: effects of infection on cognitive skills

OBJECTIVE: To determine the seroprevalence of Toxocara infections and their effects on cognitive skills in children. DESIGN AND METHODS: Serum specimens from 1009 students from 27 primary schools in Trinidad were tested by the ELISA method for the presence of antibodies to Toxocara using an excretory-secretory antigen. Students having a titre of > or = 1:800 as well as matched controls were administered with the school achievement test to measure cognitive skills. Relationships between seroloprevalence and host factors were explored using information obtained via a questionnaire. RESULTS: Overall seroprevalence was 62.3 percent while prevalence indicative of current or recent infection (> or = 1:800) was 27.2 percent. There was no significant relationship between age and the presence of infection. Males were significantly more commonly infected than females as were attendees of rural schools. Pet ownership and the absence of pipe-borne water in the house were significantly associated with positive serology (P<0.05). Measurement of cognitive skills by the school achievement test showed that children with positive serology had lower scores (P<0.001) than age- and sex-matched controls with negative serology. CONCLUSION: The high level of infection indicated by earlier though limited studies in Trinidad was confirmed. It is recommended that the public should be educated on the transmission of disease and all dogs and cats should be periodically dewormed and environmental sanitation measures should include children away from contaminated areas.(AU)