Mother-Infant Group Intervention on Maternal Depression and Bonding: A Quasi-Experimental Study.

OBJECTIVES: Parent-Infant Psychotherapy (PIP) aims at improving the interaction between parents and their infants. Group intervention has advantages in facilitating universality, support, and social learning. However, the researches on PIP adoption in a group format are limited. This study aims to explore the outcome of a mother-infant group on bonding and maternal depression. METHODS: Eighty-two infant mothers with subjective distress on parenting or depressed mood were recruited to participate in the intervention group (IG). Another sample of one hundred and ninety-four postpartum women was recruited as the control group (CG). Instruments for outcome measure were the Mother-Infant Bonding Scale, Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory-Second Edition (BDI-II), and Social Network Interaction System Questionnaire. Twelve courses of mother-infant groups were conducted for IG women. Each course consisted of twelve 90-min sessions. IG women joined the intervention with their infants and replied to the instruments at baseline, post-intervention, and follow-up. CG women replied to the instruments at similar intervals. Primary data analyses were performed by the intent-to-treat analysis, ANOVA, and GEE. RESULTS: Relative to CG participants, the IG women experienced significant benefits in most mother-infant bonding scores at both post-intervention and follow-up (ps = .000 - .026). IG women also experienced a greater reduction in follow-up depressive symptoms measured by EPDS (p = .023). However, no significant reduction was noted on BDI-II. CONCLUSIONS: Mother-infant group intervention has preliminary effects on improving bonding and reducing depressive symptoms for women with infants. Further studies are warranted to replicate the results.

Literature indicates detrimental impacts of adverse bonding and maternal depression on children development. Parent-infant group psychotherapy suggests a positive effect on facilitating bonding and reducing depression severity. However, the evidence is limited and inconclusive. Since the treatment has never been applied in Taiwan, its effect and feasibility on Taiwanese women is unknown. The results established a preliminary positive outcome of parent-infant group on maternal bonding and depression. Also, by the first practice, we observe the participants have well motivation to join intervention with their infants and with other women. Parent-infant group is a promising treatment that warranted further exploration.

Likelihood ratios of multiple cutoff points of the Taipei City Developmental Checklist for Preschoolers, 2nd version.

BACKGROUND/PURPOSE: This study aimed to examine the reliability and clinical decision validities of the Taipei City Developmental Checklist for Preschoolers, 2nd version (the Taipei II, which was filled out by parents) and the screening procedures conducted in the medical setting. METHODS: Methodology research and case control study designs were adopted. A total of 310 dyads consisting of children who were developing typically and 196 dyads of children with developmental delays and age 5.5 to 35.5 months were recruited for validity test. Among them, 165 mothers filled out the questionnaire twice within 1 week to examine the test-retest reliability of the total score and individual items. Validity indexes of the single cutoff strategy and multiple cutoff strategies were analyzed. With two cutoff point strategies, the likelihood ratios (LR) of the three test results, positive, neutral, and negative, were calculated. RESULTS: The test-retest reliabilities of the total scores of the seven checklists of the Taipei II (rs = 0.54-0.89, p<0.05) and their individual items (agreement 92% to 100%) were acceptable, except for the 30-month checklist and three individual items. The positive LR (LR+) and negative LR (LR-) of the single cutoff strategy were acceptable with most LR+ more than 2, and all LR- less than 0.5. Most of the diagnostic odds ratios of single cutoff strategies were less than 50 and they did not meet the acceptable criteria. When multiple cutoff points were used, all of the LRs with positive test results were equal to infinity that met SpPin criteria, and all of the LRs with negative test results less than 0.5 had at least a small but important diagnostic impact. CONCLUSION: Taipei II with multiple cutoff points could give more useful clinical information than using a single cutoff point. The multiple likelihood ratios of Taipei II for children older than 3 years and in different cultural backgrounds need further study.

Selecting a cutoff point for a developmental screening test based on overall diagnostic indices and total expected utilities of professional preferences.

BACKGROUND/PURPOSE: A cutoff point in a test with sounded validity and professional preferences can help to make an accurate clinical decision. This study aimed to determine a cutoff point between two strategies for a developmental screening checklist (referred to as Taipei II). Cutoff point A was set as one or more item failed and cutoff point B was set as two or more items failed or one or more marked item failed. METHODS: This study was based on the total expected utilities of professional preferences and overall diagnostic indices. A self-administered questionnaire was developed to collect the estimated utility from professionals involved in early childhood interventions (n = 81) regarding four screening outcomes (probabilities of true positive, false positive, true negative, or false negative) and costs. The total expected utilities were calculated from the probabilities of four screening outcomes and utility values. RESULTS: The diagnostic odds ratio was higher for strategy B (695 and 209, respectively) than that of strategy A (184 and 150, respectively) when using the Taipei II on children under 3 years of age and age 3 and over. Strategy B also had a higher median total expected utilities score than strategy A (0.78 vs. 0.72 for children < 3 and 0.76 vs. 0.67 for children > or = 3). CONCLUSION: If only one cutoff point can be chosen, the authors suggest that clinicians should choose cutoff point B when using the Taipei II for screening. However, two cutoff points of Taipei II, a combination of strategy A and B, can also be used clinically.

Long-term follow-up of Taiwanese Chinese patients treated early for 6-pyruvoyl-tetrahydropterin synthase deficiency.

OBJECTIVE: To report the long-term results of early initiation of treatment of 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency. DESIGN: Between 1988 and 2000, 12 newborns with PTPS deficiency who underwent early treatment at our hospital were identified. All patients received tetrahydrobiopterin replacement in a daily dosage between approximately 2 and 4 mg/kg. The dosages of levodopa replacement were 10 to 15 mg/kg/d, which is considerably higher than the typically recommended dosages of less than 7 mg/kg/d for patients aged younger than 2 years and 8 to 10 mg/kg/d for patients aged 2 years or older. Replacement with 5-hydroxytryptophan varied widely among patients. SETTING: Taipei Veterans General Hospital. Patients Twelve newborns. INTERVENTIONS: Treatment with tetrahydrobiopterin, levodopa, and 5-hydroxytryptophan. Main Outcome Measure IQ score. RESULTS: The mean (SD) IQ score of our PTPS-deficient patients was 96.7 (9.7; range 86-119), which is considerably higher than previous reports of other populations of PTPS-deficient patients. All patients reached a normal IQ on high daily dosages of levodopa replacement, without developing apparent long-term levodopa-induced adverse effects. We also observed a correlation between long-term IQ score and genotype, birth weight, and age at initiation of treatment. CONCLUSIONS: An effective newborn screening referral program and early initiation of appropriate therapy preserved the IQ scores of PTPS-deficient patients.

Experiences during newborn screening for glutaric aciduria type 1: Diagnosis, treatment, genotype, phenotype, and outcomes.

BACKGROUND: Glutaric aciduria type 1 (GA-1) is an organic acidemia with potentially severe neurological sequelae. In Taiwan, newborn screening (NBS) for GA-1 began in 2001, but large-scale reporting is lacking. This study describes Taiwan's largest newborn screening population to date. METHODS: Between 2001 and 2015, 1,490,636 newborns were screened for GA-1. Confirmatory examinations included the carnitine loading test. Confirmed patients were treated with a low lysine diet, carnitine, and high-energy intake during illness. Clinical, laboratory, and neuroimaging data were analyzed. RESULTS: Fourteen newborns were diagnosed with GA-1 (incidence: 1/106,474). C5DC concentration was clearly increased after carnitine loading in the affected newborns, but not in false-positive newborns (p = 0.004), indicating that this test is useful as an adjuvant diagnostic method. Eleven patients followed in our hospital were enrolled, namely nine NBS patients and two patients diagnosed clinically. IVS10-2A>C was the most common mutation. Two novel mutations (T36fs and N291K) were identified. Pendular nystagmus was found in two pediatric GA-1 patients. The corresponding pathology was optic atrophy in one patient, but remained undetermined in the other patient. The frequency of encephalopathic crisis decreased substantially following NBS. Among patients diagnosed by NBS, cognitive functioning was better among patients with good compliance than patients with poor compliance (p = 0.03). Abnormalities were detected by brain MRI including diffusion-weighted imaging and apparent diffusion coefficient maps; these affected various brain regions at different stages of the disease. Basal ganglion injuries occurred after an encephalopathic crisis. White matter disease was prevalent among older patients, either with or without an encephalopathic crisis. CONCLUSION: Early diagnosis by newborn screening followed by full compliance with treatment guidelines is important to a good outcome.

Long-term follow-up of Chinese patients who received delayed treatment for 6-pyruvoyl-tetrahydropterin synthase deficiency.

OBJECTIVES: 6-Pyruvoyl-tetrahydropterin synthase (PTPS) deficiency is the most important type of BH4 deficiency related to hyperphenylalaninemia. PTPS deficiency may not only cause a typical phenylketonuric phenotype, but is also accompanied by various neurological signs and symptoms due to impaired synthesis of catecholamines and serotonin. Reports of the long-term outcomes of these patients, especially after delayed onset of therapy, are few. STUDY DESIGN: We reviewed the characteristics of 10 PTPS-deficient patients whose treatment onset with tetrahydrobiopterin, L-DOPA, and hydroxytryptophan had been delayed. The relationships among clinical manifestations, biochemical findings, genotypes, and long-term outcomes were analyzed. RESULTS: We classified eight patients as having severe forms, and two as having moderate forms of PTPS deficiency. Improvements in neurological status and intelligence/developmental quotient (IQ/DQ) were observed in all patients, up to approximately 15 years of follow-up. One patient began walking and talking after 4 years of treatment. In patients with severe disease, the mean initial IQ/DQ was 45.40 +/- 13.94, and the final full-scale intelligence quotient (FIQ) score was 62.8 +/- 13.06 (p = 0.042), with a mean increment of 17.4 +/- 5.27 over 15.86 +/- 4.85 years of follow-up. Two patients with moderately severe disease had FIQ increases from 75 to 77 and from 76 to 80 points, respectively. CONCLUSIONS: The administration of neurotransmitters based on clinical response and adverse effects was beneficial in patients whose treatment of PTPS deficiency was delayed. Sustained clinical improvements were observed up to 15 years of follow-up.